How Do Oncology Nurses Cope With the Psychological Burden of Caring for Dying Patients?

BACKGROUND: Cancer is a leading cause of death worldwide, and most patients with cancer in South Korea die in hospitals. Oncology nurses experience physical, emotional, and occupational challenges associated with the psychological burden of caring for dying patients. OBJECTIVE: This study explored the coping strategies used by oncology nurses to deal with the psychological burden of patient deaths. METHODS: In this descriptive qualitative study, 10 oncology nurses who had recently experienced a patient's death were recruited via snowball sampling. All were female, with a mean age of 32.9 years (range, 27-44 years), and their mean working duration was 9.9 (range, 3-23) years. Participants were interviewed individually face-to-face 3 times, with each interview lasting 1 to 1.5 hours. RESULTS: Oncology nurses coped with the psychological burden of a patient's death in the following 4 ways: ( a ) avoiding patient deaths to the extent possible, ( b ) reflecting upon the meaning of life and death, ( c ) suppressing their emotional distress over the patient's death, and ( d ) becoming kinder and more caring toward people around them. CONCLUSIONS: The findings suggest that oncology nurses struggle to cope with the psychological burden of patient deaths. Oncology nurses are affected both negatively and positively by experiencing death as they provide end-of-life care. IMPLICATIONS FOR PRACTICE: Oncology nurses need education or counseling to reduce the psychological burden of caring for dying patients with cancer. Hospital administrators need to continuously identify ways to reduce the psychological burden of oncology nurses providing end-of-life care.

How do ethically competent nurses behave in clinical nursing practice? A qualitative study.

AIM: This study explored how ethically competent nurses behave in clinical nursing practice. BACKGROUND: Nurses' ethical competency is crucial in nursing practice as it promotes patients' safety and quality of care. METHODS: Using a purposive sampling technique, 20 clinical nurses in South Korea were interviewed via an online video platform. The data were analysed using a thematic analysis based on phenomenological approach. RESULTS: The main theme found among the participating nurses' ethical competency was caring beyond egocentrism, with two subthemes: (1) patient-centred care based on compassion and (2) responsible behaviour based on nursing professionalism. Factors that enabled this included (1) reasonable work conditions, (2) interpersonal relationships, and (3) nurses' rich personal experiences. CONCLUSIONS: Nurses' ethical competency depends on how far they can move away from their own egocentrism and act for their clients' benefit, wherein an appropriate workload and warm human relationships with one's colleagues are essential. Nurses should thus receive education on ethics and professionalism and participate in volunteer and leisure activities that cultivate their degree of empathy. IMPLICATION FOR NURSING MANAGEMENT: Nursing leaders and managers should understand nurses' ethical competency and its enabling factors to devise effective strategies to promote it.

Correction: Choe et al. Effect of Ethics Seminar on Moral Sensitivity and Ethical Behavior of Clinical Nurses. Int. J. Environ. Res. Public Health 2021, 18, 241.

The authors wish to make corrections to the order of the authors [...].

Expert nurses' coping strategies in ethically challenging situations: a qualitative study.

BACKGROUND: Nurses frequently encounter ethically challenging situations in everyday practice. In these situations, nurses often know an appropriate course of action to take but are unable to do so. Many studies have examined the ethically challenging situations faced by nurses, but how nurses cope with these situations is not well understood. Therefore, this study aims to explore the coping strategies used or adopted in ethically challenging situations by expert nurses in South Korea. METHODS: Participants were recruited via purposive sampling. Small group interviews were conducted with 26 expert registered nurses in a general hospital in South Korea. The data were analyzed using Giorgi's descriptive phenomenological method. RESULTS: The essential theme of nurses' experience of coping with ethically challenging situations was "being faithful to the nature of caring." This essential theme comprised three themes: self-monitoring of ethical insensitivity, maintaining honesty, and actively acting as an advocate. CONCLUSIONS: The findings of this study suggest that the coping strategies of expert nurses are mostly consistent with the attributes of ethical competence as previously defined in healthcare, and expert nurses can address ethically challenging situations in an effective and ethical manner by faithfully adhering to the spirit of caring. System-wide early counseling and interventions should be considered for nurses who have experienced ethical difficulties.

The applicability of the interpersonal-psychological theory of suicide among community-dwelling older persons.

INTRODUCTION: This study examined the application of the interpersonal-psychological theory of suicide to community-dwelling older persons in South Korea. METHODS: A cross-sectional study design was used. The data were collected by surveying 200 older persons (117 female, 83 male) aged over 65 years at welfare centers for older persons. The Interpersonal Needs Questionnaire, the Suicidal Ideation Scale, and the Acquired Capability for Suicide Scale were used to assess participants' thwarted belongingness, perceived burdensomeness, suicidal ideation, attempts, and the capability for suicide. Structural equation modeling was used to examine the fitness of a model based on the interpersonal-psychological theory of suicide. This theory described that perceived burdensomeness and thwarted belongingness lead to suicidal ideation, which is transformed into suicide attempts through an acquired capability for suicide. RESULTS: Perceived burdensomeness was significantly associated with suicidal ideation among older persons, whereas thwarted belongingness was not. Furthermore, suicidal ideation influenced suicide attempts. The acquired capability for suicide moderated the relationship between suicidal ideation and suicide attempts. CONCLUSIONS: To prevent suicidal ideation and suicide attempts among older persons, it is important to prevent them from feeling that they are a burden.

Mediating Effect of Hope on the Relationship Between Depression and Recovery in Persons With Schizophrenia.

Background: Depression and hope are considered pivotal variables in the recovery process of people with schizophrenia. Aim: This study examined the moderating effect of depression on the relationship between hope and recovery, and the mediating effect of hope on the relationship between depression and recovery in persons with schizophrenia. Methods: The model was tested empirically using the data of 115 persons with schizophrenia from Central Java Province, Indonesia. The Calgary Depression Scale for Schizophrenia, Schizophrenia Hope Scale-9, and Recovery Assessment Scale were used to measure participants' depression, hope, and recovery, respectively. Results: The findings supported the hypothesis that depression moderates the relationship between hope and recovery, and hope mediates the relationship between depression and recovery. Conclusions: The findings suggest that mental health professionals need to focus on instilling hope and reducing depression to help improve the recovery of persons with schizophrenia. Furthermore, mental health professionals should actively develop and implement programs to instill hope and continuously evaluate the effectiveness of the interventions, particularly in community-based and in-patient mental health settings.

Intimate Partner Violence Victimization Influences Suicidal Ideation via Interpersonal Dependency and Anger.

BACKGROUND: Intimate partner violence is a serious global social problem. While intimate partner violence is highly prevalent, few studies have examined its negative outcomes among victims in South Korea. The aim was to clarify the mediating roles of interpersonal dependency and anger on the relationship between intimate partner violence victimization and suicidal ideation. METHODS: In this descriptive, cross-sectional study, 301 participants (203 women and 98 men) aged 18-65 yr completed an online questionnaire on a social networking site. Data were collected between Feb and Mar 2017 in South Korea. Structural equation modeling was used to test the fitness of the conceptual model of this study. RESULTS: We found significant correlations between intimate partner violence victimization, interpersonal dependency, state-trait anger, and suicidal ideation. Intimate partner violence victimization influenced anger and suicidal ideation only when the victims had high interpersonal dependency. CONCLUSION: It is necessary to develop programs for reducing interpersonal dependency and improving anger management that are specifically targeted at intimate partner violence victims to prevent suicidal ideation.

Depression, Loneliness, Social Support, Activities of Daily Living, and Life Satisfaction in Older Adults at High-Risk of Dementia.

As the number of older adults with dementia increases, early diagnosis and intervention are crucially important. The purpose of this study was to conduct dementia screening on older adults to determine whether there are differences in depression, loneliness, social support, daily activities of living, and life satisfaction between older adults at high-risk for dementia compared with low-risk older adults. We hypothesized a negative relationship between high-risk older adults and these factors. This study also hypothesized a moderating effect for social support on the relationship between daily living activities and life satisfaction. This study used a cross-sectional design with survey data. Participants were recruited at 15 public community health centers in South Korea. A total of 609 older adults (male 208, female 401) living in the community were screened for early dementia, and 113 participants (18.9%) were assigned to the high-risk group. As hypothesized, participants in the high-risk group showed significantly more negative results in terms of activities of daily living, depression, loneliness, social support, and life satisfaction compared with participants in the low-risk group. The findings of this study provide a theoretical basis for the importance of early screening for dementia and policies for effective dementia prevention.

Feasibility of the Schizophrenia Hope Scale-9: A Psychometric Study.

Hope is essential in rehabilitating persons with schizophrenia, though scales to measure hope are not appropriate for this population. The purpose of this cross-sectional study was to identify the psychometric properties of the Schizophrenia Hope Scale-9 (SHS-9) using data from 83 people with schizophrenia in four mental health centers and 762 healthy persons from two universities in South Korea. The total SHS-9 score is calculated by adding all items' scores and ranges from 0 to 18. The mean (standard deviation) SHS-9 score of the participants with schizophrenia and healthy participants was 11.53 (SD = 4.78) and 14.78 (SD = 3.19), respectively. Lower scores indicate a lower level of hope. The Cronbach's alpha coefficient was 0.92 with a four-week test-retest reliability of 0.89. Criterion-related construct validity was established by examining the correlation between the SHS-9 and the State-Trait Hope Inventory scores. Divergent validity was identified through a negative relationship of SHS-9 with the Beck Hopelessness Scale. In persons with schizophrenia and healthy college students, Bartlett's test of sphericity yielded χ2 = 465.03 (p < 0.001) and χ2 = 2679.24 (p < 0.001) respectively. The values of the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy were 0.89 and 0.90, respectively. The construct validity of the SHS-9 was confirmed through principal component analysis with extraction methods, which resulted in a one-factor solution, accounting for 61.83% of the total item variance. This study provides evidence for the validity and reliability of the SHS-9; therefore, it could be used to study the relationships between hope and other variables (e.g., depression and recovery) in persons with schizophrenia and measure the effect of psychosocial interventions on their hope.

Effects of Food Art Therapy on the Self-Esteem, Self-Expression, and Social Skills of Persons with Mental Illness in Community Rehabilitation Facilities.

Persons with mental illness often have low self-esteem, a lack of self-expression, and poor social skills. This study used a quasi-experimental two-group pre-test-post-test design to investigate the effects of food art therapy on the self-esteem, self-expression, and social skills of persons with mental illness attending community rehabilitation facilities. The authors recruited persons with mental illness aged 18 years or older attending three community rehabilitation facilities. Participants in two rehabilitation facilities participated in food art therapy (experimental groups 1 and 2; n = 15 for each group), and participants in the third rehabilitation facility participated in regular programs of the facility (control group, n = 30). Participants in the experimental groups attended a total of eight sessions of food art therapy twice per week for four weeks. The Korean versions of the Rosenberg self-esteem scale, self-expression scale, and social skill rating system were administered at pre- and post-test in both the experimental and control groups. The self-esteem, self-expression, and social skills of the experimental group improved significantly compared to the control group. The findings suggested that food art therapy would be an excellent psychosocial intervention to help persons with mental illness to rehabilitate in the community.

Anxiety of Older Persons Living Alone in the Community.

Anxiety is a common mental health problem among older persons, and the prevalence is higher in those who live alone than those who live with others. This study aimed to explore the experiences of anxiety in older persons living alone. A descriptive phenomenological approach was used to collect and analyze the interview data from 15 older persons (5 males, 10 females) living alone in Seoul, South Korea. Four main themes emerged from the data analysis: fear of being alone, concern about having an aged body, apprehension mixed with depression and loneliness, and fear of economic difficulties. These findings indicate that older persons living alone should receive continuous attention to prevent them from being neglected and their anxiety from worsening. Above all, it is vital to ensure comprehensive support for older persons living alone to alleviate their anxiety.

Effect of Ethics Seminar on Moral Sensitivity and Ethical Behavior of Clinical Nurses.

While nursing is an ethical profession, unethical behavior among nurses is increasing worldwide. This study examined the effects of an ethics seminar on nurses' moral sensitivity and ethical behavior. A total of 35 nurses (17 experimental, 18 control) were recruited. The ethics seminar was held over a six-month period from May to October 2018 and comprised six sessions held once a month for two hours. Moral sensitivity and unethical behavior were measured at the start and end of the seminar. Moral sensitivity and unethical behavior showed a negative correlation (r = -0.400, p < 0.05). After the ethics seminar, the experimental group's moral sensitivity was not significantly increased (t = -1.039, p = 0.314). The experimental group's mean scores of unethical behavior at pre- and posttest were 12.59 and 9.47, respectively, indicating a statistically significant difference (t = 3.363, p = 0.004). There was no statistically significant difference in the mean score in both moral sensitivity and unethical behavior at pre- and posttest in the control group. Thus, ethics seminars can reduce the risk of unethical behavior among nurses. Regular ethics seminars and training must be provided to nurses as part of their curriculum/practice.

Pediatric nurses' ethical difficulties in the bedside care of children.

BACKGROUND:: Pediatric nurses experience ethically difficult situations in their everyday work. Several studies have been conducted to reveal ethical issues among pediatric nurses; we do not think their ethical difficulties have been explored sufficiently from their own perspective. OBJECTIVES:: This study aimed to explore the ethical difficulties faced by pediatric nurses during bedside care for hospitalized children. METHODS:: A phenomenological approach was used to collect and analyze interview data from 14 female pediatric nurses in South Korea. ETHICAL CONSIDERATIONS:: Ethical review was obtained from an ethics committee. The participants were informed about the aim of the study, and voluntary participation, anonymous response, and confidentiality were explained to them. FINDINGS:: Three themes emerged from the analysis: ethical numbness in a task-oriented context, negative feelings toward family caregivers, and difficulty in expressing oneself in an authoritative climate. Conclusion and implications: We need to develop strategies to manage ethical difficulties at an institutional level. Furthermore, it is important that pediatric nurses have the opportunity to communicate with fellow nurses and other medical staff regarding ethical difficulties. In addition, cultivation of pediatric nurses' moral, ethical, and philosophical thinking patterns requires the immediate provision of continuous education in nursing ethics at the site of clinical nursing, time to discuss ethical difficulties, and other supportive measures. Findings indicated that, to provide high-quality patient-centered care, we should enhance nurses' ethical sensitivity and autonomy and improve the ethical climate in hospitals.

The moderating role of the amount of caregiving tasks on the relationships between dementia caregivers' characteristics and outcomes.

AIM: This study identified the moderating role of the amount of caregiving tasks on relationships between dementia family caregivers' characteristics (age, education, etc.) and outcomes (burden, etc.). DESIGN: A cross-sectional analysis of surveyed data. METHOD: A convenience sample of 369 family caregivers (151 males, 218 females) aged 20 years or older was recruited from 10 cities in the southern area of South Korea. Data were collected from November-December 2011. Measures of caregiver burden, perceived health status and emotional distress of caregivers related to the memory-behaviour problems of the care recipient were used to assess the outcomes of family caregivers of older adults with dementia. RESULTS: The amount of caregiving tasks has a moderating effect on the relationships between caregivers' characteristics (such as living with the recipient and duration of caregiving) and the caregiver burden. The interaction between the amount of caregiving tasks and status of living with recipient was significant in relation to the emotional distress of caregivers related to the memory-behaviour problems of the care recipient with dementia; however, there was no effect of the amount of caregiving tasks on the relationships between caregivers' characteristics and perceived health status. CONCLUSION: The amount of caregiving tasks can have a moderating role in the caregiving stress model. Intervention programs need to be developed and implemented to reduce negative outcomes of family caregivers, particularly those living with older adults with dementia.

Mediating effects of workplace violence on the relationships between emotional labour and burnout among clinical nurses.

AIMS: To test a model of the relationship between nurses' burnout and emotional labour using structural equation modelling to identify the mediating effects of workplace violence. BACKGROUND: Nurses are a group that experiences high emotional labour and are exposed to various types of violence in the clinical setting. Burnout is related to emotional labour and exposure of workplace violence, but alternatives to reduce burnout in the context of emotional labour (e.g., reduction in workplace violence) have not been extensively investigated. DESIGN: This study adopted a cross-sectional design. METHODS: A convenience sample comprising 400 nurses from four university hospitals in Korea was selected from 10 to 30 October 2016. Data on nurses' level of emotional labour, burnout and workplace violence were collected from participants. A composite-indicator structural equation model was used to examine the mediation model. RESULTS: Overall, 356 nurses (89.0%) returned the completed questionnaires. Burnout was significantly and positively associated with emotional labour and workplace violence. In addition, workplace violence mediated the relationship between emotional labour and burnout related to the nursing job. CONCLUSION: The findings suggest that, to alleviate burnout in clinical nurses due to emotional labour, various programs and policy measures should be adopted to prevent their exposure to workplace violence and to enhance the organizational management of violence.

Effects of Mandala Art Therapy on Subjective Well-being, Resilience, and Hope in Psychiatric Inpatients.

PURPOSE: This study investigated the effects of Mandala art therapy on subjective well-being, resilience, and hope among psychiatric inpatients. METHODS: Recruited 36 people who had been treated as inpatients in a psychiatric ward at a university hospital in Seoul, South Korea, and divided them evenly into experimental and control groups. The experimental group was required to attend a total of 8 sessions of Mandala art therapy, twice per week, between August 11 and October 30, 2015; measures of the three main variables were administered at pre-test and post-test in both groups. RESULTS: Hope significantly increased in both groups, but the overall increase was greater in the experimental group (mean score of 9.5 and 15.3 at pre- and post-test, respectively) than in the control group (10.9 and 11.9). CONCLUSION: These results suggest that Mandala art therapy can have a positive effect on the hope of psychiatric inpatients. However, further research concerning its effects on subjective well-being and resilience, as well as other psychological constructs, is warranted to better understand the effects of Mandala art therapy on psychiatric inpatients.

Barriers to ethical nursing practice for older adults in long-term care facilities.

AIMS AND OBJECTIVES: To explore barriers to ethical nursing practice for older adults in long-term care facilities from the perspectives of nurses in South Korea. BACKGROUND: The number of older adults admitted to long-term care facilities is increasing rapidly in South Korea. To provide this population with quality care, a solid moral foundation should be emphasised to ensure the provision of ethical nursing practices. Barriers to implementing an ethical nursing practice for older adults in long-term care facilities have not been fully explored in previous literature. DESIGN: A qualitative, descriptive design was used to explore barriers to ethical nursing practice as perceived by registered nurses in long-term care facilities in South Korea. METHODS: Individual interviews were conducted with 17 registered nurses recruited using purposive (snowball) sampling who care for older adults in long-term care facilities in South Korea. Data were analysed using qualitative content analysis. RESULTS: Five main themes emerged from the data analysis concerning barriers to the ethical nursing practice of long-term care facilities: emotional distress, treatments restricting freedom of physical activities, difficulty coping with emergencies, difficulty communicating with the older adult patients and friction between nurses and nursing assistants. CONCLUSIONS: This study has identified methods that could be used to improve ethical nursing practices for older adults in long-term care facilities. Because it is difficult to improve the quality of care through education and staffing alone, other factors may also require attention. RELEVANCE FOR CLINICAL PRACTICE: Support programmes and educational opportunities are needed for nurses who experience emotional distress and lack of competency to strengthen their resilience towards some of the negative aspects of care and being a nurse that were identified in this study.

Associations among daytime sleepiness, depression and suicidal ideation in Korean adolescents.

The aim of this study was to examine the effects of daytime sleepiness on depression and suicidal ideation in adolescent high-school students. A survey of 538 high school students aged 16-17 years attending two academic schools was conducted. The Epworth Sleepiness Scale (ESS), the Beck Depression Inventory and the Scale for Suicide Ideation were used to assess subjects' daytime sleepiness, depression and suicidal ideation. The mean score for daytime sleepiness was 8.52, which indicates a sleep deficit. Significant positive correlations were found between daytime sleepiness and depression, between daytime sleepiness and suicidal ideation and between depression and suicidal ideation. Gender and depression were significant predictors of suicidal ideation, accounting for 48% of the variance in this measure. Depression acts as a mediator of the relationship between daytime sleepiness and suicidal ideation. High school students in Korea generally have insufficient sleep time and feel sleepy during the day; insufficient sleep during adolescence may be associated with depression and suicidal ideation.

Lived experience of Korean nurses caring for patients on maintenance haemodialysis.

AIMS AND OBJECTIVES: To understand the lived experience of nurses who care for people undergoing maintenance haemodialysis. BACKGROUND: There is a lack of research regarding the lived experience of nurses caring for people undergoing chronic haemodialysis, in spite of an increased number of nurses and patients. DESIGN: A qualitative descriptive phenomenological study was conducted. METHODS: Fourteen nurses working at two haemodialysis centres in Korea were selected via purposive sampling and participated in in-depth interviews. Data were collected from October 2013-January 2014 and analysed using the phenomenological research method. RESULTS: Four themes were extracted for haemodialysis nurses' caring experience: feelings of pity for clients scheduled for haemodialysis treatment; continuous effort to establish good relationships with clients; feeling comfortable with clients, as though they were family or friends; and reflecting on their own lives through the lives of clients. CONCLUSIONS: Haemodialysis nurses experienced therapeutic relationships while taking care of clients undergoing haemodialysis; they also experienced maturation through reflection on their lives as nurses and human beings. An understanding of nurses' experiences in caring for people undergoing haemodialysis should be the basis of practice, education and nursing research in haemodialysis. RELEVANCE TO CLINICAL PRACTICE: This study could be helpful in enabling nursing students and/or nurses to understand the experience of caring and its meaning with respect to clients undergoing haemodialysis.