Kyoung Ja Moon

Background: Delirium is common among older adults, particularly those with cognitive impairment. However, delirium among patients with dementia or mild cognitive impairment (MCI) in long-term care (LTC) hospitals has received limited attention. Objective: This study aimed to examine delirium occurrence and associated factors among patients with dementia or MCI in LTC hospitals. Methods: This cross-sectional study included 142 patients aged 65 years or older with dementia (n=100, 70.4%) or MCI (n=42, 29.6%) at 2 LTC hospitals in South Korea between September 2021 and August 2022. Delirium occurrence was defined as at least 1 positive Short Confusion Assessment Method assessment during twice-daily assessments over 4 weeks, including the first assessment. Multivariable logistic regression examined associated factors overall and within each cognitive group. Results: Delirium was identified in 55 (38.7%) of 142 patients. The proportion was 41% (41/100) in patients with dementia and 33.3% (14/42) in patients with MCI. Hypoactive delirium was the most common subtype (33/55, 60%). Overall, female sex (adjusted odds ratio [aOR] 4.344, 95% CI 1.794-10.515; P=.001), immobility (aOR 4.953, 95% CI 1.857-13.205; P=.001), and analgesic use (aOR 3.641, 95% CI 1.262-10.501; P=.02) were associated with delirium. Infection was inversely associated with delirium (aOR 0.251, 95% CI 0.101-0.623; P=.003). In patients with dementia, female sex, immobility, analgesic use, and pain were associated with delirium. Diaper use was associated with delirium in patients with MCI. Conclusions: Delirium was common among patients with dementia or MCI in LTC hospitals. The findings support regular delirium assessment, with attention to mobility and pain-related care needs. Further studies are needed to clarify the factors associated with delirium in each cognitive group.

Purpose: This study investigated the effects of need satisfaction, job crafting, and the nursing practice environment on retention intention among advanced beginner-stage nurses. Methods: Data were collected from 194 advanced beginner-stage nurses working at one university hospital in Chungcheongnam-do and two general hospitals in Gyeongsangbuk-do. The data were analyzed using descriptive statistics, the t-test, analysis of variance (ANOVA), Pearson’s correlation coefficients, and multiple regression analysis using IBM SPSS version 25.0. Results: The mean score for retention intention among advanced beginner stage nurses was 4.96 out of a possible 8 points. Factors associated with retention intention were need satisfaction (β=.47, p<.001), and job crafting (β=.23, p=.001), and gender (female; β=.16, p=.004). These variables explained 38% of the variance in retention intention in the regression model (F=31.38, p<.001). Conclusion: The findings suggest that improving need satisfaction and enhancing job crafting may increase retention intention among advanced beginner-stage nurses. The development of job-crafting enhancement programs, along with organizational initiatives that support job crafting and establish nursing policies aligned with these efforts, may contribute to improved nurse retention.

Purpose: Behavioral and psychological symptoms of dementia (BPSD) and delirium superimposed on dementia (DSD) can lead to severe complications if they are not accurately identified and managed. Effective dementia care therefore requires clear differentiation, systematic assessment, and appropriate nursing interventions. This study aimed to develop VRDementia: BPSD/DSD, a virtual reality simulation program, and to qualitatively examine its validity and usability as a development-based pilot study. Methods: Using the ADDIE model (Analysis, Design, Development, Implementation, Evaluation), the program was systematically developed. During the analysis phase, qualitative interviews and literature reviews identified educational needs among nurses in long-term care hospitals. Key challenges included distinguishing agitation/aggression (BPSD) from hyperactive DSD, and depression (BPSD) from hypoactive DSD. Based on these findings, four case-based scenarios were created. Content validity and usability were qualitatively evaluated through semi-structured interviews with five experienced nurses (≥5 years of clinical experience). Results: The program consists of four sessions addressing agitation/aggression and depression (BPSD), and hyperactivity and hypoactivity (DSD). Nurses practice symptom assessment, therapeutic communication, physician reporting, and nursing interventions. The simulation is accessible via head-mounted display (HMD), mobile devices, and PC (including laptops). Qualitative feedback indicated that participants perceived the program as useful and applicable for dementia care education, including its potential use in interdisciplinary training contexts. Conclusion: VRDementia: BPSD/DSD is a valid, practical educational tool that improves nurses’ competence in distinguishing and managing BPSD and DSD. This program may contribute to higher quality dementia care in clinical settings.

BACKGROUND Delirium is common among older adults, particularly those with cognitive impairment. However, delirium among patients with dementia or mild cognitive impairment (MCI) in long-term care (LTC) hospitals has received limited attention. OBJECTIVE This study aimed to examine delirium occurrence and associated factors among patients with dementia or MCI in LTC hospitals. METHODS This cross-sectional study included 142 patients aged 65 years or older with dementia (n=100, 70.4%) or MCI (n=42, 29.6%) at 2 LTC hospitals in South Korea between September 2021 and August 2022. Delirium occurrence was defined as at least 1 positive Short Confusion Assessment Method assessment during twice-daily assessments over 4 weeks, including the first assessment. Multivariable logistic regression examined associated factors overall and within each cognitive group. RESULTS Delirium was identified in 55 (38.7%) of 142 patients. The proportion was 41% (41/100) in patients with dementia and 33.3% (14/42) in patients with MCI. Hypoactive delirium was the most common subtype (33/55, 60%). Overall, female sex (adjusted odds ratio [aOR] 4.344, 95% CI 1.794-10.515; P=.001), immobility (aOR 4.953, 95% CI 1.857-13.205; P=.001), and analgesic use (aOR 3.641, 95% CI 1.262-10.501; P=.02) were associated with delirium. Infection was inversely associated with delirium (aOR 0.251, 95% CI 0.101-0.623; P=.003). In patients with dementia, female sex, immobility, analgesic use, and pain were associated with delirium. Diaper use was associated with delirium in patients with MCI. CONCLUSIONS Delirium was common among patients with dementia or MCI in LTC hospitals. The findings support regular delirium assessment, with attention to mobility and pain-related care needs. Further studies are needed to clarify the factors associated with delirium in each cognitive group.

Purpose: This scoping review aimed to explore the characteristics and educational effects of game-based virtual reality (VR) programs used in nursing education, providing foundational insights for future instructional design and research. Methods: Following the Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist, a comprehensive literature search was conducted across eight databases for studies published between April 2014 and March 2025. Studies were screened and selected using the population, concept, context framework. Twenty-four studies met the inclusion criteria and were analyzed. Results: Most of the 24 included studies targeted nursing students, with some involving practicing nurses. Interventions primarily employed immersive VR head-mounted displays and incorporated diverse game elements such as mission-based scenarios, challenges, feedback loops, and virtual patient interactions. Educational effects were categorized into cognitive, affective, and psychomotor domains. Improvements in knowledge acquisition, self-efficacy, learning motivation, and skill performance were consistently reported. Additionally, most studies reported enhanced learner satisfaction, engagement, and emotional immersion. However, limited evidence was found regarding teamwork and communication skills. Conclusion: Game-based VR programs show substantial potential as effective instructional strategies in nursing education. Their design features—including immediate feedback, repeatable immersive scenarios, and engaging game mechanics—support learner-centered and self-directed learning. Nevertheless, the current evidence base largely focuses on nursing students and short-term outcomes. Future studies should encompass diverse nursing populations and assess long-term effects and real-world applicability, particularly in team-based and clinical practice contexts.

Purpose: Given managing blood sugar levels is crucial for preventing complications in diabetes, development of an effective diabetic program is essential. Incorporating games into nursing education has been considered as a strategy to enhance motivation and active participation. This pilot study aimed to develop and implement a diabetes simulation program using escape rooms. Methods: This program was designed the program title, educational objectives, and educational operation methods. Participants included 30 third- and fourth-year nursing students. They completed missions involving solving puzzles, f inding passwords, and locating answer cards across three rooms themed around understanding, treating, and managing the lifestyle habits associated with diabetes. After completing the escape rooms, data were collected through telephone interviews with eight participants. The experiences and perceptions of the program were analyzed using the phenomenological approach. Results: We found three key themes: collaborating with team members, new learning methods for major subjects, and expectations for broader applications of escape rooms in nursing education. Conclusion: The escape room approach is an effective nursing education method that enhances learners’ motivation and satisfaction. Further studies with larger sample sizes are needed to validate these findings and evaluate their broader applicability.

Mild cognitive impairment (MCI) is a major risk factor for delirium. Few studies with mid- to long-term follow-up periods have examined delirium, MCI, and the conversion of MCI to dementia. This prospective, longitudinal cohort study aims to assess the incidence of dementia after delirium onset in patients with MCI and to develop an artificial intelligence algorithm for predicting the conversion of MCI to dementia. A 30-day evaluation for delirium will be performed for adults aged ≥ 65 years diagnosed with MCI who score 18–23 on the Korean Mini-Mental State Exam. Individuals exhibiting delirium at least once will be classified into the delirium group and the remainder into the non-delirium group. Over 3 years, patients will undergo follow-ups for survival and conversion to dementia at 30-day intervals to analyze risk factors for delirium and clinical outcomes. Differences between the two groups will be analyzed using the chi-square and independent t-tests. Kaplan-Meier survival and Cox proportional hazard regression will be used to assess the effects on 30-day, 60-day, 12-month, 24-month, and 36-month mortality, whereas linear regression will be used to assess the length of stay at long-term care facilities and medical costs. The results will emphasize the importance of preventing delirium in MCI patients, and preventive interventions can be strengthened. NCT05113446 (ClinicalTrials.gov). Registered 9 November 2021 - Retrospectively registered.

Background: Pressure ulcers (PUs) are a common and serious complication in patients who are immobile in health care settings. Nurses play a fundamental role in the prevention of PUs; however, novice nurses lack experience in clinical situations. Virtual reality (VR) is highly conducive to clinical- and procedure-focused training because it facilitates simulations. Objective: We aimed to explore the feasibility of a novel PU management VR simulation (PU-VRSim) program using a head-mounted display for novice nurses and to investigate how different types of learning materials (ie, VR or a video-based lecture) impact learning outcomes and experiences. Methods: PU-VRSim was created in the Unity 3D platform. This mixed methods pilot quasi-experimental study included 35 novice nurses categorized into the experimental (n=18) and control (n=17) groups. The PU-VRSim program was applied using VR in the experimental group, whereas the control group received a video-based lecture. The PU knowledge test, critical thinking disposition measurement tool, and Korean version of the General Self-Efficacy Scale were assessed before and after the intervention in both groups. After the intervention, the experimental group was further assessed using the Clinical Judgment Rubric and interviewed to evaluate their experience with PU-VRSim. Results: The results compared before and after the intervention showed significant improvements in PU knowledge in both the experimental group (P=.001) and control group (P=.005). There were no significant differences in self-efficacy and critical thinking in either group. The experimental group scored a mean of 3.23 (SD 0.44) points (accomplished) on clinical judgment, assessed using a 4-point scale. The experimental group interviews revealed that the VR simulation was realistic and helpful for learning about PU management. Conclusions: The results revealed that PU-VRSim could improve novice nurses’ learning of PU management in realistic environments. Further studies using VR for clinical training are recommended for novice nurses.

Nurses work in close proximity to patients, and as such, they can have a direct impact on the control of infections; thus, it is important for nurses to be competent in infection control. However, the scales used to measure infection control performance in nurses are not suitable for measuring infection control competencies that reflect nurses’ expertise, clinical environment, and work. Thus, this study aimed to develop a valid and reliable measure to assess infection control competency of clinical nurses. A concept analysis, using a hybrid model, was performed on the infection control competency of clinical nurses to confirm the components and develop 67 initial items. Ten experts evaluated the content validity of these items, and a Korean language expert and a Doctor of Nursing reviewed the questions to consolidate them into 59 items. Subsequently, 267 nurses working at a certified tertiary hospital in D City were surveyed to confirm the validity and reliability of the scale. As a result of the study, the final scale comprising seven factors and 33 questions was derived, and the cumulative explanatory power of these factors was 60.8%. To verify convergent and discriminant validity, confirmatory factor analysis was conducted, and the average variance extraction index, composite reliability values, and confidence interval of the correlation coefficient between factors were confirmed. Convergent and discriminant validities were verified by comparison with standard values. The Cronbach’s α for the entire scale in this study was 0.93. Consequently, the validity and reliability of the clinical nurses’ infection control competency measurement scale were verified. The validity and reliability of the infection control competency measurement scale for clinical nurses (ICCS-CN) developed in this study was verified, and the scale can be effectively used to measure the infection control competency of clinical nurses. Measuring the infection control competency of clinical nurses will help reduce the harm caused by infection and ensure patient safety by decreasing infection rates in medical institutions.

Purpose: Patients with cancer experience psychological and social problems; in particular, older patients with cancer face many difficulties during the cancer treatment process owing to aging and underlying diseases. Furthermore, the lives of individuals may be impacted by the COVID-19 pandemic. Therefore, the purpose of this study is to describe the experiences of older patients with cancer during the cancer diagnosis and treatment process amid the COVID-19 pandemic. Methods: This study employed a qualitative, descriptive phenomenological approach to explore and analyze the experiences of the participants. The participants in this study consisted of patients aged over 65 who were diagnosed with cancer, and data were collected from May 4 to June 30, 2022 through in-depth individual interviews. The collected data were analyzed using Giorgi’s phenomenological analysis. Results: Participants were six older patients with cancer with an average age of 69.66 years. Five theme clusters and 15 themes were generated. The theme clusters were “psychological adaptation to cancer diagnosis,” “receiving social and medical support,” “difficulty in the treatment process,” “fear of the COVID-19 pandemic,” and “living through difficulties.” Conclusion: This study revealed that older patients with cancer demonstrated a unique psychology about how to accept the shock of the diagnosis and the resulting coping patterns and feelings of depression. Additionally, it was verified that older patients with cancer, susceptible to infections due to their advanced age and weakened immunity, also face an increased vulnerability to COVID-19. Therefore, a support system tailored to the characteristics of older patients with cancer should be established.