Comparison of Attitudes toward Death among Nursing Students from South Korea, Japan and Indonesia / 한국호스피스완화의료학회지

PURPOSE: This study was performed to compare nursing students' attitudes toward death among South Korea, Japan and Indonesia, and to confirm the need for death education in nursing. METHODS: A total of 294 nursing students completed a questionnaire titled as the Death Attitude Profile-Revised (Wong, Recker, Gesser. 1994). Participating students were from two nursing schools in South Korea, two in Japan and one in Indonesia. Data were analyzed by using descriptive statistics and inferential statistics including, chi2-test, ANOVA and multiple comparison analysis. RESULTS: The total mean score of the DAP-R for the three countries combined was 3.84+/-0.73. By country, the mean was the highest for Indonesian students (4.32+/-0.71), followed by Korean (3.75+/-0.57) and Japanese (3.56+/-0.70) respectively. In relation to subcategories, Indonesian students showed the highest mean score for death avoidance (3.67+/-1.38) and approach acceptance (5.37+/-1.00). Korean students marked the highest (5.51+/-0.91) in neutral acceptance and Japanese students scored the best (3.63+/-1.46) in escape acceptance. Nursing students who had an experience of caring terminally ill patients tended to be affirmative in approach acceptance (P=0.047). There were significant differences in each of the four subcategories except fear of death among the three countries (P<0.001). CONCLUSION: The above results indicate it is necessary to develop education programs based on each country's social and cultural background to help nursing students form desirable attitudes toward death.

A Review Study on the Strategies for Concept Analysis / 간호학회지

PURPOSE: Concept analysis is an essential part of theory development in nursing. Thus, many strategies or methods of concept analysis have been suggested in nursing literature. However, in Korea, only limited strategies were utilized, without much consideration on a wide range of strategies in choosing a method that coincides with the characteristics of each concept to analyze. The purpose of this article was to propose various strategies for concept analysis. METHOD: A literature review method was used. RESULT: Ten methods of concept analysis were identified in the literature, and they were evaluated for advantages and limitations. In addition to the method by Walker and Avant and a hybrid model, more advanced strategies, such as triangulation method, critical analysis and the feminist approach were introduced and described in detail. The examples used in each concept analysis method were presented in table to provide the extent of utilization of each method. CONCLUSION: This article provides a wide range of strategies in identifying, clarifying, or elaborating a concept. It might help in choosing a method that best fits the concept to analyze, thus enhancing quality of concept analysis research.

Effects of Abdominal Breathing Training Using Biofeedback on Stress, Immune Response and Quality of Life in Patients with a Mastectomy for Breast Cancer / 간호학회지

PURPOSE: This study was to determine the effects of abdominal breathing training using biofeedback on stress, immune response, and quality of life. METHOD: The study design was a nonequivalent control group pretest- posttest, quasi-experimental design. Twenty-five breast cancer patients who had completed adjuvant chemotherapy were enrolled. The experimental group(n=12) was provided with abdominal breathing training using biofeedback once a week for 4 weeks. State anxiety, cancer physical symptoms, serum cortisol, T cell subsets(T3, T4, T8), NK cell and quality of life were measured both before and after the intervention. RESULT: Though state anxiety, cancer physical symptoms, and serum cortisol were reduced after 4 weeks of abdominal breathing training using biofeedback, there was no statistical significance. It showed, however, improvement in quality of life (p=.02), and T3(p=.04). CONCLUSION: Abdominal breathing training using biofeedback improves quality of life in breast cancer patients after a mastectomy. However, the mechanism of this beneficial effect and stress response requires further investigation with special consideration in subject selection and frequency of measurement. Nurses should consider this strategy as a standard nursing intervention for people living with cancer.

Effects of Biofeedback Exercise Training in Hemiplegic Patients after Stroke / 간호학회지

PURPOSE: The purpose of this study was to investigate the effects of biofeedback exercise training on muscle activity and activities of daily livings (ADL) in hemiplegic patients. An experimental group consisting of 17 people, was given biofeedback exercise training for 30- 60 minutes per week for 5 weeks, while a control group consisting of 18 people, was given normal exercise with quasi-experimental design. RESULT: The results of the study show that biofeedback exercise is effective for improving muscle activity in hemiplegic patients, especially in the hemiplegic limbs. However, this study found no significant differences in ADL and IADL between the experimental and the control groups. It implies that ADL and IADL may not be improved for a short period of time, such as 5 weeks, for people with more than five years of hemiplegia. The study suggests that the effect of biofeedback exercise on ADL and IADL should be determined in hemiplegic patients in acute stage.

Experience of Mothers with Babies by in Vitro Fertilization / 간호학회지

A phenomenological study was conducted to investigate the experiences of mothers pregnant via in vitro fertilization (IVF). Sample of nine mothers participated. Ten theme clusters emerged when the formulated meanings were organized into categories. During the infertility period, the participants were subject to self- depreciation, envy, anxiety, and depression. It changed their priorities in life from a job-oriented life to one where having a baby was the most important thing. After trying numerous alternative therapies, IVF became their last hope in having a baby. Since the success rate for IVF is low (only 20-30%), the participants for the treatment were overwhelmed with uncertainty, and it led to further anxiety, depression and despair. Success of pregnancy gave them extreme satisfaction, but they became very cautious in their day-to-day life because of their fear of abortion and early delivery. Some were even worried about the side effect of IVF during the pregnancy. Finally, the delivery of the baby gave them relief from the obligation of having a baby. Women did not have any difficulties in rearing a "test tube baby" except in the case of twins. Most women had no ethical difficulty in having a baby by IVF. However they did not wish this information to be revealed to other people. They again turned to IVF to have a son(s) when the resultory child(s) was a daughter(s). This is because of the strong preference for sons in Korean society.

Investigation of Espoused Theories in Nursing Practice / 성인간호학회지

As a nursing practice involves nurses'actions in a specific context of health care, this study has focused on exploring the espoused theories in nursing practice within the action science perspectives. Espoused theories are the belief, principles, and rationale expressed by the practitioner as guiding her/his actions in a situation of practice. The data were analysed qualitatively and 25 elements of espoused theories of nursing action were identified and clustered into 6 categories. The 25 elements of espoused theories are as follows: The clinical nurse worked in wholistic and individual nursing, focussed on the patient's needed, comfort and supportive nursing (5 theories of nursing goal); excellent skills, knowledge based, assessment and data collection, explaining, educating or a scientific basis(6 theories of nursing intervention): advocacy, value oriented, treatment, accountability and commitment(4 theories of nursing ethics); human respect, partnership, trust(3 theories of patient-nurse relationship) : knowledgable, accumulated clinical experiences and personally lived experiences, positive perspectives(4 theories of nurse), role of intervention, rewarding, peer relationship(3 theories of situations). The above mentioned espoused theories are similar to that of nursing textbooks which students learned through basic nursing education and almost the same as the Acts ofa Nurse in Korean. However, we are doubtful whether nurses actually do as they think. Therefore, it is recommended to review the theories-in-use in order to find any discrepancies between the espoused theories and the reality of nursing actions.

A Preliminary Study for Evaluating on Demonstration Project of Community-based Home Health Care Nursing Services by the Seoul Nurses Association / 간호학회지

This study, based on current home nursing services, aims at promoting measures for establishing a community-based home nursing system derived from the pilot home nursing demonstration project conducted by the Seoul Nurses Association. The study was based on an analysis of home nursing records from march 1993 to December 1999. The following is a summary analysis, based on individual characteristics of the patients, the organization, which recommended the service for their patients and personnel services. 1. The service has been used by many elderly people 60years of age or older(66.4%). and married people(60.9%). The average number of visits by service personnel for patients of city government was 23.5. This is 2.5 times as many visits by general patients. General patients(20.2%) had only one visit from service personnel, while 65.5% of patients of city government had 10 or more visits. Particularly, for government recommended patients, 72.7% of the patients were recommended by nurses, while only 21.9% where referred to the services by doctors. The main focus of a home nursing service was to maintain present health status (53.4%), and hospice(11.6%). Also to increase hospital-based home nursing services focused on recovery(55.9%) and maintain present health conditions (19.0%). 2. For general patients, 42.0% of patients were suffering from problems related to CVA, 11.3% from high blood pressure, and for patients referred from city, 21.2% from skeletal muscular disease. Results of home nursing services 29.4% of patients were able to recover or maintain their health status, but 48.9% of the patients died. Another main point of community-based home nursing services is medication(6.7%), other basic nursing services(6.1%), special treatment, instructions on how to use medical devices(5.9%), change of physical posture(4.6%), and training on changing physical positions(4.7%). As mentioned above there were some differences between the characteristics of patients who used the pilot home nursing service conducted by the Seoul Nurses Association and those hospital-based service users. The results are believed to be useful to support a community-based home nursing service model. Particularly, patients under medical supervision and patients recommended by government-run health clinics show a higher frequency and longer use of home nursing services compared to general patients or hospital-based home nursing service users. According to the study, nurses accounted for a large number of recommendations for home nursing services. Many patients with CVA, high blood pressure, skeletal muscular disease and bedsores used community-based home nursing services, while others used the service for minor treatments or maintaining their current health status. Based on the study, the researchers make several suggestions to establish a community- based home nursing service system. First, different ways of setting up a community-based home nursing system have to be mapped out based on the evaluation of the pilot home nursing service conducted by the Seoul Nurses Association. Secondly, a new, community-based, home health care nursing service model, and reimbursement payment system have to be developed. This is based on the outcome of the analysis, and implemented policy. Accordingly, efforts are needed to develop a community- based home nursing system with an intermediary role to promote the visiting nursing services of government-run health centers.

Development of Internet based Hospice Information Service System / 대한의료정보학회지

The purpose of this study is to develop an internet based hospice information service system as a solution to the problems identified in our previous studies. Databases and homepage were designed and developed for the information needed for the hospice care and these services were available through the Internet. The hospice information service system has three subsystems. Frrst subsystem, which is training and education for the hospice care personnel includes general hospice information, pain and symptom management, the role of hospice care program information, and hospice care standard. Second subsystem which is patient management includes patient's general information, medical record, nursing record, major symptoms and nursing care plan, statistical data management, and hospice care facilities. Third subsystem includes Q and A for patient, family members, and hospice care team members. The system was tested through providing hospice care to the terminally ill patients and their family members by home visiting nurses. Through this study, it was found that hospice information system is very effective for those who need hospice care at home. But in order for the system to be more effective, system needs to be upgraded with more information on spiritual and social welfare and specialists who provided spiritual care and social welfare need to be included in the hospice care team.

The Study on the Medical and Nursing Service Needs of the Terminal Cancer Patients and Their Caregivers / 간호학회지

In this study, we attempted to investigate the needs and problems of the terminal cancer patients and their family caregivers to provide them with nursing information to improve their quality of life and prepare for a peaceful death. Data was collected from August 1, 1995 to July 31, 1996 at the internal medicine unit of S hospital in Seoul area with the two groups of participants who were family members of terminal cancer patients seventy four of them were in-patients and 34 were out-patients who were discharged from the same hospital for home care. The research tool used in this study has been developed by selecting the questionnaires from various references, modifying them for our purpose and refining then based on the results of preliminary study. While general background information about the patients was obtained by reviewing their medical records, all other information was collected by interviewing the primary family caregivers of the patients using the questionnaire. The data collected were analyzed with the SPSS PC+ program. The results of this study are summarized as follows; 1) Most frequently complained symptoms of the terminal cancer patients were in the order of pain(87%), weakness(86.1%), anorexia(83.3%) and fatigue(80.6%). 2) Main therapies for the terminal cancer patients were pain control(58.3%), hyperalimentation(47.2%) and antibiotics(21.3%). 3) Special medical devices that terminal cancer patients used most were oxygen device(11.1%), and feeding tube(5.6%). Other devices were used by less than 5% of the patents. 4) The mobility of 70.4% of the patients was worse than ECOG 3 level, they had to stay in bed more than 50% of a day. 5) Patients wanted their medical staffs to help relieve pain(45.4%), various physical symptoms(29.6%), and problems associated with their emotion(11.1%). 6) 16.7% of the family caregivers hoped for full recovery of the patients, refusing to admit the status of the patients. also, 37% wished for the extension of the patient's life at least for 6 months. 7) Only 38.9% of the family members was preparing for the patient's funeral. 8) 45.4% of family caregivers prefer hospital as the place for the patient's death, 39.8% their own home, and 14.8% undetermined. 9) caregivers of the patients were mostly close family members, i.e., spouse(62%), and sons and daughters or daughter-in-laws(21.3%). 10) 43.5% of the family caregivers were aware of hospice care. 46.8% of them learned about the hospice care from the mass media, 27.7% from health professionals, and the rest from books and other sources. 11) Caregivers were asked about the most difficult problems they encounter in home care, 41 of them pointed out the lack of health professionals they can contact, counsel and get help from in case of emergency, 17 identified the difficulty of finding appropriate transportation to hospital, and 13 stated the difficulty of admission in hospital as needed. 12) 93.6% of family caregivers demanded 24-hour hot line, 80% the visiting nurses and doctors, and 69.4% the volunteer's help. The above results indicate that terminal patients and their family caregivers demand help from qualified health professionals whenever necessary. Hospice care system led by well-trained medical and nursing staffs is one of the viable answers for such demands.

Clinical Competency for Directing of Registered Nurses's National Examination: focused on Fundamental, Medical-Surgical, Psychiatric, women's health, community, Pediatric, and Administrative Nursing / 간호학회지

For producing large numbers of professional nurses who could manage 21th century's human health, it is necessary to review the direction of registered nursed' national examination which evaluates the nursing education and is granted a licence. For adapting to social expectation of the nurse, we have to nurture the nurses' problem solving capability in clinical setting. Seven divisions of Korean Academy of Nursing suggested clinical competency according to their categories. This paper was presented in the workshop for setting up direction of registered nurses' national examination. We expect that this paper would be more refine and confirm through reviewing subdivisions' learning objectives and discussing clinical minimum level of competence contents with clinical leaders.

Development of An Instrument to Measure Hope for the Cancer Patients / 간호학회지

The purpose of this study was to develop a reliable and valid instrument to measure hope for cancer patients in Korea. This Hope Scale(Kim and Lee Hope Scale : KLHS) was developed based on not only critical universal attributes explaining both basic hope (generalized hope) and specific hope but also particular characteristics varying from culture and situation, which were revealed in a comprehensive review of the literature. Initially 60 items were generated from three sources : 36 items from the Q-sample used in the Kim's study, 1992, 21 representative items(statements) from the rest Q-population of the above study, 3 items related to the newly discovered category in the new qualitative study using 10 open ended question(death and dying) from the new qualitative study on the 20 cancer patients. At first 3 items were eliminated by the critique of the content validity experts, who were high experienced nurse, nursing professors. And then 4 items were eliminated in consideration of corrected item total correlation coefficiency, theoretical framework of this study. After that, 14 items were eliminated in comparing two or three items identified with the same meaning in each factor by this research team with factor loading and communality. This Hope Scale was finally constructed with 39 items. Psychometric evaluation was done on 492 adults(104 cancer patients, 338 adults who imagined who were cancer patients ranging from 18 to 76 years old. The results revealed high internal consistency Alpha coefficiency of .9351. Principal Component Factor Analysis with Varimax Rotation resulted in 8 factors with more than 1.0 of Eigenvalue. Referring to Eigenvalues percent of variances(>60%), reproduced correlation matrix, and our theoretical framework, we decided the eight factors were the best solution to represent hope dimension sufficiently. The eight factors were "confidence in possibility of cure", "sense of internal satisfaction", "being in communion", "meaning of life", "Korean hope perspectives", "belief in god", "self confidence", "self-worth". Among these factors, "confidence in possibility of cure", "sense of internal satisfaction", "Korean hope dimensions from those of Nowotny Hope Scale and Herth Hope Scale. There was significant negative correlation of r=-.4736 between this hope scale and Beck Hopelessness Scale(BHS), and significant positive correlation of r=.3685 between this hope scale and Life Orientation Test(LOT) which indicate convergent and discriminant validity. The range of hope scores was from 71 to 244, with a mean of 171.97(SD=28.16).