Nurse-led self-care interventions for older adults with multiple chronic conditions: A protocol for a systematic review and network meta-analysis.

The importance of self-care interventions is progressively recognized, marked by a rapidly aging population that results in growing demands on costly tertiary and institutional care services, placing substantial pressure on health and social care systems. Against this background, in this study, we will provide evidence for the impact of self-care interventions on health-related quality of life by focusing on interventions led by nurses who can employ integrated approaches. Several databases, including Ovid MEDLINE, Cochrane, CINAHL, Embase, and PubMed, will be searched along with gray literature to prevent biased results. There will be no time restrictions, and all literature with English abstracts will be included. Using the Template for Intervention Description and Replication framework, we will evaluate intervention characteristics. The primary outcome will be health-related quality of life, and the secondary outcomes will be symptom burden, physical function, and cost-effectiveness. Pairwise and network meta-analyses will be performed, and network geometry and the surface under the cumulative ranking curve will be used to determine which type of nurse-led self-care intervention is best for health-related quality of life for older adults with multiple chronic conditions. We will secure study quality through PRISMA, AMSTAR 2, RoB 2.0, and the GRADE checklist. To ensure the quality of network meta-analysis, similarity will be checked based on the PICO framework. The consistency of the network meta-analysis results will be checked to ensure transitivity by using the Bayesian hierarchical framework. The study protocol is registered with PROSPERO (CRD42022365467).

Exploring the Knowledge Structure of Patient Safety in Nursing Using a Keyword Network Analysis.

Patient safety is a critical and long-standing issue in nursing research. The purposes of this study were to explore the knowledge structure of patient safety and to provide a direction for future research by offering new perspectives and a theoretical clarification of patient safety in nursing. Keyword network analysis was performed by extracting keywords from abstracts of 6072 published articles. To reflect nursing perspectives, focus group interviews were conducted and Kim's typology consisting of four domains was used as the framework of analysis. Visualized knowledge structure showed avoiding medication error and preventing pressure ulcers or falls remain important topics within this research field. The distribution of core keywords as per four domains was in the following order: practice, client, environment, and client-nurse domain. Within the client domain, patients' harm-related core keywords were limited to physical harm. The detailed knowledge structure consisted of five themes: patient, preventable patient harm, practice, error, and environment. It comprised risk assessment for patients' characteristics and environmental elements surrounding patient and nursing practice, and risk management using information as knowledge-based nursing practice. Regarding further research, we suggest a multidimensional approach to patient harm, and the utilization of the client-nurse relationship and information systems as strategies for patient safety.

Development and validation of the information security attitude questionnaire (ISA-Q) for nurses.

AIM: The aim of the study was to understand nurses' information security attitudes towards patient information. This study developed the Information Security Attitude Questionnaire (ISA-Q) to measure the physical, technical and administrative aspects of information security for nurses and assessed its validity and reliability. DESIGN: Cross-sectional study and scale development. METHODS: Exploratory and confirmatory factor analyses and correlation analyses were performed to assess construct, discriminant and convergent validity; Cronbach's α and test-retest reliability were examined. RESULTS: Exploratory and confirmatory factor analyses yielded a 6-factor, 30-item solution. Six factors accounted for 60.19% of the total variance. The confirmatory factor analysis was achieved through structural equation modelling. Discriminant and convergent validity were confirmed. The internal consistency of the ISA-Q was 0.94, and the test-retest reliability was 0.74. The ISA-Q is an appropriate questionnaire for identifying information security attitudes of nurses, making it useful for developing systematic performance methods to enhance nurses' information security levels.

Identifying the knowledge structure of electromagnetic fields and health research: Text network analysis and topic modeling.

BACKGROUND: With technological and scientific advancement, people are being increasingly exposed to electromagnetic fields, particularly from portable devices such as mobile phones. However, there is currently no consensus regarding the health effects of electromagnetic field exposure, despite the large amount of research conducted on this topic. This study aimed to understand the knowledge structure and trend of electromagnetic field and health research through text network analysis and topic modeling. METHODS: PubMed, Embase, and Cochrane were searched, and 3,880 articles published before June 2021 were identified. We explored the main keywords and research topics regarding electromagnetic fields and human health by constructing a network of keywords. A social network analysis program was used to analyze the data, visualize the network, and perform topic modeling. RESULTS: Four keywords, "exposure," "effect," "cell," and "cancer," were highly correlated to other keywords and formed each colony in the knowledge structure of research on electromagnetic fields and health. Five topics were derived from topic modeling: cell research, research on the adaption of MRI, health effects of mobile phones, pain therapy, and exposure measurement. Cell research has been continuously performed, and many studies have been conducted on the health effects of mobile phones since 2000. CONCLUSIONS: These findings will assist in gaining insights into and understanding changes in research on the health effects of electromagnetic fields, and suggest important areas and directions for future research.

Differences in Student Brain Activation from Digital Learning Based on Risk of Digital Media Addiction.

Although digital media usage is prevalent among middle school students, the safety of digital media-based learning activities for students at risk of digital media addiction is unknown. The goal of this study was to evaluate the differences in students' brain activity in relation to their risk of digital media addiction. The study was quasi-experimental, with a pre- to post-test control group design. The study participants included 83 middle school students who were engaged in digital learning. We measured their brainwaves to evaluate brain activity using a PolyG-I (LAXTHA Inc.). We found no statistically significant differences in the location of the attention index between the two groups before and after digital learning. However, there were statistically significant differences between the two groups in the P3, P4, and F4 locations of the relaxation index. These results indicate that students at risk of digital media addiction may experience learning difficulties. These results can be used to guide healthcare professionals in developing digital learning programs that are safe for students and to also verify the effects of these programs.

Development of Toddlers' Smartphone Flow State Scale: Parent Report Form.

Toddlers come into contact with smartphones by the time they are 10 months old, and smartphones eventually become a part of the daily lives of toddlers because they are used as parenting tools and are also attractive toys. Routine exposure to these electronic devices may lead to excessive immersion, which can cause smartphone dependence when toddlers grow up. Based on Csikszentmihalyi's concept of flow, we aimed to develop a new scale to measure the flow phenomenon in toddlers who are exposed to smartphones. We attempted to identify the constituent factors of a toddler's flow in smartphones through a literature review, observations, and interviews. Initially, 32 questions were screened from the field verification stage and interviews; the final 20 questions were selected by combining technical statistics, exploratory factor analysis, and expert feasibility. We also found five eligible constituent factors, namely, a playfulness-oriented experience, reaction limited by concentration, and intentional pursuit to achieve the goal, assimilate into the virtual world, and acquire desire-fulfilling skills. We then performed a confirmatory factor analysis on our parent-reported toddlers' smartphone flow state scale. To secure the criterion-related validity, the correlation between our scale and the preexisting smartphone dependence measurement tool for toddlers was evaluated. Cronbach's α value of the toddlers' smartphone flow state scale was 0.95 (each factor was verified as 0.79-0.92 and the explanatory power was 72.21%). The test-retest reliability was found to be stable with the intraclass correlation (ICC) coefficient value of 0.78 (p < 0.001). Our research findings suggest that this novel smartphone flow state scale for toddlers could be a valid and reliable tool for measuring how toddlers feel the flow phenomenon while using smartphones. Furthermore, our results could contribute to the development and evaluation of the interventions that prevent side effects from smartphone overflow in toddlers.

Health Issues with Learning to Use Smart Devices in the Digital Age: Using a Grounded Theory Approach.

The Korean government has announced a plan for a national policy to deliver smart education among all students. As a result, many people are worried about the possible health-related adverse effects. This qualitative study aimed at analyzing health issues related to middle school students who learn by using smart devices using the grounded theory approach. We conducted in-depth interviews with 30 students at four middle schools who used smart devices for more than a year. The analysis of this research data was based on the constant comparative method, using grounded theory as a theoretical framework. The data analysis revealed many concepts in 28 subcategories and 13 categories related to smart learning health issues, with the central phenomenon being experience with health problems. Students' health-related experiences were classified as physical or psychosocial symptoms. Adverse health effects related to smart learning were related to unsafe smart learning behavior and an inefficient smart learning environment. The consequences appeared to be the formation of diverse digital habits through the ambivalent use of smart devices and differences in ability to control health problems. Our findings suggest that students can form ideal habits for using smart devices if their health issues are well monitored and managed.

Exposure to extremely low-frequency magnetic fields and childhood cancer: A systematic review and meta-analysis.

BACKGROUND: Extremely low frequency magnetic fields (ELF-MFs) are classified as a possible carcinogenic factor (Group 2B). This study assessed the association between ELF-MFs and childhood cancer through a systematic review and meta-analysis. METHODS: Three databases were searched in January 2020. We conducted a meta-analysis for the association between the ELF-MFs exposure level and childhood cancer. RESULTS: A total of 33 studies were identified. Thirty studies with 186,223 participants were included in the meta-analysis. Children exposed to 0.2-, 0.3-, and 0.4-µT ELF-MFs had a 1.26 (95% confidence interval [CI] 1.06-1.49), 1.22 (95% CI 0.93-1.61), and 1.72 (95% CI 1.25-2.35) times higher odds of childhood leukemia. In childhood brain tumors, children exposed to 0.2-µT had a 0.95 (95% CI 0.59-1.56) times higher odds, and those exposed to 0.4-µT ELF-MFs had a 1.25 (95% CI 0.93-1.61). Children exposed to 0.2- and 0.4-µT ELF-MFs had a 1.10 (95% CI 0.70-1.75) and 2.01 (95% CI 0.89-4.52) times higher odds of any childhood cancers. CONCLUSIONS: Significant associations were observed between exposure to ELF-MFs and childhood leukemia. Furthermore, a possible dose-response effect was also observed.

Structural Model of the Healthcare Information Security Behavior of Nurses Applying Protection Motivation Theory.

BACKGROUND: Healthcare information includes sensitive data and, as such, must be secure; however, the risk of healthcare information leakage is increasing. Nurses manage healthcare information in hospitals; however, previous studies have either been conducted on medical workers from various other occupations or have not synthesized various factors. The purpose of this study was to create and prove a model of nurses' healthcare information security (HIS). The hypothetical model used in this study was constructed on the basis of the protection motivation theory (PMT) proposed by Rogers. METHODS: A total of 252 questionnaires scored using a five-point Likert scale were analyzed, incorporating data from nurses who had been working for more than one month in general hospitals with more than 300 beds in South Korea. The survey was conducted over a total of 30 days, from 1 to 30 September 2019. RESULTS: The results showed that coping appraisal significantly influence HIS intentions (estimate = -1.477, p < 0.01), whereas HIS intentions significantly influence HIS behavior (estimate = 0.515, p < 0.001). A moderating effect on the association between coping appraisal and HIS intentions was found in the group of nurses who had been working for <5 years (estimate = -1.820, p < 0.05). Moreover, a moderating effect on the association between HIS intentions and HIS behavior was found in the group of nurses who had been working for <5 years (estimate = 0.600, p < 0.001). CONCLUSION: The results of this study can be used to develop a management plan to strengthen nurses' HIS behavior and can be used by nursing managers as a basis for developing education programs.

Information Security in Nursing: A Concept Analysis.

The concept of information security in nursing can improve the basic understanding of security issues in nursing. This study aimed to report on information security in nursing that considers the technical, physical, and administrative aspects of information. We used a hybrid model to analyze the concept and conducted on-site interviews. The analysis revealed 7 attributes: physical aspect: environmental control, facility stability; technical aspect: information accessibility, taking advantage of features; and administrative aspect: systematicity of work, execution of education, professional responsibility. Our model could help identify the physical, technical, and administrative attributes and definitions of information security in nursing.

Development and Validation of the Medication Safety Competence Scale for Nurses.

Nurses are the most important health care personnel for medication safety. A scale to measure nurse medication competency, such as the Medication Safety Competence Scale (MSCS), would move research forward. Preliminary items were developed through a literature review and in-depth interviews. Content validity was established by ten experts. Nurses (n = 607) participated in a survey to evaluate the validity and reliability of the scale. Exploratory and confirmatory factor analyses and correlation analyses were conducted to assess construct, concurrent, and criterion validity. The 36 items and 6 factors were derived with the exploratory factor analysis, which accounted for 63.2% of the variance. The confirmatory factor analysis revealed that the hypothesized factor structure was a good fit. Criterion and discriminant validity were present. The internal consistency of the MSCS was .97, and the test-retest reliability was .78. The MSCS is a valid and reliable instrument to measure nurses' medication safety competence.

Handover in Nursing: A Concept Analysis.

BACKGROUND AND PURPOSE: The broad use of the term handover to describe any activity involving the transfer of professional responsibility from one person to another has led to an ambiguous understanding. Recently, handover has become a process central to the delivery of high-quality and safe patient care. The aim of this analysis was to clarify the concept of handover within the context of nursing practice. METHODS: Rodgers's evolutionary approach was used as the analysis method along with some aspects of the dimensional analysis guided by Caron and Bowers, to understand the perspectives of senders and receivers. RESULTS: The analysis revealed four attributes of handover: transfer of information, interaction for disambiguation, process, and strategy. Handover is defined as a process for transferring responsibility from sender to receiver through communication through the transfer of information, the interaction for disambiguation, and the context-sensitive strategy for accomplishing the continuity and safety of patient care. The salient dimension of handover was process, and the sub-dimensions were transfer of information, interaction for disambiguation, and strategy. From the sender's perspectives, it is the process of transferring information organized by the sender, and from the receiver's perspective, handover is the process establishing care plan through interactive strategy. IMPLICATIONS FOR PRACTICE: The definition and identified attributes serve as a heuristic for designing strategies and further developing the construct of handover in nursing.

Extremely Low-Frequency Magnetic Fields Exposure Measurement during Lessons in Elementary Schools.

Schools are an important place for children's exposure to electromagnetic fields, which may cause adverse health effects. To better understand environmental extremely low-frequency magnetic fields (ELF-MFs) exposure among elementary school students, we measured numeric values of ELF-MFs in five classrooms at four schools during digital learning class hours. The measurement of ELF-MFs was taken with an EMDEX II field analyzer. Specifically, we examined the level of exposure to ELF-MFs for each student's seating position in the classroom. The results showed that ELF-MFs exposure levels were lower than those in the International Commission on Non-Ionizing Radiation Protection guidelines; however, there were significant differences in the level of magnetic field exposure at each school and at each student's seat. The exposure to ELF-MFs at students' seat positions was mostly caused by electrical appliances, electronic wiring, and distribution boxes, but the exposure level decreased as the distance increased. Therefore, it is important to design safe and appropriate environments for digital learning in schools, such as proper seating arrangements, to avoid ELF-MFs exposure to students as much as possible. Future studies should measure ELF-MFs levels in other areas and investigate the effects of exposure to ELF-MFs during school hours on children's health.

Mobile-Application-Based Interventions for Patients With Hypertension and Ischemic Heart Disease: A Systematic Review.

BACKGROUND: Hypertension and ischemic heart disease are major causes of adult mortality. Related interventions to manage these conditions are important to implement during long, symptom-free periods. The recent proliferation of smartphones has spawned numerous health interventions that rely on mobile applications. PURPOSE: This systematic review was designed to summarize and analyze research on interventions using mobile applications for patients with hypertension and ischemic heart disease. METHODS: We searched for related studies published from January 2006 to August 2017 on MEDLINE, EMBASE, CINAHL, and three Korean databases. Seventeen studies were identified and evaluated against eligibility criteria that included a focus on patients with hypertension or ischemic heart disease and a discussion of the detailed effects of a mobile-app-based intervention. All of the identified studies were evaluated qualitatively using a methodology checklist. RESULTS: Twelve of the 17 studies were deemed as of acceptable quality according to the Scottish Intercollegiate Guideline Network quality assessment. According to the National Institutes of Health quality assessment tool, one article was of fair quality and four articles were of poor quality. Monitoring, education, and reminders were identified as application interventions. The effects of the app interventions were analyzed according to physiological factors, cognitive and behavioral factors, and psychological factors. Of the seven studies that measured blood pressure in patients with hypertension, five studies reported that the app-based interventions reduced blood pressure. Two of three studies showed a significant decrease of body mass index in patients with ischemic heart disease after the app-based interventions compared to the control group. Five of seven studies reported a significant change in medication adherence. Several studies showed different outcomes according to the disease, but the limited number of eligible studies was insufficient to demonstrate a conclusive effect. CONCLUSIONS: To ensure the long-term effects of mobile-application-based interventions, healthcare professionals should consider the functions of mobile applications. Moreover, because the focus of these interventions may differ based on the nature of the disease, it is recommended that the composition of interventions be tailored to the specific disease.

The clock drawing test: A systematic review and meta-analysis of diagnostic accuracy.

AIM: The aim of this study was to evaluate the accuracy of the clock drawing test and to compare its scoring methods. BACKGROUND: Dementia refers to a symptom where an adult demonstrates memory disorder and cognitive impairment. Early diagnosis of dementia is very important for medication management and prognosis. The clock drawing test is one of the most used cognitive screening tools for dementia. However, due to its scoring system, the accuracy of the clock drawing test remains a topic of debate. DESIGN: A systematic review with meta-analysis following Cochrane's methods and the guidelines of the Agency for Healthcare Research and Quality. DATA SOURCES: A literature search was carried out in the OVID-MEDLINE, OVID-EMBASE and OVID-PsycINFO databases (27 October 2015). REVIEW METHOD: The quality assessment of diagnostic accuracy studies (QUADAS-2) tool was employed for this review. We used hierarchical regression models to pool the values of diagnostic accuracy in a random effects model. RESULTS: A total of 18 studies with 5,531 participants were identified for this review. Fifteen of these studies were included for meta-analysis according to each scoring system. The pooled sensitivity and specificity of the clock drawing test using the Shulman system were 82% and 75.7% respectively. In the Sunderland system, these were 72.6% and 87.9% respectively. CONCLUSIONS: The findings indicate that the accuracy of the clock drawing test using the Shulman system was the most studied and highly sensitive. After gaining a better understanding of the clock drawing test through this study, we recommend it for widespread use in the diagnosis of dementia.

Potential Adverse Health Outcomes of Digital Textbook Use: Teachers' Perspectives.

BACKGROUND AND PURPOSE: The digital textbook (DT) is an appealing new educational medium. The positive effects of DT use include stimulation of interest in learning and stimulation of motivation to learn. Few studies have examined the awareness of classroom-based educational experts about the adverse health outcomes of DT use. The objective of this study was to understand the perspectives of elementary schoolteachers regarding the effects of DT use on students' health. METHODS: The recommended method of focus group discussions was used to clarify teachers' individual and shared views about this topic. The study design included three discussions with three different groups of teachers. RESULTS: The results indicated that the critical health issues identified by the schoolteachers were potential risks to physical health, risks to psychological health, and environmental health risks in the classroom. IMPLICATIONS FOR PRACTICE: Awareness and evaluation of adverse health effects for DT users is an important first step for effective DT implementation in our schools. This study provided fundamental data and results that can be used to understand the effects of DT use on student health and to suggest guidelines to predict and prevent adverse health effects in the users of this technology.

Evaluating Web-Based Nursing Education's Effects: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis investigated whether using web-based nursing educational programs increases a participant's knowledge and clinical performance. We performed a meta-analysis of studies published between January 2000 and July 2016 and identified through RISS, CINAHL, ProQuest Central, Embase, the Cochrane Library, and PubMed. Eleven studies were eligible for inclusion in this analysis. The results of the meta-analysis demonstrated significant differences not only for the overall effect but also specifically for blended programs and short (2 weeks or 4 weeks) intervention periods. To present more evidence supporting the effectiveness of web-based nursing educational programs, further research is warranted.

Compassion Competence in Nurses.

The purpose of study was to identify the attributes of the concept of compassion competence for nurses. A hybrid model was used to develop the concept, which included fieldwork performed. The concept of compassion competence was found to possess 3 dimensions: (a) acquisition of a wealth of knowledge; (b) development of skills of emotional communication, sensitivity, insight, and self-regulation; and (c) development of attitudes of respect and empathy, and maintenance of occupational distance. Compassion competence could be useful for developing ways to enhance the knowledge, skills, and attitudes required for nurses to provide compassionate care in various nursing practices.

Development and validation of an instrument to measure nurses' compassion competence.

AIM: To develop and psychometrically validate the Compassion Competence Scale. BACKGROUND: Compassion is a vital asset in the nursing profession; thus, it is necessary to develop a suitable instrument for assessment. METHODS: The 49-item preliminary instrument was developed using concept analysis (hybrid model). Content and face validity were confirmed by 10 experts and 10 nurses, respectively, and the number of items was reduced to 18. The tool was tested on 660 nurses working at three tertiary hospitals in South Korea in 2013. RESULTS: We selected 17 items for the final scale and extracted three factors (variance explained: 55.9%): communication, sensitivity, and insight. Correlations with the Emotional Competence Scale (.68), Compassionate Love Scale (.62), and Interpersonal Reactivity Index (.41) supported the scale's convergent validity. The reliability (Cronbach's α and test-retest reliability) was acceptable. CONCLUSIONS: The Compassion Competence Scale is a simple, effective screening tool for identifying compassion competence among nurses.

A comparison of carpal tunnel syndrome between digital and paper textbook users in elementary schools.

BACKGROUND: There are advantages to using digital textbooks, but also health concerns yet to be evaluated. OBJECTIVE: This study examines the use of digital textbooks' effects on carpal tunnel, considered one of the potential health risks in students using digital textbooks. METHODS: Data were obtained from 43 elementary school students in the sixth grade, selected from two groups who had used digital and paper textbooks, respectively. To assess carpal tunnel function, this study performed median motor nerve and median sensory nerve conduction studies. RESULTS: There were no statistically significant differences between the groups, indicating that there were no functional differences related to carpal tunnel syndrome between the groups. CONCLUSION: Usage of digital textbook is expanding nationwide in the Republic of Korea. There is no short-term risk of carpal tunnel syndrome in this population of elementary school students.