Purpose: This study was to identify behaviors preventing the recurrence of breast cancer and the level of quality of life. Methods: This descriptive study was conducted using a structured questionnaire from November 1, 2006 to December 25, 2006. One hundred and twenty two women breast cancer survivors were recruited by convenience sampling. Results: The most frequent behavior for preventing recurrence of the breast cancer was dietary treatment (90.9%) and exercise (86.8%) was the second behavior. In addition, most of them perceived these behaviors as 'very effective' (82.8%). The degree of the quality of life of a breast cancer survivor was 5.34 point indicating a 'medium level'. Conclusion: Breast cancer survivors pursued various behaviors for preventing recurrence of breast cancer. Therefore, the nursing interventions should be focused on a systematic educational approach considering healthy behaviors to prevent breast cancer recurrence for breast cancer survivors.

Purpose: The purpose of this study was to understand the level of functional health literacy and its influence on perceived health status in Korean older adults. Methods: A cross-sectional survey was conducted in Daegu, Kyungpook and Susan province. A total of 103 older adults aged 65 yr or older were interviewed in person between July 1 to August 30, 2007. Results: A high proportion of older adults were unable to read and understand written basic medical instructions. Only 40-50% were able to comprehend directions for taking medication four times a day or on an empty stomach. Only 11-38% were able to understand information regarding treatment procedure, informed consent, or educational material for elderly fall prevention. Individuals who were older, single, and had less education and income were more likely to have lower functional health literacy. After adjusting for sociodemographic variables, individuals with lower health literacy had poorly perceived health status. Conclusion: Many Korean older adults have a very low level of fuctional literacy. Low health literacy was independently associated with poorly perceived health status.

Purpose: Meta-analysis of this study was to analyze the character of adolescent smoking cessation programs, to calculate the effect size according to variables and to compare the weighted mean effect sizes on adolescent smoking cessation programs in Korea. Methods: Twenty two studies for meta-analysis were selected from dissertations, theses, articles and research papers that had been published from 1995 to 2003. The selected studies had a randomized or nonequivalent control group in a pretest-post test design and had reported statistical value to calculate the effect size. Results: The mean number of sessions was 6.5. The education time per each session varied from 40 to 150 min and the most applied theories were Bandura's social-cognitive theory and the cognitive-behavioral theory. Smoking-knowledge, smoking-attitudes and smoking-amount showed high effects on the first post test after mediating adolescent smoking cessation programs according to the criteria of Cohen. The effect size of urine-cotinine found no homogeneity on the first post test, but it was significantly effective on the second post test. Conclusion: Adolescent smoking cessation programs analyzed in this study were relatively effective in smoking abstinence.

Purpose: This study was conducted to develop and to determine the effects of an integrated symptom management program for prevention of recurrent cardiac events after percutaneous coronary intervention. Methods: Subjects consisted of 58 CAD patients (experimental group: 30, control group: 28). The experimental group participated in an integrated symptom management program for 6 months which was composed of tailored education, stress management, exercise, diet, deep breathing, music therapy, periodical telephone monitoring and a daily log. The control group received the usual care. Results: The experimental group significantly decreased symptom experiences and the level of LDL compared to the control group. The experimental group significantly increased self care activity and quality of life compared to the control group. Although no significant difference was found in cardiac recurrence, the experimental group had fewer recurrences. Conclusion: These results suggest that an integrated symptom management program for prevention of recurrent cardiac events after percutaneous coronary intervention can improve symptom aggravation, recurrent rate, self care activity and quality of life. Nursing interventions are needed to maintain and further enhance the quality of life of these patients and the interventions should be implemented in the overall transition period.

Purpose: The purpose of this study was to identify the relationship among self-efficacy, depression, life satisfaction and death attitude of college students. Methods: The subjects consisted of 232 college students. Data were collected by self-reported questionnaires, which were constructed to include self-efficacy, depression, satisfaction with life, and death attitude. Data were analyzed by the SPSS/PC WIN. 12.0 program. Results: Death attitude and life satisfaction of college students were significantly different according to frequency of death ideation. Death attitude for college students correlated with self-efficacy, depression, and life satisfaction. The most significant predictor of death attitude for college students was life satisfaction. Conclusion: The above findings indicate that death attitude for college students is influenced by self-efficacy, depression, and life satisfaction. These findings suggest that a death education program to improve life satisfaction and to give a positive attitude toward death is needed for college students.

Purpose: The purpose of this study was to measure the level of stress and symptoms of stress (SOS) in soldiers and to investigate the factors that have effects on the symptoms of stress. Methods: Data was collected from soldiers of two military units located in north Kyounggi-Do from August 2 to 9, 2006 by using the survey instruments. Results: This research found that the average values on the level of stress and symptoms of stress were about $2.53{\pm}0.60$ (range 1.00-4.35) and $0.95{\pm}0.55$ (range 0.04-2.83), respectively. The things which affected symptoms of stress, according to this study, were the external factors in the military (${\beta}=.28$, p<.001), role and relation factors (${\beta}=.21$, p<.001), work factors (${\beta}=.15$, p=.01) and passive coping styles (${\beta}=.19$, p<.001). These variables explained 28% (F=36.68, p<.001) of the variance of the total symptoms of stress. Conclusion: This study suggests that soldiers need to under go stress management.

Purpose: This study was designed to search for nursing intervention strategies centering around the meaning structure of the nurse's turnover experience by applying phenomenological methods. Methods: The participants were 6 nurses in small and medium sized hospitals who had experienced at least 1 turnover. Data were collected used MP3 records. The data analysis was done by Giorgi (1985) method. Results: The results were divided into the following categories: 1) Careless decision: wrong decisions, imprudent desire, insufficient patience, unclear future, 2) Inappropriate working environment: irregular working hours, high workload, poor working environment, insufficient understanding of related divisions, lack of opinion collection, low salary, 3) Interpersonal relations problems: discord with colleagues, difficulty in relationships with others, difficulty in daily lives, 4) Lack of specialization: feeling of inertia, lack of role identification, lack of self identification, 5) Inappropriate coping: regret with clinical challenges, difficulty with a new environment, repentance, expectation, relative humility, 6) New self-dignity: expectation, new challenge, relaxing lives, decisions based on future-oriented confidence. Conclusion: The finding of this study will offer profound information on the nurse's turnover experience and provide basic raw materials for improving the quality of nursing performance and contribute to the development of hospital organization.

Purpose: The purpose of this study was to understand and analyze the experience of restoration among Korean elders with suicide ideation. Methods: A phenomenological research method guided data collection and analysis. A total of five elders having had suicide ideation participated. Data were collected through individual in-depth interviews. All interviews were audio taped and transcribed verbatim. Coding was used to establish different concepts and categories. Results: As the results of analysis, the following three constituents have been found as a retrospective focus based on the primary suicide ideation: expanding their view and facing reality, reconstructing their view about life and death as well as self. Conclusion: The results of this study may contribute to health professionals working at various crisis settings to understand Korean elders with suicide ideation.

Purpose: This study was done to identify predictors of the fighting spirit or helplessness/hopelessness in the patients' mental adjustment to cancer. Cancer patients' characteristics like performance status, metastasis and duration of diagnosis with demographic factors, spiritual support and social support were used as predictors of a fighting spirit or helplessness/hopelessness. Methods: A total of 124 ambulatory cancer patients completed the Mental Adjustment to Cancer (MAC) scale and responded in a structured instrument about their characteristics, spiritual and social support. Results: The results of multiple regression analysis revealed that confidence in the supporter ($R^2=.114$, p=.000), duration of cancer diagnosis ($R^2=.041$, p=.000) and faith ($R^2=.030$, p=.000) were predictive of a fighting spirit ($R^2=.185$, p=.000); whereas, education ($R^2= .074$, p=.001), performance status ($R^2=.055$, p=.000), satisfaction with social support ($R^2=.046$, p=.000), and metastasis ($R^2=.037$, p=.000) were predictive of helplessness/hopelessness ($R^2=.202$, p=.000). Conclusion: Social support, spiritual support and disease related factors like metastasis, performance status, and duration of cancer diagnosis need to be considered in a psychosocial nursing intervention for a fighting spirit or helplessness/hopelessness.

Purpose: This study was done to compare edema and pain after completing a nurse's daily shift and to examine the effects of self leg massage which was usually used for reducing nurses' lower extremity edema and pain after their shift. Methods: The research design was a nonequivalent control group pretest-posttest design. Study subjects were 81 nurses who took a self leg massage program created by the researcher. Self leg massage was done 15 times during 3 weeks. Data were collected from September 21 to October 31, 2007. The level of lower extremity edema was measured by ankle and calf circumference by a tapeline in cm and the pain score was measured by using a subjective numbering rating scale. Data were analyzed with the SPSS 12.0 program using statistics of repeated measures ANOVA. Results: There was a statistically significant difference in pain according to the department. There was a statistically significant difference in lower extremity edema and pain in nurses after their shift and self leg massage. Conclusion: Self leg massage was effective for relieving nurses' lower extremity edema and pain. Therefore, it is proposed that standardized self leg massage should be applied as a method for nurses' lower extremity edema and pain.

Purpose: The purpose of this study was to identify factors related to nurses' organizational citizenship behavior using multilevel analysis which included both nurse characteristics at individual levels and nursing unit characteristics at group levels. Methods: The sample was composed of 1,996 nurses who were selected from 182 nursing units in 28 hospitals in six metropolitan cities and seven provinces using cluster sampling. Data were collected using self-reported questionnaires from February to March 2006. Results: The results of the study indicated that individual level variables related to organizational citizenship behavior were religion, job position, clinical career, self efficacy, positive affectivity, and supervisor support. The group level variables related to organizational citizenship behavior were collective efficacy, number of nurses in a nursing unit, and the average salary level of a nursing unit. 30.9% of individual level variances of organizational citizenship behavior were explained by the nurses' individual level variables. The explanatory power of group level variables, which is related to group level variances of organizational citizenship behavior, was 75.5%. Conclusion: This research showed that it was necessary to develop appropriate strategies related to not only individual factors, but also higher-level organizational factors such as collective efficacy, to improve individual performances in the hospital.

Purpose: The purpose of the study was to describe the experiences of do-not-resuscitate (DNR) among nurses. Methods: Data were collected by in-depth interviews with 8 nurses in 8 different hospitals. Conventional qualitative content analysis was used to analyze the data. Results: Eight major themes emerged from the analysis: DNR decision-making bypassing the patient, inefficiency in the decision-making process of DNR, negative connotation of DNR, predominance of verbal DNR over written DNR, doubts and confusion about DNR, least amount of intervention in the decision for DNR change of focus in the care of the patient after a DNR order, and care burden of patients with DNR. Decision-making of DNR occurred between physicians and family members, not the patients themselves. Often high medical expenses were involved in choosing DNR, thus if choosing DNR it was implied the family members and health professionals as well did not try their best to help the patient. Verbal DNR permission was more popular in clinical settings. Most nurses felt guilty and depressed about the dying/death of patients with DNR. Conclusion: Clearer guidelines on DNR, which reflect a family-oriented culture, need to be established to reduce confusion and to promote involvement in the decision-making process of DNR among nurses.

Purpose: The purpose of this study was to describe the essential structure of the postmortem- examination experiences of nurse career coroners (forensic investigators), to have a profound understanding of their experiences, and ultimately to lay the foundation for nurses' entry into the field of forensic nursing. Methods: The subjects in this study were six coroners. After an in-depth interview from January to June 2007, the collected data were analyzed by Colaizzi as qualitative research. Results: Four categories emerged from seven theme clusters. The four categories were: attracted by being dubbed a stabilized public official, a sense of achievement due to having clarified false death, self-confidence after distinguishing the victim and the wrongdoer, eternal developmental potential is seen. Conclusion: It is expected that this study will provide useful information for nurses who are interested in becoming coroners. It will be helpful for career nurses to extend their nursing science into emerging fields like coroners and select a follow-up career.

Purpose: To examine the relationship between body fat percentage (BFP) and N-K cell activity (NKCA) in Korean breast and rectal cancer patients just after diagnosis. Methods: With 35 subjects enrolled between November 2002 and May 2003, Bioelectrical Impedance Analysis was used to estimate BFP. FACS Analysis was used to measure N-K cell activity. The relationships between BFP and NKCA were identified by using curve estimation, simple regression, and multiple regression, Results: The mean BFPs of the subjects and all the sub-groups were higher than acceptable BFPs. Both the mean NKCAs of male and female subjects were lower than that of healthy women. NKCA was explained by BFP with a 14.9% variance in the total subjects (p<.05). There were significant negative relationships between BFP and NKCA after controlling age, type of cancer, and stage of cancer while no significant relationship was found after controlling for gender. The relationships between BFP and NKCA in the sub-groups of female, breast cancer, and stage I, and II were significant. The relationships between male, rectal cancer, and the stage III, and VI sub-groups were not identified, but they revealed a mild to moderate steep in curve estimation. Conclusion: Weight reduction could prevent the risk and advancement of breast and rectal cancer in Koreans.

Purpose: This study was done to investigate the practice level of 14 health behaviors between male (N=139) and female (N=175) elderly and to identify the barriers to each health behavior of elderly people in Korea. Methods: Data were collected from 314 elderly people (65yr and older) living in metropolitan, urban, and rural areas. Descriptive statistics, $x^2$-test and ordinal logistic regression were used in data analysis using the SPSS Win 15 version. Results: 1) The performances were different in some health behaviors between male and female elderly people. Male elderly showed better performances in balanced diet, regular exercise, and more than 30 min of exercise, while female elderly showed better performances in restriction of fat and cholesterol, restriction on alcohol, and smoking. There were no differences in stress management and health prevention behaviors between the two groups. 2) The common significant barriers in health behaviors of the elderly in Korea were the lack of habit and physical discomfort. However, the lack of perceived benefit was a significant barrier in male elderly. Lack of time and lack of family support were significant barriers in female elderly people in Korea. Conclusion: These results suggest that tailored strategies should be developed considering the gender difference to reduce the main barriers of each health behavior in order to improve the health status of elderly people.

Purpose: This study was to test the reliability and validity of a Drinking Refusal Self-Efficacy Questionnaire-Revised (DRSEQ-R) in Korean college students, Methods: The DRSEQ-R was designed to assess an individual's belief in their ability to refuse drinking alcohol by Oei et al. (2005) and consisted of three factors (social pressure, opportunity, and emotional relief). A methodological study design with an exploratory factor analysis for validity and correlation coefficients for reliability was used. DRSEQ-R was translated into Korean and a translation equivalency was obtained. DRSEQ-R was tested with a sample of 201 college students in Korea. The subjects consisted of 106 males and 95 females. Principal component factor analysis was used for construct validity and Cronbach's alpha was used to evaluate for internal consistency of the instrument. Results: The factor analysis showed three factors explaining 66.3% of total variance and the corresponding factors were emotional relief (48.01%), drinking contextual opportunity (11.18%), and social pressure (7.14%). The internal consistency was acceptable (Cronbach's alpha=.937). All three factors of DRSEQ-R negatively correlated with alcohol dependency and a heavy drinker showed a lower DRSEQ-R than a moderate drinker. Conclusion: Based on the findings, DRSEQ-R is a reliable and valid instrument to measure for drinking refusal self-efficacy in Korean college students.