Hesook Suzie Kim

A Survey of Hwa-Byungin Middle-Age Korean Women:

Hwa-Byung (HB) has been categorized as a Korean culture-bound syndrome that refers to insidious, long-standing, serious discontent that is projected into the body and is manifested by numerous symptoms such as insomnia, fatigue, panic, palpitations, dyspnea, and others. This study was designed to investigate the prevalence rate of HB in Korean women, validate the predominant symptoms of HB, and validate the related sociodemographic factors and lifestyle factors that differentiate women with HB from those without HB. A total of 2,807 women ages 41 to 65 years were recruited from seven metropolitan areas and six provinces in Korea. The prevalence rate of women who designated themselves as having experienced HB was 4.95%. The rates were higher in women of low socioeconomic status, living in rural areas, among the divorced or separated, smokers, and drinkers. A set of 31 HB symptoms differentiated the potential HB women from the non-HB women.

Client-nurse interaction: Testing for its impact in preoperative instruction

This study tests for the impact of client-nurse interaction, an essential element lacking in earlier research on preoperative instruction. An experimental design compared the effects of three models of intervention: Facilitator, Informational and Routine Treatment on postoperative pain and anxiety in 91 cholecystectomy patients. Planned comparisons showed that subjects in both experimental conditions reported significantly less postoperative anxiety than subjects who received the routine treatment. There were no differences in anxiety levels between the two experimental groups or in pain scores among the three groups. Refinements in the facilitator model are recommended to enhance the problem-solving nature of the interaction and to strengthen future research. The findings support the importance of providing the patient with sensation information and postoperative exercise instruction.

Family functioning in the context of chronic illness in women: a Korean study

The aims of this study were to clarify the concept of family functioning in the context of a female family members chronic illness, and to describe the processes by which the housewife copes with the situation. The study applied the hybrid model of concept development, which consists of three phases: theoretical, empirical, and analytic. In the theoretical phase, a working definition of family functioning was established and the dimensions of family functioning and subconcepts were identified through an extensive review of the literature. In the empirical phase, in-depth interviews with members of six normal families and seven families in which the housewife had a long-term diagnosis of rheumatoid arthritis were carried out in order to gain descriptions of family functioning in both contexts, and to assess how the housewife coped with her illness in relation to family functioning. The final analytic phase identified the differences and similarities in family functioning between the normal family and family with a chronically ill housewife. A refined definition of family functioning emerged that identified the concept in terms of a complex set of functional dimensions comprising affective, structural, control, cognitive, and external relationships. The data revealed that family functioning is dynamically changed when the housewife becomes ill with a chronic disease. Three types of adaptation process were identified by which the housewives adapted to family functioning in the context of their chronic illnesses: negotiated, self-accommodating, and separated-enduring. The implications of these findings for research and nursing practice are discussed.

Public health nurses' decision making in Canada, Finland, Norway, and the United States

The purpose of this study was to describe the decision-making processes of 369 public health nurses in Canada, Finland, Norway, and the United States, and to discuss any differences observed among these countries. The results indicate that public health nurses used different decision-making models on the job and that these models varied considerably. Five different decision-making models were identified, each exhibiting features of different decision-making theories. The differences between decision making of public health nurses in different countries were statistically significant. The differencies in decision making appear to be due to differences in health care systems in the 4 countries and the nature of the nursing task and context.

Outcomes-based Curriculum Development and Student Evaluation in Nursing Education

PURPOSE A curriculum development model is presented to examine the processes necessary to develop new programs or evaluate existing programs within the philosophy of outcomes-based education in nursing, especially in the context of accreditation. The philosophy of outcomes-based education is to produce individuals who can demonstrate the evidence of competencies in designated areas of education. For nursing education, this means competencies in performing the role of professional nursing as defined by the profession and social needs at the beginning level upon completing a nursing program. METHODS A curriculum development model has been developed analytically based on the literature and experiences. RESULTS A 10-step process framework incorporating the tenets of outcomes-based nursing education is illustrated. CONCLUSION This curriculum development framework can be applied in developing new educational programs in nursing or to evaluate and revise existing programs in anticipation of the accreditation process that is moving with a full force in such countries as Korea.

Double helix of research and practice-developing a practice model for crisis resolution and home treatment through participatory action research.

Over the last five years Crisis Resolution/Home Treatment (CR/HT) teams have been established in Norway. These teams provide an alternative to in-patient acute care services offering assessment as well as direct care. This paper addresses a method of examining the nature of practice models that are being developed in a CR/HT team incorporating the philosophy of open dialogue and the open lifeworld approach. The overall design of this research is action research applying a cooperative inquiry perspective. Multistage focus group interviews are used as a method for generating data, followed by phenomenological–hermeneutic approach in analyzing the data. Three themes were identified: (a) “keeping the dialogue open” referring to the emphasis of openness in dialogues and opening up for a variety of perspectives on whats going on; (b) “tolerance of uncertainty” referring to the need to accept and deal with uncertainty and multiplicity; and (c) “nurturing everyday life issues” referring to the emphasis on illustrating clinical situations in detail through remaking of stories. The on-going co-processes of research and practice was a double helix that links the happenings in the practice with the findings in the research revealing the knowledge in practice and further developing that knowledge.

Application of Critical Reflective Inquiry in Nursing Education

Critical reflective inquiry (CRI) is a method of inquiry developed by Kim (1999) to be applied in clinical practice to improve one’s practice as well as discover knowledge embedded in practitioner’s practice. The method is based on the philosophies and tenets of action science and critical philosophy, and encompasses three phases: descriptive, reflective, and critical. This chapter describes the application of CRI in a nursing education program with aims of instilling in students the mode of reflective practice and to learn not only through practicing in clinical situations but also from reflecting on and critiquing their clinical experiences. A qualitative analysis of a set of CRI reports revealed five themes in clinical practice that represented specific concerns and problems for the students. These five thematic areas are (a) client–nurse interaction and communication, (b) knowing the patient or patient identity, (c) nursing care, (d) ethics, and (e) interpersonal relationships with other health-care professionals. While these CRIs revealed the students’ insights into their own practice, students needed inputs from the faculty members to enrich their reflections and critiques. The findings of this analysis suggest that faculty members should consider these five areas as the basis for varying students’ clinical experiences so that students would gain experiences in a variety of problematic situations.

Thinking in clinical nursing practice: a study of critical care nurses' thinking applying the think-aloud, protocol analysis method.

PURPOSE The purpose of the paper is to discover the patterns and processes of decision-making in clinical nursing practice. METHODS A set of think-aloud data from five critical care nurses during 40 to 50 minutes of caregiving in intensive care units were obtained and analyzed by applying the procedures recommended by Ericsson and Simon for protocol analysis. RESULTS Four thinking processes before acting were identified to constitute various sorts of thoughts in which the nurses were engaged during patient care: reviewing, validation, consideration, rationalization, and action. In addition, three patterns of sequential streaming of thinking (short, intermediate, long) were identified to reveal various ways the nurses dealt with clinical situations involving nursing tasks and responsibilities. CONCLUSION This study specifies the initial categories of thoughts for each of the processes and various patterns with which these processes are sequentially combined, providing insights into the ways nurses think about problems and address their concerns. The findings suggest that the thinking in clinical practice involves more than focused decision-making and reasoning, and needs to be examined from a broader perspective.

Pain assessment in the perspective of action science.

Pain assessment is examined in the perspective of action science with the aim to discover espoused theories and theories-in-use for pain assessment. In action science there are 2 sets of theories of action: espouse theories and theories-in-use, which often exist in practice inconsistently with each other resulting in haphazard actions. Espoused theories of pain and pain assessment and a set of theories-in-use were revealed. Alignments between the espoused theories and the theories-in-use, and disparities between these theories were found in the pain assessment situations. The findings point to possible explanations regarding problems in pain assessment, and provide insights into our understanding of nursing practice especially in relation to pain assessment.

Assistive Technology for People with Dementia: Ethical Considerations

Assistive technology (AT) for people with dementia is in general used to improve the quality of life and prolong independent living in the community as long as possible by (a) compensating for memory impairment and disorientation, (b) helping to ensure safety which is oriented to protecting persons to remain at home safely, and (c) improving emotional status and decreasing behavioral problem which are oriented to manage psychological and behavioral problems. The AT use for people with dementia, especially those AT used for safety such as monitoring/tracking devices, raises various ethical issues related to the values of autonomy, personal dignity, privacy, and personhood. The decisions regarding the use of AT devices and implementing their uses thus have to follow a systematic examinations of various ethical issues from the perspectives of the person with dementia, family caregivers, and professional providers in order to ensure that the autonomy, privacy, and personhood are upheld at the same time achieving the highest level of safety and comfort possible for the person with dementia with the AT use.