Purpose: This study was an experimental study to compare the inhalation effects of aroma essential oil on the quality of sleep (QOS) for shift nurses after working nights. Methods: The participants were 60 healthy adults who didn't have any disease. As an experimental treatment, the participants in the experimental group were asked to inhale essential oil for 3 minutes at a distance of approximately 10 cm from their nose and then they were asked to sleep with the aroma stone beside their head (within a 30 cm distance). QOS were measured four times on Pretest, Day 1, Day 2, and Day 3 after they slept. To measure QOS, Perceived QOS (Numeric Rating Scale), the Verran & Synder-Halpern (VSH) Sleep Scale were used, and number of awakenings (NoA) was measured by Actigraph. Results: There were no significant differences in the homogeneity tests for general characteristics and dependent variables prior to the experiments, except for VSH of subjective sleep quality. Also, there was no significant interaction between group and time. The VSH of the experimental group was higher than the control group (F=6.39, p=.002). The NoA between the experimental group and the control group was significantly different after experimental treatment 3rd day (F=13.35, p=.001). Conclusion: The findings show that the inhalation of aroma essential oil had effects to increase the quality of sleep. Therefore, the inhalation of aroma essential oil could be applied to general nursing interventions to improve the quality of sleep.

Purpose: This study was conducted to develop a customized birth control program and identify its effects on attitude, subjective norm, behavioral control, intention, and behavior of contraception among immigrant postpartum mothers. Methods: In this experimental study, Vietnamese, Filipino or Cambodian married immigrant postpartum mothers were recruited. They were assigned to the experiment group (n=21) or control group (n=21). The customized birth control program was provided to the experimental group for 4 weeks. Results: The experimental group showed a significant increase in the score of attitude, subjective norm, behavioral control, intention, and behavior of contraception. Conclusion: Findings in this study indicate that the customized postpartum birth control program, a systematic and integrative intervention program composed of customized health education, counseling and telephone monitoring, is able to provide effective planning for postpartum health promotion and birth control behavior practice in married immigrant women.

Purpose: Developmental care has been recognized as a very important component for the development and health promotion of preterm infants. However, research on how to assess developmental nursing competency has not been studied as expected. This study was done to develop and evaluate a new scale to measure nursing competency for developmental support of preterm infants. Methods: Concept analysis was done with using the Hybrid model of Schwartz-Barcott and Kim (2000), from which a preliminary new scale (30 items) was developed. To test the validity and reliability of the new scale being developed, data were collected from 122 NICU nurses at 4 hospitals in 3 cities in the Republic of Korea, from December, 2014 to March, 2015. Results: The final version of the Developmental Support Competency Scale for Nurses (DSCS-N) caring for premature infants was a 4-point Likert type scale, consisting of 19 items, and categorized as 6 factors, explaining 62.5% of the total variance. Each of the factors were named as follows; 'environmental support' (4 items), 'parental support' (3 items), 'interaction' (3 items), 'critical thinking' (3 items), 'professional development' (3 items), and 'partnership' (3 items). The Cronbach's ${\alpha}$ coefficient for the scale was .83 and the reliability of the subscales ranged from .60~.76. Conclusion: The psychometric evaluation of the new scale demonstrated an acceptable validity and reliability. Findings indicate that the DSCS-N can be used as the tool to test the effect of educational programs for nurses and contribute to advance developmental care for preterm infants.

Purpose: This research was done to identify the hospital arrival rate and factors related to prehospital delay in arriving at an emergency medical center within the golden time after symptom onset in patients with acute myocardial infarction (AMI). Methods: Data used in the research was from the National Emergency Department Information System of the National Emergency Medical Center which reported that in 2014, 9,611 patients went to emergency medical centers for acute myocardial infarction. Prehospital time is the time from onset to arrival at an emergency medical center and is analyzed by subdividing arrival and delay based on golden time of 2 hour. Results: After onset of acute myocardial infarction, arrival rate to emergency medical centers within the golden time was 44.0%(4,233), and factors related to prehospital delay were gender, age, region of residence, symptoms, path to hospital visit, and method of transportation. Conclusion: Results of this study show that in 2014 more than half of AMI patients arrive at emergency medical centers after the golden time for proper treatment of AMI. In order to reduce prehospital delay, new policy that reflects factors influencing prehospital delay should be developed. Especially, public campaigns and education to provide information on AMI initial symptoms and to enhance utilizing EMS to get to the emergency medical center directly should be implemented for patients and/or caregivers.

Purpose: This study was done to develop and validate a measure to evaluate the Korean version of psychological insulin resistance (K-PIR) in patients with diabetes in Korea. Methods: Items were initially generated from literature reviews and interviews with 19 patients with diabetes. The content validity of the items was evaluated by experts. Participants were 424 patients with diabetes recruited through convenience sampling. A cross-sectional survey was designed for item-analysis, exploratory factor analysis with principal axis factoring, and confirmatory factor analysis. Cronbach's alpha was calculated to measure the internal consistency. Results: For the 24 items of the Korean version of psychological insulin resistance, six items were eliminated because of low correlation with the other items. Exploratory factor analysis with 18-item showed that two factors (psycho-cognitive factor and supportive factor) explained 41.8% of the variance, and the factor structure of K-PIR model had a good fit. Internal consistency of K-PIR with 18 items revealed good reliability. Conclusion: The findings show that the K-PIR is reliable for measuring the psychological resistance to insulin therapy for Korean patients with diabetes. However, further study is needed to evaluate the validation because the proportion of variation of K-PIR was low in this study.

Purpose: The purpose of this study was to analyze the paths of influence that a hospital's ethical climate exerts on nurses' organizational commitment and organizational citizenship behavior, with supervisor trust as the mediating factor, and verify compatibility of the models in hospital nurses. Methods: The sample consisted of 374 nurses recruited from four hospitals in 3 cities in Korea. The measurements included the Ethical Climate Questionnaire, Supervisor Trust Questionnaire, Organizational Commitment Questionnaire and Organizational Citizenship Behavior Questionnaire. Ethical Climate Questionnaire consisted of 6 factors; benevolence, personal morality, company rules and procedures, laws and professional codes, self-interest and efficiency. Data were analysed using SPSS version 18.0 and AMOS version 18.0. Results: Supervisor trust was explained by benevolence and self-interest (29.8%). Organizational commitment was explained by benevolence, supervisor trust, personal morality, and rules and procedures (40.4%). Organizational citizenship behavior was explained by supervisor trust, laws and codes, and benevolence (21.8%). Conclusion: Findings indicate that managers need to develop a positive hospital ethical climate in order to improve nurses' trust in supervisors, organizational commitment and organizational citizenship behavior.

Purpose: The purpose of this study was to examine the association between utilization of home care services under the national long-term care insurance system and family caregiver distress. Methods: A secondary data analysis was conducted in this study using data collected in 2011 and 2012 from the Korean version of International Resident Assessment Instrument (interRAI) Home Care assessment system. The study sample included 228 clients receiving community based home care and their family caregivers in Korea. Descriptive statistics, $x^2$ test, t-test, and Heckman selection model analysis were conducted using SAS 9.3. Results: Presence of family caregiver distress was significantly associated with days of nurse visits (${\beta}$=-.89, p=<.001) and home helper visits (${\beta}$=-.53, p=.014). Level of caregiver distress was also significantly associated with days of nurse visits (${\beta}$=-.66, p=.028). Other factors which were significantly associated with caregiver distress were depression, cognitive function, inadequate pain control, social support for older adult, and caregiver relationship to the older adult. Conclusion: The results of this study show that visiting nurse service and appropriate support programs for Older Adults and family caregivers experiencing caregiver distress should be developed and provided to families based on the health care needs of older adults and their family caregivers for effective and sustainable home care.

Purpose: This study aimed to investigate factors affecting frailty by age groups among vulnerable elders in Korea. Methods: In this secondary analysis, data were collected from records for 22,868 elders registered in the Visiting Health Management program of Public Health Centers in 2012. Health behaviors, clinically diagnosed disease, frailty, depression and cognitive condition were assessed. Data were analyzed using stepwise regression to determine the associated factors of frailty by age group. Results: Alcohol consumption, physical activity, number of diseases, DM, CVA, arthritis, urinary incontinence, depression and cognitive condition were found to be factors significantly associated with frailty among the elders aged 65~74 (F=135.66, p <.001). Alcohol consumption, physical activity, CVA, arthritis, urinary incontinence, depression and cognitive condition were found to be factors associated with frailty in the elders aged 75~84 (F=245.40, p <.001). Physical activity, CVA, arthritis, depression and cognitive condition were factors associated with frailty in the elders over 85 years of age (F=96.48, p <.001). Conclusion: The findings show that frailty of elders and associated factors were different by age group, and common factors affecting frailty were physical activity, CVA, arthritis, depression and cognitive condition. Thus, these factors should be considered in the development of intervention program for care and prevention of frailty and program should be modified according to age group.

Purpose: The purpose of the study was to explore and describe the adaptation process of older people to group homes. Methods: Participants were twenty older adults aged 65 or older who were living in group homes. Data were collected from January to April, 2015. In-depth unstructured interviews were conducted with individual participants. Data were analyzed using Strauss and Corbin's grounded theory method. Results: From open coding, 100 concepts, 38 sub-categories, and 14 categories were identified. Analysis showed that the central phenomenon of the adaptation process of older people to group homes was 'gradually giving up'. Causal conditions were 'good-for-nothing body', contextual conditions were 'pushed', 'beleaguered'. Intervening conditions were 'reliable pillar: children', 'having affection (情) more than having it from family: facility workers', 'comfort - like feeling at home', 'relieved: system'. Action/interaction strategies were 'facing the unfamiliar reality', 'building relationships with other people', 'accepting reality'. Consequences were 'a good place, more than expected', 'hope for the remaining days', 'waiting for a peaceful death'. Conclusion: The results of this study provide an in-depth understanding of the experience of the adaptation process of older people to group homes. The findings from this study can be used as basic data to establish policies to increase the number of small scale facilities which can help older adults adapt easily to the facilities.

Purpose: The aim of this study was to examine the validity and reliability of the Korean Version of the Spiritual Care Competence Scale (K-SCCS). Methods: A cross-sectional study design was used. The K-SCCS consisted of 26 questions to measure spiritual care competence of nurses. Participants, 228 nurses who had more than 3 years'experience as a nurse, completed the survey. Confirmatory factor analysis was used to examine the construct validity and correlations of K-SCCS and spiritual well-being (SWB) were used to examine the criterion validity of K-SCCS. Cronbach's alpha was used to test internal consistency. Results: The construct and the criterion-related validity of K-SCCS were supported as measures of spiritual care competence. Cronbach's alpha was .95. Factor loadings of the 26 questions ranged from .60 to .96. Construct validity of K-SCCS was verified by confirmatory factor analysis (RMSEA=.08, CFI=.90, NFI=.85). Criterion validity compared to the SWB showed significant correlation (r=.44, p<.001). Conclusion: The findings suggest that K-SCCS serves as an appropriate measure of spiritual care competence with validity and reliability. However, further study is needed to retest the verification of the factor analysis related to factor 2 (professionalisation and improving the quality of spiritual care) and factor 3 (personal support and patient counseling). Therefore, we recommend using the total score without distinguishing subscales.

Purpose: The purpose of this study was to develop a heart health diary to promote self-care ability among patients with heart failure (HF), and to identify the diary's effect on self-care adherence, self-efficacy, and physical activity. Methods: A randomized control-group pretest-posttest design was adopted using block randomization. A calender-typed health diary was developed and it included a self-care checklist and education information on HF management. The experimental group were given guided counseling and education for 8 weeks and wrote a daily health diary during that period. Data were collected from the outpatient department of a tertiary medical center from February to April 2016. To verify the hypotheses, data for the experimental group (n=28) and control group (n=33) were analysed using the independent t-test with SPSS/WIN 21.0. Results: At the end of 8 weeks the experimental group had significantly higher scores for self-care adherence (t=-2.48, p =.016) and exercise related self-efficacy (t=-3.44, p =.001) compared to the control group. Conclusion: The findings show that the application of a patient-directed heart health diary is an effective nursing intervention for improving HF patients' self-care adherence and exercise self-efficacy. Strategies to promote dietary self-efficacy are necessary along with further studies including repeated research with an increasing intervention period. Healthcare providers need to encourage the utilization of a health diary for HF patients as a tool for evaluation and for implementation that leads to self-care.

Purpose: The purpose of this study was to explore decision making experiences of Korean women with breast cancer who underwent breast reconstruction with/after a mastectomy. Methods: Data were collected during 2015-2016 through individual in-depth interviews with 10 women who had both mastectomy and breast reconstruction, and analyzed using phenomenological method to identify essential themes on experiences of making a decision to have breast reconstruction. Results: Five theme clusters emerged. First, "expected loss of sexuality and discovery of autonomy" illustrates various aims of breast reconstruction. Second, "holding tight to the reputation of doctors amid uncertainty" specifies the importance of a trust relationship with their physician despite a lack of information. Third, "family members to step back in position" describes support or opposition from family members in the decision making process. Fourth, "bewilderment due to the paradox of appearance-oriented views" illustrates paradoxical environment, resulting in confusion and anger. Lastly, "decision to be made quickly with limited time to oneself" describes the crazy whirling process of decision making. Conclusion: Findings highlight aims, worries, barriers, and facilitators that women with breast cancer experience when making a decision about breast reconstruction. Deciding on breast reconstruction was not only a burden for women in a state of shock with a diagnosis of breast cancer, but also an opportunity to decide to integrate their body, femininity, and self which might be wounded from a mastectomy. These findings will help oncology professionals provide effective educational counselling before the operation to promote higher satisfaction after the operation.