A Comparative Study on the Validity of Fall Risk Assessment Scales in Korean Hospitals

김금순,김진아,최윤경,김유정,박미화,김현영,송말순 한국간호과학회 2011 Asian Nursing Research Vol.5 No.1

Purpose The purpose of this study was to compare the validity of three fall risk assessment scales including the Morse Fall Scale (MFS), the Bobath Memorial Hospital Fall Risk Assessment Scale (BMFRAS),and the Johns Hopkins Hospital Fall Risk Assessment Tool (JHFRAT). Methods This study was a prospective validation cohort study in five acute care hospitals in Seoul and Gyeonggi-Do, Korea. In total, 356 patients over the age of 18 years admitted from December 2009 to February 2010 participated. The three fall risk assessment scales listed above were tested for sensitivity,specificity, positive predictive and negative predictive values. A receiver-operating characteristic (ROC)curve was generated to show sensitivities and specificities for predicting falls based on different threshold scores for considering patients at high risk. Results Based on the mean scores of each scale for falls, the MFS at a cut-off score of 50 had a sensitivity of 78.9%, specificity of 55.8%, positive predictive value of 30.8%, and negative predictive value of 91.4%, which were the highest values among the three fall assessment scales. Areas under the curve of the ROC curves were .761 for the MFS, .715 for the BMFRAS, and .708 for the JHFRAT. Conclusions Accordingly, of the three fall risk assessment scales, the highest predictive validity for identifying patients at high risk for falls was achieved by the MFS. [Asian Nursing Research 2011;5(1):28–37]

급성심근경색후에 일상활동정도와 관련 변수에 관한 연구

김금순,박광옥 한국간호과학회 1989 Journal of Korean Academy of Nursing Vol.19 No.1

경관 영양 환자의 간호

김금순 대한간호협회 1991 대한간호 Vol.30 No.5

투약과 수혈간호의 간호과정 적용 평가도구 개발

김금순,김진아,권소희,송말순 병원간호사회 2010 임상간호연구 Vol.16 No.1

Purpose: This study was conducted to develop the nursing process based performance measurement tool and the evidence based care standards for nursing care in medication management and blood transfusion. Methods: The care standards and performance measurement tool were drafted through comprehensive review of relevant literature, national guidelines, hospital protocols, and standards of recognized international accrediting bodies. The proposed care standards and performance measurement tool were reviewed by the panel of experts and refined based on the panel's suggestions. Final care standards and performance measurement tool were validated by surveying the hospital nurses. Results: All items of the performance measurement tool for medication management and blood transfusion were evaluated appropriate. All contents of care standards and the measurable elements except the evaluation of discharge education were appropriate. The performance measurement tool developed in this study was found to be acceptable as a tool to evaluate quality of nursing care in medication management and blood transfusion. Conclusion: The outcomes of this study including the performance measurement tool and evidence based care standards would be the important indicators to monitor whether necessary nursing care is implemented and be the useful primary resources to improve quality of nursing care services.

스트레스와 면역 연구의 간호학적 접근 : 스트레스와 면역에 관한 간호학 논문분석

김금순,김명애,홍혜숙,최명애,서순림,채영란,박금화,이성희,안경애,정재심 서울대학교 간호과학연구소 2002 서울대학교 간호과학연구소 학술대회 자료집 Vol.2002 No.2

재가와상노인 서비스제공 모델 개발을 위한 연구

김금순,서문자,조남옥,김인자 한국간호과학회 2001 Journal of Korean Academy of Nursing Vol.31 No.4

Purpose: This study aims to identify the ADL and IADL of bed-ridden elderly. Also it is used to show fuctional status, and to investigate the content and the level of nursing services provided. Method: The subjects were 191 elderly who received visiting nurse service through public health centers in the Seoul Metopolitan and Chungnam Province. Data collection was conducted by public health center nurses during four months in 2000. Result: As for daily living activities, 100% of subjects had at least one difficulty in ADL and IADL. Among them, only 0.5% had moderate disabilities and 99.5% had severe disabilities by HFS, 27.9% were in a semi bed-ridden state and 72.1% were completely bed-ridden by JABC. The major service provided was a visiting nurse service which was preferable to the social welfare service. In the visiting nurse service, there was no significant difference according to the elderlys' functional status. In addition there was no standadization about the qualification of the visiting nurse, and single entry point for the nursing service. Conclusion: The researchers urgently suggest that a community based comprehensive service model has to be developed to respond to the needs of the elderly in Korea.

장기이식환자의 건강관련 삶의 질

김금순,강지연,정인숙 한국간호과학회 2003 Journal of Korean Academy of Nursing Vol.33 No.3

전문간호사 성과지표에 관한 델파이 조사

김금순,강지연,김복자,이영희,이은남 병원간호사회 2010 임상간호연구 Vol.16 No.1

Purpose: The purpose of this survey was to identify a set of performance indicators for Korean APNs (Advanced Practice Nurses). Methods: A convenience sample of 78 APNs working in 2 leading hospitals in south Korea participated in the three-round Delphi survey. In the first round, subjects were asked to propose performance indicators to evaluate the effectiveness of their practice. They rated the relevancy of each indicator during the second round. In the final round of survey, subjects rated the relevancy of indicators again in the light of second round's overall results and they also were asked to check on current and future use of indicators. Results: After 5 months of three-round Delphi survey, 60 performance indicators were identified. In regard to relevancy, the 10 highly ranked indicators were patient satisfaction, self-care ability, expertise of service, family satisfaction, nurse satisfaction, satisfaction in nursing education, advanced nursing service count, education for patient/ family, education for nurse, and compliance. Advanced nursing service count, education for patient/ family, and education for nurse are currently used as indicators by more than 70% of respondents. Conclusion: Additional research is needed to identify subsets of performance indicators for specialized areas and to determine the validity and sensitivity of indicators.

간호과정 적용 평가도구 개발 : 산소요법과 흡인간호를 중심으로

김금순,최윤경,이정림,안정원,이소림,최원자,김을순 병원간호사회 2013 임상간호연구 Vol.19 No.1

Purpose: This study was conducted to develop standards to ensure nursing process-based care of oxygen therapy and airway suctioning and to develop a performance measurement tool to evaluate the care applied according to the standards, and finally to determine validity of the standards and the tool. Methods: The standards and the tool were reviewed by a panel of experts and refined based on the panel's suggestions. Validity of the standards and the tool were examined through surveying a total of 366 hospital nurses. Results: The mean validity scores of the performance measurement standards and the tool were 3.58 and 3.55, respectively, out of 4.00. So the performance measurement standards and the tool in this study were found to be acceptable in evaluating quality of nursing care provided at patient admission and discharge. Conclusion: This result indicates that the performance measurement standards and the tool developed in this study are valid instruments to monitor and improve quality of nursing care for oxygen therapy and airway suctioning.

The Effect of Preparatory Information on Stress Reduction in Patients Undergoing Cardiac Catheterization

김금순 서울대학교 간호대학 간호과학연구소 1991 간호학 논문집 Vol.5 No.1

Cardiac catheterization, because of its similarity in procedure to that of surgery and due to the fact that a catheter is inserted into the heart during the procedure, causes great anxiety to patients awaiting cardiac catheterization, adding to the psychological stress induced by the procedure itself. Conventionally when preparing for stress-inducing medical procedures, preparatory information has been provided to patients to reduce stress and to enhance their adaptation to the procedure. However, so far, previous research indicates that effects vary according to the content and type of the information and what methods of conveyance are most effective and to define the important variables influencing the effectiveness of the information. The research problem was to study the effect of preparatory information provided by a booklet containing structured preparatory sensory information and instruction one day prior to cardiac catheterization on the subject's stress response by measuring their state anxiety, blood cortisor and behavioral responses further, to analyze the correlations that exist among variables such as coping style, trait anxiety and state anxiety. the purpose was to evaluate the benefits, of this nursing intervention for patients undergoing cardiac catheterization. The theoretical framework for this study borrowed from stress theory considered relevant to the nursing domain(Lazarus and Folkman, 1984 : Scott et al, 1980) and from the theory of nursing intervention of sensory information(Johnson,1972). Within this framework, stress recognition occurs when the discrepancy between experience and expectation, after primary and secondary cognitive appraisal, exceeds the built-in stress-coping resources. As a means to cope with stress, either a problem-focused coping method of emotion-focused coping method is selected. The manifested immediate reaction is an integration of cognitive, emotional, physiological and behavioral responses. Problem-focused coping method is a problem solving process which enhances predictability and control over an unpredictable situation with the aid of structured preparatory sensory information and instruction in a stress situation, therefore contributing to the reduction of stress response. However, a negative effect of the information may manifest itself due to individual differences in coping styles and anxiety level. Several research questions in this study were addressed. Is structured preparatory sensory information and instruction effective in stress reduction? Are state anxiety, blood cortisol and behavioral responses adequate variables to measure the effect of the information? What are some of the individual characteristics that can influence the effect of the information and is there any negative effect deriving from individual characteristics? Specific objectives for the study were 1) to analyze the effect of structured preparatory sensory information and instruction: 2) to analyze the effect of the differences in coping styles and anxiety levels due to individual characteristics : 3) to define the degree of stress before, during and after catheterization. The experimental design used in this study was a non-equivalent control group with a pre-post test design : the independent variable was the structured preparatory sensory information and instruction provided to the subjects : the mediating variable were individual characteristics such as coping styles and anxiety level which may influence the outcome and the dependent variables were state anxiety, blood cortisol and behavioral responses. The subjects were selected among patients scheduled for cardiac catheterization in the internal medicine ward of SNUH during March 2nd to June 30th, 1989. Of the total 90 subjects who fully understood the purpose of theis study and consented to paricipate in the experiment, 44 were assigned to the experimental group and 46 to control group according to the ward to which they were admitted. For tools for this research, Miller's Monitor & Blunter and Spielberger's Trait Anxiety Scale were used for individual characteristics, and Spielberger's State Anxiety, blood cortisol and behavioral response scale were used for stress response. The research method was as follows ; Miller's Monitor and Blunter Scale and Spielberger's Trait and State Anxiety Scale were applied and 3cc of blood sample was sampled for cortisol analysis to the all subjects one day prior to cardiac catheterization. The experimental group was provided with a booklet by the researcher in the afternoon of the day before the cardiac catheterization. The booklet contained structured information of the procedure, sensations that the patient would experience, and instructions that would be given during the procedure. The control group was given only basic information necessary for the procedure by other medical staff. On the morning of the procedure, state anxiety was examined, 3cc of blood sampled and subject's behavior observed. After the procedure the state anxiety was tested after the subject returned to the ward. Concerning data analysis, t-test was used for the effect of preparatory information and the effect of the information according to individual characteristics ; paired t-test was used to measure the differences in stress at various points during the investigation ; reliability of the tools was analyzed using Chronbach's α-model. 1. The effect of the preparatory information State anxiety prior to the cardiac catheterization was found to be lower in the experimental group than in the control group(p<0.05) ; however, no significant differences were found in blood cortisol and behavioral response between the experimental group and the control group. For the experimental group, state anxiety was at the highest point the day before the procedure, and blood cortisol at the highest point immediately prior to the procedure ;for the control group, both state anxiety and blood cortisol were at the highest point immediately prior to the procedure. Therefore, this study concluded that preparatory information was effective in reducing the anticipatory anxiety about cardiac catheterization in the subjects and demonstrates that cardiac catheterization does, in fact, induce emotional and physiological stress. 2. The effect of coping styles and level of anxiety. With regard to coping style, the level of state anxiety of patients adopting a monitor type of conping style was high before information;level of state anxiety and blood cortisol of this group with in the experimental groups dropped significantly(p<0.05), where as patients adopting a blunter coping style showed a low level state anxiety one day prior to the procedure : the level of state anxiety and blood cortisol of this group within the experimental group did not change, displaying little negative effect. The subjects exhibited no significant differences in their behavioral responses depending on the level of trait anxiety irrespective of whether preparatory information was provided or not. With regard to trait anxiety, the level of state anxiety of the low trait anxiety group was low ; and that state anxiety level decreased in the experimental group(p<0.05). The level of state anxiety of the high trait anxiety group was high on the day before the procedure ; and that state anxiety level did not change within the experimental group, revealing little negative effect. The subjects exhibited no significant differences in their blood cortisol and behavioral response depending on the level of trait anxiety irrespective of whether preparatory information was provided or not. With regard to state anxiety before information. The level of state anxiety(p<0.05) and behavioral response(p<0.05) of the low state anxiety group within the experimental group decreased significantly where as the level of state anxiety of the high state anxiety group within the experimental group did not change, showing little negative effect. The subjects exhibited no significant difference in blood cortisol of whether preparatory information was provided or not. 3. The correlations among anxiety, blood cortisol and behavioral response. There were correlations among trait, state anxiety, and behavioral response, cortisols were correlated among themselves, and during the cardiac catheterization cortisol and the behavioral response were highly correlated. However, no significant correlations were found between anxiety and blood cortisol. Based upon the above findings, this study concludes that structured preparatory sensory information and instruction is effective in reducing the level of state anxiety immediately prior to the procedures, is effective for patients with a monitor type of coping style, low and high trait anxiety and low state anxiety before information. The anticipatory anxiety of the patients was already higher on the day before information that the average score of state anxiety for Korean college students tested in previous studies. The preparatory information proved to be effective in reducing the state anxiety as the cardiac catheterization procedure drew near ; however, it did not help alleviate the state anxiety induced by the cardiac catheterization procedure irself. Therefore this study concludes that nursing interventions to be used simultaneously with structured preparatory information and instruction to reduce state anxiety caused by the procedure itself and to ease the state anxiety of blunter type of coping styles and patients with high state anxiety before information, is indicated. Cardiac catheterization creates a situation of both emotional and physiological stress. The level of state anxiety and blood cortisol used in this study were valid tools of measurements for stress ; however, since cortisol rseponds not only to cognitive stimulus but also to physical stimulus, more stringent control over the experiment condition is requir