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Changing the Care Process: A New Concept in Iranian Rural Health Care.

Abbas ABBASZADEH ; Manijeh ESKANDARI ; Fariba BORHANI

Asian Nursing Research.2013;7(1):38-43.

PURPOSE: Health care delivery systems in rural areas face numerous challenges in meeting the community's needs. There is a lack of adequate attention for this problem. This study aims to explore the challenges of the health care process in rural Iran according to health care providers' experiences. METHODS: This was a qualitative study that used the content analysis method. We selected a total of 21 health care providers based on purposive sampling. Data collection consisted of semi-structured individual interviews that were analyzed by qualitative content analysis. RESULTS: Data analysis led to the formation of one main category, the challenges of process of health care in rural society. Within this main category, we created the following subcategories: change in characteristics of the rural society, increase in complexity of the health care process, decrease in workforce efficiency, and decrease in propensity of people's care. CONCLUSION: The findings of this study indicate that the process of health care in Iranian rural society is changing rapidly with community health workers encountering new challenges. There is diminished efficiency in responding to the changing care process in Iran's rural society. Considering this change in process of care, therefore, the health care system should respond to these new challenges by establishing new health care models.
Community Health Workers ; Data Collection ; Delivery of Health Care ; Health Personnel ; Humans ; Iran ; Nursing Care ; Rural Health ; Rural Population ; Statistics as Topic

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Understanding of Technical Terms and Contents of Informed Consent Forms for Sedative Gastrointestinal Endoscopy Procedures.

Ihnsook JEONG ; Sunmi PARK ; Jae Sim JEONG

Asian Nursing Research.2013;7(1):33-37.

PURPOSE: This was a cross-sectional study designed to evaluate the subjective understanding of technical terms and contents of the informed consent forms given to patients about to undergo conscious sedative upper gastrointestinal endoscopy. METHODS: A group of conveniently selected 180 patients, who were undergoing sedative endoscopy were recruited in the endoscopy procedure room in a tertiary hospital from June to July 2011. Data were collected with a structured questionnaire. RESULTS: The average number of terms exposed was 8.12 out of 10 items, the average number of terms understood well by the patients was 5.53 out of 10 items, and the average number of right answers was 3.30 out of 5 items, and the percent of correct answers ranged from 26.1% to 90.0%. The exposure to terms differed by gender, education, and previous exposure to sedative endoscopy procedures. The number of "understanding of the terms well" responses differed according to age and previous exposure to sedative endoscopy procedures, and the correct answer rate was differed by education. CONCLUSION: The understanding of the terms and knowledge about the procedures were disappointing. Therefore, sufficient explanations should be provided to the patients. While the informed consent was taken by doctors, the level of understanding should be monitored by nurses. In particular, subjects who did not have any previous experience with endoscopy procedures showed relatively lower level of understanding. We recommend that medical terms should be replaced with more common and nontechnical words in consent forms.
Comprehension ; Consent Forms ; Cross-Sectional Studies ; Endoscopy ; Endoscopy, Gastrointestinal ; Humans ; Informed Consent ; Tertiary Care Centers

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Factors Affecting the Perception of Importance and Practice of Patient Safety Management among Hospital Employees in Korea.

In Sook KIM ; Mijeong PARK ; Mi Young PARK ; Hana YOO ; Jihea CHOI

Asian Nursing Research.2013;7(1):26-32.

PURPOSE: The study was undertaken to identify factors affecting perception of the importance and practice of patient safety management (PSM) among hospital employees in Korea. METHODS: This study was conducted using a descriptive design and a self-report questionnaire. Two hundred and eighty employees were recruited from three hospitals using a convenience sampling method. Measures were perception of the importance, practice, and characteristics of PSM. Data were analyzed using descriptive statistics including t test, one-way analysis of variance, Pearson's correlation analysis, and multiple regression. RESULTS: Factors affecting perception of the importance of PSM were whether hospital employees were in contact with patients while on duty, weekly working hours, education on PSM, and perceived adequacy of PSM system construction. Factors affecting the practice of PSM were perceived adequacy of work load, perceived adequacy of PSM system construction and perception of its importance. CONCLUSION: The findings of this study indicate a need for developing strategies to improve perception of the importance and practice of PSM among all hospital employees, and provide a reference for future experimental studies.
Humans ; Korea ; Patient Safety ; Safety Management ; Surveys and Questionnaires

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An Exploratory Study of Parents' Perceived Educational Needs for Parenting a Child with Learning Disabilities.

Wai Tong CHIEN ; Isabella Y M LEE

Asian Nursing Research.2013;7(1):16-25.

PURPOSE: This exploratory, qualitative study was conducted to explore Chinese couples' perceived educational needs for parenting a child with specific learning difficulties (SLD). METHODS: We recruited a purposive sample of 25 couples who were caring for a child with SLD at home from one regional child mental health center in Hong Kong. Data were collected from individual couples via audio-taped, semi-structured interviews between April and June 2011. Each interview lasted for about an hour. We analyzed the interview data using qualitative content analysis, as suggested by Graneheim and Lundman (2004). RESULTS: Four identified categories of parents' perceived educational needs were information needs for caregiving, a variety of health concerns with themselves and their child, inadequate psychosocial support, and perceived stigma attached to help-seeking. These results reveal challenges and information for mental health professionals in providing effective educational and psychosocial support and culture-specific health care for these families and their children with learning disabilities. CONCLUSION: Our findings indicate a few important educational needs of parents in caring for a child with SLD that might be underestimated by mental health professionals and teachers, such as psychological support and information needs. To facilitate effective parenting, holistic and individualized needs assessment and education should be provided to address each parent's biopsychosocial and cultural needs in relation to caregiving.
Asian Continental Ancestry Group ; Child ; Delivery of Health Care ; Family Characteristics ; Family Health ; Hong Kong ; Humans ; Learning ; Learning Disorders ; Mental Health ; Needs Assessment ; Parenting ; Parents ; Qualitative Research

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Evaluation of the Clinical Usefulness of Critical Patient Severity Classification System and Glasgow Coma Scale for Neurological Patients in Intensive Care Units.

Heejeong KIM ; Jee Hee KIM

Asian Nursing Research.2013;7(1):8-15.

PURPOSE: The purpose of this study was to evaluate the clinical usefulness of the Critical Patient Severity Classification System (CPSCS) and Glasgow Coma Scale (GCS) for critically ill neurological patients and to determine the applicability of CPSCS and GCS in predicting their mortality. METHODS: Data were collected from the medical records of 187 neurological patients who were admitted to the intensive care unit of C university hospital. The datawere analyzed through chi-square test, t test,Mann-Whitney, Kruskal-Wallis, goodness-of-fit test, and receiver operating characteristic curve. RESULTS: In accordance with patients' general and clinical characteristics, patient mortality turned out to be significantly different depending on intensive care unit stay, endotracheal intubation, central venous catheter, and severity by CPSCS. Hosmer-Lemeshow goodness-of-fit tests were applied to CPSCS and GCS. The results of the discrimination test using the receiver operating characteristic curve were CPSCS0, .743, GCS0 .583, CPSCS24, .734, GCS24 .612, CPSCS48, .591, GCS48 .646, CPSCS72, .622, and GCS72 .623. Logistic regression analysis showed that each point on the CPSCS score signifies a 1.034 higher likelihood of dying. CONCLUSION: Applied to neurologically ill patients, early CPSCS scores can be regarded as a useful tool.
Central Venous Catheters ; Critical Illness ; Discrimination (Psychology) ; Glasgow Coma Scale ; Humans ; Critical Care ; Intensive Care Units ; Intubation, Intratracheal ; Logistic Models ; Medical Records ; Neurology ; ROC Curve

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Effects of Nordic Walking on Body Composition, Muscle Strength, and Lipid Profile in Elderly Women.

Min Sun SONG ; Yong Kwon YOO ; Chan Hun CHOI ; Nam Cho KIM

Asian Nursing Research.2013;7(1):1-7.

PURPOSE: The purpose of this study was to investigate the effects of Nordic walking on body composition, muscle strength, and lipid profile in elderly women. METHOD: Sixty-seven women were assigned to the Nordic walking group (n = 21), the normal walking group (n = 21), and the control group (n = 25). Nordic walking and normal walking were performed three times a week for 12 weeks. Body weight, body mass index, total body water, skeletal muscle mass, percent body fat, grip strength, sit to stand, arm curl, total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were measured before and after the program. A Chi-square test, one way analysis of variance, paired t test and repeated-measure two-factor analysis were used with the SAS program for data analysis. RESULTS: There was a significant difference in the weight (F = 8.07, p < .001), grip strength (F = 10.30, p < .001), sit to stand (F = 16.84, p < .001), arm curl (F = 41.16, p < .001), and total cholesterol (F = 5.14, p = .009) measurements between the groups. In addition, arm curl was significantly increased in the Nordic walking group compared to the normal walking group and the control group. CONCLUSION: The results indicate that Nordic walking was more effective than normal walking in improving upper extremity strength.
Adipose Tissue ; Aged ; Arm ; Body Composition ; Body Mass Index ; Body Water ; Body Weight ; Cholesterol ; Female ; Hand Strength ; Humans ; Lipoproteins ; Muscle Strength ; Muscle, Skeletal ; Muscles ; Phenothiazines ; Upper Extremity ; Walking

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Lived Experience of Thai Women with Alcohol Addiction.

Kulnaree HANPATCHAIYAKUL ; Henrik ERIKSSON ; Jureerat KIJSOMPORN ; Gunnel ÖSTLUND

Asian Nursing Research.2017;11(4):304-310. doi:10.1016/j.anr.2017.12.001

PURPOSE: This study explored the lived experiences of Thai women in relation to alcohol addiction in treatment. METHODS: Twelve women aged 20 to 65 years, were participated. The participants were recruited from two special hospitals and one outpatient clinic in a general hospital. Descriptive phenomenology was applied to analyze the transcripts of the individual interviews. RESULT: The explored phenomenon of Thai women experiencing alcohol addiction included four essential aspects, (1) feeling inferior and worthless (2) feeling physically and emotionally hurt, (3) fearing physical deterioration and premature death, and (4) feeling superior and powerful. Through these different aspects of Thai women's lived experiences, the following essence was synthesized. The essence of the lived experience of alcohol addiction among the studied Thai women was ambivalence between feeling inferior and worthless and feeling superior and powerful when acting as a man. Drinking alcohol lessened life's difficulties and fears; for example, of violence, bodily demolition, premature death and marginalization from family and society. CONCLUSION: Thai women who experience alcohol addiction are treated with gender-related double standards when trying to undo gender traditional roles. Their marginalization from family and society deepens making them even more vulnerable to the positive side effects of alcohol drinking.
Alcohol Drinking ; Alcoholism* ; Ambulatory Care Facilities ; Asian Continental Ancestry Group* ; Drinking ; Female ; Gender Identity ; Hospitals, General ; Hospitals, Special ; Humans ; Mortality, Premature ; Violence

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Validation of the Decisional Conflict Scale for Evaluating Advance Care Decision Conflict in Community-dwelling Older Adults.

JinShil KIM ; Shinmi KIM ; Sun Woo HONG ; Se Won KANG ; Minjeong AN

Asian Nursing Research.2017;11(4):297-303. doi:10.1016/j.anr.2017.11.004

PURPOSE: Decisional conflict is a significant and important barrier in end-of-life care planning, and it is often encountered in health professionals' discussions with patients and their families. Little is known about the measurement of decisional conflict, and existing measures are not suitable for all contexts. In this study, psychometric properties of the Decisional Conflict Scale, which was translated for the first time into Korean [Korean version of DCS (K-DCS)], were examined. METHODS: A sample of 273 community-dwelling elders was surveyed (mean age: 77.26 years; 80.2% women). Internal consistency reliability and stability reliability were tested by calculating Cronbach α and Pearson's correlation coefficients. Exploratory factor analysis and logistic regression analyses were performed to test validity. RESULTS: Reliability of the K-DCS was acceptable with Cronbach α =.87; test-retest correlation r = .76. Factor analysis showed a two-factor structure with nine items: informed/values clarity and uncertainty. Concordance between K-DCS and the four treatment directives was significant (kappa values ≥.78). Controlling for age and gender, those with decision implementation were more likely to implement their decisions on tube feeding (odds ratio = 5.15, p = .033) and hospice care (odds ratio = 2.83, p = .017). CONCLUSION: The K-DCS appears to be a valid measure to evaluate decisional conflict about advance directives in community-dwelling Korean older adults. Further validation of the K-DCS is warranted, though caution should be exercised in using subscales because of differences in decisional contexts.
Adult* ; Advance Directives ; Aged ; Enteral Nutrition ; Hospice Care ; Humans ; Logistic Models ; Psychometrics ; Uncertainty

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Comparison of Walking, Muscle Strength, Balance, and Fear of Falling Between Repeated Fall Group, One-time Fall Group, and Nonfall Group of the Elderly Receiving Home Care Service.

MiYang JEON ; Mee Ock GU ; JongEun YIM

Asian Nursing Research.2017;11(4):290-296. doi:10.1016/j.anr.2017.11.003

PURPOSE: The purpose of this study was to provide information to develop a program to prevent repeated falls by analyzing the difference in gait, muscle strength, balance, and fear of falling according to their fall experience. METHODS: The study subjects were 110 elderly individuals aged over 60 years who agreed to their participation in this research. The study participants were categorized into a repeated fall group (n = 40), a one-time fall group (n = 15), and a nonfall group (n = 46) of the elderly. Measurements of gait, muscle strength, balance, and fear of falling were taken in each group. RESULTS: With regard to gait, there were significant differences among three groups in gait cycle (F = 3.50, p = .034), speed (F = 13.06, p < .001), and cadence (F = 5.59, p = .005). Regarding muscle strength in the upper and lower limbs, statistically significant differences were shown among three groups in muscle strength of upper (F = 16.98, p < .001) and lower (F = 10.55, p < .001) limbs. With regard to balance, the nonfall group had significantly greater results than the one-time fall group and repeated fall group in dynamic balance (F = 10.80, p < .001) and static balance (F = 8.20, p = .001). In the case of the fear of falling, the repeated fall group had significantly higher score than other two groups (F = 20.62, p < .001). CONCLUSION: This study suggests that intervention program should be tailored to fall risk factors to enhance gait and balance and lower body muscle strength and reduce the fear of falling to prevent repeated incidences of falls in this population.
Accidental Falls* ; Aged* ; Extremities ; Frail Elderly ; Gait ; Home Care Services* ; Humans ; Incidence ; Lower Extremity ; Muscle Strength* ; Risk Factors ; Walking*

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Nurse Case Managers' Experiences on Case Management for Long-term Hospitalization in Korea.

Jinjoo OH ; Seieun OH

Asian Nursing Research.2017;11(4):283-289. doi:10.1016/j.anr.2017.11.002

PURPOSE: The implementation of case management for long-term hospitalization use has been approved for controlling medical cost increases in other countries. But, introduction of the case management in Korea has created issues that hinder its effective operation. This qualitative study aimed to obtain further understanding of the issues surrounding the management of Medical Aid beneficiaries' use of long-term hospitalization from the case managers' perspectives and to provide suggestions for successful case management. METHODS: Thematic analysis was employed to analyze the data. Medical Aid case managers with 3 or more years of case management experience were recruited from urban, suburban, and rural regions. Data were collected through in-depth interviews: 12 nurse case managers participated in focus group interviews and 11 participated in individual one-on-one interviews. RESULTS: Four major themes emerged: on-site obstacles that hinder work progress; going in an opposite direction; ambiguous position of case managers; and work-related emotions. Eleven subthemes were discovered: chasing potential candidates; becoming an enemy; discharging patients who have nowhere to go; welfare-centered national policies increasing medical costs; Medical Aid Program that encourages hospitalization; misuse of hospitalization; feeling limited; working without authority; fulfilling the expected role; fretting about social criticism; and feeling neglected and unprotected. CONCLUSION: The findings highlight the complexity and ambiguity of the issues faced by case managers. Successful management of Medical Aid resources requires the orchestrated efforts and collaboration of multiple stakeholders. More systematized support and resources for nurse case managers are essential to fully implement this nursing innovation in Korea.
Case Management* ; Cooperative Behavior ; Focus Groups ; Hospitalization* ; Humans ; Korea* ; Nursing ; Qualitative Research ; Vulnerable Populations

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