Purpose: This study was done to explore and understand acculturation focusing on reproductive health of immigrant women. Methods: For the research sixteen immigrant women were selected by snowball sampling. Qualitative data were accumulated by in-depth interviews and private document collection. Raw data was analyzed following Mandelbaum's conceptual framework. Results: The dimensions of immigrant women consisted of existence: emerging from the new environment in which it was hard to communicate and to get acquainted with others, reproduction: in the absence of learning and experience, reproductive health crisis, parenting: unmanageable burden. Turnings of life involved 'Inconvenience in one's eyes, vent for conflict and tension: pregnancy', 'strange medical care: accoucheur, rapid medical service', 'pain of morning sickness: poor maternal nutrition', 'manifestation of protective instinct for life'. In adaptations, content was as follows. 1) Standing alone as a Korean housewife, 2) Becoming aware of Korean maternal instinct: thirst for education supporting, 3) Rediscovery of family: growing maternal sense of existence. Conclusion: The results of this study show the acculturation process and the meaning of events related to reproductive health in current lives and can contribute to an integrated understanding of married immigrant women in Korean culture.

Purpose: This study was done to examine the effects of 4% hypertonic saline solution mouthwash and tooth brushing education on the oral health of elders living in long term care facilities. Methods: In this quasi-experimental study, the participants were assigned to a 2% experimental group (n=20), a 4% experimental group (n=20), and a control group (n=20). Data were analyzed using ANOVA, repeated measures ANOVA, Fisher exact test, Chi-square test, Kruskal-Wallis test and multiple response analysis with the SAS program. Results: Regular tooth brushing and use of 4% hypertonic saline solution mouthwash by elders provided better oral health by decreasing xerostomia, oral tongue plaque, halitosis, and the number of oral bacteria. Conclusion: The results indicate that regular tooth brushing with continuous 4% hypertonic saline solution mouth washing education promotes oral health for elders in long term care facilities, thus the dental care described in this study is recommended for elders in long term facilities.

Purpose: This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. Methods: A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Results: Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. Conclusion: To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

Purpose: The purpose of this study was to investigate the effects of a sexuality education coaching program given to elementary school students in terms of sex-related knowledge and attitude. Methods: The participants were elementary school students in S city (Experimental group=21, Control group=23). Data were collected and the program was conducted from Feb. 15 to Apr. 15, 2013. The experimental group of 21 elementary school students in the fifth and sixth grades who received the sexuality education coaching program, 10 sessions in the three weeks. The control group of 23 elementary school students in the fifth and sixth grades from another school received, 2 sessions in the three weeks on sexuality education including physiology and sexual abuse prevention. Data were analyzed using ${\chi}^2$-test, independent t-test, repeated measures ANOVA, and utilized the SPSS program. Results: The experimental group showed significantly better sex-related knowledge and sex-related attitudes than the control group. Conclusion: Therefore, individualized approach with emphasis on the differences of their level of understanding and strengths should be considered in providing sexuality education coaching programs for elementary school students.

Purpose: The purpose of the study was to explore and describe the experience of adult Korean children who are caregivers for parents institutionalized with dementia. Methods: Participants were fourteen adult children caregivers of elders institutionalized with dementia. Data were collected through in-depth unstructured interviews with individual participants from August to November, 2012. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using Strauss and Corbin's Grounded Theory Method. Results: From open coding, 67 concepts, 29 sub-categories, and 14 categories were identified. Analysis revealed that the core category of the experience of adult children caring for their parents institutionalized with dementia was 'enduring the role of a prop' consisting of four phases: initial turmoil, exploration, role adjustment, and acclimation. To manage the role of a prop, participants utilized various action/interactional strategies such as overcoming the unfamiliarity, overseeing the nursing home care, and counterbalancing the caring roles. As a result, participants experienced ambivalence towards the existence of parents with dementia, changes in family relationships, altered viewpoint towards nursing homes, and restructuring of life. Conclusion: In-depth understanding of the experience will guide nurses to promote effective interventions in order to better support the Korean family caregivers of parents institutionalized with dementia.

Purpose: This study was conducted to examine the late effects, social adjustment, and quality of life in adolescents who had been completely treated for childhood leukemia and their parents. Methods: Participants consisted of 41 pairs of adolescent survivors (13-18 years) and their parents. Parents checked for their child's physical late effects. The Korean Version of Post-Traumatic Symptoms for psychological late effects, social functioning questionnaire for social adjustment and the PedsQL 4.0 Generic Core Scales for quality of life were completed by adolescents and parents. Data were analyzed using SPSS. Results: Twenty out of 41 adolescents had one or more physical late effects. Adolescents showed more serious psychological late effect than parents. Five children and seven parents had above cut-off scores and they were considered the high risk group for posttraumatic symptoms. Parent-reported scores were significantly higher than child-reported scores in terms of social adjustment and emotional functioning of quality of life. Low school functioning in adolescents was associated with physical late effects. Conclusion: The results indicate that long-term and systematic management for childhood leukemia survivors affect positive social adjustment and can further improve quality of life.

Purpose: This study was done to develop and implement the Nursing KMS (knowledge management system) in order to improve knowledge sharing and creation among clinical nurses in outpatient departments. Methods: This study was a methodological research using the 'System Development Life Cycle': consisting of planning, analyzing, design, implementation, and evaluation. Quality Function Deployment (QFD) was applied to establish nurse requirements and to identify important design requirements. Participants were 32 nurses and for evaluation data were collected pre and post intervention at K Hospital in Seoul, a tertiary hospital with over 1,000 beds. Results: The Nursing KMS was built using a Linux-based operating system, Oracle DBMS, and Java 1.6 web programming tools. The system was implemented as a sub-system of the hospital information system. There was statistically significant differences in the sharing of knowledge but creating of knowledge was no statistically meaningful difference observed. In terms of satisfaction with the system, system efficiency ranked first followed by system convenience, information suitability and information usefulness. Conclusion: The results indicate that the use of Nursing KMS increases nurses' knowledge sharing and can contribute to increased quality of nursing knowledge and provide more opportunities for nurses to gain expertise from knowledge shared among nurses.

Purpose: The aim of this study was to explore how individual factors, physiologic factors, symptoms, environmental factors, functional status and health perception predict the quality of life (QOL) for older adults with osteoarthritis and to provide guidelines for interventions and strategies to improve QOL in these patients. The conceptual model was based on the Wilson and Cleary's Model. Methods: Data were analyzed using SPSS WIN 20.0 and AMOS 19.0 program. Results: The proposed model was a good fit for the data based on the model fit indices. Based on the constructed model, individual factors, social support, functional status and health perception were founded to have direct effects on QOL. Symptom had a indirect effect on QOL. Social support had a significant effect on QOL, and this model explained 63.6% of the variance in QOL. Conclusion: The results of this study suggest that nursing strategies to increase QOL in this population should contain social support to promote QOL and manage functional limitations and health perception.

Purpose: This study was conducted to examine and compare satisfaction with Korean health care services for Americans, Chinese and Russians who resided in Korea. Methods: A questionnaire was distributed to 252 participants (81 Americans, 89 Chinese, 82 Russians). Three focus group interviews were subsequently conducted in order to obtain a greater understanding of participants' experience and perspectives. Results: The average satisfaction score was 3.09, with Americans and Russians showing significantly higher scores than Chinese. Overall, participants reported higher satisfaction in 'Facility', 'Quality of care' and 'Nursing services' as opposed to 'Information/education'. 'Care with cultural respect' as well as communication related services. Data from the focus group interviews were categorized into 12 sub-categories, 7 categories and 2 themes. The two themes were common experience and contrasting experience. Common experience included 4 categories, 'Quality of care', 'Hospital facility and health care system', 'Language barrier' and 'Information and education'. Contrasting experience included 3 categories, 'Medical cost', 'Health care personnel' and 'Accessibility'. Conclusion: Results of this study provide basic knowledge on foreign residents' satisfaction and experience with Korean health care services. Further research is needed with foreigners from different cultural backgrounds. Administrative and educational efforts are required to improve communication skills and cultural competency.

Purpose: This study was performed to explore levels of stroke knowledge and identify subgroups with lower levels of stroke knowledge among adults in Korea. Methods: A cross-sectional survey was used and data were collected in 2012. A national sample of 990 Koreans aged 20 to 74 years participated in this study. Knowledge of risk factors, warning signs, and first action for stroke were surveyed using face-to-face interviews. Descriptive statistics and decision tree analysis were performed using SPSS WIN 20.0 and Answer Tree 3.1. Results: Mean score for stroke risk factor knowledge was 7.7 out of 10. The least recognized risk factor was diabetes and four subgroups with lower levels of knowledge were identified. Score for knowledge of stroke warning signs was 3.6 out of 6. The least recognized warning sign was sudden severe headache and six subgroups with lower levels of knowledge were identified. The first action for stroke was recognized by 65.7 percent of participants and four subgroups with lower levels of knowledge were identified. Conclusion: Multi-faceted education should be designed to improve stroke knowledge among Korean adults, particularly focusing on subgroups with lower levels of knowledge and less recognition of items in this study.

Purpose: The purpose of the study was to identify degrees of pain, menopause symptoms, and quality of life, and to identify factors influencing quality of life of patients with breast cancer who were on hormone therapy. Methods: A cross-sectional survey design was utilized. Data were collected using questionnaires from 110 patients with breast cancer who had been on hormone therapy for 3 months or more and were being treated at a university hospital in Seoul. Data were analyzed using ${\chi}^2$-test, t-test, ANOVA, Pearson correlation coefficient and multiple linear regression. Results: Mean age of the participants was 53.56 (SD=6.67) and 54 (51.4%) had stage 0 or I at the time of diagnosis. Most of the participants reported having pain and menopause symptoms (88.2% and 95.5% respectively). The mean score for quality of life was $87.84{\pm}21.17$. Pain, menopause symptoms and quality of life had strong correlations with each other (p<.005). Quality of life was explained by menopause symptoms (${\beta}$= -.71), economic status (${\beta}$=.20) and occupation (${\beta}$=.16). Conclusion: The results of the study suggest that menopause symptoms should be incorporated into oncologic nursing care to improve quality of life of patients with breast cancer on hormone therapy.