Journal of Korean Academy of Nursing

Illness experience of head and neck cancer patients: an interpretative phenomenological analysis: Min Ryu, Suhye Kwon; Received February 28, 2026 Accepted June 26, 2026 Published online August 18, 2026; DOI: https://doi.org/10.4040/jkan.26027 [Epub ahead of print]

Abstract PDF ePub: Purpose
Head and neck cancer is frequently diagnosed at an advanced stage and is associated with substantial mortality. Patients also experience major physical limitations and psychosocial distress. This study explored the subjective meaning of illness experiences among patients with head and neck cancer using interpretative phenomenological analysis (IPA).
Methods
This qualitative study used IPA to examine the experiences of eight adults with stage II–IV head and neck cancer recruited from two university hospitals. All participants had undergone surgery followed by radiotherapy or chemoradiotherapy at least 6 months before data collection. Data were collected through in-depth interviews conducted from February to June 2022 and were analyzed using the cyclical IPA procedure.
Results
Four superordinate themes were identified: (1) being overwhelmed by lamentation and fear when confronting a late-diagnosed illness; (2) confronting human limitations during treatment undertaken for survival; (3) losing daily life and selfhood while living in a body that had not recovered; and (4) reconstructing life beyond the fear of recurrence. Participants experienced diagnosis and treatment as traumatic and described persistent functional impairments and painful sequelae.
Conclusion
These findings provide an in-depth understanding of the illness experiences of patients with head and neck cancer and offer evidence to inform nursing interventions that support adaptation and quality of life.

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Effect of a continuous glucose monitoring-guided personalized lifestyle coaching intervention on glycemic outcomes and variability in patients with type 2 diabetes mellitus: a randomized controlled trial: Youngran Yang, Youngmin Park, Heung Yong Jin; Received March 12, 2026 Accepted June 24, 2026 Published online August 12, 2026; DOI: https://doi.org/10.4040/jkan.26036 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study examined the effects of continuous glucose monitoring (CGM)-guided personalized lifestyle coaching on glycemic outcomes and glycemic variability in patients with type 2 diabetes mellitus (T2DM).
Methods
This three-arm randomized controlled trial was conducted in South Korea from June 2023 to November 2024. Participants were assigned to CGM alone (Intervention I, n=34), CGM-guided personalized lifestyle coaching (Intervention II, n=34), or standard diabetes education (control, n=34). The intervention lasted 3 months, with assessments at baseline and at 3, 6, and 12 months. Data were analyzed using generalized estimating equations.
Results
At 3 months, glycated hemoglobin (HbA1c) and fasting plasma glucose (FPG) levels were significantly lower in both intervention groups than in the control group. Compared with the control group, HbA1c was lower by 0.78 percentage points in Intervention I (p=.008) and by 1.12 percentage points in Intervention II (p<.001). At 3 months, FPG was lower than in the control group by 34.05 mg/dL in Intervention I (p=.001) and by 34.77 mg/dL in Intervention II (p<.001). At 6 months, TBR70 (time below range <70 mg/dL) was lower in Intervention I than in Intervention II (adjusted mean difference=–2.18, p=.010), whereas TAR180 (time above range >180 mg/dL) was lower in Intervention II than in the control group and Intervention I by 7.85 and 8.28 percentage points, respectively (both p=.004).
Conclusion
CGM-guided personalized lifestyle coaching improved glycemic control and reduced hyperglycemic exposure in patients with T2DM. Real-time glucose data may support individualized lifestyle counseling and sustained diabetes self-management. This study was registered with the Clinical Research Information Service (CRIS) of the Republic of Korea (KCT0008872) on 16 October 2023.

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The actor-partner interdependence mediation model of infertility-related stress and subjective happiness in infertile couples: the mediating role of dyadic coping: Eun Jin Kim, Ju-Hee Nho; Received March 31, 2026 Accepted July 6, 2026 Published online August 11, 2026; DOI: https://doi.org/10.4040/jkan.26047 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study aimed to identify the mediating effect of dyadic coping and the actor–partner effects of infertility-related stress, dyadic coping, and subjective happiness among infertile couples by applying the actor–partner interdependence mediation model.
Methods
A total of 115 infertile couples, comprising women diagnosed with primary infertility and their spouses, participated in an online survey. Data were collected between November 17, 2022 and January 9, 2023, and analyzed using IBM SPSS Statistics version 25.0 and SmartPLS version 4.0.9.2 with the path weighting scheme. Bootstrapping with 5,000 resamples was performed to estimate 95% confidence intervals.
Results
Significant correlations were observed between infertile women and their spouses in infertility-related stress, dyadic coping, and subjective happiness, indicating mutual psychological influence within couples. Infertility-related stress in both women and spouses had actor effects on their own dyadic coping and subjective happiness. Women’s dyadic coping had an actor effect on their own subjective happiness, whereas spouses’ dyadic coping had a partner effect on women’s subjective happiness. Among women with infertility, dyadic coping significantly mediated the association between infertility-related stress and subjective happiness. A significant partner-mediated effect was also observed for women’s subjective happiness, whereas no significant mediating effect was found for spouses’ own subjective happiness.
Conclusion
Infertility-related stress was associated with subjective happiness through dyadic coping among women with infertility. In addition, spouses’ infertility-related stress was indirectly associated with women’s subjective happiness through spouses’ dyadic coping. These findings suggest that interventions designed to strengthen dyadic coping may help reduce infertility-related stress and improve subjective happiness among infertile couples.

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Bridging the evidence–practice gap: advancing nursing through implementation science: Youn-Jung Son; Received July 5, 2026 Accepted July 16, 2026 Published online August 10, 2026; DOI: https://doi.org/10.4040/jkan.26099 [Epub ahead of print]

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Psychological reactance to anti-smoking campaigns in designated smoking areas among female smokers in their 20s and 30s: a quasi-experimental study: Hyeonji Mun, Soontae An, Hyekyeong Kim; Received December 16, 2025 Accepted May 14, 2026 Published online August 10, 2026; DOI: https://doi.org/10.4040/jkan.25177 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study aimed to determine whether placing anti-smoking campaign messages in designated smoking areas elicits psychological reactance among female smokers and to assess whether message framing (controlling vs. non-controlling) moderates the association between psychological reactance and intention to quit smoking.
Methods
A quasi-experimental survey was conducted with 259 female smokers. Of these, 58 participants completed the survey before exposure to smoking-cessation messages, and 201 completed the survey after exposure. Among the exposed participants, 100 were assigned to the controlling condition and 101 to the non-controlling condition. Measures included psychological reactance, intention to quit smoking, trait reactance, smoking disclosure, and smoking-related covariates. Data were analyzed using analysis of covariance and Hayes’ PROCESS Model 1, with statistical significance set at p<.05.
Results
Smokers exposed to anti-smoking messages within designated smoking areas reported higher psychological reactance (mean±standard deviation: 2.10±0.94) than those not exposed (1.81±0.77), with a significant between-group difference (p=.017). Simple slope analysis revealed that psychological reactance was negatively associated with quit intention under controlling messages (B=–0.20, p=.031), but not under non-controlling messages (B=–0.05, p=.591).
Conclusion
Exposure to anti-smoking messages within designated smoking areas was associated with increased psychological reactance toward smoking cessation. In contrast, autonomy-supportive, non-controlling messages attenuated this effect. These findings suggest that smoking areas may serve as strategic behavioral intervention points when campaigns employ context-sensitive, autonomy-supportive message framing. This study was registered with the Clinical Research Information Service (CRIS) of the Republic of Korea (KCT0012514) on 27 August 2026.

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Regional imbalance in nursing workforce: a system dynamics approach focusing on wages and job attractiveness: Sohyun Lee, Eun Kyoung Yun; Received January 19, 2026 Accepted June 11, 2026 Published online August 7, 2026; DOI: https://doi.org/10.4040/jkan.26003 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study used a system dynamics approach to analyze the feedback structure underlying regional imbalance in the nursing workforce in Korea and to evaluate the projected effects of policy interventions through simulation.
Methods
A system dynamics model was developed using literature and public statistics from the Graduate Occupation Mobility Survey and the Korean Statistical Information Service for 2009–2024. Model validity was assessed through sensitivity analysis and comparison with historical data from 2018–2022. Policy simulations covering 2020–2035 were conducted to compare interventions targeting wages and working conditions in Seoul and Jeonnam.
Results
The analysis identified 16 feedback loops, comprising 13 reinforcing loops and three balancing loops, that formed a “success to the successful” structure dominated by a reinforcing cycle of high turnover. In the baseline simulation, the regional gap widened through 2035. Single-factor scenarios involving wage increases or improvements in working conditions had limited effects, whereas high-intensity combined scenarios showed a synergistic effect that could reverse the projected imbalance.
Conclusion
Regional imbalance in the nursing workforce appears to be a structural problem that is unlikely to be resolved through single-factor policies. Sustained, high-intensity strategies that combine wage improvement with nonfinancial improvements in working conditions are likely needed to disrupt the reinforcing cycle and reduce the nursing workforce imbalance.

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Development of a nurses’ situation awareness scale for clinical deterioration: a methodological study: Hye Jin Kang, Yi Kyung Ha; Received March 16, 2026 Accepted June 17, 2026 Published online August 5, 2026; DOI: https://doi.org/10.4040/jkan.26039 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study aimed to develop a scale for assessing nurses’ situation awareness of clinical deterioration and to evaluate its validity and reliability.
Methods
This methodological study followed the scale-development guidelines of DeVellis and Thorpe. Item generation began with 44 items derived from 17 attributes identified through a hybrid-model concept analysis, which included a literature review and focus group interviews with 13 nursing experts. After content validity was evaluated by seven experts, 30 items were retained. A pilot test was then conducted with 20 hospital nurses to assess item comprehensibility. From August 30 to October 6, 2025, a total of 446 hospital nurses participated in the survey, and data from 440 respondents were analyzed. Construct validity was examined using exploratory and confirmatory factor analyses, along with convergent and discriminant validity testing. Internal consistency was evaluated using Cronbach’s α and McDonald’s ω.
Results
Exploratory factor analysis yielded a three-factor model, which showed acceptable fit in confirmatory factor analysis. The final instrument comprised 24 items across three factors, was scored on a 5-point Likert scale, and was named the Nurses’ Situation Awareness Scale for Clinical Deterioration (NSAS-CD). The scale showed high internal consistency, with Cronbach’s α of .98 and McDonald’s ω of .98.
Conclusion
The NSAS-CD demonstrated acceptable validity and reliability for assessing nurses’ situation awareness of clinical deterioration. Further research is needed to evaluate its generalizability across diverse clinical settings and to establish standardized criteria for clinical deterioration.

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Job analysis of nurses in acute psychiatric intensive care units using the DACUM method: a cross-sectional study: Yun Ju Lee, Hee Kyung Kim, Jinhee Yoo, Sukja Kim, Jungeun Shin, Kyoungduck Park, Bunsun Cho; Received March 12, 2026 Accepted June 23, 2026 Published online August 3, 2026; DOI: https://doi.org/10.4040/jkan.26037 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study systematically analyzed the job duties of nurses in acute psychiatric intensive care units using the Developing A Curriculum (DACUM) technique and identified the core job structure that reflects the characteristics of acute mental health nursing.
Methods
This descriptive cross-sectional study used a DACUM workshop conducted in 2025 to identify job duties. The DACUM committee included one job analysis expert, one coordinator, and eight acute psychiatric nurses. Content validity was verified by eight experts using an item-level content validity index of ≥0.78. A total of 80 nurses assessed task importance, difficulty, and frequency. Data were analyzed using descriptive statistics and the determinant coefficient.
Results
The DACUM analysis identified a structured framework consisting of 10 duties and 39 tasks. “Emergency and crisis management” had the highest determinant coefficient, followed by “therapeutic milieu management,” “psychosocial interventions,” and “education and professional development.” At the task level, crisis intervention and response, physical emergency nursing care, and management of safety incident recurrence were prioritized.
Conclusion
DACUM-based job analysis clarified the structured roles of nurses in acute psychiatric intensive care units and highlighted job characteristics centered on emergency management and safety. These findings provide foundational data for standardizing nursing roles, establishing staffing strategies, and developing specialized clinical education programs for acute psychiatric care.

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Concept mapping study of positive patient experiences among family members of nursing home residents in South Korea: Hyoungshim Choi, InJa Choi, Jui Kim; Received February 6, 2026 Accepted May 23, 2026 Published online July 29, 2026; DOI: https://doi.org/10.4040/jkan.26021 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study focused on identifying key components and dimensions of positive patient experiences perceived by family members of nursing home residents in South Korea, which may inform strength-based quality improvement in nursing home care.
Methods
Data were collected from May 8, 2023, to July 18, 2023, through interviews with 19 family members of nursing home residents aged 65 years or older who had lived in the facility for at least 30 days. Interview data were used to develop empirical statements on the nature of residents’ experiences as perceived by family members. These data were then analyzed using concept mapping to identify components of positive patient experiences from the perspectives of family members of nursing home residents in Korea.
Results
Multidimensional scaling and hierarchical cluster analysis yielded 59 core statements, two dimensions, and four clusters of positive patient experiences. The two dimensions were type of support (physical vs. emotional) and centrality of care (resident-centered vs. family-centered). The four clusters of positive patient experiences were “facility management focused on quality of life,” “active communication and engagement,” “respect and trust,” and “professional and personalized care.”
Conclusion
These findings provide insight into the experiences valued by family members of older adults in nursing homes. The concept map may inform development of a patient experience index tailored to family members of nursing home residents.

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Effects of a health literacy program on COVID-19 awareness and preventive behaviors among older adults in Bangkok, Thailand: a quasi-experimental study: Walaya Tupanich, Sasawan Attaworakun, Suteekarn Chaiyalap, Nattanan Wattanawikan; Received October 30, 2025 Accepted May 12, 2026 Published online July 28, 2026; DOI: https://doi.org/10.4040/jkan.25147 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study examined the effectiveness of a health literacy (HL) enhancement program in improving awareness of and preventive behaviors related to coronavirus disease 2019 (COVID-19) among older adults in an urban community in Bangkok, Thailand.
Methods
This quasi-experimental study included 76 older adults in Dusit District, Bangkok. Eight participants were lost to follow-up; however, all 76 participants (38 per group) were included in the primary analysis using all available observations. The intervention was based on Pengjuntr’s V-shape HL model, which includes six domains: access, understanding, interactive communication, decision-making, behavior change, and advocacy. The program was delivered through group sessions, LINE-based communication, community activities, and home visits. Data were collected at pre-test (baseline), post-test (4 weeks), and follow-up (12 weeks) using questionnaires. Outcomes were analyzed using linear mixed-effects models. This study was retrospectively registered with the Thai Clinical Trials Registry (TCTR20260502013).
Results
At post-test, the experimental group had significantly higher COVID-19 awareness and preventive behavior scores than the control group (p<.001). Within-group analysis showed significant improvements in both COVID-19 awareness and preventive behavior at post-test and follow-up. Significant between-group differences were also observed at follow-up (p<.001), with higher scores in the experimental group.
Conclusion
The intervention group receiving the HL enhancement program showed significant improvements in both COVID-19 awareness and preventive behaviors, which were sustained through follow-up. These findings support the use of nurse-led, community-based HL interventions with behavioral reinforcement to promote COVID-19 prevention among urban older adults.

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Effects of a hybrid delirium nursing competency enhancement program using the metaverse and standardized patients for intensive care unit nurses: a quasi-experimental study: Juwon Yun, Mi Yang Jeon; Received February 4, 2026 Accepted June 4, 2026 Published online July 27, 2026; DOI: https://doi.org/10.4040/jkan.26013 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study evaluated the effects of a hybrid simulation program using the metaverse and standardized patients to enhance delirium nursing competency among intensive care unit (ICU) nurses. Outcomes included delirium nursing knowledge, attitudes, and performance confidence.
Methods
A quasi-experimental study with cluster allocation was conducted among 52 ICU nurses, including 28 in the experimental group and 24 in the control group. Data were collected from July 8 to August 28, 2024. The experimental group participated in a hybrid delirium nursing competency simulation program comprising two metaverse-based sessions (lectures, quizzes, discussions, and practice) followed by a face-to-face standardized patient simulation session. The control group received a conventional face-to-face lecture on delirium nursing. Data were analyzed using the chi-square test, the Fisher exact test, the independent t-test, and the paired t-test with IBM SPSS Statistics ver. 27.0.
Results
After the intervention, the experimental group demonstrated significantly greater improvement in delirium nursing attitude (t=2.05, p=.046) and performance confidence (t=3.35, p=.002) compared with the control group. However, the change in delirium nursing knowledge did not differ significantly between groups (t=0.71, p=.483).
Conclusion
The hybrid delirium nursing competency program using the metaverse and standardized patients was associated with greater positive changes in ICU nurses’ delirium nursing attitudes and performance confidence than conventional lecture-based education. This immersive and interactive hybrid simulation approach may be a sustainable continuing education strategy for strengthening delirium nursing competency among ICU nurses.

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Latent profile analysis of health and fatigue recovery among shift work nurses and differential associations with participation in a shift work improvement pilot project: a descriptive cross-sectional study: Eunhee Jung, Eunhye Kim, Suryang Seo, Sunyoung Lee, Sora An, Hyejin Kim, Ye Seul Kim, Youjin Kim, Mijeong Park, Hyoun-Joong Kong, Saram Lee, Yeong Joo Hong, Minho Jung; Received January 21, 2026 Accepted June 12, 2026 Published online July 23, 2026; DOI: https://doi.org/10.4040/jkan.26006 [Epub ahead of print]

Abstract PDF ePub: Purpose
This study aimed to identify latent profiles of shift-work nurses according to perceived health, fatigue, and recovery levels and to examine differences across profiles in work-related outcomes, including sleep quality, work-life balance, job satisfaction, and turnover intention. It also examined whether patterns associated with participation in a shift-work improvement pilot project differed by latent profile.
Methods
This descriptive cross-sectional study included 120 shift-work nurses working in pediatric wards at a tertiary hospital in South Korea. Data were collected from January 14 to 24, 2025. Latent profile analysis was performed using the 36-Item Short Form Health Survey and the Occupational Fatigue Exhaustion Recovery Scale. Differences in outcomes by latent profile membership and pilot-project participation status at the time of data collection were examined using two-way analysis of covariance, with age included as a covariate.
Results
Three latent profiles were identified: Healthy-Recovery (20.8%), Moderate (41.7%), and Burnout-Vulnerable (37.5%). Significant differences among profiles were observed in sleep quality (F=37.37, p<.001), work-life balance (F=50.86, p<.001), job satisfaction (F=12.29, p<.001), and turnover intention (F=12.11, p<.001). A significant interaction between latent profile membership and pilot-project participation was observed for job satisfaction (F=4.77, p=.010, partial η²=.078). Pilot-project participation was associated with significantly higher job satisfaction only in the Healthy-Recovery profile (p=.005).
Conclusion
Associations between pilot-project participation and work-related outcomes differed according to nurses’ health, fatigue, and recovery profiles. These findings indicate that heterogeneity among shift-work nurses should be considered when interpreting work-related outcomes and designing tailored support strategies.

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