Sun-Kyung Hwang

Purpose: This review aimed to analyze the use of behavior change techniques (BCTs) and the degree of theory implementation using a theory coding scheme (TCS) in mobile self-management interventions for type 2 diabetes mellitus (T2DM). Methods: In this scoping review, four electronic databases (PubMed, EMBASE, CINAHL, and CENTRAL) and gray literature sources were searched. Studies were independently screened according to predefined criteria. The BCT taxonomy was used to categorize techniques, and the TCS was applied to evaluate the quality of theory implementation. Results: Seventeen randomized controlled trials were included. Twenty-five unique BCTs were identified (mean, 8.1 per study). Commonly used BCTs included social support (unspecified) (n=14), instructions on how to perform a behavior (n=14), feedback on behavior (n=11), and prompts/cues (n=11). Techniques related to capability, such as habit formation, rewards, framing/reframing, and verbal persuasion, were rare (n=1 study each). TCS scores ranged from 5 to 15 (mean, 10.3). All included studies cited a theory, used it to select intervention techniques, and employed randomization. However, no study used the findings to refine the theory, and only one conducted a mediational analysis of theoretical constructs. Conclusion: Mobile T2DM self-management interventions commonly rely on a limited range of BCTs and show restricted theoretical application beyond basic implementation. Future interventions should employ a broader array of BCTs and apply theories more rigorously, including tailoring interventions, empirically testing theoretical mechanisms, and refining theories based on results to increase their effectiveness.

Purpose: This study aimed to identify risk factors associated with the readmission of patients with diabetic ketoacidosis (DKA) through a systematic review and meta-analysis.Methods: A systematic literature review was conducted in accordance with the PRISMA guidelines. Relevant studies were retrieved from international databases (PubMed, EMBASE, Cochrane Library, CINAHL, PsycINFO, and Web of Science) and Korean databases (RISS, KoreaMed, KMbase, KISS, and DBpia). Study quality was evaluated using the Newcastle-Ottawa Scale. Meta-analysis was performed using a random-effects model with the Hartung-Knapp-Sidik-Jonkman adjustment to account for the limited number of studies and heterogeneity.Results: Fifteen studies were included in the review, and eight were eligible for meta-analysis. From the systematic review, 21 risk factors for DKA readmission were identified and categorized into five domains: demographic, socioeconomic, diabetes-related, comorbidity, and health-behavioral factors. In the meta-analysis, significant risk factors included low income, psychiatric disorders, and discharge against medical advice.Conclusion: This study demonstrates that DKA readmissions result from the complex interplay of multiple clinical and social factors. By identifying these risk factors and suggesting risk-stratification criteria, the findings may support the development of tailored interventions, such as self-management education, integrated mental health care, structured discharge planning, and coordinated post-discharge follow-up.

Purpose : This study aimed to evaluate the reliability and validity of three nonverbal pain assessment tools—Checklist of Nonverbal Pain Indicators (CNPI), Pain Assessment in Advanced Dementia (PAINAD), and Critical-Care Pain Observation Tool-Neuro (CPOT-Neuro)—in brain-injured patients. Methods : This exploratory study included 70 patients with brain injury from a university hospital in Busan and assessed the validity, sensitivity, specificity, and inter-rater reliability of three pain assessment tools. Results : Criterion validity was supported by significant correlations with the Behavioral Pain Scale (BPS) (rs=.47∼.96 for CNPI, rs=.66∼.97 for PAINAD, rs=.80∼.97 for CPOT-Neuro, p ＜.001). Significant differences in pain scores were observed across all three tools before, during, and 20 minutes after suctioning, position changes, and noninvasive blood pressure measurements (p ＜.001). The sensitivity, specificity, and accuracy of each tool were evaluated using receiver operating characteristic (ROC) curve analysis. At moderate pain levels, all three tools showed good overall accuracy, with areas under the ROC (AUROC) ranging from .80 to .90. Inter-rater reliability was high, with intraclass correlation coefficient (ICC) values exceeding .90 for all tools. Conclusion : All three tools effectively assessed nonverbal pain in brain-injured patients. Among them, CPOT-Neuro demonstrated particularly strong validity and reliability, indicating its suitability for clinical use. Further research is needed to identify the optimal tool according to patient characteristics and clinical context.

Choi J, et al. Korean J Adult Nurs. 2024 Feb;36(1):63-73. https://doi.org/10.7475/kjan.2024.36.1.63

Purpose : This study aimed to examine the relationship between sleep quality and its influencing factors in patients with coronary artery disease (CAD).Methods : This descriptive correlational study included 130 patients with CAD admitted to the cardiology department of a general hospital in B City between September 2019 and February 2020. Data were collected using structured questionnaires and research instruments to measure sleep quality, anxiety, depression, chronotype, and daytime sleepiness.Results : The mean scores for sleep quality, daytime sleepiness, anxiety, and depression were 7.59±3.45, 6.45±3.46, 6.58±3.88, and 7.74±4.05, respectively. In terms of chronotypes, 10.8%, 48.5%, and 40.7% of the participants had evening-, intermediate-, and morning-type patterns, respectively. Sleep quality was significantly correlated with anxiety (r=0.38, p＜.001), depression (r=.37, p＜.001), and daytime sleepiness (r=.26, p =.002). Factors associated with sleep quality in patients with CAD included anxiety (β=.29), heart failure (β=.22), daytime sleepiness(β=.21), and sleeping alone (β=.19). Collectively, these factors had an explanatory power of 23.1% for sleep quality variance.Conclusion: Patients with CAD often experience poor sleep quality owing to various factors such as anxiety, daytime sleepiness, heart failure, and sleeping alone. It is recommended that healthcare providers objectively evaluate sleep and identify factors that influence sleep quality. This will enable the development of effective methods for sleep management as part of nursing care.

Purpose : This study aimed to compare peripheral pulse oxygen saturation (SpO2) values, measured at different monitoring sites, and arterial oxygen saturation (SaO2) of neurocritical patients.Methods : The study included 110 patients admitted to the neurosurgical intensive care unit of a university hospital. The patients’ SpO2 values were measured in their index fingers, both second toes, both earlobes, and foreheads, using the patient monitoring system. These values were compared with the standard value of SaO2 measured using a blood gas analyzer. Data were analyzed using descriptive values, Pearson’s correlation coefficients, Lin’s concordance correlation coefficients (CCC), and Bland-Altman plots.Result : Regardless of the measuring site, SpO2 was correlated with the paired measurements of SaO2 (r=.40~.60, p＜.001, CCC range=.40~.58). No significant bias in paired measurements of SpO2 and SaO2 was observed at all sites (-0.06~0.19%, p＞.05). SpO2 values at the left finger and right earlobe had the narrowest range, with a 95% limits of agreement (LOA) (left finger -3.04~2.93% and right earlobe -3.18~2.79%). SpO2 at the index finger, on the side without an arterial catheter, had a narrower range of 95% LOA than that of the opposing finger (-3.00~2.97% vs. -3.73~3.26%).Conclusion : SpO2 at the finger without an arterial catheter had the highest level of precision. This study suggests using the index finger, on the side without an arterial catheter, for pulse oximetry in neurocritical patients.

Jung S, et al. Korean J Adult Nurs. 2023 May;35(2):85-96. https://doi.org/10.7475/kjan.2023.35.2.85

Rotating shift work places a serious burden on nurses’ physical and psychological health. Gastrointestinal (GI) symptoms are a common complaint among shift workers. This study assessed GI symptoms and identified the associations between dietary habits, psychological status, and sleep quality among rotating shift nurses. Data from 125 female nurses in rotating shifts who worked at two tertiary hospitals in South Korea were collected using a questionnaire that included the Gastrointestinal Symptoms Questionnaire; the Dietary Habit Questionnaire; the Depression, Anxiety, Stress Scale (DASS)-21; and the Pittsburgh Sleep Quality Index (PSQI). All participants experienced various GI symptoms, and 47% of them complained of at least one severe GI symptom. There were significant differences in GI symptom scores according to the status of depression, anxiety, stress, and sleep quality. In multiple linear regression analysis, the factors associated with an increase in the occurrence and severity of GI symptoms were poor sleep quality and morbid anxiety and stress. The model explained power at 43.2%. As most nurses in rotating shifts experience GI symptoms, they should receive counseling and training programs at work to alleviate psychological symptoms, improve sleep quality, and pay more attention to their health status as well as GI symptom management.

조민은, et al. Korean J Adult Nurs. 2021 Feb;33(1):44-55. https://doi.org/10.7475/kjan.2021.33.1.44