Journal of Korean Academy of Nursing

Effectiveness of non-pharmacological interventions to reduce internalized stigma in people with severe mental illness: a systematic review and meta-analysis: Soyoung Kim, Sun Hyoung Bae, Myung-Sun Hyun; J Korean Acad Nurs 2025;55(1):1-18. Published online February 25, 2025; DOI: https://doi.org/10.4040/jkan.24072

Abstract PDF ePub: Purpose
This study systematically reviewed and analyzed the effects of non-pharmacological interventions on internalized stigma among people with severe mental illness.
Methods
A systematic review and meta-analysis were conducted following the Cochrane Intervention Research Systematic Review Manual and Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. This study targeted people with severe mental illness as the population, interventions aimed at reducing internalized stigma, comparisons with control groups, and internalized stigma as the outcome. A literature search was performed across multiple databases, including PubMed, EMBASE, the Cochrane Library, CINAHL, PsycArticles, RISS, KMbase, and KoreaMed. The risk of bias was evaluated using the Cochrane Risk of Bias 2.0 tool. Effect sizes were computed using Hedges’s g, and subgroup analyses were conducted with Comprehensive Meta-Analysis software version 4.0.
Results
Of 2,388 papers, 15 were included in the meta-analysis. The overall effect size (Hedges’s g) of the intervention was –0.60 (95% confidence interval, –1.01 to –0.19), indicating a statistically significant reduction in internalized stigma (Z=–2.88, p=.004). Subgroup analyses revealed that the intervention type (p=.008) and session length (p=.011) were significant moderators influencing the effectiveness of the interventions.
Conclusion
Tailoring interventions by considering variables such as the intervention type and session length could enhance the effectiveness of non-pharmacological interventions for reducing internalized stigma among people with severe mental illness (PROSPERO: CRD42023418561).

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Serial mediation effects of social support and antepartum depression on the relationship between fetal attachment and anxiety in high-risk pregnant couples of South Korea: Mihyeon Park, Sukhee Ahn; J Korean Acad Nurs 2025;55(1):19-33. Published online February 4, 2025; DOI: https://doi.org/10.4040/jkan.24070

Abstract PDF ePub: Purpose
This study examined the direct effects of fetal attachment, social support, and antepartum depression on anxiety in pregnant women with high-risk pregnancy-related conditions and their husbands. Furthermore, it aimed to explore the serial mediation effects of social support and antepartum depression in the relationship between fetal attachment and anxiety.
Methods
A survey-based study was conducted among pregnant women diagnosed with high-risk pregnancy conditions at 24–32 weeks and their husbands, recruited from a pregnant women’s online community between January 20, 2021 and July 20, 2022. Data were collected from 294 individuals (147 couples) using self-report questionnaires. Correlations between variables were analyzed using the IBM SPSS software ver. 26.0 (IBM Corp.), and the mediation effects were assessed using the PROCESS macro, model 6.
Results
In the maternal model, maternal-fetal attachment directly affected anxiety (p=.005), with antepartum depression partially mediating this relationship (95% confidence interval [CI], –0.26 to –0.01). In the paternal model, paternal-fetal attachment had no direct effect on anxiety (p=.458). However, social support and antepartum depression fully mediated the relationship between paternal-fetal attachment and anxiety (95% CI, –0.14 to –0.03).
Conclusion
The findings indicate that social support in the relationship between fetal attachment and depression in high-risk pregnant women and their partners can have direct or indirect effects on the negative emotions of high-risk pregnant couples. It is necessary to assess the level of anxiety in couples experiencing high-risk pregnancies and provide comprehensive nursing interventions that address fetal attachment, social support, and antepartum depression in order to reduce anxiety.

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Development and effects of a media-based reproductive health promotion program for male high school students at male high school: a quasi-experimental study: Joon-Young Lee, Yeoungsuk Song; J Korean Acad Nurs 2025;55(1):34-49. Published online February 20, 2025; DOI: https://doi.org/10.4040/jkan.24050

Abstract PDF ePub: Purpose
This quasi-experimental study was conducted to develop a media-based reproductive health promotion program (MRHPP) among male high school students and to evaluate its effectiveness.
Methods
The ADDIE model (analysis, design, development, implementation, and evaluation model) was used to develop the MRHPP based on Ajzen’s theory of planned behavior. The research was conducted using a non-equivalent control group with a pretest-posttest design (experimental group=23; control group=22). The program consisted of six sessions and was conducted twice a week. The participants were assessed through a pre-test, post-test immediately after training (post-test 1), and follow-up after 4 weeks (post-test 2) by using questionnaires. The collected data were analyzed using descriptive statistics, the independent t-test, chi-square test, Fisher’s exact test, and repeated-measures analysis of variance.
Results
The analysis of the group-by-time interaction showed statistically significant differences in attitudes toward reproductive health behavior (RHB) (F=4.09, p=.049), subjective norms of RHB (F=5.31, p=.026), and intention to engage in RHB (F=3.78, p=.016). The effect sizes for attitudes, subjective norms, and intention to engage in RHB ranged from 0.75 (medium) to 1.02 (large) (p<.001) at post-test 1, and those for attitudes and subjective norms of RHB ranged from 0.36 (small) to 0.69 (medium) (p<.001) at post-test 2.
Conclusion
The MRHPP was demonstrated to be an effective intervention for promoting reproductive health behavior among male high school students.

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Nomogram for predicting changes in cognitive function in community dwelling older adults with mild cognitive impairment based on Korea Longitudinal Study of Ageing Panel Data: a retrospective study: Hyuk Joon Kim, Hye Young Kim; J Korean Acad Nurs 2025;55(1):50-63. Published online February 7, 2025; DOI: https://doi.org/10.4040/jkan.24059

Abstract PDF ePub: Purpose
This study aimed to identify factors associated with normal cognitive reversion and progression to dementia in older adults with mild cognitive impairment (MCI) residing in the community and to develop a nomogram.
Methods
This longitudinal study used secondary data from the Korea Longitudinal Study of Ageing Panel Data (2006–2018). The study included 1,262 participants aged 60 or older, with initial Mini-Mental State Examination scores ranging from 18 to 23. Data were analyzed using the Rao-Scott chi-square test, panel binary logistic regression, and receiver operating characteristic (ROC) curve in Stata ver. 17.0 (Stata Corp.).
Results
The rate of reversion from MCI to normal cognition was 37.0% after 2 years and 32.9% after 12 years. The rate of progression to dementia was 18.0% after 2 years and 30.2% after 12 years. In the nomogram for reversion to normal cognition, the most significant influences were grip strength, depression, number of meetings, age, and regular exercise, with an area under the ROC curve (AUC) of .66. In contrast, in the nomogram for progression to dementia, the most significant influences were age, grip strength, instrumental activities of daily living, number of social meetings attended, depression, and regular exercise, with an AUC of .69.
Conclusion
These nomograms can serve as an effective intervention tool for preventing dementia in the field of community health care since they can serve as a visual technique for presenting information on risk to individuals with MCI.

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Factors influencing smartphone overdependence in university students: an ecological model: a descriptive study: Jeong Soon Yu, Myung Soon Kwon; J Korean Acad Nurs 2025;55(1):64-80. Published online February 20, 2025; DOI: https://doi.org/10.4040/jkan.24092

Abstract PDF ePub: Purpose
This study investigated the factors influencing smartphone overdependence in university students using an ecological model and descriptive research.
Methods
Data were collected from 482 students at 13 universities in the six regions in South Korea from October 20, 2020, to March 25, 2021. Data analysis involved descriptive statistics, the chi-square test, the independent samples t-test, analysis of variance, and hierarchical multiple regression.
Results
The significant ecological factors influencing smartphone overdependence included self-awareness of smartphone overdependence (β=.33, p<.001), autonomy (β=–.25, p<.001), average daily smartphone usage time (β=.18, p<.001), gender (β=.15, p=.001), college year (β=.15, p=.020), forming relationships with others as a motivation for smartphone use (β=–.15, p=.008), friend support (β=.14, p=.006), and age (β=–.12, p=.047). The model explained 34.9% of the variance.
Conclusion
The study emphasized the role of personal and interpersonal factors, in smartphone overdependence among university students. Tailored intervention strategies are necessary to address smartphone overdependence, considering the unique characteristics of students’ environments. A significant aspect of this study is that it provides an explanation of the multidimensional factors contributing to smartphone overdependence among university students, including intrapersonal, interpersonal, and environmental influences.

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Mediating effect of grit on the influence of nurses’ silence behavior on medication safety competence: a cross-sectional study: Haengsuk Kim, Wanju Park; J Korean Acad Nurs 2025;55(1):81-92. Published online February 20, 2025; DOI: https://doi.org/10.4040/jkan.24088

Abstract PDF ePub: Purpose
This study investigated the mediating effect of grit in the relationship between silence behavior and medication safety competence among nurses.
Methods
The study included 166 nurses from four university hospitals and general hospitals in Seoul and Gyeonggi-do, South Korea. Data were collected from March 1 to 10, 2024, using self-report questionnaires. Data were analyzed using the t-test, analysis of variance, Scheffé’s test, and Pearson’s correlation coefficients with IBM SPSS Statistics ver. 23.0 (IBM Corp.). A mediation analysis was performed using Hayes’s PROCESS macro model 4 and the bootstrapping method.
Results
Medication safety competence showed significant correlations with silence behavior (r=–.21, p=.008) and grit (r=.43, p<.001). Furthermore, grit partially mediated the relationship between silence behavior and medication safety competence.
Conclusion
This study indicates that grit is a significant mediator in the relationship between silence behavior and medication safety competence. Therefore, an integrated approach that reduces silence behavior and promotes grit is essential for strengthening nurses’ medication safety competence. Ultimately, these strategies will help ensure patient safety by improving medication safety competence.

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Reliability and validity of the Korean version of the Nurses Professional Values Scale-3 for nursing students: a methodological study: Eun Hee Yang, Mi Yu; J Korean Acad Nurs 2025;55(1):93-106. Published online February 20, 2025; DOI: https://doi.org/10.4040/jkan.24113

Abstract PDF ePub: Purpose
This study aimed to adapt the Nurses Professional Values Scale-3 (NPVS-3) for Korean nursing students and assess its reliability and validity.
Methods
The NPVS-3 was translated into Korean using forward and back translation with expert review. Data from 206 nursing students at four universities were analyzed to assess content, construct, discriminant, and criterion validity, as well as internal consistency.
Results
The Korean version (NPVS-3K) consisted of 21 items in three subscales: caring (eight items), activism (eight items), and professionalism (five items), explaining 60.9% of the total variance. For convergent validity, standardized coefficients for the items ranged from .56 to .81, construct reliability ranged from .89 to .95, and the average variance extracted ranged from .61 to .72. The model was validated by confirmatory factor analysis (χ2=526.00 [p<.001], χ2/degrees of freedom=2.83, standardized root mean residual=.03, goodness of fit index=.81, comparative fit index=.87, Turker Lewis index=.85). Discriminant validity was confirmed using a multi-trait and multi-item matrix. Criterion validity showed positive correlations between the three NPVS-3K factors and professional identity (factor 1: r=.40, p<.001; factor 2: r=.55, p<.001; factor 3: r=.43, p<.001). Internal consistency, as measured by Cronbach’s α, was .94 overall, with subscale values of .90 for caring, .92 for activism, and .78 for professionalism.
Conclusion
The NPVS-3K demonstrated satisfactory validity and reliability, establishing it as a valuable tool for assessing the professional values of Korean nursing students. Additionally, it can aid in developing educational strategies to strengthen these values, although further research is required to confirm its broader applicability.

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Formative versus reflective measurement models in nursing research: a secondary data analysis of a cross-sectional study in Korea: Eun Seo Park, Young Il Cho, Hyo Jin Kim, YeoJin Im, Dong Hee Kim; J Korean Acad Nurs 2025;55(1):107-118. Published online February 19, 2025; DOI: https://doi.org/10.4040/jkan.24095

Abstract PDF ePub: Purpose
This study aimed to empirically verify the impact of measurement model selection on research outcomes and their interpretation through an analysis of children’s emotional and social problems measured by the Pediatric Symptom Checklist (PSC) using both reflective and formative measurement models. These models were represented by covariance-based structural equation modeling (CB-SEM) and partial least squares SEM (PLS-SEM), respectively.
Methods
This secondary data analysis evaluated children’s emotional and social problems as both reflective and formative constructs. Reflective models were analyzed using CB-SEM, while formative models were assessed using PLS-SEM. Comparisons between these two approaches were based on model fit and parameter estimates.
Results
In the CB-SEM analysis, which assumed a reflective measurement model, a model was not identified due to inadequate fit indices and a Heywood case, indicating improper model specification. In contrast, the PLS-SEM analysis, assuming a formative measurement model, demonstrated adequate reliability and validity with significant path coefficients, supporting the appropriateness of the formative model for the PSC.
Conclusion
The findings indicate that the PSC is more appropriately analyzed as a formative measurement model using PLS-SEM, rather than as a reflective model using CB-SEM. This study highlights the necessity of selecting an appropriate measurement model based on the theoretical and empirical characteristics of constructs in nursing research. Future research should ensure that the nature of measurement variables is accurately reflected in the choice of statistical models to improve the validity of research outcomes.

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A qualitative meta-synthesis of the essence of patient experiences of dialysis: Soyoung Jang, Eunyoung E. Suh, Yoonhee Seok; J Korean Acad Nurs 2025;55(1):119-136. Published online February 19, 2025; DOI: https://doi.org/10.4040/jkan.24102

Abstract PDF ePub: Purpose
This study aimed to understand the experiences of dialysis and their meaning among patients with chronic kidney disease through a meta-synthesis of the existing literature. Since 2010, the prevalence of end-stage renal disease has doubled in South Korea, which has the sixth-highest incidence worldwide. Although most kidney disease patients undergo dialysis to attenuate disease-related symptoms and prolong their lives, the implications of dialysis on their lives, together with the role played by patients’ significant others, remain underexplored. Similarly, existing research has not considered both patients with hemodialysis and peritoneal dialysis.
Methods
In this meta-synthesis, seven electronic databases (PubMed, CINAHL, EMBASE, PsycINFO, DBpia, KISS, and RISS) were searched for the terms “dialysis” and “qualitative.” Thirty qualitative studies were selected for examination.
Results
The overriding theme observed in the studies was “I do not have much time left.”–navigating the dual realities of one’s limited existence, while other key themes were: (1) the inevitable experience of the troubles of dialysis, (2) life is extended, but deteriorating in every aspect, (3) accepting dialysis with a positive outlook for life, and (4) essential support experienced in an exhausting life.
Conclusion
These findings are important for the design and delivery of practical and tailored nursing interventions to help patients overcome the various challenges related to dialysis treatment, and improve their quality of life.

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Effects of a nursing leadership program on self-leadership, interpersonal relationships, clinical performance, problem-solving abilities, and nursing professionalism among nursing students in South Korea: a quasi-experimental study: Sunmi Kim, Young Ju Jeong, Hee Sun Kim, Seok Hee Jeong, Eun Jee Lee; J Korean Acad Nurs 2025;55(1):137-151. Published online February 25, 2025; DOI: https://doi.org/10.4040/jkan.24110

Abstract PDF ePub: Purpose
This study investigated the effects of a nursing leadership program on self-leadership, interpersonal relationships, clinical performance, problem-solving abilities, and nursing professionalism among nursing students in South Korea.
Methods
A quasi-experimental study was conducted. The Practice-Driven Nursing Leadership Program for Students (PDNLP-S) was developed based on the ADDIE model (analysis, design, development, implementation, and evaluation). This quasi-experimental study design included 60 nursing students. The experimental group (n=30) participated in the PDNLP-S for 120-minute sessions over 5 weeks, while the control group (n=30) received usual lectures. The PDNLP-S included lectures, discussions, and individual and group activities to cultivate core nursing leadership competencies such as individual growth, collaboration, nursing excellence, creative problem-solving, and influence. Data were analyzed using descriptive statistics, the Mann-Whitney U-test, and the independent t-test with IBM SPSS Windows ver. 26.0.
Results
The experimental group demonstrated significant improvements in self-leadership (t=3.28, p=.001), interpersonal relationships (t=3.07, p=.002), clinical performance (U=268.50, p=.004), and problem-solving abilities (t=2.20, p=.017) compared to the control group. No significant difference was observed in nursing professionalism (t=0.50, p=.311).
Conclusion
This study demonstrates that the PDNLP-S improved nursing students’ self-leadership, interpersonal relationships, clinical performance, and problem-solving abilities. The PDNLP-S can play a significant role in cultivating future nurse leaders by enhancing these nursing leadership competencies among nursing students.

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