Healthy life of Korean patients with chronic kidney failure undergoing hemodialysis: A situation-specific nursing theory.

PURPOSE: This study explored to develop a situation-specific theory explaining the healthy life of Korean patients with chronic kidney failure undergoing hemodialysis. BACKGROUND: Chronic kidney failure (CKF) patients have to reorganize their lives around their hemodialysis sessions for their survival. Nursing interventions based on specific theories may promote their health-related behaviors and outcomes. However, few theoretical frameworks or theories are available to guide hemodialysis patients on how to construct their lives under various constraints, while considering their experiences and sociocultural contexts. METHODS: An integrated approach was used to develop the situation-specific theory based on the network episode model (NEM), a review of related literature, and four of the authors' studies on hemodialysis patients' lives. RESULTS: The major concepts in the proposed theory include sociocultural context, social networks, individual-level factors, illness experiences, health-related behaviors, and health outcomes. Each major concept includes several relevant subconcepts. CONCLUSIONS: We used this theory to identify factors involved in shaping the illness experiences, health-related behaviors, and outcomes of Korean CKF patients undergoing hemodialysis. By exploring the links between these factors, we explained the healthy life that considers the uniqueness of Korean patients' sociocultural context, social network, and individual-level factors. Nurse and other healthcare professionals could integrate the proposed situation-specific theory into the development of nursing interventions based on this theory to promote health-related behaviors and outcomes of Korean CKF patients undergoing hemodialysis.

An Alternative View of a Hemodialysis-Life Balance: Life Reorganization of Korean Patients Undergoing Hemodialysis.

INTRODUCTION: Hemodialysis patients in Korea increased 2.3 fold from 2008 to 2018 and continues to rise 7% to 10% annually. Long-term treatment to prevent complications requires understanding patients' hemodialysis-life balance. Our purpose was to explore the process of life reorganization by hemodialysis patients from Korea. METHOD: Grounded theory methodology was utilized. Participants were hemodialysis patients recruited from four hemodialysis centers in Korea. Data were collected by in-depth individual interviews. Data were analyzed using constant comparative method with theoretical saturation. RESULTS: Participants (n = 14) experienced four phases with transitions. A traditional Korean belief system, the view of blessing-focused destiny promoted a change in perspective from the focus on a life crisis, and thereby, played a role in buffering negative experience. DISCUSSION: Nurses should assess the cultural individual needs of patients, which change according to each phase of life reorganization, and provide the right care at the right time to increase positive experiences.

The Mediating Effects of Social Support and a Grateful Disposition on the Relationship between Life Stress and Anger in Korean Nursing Students.

PURPOSE: Anger management is a very important issue for nursing education. However, there is a lack of research identifying related factors. This study examined the mediating effects of social support and a grateful disposition on the relationship between life stress and anger in nursing students. METHODS: The participants were 172 nursing students recruited from two universities in cities in South Korea. Baron and Kenny's regression method and the Sobel test were used to analyze the mediating effects of social support and a grateful disposition on the association between life stress and anger. RESULTS: There were significant correlations between life stress, social support, a grateful disposition, and anger. In addition, social support and a grateful disposition exerted full mediating effects on the relationship between life stress and anger. CONCLUSION: Based on this study's results, enhancing social support and grateful disposition could help nursing students who experience anger resulting from life stress to manage their anger effectively. This finding suggests that, as specific strategies for anger management, nursing educators should encourage nursing students to use sources of social support and to engage in various gratitude activities.

[An Ethnography on the Healthy Life of the Aged Women Participating the Senior Centers].

PURPOSE: This ethnography was performed to explore patterns and meanings of healthy life among aged women using senior centers. METHODS: The informants were 21 individuals aged 65 years and older at 2 community-based senior centers. Data were collected from iterative fieldwork through in-depth interviews and participant observations and analyzed using text analysis and taxonomic methods developed by Spradley. Field notes were used with follow-up interviews and dialogue between authors to enhance interpretation. RESULTS: Patterns of healthy life among aged women using senior centers were categorized by age groups within the context of the four cultural elements of taking care of the body, relationality, temporality, and spatiality: active and passive control, maintenance of interdependence and individuality, expansion and maintenance of the daily routine, unity of peer relations and sustenance of family relations, spending time productively and tediously, and complementary and alternative space of the family relations. CONCLUSION: The informants in this study demonstrated healthy life by maintaining and strengthening continuous relationships developed in the senior centers without being isolated from the family and society. Patterns of their healthy life differed across age groups within the socio-cultural context. Therefore, interventions should be tailored to address age groups and community needs.

An Alternative View of Living Well: Survival Trajectory of Korean Patients with Kidney Failure on Hemodialysis.

Patients with kidney failure undergoing hemodialysis rely on a hemodialysis machine for survival. Experiences of patients going through this situation were described using a phenomenological approach. These patients experienced early and late transitions within a dual structure of despair and hope, dependence and independence, and activity and passivity. Early transitions included experiencing shock and a struggle for survival. Late transitions included facing up to the reality and maintaining a hemodialysis-life balance. A traditional Korean belief system constituted a buffering system for the difficulties of their reality. These results may help nurses understand the survival trajectory of patients with kidney failure on hemodialysis and to respond more effectively to the needs of such patients in transition periods.

Decision-making process related to treatment and management in Korean women with breast cancer: Finding the right individualized healthcare trajectory.

BACKGROUND: After being diagnosed with breast cancer, women must make a number of decisions about their treatment and management. When the decision-making process among breast cancer patients is ineffective, it results in harm to their health. Little is known about the decision-making process of breast cancer patients during the entire course of treatment and management. OBJECTIVES: We investigated women with breast cancer to explore the decision-making processes related to treatment and management. METHODS: Eleven women participated, all of whom were receiving treatment or management in Korea. The average participant age was 43.5years. For data collection and analysis, a grounded theory methodology was used. RESULTS: Through constant comparative analyses, a core category emerged that we referred to as "finding the right individualized healthcare trajectory." The decision-making process occurred in four phases: turmoil, exploration, balance, and control. The turmoil phase included weighing the credibility of information and lowering the anxiety level. The exploration phase included assessing the expertise/promptness of medical treatment and evaluating the effectiveness of follow-up management. The balance phase included performing analyses from multiple angles and rediscovering value as a human being. The control phase included constructing an individualized management system and following prescribed and other management options. CONCLUSIONS: It is important to provide patients with accurate information related to the treatment and management of breast cancer so that they can make effective decisions. Healthcare providers should engage with patients on issues related to their disease, understand the burden placed on patients because of issues related to their sex, and ensure that the patient has a sufficient support system. The results of this study can be used to develop phase-specific, patient-centered, and tailored interventions for breast cancer patients.

Effectiveness of a community-based program for suicide prevention among elders with early-stage dementia: A controlled observational study.

The purpose of this study was to develop a small-group-focused suicide prevention program for elders with early-stage dementia and to assess its effects. This was a quasi-experimental study with a control group pretest-posttest design. A total of 62 elders diagnosed with early-stage dementia who were receiving care services at nine daycare centers in J City Korea participated in this study. The experimental group participated in the suicide prevention program twice a week for 5 weeks with a pretest and two posttests The developed suicide prevention program had a significant effect on the perceived health status, social support, depression, and suicidal ideation of elders with early-stage dementia. Nurses should integrate risk factors such as depression and protective factors such as health status and social support into a suicide prevention program. This community-based program in geriatric nursing practice can be effective in preventing suicide among elders with early-stage dementia.

[Adaptation Experience of Living Kidney Donors after Donation].

PURPOSE: This study was done to explore adaptation experience of living kidney donors after donation. Specific aims were to identify challenges donors face in the process of adaptation following surgery and how they interact with recipients and other people. METHODS: Grounded theory methodology was utilized. Participants were 13 living kidney donors at six months or more after donation. Data were collected by in-depth interviews with individual participants. Data were analyzed using constants comparative method with theoretical saturation. RESULTS: A core category emerged as 'keeping the fences of my family in spite of vulnerability'. The adaptation process after donation was manifested in four phases: exploration, balance, maintenance, and acclimatization. Phenomenon was perception of vulnerability. Strategies to manage the vulnerability were assessing changes of body awareness, tailoring regimen to one's own body condition, coping with health problems, keeping restoration of health, and ruminating on the meaning of one's kidney donation. Consequences were reestablishing family well-being, realizing the values of one's kidney donation, and living with uncertainty. CONCLUSION: Findings of the study indicate that there is a need for health professionals to understand the vulnerability of living kidney donors and help their family system maintain a healthy and productive life. The results of this study can be used to develop phase-specific, patient-centered, and tailored interventions for living kidney donors.

Factors influencing the confidence in core clinical skills among hospital nurses.

The purpose of this study was to examine the confidence to perform 20 clinical skills and identify factors influencing the confidence of hospital nurses. A descriptive, cross-sectional study was conducted with 550 hospital nurses at four hospitals in B city, Korea. The confidence to perform, frequency of performance and educational needs on 20 clinical skills identified by Korean Accreditation Board of Nursing were measured with a self-reported questionnaire. Data were analysed by SPSS 19.0 (IBM Corporation, Armonk, New York, USA). Participants were 27 years old on average, and 49.5% had less than 3 years of total working experience. The most confident skill was measuring vital signs, whereas the least confident skill was using defibrillator. In results of stepwise regression, confidence to perform was associated with educational needs, total working experience, frequency of performance and position. It is necessary to give opportunities to practice clinical skills at both schools and clinics for producing well-prepared nurses.

Development and Validation of an Online Program for Promoting Self-Management among Korean Patients with Chronic Hepatitis B.

The hepatitis B virus is second only to tobacco as a known human carcinogen. However, chronic hepatitis B usually does not produce symptoms and people feel healthy even in the early stages of live cancer. Therefore, chronically infected people should perceive it as a serious health problem and move on to appropriate health behaviour. The purpose of this paper is to develop and validate an online program for promoting self-management among Korean patients with chronic hepatitis B. The online program was developed using a prototyping approach and system developing life cycle method, evaluated by users for their satisfaction with the website and experts for the quality of the site. To evaluate the application of the online program, knowledge and self-management compliance of the subjects were measured and compared before and after the application of the online program. There were statistically significant increases in knowledge and self-management compliance in the user group. An online program with high accessibility and applicability including information, motivation, and behavior skill factors can promote self-management of the patient with chronic hepatitis B. Findings from this study allow Korean patients with chronic hepatitis B to engage in proactive and effective health management in the community or clinical practice.

[Development and evaluation of a program to promote self management in patients with chronic hepatitis B].

PURPOSE: The purpose of this study was to identify the effects of the program to promote self management for patients with chronic hepatitis B. METHODS: The research was a quasi-experimental design using a non-equivalent control group pre-post test. The participants were 61 patients, 29 in the experimental group and 32 in the control group. A pretest and 2 posttests were conducted to measure main variables. For the experimental group, the self-management program, consisting of counseling-centered activities in small groups, was given for 6 weeks. Data were analyzed using χ², t-test, and repeated measures ANOVA with PASW statistics program. RESULTS: There were statistically significant increases in knowledge, self-efficacy, active ways of coping, and self-management compliance but not in passive ways of coping in the experimental group compared to the control group over two different times. CONCLUSION: The results of this study indicate that the self-management program is effective in increasing knowledge, self-efficacy, active ways of coping, and self-management compliance among patients with chronic hepatitis B. Therefore, it can be usefully utilized in the field of nursing for patients with chronic disease as a nursing intervention for people with chronic hepatitis B.

[Adaptation experience to family of immigrant women in multicultural families].

PURPOSE: This study was to explore adaptation experience to family among women who immigrated for marriage. Specific aims were to identify problems immigrant women face as family members and how they interact with other family members. METHODS: Grounded theory methodology was utilized. Data were collected from iterative fieldwork with individual in-depth interviews from 6 immigrant women as key informants, and 2 of their husbands and 2 of their mothers-in-law as general informants. RESULTS: Through constant comparative analysis, a core category emerged as "tearing down the wall in communicating". Causal conditions were feeling frustrated in one's expectations, differences in language and life style, differences in recognition, and perceptions of discrimination and prejudice. Strategies were learning the Korean language, learning Korean culture, managing stress, mediating differences between family members, and introspecting. Intervening factors were support systems, burdens of child-rearing, and the condition of one's health. Consequences were rooting oneself in one's family and accepting one's life as it is. CONCLUSION: Results of the study indicate that there is a need for nurses to understand differences in communication with family members among immigrant women and to provide information and emotional support to improve the adaptation of these women to their Korean families.

[The effects of hand acupuncture therapy on pain, ROM, ADL and depression among elders with low back pain and knee joint pain].

PURPOSE: The purpose of this study was to identify the effects of hand acupuncture therapy on pain, ROM, ADL, and depression among older people with low back pain and knee joint pain. METHODS: The research was a quasi-experimental design using a non-equivalent control group pre-post test. The participants were 40 patients, 18 in the experimental group and 22 in the control group. A pretest and 2 posttest were conducted to measure the main variables. For the experimental group, hand acupuncture therapy, consisting of hand acupuncture and press-pellets based on corresponding points, was given. RESULTS: There were statistically significant differences in pain, ROM in knee joint, and ADL in the experimental group but not in depression compared to the control group over two different times. CONCLUSION: The hand acupuncture therapy was effective for low back pain, knee joint pain, ROM in knee joint and ADL among the elders in this study. Therefore, the hand acupuncture therapy can be utilized in the field of geriatric nursing as a nursing intervention for older people with low back pain and knee joint pain.

[Qualitative research investigating patterns of health care behavior among Korean patients with chronic hepatitis B].

PURPOSE: This ethnograpy was done to explore patterns of health care behavior in patients with chronic health problems. METHODS: The participants were 15 patients with chronic hepatitis B and 2 family members. Among the patients 4 had progressed to liver cirrhosis and liver cancer. Data were collected from iterative fieldwork in a department of internal medicine of I hospital. Data were analyzed using text analysis and taxonomic methods. RESULTS: Illness and disease, relationship between health care givers and clients, and communication patterns between health professions and clients were discussed as the context of health care behavior. Health care behavior of the participants was categorized by its focus: every day work centered, body centered, organ centered, and pathology centered. CONCLUSION: Participants' health care behavior was guided by folk health concept and constructed in the sociocultural context. Folk etiology, pathology, and interpretation of one's symptoms were influencing factors in illness behavior. These findings must be a cornerstone of culture specific care for the chronic diseases.

[The actual experiences of the living world among cancer patients].

PURPOSE: The purpose of this study was to understand the meanings and nature of living in the world among cancer patients. The present study adopted a hermeneutic phenomenological method which was developed by van Manen. METHOD: The participants for this study were 5 men and 6 women, who were over the age of 20 with admission or a follow up visit in the medical or surgical department. Data were collected by using in-depth interviews and observations from February to September, 2007. The contents of the interviews were tape-recorded with the consent of the subject. RESULT: The essential themes that fit into the context of the 4 existential grounds of body, time, space and other people were: a body that cannot be restored, a body that endures and lives, waiting in uncertainty, a valued calculation for the living day, being in a world of invisible power, reestablishing relationships, and reflection on his or her life. CONCLUSION: These findings revealed that living in the world is affected to varying degrees by the cancer. It is important for nurses to identify and take care of disabilities and to support the reorientation in the disintegrated life situation. The result of this study can give nurses some insight into these experiences and help promote empathetic care.

[Accuracy of references in eight nursing journals in Korea].

PURPOSE: This study was to investigate the reference accuracy in major nursing journals in Korea. METHODS: The references in articles from eight nursing journals from 2006 were compared with PubMed for authors, year, title, journal, volume, and page accuracy. Four hundred sixty-six references were reviewed. Errors were classified as major or minor and categorized by bibliographic headings (author, title, journal, year, volume and page). RESULTS: Of the 466 references, 223(47.9%) had citation errors. The reference error rates ranged from 28.6% to 58.7%. Most errors occurred in the author element (37.9%), followed by title (20.9%), journal (19.0%), page (13.9%), volume (5.9%), and year (2.4%). CONCLUSION: This study identified a considerable error rate in the references of nursing journals. Inaccuracy of references is a reflection on scholarly work of authors and journals. Authors and Editorial committees are responsible for the accuracy of references.

[Analysis of research papers published in the Journal of Korean Academy of Nursing].

PURPOSE: This study was to determine the current trend of nursing research as exploring both quantitative and qualitative methodologies, and to provide the explicit direction to improve the quality of published papers. METHODS: Total of 366 articles published between 2004 and 2006 was reviewed using the criteria of analysis. RESULTS: There was more number of quantitative studies than qualitative studies. More studies were conducted with subjects who had health problems, and studies that targeted women and elderly population have been significantly increased. In quantitative methodology, utilization of experimental and quasi-experimental designs has been increased, however descriptive study was dominant as yet. In qualitative methodology, studies using grounded theory and phenomenology were frequently published. It was noted that theoretical framework and rational for sample size were rarely presented in quantitative study. Philosophical position and the process of preparation for study, which guided the research, were not clearly described in qualitative study. CONCLUSION: The findings of this review suggest that published studies have been improved and diversified, however, detailed and clear evaluation tool that assesses study process and method should be developed as a way to further improve the quality of published papers.

[The experience of life experiences among patients with chronic low back and extremity pain].

PURPOSE: The purpose of this study was to understand the meaning and nature of pain experienced among patients with chronic pain. The present study adopted a hermeneutic phenomenological method which was developed by van Manen. METHOD: The participants for this study were 4 men and 5 women, who were over the age of 20 with chronic pain more than 6 months. Data was collected by using in-depth interviews and observations from September, 2004 to December, 2004. The contents of the interviews were tape-recorded with the consent of the subject. RESULT: The essential themes that fit into the context of the 4 existential grounds of body, time, space and other people were 'untamed and unremitting pain', 'the body as an obstacle', 'continuity of suffering time as if the moment would never end', 'a narrow radial range of action' and 'separating from other people'. CONCLUSION: Patients with chronic pain experienced and perceived the world through the filter of their pain. It is necessary for nurses to understand the experiences of chronic pain patients and to provide more empathic, supportive care. Further research is needed on nursing interventions that could help chronic patients cope with and find the meaning in their suffering.

[The effects of foot reflexology on nausea, vomiting and fatigue of breast cancer patients undergoing chemotherapy].

PURPOSE: The purpose of this study was to identify the effects of foot reflexology on nausea, vomiting and fatigue in breast cancer patients undergoing chemotherapy. METHOD: The research was a quasi-experimental study using a non-equivalent pre-post design and was conducted from Jan. 26, to Mar. 20, 2004. The subjects consisted of 34 patients with 18 in the experimental group and 16 in control group. A pretest and 2 posttests were conducted to measure nausea, vomiting and fatigue. For the experimental group, foot reflexology, which was consisted of 4 phases for 40 minutes, was given by a researcher and 4 research assistants. The collected data were analyzed by repeated measures ANOVA using the SPSS WIN 10.0 program. RESULTS: There was a statistically significant decrease in nausea, and vomiting in the experimental group compared to the control group over two different times. In addition, there was a statistically significant decrease in fatigue in the experimental group compared to the control group over two different times. CONCLUSION: Foot reflexology was effective on nausea, vomiting and fatigue in breast cancer patients receiving chemotherapy in this study. Therefore, foot reflexology can be usefully utilized as a nursing intervention in the field of cancer nursing for breast cancer patients receiving chemotherapy.