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Aims. The purpose of this study was to identify the incidence rate of eye disorders and further to identify factors related to incidence of eye disorders in intensive care unit patients. Background. Although the incidence of eye disorders in intensive care unit patients is very high, it is difficult to come to an accurate estimate of number of eye disorders in intensive care unit patients because eye disorders are often perceived to be minor problems. Design. A retrospective, descriptive survey design was used. Method. The medical records of a total 235 patients with eye disorders were identified through a review of the medical records of 2500 patients hospitalised in the intensive care units of Yonsei University Hospital, Seoul, Korea from January to December, 2004. To examine factors related to eye disorders, 522 patients without eye disorders from the cohort of 2265 patients were randomly selected. Factors related to incidence of eye disorder were included in a multiple logistic regression model, after screening by the chi-squared test. Results. The incidence rate for eye disorders in the intensive care unit patients was 8·6%. From the multiple regression model, the following odds ratios (95% confidence intervals) of eye disorder were estimated; length of stay in intensive care unit of at least seven days: 2·8 (1·70-4·70); death: 2·5 (1·47-4·29); drowsy mental state: 2·2 (1·10-4·37); stupor mental state: 7·0 (3·20-15·45); coma mental state: 10·8 (3·47-33·74); no self-respiration: 1·9 (1·00-3·52); positive end expiratory pressure: 2·9 (1·66-4·92); sedatives: 4·2 (2·26-7·74); muscle relaxants: 2·3 (1·11-4·95). Conclusions. Factors related to incidence of eye disorders in intensive care unit patients identified in this study support the need to pay attention to eye problems and eye care in intensive care unit patients. Relevance to clinical practice. An evidence-based eye care protocol should be provided as routine care to prevent eye complication, especially in critically ill patients with mechanical ventilators, positive end expiratory pressure, sedatives or muscle relaxants and for patients whose mental status is decreased. [ABSTRACT FROM AUTHOR]

BACKGROUND: Research utilization is vital to promote evidence-based practice in the critical care area, where nursing practice continues to grow in complexity and nurses have greater responsibility and accountability for patient care. However, information about research activities and barriers to research utilization of critical care nurses is limited. AIMS: This study aimed to describe research activities, to identify barriers to research utilization for practice and to examine factors related to research barriers among critical care nurses. METHODS: Data from 63 critical care nurses were analyzed from a national study examining research utilization of clinical nurses working in university affiliated and educational hospitals in Korea. FINDINGS: Research activities were relatively low. A lack of guidance for clinical implication and insufficient time to implement new ideas in the clinical area were identified as the highest-ranking barriers to use of research in this group. Perceptions of barriers to research utilization were significantly higher in those staff nurses with lesser clinical experience. The critical care nurses in this study shared a strong sense of valuing the contribution of research, but also shared perceptions on barriers for administrative aspects. Organizational support is crucial for critical care nurses to achieve evidence-based practice. [ABSTRACT FROM AUTHOR]

The literature on nursing leadership tends to be mainly based on Western perspectives and models, which could be viewed as an imperialistic and colonialist aspect of nursing knowledge development. Furthermore, leadership competencies and skills could differ across countries due to variations in cultural backgrounds. The purpose of this discussion paper is to identify essential competencies of leaders from Asian nurse leaders' perspectives and provide suggestions for future nursing leadership. Four themes related to the leadership competencies were identified: "harmony," "visionary," "political activism," and "good character.", (Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.)

Black and Hispanic patients who receive care from Black and Hispanic physicians have greater use of preventive care. However, receiving care from racially concordant physicians requires that such physicians are included in private insurance plan networks. Using data from 2019, we examined the extent to which racially concordant physicians are available in the Medicare Advantage (MA) program, which disproportionately enrolls Black and Hispanic Medicare beneficiaries, by linking MA physician networks to physician race and ethnicity to measure the diversity of in-network physicians. On average, 51.1 percent of White physicians in a given beneficiary's county were included in their MA network, compared with 43.2 percent of Black physicians and 44.0 percent of Hispanic physicians. Approximately 20 percent of Black and Hispanic beneficiaries had no available Black or Hispanic physicians included in their MA network, and roughly 41.3 percent and 47.2 percent of counties had no Black or Hispanic physicians, respectively, in any MA network. Our study raises significant concerns about the availability of Black and Hispanic physicians in the MA program.

Rett syndrome, a neurodevelopmental disorder primarily affecting females, presents unique challenges in managing associated scoliosis. This study aims to evaluate the efficacy and challenges of posterior spinal fusion (PSF) in Rett syndrome patients by analyzing postoperative complications. A retrospective cohort study was conducted using a large national database. We included Rett syndrome patients aged 10-18 years who underwent PSF between 2010 and 2020. Outcomes such as medical and surgical complications, emergency department visits, readmissions, mortality, and reoperation rates up to 5 years were compared with a matched neuromuscular scoliosis (NMS) group. The study identified 195 Rett syndrome patients and 973 NMS patients. Post-surgery, Rett syndrome patients showed a significantly higher incidence of pneumothorax (56.9%, P < 0.001), respiratory failure (24.6%, P = 0.013), and pneumonia (26.2%, P < 0.001). Additionally, ileus (7.2%, P = 0.041), acute kidney injury (14.9%, P = 0.029), and urinary tract infections (14.9%, P < 0.001) were also significantly more frequent in the Rett syndrome group. Rett syndrome group also had higher rates of transfusion (11.3%, P = 0.004). Interestingly, the incidence of pseudarthrosis, implant complications, junctional failures, and the necessity for reoperation did not significantly differ at postoperative year 2. Mid-term follow-up showed that the reoperation rates over a 5-year period did not significantly differ between the Rett syndrome and NMS groups. Rett syndrome is associated with increased immediate postoperative complications, necessitating tailored preoperative planning, and intensive postoperative care. Despite these challenges, the mid-term surgical outcomes are comparable to those in NMS patients., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Asian American (AA) and Native Hawaiian and Pacific Islander (NHPI) people are often aggregated into a monolithic group, but when they are disaggregated into ethnic groups (e.g., Chinese), inequities can be identified. Using a representative sample of adult Medicaid enrollees (N=55,215), the authors assessed inequities in self-reported access to mental or behavioral health services between non-Hispanic AA and NHPI Medicaid enrollees and non-Hispanic White Medicaid enrollees, both by racial group and across 10 disaggregated ethnic groups. AA and NHPI enrollees, by race and all 10 ethnicities, reported significantly worse mental health care access than did White enrollees. The magnitude of disparities also differed between ethnic groups, ranging from -14.6 percentage points for Native Hawaiian enrollees to -43.6 percentage points for Vietnamese enrollees., Competing Interests: The authors report no financial relationships with commercial interests.

Background: The development of nursing leaders is an important topic in changing healthcare environments. Successful nursing leadership is critical to the reconstruction, implementation, and evaluation of healthcare systems worldwide. However, the characteristics of successful nursing leadership remain unclear, especially in a global context. Furthermore, despite the growing importance of cultural intelligence, cross-cultural concepts of successful nursing leadership have been inadequately addressed in the literature., Purpose: This study was designed to identify the characteristics of successful leadership in nursing from the perspective of Asian leaders in four countries (United States, Taiwan, Korea, and Japan) and to make recommendations for successful leadership in nursing in the future., Methods: A qualitative approach employing five strategies, including in-depth discussions through face-to-face and email discussions, an integrated literature review using multiple databases, responses to 10 topics related to nursing leadership, and written note summaries of the characteristics of successful leadership, was used in this study. A total of 10 nursing leaders from four countries were recruited as participants using snowball sampling. The collected qualitative data were analyzed using line-by-line coding and simple content analysis to extract the characteristics of successful leadership in nursing., Results: The final sample included seven nursing leaders aged between 55 and 70 years. All of the participants were in nursing leadership positions at schools/colleges of nursing or professional organizations for at least two decades and had extensive leadership experience through their schools/colleges, professional organizations, and/or governments. Five key themes related to the characteristics of successful leadership were identified from the participants: (a) culturally and historically prescribed, (b) overcoming gendered experience, (c) equipped with good character, (d) guiding with a vision, and (e) with contextualized leadership., Conclusions/implications for Practice: Five characteristics of successful leadership were identified from the perspective of Asian nursing leaders. All of the participants recommended that successful nursing leadership be based on contextual leadership and that successful nursing leadership help meet rapidly changing needs, enable mutual trust, and actively commit and complete necessary risks. Moreover, future successful leadership should have a clear vision and strongly guide the implementation of changes as well as be equipped with cultural intelligence. Finally, successful nursing leadership should be based on ethical, trustable, and humane behaviors while promptly and adequately responding to the changing needs of their institutions/organizations. Cross-regional research on successful nursing leadership is essential to enrich the global evidence and knowledge on developing the next generation of nursing leaders., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc.)

Unplanned readmission endangers patient safety and increases unnecessary healthcare expenditure. Identifying nursing variables that predict patient readmissions can aid nurses in providing timely nursing interventions that help patients avoid readmission after discharge. We aimed to provide an overview of the nursing variables predicting readmission of patients with a high risk. The authors searched five databases-PubMed, CINAHL, EMBASE, Cochrane Library, and Scopus-for publications from inception to April 2023. Search terms included "readmission" and "nursing records." Eight studies were included for review. Nursing variables were classified into three categories-specifically, nursing assessment, nursing diagnosis, and nursing intervention. The nursing assessment category comprised 75% of the nursing variables; the proportions of the nursing diagnosis (25%) and nursing intervention categories (12.5%) were relatively low. Although most variables of the nursing assessment category focused on the patients' physical aspect, emotional and social aspects were also considered. This study demonstrated how nursing care contributes to patients' adverse outcomes. The findings can assist nurses in identifying the essential nursing assessment, diagnosis, and interventions, which should be provided from the time of patients' admission. This can mitigate preventable readmissions of patients with a high risk and facilitate their safe transition from an acute care setting to the community., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This study aims to evaluate the effectiveness of a self-management program using gain/loss-framed messages in patients with gastric cancer., Methods: In this randomized controlled trial, 69 patients with gastric cancer who underwent gastrectomy at a university hospital were assigned to the gain- or loss-framed message group. The self-management program consisted of: 1) face-to-face education, 2) gain/loss-framed text messages, and 3) self-monitoring of health behaviors. Health outcomes (i.e., nutritional status, physical activity, exercise intensity, and distress), and health behaviors (i.e., dietary habits, physical activity performance, and distress management) were measured, and a generalized estimating equation was used for the analysis., Results: Nutritional status and dietary habits in the loss framed message group were statistically higher after the intervention compared to the counterpart (β = -1.72, p = .049; β = 0.36, p = .033, respectively). There was no time-group interaction effect on physical activity, exercise intensity, physical activity performance, distress or distress management., Conclusions: A self-management program employing loss-framed messages was effective in promoting nutrition-related self-management among patients with gastric cancer., Practice Implications: Message-framing is an effective communication technique that can be easily used in clinical settings, and a loss-message-framing strategy may enhance nutrition-related self-management in patients with gastric cancer., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Nurses form the frontline of the healthcare system's response to both epidemics and pandemics, and this was especially the case during the novel coronavirus disease (COVID-19) pandemic. Although the influence of COVID-19 on nursing roles has attracted interest, there is no integrated knowledge of nurses' roles and experiences in primary health care settings during the COVID-19 pandemic. Thus, this study identifies the roles and experiences of nurses in primary health care during the COVID-19 pandemic., Methods: A scoping review study design and the Joanna Briggs Institute methodology were used. The study searched five electronic databases (PubMed, CINAHL, EMBASE, Scopus, and PsychINFO) and included studies published in English from March 2020 to June 2023 that focused on the roles and experiences of nurses (participants) during COVID-19 (concept) in primary health care settings (context)., Results: Fourteen articles were selected for review, involving a total of 1,487 nurses as study participants. The various roles undertaken by nurses in primary health care settings were categorized as comprehensive care providers, supporters and empowerers, coordinators and collaborators, information navigators, and change agents. Challenges and strategies are multilevel intrapersonal, interpersonal, organizational, community, and societal issues, but are not mutually exclusive., Conclusions: The pandemic-induced challenges revealed primary health care nurses' vital and indispensable roles and resilience. They also fostered a heightened awareness of technological influence on the progression of primary health care in the current milieu. Policymakers and healthcare organizations need to integrate primary health care nurses' expanding and emerging roles within the scope of practice, ensuring their effective implementation without excessive regulatory constraints. This study emphasizes the importance of developing multilevel interventions to address the support needs of primary health care nurses through a system-based approach. Building a strong infrastructure to support nurses' self-care, offering continuing professional development opportunities, and securing official government recognition will be essential for enhancing the resilience of primary healthcare nurses in preparation for future, potentially devastating pandemics., (© 2024. The Author(s).)

Background: Despite decades of advocacy for disaggregated data collection and reporting for Asian American, Native Hawaiian, and Pacific Islander (AA and NHPI) people, significant gaps remain in our ability to understand AA and NHPI individuals' access to care. We assess inequities in access to care measures between non-Hispanic White and AA and NHPI adult Medicaid enrollees., Methods: We used the 2014-15 Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems, the first-and-only nationally representative sample of Medicaid enrollees. Our main outcomes were access to needed care, access to a personal doctor, timely access to a checkup, and timely access to specialty care. Using multivariable linear probability models, we assessed the relationship between racial/ethnic group and our outcomes, both in the aggregate and disaggregated into ten racial/ethnic groups, and adjusted for enrollee-level sociodemographic characteristics, health status, and state-level Medicaid expansion status., Results: In aggregate, AA and NHPI enrollees reported worse access to care than White enrollees on all four metrics (p < 0.001). The magnitude of disparities varied across the ten AA and NHPI ethnic groups. Disparities relative to White enrollees were particularly large in magnitude, roughly 1.5 to 2 times greater, for Chinese, Korean, and Vietnamese enrollees than for the aggregated AA and NHPI group., Conclusions: Despite comparable insurance coverage, there were inequities in multiple access to care metrics between non-Hispanic White and AA and NHPI Medicaid enrollees. Collection of disaggregated health data on AA and NHPI patients reveals important variation in access to care by ethnic group., (© 2023. W. Montague Cobb-NMA Health Institute.)

Importance: In January 2021, under the 21st Century Cures Act, Medicare beneficiaries with end-stage renal disease (ESRD) were permitted to enroll in private Medicare Advantage (MA) plans for the first time. In the first year of the Cures Act, there was a 51% increase in MA enrollment among beneficiaries with ESRD., Objective: To examine changes in MA enrollment among Medicare beneficiaries with ESRD in the first 2 years of the Cures Act and, among beneficiaries newly enrolled in MA in 2021, to assess the proportion of beneficiaries who switched MA contracts and how the characteristics of contracts changed., Design, Setting, and Participants: This cross-sectional, population-based time-trend study was conducted from January 2020 to December 2022. Eligible participants included Medicare beneficiaries with ESRD. Data analysis was conducted from August 2023 to March 2024., Exposure: Enrollment in Medicare during the first 2 years of the 21st Century Cures Act., Main Outcomes and Measures: The primary outcomes were enrollment in MA, switching between traditional Medicare (TM) and MA, and switching between MA contracts from 2021 to 2022., Results: There were 718 252 unique Medicare beneficiaries with ESRD between 2020 and 2022 (1 659 652 beneficiary-years). In 2022, there were 583 203 beneficiaries with ESRD (mean [SD] age, 64.9 [14.1] years, 245 153 female (42.0%); 197 988 Black [34.0%]; 47 912 Hispanic [8.2%]). The proportion of beneficiaries with ESRD who were enrolled in MA increased from 25.1% (118 601 of 472 234 beneficiaries) in January 2020 to 43.1% (211 896 of 491 611 beneficiaries) in December 2022. Increases in MA enrollment were larger in the first year of the Cures Act (12.6 percentage points [pp]; 95% CI 12.3-12.8 pp) compared with the second year (5.7 pp; 95% CI, 5.5-5.9 pp). Changes between December 2020 and December 2022 ranged between 49.3% for Asian or Pacific Islander beneficiaries (difference = 13.0 pp; 95% CI, 12.2-13.8 pp) and 207.2% for American Indian or Alaska Native beneficiaries (difference = 17.0 pp; 95% CI, 15.3-18.7 pp). Changes were high among partial dual-eligible (difference = 35.5 pp; 95% CI, 34.9-36.1 pp; 134.7% increase) and fully dual-eligible beneficiaries (difference = 22.8 pp, 95% CI, 22.5-23.1 pp; 98.0% increase). Among 53 366 beneficiaries enrolled in MA in 2021, 37 439 (70.2%) remained in their contract, 11 730 (22.0%) switched contracts, and 4197 (7.9%) switched to TM in 2022. Compared with the characteristics of MA enrollees with ESRD in 2021, those in 2022 were more likely to be in contracts with lower premiums and with a rating of 4.5 stars or higher., Conclusions and Relevance: In this cross-sectional time-trend study of Medicare beneficiaries with ESRD, MA enrollment continued to increase in the second year of the Cures Act, particularly among racially or ethnically minoritized individuals and dual eligible populations. These findings suggest need to monitor the equity of care for beneficiaries with ESRD as they enroll in managed care plans.

Aims: To examine whether nursing diagnoses were associated with delirium in patients with sepsis., Background: Nursing diagnosis is a nurse's clinical judgement about clients' current or potential health conditions. Delirium is regarded as an important nurse-sensitive outcome. Nonetheless, nursing diagnoses associated with delirium have not yet been identified., Design: Retrospective correlational study., Methods: This study was carried out from December 2021 to January 2023. We analysed electronic health records of patients with sepsis admitted to the intensive care units (ICUs) of a tertiary hospital in Seoul, South Korea. Delirium was defined based on the Intensive Care Delirium Screening Checklist score. Nursing diagnoses established within 24 h of admission to the ICU were included and were based on the North American Nursing Diagnosis Association diagnostic classification. The data were analysed using logistic regression. Demographics, comorbidities, procedures and physiological measures were adjusted. Regression model was evaluated via receiver operating characteristic curve, Nagelkerke R 2 , accuracy and F1 score., Results: The prevalence of delirium in patients with sepsis was 51.8%. Ineffective breathing patterns, decreased cardiac output and impaired skin integrity were significant nursing diagnoses related to delirium. Age ≥ 65 years, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation, continuous renal replacement therapy, physical restraint and comatose state were also associated with delirium in patients with sepsis. The area under the receiver operating characteristic curve was 0.806., Conclusion: Ineffective breathing patterns, decreased cardiac output and impaired skin integrity could manifest as prodromal symptoms of delirium among patients with sepsis., Impact: The prodromal symptoms of delirium revealed through nursing diagnoses can be efficiently used to identify high-risk groups for delirium. The use of nursing diagnosis system should be recommended in clinical practice caring for sepsis patients., Reporting Methods: STROBE checklist., Patient or Public Contribution: No patient or public involvement., (© 2024 John Wiley & Sons Ltd.)

The raison d'être of nursing is caring for human beings. Mainly due to its close link to the nursing discipline's raison d'être, "caring," translational science is recently getting more attention from nursing scientists across the globe. This paper is to discuss the current status of translational science in nursing across four countries (the USA, Taiwan, South Korea, and Japan). The data used in this discussion paper included: (a) written notes on issues related translational research/science in individual countries; (b) written memos on exemplars/cases from their own experiences; and (c) summaries of literature reviews. The data analysis was conducted using a simple content analysis. Four themes reflecting the current status of translational science across the countries were identified: (a) "contextualized in unique culture and history of nursing"; (b) "connecting basic science to clinical practice"; (c) "an extension of evidence-based practice"; and (d) "highly promoted, but still minimal translation of nursing knowledge.", (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Digital health is an indispensable tool, but its use depends on the eHealth literacy (eHL) of end-users. This study aimed to understand the need for digital health and eHL among cancer patients, caregivers, and healthcare providers and to identify differences in digital health needs related to the eHL of cancer patients., Methods: A multicenter, descriptive correlational study was conducted and included a total of 209 patients, 150 caregivers and 150 healthcare providers. Digital health needs were identified, and eHL was measured using the Korean version of the eHealth Literacy Scale. Differences in digital health needs in relation to the eHL of patients were analyzed., Results: The most necessary digital health functions among cancer patients and caregivers were 'information and education on symptom management after cancer treatment' and 'education on coping methods for each type of cancer' (87.1-94.0%). Healthcare providers reported the need for a digital health function for 'medication information' and assisting in 'medical appointments' (96.7-98.0%). The preferred types of digital health were telemonitoring, mobile services, and telemedicine by telephone (81.3-90.5%). The mean eHL score of the cancer patients was 28.84 ± 6.75. Differences existed in the need for digital health functions and preferences for digital health types between cancer patients with high and low eHL., Conclusions: Cancer patients and caregivers expressed strong needs for digital health that provide information and education about symptom management and coping with cancer. Digital health interventions for cancer care need to be developed to reflect the identified needs and preferences and eHL of end-users., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Androgen deprivation therapy (ADT), a standard treatment for prostate cancer (PC), causes many physical side effects. In particular, it causes metabolic changes such as fasting glucose abnormalities or accumulation of body fat, and its continuation can lead to metabolic syndrome (MetS), which is closely related to diabetes and cardiovascular disease. Therefore, it is important to maintain and practice a healthy lifestyle in patients with PC., Objective: This study aims to evaluate the effectiveness of a nurse-led mobile-based program that aims to promote a healthy lifestyle in patients with PC undergoing ADT with MetS risk factors., Methods: This was a single-blind, randomized, waitlist control interventional study. A total of 48 patients were randomly assigned to the experimental and waitlist control groups at the urology cancer clinic of a tertiary general hospital in South Korea. The inclusion criteria were patients who had undergone ADT for >6 months, had at least 1 of the 5 MetS components in the abnormal range, and could access a mobile-based education program. The experimental group attended a 4-week mobile-based program on exercise and diet that included counseling and encouragement to maintain a healthy lifestyle, whereas the control group was placed on a waitlist and received usual care during the follow-up period, followed by the intervention. The primary outcome was a change in the lifestyle score. The secondary outcomes were changes in 5 MetS components, body composition, and health-related quality of life. The outcomes were measured at 6 weeks and 12 weeks after the initiation of the intervention. Each participant was assigned to each group in a sequential order of enrollment in a 4×4 permuted block design randomization table generated in the SAS (SAS Institute) statistical program. A linear mixed model was used for statistical analysis., Results: A total of 24 participants were randomly assigned to each group; however, 2 participants in the experimental group dropped out for personal reasons before starting the intervention. Finally, 46 participants were included in the intention-to-treat analysis. The experimental group showed more positive changes in the healthy lifestyle score (β=29.23; P≤.001), level of each MetS component (fasting blood sugar: β=-12.0; P=.05 and abdominal circumference: β=-2.49; P=.049), body composition (body weight: β=-1.52; P<.001 and BMI: β=-0.55; P<.001), and the urinary irritative and obstructive domain of health-related quality of life (β=14.63; P<.001) over time than the waitlist control group., Conclusions: Lifestyle changes through nurse-led education can improve level of each MetS components, body composition, and ADT side effects. Nurses can induce positive changes in patients' lifestyles and improve the self-management of patients starting ADT through this program., Trial Registration: Clinical Research Information Service KCT0006560; http://tinyurl.com/yhvj4vwh., (©Kyoungjin Lee, Jeongok Park, Eui Geum Oh, JuHee Lee, Chang Park, Young Deuk Choi. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 01.02.2024.)

Objective: Back pain and radiculopathy caused by disc herniation are major health issues worldwide. While macrophages are key players in disc herniation induced inflammation, their roles and origins in disease progression remain unclear. We aim to study the roles of monocytes and derivatives in a mouse model of disc herniation., Methods: Using a CCR2-CreER; R26R-EGFP (Ai6) transgenic mouse strain, we fate-mapped C-C chemokine receptor type 2 (CCR2) expressing monocytes and derivatives at disc herniation sites, and employed a CCR2 RFP/RFP mouse strain and a CCR2-specific antagonist to study the effects of CCR2 + monocytes on local inflammatory responses, pain level, and disc degeneration by immunostaining, flow cytometry, and histology., Results: CCR2 + monocytes (GFP + ) increased at the sites of disc hernia over postoperative day 4, 6, and 9 in CCR2-CreER; Ai6 mice. F4/80 + cells increased, and meanwhile, CD11b + cells trended downward. Co-localization analysis revealed that both GFP + CD11b + and GFP + F4/80 + constituted the majority of CD11b + and F4/80 + cells at disc hernia sites. Fluorescence activated cell sorter purified GFP + cells exhibited higher cytokine expressions than GFP - cells. Inhibition of CCR2 signaling reduced infiltration of monocytes and macrophages, alleviated pain, maintained disc height, and reduced osteoclast activity in adjacent cortical bone for up to 1 month., Conclusion: Our findings suggest that circulating CCR2 + monocytes play important roles in initiating and promoting the local inflammatory responses, pain sensitization, and degenerative changes after disc herniation, and thus may serve as therapeutic targets for disc herniation induced back and leg pain., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2023 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

This study aims to develop an ex vivo organ-on-a-chip model, intervertebral Disc-on-a-Chip MF , to investigate integrated effects of mechanical loading and nutrition on disc health. The system consists of a detachable multilayer microfluidic chip, a Computer-Arduino-based control system, and a mechanical loading unit, which were optimized for accurate axial force measurement and the maintenance of a 21-day ex vivo disc culture. To ensure accuracy of axial force, we optimized the axial mechanical loading regimen, used the Computer-Arduino-based system and low-profile force sensors (LPFS) to control the mechanical loading unit, and modeled the force distribution by using computational simulation. A 21-day ex vivo disc culture was demonstrated using the Disc-on-a-Chip MF system, with optimized mechanical loading (0.02 MPa at 1Hz, 1.5 hr/day) and flow rate (1 μL/min). The structural integrity, collagen breakdown, catabolic enzyme activities, and disc cell and collagen alignment revealed that the on-chip cultured discs exhibited a preferred disc health similar to that of native discs for up to 21 days, while discs in a static culture showed detrimental degenerative changes. The mouse Disc-on-a-Chip MF system mimics in vivo disc microenvironment and provides a valuable platform for studying the effects of various factors on disc health and degeneration and testing new therapies., Competing Interests: Conflict of Interests The authors have no conflict of interests to disclose.

Objectives: This study aimed to examine the effectiveness of a bowel function improvement program for male patients with rectal cancer who underwent low anterior resection., Methods: A prospective, unblinded, and randomized controlled trial was conducted. The enrolled 42 patients were assigned to the experimental or control group at a 1:1 ratio. The bowel function improvement program comprised a 4-week intensive program (face-to-face education and telephone coaching) and an 8-week maintenance program (text messages). Self-efficacy, bowel function, health-related quality of life, and healthcare resource utilization were measured. Collected data were analyzed using independent t-tests, chi-square tests, analysis of covariance, and generalized estimation equations to evaluate the effects of the program based on intention-to-treat., Results: The bowel function improvement program was effective in improving bowel function 3 months after discharge. Additionally, the number of unplanned pharmacy visits was lower in the experimental group than in the control group. Health-related quality of life, self-efficacy, and utilization of other healthcare resources were not statistically or clinically significant., Conclusion: These findings indicated that the bowel function improvement program for male patients with rectal cancer was effective in improving bowel function and reducing unplanned healthcare resource utilization. The bowel function improvement program can be delivered as a nurse-led program in clinical practice to promote early recovery after low anterior resection., Trial Registration Number: KCT0003505. https://cris.nih.go.kr/cris/search/detailSearch.do/13708., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: Digital self-management (SM) interventions targeting symptom relief have demonstrated positive as well as null outcomes, whereas no study has synthesized the effect of the interventions. In this study, we aimed to evaluate the effectiveness of digital SM symptom interventions on symptom outcomes in adult cancer patients., Methods: A systematic review and meta-analysis based on the previous scoping review was conducted. Six databases (PubMed, CINAHL, Embase, the Cochrane Library, RISS [Korean], and KoreaMed [Korean]) were searched. Population was adult cancer patients. Intervention was SM interventions applying digital health tool targeting symptom management. Comparison was usual care, waitlist controls or active controls. The primary outcome was symptom burden, and the secondary outcomes were individual symptoms., Results: Our meta-analysis of 32 randomized controlled trials (RCTs) including 7888 patients demonstrated that digital SM symptom interventions had a significant effect on reducing symptom burden (effect size [ES] = -0.230) and relieving pain (ES = -0.292), fatigue (ES = -0.417), anxiety (ES = -0.320), and depression (ES = -0.261)., Conclusions: Digital SM interventions can improve symptom outcomes in adult cancer patients. Oncology nurses should be aware that digital SM interventions have demonstrated promising outcomes in cancer patient care., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

The purpose of this article is to discuss the current status of research mentoring in nursing across 4 countries (the United States, Taiwan, South Korea, and Japan) and to make suggestions for future research mentoring. Seven leaders reflected on the current status of research mentoring in nursing, provided exemplars/cases from their own experiences, and their reviews of the literature. Six themes were discussed: ( a ) "culturally defined"; ( b ) "professionally contextualized"; ( c ) "teaching research integrity and research practice"; ( d ) "with mutual respect and care"; ( e ) "based on effective communication"; and ( f ) "supported by institutional and governmental commitment and infrastructure.", (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Heart failure is one of the most common causes of hospital readmission. Self-care is an essential but challenging task for patients with heart failure, and inadequate self-care is closely related to unplanned readmission and unnecessary health expenditure. Patient-centered education using the teach-back method emerged as a key strategy to prevent patients' adverse events by improving self-care., Objective: To evaluate the effects of discharge education using the teach-back method on self-care, self-care efficacy, symptoms of heart failure, caregiver dependency, and unplanned healthcare resource utilization among patients with heart failure., Design: A prospective, two-arm randomized controlled trial., Setting(s): Four adult cardiology units at a tertiary hospital in Seoul, South Korea., Participants: A total of 100 patients diagnosed with heart failure and scheduled to be discharged to their homes., Methods: The intervention group received the HEART program® in addition to the usual discharge education by a trained nurse before discharge, while the control group received usual discharge education only. The discharge education included the definition of heart failure, medication, symptom management, diet, physical activity, and other precautions. Data on self-care (self-care maintenance; symptom-perception; self-care management), self-care efficacy, symptoms of heart failure, and caregiver dependency were measured at 7-days after discharge (T1), and unplanned healthcare resource utilization (including readmission, emergency room visit, and healthcare professional contacts) was assessed at 1-month after discharge (T2). Outcomes were analyzed with ANCOVA., Results: A total of 94 patients (intervention group = 45, control group = 49) completed outcome measurements at the three-time points. Participants in the intervention group showed a significant improvement in self-care maintenance (F = 11.597, p = 0.001), symptom perception (F = 20.173, p < 0.001), self-care management (F = 7.205, p = 0.009), and self-care efficacy (F = 4.210, p = 0.043) compared to the control group. However, there were no statistically significant differences in symptoms of heart failure, caregiver dependency, and unplanned healthcare resource utilization between the two groups (all ps > 0.05)., Conclusions: The findings demonstrated that discharge education using the teach-back method is an effective educational strategy to improve self-care and self-care efficacy in patients with heart failure. We recommend nurses implement discharge education using the teach-back method for patients with heart failure., Registration: This study was registered at the Clinical Research Information Service (KCT0004444) on November 15, 2019, and the participant recruitment was initiated in June 2020., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Importance: Before 2021, most Medicare beneficiaries with end-stage renal disease (ESRD) were unable to enroll in private Medicare Advantage (MA) plans. The 21st Century Cures Act permitted these beneficiaries to enroll in MA plans effective January 2021., Objective: To examine changes in MA enrollment among Medicare beneficiaries with ESRD after enactment of the 21st Century Cures Act overall and by race or ethnicity and dual-eligible status., Design, Setting, and Participants: This cross-sectional time-trend study used data from Medicare beneficiaries with ESRD (both kidney transplant recipients and those undergoing dialysis) between January 2019 and December 2021. Data were analyzed between June and October 2022., Exposures: 21st Century Cures Act., Main Outcomes and Measures: Primary outcomes were the proportion of Medicare beneficiaries with prevalent ESRD who switched from traditional Medicare to MA between 2020 and 2021 and those with incident ESRD who newly enrolled in MA in 2021. Individuals who stayed in traditional Medicare were enrolled in 2020 and 2021 and those who switched to MA were enrolled in traditional Medicare in 2020 and MA in 2021., Results: Among 575 797 beneficiaries with ESRD in 2020 or 2021 (mean [SD] age, 64.7 [14.2] years, 42.2% female, 34.0% Black, and 7.7% Hispanic or Latino), the proportion of beneficiaries enrolled in MA increased from 24.8% (December 2020) to 37.4% (December 2021), a relative change of 50.8%. The largest relative increases in MA enrollment were among Black (72.8% relative increase), Hispanic (44.8%), and dual-eligible beneficiaries with ESRD (73.6%). Among 359 617 beneficiaries with TM and prevalent ESRD in 2020, 17.6% switched to MA in 2021. Compared with individuals who stayed in traditional Medicare, those who switched to MA had modestly more chronic conditions (6.3 vs 6.1; difference, 0.12 conditions [95% CI, 0.10-0.16]) and similar nondrug spending in 2020 (difference, $509 [95% CI, -$58 to $1075]) but were more likely to be Black (difference, 19.5 percentage points [95% CI, 19.1-19.9]) and have dual Medicare-Medicaid eligibility (difference, 20.8 percentage points [95% CI, 20.4-21.2]). Among beneficiaries who were newly eligible for Medicare ESRD benefits in 2021, 35.2% enrolled in MA., Conclusions and Relevance: Results suggest that increases in MA enrollment among Medicare beneficiaries with ESRD were substantial the first year after the 21st Century Cures Act, particularly among Black, Hispanic, and dual-eligible individuals. Policy makers and MA plans may need to assess network adequacy, disenrollment, and equity of care for beneficiaries who enrolled in MA.

Purpose: The purpose of this systematic review was to identify the effects of pelvic floor muscle training (PFMT) on bowel function and health-related quality of life among patients who have undergone low anterior resection., Methods: A systematic review and meta-analysis of pooled findings was conducted according to PRISMA guidelines., Search Strategy: A literature search was completed using PubMed, EMBASE, Cochrane, and CINAHL electronic databases; we searched studies published in English and Korean languages. Two reviewers independently selected relevant studies, evaluated their methodological quality, and extracted data. Meta-analysis was conducted of pooled findings., Findings: Thirty-six of 453 articles retrieved were read in full and 12 articles were included in the systematic review. In addition, pooled findings from 5 studies were selected for meta-analysis. Analysis revealed that PFMT reduced bowel dysfunction (mean difference [MD] -2.39, 95% confidence interval [CI] -3.79 to -0.99) and improved several domains of health-related quality of life: lifestyle (MD 0.49, 95% CI 0.15 to 0.82), coping (MD 0.36, 95% CI 0.04 to 0.67), depression (MD 0.46, 95% CI 0.23 to 0.70), and embarrassment (MD 0.24, 95% CI 0.01 to 0.46)., Implications: Findings suggested PFMT is effective for improving bowel function and enhancing multiple domains of health-related quality of life after low anterior resection. Further well-designed studies are required to confirm our conclusions and provide stronger evidence for the effects of this intervention., Competing Interests: The authors declare no actual or potential conflicts of interests., (Copyright © 2023 by the Wound, Ostomy and Continence Nurses Society.)

Aim: This study seeks to gain a comprehensive understanding of the experiences of frontline nurses who provided direct care for COVID-19 patients., Background: Due to the COVID-19 pandemic, the demands on healthcare systems have been higher than before. Although previous studies have explored the experiences of frontline nurses, these experiences could vary depending on each country's social, cultural, and historical contexts., Introduction: In the midst of the global pandemic, sharing the experiences of COVID-19 frontline nurses could have implications for both nursing and nursing policies that could be applied to future pandemics., Methods: This descriptive qualitative study comprised 14 South Korean nurses with a minimum of one month of experience working within a COVID-19 department. Individual interviews were conducted on a virtual platform, and a thematic analysis was employed. The consolidated criteria for reporting qualitative studies were used to ensure a detailed reporting of the study., Results: Four themes and 12 subthemes were developed. The themes included: (1) feeling forced into a world of uncertainty; (2) providing unique care for COVID-19 patients; (3) perceiving barriers to providing quality care; and (4) seeking meaning in caring for COVID-19 patients., Discussion: Nurses recognized their unique roles in caring for COVID-19 patients and sought new meanings within their profession. However, the poor work environment exacerbated the physical and emotional burden among the nurses and compromised the provision of quality care., Conclusion: This study highlighted the nursing policy issues that need to be improved to ensure better quality care and a stronger healthcare system., Implications for Nursing Policy: Governmental action is essential to ensure that nurses can maintain the quality of care they have provided during COVID-19 and any future pandemics., (© 2022 The Authors. International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.)

Objective: This study aims to review and evaluate the effectiveness of discharge education using the teach-back method (TBM) on readmission rates among patients with heart failure (HF)., Methods: Searches were conducted in five electronic databases (PubMed, CINAHL, Embase, Cochrane Library, and Web of Science) published until May 2022, followed by a manual search of reference lists. The risk of bias in the studies was assessed using the Cochrane Risk of Bias and Joanna Briggs Institute quasi-experimental critical appraisal tool, and meta-analysis was conducted using Cochrane Review Manager 5., Results: Seven studies were included in the review, and the quality of the studies varied, with two studies scoring low on the overall risk of bias. Meta-analysis was conducted using six studies, demonstrating that discharge education using TBM significantly reduced the overall readmission rates (odds ratio = 0.40, 95% confidence interval 0.17-0.94)., Conclusions: TBM is an effective educational strategy for reducing the readmission rate in discharged patients with HF. More rigorously designed studies evaluating the effectiveness of education using TBM in patients with HF are needed., Practice Implications: Nurses in clinical settings can use TBM in their discharge education to improve HF patients' understanding of the illness and impact long-term outcomes, such as readmission rates., Competing Interests: Declaration of Competing Interest The authors declare that they had no conflict of interest while conducting this research., (Copyright © 2022 Elsevier B.V. All rights reserved.)

The 21st Century Cures Act permitted people with end-stage renal disease (ESRD) to enroll in Medicare Advantage (MA) effective January 2021. It is imperative to understand the breadth of dialysis facility networks across MA contracts because most patients with ESRD need thrice-weekly dialysis to survive. In 2020 MA contracts' networks included a mean of 51 percent of dialysis facilities in their service areas. MA contracts with plans in a single state, with not-for-profit status, and with higher proportions of dually eligible enrollees with ESRD were significantly more likely to include less than or equal to 25 percent of dialysis facilities in their service area in network ("narrow networks") than contracts with plans in multiple states, with for-profit status, and with lower proportions of dually eligible enrollees with ESRD (by 12.9, 13.0, and 11.7 percentage points, respectively). Hispanic, Asian/Pacific Islander, and American Indian/Alaska Native people with ESRD were enrolled in contracts with narrow networks of dialysis facilities at markedly higher rates than non-Hispanic White people with ESRD. In contrast, Black people with ESRD were less likely to be enrolled in a narrow-network contract. Policy makers should monitor and address the adequacy of dialysis facility networks in MA contracts, as well as disparities in enrollment in narrow-network plans.

Background: Digital care has become an essential component of health care. Interventions for patients with cancer need to be effective and safe, and digital health interventions must adhere to the same requirements., Objective: The purpose of this study was to identify currently available digital health interventions developed and evaluated in randomized controlled trials (RCTs) targeting adult patients with cancer., Methods: A scoping review using the JBI methodology was conducted. The participants were adult patients with cancer, and the concept was digital health interventions. The context was open, and sources were limited to RCT effectiveness studies. The PubMed, CINAHL, Embase, Cochrane Library, Research Information Sharing Service, and KoreaMed databases were searched. Data were extracted and analyzed to achieve summarized results about the participants, types, functions, and outcomes of digital health interventions., Results: A total of 231 studies were reviewed. Digital health interventions were used mostly at home (187/231, 81%), and the web-based intervention was the most frequently used intervention modality (116/231, 50.2%). Interventions consisting of multiple functional components were most frequently identified (69/231, 29.9%), followed by those with the self-manage function (67/231, 29%). Web-based interventions targeting symptoms with the self-manage and multiple functions and web-based interventions to treat cognitive function and fear of cancer recurrence consistently achieved positive outcomes. More studies supported the positive effects of web-based interventions to inform decision-making and knowledge. The effectiveness of digital health interventions targeting anxiety, depression, distress, fatigue, health-related quality of life or quality of life, pain, physical activity, and sleep was subject to their type and function. A relatively small number of digital health interventions specifically targeted older adults (6/231, 2.6%) or patients with advanced or metastatic cancer (22/231, 9.5%)., Conclusions: This scoping review summarized digital health interventions developed and evaluated in RCTs involving adult patients with cancer. Systematic reviews of the identified digital interventions are strongly recommended to integrate digital health interventions into clinical practice. The identified gaps in digital health interventions for cancer care need to be reflected in future digital health research., (©Kyunghwa Lee, Sanghee Kim, Soo Hyun Kim, Sung-Hee Yoo, Ji Hyun Sung, Eui Geum Oh, Nawon Kim, Jiyeon Lee. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 06.01.2023.)

Objective: This study aimed to (1) translate the PG-SGA into Korean according to a translation guideline, (2) validate the translated version against the Mini-Nutritional Assessment, and (3) determine the prevalence of malnutrition in patients with gastric cancer., Methods: The translation of the PG-SGA was based on the Guidelines for Translation by the International Society for Pharmacoeconomics and Outcomes Research Task Force for Translation and Cultural Adaptation Group. The translated version was validated in 226 patients with gastric cancer, using the area under the receiver operating characteristic curve analysis (AUC-ROC), measures of sensitivity, specificity, and the Youden index. The prevalence of malnutrition was analyzed using descriptive statistics., Results: The AUC-ROC Korean version of the PG-SGA was 0.85, and a score of 12 was the most optimal cut-off score, with a sensitivity of 78.6% and a Youden index of 0.54. One-third of participants were malnourished, and 70% of them had more than one physical symptom affecting their food intake., Conclusions: The Korean version of the PG-SGA is an effective and valid assessment tool for evaluating malnutrition in patients with gastric cancer. A new cut-off score could be used in patients with gastric cancer to assess malnutrition., (© 2022 The Authors.)

Background: Disparities in access to care between non-Hispanic White and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patients are often attributed to higher uninsurance rates among AANHPI patients. Less is known about variation among individuals with Medicaid health insurance coverage and among AANHPI subgroups., Objective: The objective of this study was to examine differences in access to care between White and AANHPI adult Medicaid beneficiaries, both in the aggregate and disaggregated into 9 ethnic subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian, Native Hawaiian, and Pacific Islander)., Research Design: Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems data (2014-2015), a cross-sectional survey representative of all Medicaid beneficiaries., Subjects: A total of 126,728 White and 10,089 AANHPI Medicaid beneficiaries were included., Measures: The study outcomes were: (1) having a usual source of care; and (2) reporting a health center or clinic as the usual site of care. Multivariable linear probability models assessed the relationship between race/ethnic subgroup and our outcomes, adjusting for sociodemographic characteristics and health status., Results: Compared with White beneficiaries, Korean beneficiaries were significantly less likely to report having a usual source of care [difference=-8.9 percentage points (PP), P =0.01], and Chinese (difference=8.4 PP, P =0.001), Native Hawaiian (difference=25.8 PP, P <0.001), and Pacific Islander (difference=22.2 PP, P =0.001) beneficiaries were significantly more likely to report a health center or clinic as their usual site of care., Conclusions: Despite similar health insurance coverage, significant differences in access to care remain between White and AANHPI Medicaid beneficiaries. Disaggregated AANHPI data may reveal important variation in access to care and inform more targeted public policies., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The purpose of this study was to identify differences in factors affecting health-promoting behaviors according to the survival stage of thyroid cancer survivors., Methods: This descriptive cross-sectional study analyzed data from 354 thyroid cancer survivors after diagnosis. The survivors were divided into three stages: (1) the acute stage (< 2 years after diagnosis), (2) extended stage (2-5 years after diagnosis), and (3) permanent stage (≥ 5 years after diagnosis). To measure health-promoting behavior, the revised Korean version of the Health Promoting Lifestyle Profile questionnaires was used. The factors affecting the health-promoting behavior included social support, self-efficacy, fear of recurrence, and symptoms. Multiple regression analysis was used to analyze factors affecting the health-promoting behavior according to survival stage., Result: The factors affecting the health-promoting behavior of thyroid cancer survivors differed by survival stage. In the acute stage, the factors of health-promoting behavior were self-efficacy (t = 4.76, p < .001) and social support (t = 3.54, p < .001). In the extended stage, symptoms (t =  - 3.65, p < .001), social support (t = 2.61, p = .011), fear of recurrence (t = 2.18, p = .032), and receipt of radioiodine treatment (t =  - 2.18, p = .032) were found to be significant variables that affected health-promoting behaviors. In the permanent stage, social support (t = 2.79, p = .007), receipt of radioiodine treatment (t =  - 3.21, p = .002), and age (t =  - 2.77, p = .007) were significant variables that affected health-promoting behaviors., Conclusion: The experience of thyroid cancer survivors varies as they progress through the survival stages; thus, health-promotion interventions should be tailored to each survival stage., (© 2022. The Author(s).)

With the recent impact by the COVID-19 pandemic, nursing research has gone through unexpected changes across the globe. The purpose of this special report is to present the commonalities in the impact of the COVID-19 pandemic on nursing research across four countries, including the United States, South Korea, Japan, and Taiwan, and one region, that is, Hong Kong, and to make recommendations for future nursing research during the immediate postpandemic period and future pandemic situations. To identify the commonalities, seven researchers/leaders from the five countries/regions had discussions through 3 days of an international workshop. The content for this discussion paper derived from: (a) the exemplars/cases of the COVID-19 impact on the research process, (b) researchers/leaders' presentations on the COVID-19 impact, and (c) memos from the workshop. The materials were analyzed using a simple content analysis. The commonalities included: (a) "a heavy emphasis on teaching and fluctuating productivity," (b) "increased funding opportunities and governmental support," (c) "gendered experience complicated by professional differences," (d) "delays and changes/modifications in research process," (e) "limited research settings and difficulties in getting access," and (f) "increased online dissemination activities with positive changes in the image of nursing." With all collective wisdom that nurse researchers have obtained during the COVID-19 pandemic, nursing research will evolve again for the successful future of the nursing discipline., (© 2021 Wiley Periodicals LLC.)

Purpose: The number of childhood cancer survivors has been steadily increasing because of improved cancer treatment outcomes. We aimed to examine the level of cancer stigma, coping, spirituality, hope, family communication, social support and resilience in adolescent and adult childhood cancer survivors and identify factors associated with resilience., Method: This study is a descriptive survey conducted on 139 childhood cancer survivors aged 15-29 years who had been diagnosed with cancer prior to the age of 19 years at a general hospital in Seoul. The questionnaire consisted of the Cancer Stigma Scale, Jalowiec Coping Scale, Functional Assessment of Chronic-Illness Therapy-Spirituality (FACIT-Sp), Hearth Hope Index (HHI), Parent-Adolescent Communication Inventory (PACI), Multidimensional Scale of Perceived Social Support (MSPSS), and Haase Resilience in Illness Scale (HARS). Collected data were analyzed using multiple linear regression analysis with SPSS 23.0., Results: Resilience positively correlated with courageous coping, spirituality, hope, family communication and social support, and negatively correlated with cancer stigma and defensive coping. Regression analyses revealed that courageous coping (β = 0.303, p < .001), hope (β = 0.317, p = .001), and solid tumor diagnosis (β = -0.144, p = .012) were significantly predictive of resilience among childhood cancer survivors, and these factors explained 65.2% of the variance., Conclusions: Resilience among childhood cancer survivors was higher with increasing courageous coping and hope and lower with solid tumors. These results suggest that coping and hope management should be included in the strategies to enhance the resilience of AYA cancer survivors., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The purpose of this article is to identify the commonalities in nursing perspectives among 6 countries/regions (United States, South Korea, Taiwan, Japan, Hong Kong, and Thailand). Nine leaders from the 6 countries/regions reflected on what nursing perspectives were in their own countries/regions and provided exemplars/cases from their own experiences and literature reviews. The data were analyzed using a content analysis. Seven themes were extracted: (a) "embedded in cultural and historical contexts"; (b) "based on philosophical pluralism"; (c) "women-centered perspectives"; (d) "care-oriented holistic views"; (e) "ethical and humane views"; (f) "respecting and advocating"; and (g) "considering diversities.", (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Heart failure (HF) patients have difficulties in self-management after discharge. This study aimed to develop a discharge education program for HF patients using the teach-back method (TBM)., Methods: As a methodological study to develop a program, we applied the analysis, design, development, implementation, and evaluation (ADDIE) model comprised of (1) analysis using EMR data, systematic review, and focus group interviews, (2) design and development of a program draft, (3) tests of program validity using 15 experts, 10 nurses, and 10 patients, and (4) development of the final program. The content validity index (CVI), and understandability and actionability of the educational material were used., Results: The discharge education program provides definitions and information about medication, symptom/weight/diet management, physical activity, and other precautions. The educational method uses TBM. The overall CVI for the program was 0.96, and all item CVIs were greater than 0.8. The understandability and actionability were 90.2 and 91.3 % in patients, and 94.6 and 86.8 % in nurses. The contents and methods of the program were appropriate for patients and providers., Conclusions: We expect the discharge education program using TBM to enhance self-management among HF patients. The process we used to develop this program could guide researchers and clinical practice.

Objectives: Teach-back methods are reported to improve patient outcomes by encouraging patient understanding and participation and are increasingly being used in various clinical settings. This study attempts to identify the effectiveness of discharge education using the teach-back method on 30-day readmission., Methods: MEDLINE, CINAHL, Embase, The Cochrane Library, and Web of Science were used to search experimental studies. The search terms were "discharged patient," "teach-back," and "30-day readmission" published in English up until July 2017. Two trained reviewers performed a critical appraisal of retrieved studies using the Risk of Bias Assessment tool for Nonrandomized Studies. Data were analyzed using Cochrane Review Manager (Revman) software 5.2., Results: A total of five studies were analyzed (3 studies on heart failure, 1 study on total joint replacement, and 1 study on a coronary artery bypass graft). The main content of the teach-back education was to confirm and reinforce the patients' comprehension of health-related information. Among the five studies, three studies were included in the meta-analysis. The odds ratio of 30-day readmission for discharge education with the teach-back method and usual care was 0.55 (95% confidence interval, 0.34-0.91; P = 0.02). The I2 score was 0%, which means that the analyzed studies are homogeneous., Conclusions: The results indicate that discharge education with the teach-back method resulted in a 45% reduction in 30-day readmission. However, only a few studies were included in the analysis, and they showed a high risk of selection bias. Therefore, we suggest that well-designed randomized controlled trials be conducted., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)

Background: A literature review was conducted to assess nurse-led nonpharmacologic pain management interventions intended for total knee/hip replacement patients., Design: This was a systematic review and meta-analysis., Data Sources: The PubMed, Embase, CINAHL, and Cochrane Library databases were searched to identify relevant studies., Review Methods: The systematic review was conducted based on the Cochrane Handbook for Systematic Reviews of Interventions and all Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guidelines. Two reviewers independently selected the studies and appraised their quality. Thereafter, the effects of all described nurse-led nonpharmacologic pain management interventions were estimated regarding pain, anxiety, and satisfaction through a meta-analysis., Results: In total, 219 relevant studies were found through a search. Finally, 23 studies were selected for review, with 17 included in the meta-analysis. Nurse-led nonpharmacologic pain management was effective for pain relief (effect size, -0.22; 95% confidence interval [CI], -0.42 to -0.02), and educational interventions were especially effective (effect size, -0.36; 95% CI, -0.69 to -0.03). Although interventions reduced anxiety and improved satisfaction, these results were not statistically significant based on the analysis., Conclusion: Our findings support that nurse-led nonpharmacologic pain management interventions could help reduce pain in patients with total knee/hip replacement by supplementing pharmacologic pain management., Implications for Nursing: Nurse-led nonpharmacologic pain interventions should be considered to reduce patient pain with total knee/hip replacement., (Copyright © 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Purpose: The main objective of this study was to use the framework of the self-determination theory, incorporating both internal and external sources of motivation, to identify factors influencing physical activity among colorectal cancer survivors (CRC-S) in Korea., Method: In total, 242 patients at a university-affiliated hospital in Seoul, Korea, responded to a descriptive survey, which comprised questionnaire sets including the Global Physical Activity Questionnaire and the Patient Health Questionnaire. Motivation was then assessed on three scales: the Treatment Self-Regulation (autonomy), Perceived Competence (competence), and the multidimensional Scale of Perceived Social Support (relatedness). Logistic regression analysis was then used to identify factors associated with physical activity., Result: The mean physical activity score was 16.07 metabolic equivalent hours per week, and only 23.3% of patients had an appropriate level of exercise. In the logistic regression analysis, physical activity was associated with competence (odds ratio (OR) = 1.36, 95% confidence interval (CI): 1.06-1.74), relatedness (OR = 1.11, 95% CI: 1.04-1.18), depression (OR = 0.84, 95% CI: 0.75-0.94), and stage I or II disease (OR = 3.33, 95% CI: 1.28-1.86). This study indicated that competence, relatedness, depression, and the disease stage contributed to physical activity among these subjects while autonomy did not., Conclusion: Future interventions to achieve the recommended levels of physical activity among CRC-S could benefit from taking into account the disease stage as well as psychosocial factors including motivation and depression.

Introduction: Because virtually no theories were available to explain unique characteristics of Asian women's leadership in nursing, a middle-range theory on women's leadership in Asian culture was previously published. To reflect recent political and social changes in different countries, there is a necessity to refine the theory. The purpose of this article is to present the refined middle-range theory on Asian women's leadership in nursing. Methodology: Using an integrative approach, the theory was further developed based on two major sources: literature reviews and exemplars/cases from six different countries. Results: The Refined Middle-Range Theory on Women's Leadership in Asian Culture has two main domains: (a) leadership frames and (b) leadership contexts. The domain of leadership contexts has been extended with two additional main concepts including demographic contexts and health workforce/system contexts. Discussion: The refined theory is expected to guide Asian women's leadership in nursing across the globe.

Purpose: The aim of this study is to determine the impact of myofunctional therapy support program (MTSP) based on self-efficacy theory compared to no support during myofunctional therapy (MT) in patients with obstructive sleep apnea (OSA)., Methods: Thirty-one patients with OSA were randomized into two groups: 12 weeks of treatment with the MTSP developed in this study (experimental group) and one education session of MT (control group). Patients were evaluated at the beginning and the end of the study using questionnaires (self-efficacy scale, Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, snoring intensity and frequency, dry mouth) and polysomnography., Results: The control (n = 15) and experimental (n = 16) groups had similar results for all variables at study entry. The control group showed no significant change in any variables during the study period. In contrast, the experimental group showed a significant increase in self-efficacy 61.38 ± 9.50 to 65.56 ± 10.89 (p = 0.020) and a significant decrease in apnea-hypopnea index (AHI) 19.51 ± 11.41 to 14.11 ± 9.13 (p = 0.039), daytime sleepiness 9.88 ± 3.84 to 7.56 ± 3.42 (p = 0.028), snoring intensity 5.57 ± 3.13 to 4.44 ± 2.68 (p = 0.008), and dry mouth 6.44 ± 3.14 to 3.63 ± 2.33 (p = 0.005), compared to the baseline. No significant change in lowest SaO2 (p = 0.969), sleep quality (p = 0.307), and snoring frequency (p = 0.321) during the study period., Conclusions: The intensive and interactive intervention of MTSP improved the self-efficacy of OSA patients, and consequently, resulted in sign and symptom relief, such as AHI, daytime sleepiness, snoring and dry mouth. The MTSP was dedicated to the nurse practitioner to improve the way to dispense the MT. This research has implications for the successful treatment of OSA.

Objectives: "Second victims" are defined as healthcare professionals whose wellness is influenced by adverse clinical events. The Second Victim Experience and Support Tool (SVEST) was used to measure the second-victim experience and quality of support resources. Although the reliability and validity of the original SVEST have been validated, those for the Korean tool have not been validated. The aim of the study was to evaluate the psychometric properties of the Korean version of the SVEST., Methods: The study included 305 clinical nurses as participants. The SVEST was translated into Korean via back translation. Content validity was assessed by seven experts, and test-retest reliability was evaluated by 30 clinicians. Internal consistency and construct validity were assessed via confirmatory factor analysis. The analyses were performed using SPSS 23.0 and STATA 13.0 software., Results: The content validity index value demonstrated validity; item- and scale-level content validity index values were both 0.95. Test-retest reliability and internal consistency reliability were satisfactory: the intraclass consistent coefficient was 0.71, and Cronbach α values ranged from 0.59 to 0.87. The CFA showed a significantly good fit for an eight-factor structure (χ = 578.21, df = 303, comparative fit index = 0.92, Tucker-Lewis index = 0.90, root mean square error of approximation = 0.05)., Conclusions: The K-SVEST demonstrated good psychometric properties and adequate validity and reliability. The results showed that the Korean version of SVEST demonstrated the extent of second victimhood and support resources in Korean healthcare workers and could aid in the development of support programs and evaluation of their effectiveness.

People with Parkinson's disease (PD) reported to experience uncertainty because of gradually progressive disease characteristics with no cure, and variably manifesting and unpredictable symptoms. This study was designed to identify illness-related variables influencing uncertainty in PD patients and to analyze direct and indirect paths between these variables. Data were collected from 206 participants using a structured questionnaire. Path analysis revealed the direct and/or indirect effects of economic status, disease severity, social support, and resilience on uncertainty in people with PD. Disease severity, social support, and resilience were shown to have significant direct effects on uncertainty. Economic status and disease severity had indirect effects on uncertainty, which were mediated by social support. Disease severity and social support also had indirect effects on uncertainty, which were mediated by resilience. Therefore, the efforts of health care professionals should be directed not only toward managing PD symptoms, but also toward facilitating social support and resilience.

Objective: Early warning systems (EWSs) are an integral part of processes that aim to improve the early identification and management of deteriorating patients in general wards. However, the widespread implementation of these systems has not generated robust data regarding nurses' clinical performance and patients' adverse events. This review aimed to determine the ability of EWSs to improve nurses' clinical performance and prevent adverse events among deteriorating ward patients., Method: The PubMed, CINAHL, EMBASE, and Cochrane Library databases were searched for relevant publications (January 1, 1997, to April 12, 2017). In addition, a grey literature search evaluated several guideline Web sites. The main outcome measures were nurses' clinical performance (vital sign monitoring and rapid response team notification) and patients' adverse events (in-hospital mortality, cardiac arrest, and unplanned intensive care unit [ICU] admission)., Results: The search identified 888 reports, although only five studies fulfilled the inclusion criteria. The findings of these studies revealed that EWSs implementation had a positive effect on nurses' clinical performance, based on their frequency of documenting vital signs that were related to the patient's clinical deterioration. In addition, postimplementation reductions were identified for cardiac arrest, unplanned ICU admission, and unexpected death., Conclusions: It seems that EWSs can improve nurses' clinical performance and prevent adverse events (e.g., in-hospital mortality, unplanned ICU admission, and cardiac arrest) among deteriorating ward patients. However, additional high-quality evidence is needed to more comprehensively evaluate the effects of EWSs on these outcomes.

Background: The importance of the role of clinical nursing leaders as Evidence-based Practice (EBP) mentors has increased; however, information regarding their experiences is limited. Aims: This study aimed to explore EBP mentors' lived experiences. Design: This qualitative study used a phenomenological framework suggested by Colaizzi. Methods: The participants were seven EBP mentors working as unit managers in Korea. Data were collected via in-depth, semi-structured interviews. Findings: The experiences of EBP mentors were identified to three categories: 'challenges in taking on the new role of EBP mentor', 'forming intimate EBP mentor-staff nurse relations' and 'becoming independent as a facilitator'. The EBP mentors experienced role ambiguity, stress, and burden during the initial phase of EBP mentorship; however, they adjusted and reported positive experiences during the adjustment process. Conclusion: Before implementation an EBP initiative, systematic and educational programs that target the EBP mentors should be offered. A systematic approach to creating an institutional culture of EBP are also needed.

Purpose: Comprehensive Primary Care Plus (CPC+) is the largest test of primary care payment and delivery reform. This program aims to strengthen primary care via enhanced and alternative payment, data feedback, learning, and health information technology support for practice transformation for more than 3,000 practices. We analyzed participation rates and how CPC+ practices differ from other primary care practices in CPC+ regions., Methods: We assembled a unique data set describing all US primary care practices and compared primary care practices in CPC+ regions, CPC+ applicants, and CPC+ participants. Among CPC+ participants, we compared across 2 model tracks., Results: Of the primary care practices in CPC+ regions, 22% applied for CPC+ and 15% participated. Practices that applied to CPC+ were diverse, but they were generally larger, more sophisticated electronic health record users, more likely to be owned by a hospital or health system, more likely to have experience with transformation efforts, and more likely to be in urban areas than practices that did not apply. Applicants also generally served slightly healthier and more advantaged Medicare fee-for-service beneficiaries. Differences between practices that applied but did not join CPC+ and CPC+ participants were smaller yet systematic., Conclusions: Participants in CPC+ are diverse but not representative of all primary care practices, underscoring the need to further engage practices that are small, independent, in rural areas, and lack experience with practice and payment transformation models, as well as the need to extrapolate evaluation results carefully., (© 2020 Annals of Family Medicine, Inc.)

Aim: To develop a multimodality simulation program for hospital nurses to enhance their disaster competency and evaluate the effect of the program., Methods: The program implementation started in October 2016 and ended in December 2016. It was developed using the ADDIE model (analysis, design, development, implementation, and evaluation). Evaluation consisted of formative assessment and summative assessment. Formative assessment was performed during triage, crisis management, and problem-solving simulation programs through direct feedback and debriefing from the teacher. Summative assessment was performed using the Kirkpatrick curriculum evaluation framework., Results: Needs assessment using the modified Delphi survey resulted in these competencies for hospital disaster nursing: triage, incident command, surge capacity, life-saving procedures, and special situations. Each competency was matched with the appropriate simulation modalities. A total of 40 emergency nurses participated in the study program. The evaluation of the program resulted in improvement in perception, crisis management, problem solving, and technical skills in disaster nursing., Conclusion: Multimodality simulation training program was developed to enhance the competency of hospital nurses in disaster response. All participants improved their disaster response competencies significantly. The program that was developed in this study could be used as a fundamental tool in future research in disaster curriculum development., (© 2020 John Wiley & Sons Australia, Ltd.)

Health-related quality of life is an important aspect of migrant workers' overall well-being and adaptation. The aims of this study were to develop a structural model and test the health-related quality of life among migrant workers. A cross-sectional study design was used, and data were collected from 228 migrant workers from China who are currently living in Korea and using the services of free clinics for health issues. The structured questionnaire disseminated for the study was designed to measure health-related quality of life, health-promotion behaviors, barriers, resources, and perceptual factors. Structural equation modeling was used to test the hypotheses. Health-promotion behaviors and self-efficacy have significant positive direct effects on health-related quality of life, and acculturative stress has a significant negative direct effect on health-related quality of life. These findings suggest that certain strategies are needed for developing health-promotion programs aimed at the betterment of migrant workers' health-related quality of life. Specifically, health-promotion behaviors and self-efficacy among migrant workers should be encouraged, and strategies for decreasing their acculturative stress should be formulated., (© 2019 John Wiley & Sons Australia, Ltd.)

Cardiovascular disease is a leading cause of mortality in the United States. This study examined the cardiovascular disease risk factors and health beliefs of workers for the purpose of developing a social network service (SNS)-based (e.g., Facebook and KakaoTalk) lifestyle-modification program for workers. Participants included 68 hospital workers (aged 25-60 years), with more than two metabolic syndrome or cardiovascular disease risk factors. Participants were randomly assigned to one of three groups: SNS intervention group ( n = 23), education-only intervention group ( n = 19), or nonintervention group ( n = 26). Data were collected to compare changes in risk indicators according to the intervention method and time and analyzed using repeated-measures analyses of variance. Compared to the education and nonintervention groups, the SNS intervention group demonstrated significant improvements in waist circumference, body mass index, total cholesterol, low-density lipoprotein cholesterol, health promotion behaviors, and self-efficacy. This type of program has potential for allowing occupational health professionals to work with workers to improve lifestyle behaviors that promote health and reduce the risk of cardiovascular disease.