Purpose : The purpose of this study was to identify the factors influencing the general hospital nurses' confidence about the advance directives (ADs). Methods : This is a descriptive cross-sectional study. A total of 105 nurses were asked questions about characteristics, knowledge, attitude, learning needs, and confidence the about ADs, using structured questionnaires. Data were analyzed by descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and multiple regression. Results : The mean scores of knowledge were 7.26±1.47; attitude, 2.80±0.31; learning needs, 4.22±0.62; and confidence, 2.57±0.74. It was observed that knowledge had significant correlations with attitude (r=.43, p<.001), learning needs (r=.29, p=.003), and confidence (r=.40, p<.001), and attitude had significant correlations with learning needs (r=.31, p=.001) and confidence (r=.45, p<.001). Using multiple regression analysis, it was found that confidence was significantly influenced by knowledge (β=.27, p=.007), attitude (β=.21, p=.043), and experience of nursing or counseling a patient who wrote ADs (β=-.19, p=.046). The explanatory power of this model was 37.9% (F=5.16, p<.001, R²=.379). Conclusions : These findings suggest the need to develop a program to enhance nurses' knowledge, positive attitude, and experience of nursing or counseling a patient who wrote ADs.

Purpose : This study aimed to examine factors affecting radiation protective behaviors among emergency room nurses by assessing knowledge, attitude, and environment for radiation protection. Methods : The study employed a cross-sectional design. Subjects were a convenience sample of 129 nurses working in emergency rooms of three general hospitals. Data were collected using self-report questionnaires and analyzed using t-test, ANOVA, Pearson correlation coefficients, and multiple regression. Results : The more the nurses received radiation safety education (t=2.26, p=.026), used protective gear (t=4.40, p<.001), and took health screenings (t=2.65, p=.009), the higher their levels of radiation protection behavior. There were significant relations between radiation protective behaviors and attitude (r=.27, p=.002), and radiation protective behaviors and environment for radiation protection (r=.55, p<.001). The factors affecting radiation protective behaviors were protective environment (β=.53, p<.001), protective attitude (β=.32, p<.001), and the use of protective gear (β=.24, p=.002). Conclusions : The government, hospital administrators, and radiation protection-related organization should adopt the following measures to protect emergency room nurses from radiation: research and development of shield instrument, medical examination for emergency room nurses, protocol development of radiation protection behaviors, extension of education chances of radiation protection, and encouraging the use of protective equipment.

Purpose : This integrative review aimed to synthesize studies on intensive care unit (ICU) nurses' attitude, perceptions, and experiences toward end-of-life care decision-making. Methods : Using Whittermore and Knafl (2005)'s methods, we identified and synthesized research articles published in domestic journals between the years 2003 and 2019 and evaluated the quality of selected articles using the Mixed Methods Appraisal Tool. Results : In the 13 studies reviewed, 12 were published prior to enactment of the "The Act for Hospice and Palliative Care and Decision-Making about Life-Sustaining Treatment (2018)." All nine quantitative studies identified were based on cross-sectional descriptive survey. In four qualitative studies, content analysis (n=2) and phenomenology (n=2) were used. Overall, ICU nurses were well-aware of the necessity of communicating and limiting life-sustaining treatments. Many ICU nurses had positive attitude towards limiting life-sustaining treatments to promote patients' comfort and dignity. Although nurses were willing to take active roles, they also reported having experienced high stress in the process of decision-making and implementation. Conclusions : It is important to prepare ICU nurses with proper knowledge and attitude regarding the topic area. It is also equally important to develop systems to support nurses' emotional stress and moral distress during communication, decision-making, and implementation.

Purpose : The purpose of this study was to systematically review the measurement tools that are used to assess the pain of intensive care unit (ICU) patients. Method : In this systematic review, the studies published between 2009 and 2018 were selected based on the PRISMA flow chart. Data sources included MEDLINE, EMBASE, CINAHL, and Cochran. We assessed the quality of pain assessment tools reported in individual studies using Terwee et al.'s the Quality Criteria for Measurement Properties. Results : We reviewed 67 studies and 12 pain assessment tools that included two self-reported, seven observational, and three multifaced tools with observations and physiological indicators. The most frequently used tool was the Critical Care Pain Observation Tool. The Multidimensional Observational Pain Assessment Tool was rated the highest quality. Nine of the ten tools that included observations reported content validity, four reported construct validity and nine reported correlation coefficient. Conclusion : It was found that observational tools are appropriate for assessing pain in ICU patients with limited communication skills. To increase the validity and reliability of pain assessment in ICU patients, further research on the physiological indicators of pain is needed.

Purpose : The purpose of this study was to review mobile health (mHealth) interventions based on studies from online databases for community-dwelling patients with heart diseases. Methods : Six databases (RISS, KISS, PubMed, CINAHL, EMBASE, and SCOPUS) were searched to select studies conducted from January 1 to September 30, 2010. After this, quality appraisals were carried out using the Scottish Intercollegiate Guidelines Network checklist and a total of 11 studies were selected. Results : The selected 11 studies included 7 randomized controlled studies, 1 quasi-experimental study and 3 pilot studies. The main components of mHealth interventions included symptom monitoring at home, provisions for individualized messages for health management using text messaging, telephone or smart phone applications, and running websites for symptom monitoring or health education. Intervention periods varied from 6 weeks to 12 months. The findings of the studies suggested that the mHealth interventions were effective in improving self-management of heart diseases, quality of life, and decreasing symptoms. Conclusions : The results of the review suggested that mHealth interventions had positive effects on community-dwelling patients with heart diseases. More mHealth intervention studies need to be conducted in Korea to aid community-dwelling patients with heart diseases.

Purpose : The purpose of this study was to identify the extent to which nurses' death perceptions, death anxiety, and stress associated with terminal care affects their attitudes toward terminal care. Method : A total of 214 nurses were asked questions about characteristics, death perceptions, death anxiety, stress associated with end-of-life care, and terminal care attitudes, using structured questionnaires. The data were analyzed using descriptive analysis, t-test, ANOVA, Scheffé's test, Pearson's correlation coefficients, and stepwise multiple regression. Results : Factors influencing terminal care attitudes in participants were positive meaning associated with death, respect for life, final education, end-of-life nursing education experiences, stress associated with end-of-life care, death anxiety, and position. These factors explained 38.7% of variance in participants' terminal care attitudes (F=20.18, p<.001). Conclusion : In order for nurses to have a positive attitude toward terminal care, it is necessary to raise positive awareness about death and respect for life, and it is necessary to develop various educational programs and strengthen their capacity through continuous education.