Eun Kyeung Song

SD: Standard deviation,

Background: The prevalence and mortality rates of cardiovascular diseases have been consistently high over the past 10 years in Ulsan, South Korea. Given the importance of social determinants in cardiovascular health, it is imperative to determine clusters with social determinants by a cluster analysis and their relationships with cardiovascular health. Objective: The aims of this study were to identity clusters with distinct social determinants and to compare cardiovascular health among the identified clusters. Methods: Social determinants (age, sex, job, education, monthly income, living location, medical institution usage, and experience of public resources), awareness and knowledge of stroke and myocardial infarction warning symptoms, health behaviors, and current history of hypertension, diabetes, and dyslipidemia were obtained from 1224 adults dwelling in Ulsan. A two-step cluster analysis, χ ² test, and logistic regressions were used for data analysis. Results: Three clusters were identified and named “middle-aged male workers” (n = 379, 31.0%), “young professionals” (n = 482, 39.4%), and “older female dependents” (n = 363, 29.7%). Among the 3 clusters, there were significant differences in self-reported awareness of stroke and myocardial infarction warning symptoms, smoking, alcohol consumption, and eating habits related to salt intake (all P s ≤ .001). In logistic regressions, “middle-aged male workers” versus “young professionals” had an odds ratio of 6.41 ( P < .001) for hypertension and a 6.30 for diabetes ( P < .001), whereas odds ratios for “older female dependents” versus “young professionals” were 10.23 for hypertension ( P < .001), 7.64 for diabetes ( P < .001), and 5.04 for dyslipidemia ( P < .001). Conclusions: Understanding subgroups vulnerable to cardiovascular health with distinct social determinants should be prioritized, and on the basis of this, a public health promotion program is warranted.

Background: The theory of planned behavior is a conceptual framework of recent studies to identify and explain nurses’ intentions to care for patients with emerging infectious diseases. However, correlations between behavioral intentions and variables that explain them have been inconsistent in previous studies. The influence of new variables might be considered in this case. This study aimed to determine moderating effects of ethical nursing competence on nurses’ intention to care for COVID-19 patients in hospitals dedicated to infectious diseases based on the theory of planned behavior. Methods: A cross-sectional survey was conducted. Data on intention to care for COVID-19 patients, perceived behavioral control, attitude toward the behavior, subjective norm, and ethical nursing competence were obtained from 190 nurses in three hospitals dedicated to infectious diseases in South Korea. The moderating effect of ethical nursing competence was analyzed using model I of PROCESS Macro. Ethical considerations: This study was approved by the Institutional Review Board of Ulsan University Hospital, South Korea. Written informed consent was obtained from each subject. Results: The ethical nursing competence was a significant moderator in the relation between perceived behavioral control and the intention to care (B = 0.36, t = 2.16, p = 0.032). Ethical nursing competence did not have a significant interaction with attitude toward behavior or subjective norm. Conclusions: This study showed that the higher the ethical nursing competence level, the greater the effect of perceived behavioral control on nurses’ intention to care for COVID-19 patients. Promoting ethical nursing competence is necessary for nurses who would take care of patients at the frontline of the infectious disease pandemic. Nursing managers should include ethical nursing competence in the assessment of nurses’ competence and design educational programs to enhance ethical nursing competence for efficient nursing staffing during a pandemic.

최아영, et al. J Korean Acad Nurs. 2024 Feb;54(1):32-43. https://doi.org/10.4040/jkan.23082

Background: Burnout negatively impacts the personal and professional life of nurses. Job stress and resilience have been determined to be associated with nurse burnout. Given the importance of communication competence in operating room (OR) nurses, the associations of job stress, resilience, and communication competence with burnout have not been examined. Purpose: To determine the relationships of job stress, resilience, and communication competence to burnout of OR nurses in South Korea. Methods: This was a cross-sectional, descriptive study of 146 OR nurses. A series of self-reported questionnaires was used to assess job stress, resilience, communication competence, and burnout. Pearson correlation coefficient and a hierarchical linear regression were used for data analysis. Results: Communication competence was correlated with resilience (r = 0.65, p < .001) and burnout (r = -0.44, p < .001), and resilience was correlated with burnout (r = -0.48, p < .001). Resilience (β = -0.22, p = .027) and communication competence (β = -0.33, p < .001) were associated with burnout of OR nurses in a hierarchical linear regression (F = 6.28, p < .001). Conclusions: Increased resilience and communication competence were associated with lower burnout of perioperative nurses. To prevent and reduce burnout of OR nurses, it is necessary to develop and implement a program targeting for communication competence and resilience. Implications for nursing management: Nurse leaders should provide programs fostering communication competence and resilience to OR nurses and encourage them to actively participate in such job trainings.

Aim This study determined the relationships of satisfaction and frustration with basic psychological needs, organizational commitment, perceived authentic leadership, and turnover intention in nurses in South Korea. Background Minimizing nurse turnover is essential for improving the quality of nursing care and patient safety. Methods This was a cross-sectional, correlational pilot study of 216 nurses at a university hospital in South Korea. Data were collected with a self-report questionnaire, from September 1 to 15, 2020. Collected data were analyzed using SPSS 24.0. Results Multiple regression analysis revealed that clinical experience (3 to 5 years, β=2.35, p=.019; 5 to 10 years, β=2.23, p=.026), subjective workload (severe, β= 2.10, p=.036; extreme, β=2.84, p=.005), psychological needs frustration (β=0.35, p<.001), organizational commitment (β=-0.17, p=.011), and perceived authentic nurse leadership (β=-0.14, p=.030) were found to have significant effects on nurses’ turnover intention. Conclusions A strategy is needed for efficient nursing staffing management and reduction of nurses’ turnover intentions. Implications for Nursing Management This study offers a new approach to reducing nurses’ turnover. The results suggest that it is necessary to create a transparent work environment based on authentic leadership and consider individual frustrations with regard to basic psychological needs and organizational commitments.

허예지, et al. Korean J Adult Nurs. 2020 Oct;32(5):539-549. https://doi.org/10.7475/kjan.2020.32.5.539

Background: Depressive symptoms and vitamin D deficiency predict cardiac events in heart failure patients, but whether vitamin D supplements are associated with depressive symptoms and cardiac events in heart failure patients remains unknown. Purpose: The purpose of this study was to compare the association of vitamin D supplement use with depressive symptoms and cardiac events in heart failure patients with mild or moderate to severe depressive symptoms. Methods: A total of 177 heart failure patients with depressive symptoms (Patient Health Questionnaire-9 score 5) completed a three-day food diary to determine dietary vitamin D deficiency. Patients were split into four groups by dietary vitamin D adequacy versus deficiency and vitamin D supplement use versus non-use. The Patient Health Questionnaire-9 was used to reassess depressive symptoms at six months. Data on cardiac events for up to one year and vitamin D supplement use were obtained from patient interview and medical record review. Hierarchical linear and Cox regressions were used for data analysis. Results: Sixty-six patients (37.3%) had dietary vitamin D deficiency and 80 (45.2%) used vitamin D supplements. In patients with moderate to severe depressive symptoms, the group with dietary vitamin D deficiency and no supplements had the highest Patient Health Questionnaire-9 score at six months (=0.542, p<0.001) and shortest cardiac event-free survival (p<0.001) among the four groups, the group with dietary vitamin D deficiency and no supplements didn't have the highest Patient Health Questionnaire-9 score at six months and shortest cardiac event-free survival in patients with mild depressive symptoms. Conclusions: Vitamin D supplements predicted lower depressive symptoms and reduced cardiac events for patients with moderate to severe depressive symptoms. Vitamin D deficiency was associated with higher risk of shorter cardiac event-free survival in heart failure patients regardless of vitamin D supplementation.

Vitamin C is related to lower levels of high-sensitivity C-reactive protein (hsCRP), an inflammatory biomarker that predicts cardiovascular disease. Whether vitamin C deficiency is associated with hsCRP and cardiac events in heart failure (HF) patients has not been examined. The aim of this study is to determine the relationships among vitamin C intake, serum levels of hsCRP, and cardiac events. A total of 200 HF patients completed a 3-day food diary to determine vitamin C deficiency and provided blood to measure serum levels of hsCRP. Patients were followed for 2 years to obtain data on cardiac event-free survival. Moderation analyses with hierarchical logistic and Cox regressions were used for the data analysis. Seventy-eight patients (39%) had vitamin C deficiency and 100 (50%) had an hsCRP level higher than 3 mg/L. Vitamin C deficiency was associated with an hsCRP level higher than 3 mg/L in the hierarchical logistic regression (odds ratio, 2.40; 95% confidence interval, [1.13–5.10]; P = .023). Vitamin C deficiency (hazard ratio, 1.68; 95% CI, 1.05–2.69, P = .029) and hsCRP level higher than 3 mg/L (hazard ratio, 1.79; 95% CI, 1.07–3.01; P = .027) predicted shorter cardiac event-free survival in hierarchical Cox regression. The interaction of hsCRP level higher than 3 mg/L and vitamin C deficiency produced a 2.3-fold higher risk for cardiac events (P = .002) in moderation analysis. Higher level of hsCRP predicted shorter cardiac event-free survival only in patients with vitamin C deficiency (P = .027), but not in those with vitamin C adequacy. Vitamin C deficiency moderated the relationship between inflammation and cardiac events in patients with HF. Future study is required to determine whether adequate intake of vitamin C could play a protective role against the impact of inflammation on cardiac events in HF patients.

Background: Despite growing evidence on the important role of micronutrients in prognosis of heart failure (HF), there has been limited research that micronutrient deficiency predicts health outcomes in patients with HF. Purpose: The aim of this study was to determine whether micronutrient deficiency independently predicts adverse health outcomes. Methods: A total of 113 consecutive outpatients with HF completed a 3-day food diary to measure intake of 15 micronutrients. The Computer Aided Nutrition Analysis Program for Professionals was used to analyze the food diaries and determine dietary micronutrient deficiencies. Patients completed the Minnesota Living With HF Questionnaire to assess health-related quality of life (HRQoL) and were followed up for 1 year to determine cardiac-related hospitalization or cardiac death. Hierarchical multiple linear regressions and Cox proportional hazard regressions were used to determine whether micronutrient deficiencies predicted health outcomes. Results: Fifty-eight patients (51%) had at least 3 micronutrient deficiencies (range, 0–14). Calcium, magnesium, and vitamin D were the most common micronutrient deficiencies. Micronutrient deficiency was independently associated with worse HRQoL (β = .187, P = .025) in hierarchical multiple linear regression. Thirty-nine patients were hospitalized or died during 1-year follow-up because of cardiac problems. The number of micronutrient deficiencies independently predicted cardiac event–free survival (hazard ratio, 1.14; 95% confidence interval, 1.02–1.28). Conclusions: These findings show that micronutrient deficiency independently predicted poor HRQoL and earlier cardiac event–free survival in patients with HF. Further research is needed to provide for specific dietary guidelines for better health outcomes in HF patients.