Haejung Lee

Effects of a Cognitive-Behavioral Nursing Intervention on Anxiety and Depression in Women with Breast Cancer undergoing Radiotherapy

PURPOSE The purpose of this study was to analyze the effects of a cognitive-behavioral nursing intervention on anxiety and depression of patients with breast cancer undergoing radiotherapy. METHODS A nonequivalent control group design was used for the study. The research participants were patients with breast cancer (N=71; experimental group=35, comparison group=36) who received radiotherapy at P university hospital. The experimental group received a 6-week cognitive-behavioral nursing intervention (2 hr/week), which included nursing counseling, education about treatment choices for breast cancer and possible side effects and management strategies during radiotherapy, and rehabilitation exercise. RESULTS Following the intervention, the experimental group showed significantly lower levels of anxiety (Experimental group=34.60+/-6.35, Comparison group=44.63+/-9.93, t=3.552, p<.001) and depression (Experimental group=10.20+/-6.61, Comparison group=17.81+/-10.85, t=3.542, p<.001) than the comparison group. CONCLUSION The findings from this study showed that cognitive-behavioral counseling applied by nurses is very effective to reduce anxiety and depression among patients with breast cancer. Therefore, providing nursing counseling to broader spectrum of patients with cancer should be considered. Further research would warrant future clinical application of nursing counseling.

Effects of a nurse-led cognitive-behavior therapy on fatigue and quality of life of patients with breast cancer undergoing radiotherapy: an exploratory study.

Background: Radiotherapy can have multiple adverse effects, including patient complaints of persistent fatigue and low quality of life. Cognitive-behavior therapy (CBT) has alleviated fatigue and improved QOL of cancer patients; however, little is known about the effects of nurse-led CBT on breast cancer patients undergoing radiotherapy. Objective: The purpose of this study was to analyze the effects of a nurse-led CBT program on fatigue and QOL of patients with breast cancer undergoing radiotherapy. Methods: This study was performed using a quasi-experimental pretest/posttest design, with a nonequivalent control group. The participants were patients with breast cancer (N = 71: experimental group = 35, control group = 36) undergoing radiotherapy at P University Hospital in Korea. The experimental group received a 6-week intervention program that included cognitive restructuring, education about the disease and medical treatment, relaxation therapy, and rehabilitation exercise. Results: After the 6-week intervention, the level of fatigue increased in patients in both groups. However, the increase in the experimental group was lower than that in the control group. Quality of life of the experimental group was significantly higher than that of the control group. Conclusions: The nurse-led CBT seemed to control fatigue level and improve QOL. Therefore, the use of nurse-led CBT for patients with breast cancer undergoing radiotherapy must be promoted. Implications for Practice: Active involvement of experienced nurses in the counseling program should be considered. In addition, further research must be conducted into the implementation of the nurse-led cognitive-behavioral intervention to a broader spectrum of patients.

Depression and sleep disturbance in patients with chronic obstructive pulmonary disease.

The goal of this study was to examine the unique contributions of sleep disturbance to depression in patients with chronic obstructive pulmonary disease (COPD) after controlling for other contributing variables, including patient characteristics, self-efficacy, and physical activity. One hundred thirty-one outpatients diagnosed with COPD from 3 hospitals in South Korea participated in the study. Data were collected from March to June 2010 and analyzed with descriptive statistics, Pearson correlation, and hierarchical multiple regression using the SPSS WIN program. The level of depression reported in this study was 13.84. Sleep disturbance, not living with a spouse, and self-efficacy were all predictors of depression and accounted for 45% of the variance. These findings show the need to screen routinely for sleep disturbance in patients with COPD and support potential benefits of interventions to enhance self-efficacy and quality of sleep in reducing depression in COPD patients.

Factors associated with low-level physical activity in elderly patients with chronic obstructive pulmonary disease

Background/Aims In patients with chronic obstructive pulmonary disease (COPD), the extent of physical activity (PA) is correlated with disease severity and prognosis. However, factors associated with low-level PA in elderly COPD patients are not known. We assessed the levels of PA and clinical factors associated with low-level of PA in elderly COPD patients. Methods This was a secondary analysis of a multicenter, prospective study of 245 patients with COPD. Among them, 160 patients with 65 years or more were included. Three PA groups were defined with respect to daily activity time (low, moderate, and high). Health related quality of life (HRQL) was measured using St. George’s respiratory questionnaire (SGRQ) and 36-item short-form health survey. Anxiety and depression status were assessed employing the hospital anxiety and depression scale (HADS). Multivariate logistic regression was performed to identify independent predictors of low-level PA in elderly COPD patients. Results Of all the 160 patients, 103 (64.4%) engaged in low-level PA. Upon univariate analysis, a decreased exercise capacity (6-minute walk test < 250 m), an increased dyspnea (the modified medical research council [MMRC] dyspnea scale ≥ 2), a decreased HRQL (total SGRQ score), and a presence of depression (HADS-D ≥ 8) were significantly associated with low-level PA. Upon multivariate analysis, an MMRC grade ≥ 2 (hazard ratio [HR], 2.550; p = 0.034), and HADS-D ≥ 8 (HR, 2.076; p = 0.045) were independently associated with low-level PA in elderly COPD patients. Conclusions Two-thirds of elderly patients with COPD reported low-level of PA. More severe dyspnea and a presence of depression were independently associated with low-level PA in elderly COPD patients.

Development and Effects of Social Learning Theory Based Eye-Health Program for Preschoolers

PURPOSE The purpose of this study was to develop an eye-health program based on social learning theory (EPST) of preschoolers and evaluate its effectiveness. METHODS A nonequivalent control group pre-post test design was utilized and 141 six-year-old preschoolers and their parents participated (experimental group=69, control group=72) in the study. The EPST in this study included eye-health education and eye exercises. Attention, memory, replay, motivation, reinforcement, and self-efficacy were used as interventional strategies. To examine the effectiveness of EPST, proficiency in eye-health activities, refractive power, and visual acuity were measured before and after the intervention. Data were analyzed with SPSS WIN 21.0 using the Shapiro-Wilk test, χ²-test, Mann-Whitney U test and Wilcoxon signed rank test. RESULTS Following the intervention, eye-health activities, refractive power, and visual acuity significantly improved in the experimental group compared to the control group. CONCLUSION The results of this study suggest that EPST is effective in improving eye-health activities, refractive power, and visual acuity in preschoolers, and its wider implementation in educational institutions will promise improved eye-health among preschoolers.

Depression is a major determinant of both disease-specific and generic health-related quality of life in people with severe COPD:

The quality of life of patients with chronic obstructive pulmonary disease (COPD) decreases significantly as the disease progresses; those with severe COPD are affected most. This article investigates predictors of the disease-specific and generic health-related quality of life (HRQL) in patients with severe COPD. This multicentre prospective cross-sectional study enrolled 80 patients with severe COPD. At enrolment, all patients completed a disease-specific instrument, the St George’s Respiratory Questionnaire (SGRQ), and a generic instrument, the Short Form 36 Health Survey Questionnaire (SF-36). The data were analyzed by Pearson’s correlation and multiple linear regression. The mean age of the patients was 66 ± 8 years; 93% were males. The SGRQ and SF-36 scores were not influenced by age or sex. Depression, dyspnea, the number of exacerbations, and exercise capacity significantly predicted the total SGRQ score (p < 0.05). Depression was the strongest determinant of the total SGRQ score. The SF-36 physical component summary scores were related to depression, dyspnea, and the number of exacerbations (p < 0.05). In comparison, the SF-36 mental component summary scores were related to depression and anxiety (p < 0.05). Depression is a significant determinant of both the disease-specific and generic HRQL in patients with severe COPD. Screening and early intervention for depression in patients with severe COPD could improve the HRQL.

The Effects of Smart Program for Patients Who Underwent Percutaneous Coronary Intervention (SP-PCI) on Disease-Related Knowledge, Health Behavior, and Quality of Life: A Non-Randomized Controlled Trial

PURPOSE To identify the effects of a smart program for the patients who underwent percutaneous coronary intervention (SP-PCI) on coronary disease-related knowledge, health behaviors, and quality of life. METHODS A nonequivalent control group with a non-synchronized design was utilized and 48 participants (experimental=22, control=26) were recruited from a university hospital in Gyeongsang area from May to December, 2016. The 12-week SP-PCI consisted of self-study of health information using smart phone applications (1/week), walking exercise (>5/week) using smart band, feedback using Kakao talk (2/week), and telephone counseling (1/week). Patients in the control group received usual care from their primary health care providers and a brief health education with basic self-management brochure after the PCI. Data were analyzed using the SPSS 21.0 program through descriptive statistics, χ² test, and t-test. RESULTS After the 12-week SP-PCI, the experimental group showed higher levels of coronary disease-related knowledge (t=2.43, p=.019), heart-related health behaviors (t=5.96, p<.001), regular exercise (Z=-4.47, p<.001), and quality of life-MCS (t=3.04, p=.004) and showed lower levels of stress (Z=-3.53, p<.001) and sodium intake (t=-4.43, p<.001) than those in the control group. There were no significant group differences in medication adherence and food intake in total energy, lipids, and cholesterol. CONCLUSION The suggested SP-PCI provided easy access and cost-effective intervention for patients after PCI and improved their knowledge of the disease, performance of health behaviors, and quality of life. Further study with a wider population is needed to evaluate the effects of SP-PCI on disease recurrence and quality of life for patients after PCI.

Discriminant Factors of Clinical Competence in New Graduate Nurses

The purpose of this study was to identify the discriminating factors of clinical competence in new graduate nurses.