Purpose: This study was a systematic review to evaluate the effects of aromatherapy on menopausal symptoms, perceived stress and depression in middle aged-women. Methods: Eight databases were searched from their inception September 8, 2015. Two reviewers independently performed the selection of the studies, data abstraction and validations. The risk of bias was assessed using Cochrane criteria. For analysis of the data, a meta-analysis of the studies was performed. Results: From the electronic databases, 73 articles were selected, and 19 removed due to duplication. After two reviewers read the abstracts of 54 studies, 34 studies were selected. Complete papers for 34 s were read and, 12 studies which met selection criteria were reviewed and the effects of aromatherapy on menopausal symptoms, stress and depression analyzed using meta-analysis with RevMan. In the 2 studies which included Randomized Controlled Trials testing of aromatherapy on menopausal symptoms and comparison of control and placebo groups were done. Aromatherapy massage was favorably effective in reducing the menopausal symptoms compared to the control group (n=118, MD=-6.33; 95% CI -11.51 to -1.15), and compared to the placebo group (n=117, MD=-4.14; 95% CI -7.63 to -0.64). Also aromatherapy was effective in reducing stress (n=72, SMD=-0.64; 95% CI -1.12 to -0.17) and depression (n=158, MD=-5.63; 95% CI -10.04 to -1.22). Conclusion: There is limited evidence suggesting that aromatherapy for middle-aged women may be effective in controlling menopausal symptoms, perceived stress and depression.

Purpose: This study was designed to construct a model which explains drug misuse behaviors in community-dwelling older adults. Methods: The design of this research is a cross-sectional study using structure equation modeling. The hypothetical model consisted of two types of variables: the exogenous variables of health status, cognitive ability, and negative emotion, and the endogenous variables of number of drugs, and drug misuse behaviors. The data collection was conducted from September 2 to September 21, 2013 through self-report questionnaires. Participants were 320 community-dwelling adults over the age of 65 living in J city. Data were analyzed with SPSS 21.0 program and Amos 18.0 program. Results: The results of the model fitness analysis were satisfied. The predictor variables for the hypothetical model explained 62.3% of variance regarding drug misuse behaviors. Drug misuse behaviors were directly affected by health status, cognitive ability, negative emotion and number of drugs and indirectly affected by health status, and negative emotion through number of drugs. Conclusion: These findings indicate factors that should be used in developing effective nursing interventions for safe and proper drug use and the prevention of drug misuse behaviors in community-dwelling older adults.

Purpose: In this single repeated measures study, an examination was done on the effects of dialysate flow rate on dialysis adequacy and fatigue in patients receiving hemodialysis. Methods: This study was a prospective single center study in which repeated measures analysis of variance were used to compare Kt/V urea (Kt/V) and urea reduction ratio (URR) as dialysis adequacy measures and level of fatigue at different dialysate flow rates: twice as fast as the participant's own blood flow, 500 mL/min, and 700 mL/min. Thirty-seven hemodialysis patients received all three dialysate flow rates using counterbalancing. Results: The Kt/V ($M{\pm}SD$) was $1.40{\pm}0.25$ at twice the blood flow rate, $1.41{\pm}0.23$ at 500 mL/min, and $1.46{\pm}0.24$ at 700 mL/min. The URR ($M{\pm}SD$) was $68.20{\pm}5.90$ at twice the blood flow rate, $68.67{\pm}5.22$ at 500 mL/min, and $70.11{\pm}5.13$ at 700 mL/min. When dialysate flow rate was increased from twice the blood flow rate to 700 mL/min and from 500 mL/min to 700 mL/ min, Kt/V and URR showed relative gains. There was no difference in fatigue according to dialysate flow rate. Conclusion: Increasing the dialy-sate flow rate to 700 mL/min is associated with a significant increase in dialysis adequacy. Hemodialysis with a dialysate flow rate of 700 mL/min should be considered in selected patients not achieving adequacy despite extended treatment times and optimized blood flow rate.

Purpose: The purpose of this study was to identify the influences of oral health behaviors, depression, and stress on periodontal disease in pregnant women. Methods: The participants in this study were 129 pregnant women. Data were collected using questionnaires which included individual characteristics, oral health care behaviors, the Center for Epidemiological Studies-Depression scale (CES-D), a global measure of perceived stress, and pregnancy stress. A dentist measured periodontal probing depth and classified stages of periodontal disease according to the Community Periodontal Index (CPI). Data were analyzed using descriptive statistics, Pearson correlation, and multiple regression. Results: Periodontal disease had significant correlations with oral health care behaviors (r=-.56, p <.001), perceived stress (r=.44 p <.001), pregnancy stress (r=.37 p <.001), diet (r=-.33, p <.001) and depression (r=.18 p =.046). Factors influencing periodontal disease for these pregnant women were being in the 2nd (${\beta}=.27$, p <.001) or 3rd trimester (${\beta}=.45$, p <.001), having a pregnancy induced disease (${\beta}=.20$, p =.002), performing higher oral health behaviors (${\beta}=-.30$, p <.001), and having higher perceived stress (${\beta}=.17$, p =.028). The explanation power of this regression model was 61.6% (F=15.52, p <.001). Conclusion: The findings of this study indicated that periodic assessment of periodontal disease is essential for pregnant women who are in 2nd or 3rd trimester and have pregnancy induced diseases. Enhancing oral health care behaviors and reducing perceived stress are indicated as effective strategies to reduce periodontal disease in pregnant women.

Purpose: The purposes of this study were to develop and test a prediction model for caregiving experiences including caregiving satisfaction and burden in dementia family caregivers. Methods: The stress process model and a two factor model were used as the conceptual frameworks. Secondary data analysis was done with 320 family caregivers who were selected from the Seoul Dementia Management Survey (2014) data set. In the hypothesis model, the exogenous variable was patient symptomatology which included cognitive impairment, behavioral problems, dependency in activity of daily living and in instrumental activity of daily living. Endogenous variables were caregiver's perception of dementia patient's unmet needs, caregiving satisfaction and caregiving burden. Data were analysed using SPSS/WINdows and AMOS program. Results: Caregiving burden was explained by patient symptomatology and caregiving satisfaction indicating significant direct effects and significant indirect effect from unmet needs. The proposed model explained 37.8% of the variance. Caregiving satisfaction was explained by patient symptomatology and unmet needs. Mediating effect of unmet needs was significant in the relationship between patient symptomatology and caregiving satisfaction. Conclusion: Results indicate that interventions focusing on relieving caregiving burden and enhancing caregiver satisfaction should be provided to caregivers with high levels of dementia patients' unmet needs and low level of caregiving satisfaction.

Purpose: The purpose of this study was to develop an Allergic Rhinitis-Specific Quality of Life (ARSQOL) scale and verify its validity and reliability. Methods: ARSQOL was developed in 5 steps. Items for the preliminary instrument of ARSQOL were developed through a literature review and deep interviews with allergic rhinitis patients. Face validity with Content Validity Index (CVI), construct validity using factor analysis, and known group comparison, criterion validity test using correlation between ARSQOL and total nasal symptoms score (TNSS) were conducted to evaluate the validity of ARSQOL. Cronbach's ${\alpha}$ was used to evaluate the reliability of ARSQOL. Results: CVI for the items in the final ARSQOL were. 92. Five factors including discomfort associated with nasal symptoms (4 items), physical function (7 items), mental function (5 items), sleep disorder and social function (4 items), and problems of daily life (6 items) were identified through factor analysis and these five factors explained 66.6% of the total variance. The correlation coefficient between TNSS and the total score of life quality was -.69. In the group comparison, the persistent allergic rhinitis group showed lower ARSQOL scores than the intermittent patient group, and moderate to the severe allergic rhinitis patient group presented poorer ARSQOL than the mild symptom patient group. The Cronbach's ${\alpha}$ reliability coefficient was .95. Conclusion: Results show that the ARSQOL has good reliability and validity and thus ARSQOL is a useful scale for clinical practices and research as a measure of quality of life in adults with allergicr hinitis.

Purpose: The purpose of this study was to define and clarify the concept of volition for health behavior. Methods: For this study the process of Walker & Avant's concept analysis was used. Seventeen studies from electronic data basses met criteria for selection. Results: Volition can be defined by the following attributes: 1) planning, 2) maintenance of self-efficacy, and 3) self regulation. The antecedents of volition consisted of: 1) risk awareness, 2) outcome expectation, 3) perceived self-efficacy, and 4) social support. The consequences occurring as a result of volition were: 1) prevention of disability and complications, 2) improvement of functional ability, and 3) enhencement of quailty of life. Conclusion: Definition and attributes of volition identified by this results can be applied to develop measurements and intervention programs for chronic patients health behavior.

Purpose: This study was conducted to develop and test a structural model of evidence-based practice (EBP) implementation among clinical nurses. The model was based on Melnyk and Fineout-Overholt's Advancing Research and Clinical Practice through Close Collaboration model and Rogers' Diffusion of Innovations theory. Methods: Participants were 410 nurses recruited from ten different tertiary hospitals in Korea. A structured self-report questionnaire was used to assess EBP knowledge/skills, EBP beliefs, EBP attitudes, organizational culture & readiness for EBP, dimensions of a learning organization and organizational innovativeness. Collected data were analyzed using SPSS/WINdows 20.0 and AMOS 20.0 program. Results: The modified research model provided a reasonable fit to the data. Clinical nurses' EBP knowledge/skills, EBP beliefs, and the organizational culture & readiness for EBP had statistically significant positive effects on the implementation of EBP. The impact of EBP attitudes was not significant. The dimensions of the learning organization and organizational innovativeness showed statistically significant negative effects on EBP implementation. These variables explained 32.8% of the variance of EBP implementation among clinical nurses. Conclusion: The findings suggest that not only individual nurses' knowledge/skills of and beliefs about EBP but organizational EBP culture should be strengthened to promote clinical nurses' EBP implementation.

Purpose: In this study an examination was done of the effect of self-efficacy promoting vestibular rehabilitation (S-VR) on dizziness, exercise self-efficacy, adherence to vestibular rehabilitation (VR), subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness in patients with vestibular hypofunction. Methods: This was a randomized controlled study. Data were collected 3 times at baseline, 4 and 8 weeks after beginning the intervention. Outcome measures were level of dizziness, exercise self-efficacy, and level of adherence to VR. Subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness were also obtained. Data were analyzed using Windows SPSS 21.0 program. Results: After 4 weeks of S-VR, there was no difference between the groups for dizziness, subjective and objective vestibular functions. However, exercise self-efficacy and adherence to VR were higher in the experimental group than in the control group. After 8 weeks of S-VR, dizziness (p =.018) exercise self-efficacy (p <.001), adherence to VR (p <.001), total-dizziness handicap inventory (DHI) (p =.012), vision analysis ratio (p =.046) in the experimental group differ significantly from that of the control group. The number of patients with recurring dizziness were higher in the control group than in the experimental group (p <.001). Conclusion: The results indicate that continuous 8 weeks of S-VR is effective in reducing dizziness, and improving exercise self-efficacy, subjective vestibular function and adherence to VR. Objective vestibular function and vestibular compensation were also improved in the experimental group at the end of 8 weeks of S-VR.

Purpose: This study was done to develop a Web-based preconception health promotion program to improve preconception health promotion awareness, perceived benefits, perceived self-efficacy and health behavior, and to reduce perceived barriers in couples about to be married. Methods: Participants were assigned to the experimental group (n=26 couples) or control group (n=25 couples). This program was comprised of a six hour Web-based lecture series which was given to the experimental group over a four week period. Results: Results for the two groups showed: 1) a significant difference in preconception health promotion awareness in men (self-perception: z=-3.62, p <.001 content: F=18.49, p <.001) and in women (self-perception: z=-2.89, p =.004 content F=36.93, p <.001), 2) a significant difference in perceived benefits in men (z=-3.09, p =.002), and in women (F=6.38, p =.004), 3) a significant difference in perceived barriers in men (F=3.64, p =.030), and in women (F=11.36, p <.001), 4) a significant difference in perceived self-efficacy in men (F=12.16, p <.001), but no significant difference in women (F=1.93, p =.166), 5) a significant difference in health promoting behavior in men (F=16.31, p <.001), and in women (F=10.99, p =.001). Conclusion: The results of this study show that the program is an effective nursing intervention in couples about to be married. Therefore, this program can be useful in encouraging health-promoting behavior for couples about to be married.

Purpose: The purpose of this study was to examine factors influencing new graduate nurse turnover. Methods: This study was carried out as a secondary analysis of data from the 2010 Graduates Occupational Mobility Survey (GOMS). A total of 323 nurses were selected for analysis concerning reasons for turnover. Data were analyzed using descriptive statistics and multilevel survival analysis. Results: About 24.5% of new nurses left their first job within 1 year of starting their jobs. Significant predictors of turnover among new nurse were job status, monthly income, job satisfaction, the number of hospitals in region, and the number of nurses per 100 beds. Conclusion: New graduate nurses are vulnerable to turnover. In order to achieve the best health of the nation, policy approaches and further studies regarding reducing new graduate nurse turnover are needed.

Purpose: This study was done to investigate factors influencing successful aging in middle-aged women. Methods: A convenience sample of 103 middle-aged women was selected from the community. Data were collected using a structured questionnaire and analyzed using descriptive statistics, two-sample t-test, one-way ANOVA, Kruskal Wallis test, Pearson correlations, Spearman correlations and multiple regression analysis with the SPSS/WIN 22.0 program. Results: Results of regression analysis showed that significant factors influencing successful aging were post-traumatic growth and social support. This regression model explained 48% of the variance in successful aging. Conclusion: Findings show that the concept 'post-traumatic growth' is an important factor influencing successful aging in middle-aged women. In addition, social support from friends/co-workers had greater influence on successful aging than social support from family. Thus, we need to consider the positive impact of post-traumatic growth and increase the chances of social participation in a successful aging program for middle-aged women.

Purpose: The aim of this study was to explore the lived experiences of women problem gamblers, focusing on the meaning of gambling to them, how and why these women continue to gamble or stop gambling, and their needs and concerns. In order to effectively help women problem gamblers, practical in-depth knowledge is necessary to develop intervention programs for prevention, treatment, and recovery among women problem gamblers. Methods: The hermeneutic phenomenology approach was used to guide in-depth interviews and team interpretation of data. Sixteen women gamblers who chose to live in the casino area were recruited through snowball sampling with help from a counseling center. Participants were individually interviewed from February to April 2013 and asked to tell their stories of gambling. Transcribed interviews provided data for interpretive analysis. Results: In the study analysis one constitutive pattern was identified: moving beyond addiction by recognizing the two faces of gambling in their life. Four related themes emerged in the analysis-gambling as alluring; gambling as 'ugly'; living in contradictions; and moving beyond. Conclusion: Loneliness and isolation play a critical role in gambling experiences of women gamblers in Korea. In other words, they are motivated to gamble in order to escape from loneliness, to stop gambling for fear of being lonely as they get older, and to stay in the casnio area so as not to be alone. The need for acceptance is one fo the important factors that should be considered in developing intervention program for women.