Post-Donation Regret and Anxiety Among Family Living Liver Donors: The Mediating Roles of Family Relationships and Sense of Mastery.

BACKGROUND Post-donation regret in family living liver donors can impact their mental well-being. This study examined whether the relationship between post-donation regret and anxiety is mediated by family relationships and a sense of mastery. MATERIAL AND METHODS We conducted a secondary analysis of de-identified cross-sectional data from a prior study that included 124 living liver donors. These donors underwent partial hepatectomy between January 2011 and March 2021 at a tertiary hospital in Seoul, South Korea. The data included demographic and clinical characteristics, along with the results from administering the following measures: the Post-Donation Regret Scale, Family Relationships Index, Pearlin Mastery Scale, and the Generalized Anxiety Disorder-2 scale. RESULTS Among family living liver donors, 5.6% had anxiety after donation. The total effect of post-donation regret on anxiety was significant (B=0.41, p<0.05). However, the direct effect of regret on anxiety was not significant (B=-0.05, p=0.733). Post-donation regret had indirect effects on anxiety, solely through family relationships (B=0.329, 95% CI=0.130, 0.563) and sequentially through family relationships and mastery (B=0.088, 95% CI=0.008, 0.232), even after controlling for sex, age, postoperative complications, years since donation, and recipient's death. In addition, postoperative complication was a predictor of anxiety (B=0.64, p<0.05). CONCLUSIONS Providing family-centered and mastery-enhancing interventions may help alleviate the anxiety of family living liver donors.

Effect of COVID-19 Frontline Nurses' Profession Perception on Their Intention to Stay: The Mediating Role of Job Satisfaction.

Introduction: Understanding the factors affecting the intention of frontline nurses during the coronavirus disease (COVID-19) pandemic to stay in the nursing profession is essential for developing strategies to overcome the challenges associated with the pandemic. Objectives: This study aimed to examine the mediating effect of nurses' job satisfaction on the relationship between their sense of calling, job-esteem, and the intention to stay in their profession. Methods: The study used a previously collected dataset, sourced from a dedicated COVID-19 hospital in Seoul City, South Korea. Original data were collected from June to July 2021. The study sample consisted of 134 nurses who provided direct care to patients. The intention to stay was measured with the following question: "Are you willing to work during this COVID-19 pandemic?". The Job Satisfaction Scale from the Korean Labor and Income Panel Study, Korean version of a Multidimensional Calling Measure, and Job-Esteem Scale for Hospital Nurses were utilized. Associations between the study variables were estimated using bivariate correlation analyses and bootstrapping mediation analyses. Results: In the bivariate correlation analysis, nurses' sense of calling (r = .36, p < .001), job-esteem (r = .32, p < .001), and job satisfaction (r = .39, p < .001) were significantly associated with the intention to stay. In the mediation analysis, job satisfaction partially mediated the relationship between the sense of calling and the intention to stay (total effect; B = 0.410, p < .001) and fully mediated the relationship between job-esteem and the intention to stay (total effect; B = 0.549, p < .001). Conclusion: Enhancing nurses' job satisfaction is crucial for fostering the retention of the nursing workforce amid the pandemic. Consequently, it is imperative to closely examine the job satisfaction and work environment of frontline nurses to identify areas in need of improvement. Addressing the factors that impede nurses' job satisfaction is essential to unlock the positive effects of a sense of calling and job-esteem.

Does living liver donors' underestimation about surgical outcomes impact on their health-related quality of life after donation?: a descriptive cross-sectional study.

BACKGROUND: In South Korea, the number of living-donor liver transplantations in 2019 was 1,188. Living liver donors (LLDs) undergo surgery and the postoperative recovery process for altruistic purposes. This study explored LLDs' unmet expectations about surgical outcomes and examined their impact on the donors' health-related quality of life (HRQOL). METHODS: This descriptive cross-sectional study utilized a self-reported survey. Data were collected at a university hospital in Seoul, South Korea. Among the 535 LLDs who underwent surgery for donation between January 2011 and March 2021, 124 participated in this study. The Korean version of the 12-item Short Form Health Survey version 2 (SF-12v2) was used to measure the HRQOL of LLDs. Unmet expectations regarding surgical outcomes were measured using four items: pain, length of hospital stay, speed of recovery, and complications. Logistic regression model was applied to determine whether the unmet expectations influence HRQOL in LLDs. Odds ratios with 95% confidence interval were used. RESULTS: The percentage of the participants who reported that their actual experiences for pain, speed of recovery, hospital stay, and complications were worse than expected were 34.7%, 22.6%, 9.7%, and 7.3%, respectively. Unmet expectations about surgical outcomes were significantly associated with physical and mental HRQOL after controlling for age, sex, education level, income, postoperative complications, recipients' death, time since donation, and satisfaction with the decision to donate. CONCLUSION: LLDs should be supported in obtaining more accurate and realistic information about surgical outcomes to decrease unmet expectations, which may help improve their quality of life.

Effects of Living Alone and Sedentary Behavior on Quality of Life in Patients With Multimorbidities: A Secondary Analysis of Cross-Sectional Survey Data Obtained From the National Community Database.

BACKGROUND: Having multimorbidities may increase health problems. Moreover, health-related quality of life correlates negatively with the number of chronic conditions a patient has. Living alone has been identified as a predictor of poorer quality of life, and a sedentary lifestyle is widely known to increase health problems and mortality. PURPOSE: This study was designed to identify the effects of living alone and of sedentary behavior on health-related quality of life in patients with multimorbidities using nationally representative community data. METHODS: A secondary data analysis of the Korea National Health and Nutrition Examination Survey was conducted. In this study, 1,725 adult patients aged 19 years and above with two or more chronic diseases were selected for the analysis. Health-related quality of life was measured using the European Quality of Life-5 Dimensions. Multiple logistic regression was performed to identify the effects of living alone and of sedentary behavior on health-related quality of life. The statistical analyses took into account the components of the complex sampling design such as the strata, clusters, weights, and adjustment procedures, and missing data were treated in a valid manner. RESULTS: After adjusting for gender, age, employment status, and number of chronic diseases, it was found that the odds of having a high health-related quality of life were lower in single households than in multiperson households (odds ratio = 0.62, 95% confidence interval [0.46, 0.84]). In addition, after adjusting for gender, age, employment status, number of chronic diseases, and living arrangement, the odds of having a high health-related quality of life decreased as sedentary time increased (odds ratio = 0.93, 95% confidence interval [0.89, 0.96]). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: To improve quality of life in patients with multimorbidities, nursing interventions that support patients who live alone and have complicated disease-related issues and that reduce sedentary behavior should be developed.

Female nursing graduate students' stress and health: the mediating effects of sense of coherence and social support.

BACKGROUND: Ninety-five percent of nursing graduate students in South Korea are women, and most are often engaged in both academic coursework and work outside of the academic environment. Nursing graduate students often experience stress leading to physical and mental health problems that negatively affect their academic performance and persistence during graduate programs. The purpose of this study was to test multiple mediation effects of sense of coherence (SOC) and social support in the relationship between stress and health status of nursing graduate students. METHODS: The participants of this study were 231 female nursing graduate students from 14 universities. Data were collected using an online survey conducted between August and October 2019. Bootstrap techniques using the PROCESS macro for SPSS software were applied to assess the multi-mediating effects. RESULTS: The total effect (B = - 12.29, p < .001) and direct effect (B = - 7.07, p < .001) of perceived stress on health status were significant. Perceived stress had negative direct effects on social support (B = - 0.41, p < .001) and SOC (B = - 5.77, p < .001). SOC had a positive direct effect on health status (B = 0.59, p < .001). However, social support was not a significant predictor of health status (B = 1.24, p = .232). In addition, there was a positive direct effect of social support on SOC (B = 5.23, p < .001). Furthermore, the indirect effect of perceived stress on health status through SOC was significant (B = - 3.42, 95% CI = - 5.2616, - 1.8906). There was also a significant indirect effect of perceived stress on health status through social support and SOC (B = - 1.28, 95% CI = - 2.1663, - 0.5992). CONCLUSION: It is necessary to create strategies that enhance nursing graduate students' SOC and social support to reduce their perceived stress and to improve their health status.

An ethical issue: nurses' conscientious objection regarding induced abortion in South Korea.

BACKGROUND: The Constitutional Court of South Korea declared that an abortion ban was unconstitutional on April 11, 2019. The National Health Care System will provide abortion care across the country as a formal medical service. Conscientious objection is an issue raised during the construction of legal reforms. METHODS: One hundred sixty-seven perioperative nurses responded to the survey questionnaire. Nurses' perception about conscientious objection, support of legislation regarding conscientious objection, and intention to object were measured. Logistic regression was used to explore the factors associated with support of the legislation and the intention to conscientiously object. RESULTS: Only 28.8% of the responding nurses were aware of health care professionals' conscientious objection. The majority (68.7%) felt that patients' rights should be prioritized over health care professionals' conscientious objection. On the other hand, 45.8% supported the legislation on conscientious objection to abortion, and 42.5% indicated a willingness to refuse to participate in an abortion case if conscientious objection was permitted. Religion, awareness of conscientious objection, and prioritizing of nurses' right to conscientious objection were significantly associated with supporting the legislation. Moreover, religion and prioritizing nurses' rights were significantly associated with the intention to conscientiously object. CONCLUSIONS: This study provides information necessary for further discussion of nurses' conscientious objection. Nursing leaders, researchers, and educators should appeal to nurses and involve them in making policies that balance a women's right to non-discrimination and to receiving appropriate care with nurses' rights to maintain their moral integrity without compromising their professional obligation.

Critical Care Nurses' Perceptions of Parenteral and Enteral Nutrition at the End-of-Life in South Korea.

PURPOSE: The purpose of this study was to explore the perceptions of critical care nurses regarding the withdrawal or withholding of enteral nutrition (EN) and parenteral nutrition (PN) at the end-of-life, which is not allowed according to the current law in South Korea. METHODS: This was a cross-sectional study utilizing a self-report survey. The participants in the study were 141 nurses working in the intensive care units of a tertiary university hospital. The critical care nurses' general attitudes about EN and PN at the end-of-life were measured using the questionnaires developed by Lubart, Leibovitz, and Habot. The nurses responded to additional questions on whether withdrawal or withholding of EN or PN at the end-of-life should be legally allowed. RESULTS: The mean scores of the general attitude items on EN ranged between 3.03 and 3.35 on a 5-point Likert scale where a value of 1 represents "strongly disagree" and a value of 5 represents "strongly agree," while those for PN ranged between 2.89 and 3.65. Respecting attitudes toward EN and PN, critical care nurses had more negative attitudes about stopping PN than EN. Regarding attitudes about whether patients should be legally able to refuse EN, 34.3% agreed, while 25.7% disagreed. For PN, 40.0% agreed, while 24.3% disagreed. CONCLUSION: Discussions about making the withdrawal and withholding of artificial nutrition legal should be initiated. Moreover, education regarding evidence about the outcomes of EN and PN during end-of-life care and up-to-date clinical guidelines about it should be provided.

Willingness to pay for family education and counselling services provided by critical care advanced practice nurses.

AIM: The aim of this study was to estimate the economic value of a family education and counselling service provided by critical care advanced practice nurses in South Korea utilizing a contingent valuation approach. METHODS: A double-bounded dichotomous choice contingent valuation method was utilized to estimate the public's willingness to pay value for an education and counselling service provided by critical care advanced practice nurses. A web-based self-administered survey was conducted. RESULTS: Median willingness to pay was 43 112 Korean won (35 US dollars). Higher income and younger age were associated with higher willingness to pay. CONCLUSION: This study captured the economic value of an education and counselling service provided by critical care advanced practice nurses that is not on the benefit list under the fee-for-service system of the Korean National Health System. Policy makers should consider including such services in the health care system.

Health-promoting lifestyle behaviors and psychological status among Arabs and Koreans in the United Arab Emirates.

Cultural variations among ethnic groups may differentially influence health and health behavior. We explored and compared health-promoting lifestyle behaviors and psychological status, including depression, anxiety, and stress, among Korean migrants (n = 117) and Arab nationals (n = 103) in the United Arab Emirates (UAE). Pender's Health Promotion Model guided this research. The Health-Promoting Lifestyle Profile was used to measure health-promoting lifestyle behaviors and Lovibond and Lovibond's Depression, Anxiety, and Stress Scale to measure psychological status. The data were analyzed using bivariate procedures and multiple linear regression. No group differences were found in total scores for health-promoting lifestyle behaviors or psychological status. Both groups scored high on self-actualization and interpersonal support; Arabs scored low on exercise, and Koreans scored low on health responsibility. Across groups, psychological status (ß = -.390, p < .001), education (ß = .239, p < .001), and gender (ß = .238, p < .001) were significant determinants of health-promoting lifestyle behaviors in multivariate analysis. Ethnicity and religious attendance were not significant determinants. Education level had a moderating effect; for those with a lower educational level, psychological distress had a stronger negative effect on health behavior. Findings suggest considering cultural aspects, such as different values placed on physical fitness and social/interpersonal relationships, in developing and implementing health education and/or promotion programs. Assessment of psychological status (i.e., depression, anxiety, and stress) should also be included in health promotion programs and related health policies for Korean migrants and Arab nationals in the UAE.

Predictors of adherence to medication in older Korean patients with hypertension.

BACKGROUND AND RESEARCH OBJECTIVES: Adherence to a medication regimen is a major factor in achieving adequate blood pressure control for hypertensive patients. However, older adults often report having missed doses, which they attribute to forgetfulness. The purpose of this study was to identify significant factors, including socioeconomic variables, hypertension history, and cognitive functions, contributing to medication adherence among older Korean adults with hypertension. SUBJECTS AND METHOD: This study involved 241 older patients with hypertension from a community senior center during the period from 2008 to 2009. Data were collected through face to face interviews. The association of medication adherence with socioeconomic characteristics, hypertension-related history, knowledge, antihypertensive lifestyle, and memory was assessed by computing odds ratios in logistic regressions. RESULTS AND CONCLUSIONS: Of the 241 patients, 44% were aged 75 or older, and 60% were male. The rate of non-adherence with antihypertensive medication was 41%. Metamemory, adherence to an antihypertensive lifestyle, and employment status, were associated with participants' adherence to antihypertensive medication in both univariate and multivariate analyses. Results suggest that memory functions are a key factor to medication adherence among the Korean elderly population. In contrast to younger adults, unintentional non-adherence appears to be a major issue for older adults to keep medicating. Interventions focusing on memory ability, such as strategies for recalling and placing cues, are needed for implementation in the population of older Korean patients with hypertension. Unemployed older people who have hypertensive lifestyles should also be considered a high-risk group for non-adherence to medication.

Factors related to korean nurses' willingness to report suspected elder abuse.

PURPOSE: This study aimed to describe Korean nurses' willingness to report suspected elder abuse and examine its related factors. METHODS: A descriptive correlational design was used. A convenience sample of 365 nurses from a hospital completed our questionnaires. Stepwise logistic regression analysis was performed to examine predictors of willingness to report. RESULTS: Sixty-eight nurses (18.6%) were not willing to report suspected elder abuse. In the stepwise logistic regression analysis, fewer years in clinical work, a higher level of knowledge on elder abuse law, and the perception of more severe abuse were found to be significant predictors of willingness to report elder abuse. CONCLUSION: As the Welfare of the Aged Act included a clause on mandated reporters, nurses' role in intervening in elder abuse cases has become more critical. In order to increase nurses' reporting, education on elder abuse should be provided to all nurses, and support programs should be designed for nurses to effectively involve them in reporting elder abuse.

Reinterpreting the concept of "nursing" in the Korean context.

Florence Nightingale acts as the threshold dividing "modern" nursing and "premodern" nursing. The history of modern Korean nursing is not exceptional. It is not surprising that the history of modern Korean nursing describes the advent of "Western" nursing as it was delivered from Western medical professionals. Although traditional Korean medical doctors, Hanuisa, largely practice at traditional Korean health clinics and hospitals, the nurses who work at these traditional Korean health clinics and hospitals are trained at the same nursing education programs as those who work in Western medical clinics and hospitals. The purpose of this study was to find a concept of "nursing" in the context of traditional Korean medicine, which traditional Korean nursing in modern era may inherit and expand upon, by reinterpreting the concept of nursing in terms of a philosophy that supports traditional Korean medicine. This article utilized a philosophical analysis of literature that is essential to the reinterpretation of this concept. In terms of core concepts, nursing and traditional Korean medicine share common features with each other. On the basis of these common features, cowork in practice should be more developed and articulated. This will add new characteristics to the history of Korean nursing.

Caring for older adults: the parables in Confucian texts.

Confucianism is one of the frequently mentioned social factors in the research of care for the older adults in East Asian countries such as China, Taiwan, Japan, and Korea. Although Confucian philosophy functions as a powerful source of reference for care, the context of care in Confucian texts is not yet largely studied in nursing. This column focuses on the meaning of care in two key Confucian texts, the Analects and Mencius. The context of care in Confucian texts should provide a sound foundation and substantial understanding for researchers studying care in East Asian society.

[Patients' anxiety in intensive care units and its related factors].

PURPOSE: The purpose of this study was to describe patients' anxiety in the ICU and to investigate related factors on the anxiety level. METHODS: An exploratory cross-sectional survey design was used. Forty-eight patients participated in the study. Questionnaires were asked to patients who had been cared in the ICUs. RESULTS: Related to the anxiety level, the mean of the total anxiety score was 5.47, and 60% of the patients had moderate or severe level of anxiety. Patients from the coronary care unit had a significantly higher level of anxiety than those from surgical intensive care unit or pulmonary surgery care unit. Moreover, significantly different levels of anxiety were found among patients who had been stayed for 2, 3, or 4 days. CONCLUSION: Patients who were from the coronary care unit or had been stayed longer (up to 4 days) in the ICU were significantly associated with higher anxiety level.

Nursing philosophy: Foucault and cultural diversity issues in the nursing field.

Cultural diversity is a highly important issue in nursing education and nursing practice today. This study is a philosophical approach to the power relationship between a health care provider and a care recipient. The main purpose of this paper is to analyze the relationships between nurses and ethnic minority patients based on the discussions of some Foucauldian concepts that are related to cultural diversity. Based on the analysis, this study provides some suggestions for cultural competency in nursing practice.

The influence of abuse situation and respondent background characteristics on Korean nurses' perceptions of child sexual abuse: a fractional factorial design.

OBJECTIVE: This study was designed to identify characteristics of Korean nurses' perceptions about child sexual abuse. More specifically, it was designed to examine to what extent various child sexual abuse incident characteristics and respondent background characteristics affect Korean nurses' perceptions of the seriousness of child sexual abuse incidents. METHODS: A vignette design was used to assess 1029 Korean registered nurses' perceptions of child sexual abuse. Seven abuse situation variables were organized into 64 vignettes in a one-fourth fractional factorial design. Respondents were given randomly selected and ordered samples of 16 of the vignettes and asked to indicate the degree of seriousness of the sexual abuse incidents portrayed in the vignettes. Information was also gathered about respondent demographics and personal history of child sexual abuse. RESULTS: Logistic regression analyses showed intrusiveness of the sexual act had the greatest impact on Korean nurses' perceptions of the seriousness of child sexual abuse, followed by victim resistance, cross-gender combinations of victim and perpetrator, frequency of sexual acts, and age of perpetrator, all of which were abuse situational characteristics. With the exception of media exposure to sexual abuse, background characteristics and sexual abuse history had negligible effect on perceived seriousness. CONCLUSIONS: Situational characteristics, not respondent characteristics, influence the perceived seriousness of child sexual abuse for Korean nurses. These findings are similar to those obtained previously with US samples.