Purpose: The purpose of this study was to investigate the effects of assertiveness training on nurses' assertive behaviors, interpersonal relations, communication conflicts, conflict management style and personnel turnover rate. Method: A non-equivalent control group pretest-posttest design was used in this study, Nurses were assigned into the experimental or control groups, each consisting of 39 nurses. Data was collected between January to March 2004. An 'Assertiveness Training Program' for Nurses developed by Park was used for the study. To emphasize assertiveness practice, 5 practice sessions utilizing ABCDE principles were added to Park's program. To examine the effects of the program, differences between the two groups in assertive behaviors, interpersonal relations, communication conflicts, conflict management style and personnel turnover rate were analyzed using ANCOVA. Results: The assertiveness training was effective in improving the nurses' assertiveness behaviors, but was not effective in improving interpersonal relations, reducing the subjects' communication conflicts, changing the conflict management style or reducing their personnel turnover rate. Conclusion: There have been many studies about factors affecting nurses' personnel turnover rates, but few have been done about methods of intervention to reduce the personnel turnover rate. Thus, this study provides a significant contribution in attempting such an intervention from nursing management perspectives.

Purpose: This study was done to analyze variations in unit staffing and recommend policies to improve nursing staffing levels in intensive care units (ICUS). Method: A cross-sectional study design was used, employing survey data from the Health Insurance Review Agency conducted from June-July, 2003. Unitstaffing was measured using two indicators; bed-to-nurse (B/N) ratio (number of beds per nurse), and patient-to-nurse (P/N) ratio (number of average daily patients per nurse). Staffing levels were compared according to hospital and ICU characteristics. Result: A total of 414 institutions were operating 569 adult and 86 neonatal ICUs. Tertiary hospitals (n=42) had the lowest mean B/N (0.82) and P/N (0.76) ratios in adult ICUs, followed by general hospitals (B/N: 1.34, P/N: 0.97). Those ratios indicated that a nurse took care of 3 to 5 patients per shift. Neonatal ICUs had worse staffing and had greater variations in stafnng ratios than adult ICUs. About 17% of adult and 26% of neonatal ICUs were staffed only by adjunct nurses who had responsibility for a general ward as well as the ICU Conclusion: Stratification of nurse staffing levels and differentiation of ICU utilization fees based on staffing grades are recommended as a policy tool to improve nurse staffing in ICUs.

Purpose: The purpose of this study was to examine the effects of 'Logotherapy with Exercise' on the meaning of life, ego integrity and IADL's in the Elderly. Method: This quasi-experimental study was designed for a nonequivalent control group repeated measurement study. This study was done from Oct. 13, 2004 to Dec. 18. 2004. The subjects were between the ages of 65 to 75, who were literate in Korean and able to communicate and participate in physical exercise without any discomfort. The experimental group was 25 subjects and the control group was 26. The 5-week 'Logotherapy with Exercise' program was given to the experimental group. Data was analyzed by X$^2$, t-test, ANCOVA, ANOVA, and post-hoc comparison by Bonferroni correction with the SPSS/WIN 12.0. Results: The experimental group had a greater difference in meaning of life, ego integrity and IADL's than the control group. The experimental group had differences in changes in meaning of life, ego integrity and IADL's during time period. Conclusion: 'Logotherapy with Exercise' can be recommended as an effective nursing intervention for the elderly.

Purpose: The purpose of this study was to help understand the life and illness-experiences of focusing on a positive lifestyle, patients with Parkinson's disease, Method: The present study adopted a ethno graphic methodology. The participants for this study were 4 men and 3 women, who were treated for Parkinson's disease. Data was collected by an interview and participant observations from August 2003 to September 2004. Tape-recorded interviews were transcribed after the interview and classified and described to realistic tale. Result: Patients with Parkinson's disease experienced the stage of retake-off pursuing positive life by overcoming the acceptance process of illness including the stage of recognition of change, the stage of disruption and the stage of acceptance. The factors of positive life of Patients with Parkinson's disease were their strong will and social support. Conclusion: This study may be used in future studies as an important resource to develop nursing intervention strategies and programs for patients with Parkinson's disease that can help the patients to achieve strong willingness and positive life in Korea.

Purpose: This study was done to describe the research trend of Complementary and Alternative Medicine(CAM) in Korea and internationally. Method: A Systematic review of CAM related literature published from 2000 to 2005 was done. A comprehensive search by using 34 CAM modalities as search terms to identify all articles dealing with CAM was undertaken from 4 databases: PubMed, RICHIS, KoreaMed, and Riss4U. A Total of 588 abstracts and 223 original articles were reviewed by two independent reviewers using systematic analysis guidelines. Data regarding the types of study design, characteristics of subjects and researchers, and classification of CAM modalities was recorded. The outcome measures of CAM were identified. Results: CAM research has been rapidly increasing worldwide in the last decade. In Korea, nursing(53.5%) followed by medicine(42.7%) occupied the majority of CAM research in comparison to medicine(42.9%) and disciplines in CAM(25.0%), like homeopathy, internationally. Prevailing research designs in Korea were experimental and quasi-experimental, however, randomized clinical trials were found. Internationally, survey research was dominant, with the exception of randomized clinical trials that were mostly an experimental design. Conclusion: The findings suggest that a robust research design in CAM research is needed to accumulate strong scientific evidence and to adopt nursing interventions from CAM modalities.

Purpose: This study was to investigate the effects of non-nutritive sucking on physiological and behavioral state of pre-term infants during tube feeding. Method: This nonequivalent, non-synchronized experimental study included 50 pre-term infants. An attempt was made to match gestational age and birth weight of infants in each group. Infants in the experimental group were given a pacifier 2 minutes before, during, and for 2 minutes after tube feeding. Infants in the control group did not get a pacifier. Both groups were tested at three stages for changes in the physiologic state and behavioral state - 2 minutes before, during, and 2 minutes after feeding. Date was analyzed with SPSS WIN 10.0 using an $X^2$-test, t-test, and repeated measures ANOVA. Result: Heart rates and oxygen saturation levels of the two groups were significantly different(P=.001, P=.000). The behavioral states of the two groups were significantly different during and post feeding(P=.000, P=.000). Conclusion: This result suggests non-nutritive sucking by using a pacifier is an effective intervention for pre-term infants during tube feeding.

Purpose: This study was to identify which factors are likely to influence the effectiveness of smoking cessation on adults who smoke in Metropolitan Incheon. Method: Data from 9,083 smokers, who visited a smoking cessation clinic of a public health center from Jan. to Oct. 2005, were provided by the Korean Health Research Society, Among 9,083 smokers, 1,495 people were selected for follow up care at 6 months in order to analyze the differences between two groups one is a successful group and the other is a failure group. Results: The successful group included 639 people and the failure group 856 people. In the demographic profiles such as sex, age and motive registration, there was a significant difference between the two groups. In the view of smoking pattern and factors such as the expiratory CO level, the age of starting to smoke, the duration of smoking, alcohol, and dependence on alcohol use and nicotine, there were significant differences between the two groups. The smoking cessation method, results of uni variate analysis, the total number of visits to the smoking cessation clinics, and the use of nicotine gum or a patch(stage 1, stage 2) were significantly different in the two groups. Conclusion: The results of multi variate analysis have shown that the factors associated with the success for smoking cessation is the total number of visits to the smoking cessation clinic, and the dependence on alcohol.

Purpose: This study was to evaluate the effects of a comprehensive life style modification program on glycemic control and stress response in type 2 diabetes. Method: The participants(n=34) with type 2 diabetes were divided into either a usual care(control) or treatment(experimental) group. The experimental group(n=21) received a program that was based on a comprehensive life style modification protocol at a weekly meeting for 16 weeks. They also participated in individually prescribed exercise and diet along with stress management and self monitoring. The participants were followed for 6 months, during which postprandial glucose, HbA$_{1C]$, and stress response inventory were measured. Result: The experimental group showed a significant lower postprandial glucose and stress response compared to those of the control group. However, there was no significant change in the HbA$_{1C]$ value in either group. Conclusions: These results suggest that a type 2 diabetes comprehensive lifestyle modification program may lead to clinical improvement in glycemic control and reduce the stress response.

Purpose: Even though a number of studies have suggested that appropriate measuring instruments of family stress for working women have to be developed, the validity and reliability of the instruments used have not been consistently examined. The purpose of the present study was to develop a sensitive instrument to measure family stress for married working women, and to test the validity and reliability of the instrument. Method: The items generated for this instrument were drawn from a comprehensive literature review Twenty four items were developed through evaluation by 10 experts and twenty one items were finally confirmed through item analysis. Psychometric testing was preformed and confirmed with a convenient sample of 240 women employed in the industrial sector. Result: Four factors evolved by factor analysis, which explained 50.5% of the total variance. The first factor 'Cooperation' explained 28.1%, 2nd factor 'Satisfaction with relationships' 10.6%, 3rd factor 'Democratic and comfortable environment' 6.3%, and 4th factor 'Disturbance of own living' 5.5%, Cronbach's coefficient of this instrument was 0.86. Conclusion: The study supports the validity and reliability of the instrument.

Purpose: This study was designed to create a job description for Korean geriatric care managers and examine performance frequency, importance, and difficulty of task elements. Method: The sample consisted of 38 geriatric care managers and professors who performed duties related to geriatric care management at community based-facilities in Korea. A survey method was used, and the questionnaire included frequency, importance, and difficulty of task elements in job descriptions using the DACUM method. Using SPSS WIN 10.0, descriptive statistics such as frequency distribution, means, and standard deviation were conducted to examine the subject's general characteristics, frequency, importance, and difficulties of task performance. Result: The Job description of geriatric care managers revealed 10 duties, 34 tasks, and 105 task elements. On all ten duties, the average performance frequency, importance, and difficulty was 2.55, 2.21 and 2.43 respectively. Conclusion: The job description of geriatric care managers includes duty, task, and task elements and the definition of a completed job. Thus we recommend a data based trial to confirm and validate the information gathered.

Purpose: The purpose of this study was to conceptualize and clarify a concept of "preparatory grief" in terminal cancer patients. Method: A hybrid model of concept development was applied to develop a concept of preparatory grief, which included a field study carried out in Busan, Korea. Participants of this study were 8 cancer patients. Results: On the basis of our literature, research and clinical experience, the concept of preparatory grief emerged as a complex phenomenon playing an important role in five areas; physical, emotional, interpersonal, religious, and transcendental dimensions. Two new attributes were defined through a field phase; trust of the post-mortal world and a serene state of mind. Indicators reflected attitudes of sadness, worry, regret, capability to adapt and hope. The results of preparatory grief were loss of energy and interest, emotional chaos, contemplation, taciturnity and restoration. Conclusions : Differentiating among preparatory grief and other symptoms in cancer patients is essential because of therapeutic implications. Understanding preparatory grief is necessary in order to manage cancer patients for promoting quality of life so that its application may have a positive impact on the patient's life.

Purpose: The purpose of this study was to understand the adjustment process of middle-aged people in Korea with hemiplegia after a stroke. Method: For this study, the grounded theory method was utilized. Results: After constant comparative analysis, the core category emerged as 'rebuilding the body which was ruined'. In addition, the causal conditions were 'restriction of physical function', and 'loss of roles'. The adjustment process consisted of the 'facing reality phase', 'overcoming depression phase', 'overcoming physical limits phase' and 'reestablishing roles phase' The main strategies in the facing reality phase were 'holding on to a glimmer of hope', 'getting away from the harsh reality' and 'facing up to the reality'. The main strategies in the overcoming depression phase were 'soothing oneself', 'Self-introspection' and 'restoring self-esteem'. In addition, the main strategies in the self-initiative overcoming physical limits phase was 'discovering personal strategies and striving to recover'. The main strategies in the reestablishing roles phase were 'reestablishing a parents' role', 'reestablishing a spouse's role' and 'reestablishing social roles'. Conclusion: In conclusion, even though many middle aged stroke patients remained in the depression phase, most of them who overcame depression strived to conquer physical limits on their own initiative.

Purpose: The purpose of this study was to identify attributes of the concept of spiritual care. Method: Walker & Avant's concept analysis framework was employed to review the clinical guidelines, nursing text books, and nursing research articles which were related to spiritual care and published from 1985 to 2005. Result: The attributes of the concept of spiritual care were a three stage process such as spiritual assessment, spiritual intervention, and spiritual evaluation. Spiritual care included three dimensions of relationships such as transpersonal, interpersonal, and intrapersonal. The quality of spiritual care was dependent upon characteristics of care-givers such as perception and knowledge of spiritual care, and the clinical environment. The antecedents of spiritual care was spiritual needs due to the prompt events. The consequence of spiritual care was spiritual well-being. Conclusion: This concept analysis of spiritual care contributed to promote performance of spiritual care in clinical fields by removing conceptual ambiguity and confirming the true meaning of spiritual care.

Purpose: This study examined the effects of individual reminiscence therapy on older adults' depression, morale, and the quality of life. Methods: The design was a single-group pre-test and post-test study. Subjects consisted of 31 older adults from two senior centers and a welfare center in Seoul. Individual reminiscence therapy was applied to study subjects four times, once a week for an hour at each time. Measurement tools were the Geriatric Depression Scale Short Form Korea (GDSSF-K) for depression, Mun Ae-ri's (1996) scale for morale, and Medical Outcomes Study Short Form 36 (SF-36) for the quality of life. Data was analyzed using descriptive statistics, paired t-test, and pearson correlation. Results: The application of individual reminiscence therapy reduced older adults' depression (t=-5.65, p=.000), and enhanced older adults' morale (t=4.65, p=.000). The application of individual reminiscence therapy improved older adults' quality of life (t=5.00, p=.000). Conclusion: Findings of the study suggest that individual reminiscence therapy may be applied as a nursing intervention that contributesto the improvement of older adults' quality of life, reduces their depression, and enhances their morale.

Purpose: The purpose of this study was to examine anger-expression patterns and their association with state and trait anger and physical and psychological health status in health care workers. Method: Four hundred and forty eight nurses, physicians and technicians from a large medical center completed standardized questionnaires of anger, anger-expression patterns and mood. They also had blood pressure, cholesterol, blood glucose and body mass index measured during their annual physical examinations. Data was analyzed using descriptive statistics, independent t-test, chi-square and ANOVA. Results: Subjects showed two major clusters of anger-expression patterns: anger-control and anger-in/out. Subjects with the anger-in/out pattern reported higher state and trait anger and more anxiety, depression and fatigue than subjects with the anger-control pattern. Physical health indicators, however, were not significantly different between the two clusters of anger-expression patterns. Conclusion: Anger-expression patterns are associated with psychological health status but not with physical health status. Anger-expression patterns, however, need to be examined over time to assess their long-term effects on the physical and psychological health status in future studies.

Purpose: The purpose of the present study was to identify prevalence of excessive daytime sleepiness(EDS) and its associations with sleep habits, sleep problems, depression, subjective health status and obesity in community dwelling adults. Method: Data was collected from adults aged 20-59 years by random sampling. Subjects completed a questionnaire which was composed of the Epworth Sleepiness Scale, Center for Epidemiologic Studies Depression Scale, and questions that included items about sleep habits, sleep problems, subjective health status and sociodemographic characteristics. Height and weight were measured for calculation of body mass index. The statistical analyses was based on 3,302 adults (51.5% males and 48.5% females). Descriptive statistics, univariate logistic regression and multiple logistic regression were used. Result: The prevalence of EDS was 17.1% Multiple logistic regression showed that the associated factors of EDS were depression, obesity, dissatisfaction with sleep time, irregular sleep, and habitual snoring. Depression was the most significant associated factor(adjusted odds ratio for severe depression=2.27, 95% Confidence Interval=1.73-2.96). Conclusion: EDS is a common symptom in adults. Our finding suggested that persons with a complaint of EDS should be completely assessed for depression and obesity as well as sleep problems.

Purpose: This study was done to identify fat distribution and blood pressure according to anthropometric change patterns between NIDDM patients and control subjects. Methods: Cross-sectionally 167 NIDDM patients and 87 controls were studied. Previous maximal body weight and acute weight loss was obtained. Current height, body weight, BMI, waist-hip ratio(WHR), skinfold thicknesses(abdomen, subscapular & triceps), and blood pressure was measured. Three anthropometric change patterns were categorized by BMI changes from the maximum lifetim's BMI to the current time (obese-obese, obese-nonobese and nonobese-nonobese: obese: BMI$\geq$25kg/m$^2$, nonobese: BMI<25kg/m$^2$). The data was analyzed by $X^2$, t-test, age adjusted ANCOVA and Least Squares Means(LSM) for multiple comparison. Result: Acute body weight loss(p=0.01), anthropometric change types (p=0.001), WHR (p=0.05), and skinfold thickness (p=0.002) of NIDDM were significantly higher than those of the controls. The mean arterial pressure, WHR and skinfold thicknesses were greater in both obese-obese and obese-nonobese NIDDM and control subjects compared with both nonobese-nonobese NIDDM and control subjects. (all p's<0.05). Conclusion: NIDDM patients had more central and upper body adiposicity. Also both obese-obese and obese-nonobese NIDDM and control subjects had higher mean arterial pressures and central body obesity.

Purpose: The purpose of this study was to investigate the emotional state and related factors in patients with lymphedema. Methods: The subjects of this study consisted of 95 patients with lymphedema at 8 hospitals in Busan and Seoul. Data was collected by a self-administered questionnaire between March 2001 to December 2001. Data was analyzed by Pearson correlation coefficient, and stepwise multiple regression using SPSS Win 12.0. Results: The mean score of the emotional state of the subjects was 3.06; of their physical symptoms, 1.84; of their Activities of Daily Living(ADLs), 2.30; and of their social activities, 3.67. The emotional states of lymphedema patients correlated with their physical symptoms, their ADLs, and their social activities. The Factor influencing the emotional state of the subjects was social activities. Conclusion: These results suggest that a negative emotional state is very common in patients with lymphedema, to which appropriate attention should be given. Rehabilitation programs must be implemented to improve lymphedema patients' emotional state, physical symptoms, ADLs, and social activities.

Purpose: The purpose of this study was to identify the factors that influence the functional status of patients with heart failure. Method: A descriptive, correlational study design was used. The participants in this study were 260 patients with heart failure who were admitted at Y University and U University in Seoul, Korea. Between September 2005 and December 2005 data was collected by an interview using a questionnaire and from medical records. The Functional status was measured with KASI. Physical factors (dyspnea, ankle edema, chest pain, fatigue, and sleep dysfunction), psychological factors (anxiety and depression), and situational factors (self-management compliance and family support) were examined. Result: In general, the functional status, anxiety, depression, self-management compliance, and family support was relatively not good. The level of fatigue was highest and the level of ankle edema was lowest for physical symptom experiences. In regression analysis, functional status was significantly influenced by dyspnea(23%), age(13%), monthly income(7%), fatigue(3%), ankle edema(2%), depression(1%), and length of stay in the hospital(1%). These factors explained 50% of the variables in the functional status. Conclusion: These results suggest that psycho-physiological symptoms management should be a focus to improve the functional status in patients with heart failure.

Purpose: A descriptive correlational study was designed to examine the relationship of trait anger and anger expression to blood pressure, cholesterol, and depression in middle-aged Korean men. In addition, this study investigated the mediating effect of social support in relation to anger and other variables. Methods: Two hundred and ninety nine men aged 40 to 64 years were recruited from a health center at K University Hospital located in Ansan City, Kyungki province, Korea. The instruments used were Spielberger's state trait anger expression inventory-the Korean version for trait anger and anger expression, Beck's depression inventory for depression, and a Personal resource questionnaire for perceived social support. Results: Men with high trait anger showed significantly higher systolic blood pressure(BP) and diastolic BP The level of cholesterol did not have a significant relationship with trait anger and anger expression. The severity of depression was significantly higher in men with high trait anger or more frequent uses of anger-in or anger-out. The perceived social support had a significant mediating effect in relation to trait anger and depression. Conclusions: Various nursing interventions for managing anger or improving social support need to be developed in a future study.