The purpose of this study was to examine the effect of supportive nursing one stress reaction of breast cancer patients undergoing chemotherapy. The nonequivalent control group pre-test/post-test design was used for this experimental study. The subjects were 32 patients who were receiving chemotherapy after mastectomies at K hospital in Taegu from June, 1994 to June 1995. Among 32 subjects, 16 were placed in the experimental group and 16 in the control group. The experimental and control groups were tested for general characteristics, trait anxiety, health locus of control, family support, state anxiety, hopelessness, physical stress, and anxiety behavior. Collected data was analyzed by means of a chisquare test and a t-test for the comparative analysis of the general characteristics and homogeneity of subjects. ANOVA, and MANOVA were used for testing the hypothesis. Reliability of the tools were analyzed using the Pearson Correlation coefficient. The results of this study were as follows : 1. The hypothesis ; The stress reaction of the experimental group which took supportive nursing was lower than the stress reaction of the control group ; this was supported statistically. The main variable influenced in stress reaction was hopelessness. Supportive nursing for breast cancer patients, who are receiving chemotherapy, was especially effective in the reduction of hopelessness compared to state anxiety, physical stress, and anxiety behavior. 2. An analysis of the difference on stress reaction, according to the frequency of supportive nursing between the control and experimental group showed the level of hopelessness of the experimental group was lower than the control group after four supportive meeting sessions. But there was no statistical difference in state anxiety, physical stress, and anxiety behavior. In conclusion, this study supported utilization of supportive care as well as demonstrating the effectiveness of the System-Developmental Stress Model developed by Chrisman and Riehl-Sisca.

The purpose of this study is to provide a basis for nursing intervention strategies to promote quality of life in cancer patients. Therefore the study is designed to evaluate the effectiveness of perceived health status, self-esteem, health locus of control, self-efficacy, perceived susceptibility/severity, health promoting behaviors, and hope for quality of life. The sample was composed of 164 stomach cancer patients who visited outpatient clinics at a university hospital in Seoul. The following instruments were used in the study after some adaptation : Lawstone and others' Health Self-rating Scale, Rosenberg's Self-esteem Scale, Wallston and others' Multidimensional Health Locus of Control Scale, Sherer and Maddux's Self-efficacy Scale, Moon's Health Beliefs Scale, Welker and others' Health Promoting Lifestyle Profile, Nowotney's Hope scale and Noh's Quality of Life Scale. Data were analyzed using a SAS program for Pearson correlation coefficients descriptive correlational statistics and stepwise multiple regression. The results are as follows : 1. The scores on the quality of life scale ranged from 115 to 243 with a mean of 177.84(SD : 25.35). The mean scores(range 1-5) on the different dimensions were : emotional state 3.37 ; economic life 3.47 ; physical state and function 3.52 ; self-esteem 3.66 ; relationship with neighbors 3.73 ; family relationships 3.80. 2. There was a significant correlation between all the predictive variables and the quality of life(r=.20 -.65, p<.01). 3. Stepwise multiple regression analysis showed that : 1) Self-esteem was the main predictor of quality of life and accounted from 46.9% of the variance in quality of life. 2) Perceived health status, hope and perceived susceptibility/severity accounted for 11.8%, 8.3%, 1.5% of the variance in quality of life respectively. 3) Self-esteem, perceived health status, hope and perceived susceptibility/severity combined accounted for 68.5% of the variance in quality of life. In conclusion, self-esteem, perceived health status, hope and perceived susceptibility / severity were identified as important variables in the quality of life of cancer patients.

This descriptive study was conducted to ascertain whether the needs of patients with cancer, their caregivers and their nurses changed according to the illness phases and if the perceived needs of the three groups were different for three categories of nursing needs. At two hospitals in Seoul and Choongnam, three groups of subjects, -patients with cancer(79), caregivers(92), and nurses(72)- responded to a questionnaire consisting of items on educational need(11 items), physical need(8 items), emotional need(9 items) using a 4-point Likert scale. The patients and caregivers were selected according to the phase of the cancer(initial, intermediate or recurred, terminal phases). Finding revealed that the level of perception and degree of satisfaction of the needs were low, just around two points in patients and caregivers. Of the three categories of needs, physical needs were received the highest score and the degree of satisfaction of physical needs was also the highest. There was no significant difference between the level of perception and satisfaction of needs in patients and caregivers according to the phases of the illness and the degree of per reception and the satisfaction of the patients were not significantly different and caregivers showed the same result. There was a significant difference in the level of importance of the needs of nurses according to the phases of the cancer. They perceived emotional needs were the most important in first phase and second phase, physical needs in third phase and the educational needs were more important in the first phase than in any other phase. The degree of importance of needs was significantly lower than the degree to which needs were addressed, according to the nurses response. In a comparison of patient and caregiver's perceived degrees of need, and need satisfaction, and nurse's perceived degree of need provision, patient and caregiver scores were lower than the nurses.

With the occurrence of cancer, most cancer patients experience various emotional changes such as anxiety, depression, and emotional shock. Especially in our country, cancer has been recognized as an incurable disease resulting in death. The number of cancer patients increases daily. But as the survival rate of cancer patients is also increasing, there is a need to find the better methods of nursing care for cancer patients. The purposes of this paper are as follows : 1) To understand family support and hope and quality of life for the cancer patient both during hospitalization and at home. 2) To determine the relationship between family support, hope and quality of life. To examine the problems, we used a questionnaire and obtained data form the records of 45 home care and 94 hospitalized(in 3 university hospitals) Patients in Taegu area from the period of June 15 to August 15, 1996. SPSS /PC was used for the data analysis and the statistical methods used were the T-test and ANOVA. The results of this paper are as follow : 1 ) In the aspect of family support, there is no difference between hospitalized and home care cancer patients(t=1.63, P>0.01 ). 2) In the aspect of hope, hospitalized cancer patients have a higher score than home care cancer patients (t=3.08, P>0.01 ) 3) In the aspect of quality of life, hospitalized cancer patients have a higher score than home care patients(t=2.96, P<.01). 4) There is a correlation between quality of life and hope with a correlation coefficient r=0.5199 and P=0.000. In addition. the correlation coefficient between quality of life and family support is 4179 with P =0.000. 5) The family support of the cancer patient is influenced by sex(F=9.1863, P<0.01), education(F=4.3641, P<0.01) and the level of life (F=5.5002, P<0.01 ). 6) The hope of cancer patients is influenced by the number of hospitalizations (F=3.6413, P<.05), education(F=B.01 13, P<.01 ) and the level of life (F=5.0649, P <.01 ). 7) The quality of life of cancer patients is influenced by the number of hospitalization( F=5.1167, P<0.05), education( F=3.1590, P<0.01 ) and the level of life (F=5.6942, P<1.01 ).

The purpose of the study is to explore and describe the lived experience of family members with gastric cancer patients using the grounded theory methodology. The participants were ten spouses of gastric cancer patients who had some kind of treatment at the hospital. They were asked open-ended and descriptive questions in order for them to talk about their experiences in their owl terms. As the interview progressed the questions became more specific to discuss themes and working hypotheses that emerged from the analysis of previous interviews. All interviews were tape-recorded and transcribed for the analysis. Constant the core category that was emerged from the comparative analysis is "magmaggam" which can be described as a psychological distress due to a high level of uncertainty regarding the health of the patient and the future of the caregivers. Psychological distress includes several emotional feelings such as frustration, anxiety, fear, guilty, and self depreciation. Subcategories or strategies related to the core category are 1) managing illness, 2) using folk medicine, 3) giving the patient a reason to live, 4) being patient, 5) losing reality, 6) anticipatory experience on the patient's death and parting, and 7) changing interpersonal relationships. The results of this study would help clinical nurses to develop nursing intervention to help spouses of gastric cancer patients establish efficient coping strategies in dealing with the problems they face.

This study is a phenomenological study done to promote understanding of the dying process in patients with terminal cancer who were in an independent hospice center. The purpose of study was to explore and understand indepth information on the dying process in order to provide data for holistic hospice care in nursing and to give insights in to practical applications in the nursing care. In ?depth interviewing was done from may, through November, 1995 with 11 patient with cancer who were being cared for at K Hospice Care Center. Experiences in the dying process were discussed as they expressed feelings about death including (a) feeling of isolation because family members try to hide the diagnosis of cancer, (b) hopelessness, (c) guilt, anger, and hostility, (d) suffering from pain, (e) fear of death. However, subjects did not deny death itself and were developing peace of mind and acceptance of death through religion.

PURPOSE: The purpose of this research is to identify factors influencing anticipatory nausea and vomiting in cancer patients.
METHODS
The conceptual framework was derived from Roy's Adaptation Model. The subjects for this study were 66 adult patients with various types of cancers, who were scheduled for a third cycle of chemotherapy or above.
RESULTS
47% of the patients experienced anticipatory nausea and vomiting.
CONCLUSION
The study identified two factors, psychological symptoms (p=.002) and severity of post-chemotherapy nausea and vomiting(p=.004), which are directly related to anticipatory nausea and vomiting. These two factors accounted for 39.5% of the anticipatory nausea and vomiting. Identified environmental cues were awareness of hospital setting, sensory stimuli, and experience of chemotherapy which induced nausea and vomiting. Strategies for relieving anticipatory nausea and vomiting taken by cancer patients were religion, reminiscence, distracting imagery, positive thinking, relaxation and physical exercise.

PURPOSE: The purpose of this study wsa to necessitate auricular acupressure therapy as an independent nursing intervention on cancer paitents by confirming its effectiveness. METHOD: The experimental study was unequivalently controlled pre-post measure study. The subjects were 40 cancer patients who were hospitalized in K medical center in Seoul. The experimental group (20) and the control group (20) were randomly assigned. As measured tools, Spielberger's State-trait Anxiety (1976) measured tool by Kim's transplation (1978). The auricular acupressure therapy was applied to experimental group, and the pre-post measure was performed to both group. The data was analyzed by using SPSS computer program that included descriptive statistics, x2-test, and t-test. RESULT: 1) The experimental group with the auricular acupressure therapy showed lower trait anxiety scores in comparison with the control group (t= 8.036, p=.000). 2) The experimental group which applied the auricular acupressure therapy showed lower state anxiety scores in comparison with the control group (t= 19.616, p=.000). This result showed that cancer patients with the auricular acupressure therapy applied cancer patients decreased state anxiety and trait anxiety. Therefore , effectiveness of the auricular acupressure therapy was confirmed through this study. CONCLUSION: According to the result, anxiety of cancer pateint should be decreased and controlled by the auricular acupressure therapy as independent nursung intervension. In addition, the auricular acupressure therapy will provide effective independent nursing intervention that will decrease anxiety on patient with other disease and will improve quality of their lives.

PURPOSE: This study aimed to identify the change patterns of fatigue and quality of life during consecutive chemotherapies and to determine the relationship of these two variables. METHOD: Stomach cancer patients receiving chemotherapy were recruited from a university hospital in Seoul. Each chemotherapy, subjects were asked to respond to the questionnaires regarding their fatigue and quality of life. The number of subjects who completed 4 cycles and over was 11. Fatigue was measured with Lee's tool(1999). Quality of life was measured with a tool revised by the author based on Padilla et al(1983). RESULT: Most patients were in 1st stage(5 patients) or 3rd stage(5 patients). Fatigue was revealed at its highest level in the 3rd or 4th chemotherapy and at its lowest level in the 1st or 6th chemotherapy. A quality of life appeared at its highest level in the 5th or 6th chemotherapy and the lowest level in 3rd or 4th chemotherapy. CONCLUSION: Among 6 cycles of chemotherapy, in 3-4th chemotherapy the fatigue was the highest and the quality of life were the lowest. Many patients decided to stop treatment at the same period. Therefore we can recognize cancer patients receiving chemo- therapy are in the highest risk at the time of the 3-4 th chemotherapy.

PURPOSE: The purpose of this study was to develop Nurse's Suffering Experience Scale and to test the reliability and validity of the instrument. METHOD: The subjects used to verify the scale's reliability and validity were 220 nurses who were taking care of the end stage cancer patients, while working at university and general hospitals in Daegu and Kyungbuk province from April 20. to July 10, 2001. The data was analyzed by the SPSS/WIN 8.0 program. RESULTS: A factor analysis was conducted, and items that had a factor loading more than .40, and an eigen value more than 1.0. were selected. The factor analysis classified a total of seven factors statistically, and it's communality was 44%. The explanation of factors based on the conceptual framework and item content are as follows: The first factor was expanding self consciousness, the second factor was forming empathy with family, the third factor was professional challenge, the fourth factor was change of values, the fifth factor was spiritual sublimation, the sixth factor was helplessness, and finally the seventh factor was rejection to death. Cronbach's coefficient to test reliability of the scale was .8665 for total of 44 items. The Scale for Nurse's Suffering Experience developed in the study was identified as a tool with a high degree of reliability and validity. Therefore this scale can be effectively utilized for the evaluation of the degree of nurse's suffering experience in clinical settings.

PURPOSE: This study was conducted to detect the correlations and the main factors influencing depression, life satisfaction, burden, defenition of suffering, meaning of life, and suffering. METHOD: The samples were composed of 160 cancer patients who were or outpatients of four hospitals in Seoul. The reliability of the 6 instruments was tested with Cronbach's alpha which ranged from .62 to .90. The data was analyzed using a SAS program for descriptive statistics, Pearson correlation coefficients, and stepwise multiple regression. Results: The results were as follows: 1. The scores on the suffering scale ranged from 132 to 40 with a mean of 87.3 (SD 17.5). 2. There were significant correlations between all the predictive variables and even the amounts of suffering (r=.27-.84, p <.05). 3. Stepwise multiple regression analysis showed that depression was the main predictor of suffering, and accounted for 71.6% of the variance. In addition burden accounted for 4.6% of the variance in suffering. The two variables combined to account for 76.2% of the variance in suffering. CONCLUSION: In conclusion and depression, burden were identified as important variables in explaining the suffering of patients with cancer.

PURPOSE: The purpose of this study was to determine the effects of exercise program on cardiopulmonary functions and shoulder joint functioning in breast cancer patients who under- went radiation therapy after surgery. METHOD: Subjects in the experimental group(N=12) participated in an exercise program for eight weeks. The Exercise program consisted of shoulder stretching, arm weight training, and walking on treadmill. Maximal oxygen uptake(o2max), maximal running time, shoulder joint range of motion, and shoulder functional assessment were determined before and after the exercise program. Baseline sociodemographic and medical data were compared between experimental group and control group using the Fisher's exact test and Mann- Whitney U test. For effects of the exercise program, repeated measures ANOVA were used. RESULT: 1) Following the exercise program for eight weeks, both o2 max and maximal running time tended to increase in experimental group comparing with the control group. 2) Shoulder abduction, extension and flexion of the operated upper extremity in the experimental group comparing with control significantly increased after the exercise program(p<0.05). 3) Shoulder flexion of the normal upper extremity in the experimental group comparing with control significantly increased after the exercise program(p<0.05). CONCLUSION: The
results
suggest that the exercise program for breast cancer patients undergoing radiation therapy after breast surgery can improve shoulder functions and increase cardiopulmonary functions, which are maximal oxygen uptake and maximal running time.

The purpose of this study was to investigate the effects of coping mechanisms on uncertainty and depression. The subjects were 71 cancer patients selected from Junbook National University Hospital, and the data collection period was from June 21 to October 19 of 2000. Uncertainty was measured by using Mishel's Uncertainty Scale, problem- focused coping, and emotional-focused coping. The data was collected by a questionnaire developed by Lee (1984), and then depression measured by using Beck's depression scale. Data was analyzed with SPSS/WIN 7.5 program by Pearson Correlation Coefficients, and Path analysis. The results were as follows : 1. The mean uncertainty score was 59.17, the mean problem-focused coping score was 48.78, the mean emotional-focused coping score was 42.52. 2. The mean depression score was 15.77. 3. Uncertainty in illness was significantly related to depression (p=0.003) and emotional-focused coping (p=0.028), but uncertainty was not associated with coping mechanisms. 4. When analyzed multiple regression between uncertainty, problem-focused coping, emotional- focused coping, and depression, more specifically emotional-focused coping showed a stronger association with depression than problem-focused coping. 5. Depression was highly correlated with economic status (p=0.015), educational background (p=0.005), duration of disease (p=0.045). 6. Problem-focused coping and emotional-focused coping appeared to function as moderators instead mediators on the relation between uncertainty and depression. In addition, as a whole, uncertainty showed a significant moderating effect on depression, while problem-focused coping did on depression. Finally, limitation of present findings were discussed and implications for future studies are suggested.

When people undergo stressful situations such as a cancer diagnosis, they ask, "why me?" The causal attributions people make about cancer influence what kind of coping strategies are chosen. Weiner (1979) suggested three dimensions of causal attributions: focus of causality, stability, and controllability. The purpose of the present study was to test the relation between causal attributions and self-efficacy in patients with cancer. The subjects were 194 patients who had been diagnosed cancer one year ago and attended an outpatient clinic. 1. Each mean score of causal attribution dimensions (focus of control, stability, controllability) that each patient made about cancer was 2.47, 2.73, 2.86, 3.35, and 3.28. The mean score of self-efficacy was 71.03. 2. There was a significant negative correlation between self efficacy and controllability. Particularly, there was a significant negative relationship between self efficacy and external controllability. Based upon these results, it is recommended that the developing nursing interventions to change causal attribution and self-efficacy is necessary. A number of theoretical relationships and empirical finding are confirmed by this data, and future proposals in research is suggested.

The purpose of this study was to investigate the impact of depression, discomfort, spirituality, physical care, and opioid use on pain with terminally ill cancer patients residing in hospice units. The convenient sample of this study consisted of 41 terminally ill cancer patients at three hospice units in university affiliated hospitals. Patients were interviewed with structured questionnaires three times at predetermined intervals: admission to the hospice unit (Time 1), one week later (Time 2), and two weeks later (Time 3). The data was collected from January 1998 to January 1999 and was analyzed using ANOVA, Pearson correlation coefficient, and multivariate multiple regression. The results of this study were as follows: 1. The mean age of the participants was approximately 55 years old. In terms of diagnosis, lung cancer showed the highest frequency (19.5%), followed by stomach cancer and rectal cancer (17.1%). The motive of seeking hospice unit admission was control (72. 2%), followed by spiritual care (50%), and symptom relief (38.9%). 2. Regarding the type of pain felt, the highest pain frequency the participants experienced was deep pain (55%), followed by multiple pain (25%), intestinal pain (10%), then superficial (5%) and neurogenic pain (5%). For the level of pain measured by VAS, there was no significant difference among the three time points; Time 1 (5.04 +/-2.21), Time 2 (4.82+/-2.58) and Time 3(4.73+/-2.51). 3. There was significant change seen in spirituality and physical care in each time interval. Namely, the longer the length of admission at the hospice unit, the higher the importance of spirituality (p=0.0001) and the more the physical care the participants received (p=0.01). The opioid use at the three time points showed the following frequencies : Time 1 (75.6%), Time 2 (85.4%) and Time 3 (75.6%). 4. Regarding factors influencing pain, the pain level was significantly affected by the depression level (p <0.01) and the opioid use (p <0.1). These results were the most significant at the two time points (Time 1 and Time 2). At Time 3 (two weeks later), the pain level was significantly affected by the depression level (p <0.05) and the amount of physical care the participants received (p <0.1). In conclusion, the terminally ill cancer patients had moderate pain, were generally depressed, and were treated with opioid analgesics. As approaching death, the patients received more physical care due to increased physical symptoms experienced and they had a higher perception of the importance of spirituality. Thus, health care professionals need to provide continuous care for each of them to die comfortably physically, psycho- logically, and spiritually.

The purpose of this study was to develop a continuing nursing care program for cancer patients and the caregivers staying at their home and to test its effects on patients' symptom distress, caregiver burden, and satisfaction of life. The continuing nursing care program was based on the homecare needs of cancer patients, and was provided by three clinical nurses who took care of the patients while they were hospitalized. The program consisted of discharge education about selfcare using education materials(book and handout) and provisions of direct care. These were counselling and education during which visiting patients' home one week after discharge and telephone counseling two weeks after discharge. Counseling by telephone was always available during the research period. A quasi-experimental research design was used to test the effects of the program. Subjects for this study were 53 cancer patients discharged from the hospital and caregivers. These subjects were assigned to an experimental group (n=23) receiving continuous nursing care, or to a control group (n=30) not receiving continuous nursing care. Data from control group was collected first to protect from contamination. Data collection was done from October of 1998 to February of 2000. The collected data was analysed using mean, t-test, and chi-square test computed by SPSS software. The summary of results was as follows: 1) The symptom distress was a little decreased at posttest, but there were no significant differences between the experimental and the control group in symptom distress. 2) The score of caregiver burden was significantly decreased in experimental group at posttest, but no differences in control group. 3) There were no significant differences between the experimental and control group in the satisfaction of life. 4) The score of satisfaction of continuing nursing care program in experimental group at posttest was 2.321 of 3. In conclusion, even though this study did not obtain evidence of effectiveness of continuing nursing care program on patients, such as. It is still expected to be effective by a more improved program. Therefore we want to give some suggestions for further studies. 1) It is needed to make a communication channel with the patient's doctor to response promptly and appropriately to patient's conditions. 2) The research is necessary on patients in terminal stage or early stage of cancer diagnosis who have many nursing needs. 3) It is needed to readjust the roles and job assignment of clinical nurse to implement effectively as a program provider.

The purpose of this study is to identify and classify the different types of cancer patients who use alternative therapies, to understand their subjective frameworks in using such alternative therapies. The results of this study provided the subjective information on five types of attitudes towards alternative therapies and described characteristics of five types from 30 cancer patients. The "Dependent to Others" (the first type) decided to use alternative therapy because they were influenced by the experiences of others and invocations of the family (especially spouse) or close relatives. In general, they did not believe that it will cure the diseases but generally thought it was not harmful and it may be better than doing nothing. There were a group of patients who chose to use alternative therapy with vague hope and belief. These patients decided to try alternative methods with their own convictions and confidences because they have personally seen or heard about some people who had been cured miraculously. This group of patients was grouped as "Belief in Effects (second type)." Although, there is a very little chance for miracles, "Expecting for Effects (third type)" believed alternative therapy will strengthen immune systems, help with feces and urine, change physical constitutions, slow down the progression of cancerous cell, have no side-effects, and expects to have practical effects and uses. The fourth group of patients thought foods in alternative therapies were same as general foods, therefore, it was easy to take, did not expect miracles to happen but considered the alternative therapy as supplementary treatments. This "Supplementary for Effects (fourth type)" patients thought it was their duty to do everything possible. The last type was "Expecting for Miraculous Effects (fifth type)." The patients in this group were devastated and thought of alternative treatments as the last hope for miracles. They thought it would relieve their physical pains, reduce the chance of side effects from chemical treatments, help them for comfortable and painless death, and considered it as the last possible option with expecting for miracles. The result of this study has implications to provide practical and concrete guidelines for caring and nursing cancer patients using alternative therapies. It will be used as a tool to work on independent for nursing intervention. Furthermore, the result of study will provide practical guidelines to help develop better tools and nursing intervention strategies to nurse cancer patients.

The main objectives of this study were to analyze the concept of hope, so to provide basic data to develop a valid instrument to measure hope, and to develop hope enhancing nursing intervention a program for cancer patients. The hybrid model approach was applied in three phases, the theoretical phase, the empirical phase, and the analytic phase. The study was developed on universal attributes explaining generalized hope and specific hope, which were revealed in a comprehensive review of the literature. In the empirical phase, eight cancer patients undergoing chemotherapy were interviewed to reveal causes, motivation, and their resource of hope according to The Hope Assessment Guide (Farren, Herth, & Popovich, 1995). In the analytical phase, the results of the two previous stages of the study were compared. The results were as follows: In the theoretical phase, six dimensions of hope emerged; affective, cognitive, behavioral, affiliative, temporal and contextual dimension. The antecedent of hope was loss, crisis, uncertainity, and stress. The consequences were renewal, development of new methods, safety, peace and transcendental competence. In the empirical phase, these six dimensions emerged as theoretical phases were verified and specified as these descriptive terms: feeling, intention, expectation, activity, relation, future- orientation, reality and goal-setting. The antecedent factor of hope was occurrence or recurrence of cancer. The consequence of hope was ability to cope with real condition, feeling of safety and comfort, peace, development of new strategy and recovery of disease. The major content of hope in this phase was related to specific hope, but it was also influenced on by general hope. In the analytic phase, general and specific hope was renamed as trait and state hope. All attributes emerged at the empirical phases, and also emerged at the theoretical phase. However, cognitive and contextual dimensions were revised and specified. In conclusion, the concept of hope is divided into trait hope and state hope, and state hope is an anticipatory expectation that occurs at the time of a stressful stimulus, such as being diagnosed with cancer. Hope is a multidimensional dynamic energized mental state which has the dimensions of affective, cognitive, behavioral, affiliative, temporal and contextual. There should be further studies to develope the state and trait hope scale according to definition and attributes of hope investigated in this study. In addition, considering results of the empirical phase, the family is very a important factor as a resource of hope, so it is necessary to consider family in implementing a nursing intervention program to enhance hope.

The purpose of the present study is to identify the mediation effect of hope between fatigue and psychosocial adjustment in women with breast cancer. The framework for this study was guided by concepts and propositions derived from the theoretical and empirical literature on fatigue, hope and adjustment. The design of this study is a descriptive correlation study using a cross-sectional design. One hundred and twenty two outpatients with early breast cancer, receiving post-surgical radiation therapy or chemotherapy, were selected from three major medical centers in Seoul, Korea. A packet including PABCF (Psychosoical Adjustment to Breast Cancer Factor), revised RPFS (Revised Piper Fatigue Scale), HHI (Herth Hope Index), and self-addressed return envelope was given to the participants at seven to eight weeks post surgery. The questionnaires were to be completed at home and returned to the researcher by mail. The obtained data were analyzed using three regression equations guided by Baron and Kenny (1986); first, hope was regressed on fatigue; second, psychosocial adjustment was regressed on fatigue; and third, psychosocial adjustment was regressed on fatigue and hope, simultaneously. In the first equation, fatigue explained 4% of the variance in hope. In the second equation, fatigue explained 47% of the variance in psychosocial adjustment. In the last equation, hope and fatigue significantly explained the variance in psychosocial adjustment. Therefore, all conditions for the test of mediation effect of hope were satisfied. For the test of the mediation effect, the beta coefficients of fatigue on psychosocial adjustment on the second and third regression equations were compared. The beta coefficients were decreased from .69 (p < .001) on the second regression equation to .63 (p < .001) on the third regression equation. Thus, the hypothesis of this study was supported. As a result of this study, the negative Influence of fatigue on psychosocial adjustment is dampened through the mediator effect of hope in women with breast cancer. Therefore, when planning care for the adverse effect of fatigue on psychosocial adjustment, oncology nurses should consider hope as a mediator between fatigue and psychosocial adjustment to breast cancer.

The purpose of this study is to identify health promotion behavior, self-efficacy and role stress of family caregivers who care for hospitalized cancer patient, The results would be used to provide the necessary basic data for promoting healthy behavior of the family caregivers to the cancer patient. The results were as follow : 1) The level of health promotion behavior was significantly different depending on the existence of care givers religion and type of help from family members. There was a positive relationship between the performance level of health promotion behavior and perceived health status or age. There was a negative correlation between the performance level of health promotion behavior and time cared for. 2) The level of self-efficacy was significantly different depending on gender and if the subject was employed. There was a positive relationship between perceived health status and intimacy with patient. 3) The level of role stress was significantly different in genders and relationships with patients. 4) There was a positive relationship between health promotion behavior and self-efficacy.

Since cancer is not easily curable, patients who suffer from cancer may have physical, psychological and spiritual problems for the rest of their lives. Especially when cancer patients do not have much to live for and are placing a burden on their family they will experience more suffering emotionally as much as physically. This study was conducted to provide a basis of data for nursing intervention strategies to minimize a cancer patient`s suffering and to understand the relationship between suffering, burden and the meaning of life in cancer patients. The samples were composed of 160 cancer patients who were inpatients or outpatients of two university hospitals and two general hospitals in Seoul. Data collection were carried out from January, 25, 1999 to February, 26, 1999. The data were analyzed using a SAS program for descriptive statistics, pearson correlations, ANOVA, and Duncan tests. The results were as follows; 1. The scores on the two suffering scale ranged from 132 to 40 with a mean of 87.3(SD 17.5). The mean scores on the burden scale is 28.9(SD 6.9) and the score of the meaning of life ranged from 35 to 51 with a mean of 95.6(SD 18.4). 2. There were significant correlations between the amount of suffering and the magnitude of burden (r=.74, p=.00), the suffering and the meaning of life (r=-.59, p=.00) and the burden and meaning of life (r=-.61, p=.00). 3. In the degree of the suffering, the burden and the meaning of life were two very strong factors, the level of the suffering in cancer patients by age (F=2.64, p=.03) and education level (F=4.16, p=.00). The level of the burden in cancer patients differed by education level (F=4.70, p=.00) and type of cancer (F=2.97, p= .03). Also the level of the meaning of life in cancer patients was different by education level (F=3.55, p=.02). In conclusion, the burden and the meaning of life was identified as important variable that is contributed to reduce the suffering of cancer patients.

This study is a methodological research study to develop an instrument to measure in patients with cancer and to test the validity and reliability of the instrument. The research procedure was as follows: 1) The first step was to develop conceptual framework based on a comprehensive review of the literature and in-depth interviews with patients with cancer. This conceptual framework was organized in to three dimensions (the intrapersonal dimension, the significant-other and context related dimension, the transcendental dimension). Initially 59 items were adopted. 2) These items were analyzed through the index of content validity(CVI) and 53 items were selected which met more than 80% on the CVI. 3) The pretest was carried out with 87 patients with cancer. After the pretest results were analyzed by item analysis, 44 items were selected. A second test of content validity was conducted and 6 items were eliminated considering the 80% CVI. 4) To test for reliability and validity, data collection was done during the period from January 25, 1999, to February 26, 1999. The subjects for the test were 160 patients with cancer and 185 healthy persons. This study utilized Cronbach's alpha in analyzing the reliability of the collected data and applied factor analysis, item analysis and multitrait-multimethod method to analyze validity. The findings are as follows: 1) The Cronbach's alpha coefficient for internal consistency was .92 for the total 38 items and .79, .82, .85, for the three dimensions in that order. 2) The item analysis was based on the corrected item to total correlation coefficient( .30 or more) and information about the alpha estimate if this item was dropped from the scale. 3) As a result of the initial factor analysis using principal component analysis and varimax rotation, one item was deleted because of factor complexity (indiscriminate factor loadings). In the secondary factor analysis, 7 factors with eigenvalue of more than 1.0 were extracted and these factors explained 56 percents of the total variance. The seven factors were labeled as 'family relationship', 'emotional condition', 'physical discomfort', 'meaning and goal of life', 'contextual stimuli', 'change of body image', 'guilt feelings'. 4) The convergence effect between this instrument and the life satisfaction scale was identified and there was significant positive correlation(r= .52, p= .00). The discriminant validity between this instrument and the depression scale(CES-D) was tested and there was significant negative correlation(r= -.50, p= .00). The instrument for accessing the suffering of patients with cancer developed in this study was identified as a tool with a high degree of reliability and validity. In this sense, this tool can be effectively utilized for assessment in caring for patients with cancer.

This study was conducted to identify appetite and nutritional status of 48 cancer patients who have been irradiated over 150 cm2 on chest or pelvic area over the three-month period. The data were gathered 3 phases, Each from initiation to completion of radiotherapy through the questionnaires of anorexia, the anthropometric and biochemical measures were used such as weight, TSF, MAC, MAMC, serum albumin and hemoglobin, TLC. Using SAS program, data were analyzed by percentage, Mean+/-SD, and two-way repeated measures ANOVA. The results were summarized as follows: 1. Eighty five percent(85%) of the subjects were aged from fifties to sixties. Cancers in the chest area occurred in 100% of men, 56% of the all subjects. The other 44% were pelvic cancer and 71% of the pelvic cancer occurred in women. 2. There were no significant differences in the appetite scores by all groups(characteristics). Changes of the appetite score over time were statistically significant by age, sex, cancer areas staging, treatment modality, and radiation dosage (F=4.0, p=.022; t=6.09, p=.003; t=4.90, p=.009; F=3.28, p=.042; t=5.04, p=.0084; t=4.76, p=.011). The appetite score on the 2nd phase (4 weeks after initiating radiotherapy) decreased from the 1st phase (initiating irradiation), and then increased on the 3rd phase (completing irradiation). 3. There were no significant differences in the body weight and MAMC by all characteristics, and no changes in the body weight and MAMC over time. However there were significant differences of TSF, MAC, level of hemoglobin, level of albumin, and TLC by all characteristics during the three phases. TSF of the men and the chest cancer were lower than those of the women and the pelvic cancer (t=73.20, p=.0001; t=22.91, p=.0001). And there was significant difference by cancer staging(F=3.19, p=.050). But there was no change in TSF over time. MAC of the men and the chest cancer were lower than those of the women and the pelvic cancer each(t=9.23, p=.004; t=17.85, p=.0001). But no change in MAC over time. Levels of hemoglobin had significant differences by age, sex and cancer areas; levels of hemoglobin of older than the fifties, men, and chest area were higher than those on the others(F=3.82, p=.029; t=21.75, p=.0001; t=8.71, p=.005). Levels of albumin were significant differences by sex and cancer areas; levels of albumin on women, and pelvic area were higher than those on the others(t=6.34, p=.015; t=15.23, p=.0003). While the levels of hemoglobin were changed over time, levels of albumin were not changed and within normal limit. TLC of the men was higher than women(t=5.05, p=.029). Changes in the level of hemoglobin over time were statistically significant according to sex, cancer areas, and radiation dosage(t=3.49, p=.035; t=3.36, p=.039; t=4.04, p=.021).

The author investigated pain experiences of 90 cancer patients and adequacy of pain treatment they have received during their stay at a large medical center in T city between October 1994 and August 1995. Pain was assessed by the Shortened BPQ and results are summarized as follows: As for ratings of "worst pain" during the 24 hour period, 70% of the patients reported they had "severe" pain. As for ratings on "pain now" 43% of the cancer patients reported "moderate to severe" pain. Over 46% of the patients reported a pain relief score of 0(not at all) or 1(somewhat) even after receiving pain medication. Adequacy of analgesic treatment was evaluated by comparing the patient's reported level of pain and the analgesic use, namely, the pain management index(PMI). The PMI indicated that 58% of the patients were undertreated for the pain control. In review of nurse's notes, systematic pain assessment was scarcely recorded, although pain documentation appeared in 70% of the notes; and the contents were mostly simple description. In conclusion, the results of patient's pain ratings, the PMI and poor pain documentation in the nurse's notes implied poor pain assessment and management.

Most people experience fatigue at some point in their lives, and they say the word 'fatigue' in their ordinary conversational speech. The ordinary word is used as a military or engineering term and has been studied in various different disciplines such as ergonomics, physiology, psychology, medicine, and nursing. In spite of its widespread uses, however, fatigue has not been well defined. The terms of fatigue is thus often used with different meanings and is applied in diverse contests that had led to a confusion of ideas. In people with cancer, fatigue is reported as a major distress. Despite the importance of fatigue in cancer patients, the phenomena of fatigue is poorly understood. Therefore, the purpose of the present study is to analyze the concept of fatigue in people with cancer. The process for the concept analysis was guided by Walker and Avant's conceptual analysis methodology. The identified attributes of fatigue in the present study were subjective feeling, lack of energy, sustenance, and multi-dimensions. The antecedents were cancer treatment and economic status. The consequences were decreased daily, vocational, leisure, and social activities, uncertainty, and difficulties in adjustment. Symptoms(pain, anorexia, and insomnia) and emotional disturbance were not clear whether they are antecedents or consequences. However, they are related with cancer related fatigue. Even though still in the beginning stage, instruments measuring cancer related fatigue have been developed by some nursing investigators.

The purpose of this descriptive study was to identify the homecare needs of patients with cancer and to provide a basis of interventions. One hundred and two patients at one general hospital in Gyeongnam responded to a questionnaire developed on the basis of care needs perceived by nurse caring for hospitalized patients with cancer. The questionnaire was a Likert type 5 point scale with 56 items on five need categories ; 1) informational 2) physical care 3) emotional care 4) socioeconomic care and 5) special care needs. Internal consistency of this questionnaire was Cronbach's alpha=.9101 for total items. The data was collected from March 1st to May 31th, 1998, by tow graduate nurses. In the data analysis, mean & standard deviation were calculated to identify the degree of care need of each item, and the t-test & ANOVA were done to determine the effects of patients' demographic background on their care needs. The findings are summarized as follows ; 1) The mean score of total of need items was 3.048. Of the four need categories the highest score was informational at 3.4, followed by emotional care, 3.063, physical care, 2.623, and socioeconomic care, 2.599. 2) In the informational and category there were four subcategories with 19 items. Medication and pain control had the highest score, 3.755 ; second was diet and exercise, 3.613 ; third was disease and treatment process, 3.337 ; and last was personal hygiene and infection prevention at 2.687. 3) In the physical care need category there was nine items, IV infusion for nutrition and management of treatment complication was above 3.2 points and the remaining items were in the 2.847-2.070 score ranges. 4) In the emotional care need category there were seven items. The highest need was in support for relationships with health personnel, 3.673. The need for support of religions beliefs and support fir having a religion were low at about 2 points. 5) In the socioeconomic care need category there were six items. Support for medical insurance expansion and financial support were above 3 points. Legal support and support for caring of children were low in the care needs. 6) In the special care need category the there were 15 items. Informational need about immunization and informational need about effects of disease on growth and development were high, above 4.1 points. Need for decubitus care and prevention, sitz bath and incontinence care were low, below 2 points. 7) There were significant differences in degree of care need according to admission rate, education level, marital status, religion and caregiver's religion. In conclusion, homecare needs perceived by hospitalized patient's with cancer was moderate, but informational need was higher than direct care needs, leading to the conclusion that the provision of sufficient information to patients with cancer at discharge is needed. Nursing interventions should be developed considering the patient's background.