Development and Validation Study of an Instrument to Measure Work Environment of Nurses in Nursing Homes

Purpose: This study was done to develop an instrument to measure the work environment in nursing homes and to evaluate its psychometric properties. Methods: Instrument development was conducted in three phases: development of the initial questionnaire, content validity and pilot-testing, and construct validity and reliability testing. Participants were 184 nurses from 62 nursing homes in South Korea. Exploratory factor analysis, confirmatory factor analysis, and examination of internal consistency were used to verify the psychometric properties of the instrument. Results: The final model derived from the factor analysis yielded 27 items across five domains: nurses’ participation in nursing home affairs; well-defined scope of practice; nurse managers’ ability, leadership, and support of nurses; staff and resource adequacy; and communication and coordination. The fit indices in the confirmatory factor analysis were acceptable. Total Cronbach’s ⍺ was .93 (sub-domains ranged .77~.88). Conclusion: The results indicate that the selected items are suitable for measuring the work environment of nursing homes in South Korea. This instrument may be useful in nursing home-related research and may be used to improve the health outcomes of older adults in nursing homes.ope

Lifestyle factors related to glucose control for diabetes management strategies: Nested case control design using KNHANES data

This study aimed to find health related lifestyle factors that influence glycemic control for diabetes mellitus (DM) management strategies. This study used nested case-control design with matching variables that were not controlled by individuals such as age, sex, insulin or oral hypoglycemic agent (OHA) use, disease duration, education level and household income. This study analyzed 983 subjects with type 2 DM who enrolled in the 7th (2016-2017) Korean National Health and Nutrition Examination Survey (KNHANES). The target HbA1c level of controlled glucose was defined as less than 6.5%, and 289 (30%) were achieved. Conditional multivariable logistic regression analysis was performed to find self-control factors associated with HbA1c levels. The results statistically significant for variables such as duration of diabetes, insulin or OHA use in overall cohort and body mass index (BMI), smoking and fundus Examination in matched cohort. These results are expected to provide as evidence for the intensive care criteria(disease duration, drug use) and lifestyle management strategy(BMI, smoking, fundus examination).ope

Emergency Department Nursing Activities : Retrospective Study on Data from Electronic Nursing Records

Purpose : This study aimed to identify the type and frequency of nursing activities targeting emergency department patients by analyzing electronic nursing records. Methods : This retrospective study identified the characteristics of and nursing activities for adult patients who visited a university hospital emergency department for 6 months from January to June 2018 by analyzing the hospital’s electronic nursing records. Descriptive statistics and one-way analysis of variance were used to analyze the characteristics of patients and the nursing records. Results : A total of 36,435 patients, with an average age of 52.82±19.91 years and a male-to-female ratio of 1:1.16, participated in the study. The number of patients with Korean Triage and Acuity Scale levels 4 (less urgent) and 5 (non-urgent) were 24,403 (67% of the total number). Referrals were requested 1.21±0.54 times per patient. The most frequent NANDA diagnosis and Nursing Intervention Classification intervention were “Risk for unstable blood glucose level” (858, 28.4%), and “Surveillance” (83,131, 23.9%). The most frequent Clinical Care Classification action type was “Assess or Monitor” (313,729, 38.5%). The higher the severity level and the number of referrals, the more the recorded numbers of nursing diagnoses, interventions, and care activities. Conclusion : This study demonstrated the possibility of nursing task analysis by identifying the type and frequency of nursing activities based on the data from electronic nursing records. Further research on electronic nursing records would contribute to the usefulness of these records for nursing workload analysis and effective workforce management.ope

Risk Factors for Falls among Community-dwelling Older Adults -Using KLoSA Data-

Purpose: The purpose of this study was to identify incidence, characteristics and risk factors for falls among community-dwelling older adults. Methods: This study was a secondary analysis using data from the Korean Longitudinal Study of Aging (KLoSA). KLoSa is a national panel data set that is publicly available. Data collected from 3,511 community-dwelling older adults in 2006 and 2008 were analyzed using Chi-square, t-test, and multiple logistic regression. Results: The incidence of falls among community-dwelling older adults in Korea was 6.3%. There were significant differences, between elders who had fallen at least once, and elders who had no falls, in gender, living arrangements, region, health status, depression, experience of falling, fear of falling, number of diseases, number of medications, diabetes, and arthritis. Significant risk factors for falls among communitydwelling older adults were gender (female), living arrangements (living alone), experience of falling (yes), and number of medications (increase). Conclusion: The results indicate a need to assess risk factors to identify older adults with high risk for falling and to develop interventions to prevent falls in community-dwelling older adults.ope

Importance of work environments on hospital outcomes in nine countries

PURPOSE: To determine the effect of hospital work environments on hospital outcomes across multiple countries. DESIGN: Primary survey data using a common instrument were collected from separate cross sections of 98 116 bedside care nurses practising in 1406 hospitals in 9 countries between 1999 and 2009. MAIN OUTCOME MEASURES: Nurse burnout and job dissatisfaction, patient readiness for hospital discharge and quality of patient care. RESULTS: High nurse burnout was found in hospitals in all countries except Germany, and ranged from roughly a third of nurses to about 60% of nurses in South Korea and Japan. Job dissatisfaction among nurses was close to 20% in most countries and as high as 60% in Japan. Close to half or more of nurses in every country lacked confidence that patients could care for themselves following discharge. Quality-of-care rated as fair or poor varied from 11% in Canada to 68% in South Korea. Between one-quarter and one-third of hospitals in each country were judged to have poor work environments. Working in a hospital with a better work environment was associated with significantly lower odds of nurse burnout and job dissatisfaction and with better quality-of-care outcomes. CONCLUSIONS: Poor hospital work environments are common and are associated with negative outcomes for nurses and quality of care. Improving work environments holds promise for nurse retention and better quality of patient care.ope

간호학 학사과정의 노인간호학 핵심역량, 교과내용, 학습목표 개발

Purpose: This study was done to develop competencies and core curriculum for gerontological nursing education in programs towards a Bachelor of Science in Nursing (BSN). Methods: From June 2015 to January 2016, competencies and core curriculum from gerontological nursing education in foreign countries were analyzed using a literature review, along with an analysis of the current gerontological nursing curriculum in Korean BSN programs. Competencies and core curriculum of undergraduate nursing education for gerontological nursing were determined through expert panel discussions in the Korean Gerontological Nursing Society. Results: Data were collected from 30 BSN programs in Seoul, Kyunggido, Kangwondo, Chungchungdo, Kyungsangdo, and Jeollado. Compared with the core curriculum for gerontological nursing recommended by the National Gerontological Nursing Association, there were deficiencies in legal/ethical issues, administrative issues, nursing research in gerontological nursing, and care and service delivery. From the data and panel discussion, 13 competencies and core curriculum including 6 contents, 32 programs, and 197 learning objectives were found to be important. Conclusion: Use of the recommended curriculum from this study can address deficiencies in baccalaureate gerontological nursing education, but it is also necessary to develop textbooks based on the recommended 13 competencies and core curriculum including 6 contents, 32 programs, and 197 learning objectives.ope

Concept Analysis of Good Death in the Korean Community

Purpose: The purpose of this study was to define the meaning of a good death mentioned in Korean culture. Methods: This study was carried out using Rodgers' evolutionary concept analysis strategy. A review of the literature was done with key words related to good death and other relevant words in literature published in English or Korean. The literature search was conducted from 1995 to 2016 for overseas and from 2000 to 2016 for domestic. The final selection target was 44 pieces. Each document was divided into 7 disciplines, including 25 domestic documents. Results: Three dimensions and seven attributes were identified; 1) The preparation stage for death: living well, preparation for dying, 2) The final stage of death: avoiding meaningless extension of life, dignity, comfort and interaction with healthcare providers, 3) The post death stage: positive feeling of families. Antecedent to good death were dying persons, families and healthcare providers' wishes for good death, The consequences were their experience during the period of dying and feeling after dying. Conclusion: There was a change in the concept of good death according to the times. It is important for nurses to understand the concept of good death in order to provide care with good quality to patients who are faced with death, their families and healthcare providers.ope

Transitional care from hospital to home for frail older adults: A systematic review and meta-analysis

Frail older adults are vulnerable to hospitalization and transitional care is needed to maintain care continuity; however, there exists no review regarding transitional care focusing on frailty. This study aimed to investigate transitional care for frail older adults and its effectiveness. Search terms were (P) frail older adults; (I) transitional care initiated before discharge; (C) usual care; (O) all health outcomes. Fourteen trials were identified. The most measured outcome was readmission (n = 13), followed by mortality (n = 9), function (n = 7), quality of life (n = 5), and self-rated health (n = 5). Statistical significance effects were reported in the followings: n = 6, readmission; n = 0, mortality; n = 3, function; n = 2, quality of life; and n = 4, self-rated health. The meta-analysis demonstrated that transitional care reduced readmission at six months but not other time points nor mortality or quality of life. The intervention effectiveness was inconclusive; therefore, an evidence-based yet novel approach is necessary to establish an adequate transitional care intervention for frail older adults.ope

Associations among health behaviors, body mass index, hypertension, and diabetes mellitus: A path analysis

Hypertension (HTN) and type 2 diabetes are common diseases; however, the effects of health behavior and body mass index (BMI) on their incidence and relationship are unclear. The purpose of this study was to investigate the associations among health behaviors, BMI, HTN, and type 2 diabetes.This study was a secondary data analysis using Korean Longitudinal Study of Aging data between 2010 and 2014 (third and fifth). The sample consisted of 3481 people aged 45 years or older. Path analysis was conducted using the generalized structural equation modeling of STATA 13.1 that enabled analyzing the types of binary variables and logit links.There were 129 underweight, 1714 normal, and 1638 overweight and obese individuals. In underweight and normal groups who had regular meals (B = 0.670, P < .001), BMI was higher. However, for those who were older (B = -0.041, P < .001) and female (B = -0.229, P = .021), BMI was lower. The incidence of HTN increased with age (B = 0.038, P = .001). In addition, the incidence of type 2 diabetes increased with age (B = 0.051, P = .005) and smoking (B = 1.539, P = .001). However, the incidence of type 2 diabetes was lower (B = -1.077, P = .036) for those who had regular meals. In the normal and overweight groups, BMI decreased with age (B = -0.033, P < .001). The incidence of HTN increased with age (B = 0.042, P < .001) and BMI (B = 0.145, P < .001). Moreover, the incidence of type 2 diabetes increased with age (B = 0.046, P < .001), smoking (B = 0.682, P = .020), and higher BMI (B = 0.151, P = .001).In the underweight and normal group, health behaviors were related to BMI. In the normal and overweight group, health behaviors were not related to BMI, but high BMI was related to the incidence of HTN and type 2 diabetes. Smoking has a direct effect on the incidence of type 2 diabetes. Thus, the importance of maintaining an ideal BMI and smoking cessation are highlighted.ope

Social engagement and cognitive function among middle-aged and older adults: gender-specific findings from the Korean longitudinal study of aging (2008-2018)

Recent findings suggest that social disengagement in later life may result in cognitive decline and increase risk of Alzheimer's and related dementias. However, little is known regarding the gender-specific longitudinal association between social engagement and cognition among middle-aged and older adults. Using data from a nationally representative sample of 2707 men and 5196 women from the Korean longitudinal study of aging, we examined the gender-specific association between social activity and cognitive function. Results from the generalized estimating equation model showed that compared to individuals with consistent social engagement (religious, senior center, sport, reunion, voluntary, political), individuals with inconsistent engagement had lower cognitive function. Transitioning from engagement to non-engagement was associated with lower cognitive function among men only. Not being part of a senior center was associated with decreased cognitive function among both genders, while not being part of a religious group was significant for women only. While marital status was a significant predictor of cognitive ability for women, depression was a significant predictor for men. These findings have implications for policy-makers as interventions targeting improved cognitive function among middle-aged and older adults may be more effective when gender-specific predictors are taken into consideration.ope