Background: Simulation is an alternative or complementary method for students who cannot obtain sufficient direct care experience, as they allow students to experience various clinical situations. Mixed learning is becoming increasingly common as a way to provide students with opportunities to experience real-life clinical scenarios. This study compared the learning effects of a virtual simulation and a high-fidelity simulation in a different order of presentation, with a focus on training for premature rupture of membranes in the field maternity nursing. Through this comparison, this study aimed to obtain evidence to support decision-making regarding the most effective way to utilize mixed simulation strategies. Methods: A quasi-experimental, crossover-design study was performed with two randomly allocated groups of 26 junior nursing students each. The virtual simulation used the vSim® for nursing, and the high-fidelity simulation used a scenario developed by the research team. The learning effects were measured in terms of the problem-solving process, clinical reasoning, reflective thinking, satisfaction with the practicum, and self-confidence. The data collected with a structured questionnaire were analyzed using the Mann–Whitney test. Results: The virtual simulation-first, high-fidelity simulation-second order led to significantly higher scores for reflective thinking (z = 3.53, p < .001) and self-confidence (z = 2.47, p = .013) than the other order. Conclusions: The initial application of virtual simulation seemed to improve students’ thought processes, and then high-fidelity simulation seemed to allow them to perform actual practice better. Further trials of mixed learning methods are necessary to maximize learning effects in nursing education. Trial registration: KCT0005767 at 2021–01-12 registered.

Background: Breast cancer is not a disease merely experienced by the diagnosed woman. Despite the increased prevalence of breast cancer in Korea, the impact of the illness on married couples has not previously been studied. Objective: This study aimed to explore the experiences of women with breast cancer and their spouses in South Korea. Methods: A descriptive, single-occasion study design was used. Fourteen participants, comprising 7 dyads, were recruited from a university-affiliated hospital breast clinic in Seoul. Inclusion criteria were that the women were married and with a diagnosis of primary breast cancer without metastasis or recurrence. Using a semistructured interview schedule, interviews were conducted in a private room. Audio-recorded data in the Korean language were translated into English and coded using an inductive content analysis method. Results: The core constructs found in the experiences of women, husbands, and couples were “Coming Into My Own Voice,” “Doing What It Takes to Keep Her Alive,” and “Learning Through Struggling,” respectively. Conclusions: The diagnosis of breast cancer caused substantial distress for the couples and was transformative for the women and their husbands. The couples were still experiencing some unresolved hardships that required open communication and mutual effort for coping. Implications for Practice: Health care practitioners should be sensitive to the cultural traditions and values that couples with breast cancer hold. After training nurse interventionists, educational counseling interventions should be launched, so as to empower the dyads.

Background: Exposure to endocrine-disrupting chemicals (EDCs) occurs mainly through dietary intake. Due to current lifestyle trends, young people tend to consume fast food, to use disposable products, and to utilize convenient household items, all of which are major sources of EDCs. This study aimed to investigate the effects of a dietary modification intervention on menstrual pain and urinary bisphenol A (BPA) levels throughout three menstrual cycles in female college students who experienced severe menstrual pain. We also analyzed participants’ adherence to the intervention and examined whether their level of adherence was associated with differences in the effects of the intervention. Methods: A single-group pretest and repeated posttest experimental design was employed. Thirty female college students with a score of 5 or higher on a menstrual pain scale were recruited through convenience sampling. During three menstrual cycles, menstrual pain was scored on a 10-point scale after each cycle, and urinary BPA levels were measured from the first morning urine collected after each cycle. The intervention involved three components: small-group education, follow-up monitoring, and peer support via social network communication. Statistical analyses were conducted using Friedman one-way repeated-measure analysis of variance by ranks, non-parametric two-way analysis of variance, and the Wilcoxon signed-rank test as a post-hoc test. Results: The dietary modification intervention had significant effects on menstrual pain at all three time points of menstrual cycles (χ² = 119.64, p = 0.000) and on urinary BPA levels until the 2^nd menstrual cycle (χ² = 205.42, p = 0.000). Slightly fewer than half (43.3%) of the participants were highly adherent. Menstrual pain differed according to adherence level (F = 4.67, p = 0.032) and decreased over time through the third cycle post-intervention (F = 18.30, p = 0.000). Urinary BPA levels also decreased significantly (F = 7.94, p = 0.000), but did not differ according to adherence level. Conclusions: The dietary modification intervention was effective and sustainable for reducing menstrual pain and urinary BPA levels. Detailed information about EDCs and dietary experiences seemed to encourage the young women to become more concerned about EDCs and to perform self-protective actions. Further experimental research is suggested to examine the relationships of EDCs with various health indicators in women. Trial registration: KCT0005472 at 2020-9-24 retrospectively registered.

Park S, et al. J Korean Acad Nurs. 2023 Apr;53(2):177-190. https://doi.org/10.4040/jkan.23003

The purpose of this study was to identify health behavior and risk factors for chronic kidney disease (CKD) in Korean patients with diabetes. This study was a secondary analysis of the Fourth Korean National Health and Nutritional Examination Survey (2007-2009). Of the 24,871 participants, 1,239 aged over 19 years with diagnosis of diabetes were included. Stratified and cluster variables in the analysis-plan file for a weighted, complex sample were analyzed. CKD was confirmed by the estimated glomerular filtration rate level of 15.0-59.9 mL/min/1.732 m(2). Odds ratios between the variables and CKD were calculated using logistic regression analysis with adjustment for gender, age, educational background, income, and duration of diagnosis. The results showed that 14.7% of participants with diabetes were accompanied with CKD. The risk of developing CKD in those who made efforts to take proper nutrition but failed was 1.76 times higher than those taking nutrition properly. In those who used to smoke compared to their nonsmoking counterparts, the risk was 2.06 times higher; in those who did not do vigorous exercise compared to those who did, the risk was 2.12 times higher; in those with hypertension than those without, the risk was 2.4 times higher; and in those with anemia compared to those without, the risk was 2.32 times higher. Only 19% of the participants received health education for diabetes, which did not affect the incidence of CKD. Since renal functions are affected by lifestyle factors, it is critical for healthcare professionals to provide diabetic patients with health education focused on changing their behavior so that it is conducive to health. It is also necessary to consider that diabetes education should be made more available and provided more effectively to these patients.