Purpose: The purpose of this study was to evaluate the methodological quality of nursing studies using structural equation modeling in Korea. Methods: Databases of KISS, DBPIA, and National Assembly Library up to March 2014 were searched using the MeSH terms 'nursing', 'structure', 'model'. A total of 152 studies were screened. After removal of duplicates and non-relevant titles, 61 papers were read in full. Results: Of the sixty-one articles retrieved, 14 studies were published between 1992 and 2000, 27, between 2001 and 2010, and 20, between 2011 and March 2014. The methodological quality of the review examined varied considerably. Conclusion: The findings of this study suggest that more rigorous research is necessary to address theoretical identification, two indicator rule, distribution of sample, treatment of missing values, mediator effect, discriminant validity, convergent validity, post hoc model modification, equivalent models issues, and alternative models issues should be undergone. Further research with robust consistent methodological study designs from model identification to model respecification is needed to improve the validity of the research.

Purpose: This study was a meta-analysis designed to identify effects of Cognitive Behavioral Therapy (CBT) interventions in alleviating main symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among school-aged children in Korea. Methods: Examination of several databases including Research Information Sharing Service, Korean Studies Information Service System, Data Base Periodical Information Academic and hand-searched article references, resulted in identification of 1,298 studies done between 2000 and 2013 of which 21 met the inclusion criteria. Comprehensive Meta-Analysis version 2.0 was used to analyze effect sizes, explore possible causes of heterogeneity, and check publication bias with a funnel plot and its trim-and-fill analysis. Results: Overall effect size of CBT intervention was large (g=1.08) along with each outcome of self-control (g=1.26), lack of attention (g=1.02), social skills (g=0.92), and hyperactivity (g=0.92). For heterogeneity, moderator analysis was performed, but no significant differences were found between the RCT (Randomized Controlled Trials) group and the NRCT (Non RCT) group. Also, meta-regression was performed using sample size, number of sessions, and length of session as predictors, but no statistically significant moderators were found. Finally, a funnel plot along with trim-and-fill analysis was produced to check for publication bias, but no significant bias was detected. Conclusion: Based on these findings, there is clear evidence that CBT intervention has significant positive effects on the main symptoms of school-aged children suffering ADHD. Further research is needed to target diverse age groups with ADHD along with more RCT studies to improve the effectiveness of the CBT intervention.

Purpose: For the current article an examination was done as to whether engaging in sexual intercourse before or during adolescence has a negative impact on the suicidal behaviors of suicide ideation, suicide attempt, and suicide lethality and whether the impact varies according to the context of sexual intercourse and/or gender. Methods: Adolescents who experienced casual sex and romantic sex were compared to adolescents who retained their virginity. Data was from samples drawn from the three waves (2010~2012) of the Korea Youth Risk Behavior Web-Based Survey. Logistic models were used to adjust for a wide array of confounding variables. Results: Any type of sexual intercourse increases risk of all suicidal behaviors. Sexual intercourse in a romantic relationship exhibits enhanced risk of suicidal behaviors compared to casual sex. Adjusting for experience of sexual violence, however, decreases risk of romantic sex substantially, turning some estimates statistically insignificant. In addition, risks for suicide lethality are greater for girls than boys. Conclusion: Romantic sex put adolescents at higher risk for suicidal behaviors than casual sex owing to prevalent sexual violence in the relationships. Girls suffer more substantively adverse outcomes than boys. These results suggest that adolescents will benefit from comprehensive education on sexuality and sexual behaviors regarding how to form and maintain a romantic relationship that is characterized by personal integrity and mutual respect. It is also important to help victims of sexual violence recover from traumatic events by providing emotional support and effective counseling.

Purpose: The purpose of this study was to develop a multi-disciplinary self-management intervention based on empowerment theory and to evaluate the effectiveness of the intervention for older adults with chronic illness. Methods: A randomized controlled trial design was used with 43 Korean older adults with chronic illness (Experimental group=22, Control group=21). The intervention consisted of two phases: (1) 8-week multi-disciplinary, team guided, group-based health education, exercise session, and individual empowerment counseling, (2) 16-week self-help group activities including weekly exercise and group discussion to maintain acquired self-management skills and problem-solving skills. Baseline, 8-week, and 24-week assessments measured health empowerment, exercise self-efficacy, physical activity, and physical function. Results: Health empowerment, physical activity, and physical function in the experimental group increased significantly compared to the control group over time. Exercise self-efficacy significantly increased in experimental group over time but there was no significant difference between the two groups. Conclusion: The self-management program based on empowerment theory improved health empowerment, physical activity, and physical function in older adults. The study finding suggests that a health empowerment strategy may be an effective approach for older adults with multiple chronic illnesses in terms of achieving a sense of control over their chronic illness and actively engaging self-management.

Purpose: The purpose of this study was to describe depression, caregiving burden and the correlation of the two variables in the families of patients with amyotrophic lateral sclerosis (ALS) and to clarify factors predicting caregiving burden. Methods: A descriptive and cross-sectional study was conducted with 139 family members who provided care to patients with ALS. The characteristics of patients and families, Korean-Beck Depression Inventory (K-BDI), Korean version of Zarit Burden Interview (K-ZBI) and Korean-Amyotrophic Lateral Sclerosis Functional Rating Scale - Revised (K-ALSFRS-R) were used as study measures. Results: The mean score for K-BDI was 19.39 out of 63 suggesting sub-clinical depression and 38.2% of the family members exhibited depression. The mean score for K-ZBI was 66.03 out of 88. The predictors for K-ZBI were K-BDI, age of family member, length of time spent per day in caring, relationship to patient and K-ALSFRS-R. Conclusion: The results of this study suggest that levels of depression and caregiving burden are high among family members caring for patients with ALS. As depression is associated with caregiving burden, screening and emotional supports should be provided to reduce the burden of care for these family. Support programs to alleviate the care burden are also needed, considering family demographics, time per day in caring giving and K-ALSFRS-R.

Purpose: This study was done to develop a prediction model for postpartum depression by verifying the mediation effect of antepartum depression. A hypothesized model was developed based on literature reviews and predictors of postpartum depression by Beck. Methods: Data were collected from 186 pregnant women who had a gestation period of more than 32 weeks and were patients at a maternity hospital, two obstetrics and gynecology specialized hospitals, or the outpatient clinic of K medical center. Data were analysed with descriptive statistics, correlation and exploratory factor analysis using the SPSS/WIN 18.0 and AMOS 18.0 programs. Results: The final modified model had good fit indices. Parenting stress, antepartum depression and postpartum family support had statistically significant effects on postpartum depression, and defined 74.7% of total explained variance of postpartum depression. Antepartum depression had significant mediation effects on postpartum depression from stress in pregnancy and self-esteem. Conclusion: The results of this study suggest that it is important to develop nursing interventions including strategies to reduce parenting stress and improve postpartum family support in order to prevent postpartum depression. Especially, it is necessary to detect and treat antepartum depression early to prevent postpartum depression as antepartum depression can affect postpartum depression by mediating antepartum factors.

Purpose: This study was done to examine how laughter therapy impacts serotonin levels, QOL and depression in middle-aged women and to perform a path analysis for verification of the effects. Methods: A quasi-experimental study employing a nonequivalent control group and pre-post design was conducted. Participants were 64 middle-aged women (control=14 and experimental=50 in 3 groups according to level of depression). The intervention was conducted five times a week for a period of 2 weeks and the data analysis was conducted using repeated measures ANOVA, ANCOVA and LISREL. Results: Results showed that pre serotonin and QOL in women with severe depression were the lowest. Serotonin in the experimental groups increased after the 10th intervention (p=.006) and the rise was the highest in the group with severe depression (p=.001). Depression in all groups decreased after the 5th intervention (p=.022) and the biggest decline was observed in group with severe depression (p=.007). QOL of the moderate and severe groups increased after the 10th intervention (p=.049), and the increase rate was highest in group with severe depression (p<.006). Path analysis revealed that laughter therapy did not directly affect depression, but its effect was indirectly meditated through serotonin variation (p<.001). Conclusion: Results indicate that serotonin activation through laughter therapy can help middle-aged women by lessening depression and providing important grounds for depression control.

Purpose: This study was conducted to examine the prevalence of successful aging and factors influencing successful aging. Methods: This was a secondary analysis study. Data were analyzed from 10,462 elderly people who participated in the 2011 National Elderly Survey. According to the use of community senior facilities, participants were divided into 4 groups: those who used senior centers (group A, n=580), village senior clubs (group B, n=3,240), both of the 2 facilities (group C, n=339), and neither of the 2 facilities (group D, n=6,303). Cross-tabulation and logistic regression were performed. Results: The prevalence of successful aging was highest in group C (20.94%) and lowest in group D (10.41%). The physical & mental function and active engagement domains were highest in group C, while they were lowest in group D. The disease & risk factors domain were highest in group A, while lowest in group B. An educational level of middle-school or higher and income level in the third or higher quintile were significant factors for predicting successful aging in all groups. Conclusion: These results provide a basis for designing prevention and management programs as interventions to increase the prevalence of successful aging in Korean older adults.

Purpose: The purpose of this study was to validate the Korean version of the Ethical Leadership at Work questionnaire (K-ELW) that measures RNs' perceived ethical leadership of their nurse managers. Methods: The strong validation process suggested by Benson (1998), including translation and cultural adaptation stage, structural stage, and external stage, was used. Participants were 241 RNs who reported their perceived ethical leadership using both the pre-version of K-ELW and a previously known Ethical Leadership Scale, and interactional justice of their managers, as well as their own demographics, organizational commitment and organizational citizenship behavior. Data analyses included descriptive statistics, Pearson correlation coefficients, reliability coefficients, exploratory factor analysis, and confirmatory factor analysis. SPSS 19.0 and Amos 18.0 versions were used. Results: A modified K-ELW was developed from construct validity evidence and included 31 items in 7 domains: People orientation, task responsibility fairness, relationship fairness, power sharing, concern for sustainability, ethical guidance, and integrity. Convergent validity, discriminant validity, and concurrent validity were supported according to the correlation coefficients of the 7 domains with other measures. Conclusion: The results of this study provide preliminary evidence that the modified K-ELW can be adopted in Korean nursing organizations, and reliable and valid ethical leadership scores can be expected.

Purpose: The purpose of this study was to develop an integrated internet addiction prevention program and test its effects on the self-regulation and internet addiction of elementary students who are at risk for internet addiction. Methods: A quasi-experimental study with a non-equivalent control group pretest-posttest design was used. Participants were assigned to the experimental group (n=28) or control group (n=28). Contents of the program developed in this study included provision of information about internet addiction, interventions for empowerment and methods of behavioral modification. A pre-test and two post-tests were done to identify the effects of the program and their continuity. Effects were testified using Repeated measures ANOVA, simple effect analysis, and Time Contrast. Results: The self-regulation of the experimental group after the program was significantly higher than the control group. The score for internet addiction self-diagnosis and the internet use time in the experimental group were significantly lower than the control group. Conclusion: The effects of the integrated internet addiction prevention program for preventing internet addiction in elementary students at risk for internet addiction were validated.

Purpose: This study was conducted in order to examine the effects of death anxiety and meaning of life on somatization of grandparents raising grandchildren. Methods: A convenience sample of 92 elderly grandparents raising grandchildren was recruited. The study instrument for death anxiety was the 5-point 15 items scale designed by Templer and translated by Ko, Choi, & Lee and for meaning of life, the 7-point 10-items scale by Steger, Frazier, Oishi & Kaler and translated by Won, Kim & Kwon. For somatization, the 5-point 12 items scale designed by Derogatis and translated by Kim, Kim & Won was used. Collected data were analyzed with descriptive statistics, independent t-test, one-way ANOVA, Pearson Correlation and regression using the SPSS 21.0 program. Results: Average scores were 3.55 for death anxiety, 3.43 for meaning of life, and 2.74 for somatization. Death anxiety had the highest positive correlation with somatization. Meaning of life was negatively correlated with death anxiety and somatization. Death anxiety and health status were shown to influence somatization but meaning of life was not shown to influence somatization. Conclusion: The research results indicate that death anxiety and health status influence somatization in grandparents raising grandchildren. These results also provide basic information on the importance of nursing interventions in which the variables influencing somatization in grandparents raising grandchildren are considered.

Purpose: This study was done to examine the relation of uncertainty, uncertainty appraisal, and self-management in patients undergoing hemodialysis, and to identify factors influencing self-management. Methods: A convenience sample of 92 patients receiving hemodialysis was selected. Data were collected using a structured questionnaire and medical records. The collected data were analyzed using descriptive statistics, t-test, ANOVA, Pearson correlations and multiple regression analysis with the SPSS/WIN 20.0 program. Results: The participants showed a moderate level of uncertainty with the highest score being for ambiguity among the four uncertainty subdomains. Scores for uncertainty danger or opportunity appraisals were under the mid points. The participants were found to perform a high level of self-management such as diet control, management of arteriovenous fistula, exercise, medication, physical management, measurements of body weight and blood pressure, and social activity. The self-management of participants undergoing hemodialysis showed a significant relationship with uncertainty and uncertainty appraisal. The significant factors influencing self-management were uncertainty, uncertainty opportunity appraisal, hemodialysis duration, and having a spouse. These variables explained 32.8% of the variance in self-management. Conclusion: The results suggest that intervention programs to reduce the level of uncertainty and to increase the level of uncertainty opportunity appraisal among patients would improve the self-management of hemodialysis patients.

Purpose: In this study a system dynamics methodology was used to identify correlation and nonlinear feedback structure among factors affecting unplanned extubation (UE) of ICU patients and to construct and verify a simulation model. Methods: Factors affecting UE were identified through a theoretical background established by reviewing literature and preceding studies and referencing various statistical data. Related variables were decided through verification of content validity by an expert group. A causal loop diagram (CLD) was made based on the variables. Stock & Flow modeling using Vensim PLE Plus Version 6.0b was performed to establish a model for UE. Results: Based on the literature review and expert verification, 18 variables associated with UE were identified and CLD was prepared. From the prepared CLD, a model was developed by converting to the Stock & Flow Diagram. Results of the simulation showed that patient stress, patient in an agitated state, restraint application, patient movability, and individual intensive nursing were variables giving the greatest effect to UE probability. To verify agreement of the UE model with real situations, simulation with 5 cases was performed. Equation check and sensitivity analysis on TIME STEP were executed to validate model integrity. Conclusion: Results show that identification of a proper model enables prediction of UE probability. This prediction allows for adjustment of related factors, and provides basic data do develop nursing interventions to decrease UE.

Purpose: The aim of the study was to assess and identify gender differences in factors associated with prevalence, awareness, and treatment of osteoporosis. Methods: Data for 3,071 men and 3,635 women ($age{\qeq}50$) from the Korea National Health and Nutrition Examination Survey 2008~2011 were included. Osteoporosis was defined by World Health Organization T-score criteria. Impact factors and odds ratios were analysed by gender using multivariate logistic regression. Results: Osteoporosis prevalence rates were 7.0% in men and 40.1% in women. Osteopenia rates were 45.5% and 46.0% respectively. Among respondents with osteoporosis, 7.6% men and 37.8% women were aware of their diagnosis. Also 5.7% men with osteoporosis and 22.8% women were treated. Higher prevalence was found among respondents who were older, at lower socioeconomic levels, with lower body mass index and shorter height in both genders, and among women with fracture history, and non-hormonal replacement therapy. Awareness and treatment rates for the risk groups were similar compared to the low risk controls for both genders. Fracture history increased awareness and treatment rates independently for both genders. Women with perceived poor health status and health screening had increased awareness and treatment rates, but not men. Conclusion: Results indicate that postmenopausal women have a higher prevalence of osteoporosis than men and awareness and treatment rates were higher than for men. Despite gender difference in prevalence, osteoporosis was underdiagnosed and undertreated for both genders. Specialized public education and routine health screenings according to gender could be effective strategies to increase osteoporosis awareness and treatment.

Purpose: The objective of this study was to examine the factors associated with initiation and continuation of breastfeeding among Korean women in relation to their employment status. Methods: Data were collected using a web-based self-administered questionnaire from 1,031 Korean mothers living in Seoul with babies younger than 24 months. Demographic characteristics, education on breastfeeding, rooming in, breastfeeding during hospital stay, and breastfeeding knowledge were examined. Multivariate logistic regression analyses were performed to identify factors associated with initiation and continuation at 1, 6 and 12 months according to mothers' employment status. Results: Breastfeeding initiation rates were similar regardless of mothers' employment status. Continuation rates decreased for both groups of mothers, but were significantly lower among employed mothers at all duration points. Unemployed mothers who were able to keep their babies in the same room during the hospital stay were more likely to initiate breastfeeding. The factor that was consistently associated with breastfeeding continuation for all duration points among unemployed mothers was whether the mother breastfed during the hospital stay. Higher knowledge scores and having an infant with atopic dermatitis were also associated with breastfeeding continuation at 6 months and 12 months, respectively for unemployed mothers, and receiving education on breastfeeding was associated with 12-month continuation for employed mothers. Conclusion: These results emphasize the significant roles of hospitals for breastfeeding initiation and continuation, with rooming-in, initial breastfeeding practice and education during hospital stay as important practices. In addition, for working mothers to continue their breastfeeding, significant support from the workplace is crucial.