Purpose. The purpose of this study was to differentiate the change in exercise behavior into different stages and to investigate differences in the process of change, self efficacy, decisional balances and depression according to the stages of exercise behavior change among middle aged women in Korea by using the transtheoretical Model. Methods. A convenience sample of 434 middle aged women (40-64 years) completed measures of all transtheoretical model constructs involved in exercise behaviors (stages and processes of exercise behaviors change, self efficacy and decisional balance) and depression. The data were analyzed by using the SPSS 10.0 program including descriptive statistics, and one-way ANOVA. Results. The subjects were distributed in each stage of change in exercise behaviors: pre-contemplation (n = 106; 24.4%), contemplation (n = 126; 29%), preparation (n = 88; 20.3%), action (n = 51; 11.8%), and maintenance (n = 63; 14.5%). The processes of change, pros (advantages of behaviors), self-efficacy and depression were significantly differentiated across the stages of exercise behavior change. Cons(disadvantage of behaviors) was not significantly differentiated across the stages of exercise behavior change. Conclusions. Results of this study suggested that discriminating of processes of change, self-efficacy, decisional balance, and depression could provide positive information to people about the stages of change in exercise behavior. Therefore, in designing interventions, the stage of a client's exercise behaviors change needs to be assessed prior to application of intervention programs in order to increase and maintain exercise behavior in middle aged women.

Purpose. This study examined Korean clinical nurses' intentions to care for SARS patients and identify determinants of the intentions. Theory of planned behavior was the framework to explain the intentions of Korean nurses for SARS patients care. Methods. A convenient sample of six hundreds and seventy nine clinical nurses from four university-affiliated hospitals located in Seoul and in Kyung-gi province was used. Self-administered (83-items) questionnaire was used to collect data. Intentions, attitude, subjective norm, perceive behavioral control, behavioral beliefs, normative beliefs, and control beliefs were the study variables. All items were measured using 7point Likert scale (-3 to +3). Data were analyzed using descriptive statistics, Pearson correlation method, and stepwise multiple regression methods. Results. Intentions and attitudes toward SARS patient care among Korean clinical nurses were moderate, but their subjective norm and perceive behavioral control of SARS patients care were negative. Stepwise multiple regression analysis indicated that attitude toward SARS patient care, perceived behavioral control, subjective norm were the determinants of the intentions for SARS patients care as theory proposed. Among the behavioral beliefs, 'SARS-patient caring would be a new experience', 'during SARS-patient caring, I should be apart from my family', 'after completing SARS-patient caring, I would be proud of myself being able to cope with a stressful event' and 'with my SARS-patient caring, patients could recover from SARS' were the significant determinants. Among the normative beliefs, colleague approval, spouse approval, and physician approval were significant determinants of the intentions. Among the control beliefs, 'SARS-patient caring would be a challenge' 'SARS-patient caring is a professional responsibility', 'tension during the care of SARS patients' and 'support from team members' were the significant determinants of the intentions. Conclusions. Korean clinical nurses in this study were not willing to care for SARS patients and showed negative attitude toward the care. They believed their friends and family were not approved their care for SARS patients. Nurses were in conflicts between professional responsibilities to care for SARS patients and personal safety. This study was the first to understand stress and burden of Korean clinical nurses who are in front line to care for newly developed communicable disease such as SARS. Under the circumstance where several fatal communicable diseases are predictable, conflicts between professional responsibility and their personal risks should be taken into considerations by nurses themselves and by nursing administrators in order to improve quality of care.

Purpose. Koreans are one of the fastest growing Asian populations in the U.S. since 1960s. In Korean immigrant women (KIW), breast cancer was reported as the most frequently diagnosed cancer. However, their screening rates for breast cancer are lower than national guidelines; it is assumed that underlying cultural schemas of breast, breast cancer, and its screening modalities exist and need to be studied. This study was aimed to investigate cultural meanings of breast, breast cancer, and breast cancer screenings in KIW. Methods. Using cultural models theory from cognitive anthropology, naturalistic qualitative methodology was utilized. Three focus group interviews with fifteen KIW were conducted. Thematic analysis with constant comparison technique was performed eliciting units of meaning, categories, and themes. Results. The cultural schema of the meaning of breast is 'mother who is breast-feeding her baby,' with two themes of 'balance in size,' and 'shyness.' Regarding breast cancer, three themes, i.e., 'indifference,' 'fear,' and 'uncertainty' are emerged. 'Lack of information about screening modalities' is the overarching schema with reference to breast cancer screenings. Conclusions. The findings of this study demonstrate unique cultural models of KIW related to breast cancer and its screenings, which are critical to understand and penetrate their barriers to breast cancer screening.

Purpose. Smoking is the leading cause of death and smoking initiation rarely occurs after adolescence. Thus research on adolescent smoking is crucial. A consistent definition of smoking is important because inconsistent definitions make comparisons across studies an arduous task. Thus, the aim of the study was to suggest future research directions for smoking definitions after examining pitfalls in the literature. Methods. In this study the literature on adolescent smoking in the U.S. and South Korea was examined, and three types of smoking definitions were identified. Limitations in the studies are identified and future research directions are suggested. Results. In the U.S. literature, smoking definitions can be categorized into three groups: definitions based on stage models, smoking trajectories, and definitions derived from specific data. In the South Korean literature, various levels of smoking have not been differentiated. Conclusions. While the literature does not provide a definitive answer regarding the definition of smoking, it suggests three issues to consider for future research. First, multiple measures of smoking are more desirable than a one-time measure. Second, theory- or trajectory-based smoking definitions are more desirable than definitions derived from available data. Finally, regularity and amount of cigarette use should be incorporated in defining smoking behavior.

Purpose. The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. Methods. The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. Results. The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. Conclusions. The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation methods. This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.

Purpose. To determine the effects of music therapy on pain, discomfort, and depression for patients with leg fractures. Methods. Data were collected from 40 patients admitted in an orthopedic surgery care unit. The subjects included 20 intervention group members and 20 control group members. Music therapy was offered to intervention group members once a day for 3 days for 30-60 minutes per day. Pain was measured with a numeric rating scale and by measuring vital signs. Discomfort and depression were measured with self-administered questionnaires. Results. Patients who received music therapy had a lower degree of pain than patients who did not receive music therapy as measured by the numeric pain score (p < 0.001), systolic blood pressure (p < 0.01), diastolic blood pressure (p < 0.001), pulse rate (p < 0.001) and respiration (p < 0.001). Patients who were provided with music therapy also had a lower degree of discomfort than patients who were not provided with this therapy (p < 0.01). Effects of Music Therapy on Pain, Discomfort, and Depression for Patients with Leg Fractures Conclusions. These results demonstrate that music therapy is an effective method for decreasing pain and discomfort for patients with leg fractures.

Purpose. The purpose of this study was to construct a measurement instrument for climacteric symptoms among Korean and Japanese women. Methods. From Dec. $1^{st}$ of 2003 to March $30^{th}$ of 2004, in-depth interviews were made with 26 women (15 in Jinju, Korea and 11 in Nagasaki, Japan) aged from 45 to 59 years who had not taken hormone replacement therapy to relieve the climacteric symptoms. A draft questionnaire with 45 items was constructed on the basis of the interview data and literature review. Three obstetricians, three PhDs in nursing science, and a chief nurse who was exclusively in charge of the climacteric management, examined the draft questionnaire to evaluate content validity. After deletions 39 items remained for a preliminary questionnaire. A survey was conducted by using a convenient sampling method in Jinju of Korea and Nagasaki of Japan during the period from April $1^{st}$, 2004 to July $10^{th}$, 2005. Results. Factor analysis identified 4 factors, which were 'mental and psychological symptoms', 'physical symptoms', 'loss of autonomic nervous system symptoms', 'sexual symptoms'. These four factors explained 46.9% of total variance. Conclusions. The results demonstrated that climacteric symptom scale was multidimensional, and the reliability and validity of the scale was supported.

Purpose. This study investigated changes in attitudes toward elders in general and elders with dementia after students finished a gerontological nursing practicum. Methods. Questionnaires developed for Asian cultures were administered pre practicum, immediately post practicum, and at 8-months follow up to 31 senior students in a baccalaureate nursing program. The 1-week practicum occurred at two adult day care centers: a center for elders with dementia and a center for elders with stroke. Repeated measures ANOVA and Bonferroni correction procedures were used to analyze data. Results. Students' evaluation of elder vitality and flexibility increased significantly at post practicum, however this increase was not sustained at follow up. Score of generosity of elders, the only positively evaluated dimension for elders in general, improved partly at post practicum. Students evaluated flexibility and generosity of elders with dementia more negatively than general elders. All of the decreased attitudes at follow up were not significantly different from those at pre practicum. Conclusions. Students had more negative attitudes toward elders with dementia. Attitudes of students in direct contact with elders with dementia were improved through the practicum regarding generosity and flexibility. However the sustainability of the immediate effect was not observed at follow up.

Purpose. The purposes of this study were to apply data mining tool to nursing specific knowledge discovery process and to identify the utilization of data mining skill for clinical decision making. Methods. Data mining based on rough set model was conducted on a large clinical data set containing NMDS elements. Randomized 1000 patient data were selected from year 1998 database which had at least one of the five most frequently used nursing diagnoses. Patient characteristics and care service characteristics including nursing diagnoses, interventions and outcomes were analyzed to derive the meaningful decision rules. Results. Number of comorbidity, marital status, nursing diagnosis related to risk for infection and nursing intervention related to infection protection, and discharge status were the predictors that could determine the length of stay. Four variables (age, impaired skin integrity, pain, and discharge status) were identified as valuable predictors for nursing outcome, relived pain. Five variables (age, pain, potential for infection, marital status, and primary disease) were identified as important predictors for mortality. Conclusions. This study demonstrated the utilization of data mining method through a large data set with stan dardized language format to identify the contribution of nursing care to patient's health.

Purpose. This study was performed to develop and test a decision-tree model of treatment-seeking behaviors about when Korean patients visit a doctor after experiencing stroke symptoms. Methods. The study used methodological triangulation. The model was developed based on qualitative data collected from in-depth interviews with 18 stroke patients. The model was tested using quantitative data collected from interviews and a structured questionnaire involving 150 stroke patients. The predictability of the decision-tree model was quantified as the proportion of participants who followed the pathway predicted by the model. Results. Decision outcomes of the model were categorized into immediate and delayed treatment-seeking behavior. The model was influenced by lowered consciousness, social-group influences, perceived seriousness of symptoms, past history of hypertension or stroke, and barriers to hospital visits. The predictability of the model was found to be 90.7%. Conclusions. The results from this study can help healthcare personnel understand the education needs of stroke patients regarding treatment-seeking behaviors, and hence aid in the development of educational strategies for stroke patients.