Purpose: This study was aimed to evaluate the effect of progressive muscle relaxation training using biofeedback on perceived stress, stress response, immune response and climacteric symptoms, Method: This was a crossover, pre-post test design, The study subjects are 36 middle-aged women who were selected at 2 public health centers, The independent variable was Biofeedback training for 4 weeks, twice a week and home training for 4 weeks, Dependent variables were perceived stress, stress response, immune response, and climacteric symptoms measured with Hildtch's scale (1996), Result: Progressive muscle relaxation training using biofeedback was not effective in reducing perceived stress, but it was shown to be effective in reducing physiological stress responses such as pulse rate and EMG, Though blood pressure and skin conductance were repeatedly down, and skin temperature slowly increased, there were no statistically significant differences. Progressive muscle relaxation training using biofeedback was not effective in reducing serum cortisol, enhancing immune responses, or decreasing climacteric symptoms. Conclusion: The findings point to a pressing need for further, well-controlled and designed research with consideration in selection of subjects and instruments, frequency of measurements, the sampling method, and intervention modalities.

Purpose: The purpose of this study was to develop a tool that measures the quality of nursing service, to measure the quality of nursing service perceived by consumers, and to identify the gaps between ideal and actual nursing services. Method: A questionnaire was developed and distributed to 300 people who had been hospitalized in one of six general hospitals with quality of nursing services in five provincial cities in Korea. For data analysis, the SPSS/WIN(ver 10.0) program was used. Result: The 20 attributes included in the instrument of quality of nursing service is abstracted into 2 factors: tangibility and intangibility. In quality analysis, 15 of 20 attributes are minus scores, meaning that those nursing services are perceived as generally low. However among the minus scores' attributes, only two attributes are significant statistically. Gaps between importance and performance of the nursing service exists in 19 among 20 attributes. Conclusion: Nursing service quality (performance-expectation) needs to be improved, and Gaps (importance-performance) reduced. In addition, a tool measuring nursing service quality has to be developed so nurses can deal successfully with the quality and gaps of nursing service perceived by consumers.

Purpose: The main purpose of this study was to identify the correlation between the child rearing attitudes and the maternal role strain of mother with infants. Method: This study is designed as a descriptive research study and the data was collected from 82 mothers and infants by means of an interview and questionnaire in a period from July 2002 to December 2002, when they came to screen their infant's growth and developmental state at a public health center. Result: The results of this study were as follows: There was a significant positive correlation between the child rearing attitudes and maternal role strain(r.=.53, p=.000). There was a significant difference between the father's employment state and child rearing attitude of mothers(t.=5.22, p<.000). There was a significant difference between male infant and female infants in maternal role strain(t.=3.8, p=0.04). Conclusion: When the child rearing attitude was positive, the subject's maternal role strain was high. Also further research is needed on social support or other factors in the subjects in child-rearing attitudes and maternal role strain.

Purpose: The purpose of this study was a comprehensive understanding about maternal transition in mothers with high risk newborns according to the degree of situational meaning. Method: A methodological triangulation that combines qualitative and quantitative methods was used. The situational meaning of a high risk newborn mother was identified using a Family Meaning Attribution Scale. According to the degree of situational meaning, in-depth interviews were conducted at 3 time periods postpartum: between 3-10 days after childbirth, around the time of the newborn's discharge, and between 10-12 weeks after childbirth. Quantitative data was analyzed using descriptive statistics and t-test. Qualitative data was analyzed using Tutty, Rothery, & Grinnell's methodology. Result: The average score of the situational meaning in high the risk newborn mother was 53.57(possible score is between 0-96) and the average score of each item was 1.67. A Maternal transition process in the mother that has a positive situational meaning was conceptualized in three distinctive phases: confusion, accepting, and shaping phases. The Maternal transition process in the mother that has a negative situational meaning was also conceptualized in three distinctive phases: avoiding, conflicting, and accepting phases. Conclusion: It is necessary that the nurses provide high risk newborn mothers with individualized care considering both the situational meaning that is attributed to them and the maternal transition phase that they are faced with.

Purpose: This study was to investigate the factors influencing problem behaviors among adolescents. Method: The subjects for this study were 596 students in middle school in Seoul. The data was collected during the period from May to November; 2001 by use of questionnaires. The instruments used were the Child Problem Behavior list by Hong (1986), the Body Cathexis Scale by Secord and Jourard(l953), and the Beck Depression Inventory by Beck(l978). The data was analyzed by using the SPSS- Win program. Result: Problem behaviors showed a significant negative correlation, with body image (r=-.310. p=.000) and positive correlation with depression (r=.674, p=.000). There were significant differences in the problem behavior scores of subjects according to sex, family status, economic status, and school scores. Female students were found to have a high degree of internalized problem behaviors. In addition, depression, body image, and sex were significant predictors to explain problem behaviors(47.3%). Depression, sex, grade, and school scores were significant predictors to explain externalized problem behaviors(21.9%) and depression and body image, internalized problem behaviors(51.4%). Conclusion: Since predicting factors of problem behaviors among middle school students by problem behavior type and sex were different, then practitioners should consider these differences when developing programs for them.

Purpose: This study was to exam me the correlations among management of menopause, marital satisfaction, and quality of life in middle-aged women. Method: The sample was 158 middle-aged women who were 40-64 years. Data were collected from June 14 to July 10, 2003 using questionnaires and were analyzed by using the SPSS 10.0 PC+ program. Result: The level of marital satisfaction was related positively to the level of quality of life(r=.504, p<.01) and management of menopause(r=.3l5, p<.0l). In addition, there were significant correlations between the level of quality of life and management of menopause(r=.251, p<.01). In stepwise multiple regression analysis, 25.9% of the variance in quality of life was explained by marital satisfaction. Conclusion: Marital satisfaction and management of menopause serve to improve the quality of life of middle-aged women. It is necessary to develop an effective intervention program to improve marital satisfaction and management of menopause.

Purpose: The purpose of this study was to investigate the relationship between decision-making factors(theoretical knowledge, expertise, empowerment, intuition) and participation in proportion to nurses's clinical experience. Method: Data was collected by quota sampling from July 10, 2001 to August 22, 2001 from 132 clinical nurses who work for 3 General hospitals. Data was analyzed using SPSSWIN 10.0 with crosstab, ANOVA, and stepwise multiple regression. Result: Expertise(F=34.347, p=.000), empowerment(F=29.316, p=.000), and participation(F=3.276, p=.041) were significantly different among 3 clinical experience groups. Clinical experience correlated with expertise(r=.551, p=.000) and empowerment(r=.492, p=.000), and Decision-making participation also correlated with expertise(r=.351, p=.000) and empowerment(r=.265, p=.002). Decision-making participation is effected by theoretical knowledge(under 3.00yr clinical experience), expertise(3.01-5.00yr), and empowerment(above 5.01yr). Conclusion: These findings indicate that factors(theoretical knowledge, expertise, or empowerment) on decision-making participation varies as nurses's clinical experience differs. Therefore, decision-making needs bilateral agreement between staff nurses and nurse managers rather than the responsibility of one.

Purpose: The purpose of this study was to classify the elderly in long-term care facilities using the Resource Utilization Group(RUG-III) and to examine the feasibility of a payment method based on the RUG-III classification system in Korea. Method: This study measured resident characteristics using a Resident Assessment Instrument-Minimum Data Set(RAI-MDS) and staff time. Data was collected from 530 elderly residents over sixty, residing in long-term care facilities. Resource use for individual patients was measured by a wage-weighted sum of staff time and the total time spent with the patient by nurses, aides, and physiotherapists. Result: The subjects were classified into 4 groups out of 7 major groups. The group of Clinically Complex was the largest (46.3%), and then Reduced Physical Function(27.2%), Behavior Problems (17.0%), and Impaired Cognition (9.4%) followed. Homogeneity of the RUG-III groups was examined by total coefficient of variation of resource use. The results showed homogeneity of resource use within RUG-III groups. Also, the difference in resource use among RUG major groups was statistically significant (p<0.001), and it also showed a hierarchy pattern as resource use increases in the same RUG group with an increase of severity levels(ADL). Conclusion: The results of this study showed that the RUG-Ill classification system differentiates resources provided to elderly in long-term care facilities in Korea.

Purpose: The purpose of this study was to develop a home care nursing network system for operating home care effectively and efficiently by utilizing a wire-wireless network and mobile computing in order to record and send patients' data in real time, and by combining the headquarter office and the local offices with home care nurses over the Internet. It complements the preceding research from 1999 by adding home care nursing standard guidelines and upgrading the PDA program. Method: Method/l and Prototyping were adopted to develop the main network system. Result: The detailed research process is as follows: 1 )home care nursing standard guidelines for Diabetes, cancer and peritoneal-dialysis were added in 12 domains of nursing problem fields with nursing assessment/intervention algorithms. 2) complementing the PDA program was done by omitting and integrating the home care nursing algorhythm path which is unnecessary and duplicated. Also, upgrading the PDA system was done by utilizing the machinery and tools where the PDA and the data transmission modem are integrated, CDMX-1X base construction, in order to reduce a transmission error or transmission failure.

Purpose: This study was done to identify the relationship between social support and morale in the elderly. Method: A structured questionnaire was carried out from April, 2003 to June, 2003 on 203 elderly. The data was analyzed with a SPSS program for descriptive statistics, Pearson's correlation coefficients, t-test, ANOVA, and stepwise multiple regression was done Result: The level of social support was moderate, and family support was the highest score. In types of support, appraisal support was the highest score. The level of morale was slightly lower than moderate, and the score of social support showed significantly positive correlation with morale. In general characteristics, several variables were significantly related to social support and morale. The most powerful predictor of morale was material support by family and the variance was 19.6%. A combination of material support by family, emotional support by relatives, level of satisfaction with pocket money, perceived health, level of intimacy with one's children, and material support by friends account for 43.3% of the variance in morale of the elderly. Conclusion: To increase the morale of the elderly, it is necessary to consolidate material support by family and relatives.

Purpose: This cross-sectional survey was undertaken to examine the differences of BSE (breast-self examination) performance and health beliefs between Korean and Korean-American women and to identify which factors influence the BSE based on the HBM variables. Method: The study subjects were recruited from both Korea(189 women) and Cleveland in Ohio, USA(I46 women). The HBM variables were measured using a reliable and valid Health Belief Model Scale. The subjects were also asked whether or not they did a BSE in the last year. Result: The Korean-American women who performed the BSE was statistically higher than that of Korean women. Regarding to the BSE-related health belief, the scores of benefits, confidence, and health motivation was significantly higher in Korean-American. After controlling for living places, age, education, and job, barriers and confidence variables significantly explained the BSE performance of Korean and Korean-American women. Conclusion: There was a differences in BSE-related health belief and performance between Korean and Korean-American women. Among health belief variables, barriers and confidence were core variables predicting the BSE performance of Korean and Korean-American women together.

Purpose: The purpose of this study was to identify the theoretical characteristics and direction of inquiry in the discipline of nursing by analyzing doctoral dissertations. Method: The materials used in this study were 277 doctoral dissertations from five universities in Korea. The framework for the study was derived from Kim's(l993) alternative linkage among philosophy, theory, and method in nursing science. Result: Of the 277 dissertations it was found that there were 13 types of linkages out of a possible 54 types. Most of the dissertations (128 of 277) were done within the linkage of realism/etic/quantitative/explanatory knowledge type. Of the 218 dissertations within scientific realism, 42 were within relativism, and 17 within practicism. There were 134 dissertations of the explanatory knowledge type, 112 descriptive ones, and 31 prescriptive ones. Studies done within the etic quantitative methodology included 209 dissertations and within the emic perspective, 43 with qualitative methodology, and 7 with quantitative. Conclusion: The results show that it is necessary to develop more alternative linkages for nursing practice and this will lead to expanding nursing knowledge.

Purpose: The purpose of this study was to explain differences of cesarean section rates according to San- Yin-Jiao(SP6) acupressure for women in labor. Method: A noneqivalent control group pre test - post test design was used to explain differences of cesarean section rates according to SP6 acupressure. The participants were 209 women who were assigned to one of three groups SP6 acupressure(n=86), SP6 touch(n=47), and control group(n=76). For 30 minutes, the SP6 acupressure group received SP6 acupressure, and the SP6 touch group received SP6 touch for the duration of each uterine contraction. The Control group was encouraged to deep breath and relax for the duration of each uterine contraction for 30 minutes. Result: The rates of cesarean section were 12.8%, 29.8%, and 22.4% for the SP6 acupressure group, SP6 touch group, and control group respectively. There was a significant difference among groups (p=0.049). Cesarean section rateswere significantly different between the SP6 acupressure and non-SP6 acupressure group(p=0.035). Conclusion: This finding shows that 30 minutes of SP6 acupressure was effective in decreasing the cesarean section rate. Therefore, SP6 acupressure during labor could be applied as an effective nursing intervention.

Purpose: This study was designed to construct a structural model for symptom management of life of the patients with chronic fatigue. The hypothetical model was developed based on the literature review and Self-regulating Model. Method: Data were collected by questionnaires from 252 patients with chronic fatigue in the 8 community from December 2002 to April 2003 in Seoul. Data analysis was done with SAS for descriptive statistics and PC-LISREL Program for Covariance structural analysis. Result: The fit of the hypothetical model to the data was moderate, thus it was modified by excluding 4 path and including free parameters and 3 path to it The modified model with path showed a good fitness to the empirical data($x^2$=318.11, p=0.0, GFI=.98, AGFI=.98, NNFI=.95, RMSR=.03, RMSEA=.05). The symptoms of stress, self-efficacy, and present fatigue level were found to have significant direct effect on symptom management of the patients with chronic fatigue. The ways of coping, perceived stress, and fatigue symptom were found to have indirect effects on symptom management of the patients with chronic fatigue. Conclusion: The derived model is considered appropriate in explaining and predicting symptom management of the patients with chronic fatigue. Therefore, it can effectively be used as a reference model for further studies and suggested direction in nursing practice.

Purpose: The purpose of this study is to identify the effect of aroma inhalation on stress responses (physical symptoms, levels of anxiety, perceived stresses)of nursing students. Method: This study was a quasi-experimental research using anon-equivalent pre-post design and was conducted from June 1 to June 5, 2002. The subjects consisted of 77 junior nursing students who were divided into 39 experimental group members and 38 control group members. A pretest and Post-test were conducted to measure body symptoms, the level of anxiety, and the level of perceived stress. In the experimental group, aromas were given using an aroma lamp, lavender, peppermint, rosemary and Clary-Sage. In the control group, the treatment was not administered. Result: As a result of administering aroma inhalation to nursing students, their physical symptoms decreased, their anxiety scores were low, and their perceived stress scores were low, showing that aroma inhalation could be a very effective stress management method. Conclusion: Nursing educators should play an important role in contributing to college students' physical and psychological health by helping enhance their recognition of stress management and effectively relieving their stress using essential oils.

Purpose: This study was conducted to examine the relationship among Depression, Stress, and Social support in Korean Adult Women. Method: The subjects of this study consisted of 2,503 Korean Adult Women from 20 to 64years. The data was collected through personal interviews from March to May of 2001 using questionnaires. The data was analyzed by the SPSS(ver. 10.0) computer program, and it included descriptive statistics, t-test, one way ANOVA, the pearson correlation coefficient, and Stepwise multiple regression. Result: The level of depression, stress, and social support were 16.22 for depression, 27.43 for stress, and 87.48 for social support. There was a significant difference in social support according to residence area, age, level of education, marital status, type of family, religion, income, and job. There was a significant positive correlation between stress and depression, a significant negative correlation between stress and social support, and social support and depression. Stress and social support were significant predictors (29.6%) of depression. Conclusion: This study showed that thorough nursing assessment of variables related to social support is needed for development of nursing intervention strategies. Further studies need to be conducted for group comparisons according to the life cycle of Korean women.

Purpose: The study was performed to identify the process of change, decisional balance and self-efficacy corresponding to the stage of exercise behavior change based on a Transtheoretical Model in middle aged women. Method: The subjects consisted of 317 women by convenience sampling residing in city B. The collected data were analyzed using one-way ANOVA, Scheffe test, and Discriminant analysis by SPSS/WIN program. Result: The subjects were distributed in each stage of change of exercise behaviors: 53 subjects (16.7%) in the precontemplation stage, 86 subjects (27.1%) in the contemplation stage, 88 subjects (27.8%) in the preparation stage, 51 subjects (16.1%) in the action stage and 39 subjects(12.3%) in the maintenance stage. Analysis of variance showed that consciousness raising (F=24.96, p=.00), environmental reevaluation (F=7.l3, p=.00), self reevaluation (F=19.47, p=.00), dramatic relief (F=15.22, p=.00), social liberation (F=4.26, p=.00), counter conditioning (F=26.44, p=.00), a helping relationship (F=13.l7, p=.00), reinforcement management (F=21.25, p=.00), self liberation (F=27.70, p=.00), stimulus control (F=13.49, p=.00), pros (F=14.40, p=.00) and self-efficacy (F=39.9l, p=.00) were significantly associated with the stages of change of exercise behaviors. Through discriminant analysis, it was found that ‘stimulus control’ was the most influential variable in discriminating the five stages of change. Conclusion: This study can provide the basis of a staged matching exercise program using TTM for more effective and useful intervention.

Purpose: The purpose of this study was to measure the functional status of stroke patients cared for in different long-term care settings. Method: We assessed all stroke patients in two home health care agencies, four nursing homes and one geriatric hospital in Korea (n=171) using the Resident Assessment Instrument (RAI), which comprises Activity of Daily Living (ADL), urine incontinence, bowel incontinence, a Cognitive Performance Scale (CPS),and being understood and understanding others. Data was collected by face-to-face surveys with patients. Results: The mean ADL score, urine incontinence score, bowel incontinence score, CPS, and being understood score and understanding others score were lowest for the patients receiving home health care, and highest for the patients in nursing homes. Low scores described poor and high scores good functional status. The results showed significant differences in physical and cognitive function scores between the three groups of patients. Conclusion: This study suggests that there may be large differences between the patients in these three types of long-term care settings. These findings can be used to help develop and implement efficient long-term care programs.