Critical Thinking of Clinical Nurses / 기본간호학회지

INTRODUCTION: Critical thinking involves identifying problem(s), assessing resources, and generating possible solutions and allows clinical nurses to decide which solution is the most reasonable under the given circumstances, taking into consideration the "what ifs" and how they will affect the end result. This research was conducted to further understanding and identification of subjective factors in critical thinking in clinical nurses. METHODS: The research design was a Q-Methodological Approach. Q-population was formulated from a non-structured questionnaire and interviews from 17 experienced clinical nurses. Thirty selected Q-statements were sorted by 30 experienced clinical nurses. RESULTS: Four factors for critical thinking were identified: (1) Deductive reasoning based on causal relation, (2) Construction of an effective model based on patients' responses, (3) Formulating categories based on priorities for effective interventions, and (4) Judging validity of the situational significance on clinical performances. CONCLUSION: Critical thinking is an attitude and reasoning process. From this study, the frame of reference for clinical nurses in formulating critical thinking within the context of clinical settings is identified and indicates the way nurses utilize thinking skills when they care for patients and areas that need further exploration as nurses and faculty develop education systems to advance clinical performance competency.

Family Functioning and Quality of Life of the Family Care-giver in Cancer Patients / 간호학회지

PURPOSE: The purpose of this study was to identify the relationship among quality of life, family coherence, family hardiness, and family resources of the family care-giver caring for a cancer patient. METHOD: Data was collected by questionnaires from 137 families with a cancer patient at a General Hospital and Government Cancer Hospital. Data was analyzed using descriptive statistics, pearson correlation coefficients, and stepwise multiple regression. RESULTS: The score of quality of life showed a significant positive correlation with the score of the level of family sense of coherence, family hardiness, and family resources. The most powerful predictor of quality of life was sense of coherence and the variance was 30%. A combination of sense of coherence and family resources account for 34 % of the variance in quality of life of the family care-giver caring for a cancer patient. CONCLUSION: The results showed that family sense of coherence, hardiness, and family resources were significant influencing factors on the quality of life of the family care-giver caring for a cancer patient.

Exploring the Nature of Caring in Hwa-Byung: Transpersonal Caring-Healing Model / 간호학회지

Hwa-Byung(HB) has been categorized as a Korean culture-bound syndrome that is prevalent in married women of low socioeconomic status. PURPOSE: The Purpose of the study was to search for the essence of HB and a caring-healing process of HB. Then the research result discusses whether the Transpersonal Caring-Healing Model has been congruent with it. METHOD: Case examples resulted from in-depth telephone counseling over a period of time at the Women's Hot Line with a client who is a housewife with HB. The counseling content was analyzed through Giorgi's method of descriptive phenomenology. RESULT: The core meaning of the essence of HB was 'injustice'; and essential themes were 'lack of reciprocity', 'infidelity' 'suppressed aggression and powerlessness' and 'need for recognition'. The core meaning of the essence of the caring-healing process was 'caring-healing experience(maintaining a trust relationship)'; and essential themes were 'active listening', 'empathy' and 'forming a therapeutic relationship'. According to Watson, 'active listening', 'empathy' and 'forming a therapeutic relationship' were identified as intentionality, intersubjectivity and transpersonal. CONCLUSION: Transpersonal caring can release inner power and strength and help the person to gain a sense of inner harmony. Transpersonal caring is as important to healing as are conventional treatment approaches and even more powerful in the long run.

Exploring the Nature of "Hwa-Byung" Using Pragmatics / 간호학회지

PURPOSE: While most psychiatrists diagnose Hwa-Byung as a chronic psychogenic disorder associated with familial, financial and personality, the purpose of study was to shed light on the nature of Hwa-Byung through pragmatics. Hwa-Byung is characterized as 'Hwa' which means fire 'Byung' which means disease. This condition cannot be empirically experienced, rather it is represented by suffering internally (in the mind). It also could find an aspect of somatization, and self-diagnosing. METHOD: As patients themselves diagnose Hwa-Byung, pragmatical approach was taken to analyze the context of the learning through their communication with others. The case examples resulted from in-depth telephone counseling with a client who is housewife with Hwa-Byung over a period of time at the Women's Hot Line. RESULT: The study showed that the client experienced continuous improper attacks by her husband. She expressed improperness by applying her personal emotions to social-justice reasoning. CONCLUSION: 'Hwa' means lack of mutual intimacy in this research. By expressing this 'Hwa', the client would like to recover mutual intimacy with her husband.

Construct a Structural Model for Health Promoting Behavior of Chronic Illness / 간호학회지

PURPOSE: This study was designed to construct a structural model for health promoting behavior of patients with chronic disease. The hypothetical model was developed based on the literature review and Pender's health promotion model. METHOD: Data was collected by questionnaires from 1748 patients with chronic disease in General Hospital from December 1999 to July 2000 in Seoul. The disease of subject were cardiac disease included hypertension peptic ulcer, pulmonary disease included COPD and asthma, DM, and chronic kidney disease. Data analysis was done with SAS 6.12 for descriptive statistics and PC-LISREL 8.13 Program for Covariance structural analysis. RESULTS: 1. The fit of the hypothetical model to the data was moderate, it was modified by excluding 4 path and including free parameters to it. The modified model with path showed a good fitness to the empirical data (x2=591.83, p<.0001, GFI=0.97, AGFI= 0.94, NNFI=0.95, RMSR=0.01, RMSEA=0.05). 2. The perceived benefits, perceived barriers, self-efficacy, self-esteem, and the plan for action were found to have significant direct effect on health promoting behavior of chronic disease. 3. The health concept, health perception, emotional state, social support were found to have indirect effects on health promoting behavior of chronic disease. CONCLUSION: The derived model in this study is considered appropriate in explaining and predicting health promoting behavior of patients with chronic disease. Therefore, it can effectively be used as a reference model for further studies and suggested implication in nursing practice.

An Effect of a Self-Efficacy Information Resources Program on Perceived Self-Efficacy and Self-Care in Patients with Coronary Artery Disease / 성인간호학회지

PURPOSE: This study was conducted to investigate whether a self-efficacy information resources program based on the self-efficacy theory of Bandura (1986) would increase self-efficacy and self-care in patients with CAD. METHOD: The study was a one group, pretest- posttest pre-experimental design research. The Self-Efficacy Information Resources Program was composed of a video tape program and a telephone coaching program and based on vicarious experiences and verbal persuation. The Program was used as an experimental treatment from February 27. to May 27, 1999. Twenty patients participated from a university hospital located in Seoul. Three days later after a pretest the telephone coaching program was given. It was repeated weekly during a 3 week period. At the end of this period post-test data were collected by mail. Data were analyzed with a random permutation test using SAS program. RESULT: 1) Scores on self-efficacy after the Self-Efficacy Information Resources Program were significantly higher than before the program (p=0.06). 2) Scores on self-care after the Program were significantly higher (subjective self-care, p=0.0005; objective self-care, p= 0.0002) than before the program. CONCLUSION: The Program was found to be an effective nursing intervention for increasing self-efficacy and self-care. When nurses who care for CAD patients plan to increase their patients' self care ability, they should always consider the concept of self-efficacy.

A Structural Model for Health Promoting Behaviors in Patients with Chronic Respiratory Disease / 간호학회지

PURPOSE: This study was designed to construct a structural model for health promoting behavior in patients with chronic respiratory disease. A hypothetical model was developed based on the literature review. METHOD: Data was collected by questionnaires from 235 patients with chronic respiratory disease in a General Hospital in Seoul. Data analysis was done using SAS 6.12 for descriptive statistics and the PC-LISREL 8.13 Program for Covariance Structural Analysis. RESULT: The results are as follows : 1. The fit of the hypothetical model to the data was moderate. It was modified by excluding 2 path and including free parameters and 3 path to it. The modified model with path showed a good fitness to the empirical data(X2=80.20, P=0.05, GFI=0.95, AGFI=0.88, NNFI=0.95, NFI=0.96, RMSR=0.01, RMSEA =0.06). 2. The perceived benefits, self-efficacy, and a plan of action were found to have significant direct effects on the health promoting behavior in patients with chronic respiratory disease. 3. The health perception, self-esteem, and activity related to affect were found to have indirect effects on the health promoting behavior in patients with chronic respiratory disease. CONCLUSION: The modified model of this study is considered appropriate in explaining and predicting health promoting behavior in patients with chronic respiratory disease. Therefore, it can effectively be used as a reference model for further studies and suggested direction in nursing practice.

A Structural Model Based on Pender's Model for Quality of Life of Chronic Gastric Disease / 간호학회지

This study was designed to construct a structural model for quality of life of chronic gastric disease. The hypothetical model was developed based on the literature review and Pender's health promotion model. Data were collected by questionnaires from 459 patients with chronic gastric disease in a General Hospital from July 1999 to August 2000 in Seoul. Data analysis was done with SAS 6.12 for descriptive statistics and PC-LISREL 8.13 Program for Covariance structural analysis. The results are as follows : 1. The fit of the hypothetical model to the data was moderate, thus it was modified by excluding 1 path and including free parameters and 2 path to it. The modified model with path showed a good fitness to the empirical data (Chi2=934.87, p<.0001, GFI=0.88, AGFI=0.83, NNFI=0.86, RMSR =0.02, RMSEA=0.07). 2. The perceived barrier, health promoting behavior, self-efficacy, and self-esteem were found to have significant direct effects on the quality of life. 3. The health concept, health perception, emotional state, and social support were found to have indirect effects on quality of life of chronic gastric disease. In conclusion, the derived model in this study is considered appropriate in explaining and predicting quality of life of chronic gastric disease. Therefore it can effectively be used as a reference model for further studies and suggested direction in nursing practice.

The Lives of Daughters-in-Law Who Care for Parents with Dementia / 간호학회지

This study was done to investigate the lives of the daughters- in- law caring for parents with dementia and participate in their lives through having quality time with them. Data were collected by depth interviews and interpreted through the hermeneutic circle as follows. These daughters-in-law have conflict between social custom and subjective self. They had ambivalence toward their demented partents-in- law and were fighting a battle between rationality and emotions in their mind. These daughters-in law and mothers-in- law did not get along and the parents' dementia aggravated the relationships. They were alienated from their family by the parents with dementia. The indifference of their family especially their husbands, made these subjects live in misery. They cared for the demented mother-in-law with hatred. Even though they had this yoke, there daughters- in-law were not able to throw off the shackles of convention.

The Concept of Hwa-Byung in Nursing / 간호학회지

The purpose of this study was to study how nurses interpreted the meaning of Hwa-Byung. It was carried through a review of literature, and the result is expected to explore ways that nursing intervention can promote the understanding of Hwa-Byung. The literature review focused on cultural psychology and psychiatrists' views toward Hwa-Byung. After that, it was reconfirmed concept of Hwa-Byung in nursing devived from historical analysis of the examples of Hwa-Byung from a true record of the Cho-Sun Dynasty(CD ROM, 1997). Characteristics of patients with Hwa-Byung include 'Hwa', an aspect of somatization, and self-diagnosing. It also could find that Hwa-Byung is characterized as 'Hwa', 'somatization' and 'self-diagnosis(subjectiveness)' according to a true record of the Cho-Sun Dynasty(CD ROM, 1997). The conceptual definition of 'Hwa', 'somatization' and 'self-diagnosing (subjectiveness)' are as follows. The core concept of Hwa-Byung, 'Hwa,' has the property of 'fire', and equals the feeling of injustice. Hwa-Byung means congestion of 'Hwa'. Therefore Hwa-Byung is the accumulation of being mistreated and mortified. The feeling of mistreatment comes from subjective experiences, which cannot be in harmony with the values, beliefs and rights of the patients. The situations that they have to endure again and again, though they are the sufferers, connote suppressed aggression and powerlessness endured over time. Suppressed aggression subordinated hostility, hatred and revengeful thoughts; powerlessness subordinates frustration, resignation, and fatalism. Somatization is another form of expressing 'Hwa' through physical symptoms. The somatization of clients with Hwa-Byung plays a role in expressing non-verbalized and suppressed emotions within themselves. The clients who experiences Hwa-Byung think that they know the cause of their illness and self-diagnose their problem as Hwa-Byung. Therefore, the feeling of unfairness which is the premise of Hwa-Byung infers 'subjectiveness' In conclusion, nursing's concept of Hwa-Byung is the accumulation of feelings of being mistreated and mortified. Hwa-Byung is the internalized 'Hwa' from enduring again and again. The feeling of being mistreated comes from subjective judgements about unfairness that cannot be harmonized with the clients' values, beliefs and rights. Those who can express their 'Hwa' only through their bodies imply suppressed aggression and powerlessness.