Purpose: Clinical training for nursing students is limited to rudimentary skills to avoid potential risks. Simulation-Based Training (SBT) can overcome the shortcomings of clinical training. We evaluated the educational effect of SBT for obstetrical nursing students using high-fidelity simulation courses. Methods: We developed a simulation program for obstetrical nursing students to practice nursing skills that are necessary to provide quality care. The program consisted of four sessions. 1st: An orientation and a preliminary test. 2nd: Learning core skills required in obstetrical nursing. 3rd: Testing each student with scenario. 4th: Providing a debriefing session. At the beginning of the program, students were surveyed about their self-confidence in obstetrical nursing care, and at the end of the program, they were surveyed about the adequacy of SBT as well as self-confidence. Results: Students' self-confidence showed a significant difference before and after simulation. Mean adequacy of SBT was $7.15{\pm}1.35$ (out of 10). Most students became more interested in Women's Health Nursing after SBT. Conclusion: The results from evaluating the effects of simulation-based obstetrical nursing training show that SBT provides invaluable clinical experience for obstetrical nursing students by overcoming the lack of actual clinical involvement in clinical training programs.

Purpose: Mothers' postpartum depression is a worldwide health concern that produces compromising effects on their infants. This study was conducted to compare the infants' temperament and health problems according to the presence of maternal postpartum depression. Methods: Data were collected from May to October in 2009. The sample was 137 mothers at one month postpartum. The Edinburgh Postpartum Depression Scale (EPDS) was used to assess depressive symptoms. Results: At one month postpartum, 22.6% of mothers were classified as having postpartum depression. Infants of depressed mothers were more frequently classified as difficult temperament infants. They showed lower scores on the amenability, rhythmicity and persistency and higher scores on activity in temperament. Also, infants of depressed mothers reported more infant health problems at one months. Maternal depression showed significant negative correlations with family functioning, social support and marital satisfaction. Conclusion: Study findings show that postpartum maternal depression is associated with infants' temperament and health, and thus screening and early interventions for postpartum depression would promote the health of both the mother and infant.

Purpose: In this study the effects of breast massage on breast pain, breast-milk sodium, and newborn suckling in early postpartum mothers were investigated. Methods: The design was a non-synchronized nonequivalent control group pretest-post-test design. Sixty postpartum mothers who were admitted to a postpartum care center and had problems with breastfeeding were recruited. Of these mothers, 44 were assigned to the intervention group and received two 30-minute breast massages within 10 days of postpartum period. The others were assigned control group and received only routine care. Breast pain was measured using a numeric pain scale and number of times newborns suckled was observed throughout breastfeeding. Breast milk was self-collected to evaluate breast-milk sodium. Results: Mean age of postpartum mothers was 30 years old. Compared to the control group, women in the intervention group reported significant decreases in breast pain (p<.001), increases in number of times newborns suckled after the first and second massage (p<.001), and a decrease in breast-milk sodium after the first massage (p=.034). Conclusion: Breast massage may have effects on relieving breast pain, decreasing breast-milk sodium, and improving newborn suckling. Breast massage can be used to solve breast problems. Further research is needed to validate our findings.

Purpose: The aim of this study was to develop and test an explanatory model for sleep disorders in people with cancer. A hypothetical model was constructed on the basis of a review of previous studies, literature, and sleep models, and 10 latent variables were used to construct a hypothetical model. Methods: Data were collected from April 19 to June 25, 2010, using self-report questionnaires. The sample was 291 outpatients with cancer who visited the oncology cancer center at a university hospital. Collected data were analyzed using SPSS Win 15.0 program for descriptive statistics and correlation analysis and AMOS 7.0 program for covariance structural analysis. Results: It appeared that overall fit index was good as ${\chi}^2/df=1.162$, GFI=.969, AGFI=.944, SRMR=.052, NFI=.881, NNFI=.969, CFI=.980, RMSEA=.024, CN=337 in the modified model. The explanatory power of this model for sleep disorders in people with cancer was 62%. Further, sleep disorders were influenced directly by cancer symptom experience, dysfunctional beliefs and attitudes about sleep, and past sleep pattern. Conclusion: Findings suggest that nurses should assess past sleep pattern and consider the development of a comprehensive nursing intervention program to minimize the cancer symptom experience, dysfunctional beliefs and attitudes about sleep, and thus, reduce sleep disorders in people with cancer.

Purpose: The purpose of this study was to evaluate the effectiveness of the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model sexual program on female sexual function for women with gynecologic cancer. Methods: The integrative 6-hr (two hours per session) program reflecting physical and psychosocial aspects of women's sexuality was developed based on Annon's PLISSIT model. Participants were 61 women with cervical, ovarian, or endometrial cancer. Of them, 29 were assigned to the experimental group and 32 to the control group. The women completed the Female Sexual Function Index (FSFI) including sexual desire, arousal, lubrication, orgasm, satisfaction, and pain. Independent t-test and repeated measured ANOVA were used to test the effectiveness of the program. Results: Significant group differences were found on FSFI sub-domain scores including sexual desire, arousal, lubrication, orgasm, and satisfaction but not pain. Significant time differences were found on all domains except for pain in the experimental group repeated measured ANOVA. Conclusion: The results indicate that the three-week PLISSIT model sexual program is effective in increasing sexual function for women with gynecologic cancer. Nurses may contribute to improving women's sexual function by utilizing the program. Strategies to relieve sexual pain need to be considered for greater effectiveness of the program.

Purpose: The purpose of this study was to identify from the International Classification of Functioning model, factors influencing quality of life in elderly persons and to describe the concrete pathway of influence and the power of each variable. Methods: The sample included 334 elders who lived in 5 districts of D Metropolitan City. A structured questionnaire was used and the collected data were analyzed for fitness, using the AMOS 18.0 program. Results: This model was concise and extensive in predicting the quality of life of elders. The research verified the factors influencing quality of life for elders as direct factors such as activity of daily living (ADL) (${\beta}$=.13, t=2.47), leisure activity (${\beta}$=.55, t=5.04), social disengagement (${\beta}$=-.25, t=-2.25), and depression (${\beta}$=-.62, t=-10.86). Indirect factors including economic status (${\gamma}$=.17, p=.009), type of residence (${\gamma}$=.19, p=.004), ADL (${\gamma}$=.12, p=.027) were important factors in predicting quality of life for elders. These variables explained 75.6% of variance in the prediction model. Conclusion: The findings indicate a need for the nursing scientific community to develop intervention programs considering these variables to improve the quality of life for elders.

Purpose: The study was conducted to develop and test a hypothetical model which explains self-care behavior in patients with type 2 diabetes was established based on the Self-Determination Theory. Methods: The participants were 218 patients with type 2 diabetes mellitus enrolled in an outpatient clinic of one endocrine center in Korea. The data were collected using questionnaires from April 5 through May 7, 2010. The descriptive and correlation statistics were analyzed using the SPSS/WIN 15.0 and the structural equation modeling procedure was performed using the AMOS 7.0 program. Results: The results of this study showed that competence and autonomous motivation were the strong factors influencing self-care behavior in patients in this sample. Support from health provider for autonomy was a significant indirect factor on self-care behavior. These factors explained 64.9% of variance in the participants' self care behavior. The proposed model was concise and extensive in predicting self-care behavior of the participants. Conclusion: Findings may provide useful assistance in developing effective nursing interventions for maintaining and promoting self-care behavior in patients with type 2 diabetes.

Purpose: Time-driven activity-based costing was applied to analyze the nursing activity cost and efficiency of a medical unit. Methods: Data were collected at a medical unit of a general hospital. Nursing activities were measured using a nursing activities inventory and classified as 6 domains using Easley-Storfjell Instrument. Descriptive statistics were used to identify general characteristics of the unit, nursing activities and activity time, and stochastic frontier model was adopted to estimate true activity time. Results: The average efficiency of the medical unit using theoretical resource capacity was 77%, however the efficiency using practical resource capacity was 96%. According to these results, the portion of non-added value time was estimated 23% and 4% each. The sums of total nursing activity costs were estimated 109,860,977 won in traditional activity-based costing and 84,427,126 won in time-driven activity-based costing. The difference in the two cost calculating methods was 25,433,851 won. Conclusion: These results indicate that the time-driven activity-based costing provides useful and more realistic information about the efficiency of unit operation compared to traditional activity-based costing. So time-driven activity-based costing is recommended as a performance evaluation framework for nursing departments based on cost management.

Purpose: The purposes of this study were to identify the factors influencing service quality in nursing homes, and to develop an evaluation instrument for service quality. Methods: A three-phase process was employed for the study. 1) The important factors to evaluate the service quality in nursing homes were identified through a literature review, panel discussion and focus group interview, 2) the evaluation instrument was developed, and 3) validity and reliability of the study instrument were tested by factor analysis, Pearson correlation coefficient, Cronbach's ${\alpha}$ and Cohen's Kappa. Results: Factor analysis showed that the factors influencing service quality in nursing homes were healthcare, diet/assistance, therapy, environment and staff. To improve objectivity of the instrument, quantitative as well as qualitative evaluation approaches were adopted. The study instrument was developed with 30 items and showed acceptable construct validity. The criterion-related validity was a Pearson correlation coefficient of .85 in 151 care facilities. The internal consistency was Cronbach's ${\alpha}$=.95. Conclusion: The instrument has acceptable validity and a high degree of reliability. Staff in nursing homes can continuously improve and manage their services using the results of the evaluation instrument.

Purpose: The purpose of this study was to examine effects of nitric oxide synthase (NOS) inhibitor on muscle weight and myofibrillar protein content of affected and unaffected hindlimb muscles in rats with neuropathic pain induced by unilateral peripheral nerve injury. Methods: Neuropathic pain was induced by ligation and cutting of the left L5 spinal nerve. Adult male Sprague-Dawley rats were randomly assigned to one of two groups: The NOSI group (n=19) had NOS inhibitor (L-NAME) injections daily for 14 days, and the Vehicle group (n=20) had vehicle injections daily for 14 days. Withdrawal threshold, body weight, food intake and activity were measured every day. At 15 days all rats were anesthetized and soleus, plantaris and gastrocnemius muscles were dissected from hindlimbs. Muscle weight and myofibrillar protein content of the dissected muscles were determined. Results: The NOSI group showed significant increases as compared to the Vehicle group for body weight at 15 days, muscle weight and myofibrillar protein content of the unaffected soleus and gastrocnemius. The NOSI group demonstrated a higher pain threshold than the vehicle group. Conclusion: NOSI for 14 days attenuates unaffected soleus and gastrocnemius muscle atrophy in neuropathic pain model.

Purpose: The purpose of the study was to examine the effects of multisensory stimulation (MSS) using familiarity on persons with dementia (PWDs) residing in nursing homes in Korea. Methods: A nonequivalent control group with pre and posttests was used. Fifty one PWDs were included if they: 1) were over 65 yr old, 2) were diagnosed with dementia, 3) had no visual or speech impairments, 4) were able to communicate, and 5) had spent more than one month in a nursing home. The experimental group (n=25) received a 55 min MSS program twice a week for 10 weeks. The outcome variables included were cognition, activities of daily living, grip strength, depression, wandering, and aggressive behaviors. Repeated ANOVA was used for data analysis. Results: There were no significant differences in demographics or the main variables at pretest. Cognition, depression, wandering, and aggressive behaviors were significant over time between the two groups. Grip strength was only significant when accounting for interaction between group and time. Conclusion: An intervention of MSS using familiarity was marginally effective in improving cognition, depression, wandering, and aggression. Future study is suggested with a larger sample and longer treatment to retest the effects of MSS.

Purpose: The purpose of this study was to identify attitudes of adolescents toward suicide. Methods: Q-methodology which provides a method of analyzing the subjectivity of each item was used. Thirty middle and high school students classified 37 selected statements into a normal distribution using a 9 point scale. Collected data were analyzed using the Quanl PC Program. Results: Three types of attitudes toward suicide were identified. The first type (opposing suicide-moral minded) showed an attitude of opposing suicide and thinking that suicide is a sin. The second type (understanding-empathizing suicidal person) showed an attitude of understanding the situation of the adolescents who has suicidal ideation and empathizing with them. The third type (ambivalent attitude) showed an attitude of understanding the suicidal person but, at the same time, opposing suicide. Conclusion: Results of the study indicate that different approaches to suicide prevention programs should be developed based on the three types of suicide attitudes among adolescents.

Purpose: The purpose of this study was to investigate the prevalence of depression among school girls in Korea and identify factors influencing the tendency to depression. Methods: A self-report survey was conducted with South Korean middle schoolgirls who were in the 8th and 9th grades. Four hundred and one schoolgirls were included in the study. The instruments utilized in this study were the Center for Epidemiologic Studies - Depression Scale and Social Problem Solving Inventory-Revised. Data were analyzed using descriptive statistics, Pearson correlation and multiple logistic regression with SPSS WIN 14.0 program. Results: The average depression score of the participants was 20.68, which indicates moderate levels of depression. About 35% of the schoolgirls in this study reported a tendency to depression. Significant predictors for depression were 'decreased problem-solving abilities', 'no family members with whom they can discuss their concern', 'decreased satisfaction in relationship with friends', and 'increased negative self-perception of body-image'. Conclusion: The study findings suggest that schoolgirls require special concern regarding the risk of developing depression. Regular depression screening could be beneficial for early detection of depression in schoolgirls and enhancing problem-solving ability could be considered as an effective strategy to reduce the risk of depression among schoolgirls.

Purpose: The purpose of this study was to monitor the use of health-related quality of life (HRQOL) instruments in Korean studies of patients with diabetes. Methods: Of 86 Korean studies initially identified, 17 studies met the inclusion criteria. For each study, a description of the instrument and its psychometric properties were monitored by the Instrument Review Criteria of the Scientific Advisory Committee. These criteria include conceptual definition, attributes, taxonomy, reliability, validity, responsiveness, administrative mode, and language adaptations. Results: Five generic and one diabetes specific type questionnaires were identified from the 17 studies. Of those studies, conceptual definitions with the attributes of multi-dimension and subjectiveness were provided for 11 studies (71%). In the analysis of conceptual taxonomy, only 6 studies were classified as HRQOL, while other studies were done as QOL or health status. In monitoring of psychometric properties, reliability, validity, and responsiveness were reported for 88.2%, 64.7%, and 29.4%, respectively. One generic instrument was developed with a Korean population, while the other instruments were developed for Western countries. However, language adaptations were performed for only a few of the instruments. Conclusion: The psychometric properties including responsiveness of most instruments warrants further research, and the development of diabetes-specific HRQOL measurements should be sought to facilitate intervention outcomes across Korean studies of patients with diabetes.

Purpose: The purpose of the study was to understand and describe the hospital workers' experience related to the hospital evaluation program implemented in Korea between 2004 and 2009. Methods: During 2010, data were collected using focus group interviews. Four focus group interviews were held with a total of 28 hospital workers participating. All interviews were recorded and transcribed as they were spoken, and data were analyzed using qualitative content analysis. Results: Nine themes emerged from the analysis: 1) Positive change in the necessity of the evaluation; 2) Improvement in the hospital system, facilities, and human resources; 3) Unity through cooperation among departments; 4) Nursing work overload; 5) Lack of physicians' awareness and responsibilities; 6) Unfair and unrealistic evaluation items; 7) Lack of credibility of the outcome; 8) Shifting responsibility for negative outcomes to the workers; 9) Lack of pragmatic utility. Conclusion: The results of the study demonstrate that the hospital evaluation program played a key role in improving some work environments and communication among departments. At the same time, they show various negative themes resulting from the context of very authoritarian hospital systems and a connection-oriented society in Korea.