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Volume 22(3); June 2010

Randomized Controlled Trial

Effects of Maximal Sterile Barrier Precaution on the Central Venous Catheter-related Infection and Cost
Jung Hye Lim, Nam Cho Kim
J Korean Acad Adult Nurs 2010;22(3):229-238.   Published online June 30, 2010
PURPOSE
The purpose of this study was to examine the effect of maximal sterile barrier precaution on the central venous catheter-related infection and subsequent cost savings.
METHODS
Study subjects were 462 hospitalized patients with central venous, catheter of more than 48 hours duration. Data collection period was from April 2008 to February 2009 at a tertiary university hospital in Seoul. Subjects were randomly assigned to either the treatment or the usual care group. Patients in the treatment group (n=209) were treated by staff using maximal sterile barrier precautions and the comparison group(n=253) received traditional care.
RESULTS
Central venous catheter-days was2,821 in treatment group and 3,515 in comparison group. The incidence density of central venous catheter-related infection was 2.1 times higher in the comparison group (8.2 per 1,000 catheter-days) compared with the treatment group (3.9 per 1,000 catheter-days). The incidence density of central venous catheter-related bloodstream infection was 4.54 times higher than in the comparison group (3.2 per 1,000 catheter-days) compared with the treatment group (0.7 per 1,000 catheter-days). The attributable cost of central venous catheter-related infection in the treatment group was 10,174,197 won and that of the comparison group was 22,224,554 won. Attributable cost by area was also significantly lower compared with that of the comparisons.
CONCLUSION
The maximal sterile barrier precaution during central venous catheter insertion was an effective intervention to reduce central venous catheter-related infection rate and provides a significant cost savings.
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Original Articles

Family Function and Successful Aging for Vulnerable Elderly Based on Circumplex Model
Jee Won Park, Keum Ok Ban
J Korean Acad Adult Nurs 2010;22(3):239-249.   Published online June 30, 2010
PURPOSE
The objective of this study was to identify the relationships between family function and successful aging of vulnerable elderly using the circumplex model.
METHODS
The participants were the elderly (N=401) who were over 65 years old living in H city under the National Livelihood Security Act. Family Adaptability and Cohesion Evaluation Scale III and Successful Aging Instrument were used.
RESULTS
The family function perceived by the study subjects was average 43.20 +/- 16.62 out of maximum 100 points. According to the analysis on family types suggested by circumplex model, there were 183 people for balance family (45.6%) and 218 people (54.4%) for extreme family. The total points on successful aging were 1.67 +/- 0.37 out of 3 points. When the difference in points on the Successful Aging instrument were analyzed according to the scores on the Family Adaptability and Cohesion Scale those points of the balanced family were statistically significant (t=2.087, p=.038).
CONCLUSION
In case of the balanced family type, the level of perceiving successful aging was relatively higher. For the improvement of family function, it is advised that the successful aging perception among vulnerable elderly can be uplifted through a program that enables effective communication with other family members.
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Perceived Knowledge, Attitude, and Compliance with Preventive Behavior on Influenza A (H1N1) by University Students
Jeong Sil Choi, Nam Young Yang
J Korean Acad Adult Nurs 2010;22(3):250-259.   Published online June 30, 2010
PURPOSE
This study was examined to identify the relationship among knowledge, attitude, and compliance with preventive behavior on influenza A (H1N1) by University students.
METHODS
The sample consisted of 101 students. The data were collected from August to September 2009 and analyzed using descriptive statistics, t-test, ANOVA, Pearson correlation coefficients, and stepwise multiple regression.
RESULTS
The mean scores of knowledge (11.89 +/- 1.39), attitude (30.16 +/- 2.87), and compliance with preventive behavior (22.35 +/- 3.51) on influenza A (H1N1) were above the average. The level of knowledge was not significantly different regardless of characteristics. Students' attitude differed according to gender (p<.001), and plan to seasonal influenza vaccination for this year (p=.007). Compliance with preventive behavior was significantly different according to experience of seasonal influenza vaccination during last year (p=.010), experience of obtained information about influenza A (H1N1) (p=.037). Significant correlations were found between knowledge and compliance with preventive behavior (p<.001), attitude and compliance with preventive behavior (p<.001). Knowledge and attitude was a predictor of compliance with preventive behavior (23.4%).
CONCLUSION
These findings indicate that perceived knowledge and attitude may be necessary to improve compliance with preventive behavior on influenza A (H1N1) among university students. The results of the study can be utilized in educational programs about preventing the occurrence of influenza among university students.
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Analysis of Researches on the Warming Therapy for Surgical Patients
Jumyi Jun
J Korean Acad Adult Nurs 2010;22(3):260-270.   Published online June 30, 2010
PURPOSE
The main question is systematic review of the published in Korea and foreign countries on warming therapy for surgical patients.
METHODS
The researchers searched at Medline, CINAHL, KERIS, Adult Nursing Association, Korean Society of Nursing Science, Korean Academy of fundamentals of Nursing, and National Assembly Library web site for the published on warming therapy for surgical patients from 1980 to 2008. Words for search were operation/surgery, warming, operation/surgery and warming. Studies were included randomized controlled trial, and there were no restrictions regarding operative phase and outcome measures.
RESULTS
36 published researches that met the criteria were mostly published in foreign countries between 2000 and 2008 and focused on surgery with general anesthesia. Sample size ranged from 21 to 60 subjects, age range between 21 and 60 years of age. Thirty different warming therapies were reported, fifty-two different dependent variables. Outcome indicators included active external warming, intra-operative, and body temperature. 'Positive effects' and 'no effects' equaled. The most frequently reported 'positive effects' were body temperature, shivering, and acid-base balance. No effects were more likely to be heart rate, blood pressure, and hemodynamics.
CONCLUSION
Many types of warming therapy, are reported in the literature with little information about the efficacy of each, many different dependant variables were studied. There were no consistent reports as to length of time used for warming procedures. Overall, the effects of warming therapy are inconsistent. And additional research must be down before any particular method of warming can be used with confidence as to its effectiveness. Attention must be made as to the research design, better measurement of the dependent variables. This review may serve as a base.
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A Study on Blood Glucose Level and Self Management among Community Dwelling Type II Diabetes Patients
Ju Young Park, Tae Yong Lee, Keong Sug Jang, Hee Young Oh
J Korean Acad Adult Nurs 2010;22(3):271-280.   Published online June 30, 2010
PURPOSE
The purpose of this study was to examine relationships among blood glucose, HbA1c, and self management comparing these with general and illness characteristics of subjects with Type II Diabetes living in the community.
METHODS
Using a comprehensive survey developed for the study, data were collected from 82 type II diabetes patients who were registered at five community health departments. The variables of self management, blood glucose and HbA1c were assessed by nurses. Data were analyzed with descriptive statistics including t-test, ANOVA and Pearson's correlation coefficient to compare self management and level of HbA1c by subject's general and illness characteristics and to examine the relationships among variables.
RESULTS
About 73.2% of the subjects' HbA1c were 7.0% or higher and 54.9% of subjects' blood glucose were 200 mg/dL or higher. The level of self management was moderate. Most frequently perceived reasons for failure of blood glucose control were dietary failure (32.9%). There was significant relationship between self management and HbA1c(r=-.223, p=.040). The mean score of self management were higher among female (t=-2.37, p=.021), who are not on diabetes medication (t=6.70, p=.011).
CONCLUSION
Comprehensive intervention is needed to improve dietary self management, especially for male and those who is on diabetes medication.
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Factors related to the Health related Quality of Life among Institutionalized Elders
Eun Ha Kim, Yeong Kyeong Kim
J Korean Acad Adult Nurs 2010;22(3):281-290.   Published online June 30, 2010
PURPOSE
This purpose of this study was to identify the factors related to the health related quality of life among institutionalized elders.
METHODS
The subjects were 247 elders institutionalized among one of the four nursing homes in Busan. Data were collected through interview with four standardized questionnaires from August to October, 2008. Questionnaires were related to health related quality of life (SmithKline Beecham's Quality of Life scale, SBQoL), quality of sleep(Pittsburgh Sleep Quality index, PSQI), activity of daily living (Katz ADL Index), and depression (Geriatric Depression Scale Short Form Korea, GDSSF-K). Data were analyzed for descriptive analysis, t-test, one-way ANOVA, Pearson's correlation coefficient, and stepwise multiple regression by using SPSS/WIN 17.0 program.
RESULTS
The mean HRQoL in the subjects was 6.62 +/- 0.91. Percentage of the respondents reporting sleep disorders were 72.5% and 27.1% reported being vulnerable to depression. The significant predictors of the HRQoL were sleep quality, activity of daily living (ADL), level of education, and depression. The factors accounted for 28.8% of variance in the health related quality of life of institutionalized elders.
CONCLUSION
Sleep quality, activity of daily living, and depression need to be considered as the important control factors for improving the health related quality of life in the institutionalized elders.
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PURPOSE
This study was a secondary data analysis aimed at identifying the predictors of health-related quality of life (HRQoL) of the home-dwelling disabled person by using EQ-5D which is a standardized instrument used as a measure of health outcome.
METHODS
Data were drawn from the 3rd Korea National Health and Nutritional Examination Survey conducted by the Ministry of Health and Welfare (MOHW). Subjects were 1,021 home-dwelling disabled persons over 19 years of age. Data were analyzed by using descriptive statistics, t-test, Pearson's correlation, one-way ANOVA, Scheffe test, and Stepwise multiple regression.
RESULTS
HRQoL (Health Related Quality of Life) is differentiated within age, genders, educational level, employment status, economic status, types and grades of disability, health problems associated with limited mobility, and the limited duration of time. HRQoL is correlated with age, number of cohabiters, educational level, grades of disability, activities of daily living (ADL), and instrumental ADL (IADL). HRQoL is significantly associated with ADL, health problems in connection with limited mobility, employment status, types of disability, marital status, grades of disability, and the limited duration of time. These factors explained 63.7% of variance in HRQoL.
CONCLUSION
HRQoL among the disabled is related to their characteristics, ADL, and IADL. For this reason, it is necessary to develop health programs to promote those variables required to improve HRQoL.
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Influencing Factors and Importance of Nurses' Caring Behaviors for Chronically Sick Elderly
Chun Gill Kim
J Korean Acad Adult Nurs 2010;22(3):303-311.   Published online June 30, 2010
PURPOSE
The purpose of this study was to investigate the importance of nurses' caring behaviors and to identify the factors influencing of nurses' caring behaviors.
METHODS
The participants were 404 nurses who were caring the chronically sick elderly in five H university hospitals. Data were collected through self-reported questionnaires on the importance of caring behaviors, nursing professional value and job satisfaction. Data were analyzed with descriptive statistics, t-test, ANOVA, Scheffe-test, Pearson's correlation coefficient and stepwise multiple regression with SPSS/WIN 16.0.
RESULTS
The average score for importance of nurses' caring behaviors was 3.38 and the 'professional knowledge and skill' factor was the highest level. The mean score of nursing professional value was 7.53 and job satisfaction, 3.18. Importance of nurses' caring behaviors had a significant positive correlation with nursing professional value, job satisfaction, nurse's age and work experience among demographic variables. Two significant variables influencing importance of nurses' caring behaviors were nursing professional value and job satisfaction. But characteristics of nurses did not influence.
CONCLUSION
The findings of this study indicate that importance of nurses' caring behaviors can be improved by intervening factors affecting this importance. Based on the findings of this study, further nursing practice and nursing research for nurses caring the sick elderly should be focused on their nursing professional value and job satisfaction.
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Effects of a Balance Taping on Pain and ROM of the Knee Joint in the Elderly with Lower Limbs Arthritis
Ka Yoon Park, Kyungsook Park
J Korean Acad Adult Nurs 2010;22(3):312-321.   Published online June 30, 2010
PURPOSE
The purpose of this study was to investigate the effects of balance taping on pain and Range of Motion (ROM). ROM of the knee joint in the elderly with lower limbs arthritis.
METHODS
This study was a nonequivalent pretest-posttest design, quasi-experimental study. An experimental group of 35 elderly and a control group of 35 elderly were assigned. Subjects responses to the Visual analogue Scale (VAS) and range of motion scores as measured by a joint goniometer. Data were analyzed by, t-test and repeated measures ANOVA.
RESULTS
In the experimental treatment group, the pain score was significantly decreased from 6.46 to 2.09 after balance taping (p<.001). In addition, knee joint ROM of the experimental group was significantly increased from 114.80 to 121.92 after balance taping (p=.003, p<.001, p<.001).
CONCLUSION
This is a very important study as it is an excellent treatment that nurses can utilize and these data support the efficacy of the method.
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Randomized Controlled Trial

Effects of Individualized Cardiac Health Education on Self Care Behavior and Serum Cholesterol in Patients with Coronary Artery Disease
Hye young Cho, Hee Seung Kim
J Korean Acad Adult Nurs 2010;22(3):322-328.   Published online June 30, 2010
PURPOSE
The purpose of this study was to investigate the effects of an individualized cardiac health education on self-care behavior and serum cholesterol levels patients with coronary artery disease.
METHODS
Twenty-two patients in the intervention group and 22 in the control group were assigned randomly in this study. The intervention group received an individualized cardiac health education program which consisted of four different sessions for a total of four sessions. Specifically, two sessions occurred during the patients' hospitalization with a third session at the time of discharge with a fourth session scheduled via telephone one week post discharge. Data were collected through a questionnaire for self-care behavior and a blood test for total cholesterol at the time of admission and the two weeks after discharge. The questionnaire for self-care behavior was a standardized instrument and serum cholesterol was measured by Accutrend GC (Roche, Germany).
RESULTS
Self-care behavior scores included diet, medication, exercise, risk factor, blood pressure measurement, and visits to hospital were significantly more in the experimental group compared to the control group.
CONCLUSION
The above findings indicate that the individualized cardiac health education was effective in increasing of self-care behavior.
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Original Articles
A Meaning of Death through Emotional Expression about Death after Nursing and Medical Students' End-of-Life Care Practice
Kae Hwa Jo
J Korean Acad Adult Nurs 2010;22(3):329-341.   Published online June 30, 2010
PURPOSE
The purpose of this study was to understand the meaning of death experienced by medical and nursing students through end-of-life care practice.
METHODS
Data were collected by in-depth interviews with twelve (six nursing and six medical) students. Conventional qualitative content analysis was used to analyze the data.
RESULTS
This findings were analyzed in three areas: 'feeling from the word of death', 'color association of death', and 'relation between life and death'. Results were three major themes and sixteen categories from the analysis. Three major themes include 'reality of uncertain death', 'have to leave, and 'new perception about death'. Sixteen categories include 'being well', 'fear', 'unknown', 'boundless', 'being with', 'out of sight', 'new start', 'go back to', 'place going by itself', 'place to meet with', 'being transformed', 'a sense of futility', 'the same point', 'a different point', 'continuous line', and 'a crossroad'.
CONCLUSION
The findings suggest a number of themes that nursing and medical students reported about the end of life experiences that could be explored as a way of improving end of life care.
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The Recovery Experience of Young Adults and Middle Aged Stroke Patients
Ju Young Ha, Hyung Suk Park, Sang Ju Lee, Jeong Hae Jeon, Ho Yoon Jo, Young Ju Jee
J Korean Acad Adult Nurs 2010;22(3):342-351.   Published online June 30, 2010
PURPOSE
The purpose of this study was to determine an increase in the number of younger and middle-aged people who have a stroke and the differences in their recovery experience compared with older people.
METHODS
The research question for this study was "What is the recovery experience of young adults and middle-aged people who suffer a stroke?". In order to answer the question, the grounded theory method was utilized. The data was collected through individual in-depth interviews of six participants, their age ranged from 36 to 45 years old.
RESULTS
After comparative analysis, the core category was "standing up for oneself with limit". The experience process were categorized into four stages: 'Facing Reality stage', 'Motivation stage', 'Desire Recovery stage', 'Self-Overcoming stage'.
CONCLUSION
Most of the research for the recovery process was prognostic in nature and the results. This study was demonstrated certain indicators which can be useful in further research.
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