• Journal of Korean Academy of Nursing
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• v.30 no.1
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• pp.122-136
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• 2000

Chronic illness requiring attention and management during a long period of time puts great burden onto patients, their family and society. For patients with chronic illnesses, providing social support is the most important, and the fundamental support comes from their spouses. Amount and quality of support from spouses seems to differentiated according to the sex of patients. Female patients tend to believe that their spouses are not very supportive. Therefore, the researchers assessed the burden of husbands of female arthritis patients to discover the factors that result in greater burden. Also, they developed a theoretical model of husbands′ care for their wives through a qualitative research into husbands′ experience. Method 1: The study material was 650 female arthritis patients registered in an arthritis clinic. The questionnaire about the disease experience of female arthritis patients and the burden of husbands were sent. Returned questionnaires numbered 210(32.3%) and 27 were excluded because of inadequate answers. The remaining 183 questionnaires were analyzed. The mean age of the patients was 51 years and the mean age of spouses was 55 years. The mean marital period was 28 years. The average duration since diagnosis was 9.1 years. Education level was varied from primary school to graduate school, and average income/month was 1,517,300 won. Method 2: Initial questionnaire studies on the burden of husbands were performed. Among 183 responding husbands, 23 consented to participate for a qualitative research. Data was obtained by direct and telephone interviews. The mean age of participants was 58 years, and the educational level and socioeconomic status also varied. Result: 1. Husbands′ burden: The average burden was 57.68 with a range of 6-96. 2. Burden and general characteristics: The husband′s burden correlated with the age of the patients, numbers in the family, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and the husband′s understanding of the level of severity. 3. Linear correlation analysis on burden: The husbands′ burden is explained in 22.5% by husband′s recognition of level of severity and husbands′ age. 4. There were four patterns of the burden on husbands: both objectve burden and subjective burden were high(pattern I), both of objectve burden and subjective burden were low(pattern II), objective burden was high but subjective burden was low(pattern III), objective burden was low but subjective burden was high(pattern IV). The pattern was correlated with the family income, educational level of the patients and their husbands, therapy methods, patient′s level of discomfort, patient′s disease severity, patient′s level of dependence and husband′s understanding of level of severity. 5. The core category of the caring experience of the husbands with arthritis patients was "companionship". The causal factor was the patients′ experience due to symptoms : physical disfigurement, pain, immobility, limitation of house chores, and limitation of social activities. Contextural factors are husbands′ identification of housework and husbands′ concern about the disease. The mediating factors are economic problems, fear of aging, feeling of limitation and family support. The strategy for interaction is mind control and how to solve emotional stress. The "companionship" resulted from caring activities, participation of household activities, helping patients′ to coping with emotional experience. 6. Companionship is established through the process of entering intervention, and caring state of mind. Entering intervention is the phase of participation of therapy and involvement of houseworks. The caring phase consists of decision on therapy, providing therapy, providing direct care, and taking over the household role of wife. Through caring phase, the changing phase set a stage in which husbands consolidate the relationship with their wives, and are reminded of the meaning of marriage. As a result, in changing phase, husbands′ companionship is enhanced. In conclusion, nursing care of chronic illnesses should include a family member especially the spouse. All information on disease shoud be provided to patients and whole family member. Strong support should also be provided to overcome difficulties in taking over role of other sex. Then the quality of life of patients and families will be much improved.

• Radiation Oncology Journal
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• v.7 no.1
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• pp.59-70
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• 1989

Cervix cancer is the most common female cancer in Korea. In spite of their relatively local invasive tendency, still $44\%$ of patient will develop recurrent cancer. This result suggests that more aggressive local treatment may increase the cure rate but increased complication risk also cannot be avoidable. Various institutions proposed different treatment regimen, but recommended dose were about 4500 cGy for whole pelvis and 8000 cGy at point A, even though they agreed that those doses may not be satisfactory for control of bulky disease. 96 cases of invasive cervical cancer, treated with postoperative or primary radiation therapy were analyzed to determine the complication rate and prognostic factor in our treatment regimen Which is $5500\~1000 CGy$ higher than Other institution. Mean follow up duration was 21 months. Symptomatic patients including mild but persistent abdominal discomfort was $46\%$, but only 1 patient $(1\%)$ had operative treatment because of incomplete obstruction of small bowel. Most symptoms appeared within 12 months and most common complaints were frequent bowel movement. Barium enema and sigmoidoscopy were performed for persistent symptomatic patients. Only one patient had abnormal finding in barium enema which showed inefficiency of this method for detecting bowel complication. Patient's age, total tumor dose, total TDF, rectal dose were not significant risk factors for complication, but boost dose, previous history of operation had some relationship with complication risk. Even though dose of point A and rectum is $500\~1,000cGy$ higher than other institution, such a low rate of severe complications may suggest that fear of complications should not be overestimated than cure rate and the possibility of more aggressive treatment for better local control should not be underestimated.

• Korean Journal of Adult Nursing
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• v.12 no.2
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• pp.184-195
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• 2000

It has been believed that cancer is an omnious factor threatening the future and life itself. Patients having the disease experience anxiety, fear, feeling of weakness, depression and feelings of uncertainty and hopelessness. Most cancer patients, however, have expectations of possible recovery and a better future, very different from the patients who feel hopeless. Therefore. hope allows people to respond effectively to the fatal disease they have and prevents them from detoriorating physically and spiritually, positively influencing their survival, response to treatment and sense of security. Studies previously performed showed that hope is positively correlated with social and family supports, self-esteem, spiritual well-being, responsive action, health promotion behavior and quality of life. Thus, the study attempted to provide basic information on nursing cancer patients by investigating their levels of hope and determining predictive factors which influence hope. For the study 200 cancer patients in two university hospitals located in Pusan were sampled as subjects. Data were collected for twenty nine days from Feburary 1, 1999 to March 1. Instrumets for the study included 10 items from the self-esteem scale by Rosenberg (1965), 39 hope measurements by Kim and Lee(1965), 16 of the social support scale by Tae(1986) and 16 of the general characteristics scale, all of which totaled 81 items. The data were analyzed using the SPSS program. General characteristics of the investigated based on numbers and percentage. Hope, self-esteem and social support were analyzed using means, minimum, maximum and standard deviation. Relations among the foregoing three factors were analyzed using Pearson' correlation coefficient. Levels of hope in cancer patients were determined using t-test, ANOVA and Scheffe test. Predictive factors influencing hope were investigated using multiple stepwise regression analysis. Results of the study are summarized as follows: 1. An average level of hope was $185.55{\pm}23.39$ points(96 min. and 234 max.) 2. Levels of hope showed a significant difference among them according to sex (t=-3.69, P=.000), age(F=4.714, P=.000), job(F=3.247, P=.008), monthly income (F=6.113, P=.003), treatment charge (F=3.796, P=.011), supportive resources (F=10.554, P=.000), diagnosis(F=2.287, P=.029), perceived health status(F=22.184, P=.000), level of pain(F=3.334, P=.021), religion (F=4.911, P=.001) and religion's effect in life (F=11.706, P=.000), 3. For the subjects, self-esteem and social support were $38.32{\pm}7.21$(13 min, and 50 max.) and $52.97{\pm}8.49$points(28 min, 80 max.). Concerning social support, average levels of family support and medical support were found $35.95{\pm}6.05$(18 min, and 40 max) and $27.02{\pm}4.99$ points(20 min and 40 max). The hope the cancer patients showed significant correlations with self-esteem (r=.588, P=.000), family support(r=.224, p=.001) and medical support(r=.221, P=.002). 4. The five variables related to hope (self-esteem, religion's effect in life, perceived health status, social support and age) accounted for 54.2 percent of the hope level; especially, self-esteem was the highest at 34.6%. As shown in the above results, predictive factors which most influence hope in cancer patients were self-esteem and religion's effect of life. Therefore, nursing interventions to increase self-esteem should be developed. Regarding religion's effects, studies on spiritual aspects should be carried out in a way that contributes to promotion of hope.

• Pediatric Infection and Vaccine
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• v.13 no.2
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• pp.155-162
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• 2006

Purpose : Appropriate use of antimicrobials is an essential factor to treat infectious diseases and prevent acquisition of antimicrobial resistant pathogens. This study was undertaken to search that application of computerized management program for restriction of antimicrobials use in a hospital is helpful to decrease antimicrobial use density. Methods : Antibiotics utilization committee decided to restrict the use of 16 antimicrobials(14 expensive drugs having fear of drug resistance by pathogens and additional two drugs with inappropriate using tendency). Retrospective evaluation of antimicrobial user numbers between May and July of 2004 and 2005(study group) was conducted to compare with previous use density during same period of 2002 and 2003(control group). Results : Inpatients number of control group($823.5{\pm}37.1$ persons) was more than study group($809.2{\pm}39.3$ persons, P<0.001), but, outpatients number and hospitalized duration were equal in two groups. Antimicrobial user number/100 inpatients per day of glycopeptides and antifungal agents was equal in two groups, and study group was significantly higher density than control group in the use of carbapenems, piperacillin-tazobactam and quinolones(P<0.001). But study group was significantly lower density than control group in the use of drugs with inappropriately using tendency and expensive cephalosporins having broad antimicrobial spectrum(P<0.001). Conclusion : Application of computerized management program for restriction of antimicrobials use in a hospital is effective to decrease the use density of antimicrobials with inappropriately using tendency, but it is an insufficient measures for the restricted use of other antimicrobials on the whole.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.221-231
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• 2004

Purpose: The purpose of this study was to analyze the need for child hospice care programs in families of children with cancer. Methods: The survey of 104 families who were taking care of children with cancer was conducted. This survey was conducted from February 2004 to July 2004 at two general hospitals in Seoul. The data were collected through a self-reporting questionnaire of 22 items. The items were classified into five areas by factor analysis to identify the construct validity. The reliability of the tool was established by Cronbach's alpha as .94 and the data collected were analyzed by descriptive statistics, t-test and ANOVA. Results: 1) The degree of need for hospice care of the subjects showed a high average of 3.40 (${\pm}3.8$). The need for 'emotional care of children' showed the highest mean (M=3.55), 'management of terminal physical symptoms'(M=3.49), 'control of secondary physical problems' (M=3.41), 'acceptance of the family's difficulty' (M=3.20), 'spiritual care for preparing for death'(M=3.17), respectively. 2) With respect to the demographic characteristics of the subjects, there were statistically significant differences in hospice care needs, according to the child's mother's age (F==4.980, P=.009), whether or not there were cancer patients among their siblings or relatives (t=2.423, P=.017). Conclusion: The family of children with cancer have a heavy burden of ambivalence, especially in relieving the anxiety and fear of their children, communicating about death, and managing physical symptoms. Child hospice care must be provided considering the needs of families of children with cancer. Thus popular needs as well as hospice nurses' higher concern and support for hospice care of children require further education and program development to meet the current demands.

• Korean Journal of Hospice Care
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• v.6 no.1
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• pp.1-11
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• 2006

There are various understandings how to define death. In the context of medicine, death is defined as the irreversible change of the tissue according to the cessation of circulation and respiration. According to the psychologists, a person need to accept the finiteness as a human being and remain conscious that the death is not avoidable. And they say if a person doesn't regard death as unavoidable reality of life he or she will not confront the humanistic death and after all will die like animals. In philosophy, death is viewed as an unwelcome reality in the end of the journey of life. Sociologists usually understand that the society is the organization composed with living persons and human beings which construct and transmit the culture from generation to generation between the both ends of life and death. In society, the generation is changed, maintained, and developed through the phenomenon of death. Although death of human being is natural event in society, the death of a specific person brings a sense of loss, crisis, and anxiety to the communities like family, regional society, nation, and the world. In this context, death is not confined to personal dimension and it can be regarded as a social problem. It is valuable to summarize the religious perspectives on the meaning of death for the better hospice care. In shamanism, there are basic idea that although the flesh of human being disappears, soul never die. If human dies, the flesh of human being disappears but soul never disappear and come back to the origin of soul as it is called chaos. So in shamanism, it is said that shaman can solve the mortified feeling, restore the broken harmony, send the soul to comfortable space- the origin, and guarantee the blessing of descendents. Buddhists regard the death as an essential component through the cycles of life. Through this cycle, human being exits as an endlessly transmigrating being and the death is just a restoration to the original status. In Confucianism, the view on the death based on the philosophy of the "Yin and Yang" and "Five elements". In Buddhist tradition, many believers said the philosophy of "Death is the same as life". Unlike usual thoughts that a god governs "life and death" and "fortune and misfortune", Confucianists deny the governance of a god and emphasize the natural orders in which every phenomenon in the world moves according to the principle. Confucianists understand the death as a natural order with this principle. In Confucianists' belief, the essence of human being remains in their own descendent's lives after the death of ancestor, so in Confucianism there is no concept of immortality of the soul. In the history of Christianity, death has been defined generally as the separation of the immortal soul from the mortal body. In the earlier days of Old Testament, the death is regarded as a disappearance of just a flesh and human never disappear and always live in the relationship with God. Later days in Old Testament, we can find the growing concern for the life after the death because of the entrance of the theodicy. In the New Testament, the death is not regarded as the normal process of the human life and regarded as the abnormal status in which death come to human because of sin as a decisive factor and it should be conquered. In fact, the most of us afraid death because not of the fear of death itself but of the sense of the emptiness and regrets. so many people often make the monument hoping to live forever. But Christian usually regard this behavior as a sinful act because human being usually think themselves as a master of their life and attempt to become immortal in this kind of trial mortal. But if we live with God, we cannot confront such a condition because we aware limits as a mortal human being and entrust everything on Him and want to live according to His guidance. Therefore, in the Christian tradition, the death is regarded as accomplishment of life, fruits of life, invitation to the eternal life, and the last stage of human growth. For human being, the death is the great step of maturation as a human in the final stage of life.

• Analyses & Alternatives
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• v.7 no.1
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• pp.229-258
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• 2023

For the main countries of the Asia-Pacific region, the United States, China and Russia, a situation of "new normality" is emerging. Moreover, for each of the countries, this "new normality" has its own meaning. For the United States, this is an aggravation of the military confrontation with China in the Taiwan Strait. For China, this is an increase in the degree of rivalry with the United States and a slowdown in the pace of economic development with a very high probability of their decline in the future. For Russia, this is an almost complete curtailment of relations with the United States against the background of a special military operation and imposed sanctions. These nuances, in addition to the results of the 20th CPC Congress, will determine the main trends in Sino-American and Sino-Russian relations. It seems that China's attitude towards Russia will not change against the background of the Ukrainian crisis. Beijing will maintain a position of "benevolent neutrality" towards Moscow. At the same time, the balance between "goodwill" and "neutrality" may vary depending on the scope of Sino-Russian cooperation. For example, in the economic sphere, Chinese companies will be afraid to cooperate with Russian partners for fear of secondary sanctions. However, in general, Russia will retain its importance for China as the strongest anti-American pole. In relations with the United States, China will continue to firmly defend its interests, while at the same time not excluding the normalization of relations with Washington in certain areas of cooperation: strategic stability, non-traditional threats, ecology, etc. In general, the decisions of the 20th CPC Congress do not allow us to say either in favor or against the idea of China's readiness to resume dialogue with the United States in the post-congress period. Sino-American relations, as noted above, have their own logic and will probably continue to develop within its framework. However, so are Sino-Russian relations. Within the framework of these logics, Beijing seems to continue to balance between the two vectors of its foreign policy. On the one hand, this is the development of bilateral cooperation with Russia in order to strengthen its own negotiating positions in the confrontation with the United States: military cooperation with an emphasis on joint exercises, political cooperation based on anti-Americanism, economic cooperation with an eye to the risks of secondary sanctions. On the other hand, it is unacceptable for China to recognize the collapse of Ukraine, the inadmissibility of a direct military clash with the United States and the extreme undesirability of further aggravation of relations with the United States on the factor of Chinese friendship with Russia.

• Journal of Global Scholars of Marketing Science
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• v.17 no.2
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• pp.1-29
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• 2007

The flow theory becomes one of the most important frameworks in the internet research arena. Hoffman and Novak proposed a hierarchical flow model showing the antecedents and outcomes of flow and the relationship among these variables in the hyper-media computer circumstances (Hoffman and Novak 1996). This model was further tested after their initial research (Novak, Hoffman, and Yung 2000). At their paper, Hoffman and Novak explained that the balance of challenge and skill leads to flow which means the positive optimal state of mind (Hoffman and Novak 1996). An imbalance between challenge and skill, leads to negative states of mind like anxiety, boredom, apathy (Csikszentmihalyi and Csikszentmihalyi 1988). Almost all research on the flow 4-channel model have been focusingon flow, the positive state of mind (Ellis, Voelkl, and Morris 1994 Mathwick and Rigdon 2004). However, it also needs to examine the formation of the negative states of minds and their outcomes. Flow researchers explain play or playfulness as antecedents or the early state of flow. However, play has been regarded as a distinct concept from flow in the flow literatures (Hoffman and Novak 1996; Novak, Hoffman, and Yung 2000). Mathwick and Rigdon discovered the influences of challenge and skill on play; they also observed the influence of play on web-loyalty and brand loyalty (Mathwick and Rigdon 2004). Unfortunately, they did not go so far as to test the influences of play on state of mind. This study focuses on the relationships between state of mind in the flow 4-channel model and play. Early research has attempted to hypothetically explain state of mind in flow theory, but has not been tested except flow until now. Also the importance of play has been emphasized in the flow theory, but has not been tested in the flow 4-channel model context. This researcher attempts to analyze the relationships among state of mind, skill of play, challenge, state of mind and web loyalty. For this objective, I developed a measure for state of mind and defined the concept of play as a trait. Then, the influences of challenge and skill on the state of mind and play under on-line shopping conditions were tested. Also the influences of play on state of mind were tested and those of flow and play on web loyalty were highlighted. 294 undergraduate students participated in this research survey. They were asked to respond about their perceptions of challenge, skill, state of mind, play, and web-loyalty to on-line shopping mall. Respondents were restricted to students who bought products on-line in a month. In case of buying products at two or more on-line shopping malls, they asked to respond about the shopping mall where they bought the most important one. Construct validity, discriminant validity, and convergent validity were used to check the measurement validations. Also, Cronbach's alpha was used to check scale reliability. A series of exploratory factor analyses was conducted. This researcher conducted confirmatory factor analyses to assess the validity of measurements. All items loaded significantly on their respective constructs. Also, all reliabilities were greater than.70. Chi-square difference tests and goodness of fit tests supported discriminant and convergent validity. The results of clustering and ANOVA showed that high challenge and high skill leaded to flow, low challenge and high skill leaded to boredom, and low challenge and low skill leaded to apathy. But, it was different from my expectation that high challenge and low skill didnot lead to anxiety but leaded to apathy. The results also showed that high challenge and high skill, and high challenge and low skill leaded to the highest play. Low challenge leaded to low play. 4 Structural Equation Models were built by flow, anxiety, boredom, apathy for analyzing not only the impact of play on state of mind and web-loyalty, but also that of state of mind on web-loyalty. According the analyses results of these models, play impacted flow and web-loyalty positively, but impacted anxiety, boredom, and apathy negatively. Results also showed that flow impacted web-loyalty positively, but anxiety, boredom, and apathy impacted web-loyalty negatively. The interpretations and implications of the test results of the hypotheses are as follows. First, respondents belonging to different clusters based on challenge and skill level experienced different states of mind such as flow, anxiety, boredom, apathy. The low challenge and low skill group felt the highest anxiety and apathy. It could be interpreted that this group feeling high anxiety or fear, then avoided attempts to shop on-line. Second, it was found that higher challenge leads to higher levels of play. Test results show that the play level of the high challenge and low skill group (anxiety group) was higher than that of the high challenge and high skill group (flow group). However, this was not significant. Third, play positively impacted flow and negatively impacted boredom. The negative impacts on anxiety and apathy were not significant. This means that the combination of challenge and skill creates different results. Forth, play and flow positively impacted web-loyalty, but anxiety, boredom, apathy had negative impacts. The effect of play on web-loyalty was stronger in case of anxiety, boredom, apathy group than fl ow group. These results show that challenge and skill influences state of mind and play. Results also demonstrate how play and flow influence web-loyalty. It implies that state of mind and play should be the core marketing variables in internet marketing. The flow theory has been focusing on flow and on the positive outcomes of flow experiences. But, this research shows that lots of consumers experience the negative state of mind rather than flow state in the internet shopping circumstance. Results show that the negative state of mind leads to low or negative web-loyalty. Play can have an important role with the web-loyalty when consumers have the negative state of mind. Results of structural equation model analyses show that play influences web-loyalty positively, even though consumers may be in the negative state of mind. This research found the impacts of challenge and skill on state of mind in the flow 4-channel model, not only flow but also anxiety, boredom, apathy. Also, it highlighted the role of play in the flow 4-channel model context and impacts on web-loyalty. However, tests show a few different results from hypothetical expectations such as the highest anxiety level of apathy group and insignificant impacts of play on anxiety and apathy. Further research needs to replicate this research and/or to compare 3-channel model with 4-channel model.