This study aimed to examine changes of empathy levels of nursing student in two different curricula structures, one called “traditional” and the other called “integrated” curricula. The study was a longitudinal design to follow a cohort of nursing students to examine the magnitude of changes in empathy in their education years.

The study was conducted in a public school of nursing giving a baccalaureate degree, which had a fundamental change in their curricula. In all, 81 students from the traditional curricula and 66 students from the integrated curricula completed the study, and data from a total of 147 students were analyzed between 2003 and 2008. The Empathic Communication Skills Scale and the Empathic Tendency Scale were given to the students in the beginning of their freshman year and at the end of the fourth year just before graduation.

Although both of the curricula were seemed effective at improving empathic skills of students, especially the scores of students who completed the integrated curricula were higher than the scores of the other group attending the traditional curricula (p<.05). However, the empathic tendency scores of students in both curricula decreased at the end of fourth year.

Although undergraduate nursing curricula either traditional or integrated improved empathic skills, it seemed that integrated curricula were more effective than traditional curricula in increasing empathic skills. The more hours and more experiential methods contributed to improved empathy. The decrease in empathic tendency requires further attention of educators and nurse managers.

To compare the effects of the Interaction Model of Client Health Behavior (IMCHB)-based oral health program (OHP) and walking exercise program (WEP) on oral health behaviors, periodontal disease, physical activity, and psychological indicators (depression, stress, and quality of life) in pregnant women.

A nonequivalent control group pretest-posttest design was adopted to compare the effects of a 12-week OHP and WEP on pregnant women (n=65). Pregnant women were randomly assigned to the oral health group (OHG; n=23), walking exercise group (WEG; n=21), or control group (CG; n=21). Data were analyzed by the χ²-test, Fisher's exact test, Scheffe test, and repeated measures ANOVA, using the Statistical Package for the Social Sciences for Windows (version 21.0).

The OHG and WEG showed significant improvements in oral health behaviors, periodontal disease, and psychological indicators as compared to the CG. The WEG showed significant improvement in physical activity as compared to the OHG and CG.

These findings indicate that the IMCHB-based OHP and WEP were effective in improving periodontal disease, physical activity, and psychological indicators. However, further studies are needed to identify the positive effects of the OHP and WEP on birth outcomes.

The aims of this study are to provide a theoretical framework for improving the self-care of adults with severe hypertension and to examine the practical suitability of a middle-range theory of self-care for chronic illness by validating the structural model.

Data were collected at a university hospital in D metropolitan city from July 1 to August 14, 2015. A total of 224 Korean adult patients with severe hypertension were recruited. Data were analyzed using SPSS 22.0 and AMOS 22.0.

The results show that the fit index of the hypothetical model meets the recommended level; 7 out of 8 hypothetical model paths were statistically significant. Motivation, self-efficacy, support from others, and accessibility to care showed statistical significance and explained 67.3% of the self-care process. The self-care process explained 45.3%, 63.6%, and 26.5% of quality of life, health, and illness stability, respectively.

This model can be used as a theoretical framework for improving self-care among adult Korean patients with severe hypertension. Moreover, the practical suitability and validity of the middle-range theory of self-care for chronic illness is secured.

This study was conducted to construct and test a structural model on family life satisfaction of aged individuals living at home. The conceptual model was based on Bandura's self-efficacy and social cognitive theories (1977; 1986) and Bowen's (1976) family systems theory.

From January 25 to March 5, 2016, 227 older adults living at home completed a structured questionnaire. Data were analyzed to calculate the direct and indirect effects of factors affecting family life satisfaction. SPSS WIN 20.0 and AMOS 20.0 were used.

The hypothetical model was a good fit for the data. The model fit indices were χ²=78.05, χ²/df=1.35, RMSR=.02, GFI=.98, AGFI=.96, NFI=.94, CFI=.98, and RMSEA=. 05. Family life satisfaction was positively affected by perceived collective family efficacy, status of physical health, family communication, and family support. Depression resulted in a significant negative effect. Family differentiation had a significant indirect effect on family life satisfaction. The model explained 76% of variance in family life satisfaction.

Perceived collective family efficacy, status of physical health, depression, family differentiation, family communication, and family support were significant factors explaining family life satisfaction among older adults staying at home. Further research should be conducted to seek intervention strategies to improve family life satisfaction among older adults living at home by focusing on the respective contributing factors.

The increasing survival rate of colorectal cancer demands various nursing interventions and continuous care for patients to adapt to their psychosocial daily lives. The purpose of this study was to identify factors associated with psychosocial adjustment in colorectal cancer survivors.

A cross-sectional descriptive study with face-to-face interviews was conducted of 156 colorectal cancer survivors after surgery visiting an outpatient cancer clinic at a tertiary hospital in S city, Korea. Posttraumatic growth, health-promoting behavior, length of treatment, difficulty in activities of daily living, and having a stoma were entered into the linear regression model.

The strongest factor influencing the level of psychosocial adjustment was health-promoting behavior (β=.33, p<.001), followed by difficulty in activities of daily living (β=-.24, p=.001), posttraumatic growth (β=.20, p=.004), and having a stoma (β=-.19, p=.004).

Nursing interventions for psychosocial adjustment in colorectal cancer survivors need to include the contents for posttraumatic growth, as well as health-promoting behavior, and activities of daily living.

This study aimed to construct a management model for patient transfer in a multilevel healthcare system and to predict the effect of counseling with nurses on the patient transfer process.

Data were collected from the electronic medical records of 20,400 patients using the referral system in a tertiary hospital in Seoul from May 2015 to April 2017. The data were analyzed using system dynamics methodology.

The rates of patients who were referred to a tertiary hospital, continued treatment, and were terminated treatment at a tertiary hospital were affected by the management fee and nursing staffing in a referral center that provided patient transfer counseling. Nursing staffing in a referral center had direct influence on the range of increase or decrease in the rates, whereas the management fee had direct influence on time. They were nonlinear relations that converged the value within a certain period.

The management fee and nursing staffing in a referral center affect patient transfer counseling, and can improve the patient transfer process. Our findings suggest that nurses play an important role in ensuring smooth transitions between clinics and hospitals.

The purpose of this study was to construct and test a hypothetical model about impact of parents’ problem drinking on suicidal ideation of their children who are university students and the multiple mediating effects of childhood trauma, experiential avoidance, and depression based on stress-vulnerability model.

A purposive sample of 400 university students was recruited from three universities in provincial areas and the data were collected between October and November 2016. The collected data were then analyzed using SPSS 20.0 and AMOS 20.0 programs. For data analysis, descriptive statistics, factor analysis, and structural equation modeling were performed. Multiple mediating effects analysis using phantom variable and bootstrapping were implemented to verify the mediating effect of the research model.

We found no significant direct effect on depression and suicidal ideation of parents’ problem drinking, but multiple mediating effects of childhood trauma and experiential avoidance between parents’ problem drinking and depression (B=.38, p=.001). The path from parents’ problem drinking to suicidal ideation was significantly mediated by childhood trauma and depression (B=.02, p=.016) and by childhood trauma, experiential avoidance, and depression (B=.05, p=.011), but experiential avoidance did not have a significant direct effect on suicidal ideation (B=.02, p=.616). Conclusions: Based on the results of this study, it can be suggested that in order to decrease depression and prevent suicide of university students, considering of parents’ problem drinking and childhood trauma, intervention methods that decreased chronic use of experiential avoidance and strengthen acceptance should be developed and made available to them.

This study aimed to understand the mechanisms of decision regret and stress of family surrogates' end-of-life decision making using an exploratory path model. In particular, the research identified the direct effects of perceptions of uncertainty and effective decisions on decision regret and stress, and examined the indirect effects of being informed, having clear values, and being supported for decision regret and the stress of end-of-life decision making through the mediating variables of perceptions of uncertainty and effective decisions.

Data were collected from 102 family surrogates who had participated in end-of-life decision making for patients with terminal cancer in a tertiary hospital.

Perception of effective decisions was a significant direct predictor of decision regret, and uncertainty was a significant predictor of stress among the participants. Being informed, having clear values, and being supported had a significant indirect influence on decision regret through the perception of effective decisions among family surrogates. However, only having clear values had a significant indirect influence on stress through the perception of uncertainty. The model explained 63.0% of decision regret and 20.0% of stress among the participants and showed a good fit with the data, χ²=12.40 (df=8, p=.134), TLI=.97, and RMSEA=.07.

Nurses can support family surrogates in end-oflife decision-making processes to decrease their decision regret by providing information about end-of-life care choices, clarifying personal values, and supporting the decision-making process, and to relieve their stress by facilitating the clarification of personal values.

The purpose of this study was to test a model of nursing competencies of nursing simulation learners. The conceptual model was based on the theory of Jeffries's simulaton theory.

Data collection was conducted in October 2017 for 310 students from two nursing universities in Kyungbuk area for 20 days. Data analysis methods were covariance structure analysis using SPSS 21.0 and AMOS 22.0 statistical programs.

The hypothetical model was a good fit for the data. The model fit indices were comparative fit index=.97, normed fit index=.94, Tucker-Lewis Index=.97, root mean square error of approximation=.44, and standardized root mean square residual=.04. Teacher factors were directly related to simulation design characteristics, and it was confirmed that the curriculum, classroom operation and teaching method of the instructors were important factors. Learner factors were found to have a direct effect on nursing competence, self-confidence, and clinical performance that belong to nursing capacity. In particular, the results of this study indicate that the simulation design characteristics have a partial mediating effect on learner factors and clinical performance, and a complete mediating effect on learner factors and clinical judgment ability.

In order to improve the learner's clinical performance and clinical judgment ability, it is necessary to conduct practical training through nursing simulation besides preparing the learner and the educator.

This study aimed to synthesize the caring experiences of Korean family members of patients with dementia through a qualitative meta-synthesis method.

By searching through nine Korean and English databases, we compared 37 qualitative studies on caring experiences of family members of patients with dementia. The selected studies were synthesized through meta-synthesis, proposed by Sandelowski and Barroso (2007).

The meta-synthesis elicited four themes: tough life due to care for patients, changes in relationships, adaptation to caregiver's roles, and new perspectives of life through personal growth. Caregivers were shocked when a sudden diagnosis of dementia was made prior to any preparation on their part. They were tied to their patients all the time and their mind and body got exhausted. Their relationship with patients began to change and they looked at them differently. They experienced conflicts with the other non-caring family members and were alienated from them. They were also socially isolated. However, by building their own care strategies and utilizing social resources, they gradually adapted to their caregiver roles. Finally, they experienced personal growth and acquired a new perspective toward life by accepting their roles and finding meaning in their lives. Shifting the caregiver's centricity from themselves to the patient was the process of becoming human beings who actively constructed their realities while giving meaning to their painful lives and interacting with the environment.

The results of the study can be useful for nurses in understanding the experiences of caregivers of the patients with dementia and in providing them with practical interventions.

This study aimed to develop and test a structural model for sleep quality in female shift work nurses. The hypothetical model was constructed on the basis of Spielman's 3P model of insomnia and previous research related to the sleep quality of shift nurses.

This cross-sectional study used structural equation modeling and recruited 285 female shift work nurses from four general and university hospitals with over 300 beds located in C and J cities in Gyeongsangnamdo. Data were collected from September 27 to October 20, 2016, and then analyzed using descriptive statistics, Pearson's correlation, and structural equation modeling. The study used SPSS/Win 18.0 and AMOS 18.0 in processing the data.

The final model showed good fit to the empirical data: χ²/df=2.19, SRMR=.07, RMSEA=.07, AGFI=.85, TLI=.91, GFI=.93, GFI=.89, NFI=.87. The factors that influenced sleep quality were sleep hygiene (β=.32), perceived shift work status (β=−.16), stress response (β=.16), shift work experience (β=.15), perceived health status (β=−.14), and circadian rhythm (β=−.13) explaining 36.0% of the variance.

The model of sleep quality of the shift work nurses constructed in this study is recommended as a model to understand and predict the sleep quality of shift work nurses. The results suggest that strategies for improving the sleep quality of shift work nurses should focus on sleep hygiene, perceived health status, stress response, circadian rhythm, perceived shift work status, and shift work experience.