This study identified the impact of childhood cancer on the Korea family. The purpose was to contribute knowledge for family nursing and pediatric hospice care practice with sick children and their families. This descriptive study was conducted during a 6 month period with children who were being treated for cancer at six university hospitals in Seoul. the data were gathered from members of 68 families ; 24(Group A), with a child newly diagnosed with cancer ; 27(Group B), with a child under treatment and without complications, and 17 (Group C), with a child in relapse. Medical records., structured questionnaires and interviews were used for data collection. The questionnaires and interview schedules had been used previously in Martinson's research in the USA and China. The findings, conclusions, and suggestions are as follows. 1. The impact of childhood cancer on the family. Members of the family experienced fear, helplessness, guilty feelings, and anger at the time of the initial diagnosis and at relapse. Mothers complained of headache, anorexia and poor appetite, weight loss, sleep disturbance, and bad dreams. Many of the fathers either lost or changed jobs, and all working mothers stopped working. half the parents reported changes in their marital relationships such as frequent quarrels but also stronger unity. Family members perceived cancer as the most frightening disease. Change in their world view was expressed as living on faith understanding suffering, determining to live a better life, wanting to live an upright life and valuing health as the most important. Religious activities are found most helpful through this difficult experience. Financial debt due to the treatment and care of the sick child, burdened 22 families. The above mentioned impact was most evident in Group B(those presently undergoing treatment) and Group C(those in relapse). Findings indicate that nursing care should embrace the family of a child who is being treated for cancer. 2. Characteristics of the child with cancer The majority of the children in this sample had a diagnosis of leukemia. Their mean age was 6.8 and the ratio of boys to girls was 1.12 ; 1. The mean hospitalization frequency was 13.5 times and the mean duration of illness was 16.8 months. Most of the children perceived cancer as the most frightening disease ; 32.7% of the children described their sickness as serious. Children in Group C were hospitalized more frequently, stayed in hospital for longer periods, and expressed their sickness as quite serious more often than the other two groups. These findings indicate how much comprehensive pediatric hospice nursing care services are needed along with relevant research and nursing education. 3. Characteristics of the families. The mean age of the father was 39.5 and the mother, 36.5 ; they are in their most productive life period. Mothers especially expressed feelings of financial uneasiness and powerlessness about giving up their jobs, and guilty feelings for not providing enough care and concern to other children due to taking care of the sick one. The burden of caring for the sick child can bring negative changes in family dynamics which they think provoke potential health problems in members of the family. These findings suggest a need for nursing support and counselling resources. Findings also suggest the need for ethical inquiry about such questions as who should give information to the child in regard to diagnosis and prognosis, when, and how. Other suggestions included : 1) Quality health care for childhood cancer such as home care and pediatric hospice programs should be established. 2) Special and practical consideration fro long-term patients should be made in the present insurance coverage. The reimbursement period for long-term patients should be lengthened. 3) Further in-depth qualitative studies are needed. 4) Education programs including guided practice experience for pediatric hospice care practitioners are needed.

The purpose of this research was to understand the structure of the lived experience of parents of a child terminally ill with cancer. The research question was "What is the structure of the experience of parents of a child terminally ill with cancer?" The sample consisted of 17 parents of children admitted to the cancer units of two university hospitals in Seoul. The unstructured interviews were carried out from October 10, 1991 through January 10, 1992. They were audio-recorded and analyzed using Van Kaam's method. Parents ascribed the cause of the cancer to the mother's emotional imbalance during pregnancy, the mother's stress, failure to observe religious rites, food, the parent's sin, misfortune and pollution. The theme clusters were tension, fear and depression experienced during pregnancy, stress that children suffer from abusive parents, failure to observe religious activities, bad luck, and sins committed during a previous life. When the child suffered a recurrence of cancer, the parents experienced negative emotions, nervousness, sorrow, depression and death. The theme clusters were feelings of despair, helplessness, regret, guilt, insecurity, emptiness and apathy. The long struggle with cancer resulted in the loss of economic security, loss of psychological and physical well being, and social withdrawal. The theme clusters were the economic burden of medical cost, giving up treatment, debt, limited medical insurance coverage and blood transfusion. The loss of psychological well being included stress, lack of support systems, inability to carry out responsibilities, lack of trust of the medical team, family breakdown, inappropriate expression of emotion and not disclosing the diagnosis to the child. Physically the parents suffered fatigue, insomnia, loss of appetite, loss of weight, dizzness, headache, psychosomatic symptoms, and increased consumption of liquor and cigarettes. Social withdrawal was manifested by taking time off from work to look after the child, decrease of outside social activities and feelings of isolation. Influences on family life were spousal conflicts, negative response of siblings, separation of the family members and economic hardship. The theme clusters were blaming a spouse for the cause of the illness and disagreements, maladjustment, loneliness, hostility and depression of siblings. The high price of medical care over the long period was a major factor influencing the life of the family. Positive experiences during the child's long illness were the strengthening of support systems and religious beliefs and financial help from social organizations. The support of one's spouse primarily helped to overcome the stress of the long illness. In addition, support was received from parents of other children with cancer and from nurses and religious leaders. The nurse, by providing empathetic support, should be a person with whom parents can express their feelings and share their experiences.

This literature review was undertaken to explore theoretical models of depression for their potential usefulness in nursing research and practice. Depression has been accounted for by numerous theories or models of causation ; 11 theories selected from psychology, medicine and psychoanalysis and supported by empirical or experimental research were reviewed. These theories identify a variety of precipitating and predisposing factors that may affect the individual's depression. Aggression-turned-inward theory, object loss theory, ego functioning theory, personality organization theory, behavioral theory, learned helplessness theory, cognitive theory, genetic factors, and biological theories conceptualize predisposing factorrs. Only life stressors theory identifies precipitating facotrs. Each of these theories contributes to an understanding of depression, but many of them use overlapping and interrelated factors. It is also evident from recent research that there are multiple causes for depression involving an interactive effect among predisposing and precipitating factors that are both biological and psychological in origin. That is. a single theory is not useful, but perhaps a unified theory could be developed that would be helpful to nursing. This review points to the need for continuing development and testing of theories that would integrate the multiple conceptualizations of depression.

This parper argues that nursing theories ideosyncratic to situations should be developed through research, if nursing practice is to be effective in achieving the objective of promoting, maintaining, or restoring health of clients / patients. After reviewing (1) the interactive relationship between the theory and research, (2) the type and sequence of research for theory- building, (3) the hierarchy of theories, and (4) congruence between the type of theory and research approach, it suggests (1) that more exploratory studies (research) should be undertaken as a way to develop descriptive theories that may lead to new hypotheses, (2) that more empirical studies should also be undertaken to test if new hypotheses generated from exploratory studies may be useful in the setting of nuring practice, (3) that more studies should be undertaken to develop useful measures of nursing concepts, and (4) that more replicated studies should be undertaken in order to give rise to the external validity of new theories. It also discusses the ethical considerations of nursing research in the future.

The purpose of this study was (1) to undertake a survey to identify the profile of inactive nurses, who account for 42.2% of the 130,000 RN(Registered Nurses) in Korea, (2) to identify factors related to the inactivation of these nurses, (3) to identify reasons behind the high turnover rate of nurses, and (4) to delineate measures for inactive nurses to participate in professional nursing activities so as to upgrade the quality of the health care delivery system in Korea. For these purposes, this study surveyed existing literature on the turnover of nurses and, used the nominal group technique of action research, to collect ideas from hospital/nurse administrators, inactive nurses, nurses on the job, graduate students in nursing, part-time nurses, patients, and their families to formulate strategies to mobilize inactive nurses. The findings are as follows : First, institutional supports should be provided to mobilize inactive nurses. To be more specific : (1) A data-base needs be created at the Korean Nurses Association to link inactive nurses with jobs available. (2) Retraining programs need be established to equip inactive nurses for new jobs. (3) Comprehensive information related to employment needs should be made available. Second, a conducive environment needs to be created to draw in inactive nurses to the job market. The be more specific. (1) A system of part-time work needs to be introduced in hospitals. (2) Nurse-specialists need to be promoted. (3) Potential jobs need to be created. (4) Working environment and terms and conditions for nurses need to be improved. (5) Competent nurses need to be secured in the health care delivery system. To achieve the goals presented above, this paper presented 55 specific strategies that may help mitigate the turmover rate of nurses and, in turn, help make the Korean Nurses Association effective in implementing its policies.