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Volume 20(1); February 2008

Original Articles
Uncertainty and Nursing Need According to Illness Phases in Cancer Patients
Mi Sun Lee, Hee Ju Kim, Soon Rim Suh
J Korean Acad Adult Nurs 2008;20(1):1-9.   Published online February 29, 2008
PURPOSE
S: This study examined uncertainty and nursing need according to illness phases(phase I, II, III) in cancer patients, and investigated relationships between uncertainty and nursing need.
METHODS
A cross-sectional descriptive study was conducted with a sample of 121 adult cancer patients treated in two hospitals.
RESULTS
As for the total score, the uncertainty was not significantly different across the subgroups by illness phase. As for the subscale score, however, two sub-scales of the uncertainty were different across the subgroups. 'The unpredictability' was highest in illness phase I and II groups, while 'the lack of information' was highest in the illness phase III group. Nursing need as the total score was not significantly different across the subgroups by illness phase. However, all subscale scores of the nursing need were significantly different across the subgroups. Educational need was highest in the illness phase I group; physical and emotional needs were highest in the illness phase III group. Uncertainty and nursing need were not related to each other at any illness phase.
CONCLUSION
The results suggest that nursing need and uncertainty may change across illness phases. Clinicians need to consider this pattern in caring for cancer patients.
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A Study on the Relationship between Professional Self-Concept, Self-Efficacy and Job Satisfaction in Clinical Nurses
Seung Hee Lee
J Korean Acad Adult Nurs 2008;20(1):10-20.   Published online February 29, 2008
PURPOSE
The purpose of this study was to analyze the effects of professional self-concept and self-efficacy on job satisfaction and to identify the relationship among them in clinical nurses.
METHODS
The subjects were nurses who were working for three general hospitals in Seoul and Gangwon province for two month starting in July 2007. Three questionnaires were used. One was job satisfaction and the others were professional self-concept and self-efficacy. The data were analyzed by SPSS/PC ver 12.0.
RESULTS
The mean score of job satisfaction was 2.99 (range: 1-5). The mean score of professional self-concept and self-efficacy were 2.71(range: 1-4) and 3.49(range: 1-5), respectively. Differences of job satisfaction were significantly related to differences in age, marital status, level of education, clinical career, annual salary, and shift pattern. With respect to job satisfaction, the pearson correlation coefficients were .43 for professional self-concept and .29 for self-efficacy. The multiple regression revealed that the significant predictor of job satisfaction was professional self-concept.
CONCLUSION
This study showed that a strong professional self-concept improves job satisfaction, so professional self-concept improvement programs should be developed to improve job satisfaction and to improve the quality of nursing.
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A Study on the Effects of the Hand Acupressure Therapy on Sleep Quality and Mood State of Insomniac Adults
Eun Hee Hwang, Mi Young Kim
J Korean Acad Adult Nurs 2008;20(1):21-32.   Published online February 29, 2008
PURPOSE
This study was to identify the effects of the hand acupressure therapy on sleep quality and mood state of adults having insomnia.
METHODS
The study was a one group pretest-posttest design. The subjects for this study were 15 insomniac adults. All the subjects were assessed for their sleep quality and mood state using PSQI(Pittsburgh Sleep Quality Index) and POMS(Profile of Mood States). The pellet stimulating hand acupressure therapy was applied using New Seoam Press Pellets 1 Ho for 4 weeks. Data were analyzed by the SPSS 12.0 version program with descriptive statistics and wilcoxon signed-rank test.
RESULTS
The mean total score of PSQI was 6.67 and the POMS was 6.68. There were significant decreases in subject's total PSQI score(p=.000) and in total POMS score(p=.008) after the therapy.
CONCLUSION
These results suggest that pellet stimulating hand acupressure therapy is effective for sleep quality and mood state of adults having insomnia.
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Sex differences in Risk of Cardiovascular Disease, Depression and Self-Care Activities in Type 2 Diabetes with Metabolic Syndrome
Chun Ja Kim
J Korean Acad Adult Nurs 2008;20(1):33-43.   Published online February 29, 2008
PURPOSE
This study was to investigate the sex differences in risk of cardiovascular disease(CVD), depression and self-care activities in type 2 diabetes with metabolic syndrome.
METHODS
The descriptive correlational design was conducted using a convenient sample. One hundred and twenty-nine diabetic patients with metabolic syndrome were recruited in a university hospital. The data were analyzed using descriptive statistics, the Pearson correlation coefficient, Students' t-test, one way ANOVA, and stepwise multiple regression with SPSS/WIN 12.0.
RESULTS
The risk of CVD in diabetic patients with metabolic syndrome indicated a significantly negative correlation to self-care activities and age, and positive correlation to waist_C, SBP, DBP and TG. The metabolic syndrome is associated with an approximate 1.7-fold increase in the relative risk in CVD in diabetic women. The main significant predictors influencing CVD risk of diabetes with metabolic syndrome were age, waist_C, SBP and TG, which explained about 29.7%.
CONCLUSION
These results indicate that patients with diabetes with metabolic syndrome with a high degree of waist_C, SBP and TG are likely to be high in risk of CVD.
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Changing Pattern and Comparison of Nutritional States before and after Nasogastric Tube Feeding for the Severe Brain Injury Patients in Critical Period
Jong Suk Park, Hyun Soo Oh, Wha Sook Seo, Yeon Ok Seo
J Korean Acad Adult Nurs 2008;20(1):44-54.   Published online February 29, 2008
PURPOSE
The purpose of the study were to examine the nutritional status of severe brain injury adult patients in critical period, and to compare the nutritional states before and after tube feeding.
METHODS
Data from 19 patients admitted to the SICU in a university hospital due to severe brain injury were analyzed. Nutritional states were measured by anthropometric and blood biochemical indicators.
RESULTS
MAC and MAMC were significantly decreased only at 7 days after admission compared with those on the day of admission. TSF was significantly decreased from 7 days to 14 days after admission. Fat rate was significantly decreased from 3 days to 14 days after admission. Hb was significantly decreased only at 3 days after admission. Albumin was significantly decreased from 3 days to 14 days after admission. However, lymphocyte was significantly increased at 14 days after admission. TSF and Albumin became significantly worse even after initiating tube feeding.
CONCLUSIONS
Nutritional status of severe brain injury patients in SICU became worse after admission whichever indicators were adopted to evaluate nutritional status, anthropometric or blood biochemical indicators, and became worse even after initiating tube feeding.
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Effect of the Meridian Pressure on the Functions of Upper Extremities and Discomfort of ADLs of Hemiplegic Patients
Jeong Wha Kim, Sung Nam Choi
J Korean Acad Adult Nurs 2008;20(1):55-64.   Published online February 29, 2008
PURPOSE
The purpose of this study was to identify the effect of Meridian pressure on the functions of upper extremities and discomfort of ADLs of hemiplegic patients. METHODS: The research design was a nonequivalent control group, non-synchronized design. Subjects were 35 hemiplegic patients who were hospitalized at L Oriental Medical Hospital; 18 for the experimental group and 17 for the control group. The experimental group was given meridian pressure for 10 minutes daily for 2 weeks. The data were analyzed by SPSS 12.0 program. The chi-square-test and t-test were used for the two groups' homogeneity, and t-test was used for the hypothesis test.
RESULTS
Manual muscle test, ROMs of wrist extension, elbow flexion, and shoulder extension of the experimental group increased compared to the control group. Shoulder pain and index finger circumference of the experimental group decreased compared to the control group. The experimental group showed to have less discomfort of ADLs than the control group.
CONCLUSION
The study results verified that meridian pressure is effective for improving the functions of hemiplegic patients' upper extremities as well as reducing discomfort of ADLs.
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The Effects of Spirituality/Hope Promoting Programs on Fighting Spirit, Helplessness, Anxiety, and Self-care in People with Cancer
Pok Ja Oh
J Korean Acad Adult Nurs 2008;20(1):65-76.   Published online February 29, 2008
PURPOSE
The purpose of this study was to investigate the effect of a spirituality/hope promoting program on fighting spirit, helplessness, anxiety, and self-care behaviors. METHODS: A nonequivalent control group pretest- posttest design was used. Study subjects were 22 cancer patients undergoing chemotherapy for the experimental group and 31 for the control group. The experimental group received a 4-week intervention, 30-50 minutes a day weekly. Variables were measured at baseline, 4 and 8 weeks later. Fighting spirit and helplessness were measured by MAC(Mental Adjustment to Cancer) and anxiety was measured by Hospital Anxiety and Depression scale. Self-care behaviors scale developed by Oh et al.,(1997) was used.
RESULTS
The experimental group revealed significantly more fighting spirit(t=-4.10, p=.000). more self-care behaviors(t=-5.91, p=.000). and less helplessness(t=3.94, p=.000). No difference, however, was found in anxiety between the two groups(t=.24, p=.861).
CONCLUSION
These results suggested positive effects of a spirituality/hope intervention program. Helplessness decreased mainly through an increase in fighting spirit. Self-care behaviors increased mainly through an decrease in helplessness and increase in fighting spirit.
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Types of Smoking in Adult Smokers and Influential Variables Related to Smoking
Sung Ok Chang, Jun Ah Song, Su Jung Lee
J Korean Acad Adult Nurs 2008;20(1):77-90.   Published online February 29, 2008
PURPOSE
This study attempted to identify influential variables on types of smoking in adult smokers, which have been derived from Q-study.
METHODS
A survey was conducted with 328 adult smokers at community settings in Seoul, South Korea from April 2006 to July 2006. To identify the influential variables related to smoking, variables from the Trans-theoretical model(i.e., self-efficacy for smoking abstinence, smoking temptation, process of change, decisional balance(pros and cons)) and nicotine dependency were analysed by ANOVA. Post-comparison tests were also done.
RESULTS
The scores of nicotine dependency and smoking temptation were higher in habitual craving types than any other types, while the scores of self-liberation and self-efficacy for smoking abstinence were higher in self control types than any other types.
CONCLUSION
Specific smoking intervention methods for each of the smoking types needs to be developed, based on how different groups of individuals gets into a decisions to quit smoking within their contexts.
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A Study on the Falls, Fear of Falling, Depression, and Perceived Health Status among the Older Adults
Dukyoo Jung, Kyung Rim Shin, Younhee Kang, Ji Sook Kang, Kon Hee Kim
J Korean Acad Adult Nurs 2008;20(1):91-101.   Published online February 29, 2008
PURPOSE
The purpose of this study was to investigate the relationships between a experience of falling, fear of falling, depression, and perceived health status in urban areas.
METHODS
After obtaining Institutional Review Board (IRB) approval, a one-time, face-to-face, and private interview was conducted with each participant who was eligible and agreed to participate in this study from May 2007 to August 2007 by trained graduate-level nursing students. The questionnaires consisted of Fall Efficacy Scale, K-GDS, and SF-36. The collected data were analyzed with SPSS/PC 12.0 program, which was used for frequency, percentage, mean, standard deviation, t-test, and hierarchical regression.
RESULTS
The major findings of this study were as follows; 1) approximately 9% of participants had fallen within one year. Study participants reported moderate fear of falling(M=43.80); moderate physical health (M=42.31) and mental health(M=46.05); and low depression status(M=10.38). 2) there were significant differences in fear of falling according to gender, experience of falling, exercise, and depression. 3) significant factors influencing on fear of falling were experience of falling and physical health status.
CONCLUSION
The results of this study indicate that nurses working closely with older adults should be taught the impact of previous falls and physical health status on fear of falling and need to reinforce exercise behavior for older adults who are vulnerable to fear of falling.
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Self Care Behavior according to the Risk of Vascular Complications in Elderly Women with Hypertension
Kyung Mi Kim, Haejung Lee, Yong Suk Kim
J Korean Acad Adult Nurs 2008;20(1):102-112.   Published online February 29, 2008
PURPOSE
The purpose of this study was to examine self care behaviors according to the risk levels of vascular complications in elderly women with hypertension.
METHODS
The subjects of this study were 162 women living in the community who had been diagnosed with hypertension in clinics. The data were analysed by the SPSS 10.0 program using descriptive statistics, t-test, and ANOVA with Scheff. post-hoc test.
RESULTS
The average self care behavior score of the elderly women was 2.79. Total self care behavior was significantly different depending on the risk levels of vascular complications such as systolic blood pressure, diastolic blood pressure, ankle-brachial index, and the framingham point score. Among sub-scores of self care behaviors, exercise management was the poorest performance compared with other self care behaviors.
CONCLUSION
This study proved the differences in self care behaviors according to the risk levels of vascular complications. To decrease the prevalence of vascular complication, it is necessary to develop programs specifically to enhance self care behaviors of elderly women with hypertension.
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A Grounded Theory Approach on the Multiple Role Experience of Married Women Graduate Students
Eun Ha Kim, Yeon Ok Lim, Gyung Sook Park, Nam Young Kim
J Korean Acad Adult Nurs 2008;20(1):113-125.   Published online February 29, 2008
PURPOSE
This research was conducted to explore the experiences of graduate student women with children fulfilling multiple roles and to generate a substantive theory.
METHODS
This study uses the grounded theory method based on Strauss and Corbin(1988)'s method. Interviews were conducted with 11 graduate student women who had children aged three of older.
RESULTS
The core category of this research is 'Role balancing for self-generativity'. Based on the core category, three types of married women graduate students' experiences were found. They are 'concentrating on graduate-work' 'postponing graduate-work' and 'adjustment between two roles' CONCLUSIONS: Through understanding the married women's multiple roles experience process, there can be a basis for making a women's health system and social support system for the married women graduate student. Also, this research is to generate a substantive theory which can helps to change social perspectives on the quality of life for the women who will contribute in Korean society as professionals.
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Comparison of Presentation in Acute Myocardial Infarction by Gender
Gui Yun Choi, Eun Seog Hong
J Korean Acad Adult Nurs 2008;20(1):126-134.   Published online February 29, 2008
PURPOSE
This study was to explore gender differences on presenting patients with acute myocardial infarction in the emergency department.
METHODS
The survey was done with 143 emergency medical charts presented to the emergency department and diagnosed with acute myocardial infarction between January 2005 and December 2006. The collected data were analyzed with frequency, chi-square, and t-test.
RESULTS
Significant gender differences were apparent in age, route to the emergency department, elapsed time from onset of symptoms to arrival, and initial heart rate. Women were significantly more likely to report hypertension, diabetes, and congestive heart failure than men, but men were significantly more likely to report smoking. Chest pain was the most common initial symptom in both men and women. Women were significantly more likely to report dyspnea and nausea/vomiting than men.
CONCLUSION
Although similarities exist in the associated symptoms of acute myocardial infarction, women might experience different symptoms, compared to men. These findings have implication that patients and health care providers should consider gender difference in presenting symptoms.
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Comparison of Forced Air Warming and Radiant Heating on Body Temperature and Shivering of Post-operative Patients
Kyoung Hee Choi
J Korean Acad Adult Nurs 2008;20(1):135-148.   Published online February 29, 2008
PURPOSE
This study compared the effects of forced air warming and radiant heating on body temperature and shivering of patients with postoperative hypothermia.
METHODS
The quasi-experimental study was conducted with two experimental groups who had surgery under general anesthesia; 20 patients of group 1 experimented with the Bair Hugger as a forced air warming and 20 patients of group 2 experimented with the Radiant heater. The study was performed from July 3 to August 31, 2006 in a recovery room of an university hospital in a city. The effects of the experiment were measured by postoperative body temperature and chilling score at arrival and after every 10 minutes. The data were analyzed by t-test or chi-square-test, repeated measures ANCOVA using SPSS/WIN 12.0.
RESULTS
The mean body temperature showed differences between the Bair Hugger group and Radiant Heater group at 40 minutes(F=-2.579, p=.034), 50minutes(F=-2.752, p=.027), and 60 minutes(F=-2.470, p=.047) after arrival to the recovery room. So, hypothesis 1 was partially accepted. The mean score of shivering showed differences between the Bair Hugger group and the Radiant Heater group, but it had no significant meaning. Hypothesis 2 was not accepted.
CONCLUSION
We need more study to explore the effects and side effects of heating modalities to select a more effective heat treatment. The efficiency of heat modalities with regards to cost benefit, time consumption, and patients' discomfort such as burns should be considered.
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Experiences of Admission for Critically Ill Patients in ICU
Jin Hyang Yang
J Korean Acad Adult Nurs 2008;20(1):149-162.   Published online February 29, 2008
PURPOSE
The purpose of this study was to understand the meanings and nature of ICU admission experienced among patients with critical illness. The present study adopted a hermeneutic phenomenological method which was developed by van Manen.
METHODS
The participants for this study were 6 men and 3 women, who were over the age of 20 with ICU admission period more than 3 days. Data were collected by using in-depth interviews and observations from March, 2007 to September, 2007. The contents of the interviews were tape-recorded with the consent of the subject.
RESULTS
The essential themes that fit into the context of the 4 existential grounds of body, time, space and other people were as follows: a body that cannot react the way it wants, a wave of fear and insecurity everywhere, a struggle to survive, coming out from death's door, loss of time path, a long and continued waiting until escaping, more of machinery room than a patient's room, existence of life and death, an abyss of suffering seen thru another patient, taken care of by a doctor, trust and distrust, family, the ultimate safe zone.
CONCLUSION
Critically ill patients in ICU experienced feelings of discomfort, unsafety, and insecurity. The result of this study can give nurses some insight into these experiences and help promote empathetic care.
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Self-Care, Symptom Experience, and Health-Related Quality of Life by COPD Severity
Gui Jung Kang, Myung Hee Kim, Sun Kyung Hwang
J Korean Acad Adult Nurs 2008;20(1):163-175.   Published online February 29, 2008
PURPOSE
This study aimed to define the relationship among self-care, symptom experiences, and health-related quality of life(HRQoL) according to the severity of disease in chronic obstructive pulmonary disease(COPD) patients.
METHODS
The participants, 195 COPD patients, were recruited at a pulmonology clinic of a universityaffiliated medical center in B metropolitan city. Inclusion criteria were patients who were diagnosed as COPD and had less than 0.7 of FEV1/FVC(Forced Expiratory Volume for 1 second/Forced Vital Capacity) ratio. The severity was classified with GOLD(Global initiative for Obstructive Lung Disease) stages, FEV1% predicted value from mild to very severe. The data were gathered by the medical records and self-reported questionnaires.
RESULTS
The self-care, symptom experience, and HRQoL were all significantly different by COPD severity based on pulmonary function(p<.05). There were significant moderate negative relationships between symptom experiences and self-care(r=-.54, p<.001) and between symptom experiences and HRQoL(r=-.64, p<.001). There was a moderate positive correlation between self-care and HRQoL(r=.63, p<.001).
CONCLUSION
It suggests that the assessment of disease severity based on pulmonary function and subjective symptom experience in patients with COPD may be a key component to develop a tailored self-management program and to improve their quality of life.
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The trends of Nursing Research in the Journal of Korean Academy of Adult Nursing
Yeon Hwan Park, Young Whee Lee, Ok Soo Kim, Myung Ok Cho
J Korean Acad Adult Nurs 2008;20(1):176-186.   Published online February 29, 2008
PURPOSE
The purpose of this study was to analyze the published articles in the Journal of Korean Academy of Adult Nursing from 2004 through 2006.
METHODS
Two hundreds and ten articles were analyzed focusing on research methodology and key words using descriptive statistics.
RESULTS
The proportion of quantitative research was 88.1%, while the proportion of qualitative research was 5.2%. The majority of the qualitative research design was survey(67.1%). Seventy-four percent of the research had verbal consent and 8% had written consent from the participants. Eight percent of the research provided conceptual framework. The prevailing data collection settings were hospitals(50.5%) and community(37.1%). For the data analysis, 95% used parametric analysis methods; descriptive statistics(26.2%), chi-square test(18.3%), t-test(18%) and ANOVA(17.4%). Key words were categorized into four nursing domain: human, health, nursing, and environment. The most frequently used domain was health.
CONCLUSION
The number of the published articles in the Journal of Korean Academy of Adult Nursing has been increased and quality has been improved compared with the articles published before the 2000 year. Varied research methodology and data analysis methods were utilized.
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