Nurse Education Today 31 (2011) 192–197
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Nurse Education Today
j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t
Assessment of nurses' nutritional knowledge regarding therapeutic diet regimens
K.A. Park a,1, W.I. Cho b,2, K.J. Song c,3, Y.S. Lee d,4, I.S. Sung e,5, S.M. Choi-Kwon b,⁎
a
Department of Culinary Arts and Nutrition, Kaya University, Kyungnam 621-748, Republic of Korea
Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul 110-799, Republic of Korea
c
Seoul National University Hospital, Seoul 110-744, Republic of Korea
d
Asan Medical Center, Seoul 138-736, Republic of Korea
e
Samsung Medical Center, Seoul 135-710, Republic of Korea
b
a r t i c l e
i n f o
Article history:
Accepted 25 May 2010
Keywords:
Cardiovascular disease
Nurses
Nutritional knowledge
s u m m a r y
Metabolic diseases and cardiovascular disease (CVD), the incidence of which is currently increasing in Korea,
can be managed well with dietary education and modification. However, it has yet to be established whether
nurses have sufficient knowledge to impart appropriate nutritional counseling to patients with these
diseases. Our study involved 506 nurses working at Asan Medical Center, Samsung Medical Center, and Seoul
National University Hospital between March and May, 2006. The questionnaire was comprised of 42 dietrelated questions pertaining to diabetes, obesity, and CVD. Nurses' correct-response rate for overall
nutritional knowledge was worse than reported in Western countries (58.4%), and particularly so with
regard to obesity and CVD. Although many nurses were aware of the therapeutic aspects of nutrients in
relation to CVD, most of them had limited knowledge about low-cholesterol diets and sources of watersoluble fiber, fatty acids and the specific food items that prevent CVD. Our results suggest that there is an
urgent need to update the contents of nutrition education for nurses to reflect the current changes in the
Korean diet and the increasing incidence of metabolic diseases and CVD.
Crown Copyright © 2010 Published by Elsevier Ltd. All rights reserved.
1. Introduction
The incidence of patients with metabolic diseases and CVD has
increased rapidly over the past 10 years, and CVD is now the third
leading cause of mortality and morbidity in Korea (The Statistics
Korea, 2009). These diseases often induce subsequent disabilities and
negatively affect the quality of life in these patients (Park et al., 2008).
Among the risk factors for the metabolic diseases and CVD, those
related to nutrition and diets are modifiable. Case–control studies
have shown that there is a strong correlation between quality of diet
and the prevention of metabolic and cardiovascular diseases (de
Lorgeril et al., 1994; Conlin et al., 2000; Hu and Willet, 2002).
Whilst the guidelines of the European Society of Cardiology stress
that secondary prevention of CVD should involve general lifestyle
modification, including changes to dietary habits (Graham et al.,
2007), patients with CVD reportedly tend not to follow the
appropriate dietary therapy in Western countries, where CVD is a
⁎ Corresponding author. Tel.: + 82 2 740 8830; fax: + 82 2 745 8017.
E-mail addresses: [email protected] (K.A. Park), [email protected] (W.I. Cho),
[email protected] (K.J. Song), [email protected] (Y.S. Lee),
[email protected] (I.S. Sung), [email protected] (S.M. Choi-Kwon).
1
Tel.: +82 55 330 1114; fax: + 82 55 331 0112.
2
Tel.: +82 2 740 8454; fax: + 82 2 745 8017.
3
Tel.: + 82 2 2072 2815; fax: + 82 2 762 5376.
4
Tel.: + 82 2 3010 5359; fax: + 82 2 3010 5400.
5
Tel.: + 82 2 3410 2908; fax: + 82 2 3410 2920.
leading cause of death (Suter et al., 1995; Jallinoja et al., 2007; Samal
et al., 2007). This might be due to inaccurate or insufficient nutritional
knowledge in these patients or to medical personnel not providing
sufficient dietary education (Waśkiewicz et al., 2008).
The traditional Korean diet used to consist primarily of rice,
vegetables, fermented cabbage (Kimchi), and fish, all of which are
reported to be helpful in preventing metabolic diseases and CVD
(Esmaillzadeh et al., 2006; Ruidavets et al., 2007; Mirmiran et al.,
2009; Panagiotakos et al., 2009). However, the 4th Korea National
Health and Nutrition Examination Survey (KNHANES IV) revealed
that the composition of the Korean diet has shifted toward one that is
high in fat and low in carbohydrates (Korean Ministry of Health and
Welfare, 2009). It can therefore be speculated that the degree of
nutritional knowledge among Korean patients with CVD is even lower
than that reported for their Western counterparts, since until recently
CVD has been only the third leading cause of death in Korea. Warber et
al. (2000) and Schaller and James (2005) reported that even nurses
exhibit a suboptimal level of nutritional knowledge in Western
countries, and there are few reports on the level of therapeutic
nutritional knowledge among nurses in Korea (Youn et al., 2003).
Nurses who have direct interactions with patients during hospitalization are in a good position to inform those who are at risk of these
diseases and counsel them on scientific and practical dietary
therapies. Yet the ability of hospital staff to provide accurate, practical,
and consistent dietary advice that is appropriate to the needs of the
patients may be questioned, since they may not be aware of the recent
0260-6917/$ – see front matter. Crown Copyright © 2010 Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.nedt.2010.05.017
K.A. Park et al. / Nurse Education Today 31 (2011) 192–197
changes in the Korean diet or have learned how to correctly manage
patients with dietary changes.
Whilst much of the current nursing-related health-promotion
literature uses the terms “health promotion” and “health education”
interchangeably within the parameters of their practice (Norton, 1998;
Whitehead, 2006), health education is part of a broad health-promotion
strategy (Casey, 2007; Whitehead, 2007), and health education and
health promotion are not interdependent concepts (Whitehead, 2003,
2004).
The current study investigated the level of nutritional knowledge and
the ability of Korean nurses to provide appropriate dietary education to
patients with metabolic diseases and CVD, with the specific aim of
identifying effective strategies for providing dietary education to patients
with CVD that would motivate them to perform the required behavioral
modifications.
2. Methods
2.1. Subjects
Structured questionnaires were delivered to those nurses in each unit
who were working on the day shift in one of the three largest general
hospitals in Seoul, South Korea, between March and May, 2006: Asan
Medical Center (AMC), Samsung Medical Center (SMC), and Seoul
National University Hospital (SNU). This study was approved by the
Institutional Review Board of Seoul National University, Seoul, Korea. The
study participants were registered nurses who agreed to participate and
who returned a completed questionnaire. Questionnaires were sent to
595 nurses who agreed to participate, of which 506 returned completed
questionnaires to give response rate of 85.0% (21 from AMC, 48 from SMC,
and 20 from SNU did not return completed questionnaires). The
participants included nurses who worked in the fields of internal
medicine, nephrology, surgery, and neurology. Demographic data
regarding educational level, field of work, and years of experience were
also obtained.
2.2. Dietary-knowledge questionnaire
The questionnaire comprised 42 questions on dietary nutritional
knowledge in 3 subcategories (8 on diabetes, 14 on obesity, and 20 on
CVD). Responses to these categories were used to calculate the correctresponse rates, reflecting levels of knowledge about specific aspects of
nutrition. We developed the questionnaire by modifying the questions
used in previous studies (Warber et al., 2000; Youn et al., 2003; Hankey
et al., 2004; Schaller and James, 2005). To reflect Korean dietary habits,
commonly eaten Korean food items such as bibimbap (boiled rice with
assorted ingredients) and kimbap (rice rolled in dried seaweed with a
filling of vegetables and fish or meat) were added to the questionnaire. A
content-validity index was obtained by asking nine experts (three
dietitians, three faculty members who teach nutrition in nursing
schools, and three nurses) to rate the relevancy of each item on a 4point scale (Lynn, 1986). Questions that scored less than 75% according
to the experts were discarded (8 out of a total of 50 questions). Bias
induced by guessing was reduced by including a “don't know” category
(Parmenter et al., 2000). Responses were scored as follows: correct
response = 1, incorrect response = 0, and unsure = 0; based on the
assumption that nurses who were “unsure” were also “unaware” of the
correct response at the time of the data collection.
for the nutritional knowledge scores pertaining to diabetes, obesity, and
CVD were performed using ANOVA, with the level of statistical
significance set at p b 0.05. Statistical analyses were performed using
SPSS software (version 12.0 for Windows; SPSS, Chicago, IL, USA).
3. Results
3.1. Demographics
Of the 506 nurses who responded with a completed questionnaire,
179 were from AMC, 147 from SMC, and 180 from SNU. Since the
demographics of the participants did not differ significantly among the
three hospitals, we pooled the data and analyzed them together. Of the
506 nurses, 95 (18.8%) had a diploma, 372 (73.5%) had a Bachelor of
Science in nursing, and 39 (7.7%) had a master's degree (Table 1). The
numbers of nurses who worked in internal medicine, surgery, neurology,
and other units (gynecology and intensive care units) were 198 (39.1%),
143 (28.3%), 73 (14.4%), and 92 (18.2%), respectively. A total of 310
nurses (61.3%) had less than 5 years of nursing experience, 130 (25.7%)
had between 5 and 10 years, and 66 (13.1%) had 11 or more years
(Table 1).
3.2. Nutritional knowledge
The correct-response rate for all the nutrition questions was 58.4%. For
dietary questions regarding diabetes, obesity, and CVD, the correctresponse rates were 67.6%, 53.8%, and 57.7%, respectively (Table 2).
Thirteen out of 42 questions were answered incorrectly by more than 50%
of the nurses. The correct-response rates for nutritional knowledge were
higher among the nurses with more experience (N11 years, pb 0.05) and
those with a master's degree (pb 0.05; Table 2). The level of knowledge
did not differ significantly among nurses working in different fields of
medicine (e.g., internal medicine, surgery, neurology, or others).
3.2.1. Diabetes-related nutritional knowledge
The average correct-response rate of diabetes-related nutritional
knowledge was 68%, which was higher than the rates for obesity- and
CVD-related diets. More than 90% of the respondents knew that fruit could
be consumed by diabetic patients. However, about 40% of the subjects
were not aware that animal fat should be restricted for these patients.
Although 96% of the participants knew that carbohydrates should be
restricted, about 70% of nurses did not know that complex carbohydrates,
unlike honey and sugar, do not have to be restricted (Table 3).
3.2.2. Obesity-related nutritional knowledge
The correct-response rate for obesity-related nutritional knowledge
was 53.8%. Higher correction rates were obtained for questions regarding
food containing the highest amount of carbohydrate (91.7%), the desirable
weight loss per week (81.1%), and whether or not a high-fiber diet was
recommended for obesity (89.0%). However, only 40% knew that obesity
is attributable more to a high-fat intake than a high sugar intake. Only
Table 1
Demographic characteristics in nurses.
Variables
Field of work
2.3. Statistical analyses
Demographic data and the average correct-response rate of
nutritional knowledge pertaining to diabetes, obesity, and CVD are
expressed as N (%) values. Correct-response rates of the nutritional
knowledge score pertaining to diabetes, obesity, and CVD are expressed
as mean (SD) values. Intergroup comparisons of correct-response rates
193
Years of experience
Education
N(%)
Internal medicine
Surgery
Neurology
Nephrology
Obstetrics, pediatrics
Others
1–5 years
6–10 years
11 or more years
Associate degree
Bachelor's degree
Master's degree
173(34.2)
143(28.3)
73(14.4)
25(4.9)
81(16.0)
11(2.2)
310(61.3)
130(25.7)
66(13.0)
95(18.8)
372(73.5)
39(7.7)
194
K.A. Park et al. / Nurse Education Today 31 (2011) 192–197
Table 2
Correction-response rates of the nutritional knowledge score in nurses.
Variables
Field of work
Internal medicine
Surgery
Neurology
Others
p value
Years of experience
1–5 years
6–10 years
11 or more
p value
Education
Associate degree
Bachelor's degree
Master's degree
p value
1)
2)
N
Diabetes
Obesity
Cardiovascular disease
Total
506
67.59(15.40)1)
53.76(13.21)
57.66(11.42)
58.39(8.60)
198
143
73
92
67.4(15.63)
66.87(16.11)
67.92(13.69)
68.81(15.19)
0.793
55.86(14.81)b2)
52.11(11.55)ab
50.39(12.56)a
54.56(11.75)ab
0.005
58.08(11.85)
58.19(10.67)
56.98(10.69)
56.42(12.24)
0.568
59.21(9.49)
58.14(7.47)
57.14(7.32)
57.97(9.11)
0.299
310
130
66
67.48(16.04)
67.10(14.62)
68.99(67.59)
0.670
52.58(12.23)a
55.02(14.17)ab
56.93(15.06)b
0.021
55.91(10.89)a
59.39(11.71)b
62.16(11.59)c
0.000
57.18(8.01)a
59.56(9.09)b
61.72(9.23)b
0.022
95
372
39
66.70(13.78)
67.48(15.93)
70.57(14.24)
0.336
53.86(14.94)
53.52(12.46)
55.89(15.59)
0.555
57.38(12.41)a
57.10(10.96)a
63.04(11.81)b
0.004
58.10(9.30)a
58.08(8.29)a
62.03(9.19)b
0.022
N (%).
Means labeled different letters are significantly different at pb0.05 by ANOVA test.
10.1% correctly responded that decreasing the total fat intake is the
recommended first-line diet change for a 45-year-old obese male with a
cholesterol level of 239 mg/dl. About 26% knew the daily minimum
recommended carbohydrate intake required to prevent ketosis, whereas
only 3.2% knew that the effectiveness of the Atkins diet in reducing weight
loss is attributable to the associated diuretic effect (Table 4).
3.2.3. CVD-related nutritional knowledge
Our subjects generally had higher correct-response rates for the
questions related to the therapeutic aspects of nutrients on CVD. Most
of the subjects knew that patients who are on diuretics are likely to be
deficient in potassium (83.0%) and that omega-3 fatty acids help to
reduce CVD (77.3%). On the other hand, only 21.6% knew that waterinsoluble fiber is not effective in reducing blood cholesterol, and 45.7%
knew that calcium lowers the risk of hypertension. The subjects did
not accurately understand the food sources of cholesterol (83.5%) and
fatty acids (76.6%); nor did they know the daily recommended amount
(300 mg) of cholesterol for a low-cholesterol diet (89.0%) (Table 5).
Table 3
Correction-response rates of diabetes-related nutritional knowledge in nurses.
*Correct answer.
4. Discussion
Over the last decade, the concept of health promotion has shifted from
the conventional health education model of Pender (1996) to broader
societal, economic, ecological, and political dimensions of health
promotion (Whitehead, 2006). However, many nursing researches still
focus singularly on measuring behavioral and lifestyle activities of
subjects, utilizing Pender's health-promotion model as an underlining
framework (Kim et al., 2003; McCabe et al., 2005; Shin et al., 2005; Wu and
Pender, 2005).
In our study, we specifically focused on the ability of nurses to
provide health education on dietary changes in patients with CVD by
investigating the nutritional knowledge pertaining to metabolic
diseases and CVD. We found that nurses generally exhibit a suboptimal
level of nutritional knowledge, particularly so in areas pertaining to
obesity and CVD. We also found that nurses who are less experienced
and have a lower level of education achieved lower correct-response
rates for nutritional knowledge.
K.A. Park et al. / Nurse Education Today 31 (2011) 192–197
195
Table 4
Correction-response rates of obesity-related nutritional knowledge in nurses.
(%)
1. High sugar intake is more responsible for causing obesity than high-fat intake.
1) Agree
2) Disagree*
3) Don't know
2. Desirable weight loss is reducing 2kg per week.
1) Agree
2) Disagree*
3) Don't know
3. A High-fiber diet is recommended for obesity.
1) Agree*
2) Disagree
3) Don't know
4. Carbohydrate intake should be reduced to lose body weight.
1) Agree*
2) Disagree
3) Don't know
5. Carbohydrates such as bread, potato, and noodles are fattening.
1) Agree
2) Disagree*
3) Don't know
6. Animal fats should be removed from meal to lose body weight.
1) Agree*
2) Disagree
3) Don't know
7. Android (upper body) obesity has more complications such as hypertension and diabetes than Gynoid (lower body) obesity.
1) Agree*
2) Disagree
3) Don't know
8. An obese 45-year-old adult has blood cholesterol level of 239mg/dl. Which of the following dietary therapy is the first recommended?
1) Decrease monounsaturated fat
2) Decrease polyunsaturated fat
intake
intake
3) Decrease total fat intake*
4) Decrease total cholesterol intake
5) Decrease carbohydrate intake
9. What is the daily minimum recommendation of carbohydrates to prevent ketosis and spare the protein when trying to reduce the body weight?
1) 50g
2) 100g*
3) 150g
4) 200g
5) 250g
10. The nutrient which is recommended to supply essential fatty acid and lipid-soluble vitamins, when trying to lose body weight is __________.
1) Vegetable oil *
2) Animal fat
3) Fish oil
4) Animal protein
5) Plant protein
11. A low-carbohydrate, high-protein and fat diet such as Atkins diet lead to a faster weight loss is attributable to __________.
1) Diuretic effect*
2) Dietary restraint
3) Lipolysis
4) Glycogenolysis
5) Diabetes
12. __________ is not related to the android obesity.
1) Diabetes
2) Hyperlipidemia
3) Hypertension
4) Kidney failure*
5) Myocardial
infarction
13. The food which contains the highest amount of carbohydrate is __________.
1) Chicken
2) Cheese
3) Potato*
4) Peanut butter
5) Milk
14. The food which contains the highest amount of fat is __________.
1) Low-fat milk*
2) Orange juice
3) Corn
4) Honey
5) Soy sauce
40.4
81.1
89.0
77.3
74.0
57.7
72.0
10.1
25.8
57.5
3.2
62.3
91.7
57.3
*Correct answer.
The mean correct-response rate for nutritional knowledge was
58.3%, which is lower than that reported by Warber et al. (2000).
Differences in the number and difficulty of questions in the
questionnaires used in our study and that of Warber et al. (2000)
may explain this discrepancy, although this is unlikely since our
questionnaire was based on those used in previous studies (Warber
et al., 2000; Youn et al., 2003; Hankey et al., 2004; Schaller and James,
2005). Rather, it may have been due to the different educational
levels of the participants. Master's degrees were held by 81% of those
surveyed by Warber et al., whereas only 8% of our participants had a
master's degree. This concurs with our results, which show that
nurses with a higher level of education have a higher nutritional
knowledge.
It was reported in KNHANES IV that the incidence of obesity in Korea is
increasing rapidly, and is now present in approximately one-third of the
population (Korean Ministry of Health and Welfare, 2009). This finding
requires an immediate reaction from both the medical personnel and the
public, since obesity is a major risk factor for hypertension, CVD, and
cerebrovascular disease. However, we found that the correct-response
rate of obesity-related nutritional knowledge was the lowest of the three
topics tested. We can speculate that nutritional education for undergraduates has been suboptimal and limited by not reflecting recent
changes in the Korean diet, since obesity was not previously a major
health problem in Korea. Specifically, about 60% of nurses did not know
that obesity is attributable more to a high-fat intake than a high sugar
intake.
The Atkins diet has recently become popular among some people with
obesity in Korea, although in the United States it is not perceived as being a
healthy means of losing weight (Rutten et al., 2008). However, most of our
respondents (97%) did not know the cause of weight loss for this lowcarbohydrate, high-protein, and high-fat diet, suggesting a lack of
knowledge regarding the metabolic pathways of major nutrients. This
may be attributable to the recent removal of biochemistry courses from
the curriculum in many nursing schools in Korea, and to a lack of nutrition
and diet courses in more than half of Korean universities (according to
their Websites). Although we did not investigate the nutritional
curriculum for nurses, about 60% of universities (31/52) and 40% of
colleges (20/49) do supply a nutrition-related course (nutrition or diet
therapy) in Korea.
This speculation is supported by the correct-response rates achieved
in our study being lower than those of general practitioners who have
participated in continuing education programs on nutrition principles
and interventions (Warber et al., 2000). Moreover, when we researched
the list of continuing education programs offered in each hospital and by
the Korean Nurses Association over the last 5 years, we found that no
continuing education on up-to-date patient dietary nutritional problems and demands had been offered. This is consistent with their
Western registered-nurse counterparts (Crogon et al., 2001) having
limited opportunities for updating their nutritional knowledge.
The consumption of animal fat has recently increased in Korea, partly
due to the increasing adoption of the westernized lifestyle and dietary
habits. Moreover, the incidences of CVD and metabolic diseases, such as
type 2 diabetes, have increased over the last 20 years (Korean Ministry
of Health and Welfare, 2009). However, it is surprising to find that more
than 90% of the nurses in our study had limited knowledge regarding
nutrients specific to the prevention of coronary artery disease and did
not know about the sources of cholesterol (16.5%) and fatty acids
(23.4%). Only 10.1% of nurses responded correctly that decreasing the
total fat intake would help to lower the blood cholesterol of a 45-yearold obese adult with a cholesterol level of 239 mg/dl. Our results
contradict previous studies performed in Western countries that found
that health professionals are knowledgeable regarding the link between
intake of saturated fatty acids and blood cholesterol (Buttriss, 1997;
Makowske and Feinman, 2005).
Dietary soluble fiber has been found to lower serum cholesterol and
decrease the risk of CVD in epidemiologic and experimental studies
(Bazzano, 2008; Theuwissen and Mensink, 2008; Talati et al., 2009).
However, most of our subjects were unaware of the blood-cholesterol-
196
K.A. Park et al. / Nurse Education Today 31 (2011) 192–197
lowering effect of water-soluble fiber (88.4%). Moreover, fiber consumption in Korea reportedly decreased; the recommended dietary reference
intake (DRI) of fiber for Koreans is 22–31 g/day, irrespective of the fiber
type (The Korean Society of Nutrition, 2005). The reasons underlying the
lower correct-response rates are unclear; however, they may be
attributable to a limited nutritional education on the benefits of fiber
consumption in the nursing school curriculum.
Recent efforts to reduce the prevalence of hypertension have
focused specifically on diet (Houston and Harper, 2008), and the
protective effects of dietary calcium on hypertension have been
studied in detail (Hamet, 1995; Houston and Harper, 2008). However,
the nurses in our study were not aware of the protective effect of
calcium. This brings our attention to recent KNHANES IV results, which
show that Koreans consume less calcium (63.4% of the recommended
intake) and more sodium (311.5% of the recommended intake) than
the DRI, and that the incidence of hypertension has increased (Korean
Ministry of Health and Welfare, 2009).
Lack of nutritional education is reportedly common among medical
professionals. It has been reported that Canadian physicians generally
receive meager nutrition instruction in their MD program (43% receive
under 5 h, 28% receive 5–10 h, 23% receive 10–20 h, and the remaining 6%
receive over 20 h) and do not have the expertise to properly advise their
patients on important aspects of the role that nutrition plays in the
causation, prevention, and therapy of diseases such as hypertension,
thrombosis, and hypercholesterolemia (Temple, 1999). This finding is in
line with those for Korean medical students, residents, nurses (Chang and
Kwon, 1996), and oriental-medicine students (Won and Park, 2004), who
all had more limited knowledge on clinical nutrition than those majoring
in food and nutrition. This suggests that nutritional counseling has been
overlooked in the Korean medical/nursing curricula, and that specific
clinical nutrition courses should be introduced to these curricula. This is
particularly important to nurses since they are in a good position to inform
and educate patients with CVD at the bedside during hospitalization about
dietary modifications.
Table 5
Correction-response rates of cardiovascular disease-related nutritional knowledge in nurses.
(%)
1. There is a close relationship between hypertension and obesity.
1) Agree*
2) Disagree
3) Don't know
2. For the treatment of hypertension, a low-sodium diet is routinely recommended.
1) Agree*
2) Disagree
3) Don't know
3. What kind of mineral is likely to be deficient for the patients who are on diuretics?
1) sodium
2) Potassium*
3) Calcium
4) Magnesium
4. The mineral which decreases the risk of hypertension is _________.
1) Sodium
2) Calcium*
3) Iron
4) Copper
5. A lower intake of saturated fats decreases the risk of coronary artery disease.
1) Agree*
2) Disagree
3) Don't know
6. High blood cholesterol increases the incidence of heart disease.
1) Agree*
2) Disagree
3) Don't know
7. The trans fats such as margarine are recommended for cardiovascular disease.
1) Agree
2) Disagree*
3) Don't know
8. Omega-3 fatty acids such as fish oil help to reduce hyperlipidemia.
1) Agree*
2) Disagree
3) Don't know
9. Caffeinated beverages are harmful for myocardial infarction.
1) Agree*
2) Disagree
3) Don't know
10. Low-fat milk is good for replacing whole milk, when trying to reduce total fat intake.
1) Agree*
2) Disagree
3) Don't know
11. Water-insoluble fiber such as vegetables and wheat are effective in reducing blood cholesterol.
1) Agree
2) Disagree*
3) Don't know
12. Which of the following food is not a major source of the described fatty acids?
1) Pork—saturated fatty acids
2) Mayonnaise—polyunsaturated fatty acids*
3) Olive oil—monounsaturated fatty acids
4) Egg—saturated fatty acids
5) Peanut—monounsaturated fatty acids
13. Which of the following vegetable oil contains the highest amount of saturated fat?
1) Palm oil*
2) Olive oil
3) Corn oil
4) Soybean oil
14. The dietary therapy which is not recommended for preventing coronary artery disease is __________.
1) Replace the equal amount of calories of unsaturated fatty acid and margarine by saturated fatty acid*
2) Consume complex carbohydrates as the majority of the daily caloric intake
3) Reduce food high in cholesterol
4) Decrease total fat intake
5) Increase fruit and non-starch vegetables
15. Which of the following foods is not a source of cholesterol?
1) Meat
2) Egg
3) Margarine*
4) Milk
16. Intake of less than ( ) mg of cholesterol is recommended for low-cholesterol diet.
1) 100
2) 200
3) 300*
4) 400
17. The food which is not restricted for people with hyperlipidemia is _________.
1) Bacon(Fatback)
2) Sausage
3) Chicken breasts*
4) Shrimp
18. When dining out, the food which should be restricted for people with hyperlipidemia
1) Boiled rice with assorted mixtures
2) Broiled fish
3) A meal of Korean fixed menu
4) Kimbab (rice rolled in dried laver)
19. The dietary factor which is not correlated with prevention of cardiovascular disease is _________.
1) Vitamin C
2) Vitamin E
3) Pectin
4) Fish oil
20. The incorrect way to to lower fat intake is _________.
1) Replace pie by roll cake between meals*
2) Remove the chicken skin
3) Replace mayonnaise by soy sauce as salad dressing
4) Replace whole milk by low-fat or skim milk
5) Replace one whole egg by 2 egg whiles
*Correct answer.
94.2
99.6
83.0
5) Iodine
45.7
5) Zinc
67.8
97.0
80.2
77.3
89.6
61.9
21.6
23.4
50.4
5) Grape seed oil
41.6
16.5
5) Fish
11.0
5) 500
67.6
5) Milk
47.6
5) Chatang (Loach soup)*
8.8
5) Alcohol*
50.8
K.A. Park et al. / Nurse Education Today 31 (2011) 192–197
5. Limitations
This study was subject to several limitations. First, our study may not
be generalized to other nurses, since all of the participants were nurses at
one of the three largest hospitals in a single geographic region (Seoul), and
nurses working in all fields of medicine were not included. However,
selection bias may have been low since all participants were volunteers
and the response rate was high.
Second, we used a nutritional questionnaire that was slighted
modified from those used previously by adding commonly eaten Korean
food items and adding items to reflect Korean dietary eating habits
(Warber et al., 2000; Youn et al., 2003; Hankey et al., 2004; Schaller and
James, 2005). Although we obtained a high content-validity index and
questions scoring less than 75% were discarded, the reliability of the
questionnaire was not tested.
6. Conclusions
In conclusion, with the increased consumption of processed and
Westernized food and the change to a more sedentary lifestyle, the rates of
obesity and chronic diseases have increased rapidly in Korea. However,
there is uncertainty and unpreparedness among Korean nurses to offer
dietary advice, particularly to patients with CVD and obesity. Nurses with
incorrect nutritional knowledge may unwittingly offer inaccurate dietary
guidelines to patients with CVD and metabolic diseases, and thus hamper
their recovery. Strategies to increase the level of science-based nutritional
knowledge among Korean nurses are urgently needed, such as recommending and updating the contents of nutritional parts of the curriculum
in college education and providing up-to-date continuing nutritional
education.
Acknowledgement
This study was supported by National Research Foundation of
Korea (810–20090018).
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