OBJECTIVES: This study draws from the resource depletion and conservation theories to develop a process model of informal caregiving. The model includes the burnout as a key mediator of the relationship between benefit/threat appraisals and critical outcomes including perceived physical health, depression and life satisfaction. METHODS: A self-report questionnaire was utilized to collect relevant data from 137 informal caregivers of older adults. The proposed model and hypotheses were evaluated with the Structural Equation Modeling method using the software EQS. RESULTS: The relatively high reported levels of emotional exhaustion and reduced personal accomplishment established the relevance of the burnout construct for informal caregivers. In addition, the test of the proposed model provides support for the hypothesis that burnout is an important mediator in the appraisal process model of informal caregiving. However, while burnout effectively mediates the influence of threat appraisals, its role in mediating the effect of benefit appraisals is mixed. CONCLUSION: The proposed model and results highlight the significance and potential for utilizing a process approach for understanding the link between appraisals and outcomes for informal caregivers. More importantly, the proposed model suggests that attention must be paid toward burnout tendencies to reveal fruitful intervention directions for researchers and practitioners to enhance the positive outcomes of informal caregivers, and maintain their psychological and physical well-being.
Adult ; Aluminum Hydroxide ; Carbonates ; Caregivers ; Depression ; Fruit ; Humans ; Negotiating ; Surveys and Questionnaires

PURPOSE: The purposes of this study were to develop a taxonomy for detection of errors related to hypertension management and to apply the taxonomy to retrospectively analyze the documentation of nurses in Advanced Practice Nurse (APN) training. Method: We developed the Hypertension Diagnosis and Management Error Taxonomy and applied it in a sample of adult patient encounters (N = 15,862) that were documented in a personal digital assistantbased clinical log by registered nurses in APN training. We used Standard Query Language queries to retrieve hypertension-related data from the central database. The data were summarized using descriptive statistics. Result: Blood pressure was documented in 77.5% (n = 12,297) of encounters; 21% had high blood pressure values. Missed diagnosis, incomplete diagnosis and misdiagnosis rates were 63.7%, 6.8% and 7.5% respectively. In terms of treatment, the omission rates were 17.9% for essential medications and 69.9% for essential patient teaching. Contraindicated anti-hypertensive medications were documented in 12% of encounters with co-occurring diagnoses of hypertension and asthma. CONCLUSION: The Hypertension Diagnosis and Management Error Taxonomy was useful for identifying errors based on documentation in a clinical log. The results provide an initial understanding of the nature of errors associated with hypertension diagnosis and management of nurses in APN training. The information gained from this study can contribute to educational interventions that promote APN competencies in identification and management of hypertension as well as overall patient safety and informatics competencies.
Adult ; Advanced Practice Nursing ; Asthma ; Blood Pressure ; Computers, Handheld ; Diagnostic Errors ; Education, Nursing ; Humans ; Hypertension ; Informatics ; Medical Errors ; Patient Safety ; Retrospective Studies

PURPOSE: This study aimed to identify factors affecting the use of the hearing protection devices (HPDs) among workers exposed to noise using the Pender Health Promotion Model. METHODS: The 222 subjects came from thermal power plants with similar noise levels, which are between 80 dB and 90 dB in South Korea. Data were collected with self-administered questionnaires designed to measure concepts from the Health Promotion Model. RESULTS: Mean percent times of using the HPDs at their most recent job site were 50.9%, and 20.3% had never the HPDs. The predictors of HPD use were social modeling (OR = 1.380), perceived benefits (OR = 1.150), and working at noisy worksites (OR = 4.925) when the outcome was based on the "non-use" versus "used at least once". However, the predictors of HPD use were social modeling (OR = 1.795) and perceived benefits (OR = 1.139) based on the "less than half-of-the-time-use" versus "more than half-of-the-time-use". CONCLUSION: Social modeling and perceived benefits of using the HPDs are important for workers to keep minimal or certain level of using the HPDs.
Ear Protective Devices ; Health Promotion ; Hearing ; Noise ; Porphyrins ; Power Plants ; Republic of Korea ; Workplace ; Surveys and Questionnaires

PURPOSE: End-of-life caregiving experiences can be complex. Family members experience physical and mental suffering as they anticipate their impending loss. Healthcare providers should be able to provide good quality of end-of-life (EOL) care and support for primary EOL caregivers. Studies have highlighted the role of healthcare providers providing information in the EOL situation to caregivers of chronic disease patients. This has resulted in the development of the End-of-life Caregiving Experience Appraisal Scale (EOLCAS) presented in this paper. The purposes of this study were to develop a scale that can evaluate the experiences of EOL caregivers, and to test the reliability and validity of this scale. METHODS: The scale domains were derived from systematic review of 35 relevant studies. We then examined its content validity with nurse scholars and clinicians using content validity index. To examine construct validity, a total of 175 caregivers from tertiary hospital setting in Korea participated in this study from December 2007 to May 2008. For the construct validity, factor analysis was utilized. RESULTS: The scale was composed of 32 items with four subscales: two negative appraisals (physical suffering and burden), one positive appraisal (maturation), and one neutral appraisal (social support pursuit). In this sample, the Cronbach's alpha for the entire scale was .84 indicating adequate reliability. However, Cronbach's alpha of subscales was varied. CONCLUSION: Nurses and other healthcare professionals could use the EOLCAS to assess the experiences of EOL caregivers to understand their experience in the EOL and enhance their quality of life although psychometrics of EOLCAS shows limited findings.
Advance Care Planning ; Caregivers ; Chronic Disease ; Delivery of Health Care ; Health Personnel ; Humans ; Korea ; Psychometrics ; Quality of Life ; Reproducibility of Results ; Stress, Psychological ; Tertiary Care Centers

PURPOSE: We evaluated the efficacy of the Chronic Disease Self-management Program (CDSMP) among older Korean adults and investigated the question of whether the effects differed according to their levels of health literacy. METHODS: Measures of self efficacy, physical activity, physical health, and mental health were assessed at baseline, and at 6-week, and 18-week follow up for the CDSMP intervention group (n = 23) and control group (n = 31) according to their health literacy status. RESULTS: The older adults in the CDSMP intervention group showed significantly higher levels of self efficacy and physical activity at follow up. Participants with low health literacy had greater benefits from the intervention than had those with high health literacy. CONCLUSIONS: The CDSMP is a beneficial intervention for older Korean adults with chronic disease. Healthcare professionals should encourage older Korean adults with chronic illness to participate in the CDSMP, in particular for those with low health literacy.
Aged ; Aged, 80 and over ; Case-Control Studies ; Chronic Disease/*rehabilitation ; Female ; Follow-Up Studies ; Health Behavior ; *Health Knowledge, Attitudes, Practice ; Health Status ; Humans ; Male ; Motor Activity ; *Self Care ; Treatment Outcome

PURPOSE: Professional hemodialysis (HD) nursing tends to be task-oriented and lack consideration of the client's viewpoint. This study aims to interpret the process of psychosocial adaptation to dealing with HD in people with end-stage renal disease (ESRD). METHODS: A grounded theory guided this study. Theoretical sampling included 15 people receiving HD at the HD center of a hospital from July to November 2010. Participants received an information sheet in writing, a verbal invitation, and informed consent forms before interviews were conducted. A constant comparative data analysis was analyzed using open, axial and selective coding. The computer software ATLAS.ti assisted data management. Credibility, transferability, dependability, and confirmability ensured the rigor of study process. RESULTS: This study identified "adopting life with hemodialysis", which captures the process of the psychosocial adaptation in people with ESRD as one transformation. Four categories that evolved from "adopting HD life" are (a) slipping into, (b) restricted to a renal world, (c) losing self control, and (d) stuck in an endless process. CONCLUSIONS: The findings of this investigation indicate the multidimensional requirements of people receiving maintenance dialysis, with an emphasis on the deficiency in psychosocial and emotional care. The study's findings contribute to clinical practice by increasing the understanding of the experience of chronic HD treatment from the recipient's viewpoint. The better our understanding, the better the care provided will meet the needs of the people receiving HD.
*Adaptation, Psychological ; Adult ; Aged ; Female ; Humans ; Kidney Failure, Chronic/*psychology/therapy ; Male ; Middle Aged ; Qualitative Research ; Renal Dialysis/*psychology

PURPOSE: Social network analysis (SNA) is increasingly being used to provide a visual and quantitative analysis of relationships among groups of staff and other subjects of interest. This paper examines the role SNA can play in identifying existing networks, and measures the impact of participation in brief task-focused project groups on the underlying communication pathways. METHODS: An SNA of a closed group of nurse leaders was conducted in a health system in Scotland, UK. Data were collected on two occasions 6 months apart. Analysis of both whole network and individual node-based (nurse leader) measures were undertaken. RESULTS: Analysis revealed that the initial network structure was related to functional departments. By establishing task and finish groups, network density and other key measures could be improved. CONCLUSIONS: SNA is a useful tool in mapping existing networks and evaluating how these can be strengthened through the use of task orientated project work. This easy-to-use technique can provide useful insights and a means of targeting management action to improve communication pathways in a moderately large and complex nurse leadership group. Further clinical and academic potential uses of the technique are suggested.
*Communication ; *Cooperative Behavior ; Humans ; *Leadership ; *Nurses ; Scotland ; Social Networking

PURPOSE: The aim of this study was to explore how first-line nurse managers constructed the meaning of resilience and its relationship to work-life balance for nurses in Korea. METHODS: Participants were 20 first-line nurse managers working in six university hospitals. Data were collected through in-depth interviews from December 2011 to August 2012, and analyzed using Strauss and Corbin's grounded theory method. RESULTS: Analysis revealed that participants perceived work-life balance and resilience to be shaped by dynamic, reflective processes. The features consisting resilience included "positive thinking", "flexibility", "assuming responsibility", and "separating work and life". This perception of resilience has the potential to facilitate a shift in focus from negative to positive experiences, from rigidity to flexibility, from taskcentered to person-centered thinking, and from the organization to life. CONCLUSIONS: Recognizing the importance of work-life balance in producing and sustaining resilience in first-line nurse managers could increase retention in the Korean nursing workforce.
Adult ; Female ; Grounded Theory ; Hospitals, University ; Humans ; Middle Aged ; Nurse Administrators/*psychology ; Nurse's Role/*psychology ; Qualitative Research ; *Resilience, Psychological ; Work Schedule Tolerance/*psychology ; Workplace/*psychology

PURPOSE: To examine levels of teamwork and its relationships with clinical error reporting among Korean hospital nurses. METHODS: The study employed a cross-sectional survey design. We distributed a questionnaire to 674 nurses in two teaching hospitals in Korea. The questionnaire included items on teamwork and the reporting of clinical errors. We measured teamwork using the Teamwork Perceptions Questionnaire, which has five subscales including team structure, leadership, situation monitoring, mutual support, and communication. Using logistic regression analysis, we determined the relationships between teamwork and error reporting. RESULTS: The response rate was 85.5%. The mean score of teamwork was 3.5 out of 5. At the subscale level, mutual support was rated highest, while leadership was rated lowest. Of the participating nurses, 522 responded that they had experienced at least one clinical error in the last 6 months. Among those, only 53.0% responded that they always or usually reported clinical errors to their managers and/or the patient safety department. Teamwork was significantly associated with better error reporting. Specifically, nurses with a higher team communication score were more likely to report clinical errors to their managers and the patient safety department (odds ratio = 1.82, 95% confidence intervals [1.05, 3.14]). CONCLUSIONS: Teamwork was rated as moderate and was positively associated with nurses' error reporting performance. Hospital executives and nurse managers should make substantial efforts to enhance teamwork, which will contribute to encouraging the reporting of errors and improving patient safety.
Adult ; *Attitude of Health Personnel ; Clinical Competence/*statistics & numerical data ; *Cooperative Behavior ; Cross-Sectional Studies ; Female ; Hospitals, Teaching ; Humans ; Logistic Models ; Male ; Medical Errors/*statistics & numerical data ; Nursing Staff, Hospital/standards/*statistics & numerical data ; Republic of Korea/epidemiology ; Surveys and Questionnaires ; Young Adult

PURPOSE: This descriptive study aims to describe the levels of mobility in community-dwelling older Koreans with chronic illnesses, and to examine the associations of their mobility with sleep patterns, physical activity and physical symptoms including fatigue and pain. METHODS: The participants were a total of 384 community-dwelling older adults recruited from three senior centers in Seoul, Korea. Measures included mobility assessed using 6-minute walk test (6MWT), physical activity behavior, sleep profiles, fatigue and pain. Data were collected from July to December 2012. RESULTS: The mean 6MWT distance was 212.68 meters. Over 90% of the study participants (n = 373) were classified as having impaired mobility using 400 meters as the cutoff point diagnostic criteria of normal mobility in 6MWT. The 6MWT distance was 246.68 meters for participants in their 60s, 212.32 meters for those in their 70s, and 175.54 meters for those in their 80s. Significant predictors of mobility included younger age, taking mediation, regular physical activity, female gender, higher income, higher fatigue and better perception on sleep duration, which explained 18% of the total variance of mobility. CONCLUSION: A high-risk group for mobility limitation includes low income, sedentary older men who are at risk for increased fatigue and sleep deficit. Further research should incorporate other psychological and lifestyle factors such as depression, smoking, drinking behavior, and/or obesity into the prediction model of mobility to generate specific intervention strategies for mobility enhancement recommendations for older adults.
Aged ; Aged, 80 and over ; Chronic Disease/*epidemiology ; Cross-Sectional Studies ; Fatigue/epidemiology ; Female ; Humans ; Independent Living/*statistics & numerical data ; Male ; *Mobility Limitation ; Motor Activity ; Pain/epidemiology ; Risk Factors ; Seoul/epidemiology ; Sleep ; Surveys and Questionnaires