The pregnancy experience of Korean mothers with a prenatal fetal diagnosis of congenital heart disease.

BACKGROUND: Prenatal diagnosis of fetal congenital heart disease (CHD) is becoming widely available but there is a lack of understanding on such expectant mothers' experiences during pregnancy. This was the first study to investigate the pregnancy experience of Korean mothers with a prenatal fetal diagnosis of CHD. METHODS: In-depth interviews were conducted with 12 mothers regarding their child's prenatal diagnosis of CHD and the adaptive processes during pregnancy. The data were transcribed and analyzed according to the grounded theory framework. RESULTS: When the diagnosis of fetal CHD was suspected, mothers desperately sought accurate information regarding CHD while hoping in vain for a misdiagnosis. When the definitive diagnosis was made, most pregnant women experienced psychological trauma and pain, framed in the stigma and burden of having an imperfect child. Provision of accurate health advice and emotional support by a multidisciplinary counseling team was crucial at this phase, forming recognition that CHD could be treated. When fetal movements were felt, mothers came to acknowledge the fetus as an independent being, and made their best efforts to protect the fetus from harmful external influences using traditional TaeKyo mindset and practices, which in turn, were helpful in restructuring the meaning of the pregnancy. CONCLUSIONS: Mothers went through a dynamic process of adapting to the unexpected diagnosis of CHD, which was closely linked to being able to believe that their child could be treated. Early counseling with precise information on CHD, continuous provision of clear explanations on prognosis, sufficient emotional support, and well-designed prenatal education programs are the keys to an optimal outcome.

Health Promotion Behavior of Chinese International Students in Korea Including Acculturation Factors: A Structural Equation Model.

PURPOSE: The purpose of this study was to explain the health promotion behavior of Chinese international students in Korea using a structural equation model including acculturation factors. METHOD: A survey using self-administered questionnaires was employed. Data were collected from 272 Chinese students who have resided in Korea for longer than 6 months. The data were analyzed using structural equation modeling. RESULTS: The p value of final model is .31. The fitness parameters of the final model such as goodness of fit index, adjusted goodness of fit index, normed fit index, non-normed fit index, and comparative fit index were more than .95. Root mean square of residual and root mean square error of approximation also met the criteria. Self-esteem, perceived health status, acculturative stress and acculturation level had direct effects on health promotion behavior of the participants and the model explained 30.0% of variance. CONLCUSIONS: The Chinese students in Korea with higher self-esteem, perceived health status, acculturation level, and lower acculturative stress reported higher health promotion behavior. The findings can be applied to develop health promotion strategies for this population.

Post-traumatic growth in survivors of allogeneic hematopoietic stem cell transplantation.

OBJECTIVE: This study aimed to understand factors related to post-traumatic growth (PTG) in patients who received allogeneic hematopoietic stem cell transplantation (HSCT), building baseline data for developing intervention programs to enhance PTG in HSCT survivors. METHODS: A self-report survey was administered to 100 patients who received HSCT within the last 5 years. The Post-traumatic Growth Inventory, Impact of Event Scale-Revised, Perceived Social Support Scale, and Healthcare Professional's Support Scale were used, as well as items on demographic and clinical characteristics. Standard deviations of frequency and percentage, Chi-squared test between genders, independent t-test, correlation analysis between independent variables and extent of PTG, and regression analysis were conducted. RESULTS: The PTG levels of HSCT survivors were statistically significantly higher when participants were women, carried out more religious activities, had higher educational levels, or utilized nurse counseling. The 'intrusive thinking' traumatic impact subcategory, as well as social support and support from healthcare professionals, were found to be highly related to PTG scores. Upon multiple regression analysis, factors with greatest influence on PTG in HSCT survivors were support from healthcare professionals, followed in order, by social support, utilization of nurse counseling, intrusive thinking, and frequency of religious activities. CONCLUSIONS: We suggest implementing programs for HSCT patients to enhance support from healthcare professionals and to increase post-traumatic growth through greater utilization of nurse counseling, self-help meetings, and writing.

Resilience in families of children with Down syndrome in Korea.

This study aims to identify the factors related to resilience of the families of children with Down syndrome (DS). Data were collected from 126 parents of children with DS in Korea, using a self-administered questionnaire. The age of the child, developmental level of the child, parental depression, and stress and strain were negatively related with family adaptation, whereas health of parents, family cohesiveness, flexibility, communication skills, supportive family/relatives, and quality of community service were positively related. Parental depression, family cohesiveness and communication skills were the factors that were strongly related to family resilience and adaptation. It is suggested that nursing interventions to decrease parental depression and increase family cohesiveness and communication skills should be included to increase resilience of the families of children with DS.

Effects of nurse staffing, work environments, and education on patient mortality: an observational study.

BACKGROUND: While considerable evidence has been produced showing a link between nursing characteristics and patient outcomes in the U.S. and Europe, little is known about whether similar associations are present in South Korea. OBJECTIVE: To examine the effects of nurse staffing, work environment, and education on patient mortality. METHODS: This study linked hospital facility data with staff nurse survey data (N=1024) and surgical patient discharge data (N=76,036) from 14 high-technology teaching hospitals with 700 or more beds in South Korea, collected between January 1, 2008 and December 31, 2008. Logistic regression models that corrected for the clustering of patients in hospitals were used to estimate the effects of the three nursing characteristics on risk-adjusted patient mortality within 30 days of admission. RESULTS: Risk-adjusted models reveal that nurse staffing, nurse work environments, and nurse education were significantly associated with patient mortality (OR 1.05, 95% CI 1.00-1.10; OR 0.52, 95% CI 0.31-0.88; and OR 0.91, CI 0.83-0.99; respectively). These odds ratios imply that each additional patient per nurse is associated with an 5% increase in the odds of patient death within 30 days of admission, that the odds of patient mortality are nearly 50% lower in the hospitals with better nurse work environments than in hospitals with mixed or poor nurse work environments, and that each 10% increase in nurses having Bachelor of Science in Nursing Degree is associated with a 9% decrease in patient deaths. CONCLUSIONS: Nurse staffing, nurse work environments, and percentages of nurses having Bachelor of Science in Nursing Degree in South Korea are associated with patient mortality. Improving hospital nurse staffing and work environments and increasing the percentages of nurses having Bachelor of Science in Nursing Degree would help reduce the number of preventable in-hospital deaths.

Post-partum blues among Korean mothers: a structural equation modelling approach.

The objective of this study was to propose the post-partum blues (PPB) model and to estimate the effects of self-esteem, social support, antenatal depression, and stressful events during pregnancy on PPB. Data were collected from 249 women post-partum during their stay in the maternity units of three hospitals in Korea using a self-administered questionnaire. A structural equation modelling approach using the Analysis of Moments Structure program was used to identify the direct and indirect effects of the variables on PPB. The full model had a good fit and accounted for 70.3% of the variance of PPB. Antenatal depression and stressful events during pregnancy had strong direct effects on PPB. Household income showed indirect effects on PPB via self-esteem and antenatal depression. Social support indirectly affected PPB via self-esteem, antenatal depression, and stressful events during pregnancy.

Factors associated with needlestick and sharp injuries among hospital nurses: a cross-sectional questionnaire survey.

BACKGROUND: The current status of needlestick or sharp injuries of hospital nurses and factors associated with the injuries have not been systematically examined with representative registered nurse samples in South Korea. OBJECTIVE: To examine the incidence to needlestick or sharp injuries and identify the factors associated with such injuries among hospital nurses in South Korea. DESIGN, SETTINGS AND PARTICIPANTS: A cross-sectional survey of hospital nurses in South Korea. Data were collected from 3079 registered nurses in 60 acute hospitals in South Korea by a stratified random sampling method based on the region and number of beds. METHODS: The dependent variable was the occurrence of needlestick or sharp injuries in the last year, and the independent variables were protective equipment, nurse characteristics, and hospital characteristics. This study employed logistic regression analysis with generalized estimating equation clustering by hospital to identify the factors associated with needlestick or sharp injuries. RESULTS: The majority (70.4%) of the hospital nurses had experienced needlestick or sharp injuries in the previous year. The non-use of safety containers for disposal of sharps and needles, less working experience as a registered nurse, poor work environments in regards to staffing and resource adequacy, and high emotional exhaustion significantly increased risk for needlestick or sharp injuries. Working in perioperative units also significantly increased the risk for such injuries but working in intensive care units, psychiatry, and obstetrics wards showed a significantly lower risk than medical-surgical wards. CONCLUSIONS: The occurrence of needlestick or sharp injuries of registered nurses was associated with organizational characteristics as well as protective equipment and nurse characteristics. Hospitals can prevent or reduce such injuries by establishing better work environments in terms of staffing and resource adequacy, minimizing emotional exhaustion, and retaining more experienced nurses. All hospitals should make safety-engineered equipment available to registered nurses. Hospitals as well as specific units showing higher risk for needlestick and sharp injuries should implement organizational strategies to prevent such injuries. It is also necessary to establish a monitoring system of needlestick and sharp injuries at a hospital level and a reporting system at the national level in South Korea.

Relationship between attention deficit hyperactive disorder symptoms and perceived parenting practices of school-age children.

AIMS AND OBJECTIVES: To examine the relationship between the perception on parenting practices and attention deficit hyperactivity disorder (ADHD) symptoms in school-age children. BACKGROUND: Psychosocial attention deficit hyperactivity disorder intervention approaches emphasise environmental risk factors at the individual, family and community level. Parenting variables are strongly related to attention deficit hyperactivity disorder symptom severity. DESIGN: A cross-sectional questionnaire survey. METHODS: The participants were 747 children and their parents in two elementary schools. The instruments used were Korean Conners Abbreviated Parent Questionnaire and Korean version Maternal Behavior Research Instrument (measuring four dimensions of parenting practices: affection, autonomy, rejection, control). Descriptive and logistic regression analyses were performed. RESULTS: The rejective parenting practice was statistically significant in logistic regression controlling gender and age of children, family structure, maternal education level and socio-economic status. The rejection parenting is associated with attention deficit hyperactivity disorder symptoms in children (OR=1.356). CONCLUSIONS: These results suggest the importance of specific parenting educational programmes for parents to prevent and decrease attention deficit hyperactivity disorder symptoms. It would be more effective rather than focusing only on the child's attention deficit hyperactivity disorder symptoms, developing educational programmes for parents to prevent rejection parenting practice and improve parenting skills in the family system. RELEVANCE TO CLINICAL PRACTICE: When developing a treatment programme for children with attention deficit hyperactivity disorder, healthcare providers should consider not only the child's attention deficit hyperactivity disorder symptoms, but also the parenting practices. Comprehensive interventions designed to prevent rejection and improve parenting skills may be helpful in mitigating attention deficit hyperactivity disorder symptoms.

[Construct validity and reliability of the Korean version of the practice environment scale of nursing work index for Korean nurses].

PURPOSE: To develop and test the validity and reliability of the Korean version of PES-NWI measuring nursing work environments in hospitals. METHODS: The Korean version of the PES-NWI was developed through forward-backward translation techniques, and revision based on feedback from focus groups. An internal consistency reliability and construct validity using confirmatory factor analysis were conducted using SPSS WIN (16.0) and AMOS (18.0). Survey data were collected from 733 nurses who worked in three acute care hospitals in Seoul, South Korea. RESULTS: The Korean version of PES-NWI showed reliable internal consistency with a Cronbach's alpha for the total scale of .93. Factor loadings of the 29 items on the five subscales ranged from .28 to .85. The five subscales model was validated by confirmatory factor analysis (RMR<.05, CFI>.9). CONCLUSION: The findings of this study demonstrate that the Korean version of PES-NWI has satisfactory construct validity and reliability to measure nursing work environments of hospitals in Korea.

Factors associated with emotional response of parents at the time of diagnosis of Down syndrome.

PURPOSE: The purpose is to describe factors associated with emotional responses of parents at the time of diagnosis of Down syndrome. DESIGN AND METHODS: Using a survey design, data on attitudes of healthcare providers, content of information, and emotional responses were collected from 131 parents in Korea. RESULTS: There were positive relationships between healthcare providers' attitudes and the content of information (r = .622; p < .0001), and content of information and parents' responses (r = .271; p = .002). PRACTICE IMPLICATIONS: By providing positive information, healthcare providers can help parents to develop a more optimistic outlook on their children's future.

[Development of a questionnaire to measure resilience in children with chronic diseases].

PURPOSE: The purpose of this study was to develop and evaluate a Korean questionnaire to measure resilience in children with chronic illness. METHODS: Item construction was drawn from an extensive review of the literature, existing questionnaires and interviews with parents. Content validity was tested by experts. To further refine the questionnaire and test its reliability and validity, data were collected from the 202 children with asthma, diabetes mellitus or nephrotic syndrome. Corrected items were used to total correlation coefficient and test-retest reliability. Questionnaire testing was conducted using factor analysis, Cronbach's alpha, and correlation coefficients. Validity of the questionnaire was tested using internal consistency, construct validity, and criterion-related validity. RESULTS: Components of the questionnaire were in three domains; interpersonal characteristics, characteristics of coping, and intrapersonal characteristics. Factor analysis is showed five factors; positive self-understanding, self-reliance, resourcefulness, perception of positive family relationships, and intimacy. The questionnaire showed a high internal consistency. A significant positive correlation with the Numerical Rating Score and negative correlation with the Child Depression Inventory support the validity of the questionnaire. CONCLUSION: This instrument demonstrated high reliability and validity. Therefore, this instrument can contribute to the evaluation of resilience of chronically ill children and to any subsequent intervention as well as to develop a theory for resilience.

Nursing students' self-evaluation using a video recording of foley catheterization: effects on students' competence, communication skills, and learning motivation.

An opportunity for a student to evaluate his or her own performance enhances self-awareness and promotes self-directed learning. Using three outcome measures of competency of procedure, communication skills, and learning motivation, the effects of self-evaluation using a video recording of the student's Foley catheterization was investigated in this study. The students in the experimental group (n = 20) evaluated their Foley catheterization performance by reviewing the video recordings of their own performance, whereas students in the control group (n = 20) received written evaluation guidelines only. The results showed that the students in the experimental group had better scores on competency (p < 0.001), communication skills (p < 0.001), and learning motivation (p = 0.018) than the control group at the post-test, which was conducted 8 weeks after the pretest. Self-awareness of one's own performance developed by reviewing a videotape appears to increase the competency of clinical skills in nursing students.

Factors associated with depression and resilience in asthmatic children.

The purposes of this study were to examine relationship between depression and resilience in children with asthma and identify factors associated with depression. Data were collected from 86 children who ranged in age from 10 to 15 years and who had been diagnosed with asthma for over 6 months. Resilience was measured with an instrument developed by Kim (2002) and depression with the Child Depression Inventory by Kovac (1985). The results showed that older children, children with lower resilience scores, and children whose parents were rigid and restrictive had significantly more depression. Education on parenting should be included in comprehensive care programs for asthmatic children.

Parenting stress in mothers of children with congenital heart disease.

PURPOSE: The main purposes of this study were to examine the relationships among uncertainty, social support and parenting stress in mothers of children with congenital heart disease (CHD) and to identify the factors related to parenting stress. METHODS: This was a survey study using a questionnaire. Fifty-one mothers of children with CHD were recruited at the pediatric cardiac outpatient clinic at one university-affiliated hospital in Seoul between July 14th and September 25th, 2006. Abidin's Parenting Stress Index-Short Form, Mishel's Parents' Perception Uncertainty in Illness Scale, and Brandt and Weinert's Personal Resource Questionnaire were used to collect data. RESULTS: The results of bivariate analysis showed that parenting stress was significantly related to social support, ambiguity, lack of clarity, and lack of information, but was not related to unpredictability, one of the subconcepts of uncertainty. Multiple regression analysis showed that parenting stress was significantly related to social support and Internet information. CONCLUSION: Mothers who reported they had more social support and less uncertainty showed lower parenting stress. Also, the Internet could be an effective method to obtain information and to share child-rearing experiences with other mothers of children with CHD.

[Effects of non-nutritive sucking on the physiological and behavioral states of pre-term infants during tube feeding].

PURPOSE: This study was to investigate the effects of non-nutritive sucking on physiological and behavioral state of pre-term infants during tube feeding. METHOD: This nonequivalent, non-synchronized experimental study included 50 pre-term infants. An attempt was made to match gestational age and birth weight of infants in each group. Infants in the experimental group were given a pacifier 2 minutes before, during, and for 2 minutes after tube feeding. Infants in the control group did not get a pacifier. Both groups were tested at three stages for changes in the physiologic state and behavioral state--2 minutes before, during, and 2 minutes after feeding. Date was analyzed with SPSS WIN 10.0 using an Chi2-test, t-test, and repeated measures ANOVA. RESULT: Heart rates and oxygen saturation levels of the two groups were significantly different(P=.001, P=.000). The behavioral states of the two groups were significantly different during and post feeding(P=.000, P=.000). CONCLUSION: This result suggests non-nutritive sucking by using a pacifier is an effective intervention for pre-term infants during tube feeding.

[Factors influencing functional status in patients with heart failure].

PURPOSE: The purpose of this study was to identify the factors that influence the functional status of patients with heart failure. METHOD: A descriptive, correlational study design was used. The participants in this study were 260 patients with heart failure who were admitted at Y University and U University in Seoul, Korea. Between September 2005 and December 2005 data was collected by an interview using a questionnaire and from medical records. The Functional status was measured with KASI. Physical factors (dyspnea, ankle edema, chest pain, fatigue, and sleep dysfunction), psychological factors (anxiety and depression), and situational factors (self-management compliance and family support) were examined. RESULT: In general, the functional status, anxiety, depression, self-management compliance, and family support was relatively not good. The level of fatigue was highest and the level of ankle edema was lowest for physical symptom experiences. In regression analysis, functional status was significantly influenced by dyspnea(23%), age(13%), monthly income(7%), fatigue(3%), ankle edema(2%), depression(1%), and length of stay in the hospital(1%). These factors explained 50% of the variables in the functional status. CONCLUSION: These results suggest that psycho-physiological symptoms management should be a focus to improve the functional status in patients with heart failure.

[Relationship between depression and resilience among children with nephrotic syndrome].

PURPOSE: The purposes of this study were to describe the relationship between depression and resilience and to identify variables associated with depression among children with nephrotic syndrome. METHOD: Data was collected from 45 children who were registered at one hospital in Seoul. The criteria for sample selection were 10 to 15 year-old children who were diagnosed at least 6 month prior. The instruments included a self-reported questionnaire on resilience by Kim, CDI by Beck, and MBRI by Kwak. Descriptive, Pearson correlation and multiple regression analyses were done. RESULT: The mean score of depression was 11.44 (range:0-54) and resilience was 97.47 (range:32-128). There were significant positive relationships between depression and age (r=0.302, p<.005) and academic achievement (r=-0.318, p<.005). In addition, negative relationships between depression and maternal attitude (r=-0.412, p<.001) and resilience (r=-0.649, p<.001) occurred. The results of multiple regression analysis showed that maternal behavior (beta=-0.421, p<.005) and resilience (beta=-0.639, p<.001) were related to depression. CONCLUSION: Children with higher resilience and with an affectionate mother were less depressed. Thus, it is important to identify strengths of children and help them to increase resilience and implement parenting and counseling programs for parents' of these children. Similar studies with children with other chronic illnesses are needed.

Community health service needs assessment in Korea using OMAHA Classification System.

This study examined the appropriateness of OMAHA Classification System in identifying health service needs and relevant strategies for intervention by public health nurses working in community health centers in Seoul. The face-to-face interview using a questionnaire was used to assess individual and family health needs in the targeted district. Respondents were 4024 persons from 1449 households in one municipal district in Seoul, Korea. Based on OCS, 16 problems were identified including insufficient income and inadequate living space, ineffective communication with community resources, pain, and substance use. Health teaching, guidance and counseling, case management, treatment, and surveillance were identified as interventions for these problems. These results suggest that OCS is appropriate to implement in Korea to plan and organize better nursing interventions for community residents by public health nurses working in health centers.

The effectiveness of standardized patients as a teaching method for nursing fundamentals.

This study compared two teaching methods and examined their effects on student nurses' clinical competence. A nonequivalent control group was used for this quasi-experimental research, and a posttest design was used to compare the effects on clinical competence. A protocol was developed to include critical behaviors and was used as a checklist for evaluation. The results showed that the standardized patient (SP) method was more effective than the traditional method in helping students: * Identify patient needs. * Perform mouth care, back care, position change, nelaton catheterization, and glycerine enema. * Use more effective communication skills. The authors believe use of the SP method should be expanded to more areas of the fundamentals of nursing course, and its effectiveness and efficiency evaluated. Also, the SP method should be used to evaluate the clinical competence of both students and graduate nurses.