Purpose: This study was conducted to develop an Empowerment Education Program (EEP) for kidney transplant patients and to test the program's effects on uncertainty, self-care ability, and compliance. Methods: The research was conducted using a nonequivalent control group with a pretest-posttest design. The participants were 53 outpatients (experimental group: 25, control group: 28) who were receiving hospital treatment after kidney transplants. After the pre-test, patients in the experimental group underwent a weekly EEP for six weeks. The post-test was conducted immediately after, and four weeks after the program's completion in the same manner as the pre-test. For the control group, we conducted a post-test six and ten weeks after the pre-test, without and program intervention. A repeated measure ANOVA was performed to compare the change scores on main outcomes. Results: Uncertainty was significantly lower in the experimental group than in the control group, both immediately after (t=-3.84, p=<.001) and 4 weeks after (t=-4.51 p=<.001) the program, whereas self-care ability (t=5.81, p=<.001), (t=5.84, p=<.001) and compliance (t=5.07, p=<.001), (t=5.45, p=<.001) were significantly higher. Conclusion: Kidney transplant patients who underwent an EEP showed a decrease in uncertainty and an improvement in self-care ability and compliance. Thus, our findings confirmed that an EEP can be an independent intervention method for improving and maintaining the health of kidney transplant patients.

Purpose: This study was designed to determine the effects of pre-warming on core body temperature (CBT) and hemodynamics from the induction of spinal anesthesia until 30 min postoperatively in surgical patients who undergo total hip replacement under spinal anesthesia. Our goal was to assess postoperative shivering and inflammatory response. Methods: Sixty-two surgical patients were recruited by informed notice. Data for this study were collected at a 1,300-bed university hospital in Incheon, South Korea from January 15 through November 15, 2013. Data on CBT, systemic blood pressure (SBP), and heart rate were measured from arrival in the pre-anesthesia room to 3 hours after the induction of spinal anesthesia. Shivering was measured for 30 minutes post-operatively. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were measured pre-operatively, and 1 and 2 days postoperatively. The 62 patients were randomly allocated to an experimental group (EG), which underwent pre-warming for 30 minutes, or a control group (CG), which did not undergo pre-warming. Results: Analysis of CBT from induction of spinal anesthesia to 3 hours after induction revealed significant interaction between group and time (F=3.85, p=.008). In addition, the incidence of shivering in the EG was lower than that in the CG ($x^2=6.15$, p=.013). However, analyses of SBP, heart rate, CRP, and ESR did not reveal significant interaction between time and group. Conclusion: Pre-warming for 30 minutes is effective in increasing CBT 2 and 3 hours after induction of spinal anesthesia. In addition, pre-warming is effective in decreasing post-operative shivering.

Purpose: This study aimed to identify the actor and partner effects of self-efficacy, marital adjustment, and social support on the health promoting behavior of Korean pregnant couples. Methods: Participants were 132 couples who met the eligibility criteria. Data were collected from June to November, 2016 at a community health center. The Actor-Partner Interdependence Model was used for analyzing the actor and partner effects of self-efficacy, marital adjustment, and social support on health promoting behavior. Results: The fitness indices for the model were GFI=0.90, NFI=0.92, CFI=0.91, TLI=0.90, and RMSEA=0.04, which satisfied the criteria. Self-efficacy had actor and partner effect on health promoting behavior of wives, but had only actor effect of on health promoting behavior of husbands. Marital adjustment showed actor and partner effect on the health promoting behavior of pregnant couples. Social support only had an actor effect on the health promoting behavior of wives. And, marital adjustment and social support had a mutual effect. Conclusion: This study indicates that the partner involvement is needed to develop health promotion programs for pregnant couples.

Purpose: This study aimed to examine the effects of cognitive behavior therapy for insomnia (CBT-I) based on the mobile social networking service (SNS) on dysfunctional beliefs and attitudes about sleep, sleep quality, daytime sleepiness, depression, and quality of life among rotatingshift nurses in a hospital in Korea. Methods: A nonequivalent control group pre-post test design was used. The participants included 55 nurses with rotating three-shift work (25 in the experimental group and 30 in the control group). For the experimental group, CBT-I using mobile SNS was provided once a week for 60 minutes over six weeks. Data were analyzed using descriptive statistics, $x^2-test$, independent samples t-test, and Mann-whitney U test with the SPSS 21.0 program. Results: In the homogeneity test of the general characteristics and study variables, there were no significant differences between the two groups. Nurses in the experimental group had significantly lower scores on dysfunctional beliefs and attitudes regarding sleep and sleepiness than nurses in the control group. Nurses in the experimental group had significantly higher scores on sleep quality and quality of life than nurses in the control group. Conclusion: These findings indicate that using the mobile SNS-based CBT-I is feasible and has significant and positive treatment-related effects on rotating-shift nurses' irrational thoughts and beliefs in association with sleep, sleep quality, daytime sleepiness, and quality of life. These contribute to expanding our knowledge of rotating-shift nurses' sleep issues and their preferences for intervention.

Purpose: The focus of the study was on the selection-optimization-compensation (SOC) strategy to predict successful aging mediated by dyspnea symptoms in older adults with chronic obstructive pulmonary disease. The model was constructed based on the hypotheses that coping strategy and social support of the elders predict successful aging through the SOC strategies. Methods: Participants were 218 outpatients with chronic obstructive pulmonary disease recruited for the study. Data collection was done from March 25 to September 11, 2015, and analyzed using SPSSWIN 22.0 and AMOS 21.0. Results: The hypothetical model appeared to be fit to the data. Seven of eight hypotheses selected for hypothetical model were statistically significant. The SOC strategy has only significant indirect effects through dyspnea symptoms on successful aging. Coping strategy, social support, SOC strategies and dyspnea symptoms explained 62% of variance in successful aging. Conclusion: The SOC strategies with social support and dyspnea symptoms significantly explained successful aging among patients with chronic obstructive pulmonary disease. Nursing strategies should be focused on social support and coping strategies to optimize SOC strategies so that older adults with chronic obstructive pulmonary disease are able to manage dyspnea symptoms and eventually achieve successful aging.

Purpose: This concept analysis was done to clarify 'uncertainty in epilepsy'. Methods: Walker and Avant's methodology guided the analysis. In addition, the concept was compared with uncertainty in other health problems. Results: 'Uncertainty in epilepsy' was defined as being in the condition as seen from the epilepsy experience where cues were difficult to understand because they changed, were in discord with past ones, or they had two or more contradictory values at the same time. Uncertainty in epilepsy is evolved from appraisal of the epilepsy experience. As a result, uncertainty leads epilepsy patients, their family or health care providers to impaired functioning and proactive/passive coping behavior. Conclusion: Epilepsy patients with uncertainty need to be supported by nursing strategies for proactive, rational coping behavior. This achievement has implications for interventions aimed at changing perception of epilepsy patients, their families or health care providers who must deal with uncertainty.

Purpose: The purpose of this study was to construct and test a structural equation model for Diabetes self-management (DSM) behavior and Quality of life (QoL) in older adults with diabetes who use Citizen Health Promotion Centers. The theory used this study was a combination of the Information-Motivation-Behavioral Model (IMB) and Self-Determination Theory (SDT) to reflect autonomous characteristics of participants. Methods: Data were collected from April 20 to August 31, 2015 using a self-report questionnaire. The sample was 205 patients with type 2 Diabetes who regularly visited a Citizen Health Promotion Center. SPSS 22.0 and AMOS 22.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factor affecting the participants' DSM behavior and QoL. Results: The supported hypotheses were as follows; 1) The variable that had a direct effect on QoL was health behavior adherence (${\gamma}=.55$, p=.007). 2) The variables that had a direct effect on DSM behavior were DSM information (${\gamma}=.15$, p=.023), DSM confidence (${\gamma}=.25$, p<.001), and autonomous motivation (${\gamma}=.13$, p=.048). 3) The variable that had a direct effect on DSM confidence was autonomy support (${\gamma}=.33$, p<.001). Conclusion: The major findings of this study are that supporting patient's autonomous motivation is an influential predictor for adherence to DSM behavior, and integrative intervention strategies which include knowledge, experience and psychosocial support are essential for older adults with diabetes to continue DSM behavior and improve QoL.

Purpose: This study was undertaken to develop and test a mastery learning program of nursing skills for undergraduate nursing students. Methods: In this methodological study, first, the preliminary draft of a mastery learning program to provide training for nursing skills was developed based on Bloom's framework for mastery learning. Second, to test the developed program, a single-blinded, nonequivalent control group nonsynchronized study was conducted on 50 senior nursing students in a University selected by convenient sampling. Thirteen students were assigned to a control group; 13, 12, and 13 of them were assigned to intravenous therapy, transfusion, and patient transfer groups, respectively. The achievement levels and performance scores of the selected nursing skills were measured before and after the completion of the program in all the groups. Lastly, the final program was confirmed based on the results of the program testing. Results: Intravenous therapy, transfusion, and patient transfer were selected as essential nursing skills for the program based on the priorities rated by clinical instructors and staff nurses. The achievement levels of selected nursing skills were determined by Angoff scores. After participating in the program, the proportion of passers and performance scores of the nursing skills in the experimental groups were significantly higher than those in the control group. The final program was confirmed which included a diagnostic test, enrichment activities for the passers and three repetitions of corrective activities and formative assessments for non-passers. Conclusion: The results suggest that a mastery learning program for undergraduate students can lead to better improvement and performance of essential nursing skills.

Purpose: The aim of this study was to identify the effect of Dongchimi juice containing kimchi Lactobacillus as an oral hygiene agent and to compare it with that of chlorhexidine solution (0.12% dilution). Methods: This study employed a pretest-posttest experimental design in which a single group of patients was exposed to two different treatments over a period of time. The study included 32 patients hospitalized at a longterm care hospital in Korea. Data were collected between August 12, 2016 and September 28, 2016. The patients first used chlorhexidine solution as an oral care agent for 1 week. After an interval of 2 weeks, they used Dongchimi juice for 1 week. Each agent was applied 2 times a day depending on the protocol. The oral status of the patients was measured using Beck's Oral Exam Guide (OEG) scores. The number of pathogens in the oral cavity was counted by culture, and the patients' subjective satisfaction score for each oral agent was measured using a visual analogue scale. T-test and Mann-Whitney test were performed to identify significant differences between Dongchimi juice and chlorhexidine solution by using PASW Statistics for Windows, Version 18.0 (SPSS Inc., Chicago, IL, USA). Results: The OEG score was not statistically different with the use of chlorhexidine solution and Dongchimi juice. However, decreasing number of pathogens and the subjective satisfaction score were higher with Dongchimi juice than with the chlorhexidine solution. Conclusion: These findings support the use of Dongchimi juice containing kimchi Lactobacillus as an oral hygiene agent for Korean patients.

Purpose: This study aimed to present and test a structural model for describing and predicting the factors affecting subjective career satisfaction of nurses experiencing rotation and to develop human resources management strategies for promoting their career satisfaction related to rotation. Methods: In this cross-sectional study, we recruited 233 nurses by convenience sampling who had over 1 year of career experience and who had experienced rotation at least once at G university hospital. Data were collected from August to September in 2016 using self-reported questionnaires. The exogenous variables consisted of rotation perception and rotation stress. Endogenous variables consisted of career growth opportunity, work engagement, and subjective career satisfaction. A hypothetical model was tested by asymptotically distribution-free estimates, and model goodness of fit was examined using absolute fit, incremental fit measures. Results: The final model was approved and had suitable fit. We found that subjective career satisfaction was directly affected by rotation stress (${\beta}=.20$, p=.019) and work engagement (${\beta}=.58$, p<.001), indirectly affected by rotation perception (${\beta}=.43$, p<.001) through career growth opportunity and work engagement. However, there was no total effect of rotation stress on subjective career satisfaction (${\beta}=-.09$, p=.270). Career growth opportunity directly and indirectly affected subjective career satisfaction (${\beta}=.29$, p<.001; ${\beta}=.28$, p<.001). These variables accounted for 65% of subjective career satisfaction. Conclusion: The results of this study suggest that it is necessary to establish systematic and planned criteria for rotation so that nurses can grow and develop through sustained work and become satisfied with their career.

Purpose: This study attempts to explore the subjective experience of frailty among elderly individuals in Korea. Methods: From June to August in 2014, 11 elderly persons who had experienced frailty in a community were interviewed. For data analysis, the method suggested by Colaizzi was applied as a phenomenological method. Results: According to the analysis, the study participants' frailty process was structured in seven categories: (a) 'natural phenomenon with ageing,' (b) 'life force comes to an end,' (c) 'the light in my heart turns off,' (d) 'unavoidable situation,' (e) 'continuous and connected vicious cycle,' (f) 'the limit of recovery energy already passes,' and (g) 'life is supported by someone's help.' Conclusion: The frailty experience in the participants is a natural process of aging, which cause vicious cycle acting with each other among physical, psychological, and social health. It is said that the cycle of frailty was started from weight loss and insufficient sleep, and boostered by pain. The participants from repetition of the vicious cycle become exhausted and pass the threshold of their recovery energy at some points. If they meet with sudden accidents such as falling, traffic accident and so on, they become to live a dependent life supported by someone's help in a moment. To prevent frailty and worsening conditions in Korean elderly individuals, it is recommended to provide a interventional programs using this study's results.