Jia Lee

Effects of a Face-to-face Self-management Program on Knowledge, Self-care Practice and Kidney Function in Patients with Chronic Kidney Disease before the Renal Replacement Therapy

PURPOSE The purpose of this study was to examine the effects of a face-to-face self-management educational program on knowledge, self-care practice and kidney function in patients with chronic kidney disease (CKD) before kidney replacement therapy. METHODS This study employed a nonequivalent control group, non-synchronized design. Data were collected from 61 patients with CKD visiting an outpatient department of nephrology in a university hospital in Seoul, South Korea. The experimental group (n=31) took the pre-test, then after 3 weeks, face-to-face education and individualized consultation (1st intervention), after a week of self-practice, the 1st post-test, followed by re-enforcement education and consultation (2nd intervention), and 4 weeks later, the 2nd post-test. The control group (n=30) took the pre-test and post-tests at 4 and 8 weeks. RESULTS Scores for knowledge of CKD and self-care practice over time improved significantly in the experimental group compared to the control group. Kidney function did not improve significantly in the experimental group. CONCLUSION Health care providers can identify various and individualized needs, and provide effective education and consultation through face to face self-management for patients with chronic irreversible illnesses. Nurses can coordinate for these program by designing and providing systematic and effective education.

Development of a Multimedia Learning DM Diet Education Program using Standardized Patients and Analysis of Its Effects on Clinical Competency and Learning Satisfaction for Nursing Students

PURPOSE The purpose of this study was to develop a multimedia learning program for patients with diabetes mellitus (DM) diet education using standardized patients and to examine the effects of the program on educational skills, communication skills, DM diet knowledge and learning satisfaction. METHODS The study employed a randomized control posttest non-synchronized design. The participants were 108 third year nursing students (52 experimental group, 56 control group) at K university in Seoul, Korea. The experimental group had regular lectures and the multimedia learning program for DM diet education using standardized patients while the control group had regular lectures only. The DM educational skills were measured by trained research assistants. RESULTS The students who received the multimedia learning program scored higher for DM diet educational skills, communication skills and DM diet knowledge compared to the control group. Learning satisfaction of the experimental group was higher than the control group, but statistically insignificant. CONCLUSION Clinical competency was improved for students receiving the multimedia learning program for DM diet education using standardized patients, but there was no statistically significant effect on learning satisfaction. In the nursing education system there is a need to develop and apply more multimedia materials for education and to use standardized patients effectively.

Perspectives of Korean Patients, Families, Physicians and Nurses on Advance Directives

PURPOSE The purpose of this study was to explore the perspectives of lung cancer patients, their families, physicians and nurses on advance directives. METHODS The study employed a comparative descriptive design. A total of 124 participants from six general hospitals in Seoul and metropolitan area participated in this study from January 1, 2009 to November 15, 2009. Face-to-face interviews were conducted using a structured questionnaire. RESULTS The majority of participants were not aware of advance directives. Most participants desired the establishment of a reliable legal system and a specific legal protocol for the design and application of advance directives. The perspectives of patients, their families, physicians and nurses differed regarding end-of-life care decisions. The least preferred treatment by patients with lung cancer was intensive care, followed by cardiopulmonary resuscitation, tracheotomy and artificial ventilation, and radiotherapy. CONCLUSIONS There were many differences in the perspectives of patients, families, physicians and nurses on advance directives. End-of-life care decisions should take the wishes of patients into account, and that such decisions should therefore be made before the patients lose the capacity to make them. To make well-informed decisions regarding future care, patients and families must be fully educated about advance directives and expected outcomes.

Predictors of facility adaptation in nursing home residents

PURPOSE The purposes of this study were to examine the relationships among activities of daily living, self-efficiency, nursing home care quality and nursing home adaptation, and to identify the influencing factors of nursing home adaptation in nursing home residents. METHODS The study employed a descriptive correlational design. The data were collected from 148 older adults without dementia by interview from six nursing homes in three cities from February 1, 2008 to February 28, 2008. RESULTS Levels of nursing home adaptation in older adult residents were different by type of decision maker of nursing home admission, reason of nursing home admission, type of payment and length of nursing home stay. The nursing home adaptation was significantly correlated with self-efficiency and nursing home care quality. The strongest predictor of nursing home adaptation was type of decision maker of nursing home admission followed by the self-efficiency. CONCLUSION The study suggested that during the decision making period of nursing home admission, older adults should have enough time and careful considerations of their families to decide by themselves in positive ways. Nursing home staff should be able to identify reasons of nursing home admission and demands or expectations of older adults and their families.

Development of an Evaluation Instrument for Service Quality in Nursing Homes

PURPOSE The purposes of this study were to identify the factors influencing service quality in nursing homes, and to develop an evaluation instrument for service quality. METHODS A three-phase process was employed for the study. 1) The important factors to evaluate the service quality in nursing homes were identified through a literature review, panel discussion and focus group interview, 2) the evaluation instrument was developed, and 3) validity and reliability of the study instrument were tested by factor analysis, Pearson correlation coefficient, Cronbachs α and Cohens Kappa. RESULTS Factor analysis showed that the factors influencing service quality in nursing homes were healthcare, diet/assistance, therapy, environment and staff. To improve objectivity of the instrument, quantitative as well as qualitative evaluation approaches were adopted. The study instrument was developed with 30 items and showed acceptable construct validity. The criterion-related validity was a Pearson correlation coefficient of .85 in 151 care facilities. The internal consistency was Cronbachs α=.95. CONCLUSION The instrument has acceptable validity and a high degree of reliability. Staff in nursing homes can continuously improve and manage their services using the results of the evaluation instrument.

Introducing nursing students to quality assurance activities in skilled nursing facilities.

The purpose of this column is to discuss innovations and quality improvement efforts in a variety of long-term care settings. These issues are of importance to healthcare professionals as our nation faces the burgeoning growth of the aging population, creating increased demand for improved and innovative long-term care services. This column is coordinated by Marilyn J. Rantz, PhD, RN, FAAN, NHA, e-mail: rantz@missouri.edu.

Health Behavioral Patterns Associated with Psychologic Distress Among Middle-Aged Korean Women

PURPOSE Middle aged women are exposed to high levels of psychologic distress due to various factors including health problems of family members, their own declining health, negative outlook towards menopause, loss of significant supportive relationships, and uncertainties regarding the future. The purpose of this study was to identify the factors associated with psychologic distress of middle-aged Korean women in the Seoul metropolitan area. METHODS The data were collected from 277 community-dwelling women between the ages of 40 and 60 years without any known severe illnesses from May 6, 2004 to May 31, 2004. The researcher or two research assistants visited the participants in person, handed out copies of the questionnaire after receiving study permission, and answered if they had any questions. RESULTS Hierarchical multiple regression analysis found that women with low scores of health promoting behaviors for self-actualization, nutrition, and interpersonal relation reported high levels of psychologic distress. In addition, women with low scores of marital satisfaction reported high psychologic distress. CONCLUSION The study found cultural characteristics of middle-aged Korean women in psychologic distress. Health care providers should consider marital satisfaction, self-actualization, nutrition, and interpersonal relations, in particular, among Korean middle-aged women.

An imperative to improve discharge planning: predictors of physical function among residents of a medicare skilled nursing facility.

Given the pressure to effects of shorter length of stay among older adults, it is important to understand factors that predict trajectories of physical function in a posthospital recovery period. Data were collected from the medical records of 131 older adults following lower extremity surgery to identify admission factors that predict physical function at discharge, length of stay, and discharge disposition in a Medicare skilled nursing facility. Knowing on admission those who are most at risk for poor physical function at discharge can arm nurse administrators with critical information for better discharge planning for continuing services.

Effect of an Integral Care System: a Combination of Oriental and Western Care for Older Adults with Degenerative Arthritis

PURPOSE This study was done to examine the effect of an integrated care service which included a combination of oriental and western care on health outcomes in elderly patients with degenerative arthritis. METHODS A prospective comparative design was used. Data were collected from May 1, 2008 to June 30, 2009 from 85 elderly patients with degenerative arthritis in the lower extremities who were followed in a hospital out-patient department for 8 weeks. The integrated care service group (n=36) received a combination of physical therapy, acupuncture, western medicines or herbal medicines, and the western care group (n=49) received physical therapy or western medicines. Functional independence, walking speed, rotation balance, pain intensity, service satisfaction and total medical costs for the two groups were compared at 8 weeks. RESULTS Functional independence (t=2.14, p=.036) and walking speed (t=2.51, p=.014) improved significantly in the integrated care group while pain intensity improved significantly in the western care group (t=3.35, p=.002). The integrated care group reported higher scores for service satisfaction (t=2.09, p=.041) and higher medical costs than the western care group (t=2.15, p=.035). CONCLUSION The results suggest that integrated care services are effective modalities to improve mobility and quality of life for elders with degenerative arthritis.

An international comparison of Korean and Chinese nursing students with nursing curricula and educational outcomes

AIM The aim of this study was to compare Korean and Chinese nursing students with respect to their nursing curricula and educational outcomes including critical thinking, professionalism, leadership, communication skills, and nursing practice skills. METHODS Data were collected from 762 nursing college students (355 in Korea and 407 in China) using the validated self-report questionnaires. The instruments were translated into Chinese for the Chinese students. FINDINGS Korea offered various nursing courses more focused on specific nursing compared to China. With respect to critical thinking skills, the Korean students had significantly higher scores than the Chinese students. The Chinese students had significantly higher scores than the Korean students on the professionalism and communication skills. There were no differences between the groups in scores of leadership and nursing practice skills. CONCLUSION AND RECOMMENDATIONS This study provides preliminary information on cross-national nursing educational outcomes. A comparison of educational outcomes among nursing students of other countries as well as China will determine differences in nursing educational outcomes that the nursing program is located in, and an international flow of students through the nursing educational should develop a general direction for nursing education.