Purpose
This descriptive correlational study aimed to evaluate the impact of patient activation on self-management and explore the mediating role of shared decision-making (SDM) among patients on hemodialysis.
Methods
A cohort of 136 participants was recruited from hemodialysis units in Gwangju, South Korea, between August 9 and 22, 2024. Patient activation, self-management, and SDM were assessed using the Patient Activation Measure (PAM-13), the Hemodialysis Self-Management Instrument (HDMI-K), and the 9-item Shared Decision-Making Questionnaire (SDM-Q-9), respectively. Descriptive statistics, Pearson’s correlation analysis, and mediation analysis using the PROCESS macro were conducted to analyze the data.
Results
Patient activation, SDM, and self-management were positively correlated with one another. Mediation analysis showed that patient activation significantly predicted both SDM and self-management. SDM also significantly predicted self-management, confirming its partial mediating effect. The final model explained 54.5% of the variance in self-management. The indirect effect of patient activation on self-management through SDM was statistically significant (indirect effect=0.05, 95% confidence interval [CI]=0.02–0.10). The indirect effect of patient activation on self-management through SDM was statistically significant (indirect effect=0.05, 95% CI=0.02–0.10).
Conclusion
Patient activation directly and indirectly enhances self-management through SDM, verifying the partial mediating role of SDM. Integrating SDM into nursing interventions is essential for effectively supporting self-management in patients undergoing hemodialysis.

PURPOSE
As advanced medical care has resulted in the unintended consequence of prolonging deaths, there is a growing interest in the decision to withhold life-sustaining treatments. The purpose of this study was to determine factors associated with the decision to withhold life-sustaining treatments in middle-aged and older adults who die in hospital in the United States.
METHODS
This cross-sectional correlational study conducted secondary analysis of 2000–2012 exit interview data from the Health and Retirement Study. Adults aged 50 and older who died in hospital and who had made a decision regarding life-sustaining treatments were included. Multivariable logistic regression was used to identify factors related to the decision to withhold life-sustaining treatments.
RESULTS
Among 1,412 adults, the prevalence of the decision to withhold life-sustaining treatments was 61.1%. Significant factors associated with the decision to withhold life-sustaining treatments were being African American (Adjusted Odds Ratio [AOR]=0.50, 95% Confidential Interval [CI]=0.30~0.86), Catholic (AOR=0.5, 95% CI=0.32~0.93), having at least one private insurance policy (AOR=1.40, 95% CI=1.02~1.92), having a living will (AOR=1.71, 95% CI=1.04~2.83), and having discussed end-of-life care with someone (AOR=1.810, 95% CI=1.25~2.62).
CONCLUSION
Differences in race and religious affiliation should be considered when older adults, family members, and health care providers make decisions regarding life-sustaining treatments at the end-of-life. Also, health insurance coverage for advance care planning makes it easier for people to discuss life-sustaining treatments with health care providers.

PURPOSE
The purpose of this study was to explore how knowledge management of hospital and nurses' beliefs and competences on evidence-based practice can affect evidence-based decision making.
METHODS
In this descriptive study, a total of 184 nurses who were working in the five general hospitals participated. The data were collected through a self-administered questionnaire in September, 2014. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson correlation coefficient, and step-wise multiple regression with SPSS/WIN Statistics 21.0 program.
RESULTS
Evidence-based decision making was correlated with EBP beliefs (r=.55, p<.001), EBP competence (r=.57, p<.001), and knowledge management (r=.50, p<.001). Hierarchical regression analysis showed that EBP beliefs (β=.18, p=.005), EBP competence (β=.37, p<.001), organizational knowledge management (beta=.27, p<.001) explained 48.6% of evidence based decision making (p<.001).
CONCLUSION
The study results indicated that evidence-based practice competences, organizational knowledge management, and evidence-based practice beliefs were important factors on evidence-based decision making. In order to improve evidence-based practice among nurses through organizational knowledge management, EBP beliefs and competence at individual level need to be considered and incorporated into any systemic training of EBP.

Citations

• Influence of Nursing Students’ Competencies Who Participated in Simulation Training on Competency with Evidence-based Practice
  Yeon Jeong Su
  Journal of Korea Society for Simulation in Nursing.2024; 12(1): 33.     CrossRef
• Translation and cross-cultural adaptation of the National Health Service Sustainability Model to the Chinese healthcare context
  Jie Lai, Lynne Maher, Chaixiu Li, Chunlan Zhou, Hasan Alelayan, Jiaqi Fu, Yanni Wu
  BMC Nursing.2023;[Epub]     CrossRef
• Evaluating the performance of an integrated evidence-based nursing knowledge management (I-EBNKM) platform in real-world clinical environments
  Myonghwa Park, Insook Jang, Sung Lim Kim, Wonjae Lim, Ga Ae Kim, Gyeongho Bae, Yerin Kim
  International Journal of Medical Informatics.2023; 179: 105239.     CrossRef
• Barriers to implementing evidence-based nursing practice from the hospitals' point of view in China: A regional cross-sectional study
  Jie Lai, Alison Brettle, Yingjie Zhang, Chunlan Zhou, Chaixiu Li, Jiaqi Fu, Yanni Wu
  Nurse Education Today.2022; 116: 105436.     CrossRef
• Development and Effectiveness of Practice Application Program of Intravenous Infusion Evidence-Based Nursing Practice Guideline - for Small and Medium Sized Hospitals
  Inhwa Hong, Young Eun
  Journal of Korean Academy of Nursing.2020; 50(6): 863.     CrossRef
• Influences of Critical Thinking Disposition, Nurse Managers' Transformation and Transactional Leadership Style on Nurses' Competency with Evidence Based Practice
  Geum Ah Lee, Sung Hee Shin, Suk Jeong Ko
  Journal of Korean Academy of Nursing Administration.2020; 26(4): 305.     CrossRef
• Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture
  Jae Yong Yoo, Jin Hee Kim, Jin Sun Kim, Hyun Lye Kim, Jung Suk Ki, Tim Schultz
  PLOS ONE.2019; 14(12): e0226742.     CrossRef
• Factors associated with Oncology Nurses' Adherence to Chemotherapy-Induced Neutropenia Guidelines based on Pender's Health Promotion Model
  Gyeong-Jin Kim, Ja Yun Choi
  Korean Journal of Adult Nursing.2019; 31(4): 389.     CrossRef
• Effects of an Evidence-Based Practice (EBP) Education Program on EBP Practice Readiness and EBP Decision Making in Clinical Nurses
  Ae Ri Na Nam, Eun Ho Lee, Jeong Ok Park, Eun Jung Ki, Su Min Nam, Mi Mi Park
  Journal of Korean Academy of Nursing Administration.2017; 23(3): 239.     CrossRef
• Heat Application According to Nurse's Belief on Evidence-Based Practice and Behavioral Intention Related to Research
  Sukyung Yoon, Yong Soon Shin
  Journal of Korean Academy of Fundamentals of Nursing.2016; 23(3): 264.     CrossRef
• Factors Influencing Nurses’ Implementation of Evidence-based Restraint Use in Long-term Care Hospitals
  Myonghwa Park, Mi Hwa Park
  Journal of Korean Gerontological Nursing.2016; 18(3): 172.     CrossRef

PURPOSE
Knowledge, clinical reasoning, and self-confidence are the basis for undergraduate education, and determine students\' level of competence. The purpose of this study was to assess the effects of the addition of a one-time simulation experience to the didactic curriculum on nursing students' knowledge acquisition, clinical reasoning skill, and self-confidence.
METHODS
Using a quasi-experimental crossover design consisted of intervention and wait-list control groups. Participants were non-randomly assigned to the first intervention group (Group A, n=48) or the wait-list control group (Group B, n=46). Knowledge level was assessed through a multiple choice written test, and clinical reasoning skill was measured using a nursing process model-based rubric. Self-confidence was measured using a self-reported questionnaire.
RESULTS
Results indicated that students in the simulation group scored significantly higher on clinical reasoning skill and related knowledge than those in the didactic lecture group; no difference was found for self-confidence.
CONCLUSION
Findings suggest that undergraduate nursing education requires a simulation-based curriculum for clinical reasoning development and knowledge acquisition.

Citations

• Effects of Discussion-Based Legality-Focused Nursing Record Education on Nursing Students’ Knowledge, Self-Confidence, and Nursing Record Performance
  Dohye Kim, Kyoungrim Kang, Jeongyeong Jeon
  Journal of Korean Academy of Fundamentals of Nursing.2025; 32(1): 14.     CrossRef
• Simulation-Based Learning Supported by Technology to Enhance Critical Thinking in Nursing Students: Scoping Review
  Hege Vistven Stenseth, Simen A Steindal, Marianne Trygg Solberg, Mia Alexandra Ølnes, Anne Lene Sørensen, Camilla Strandell-Laine, Camilla Olaussen, Caroline Farsjø Aure, Ingunn Pedersen, Jaroslav Zlamal, Jussara Gue Martini, Paula Bresolin, Silje Christi
  Journal of Medical Internet Research.2025; 27: e58744.     CrossRef
• Strategies to develop clinical reasoning in nursing students: A structured review
  Adele Neethling, Lizeth Roets
  Health SA Gesondheid.2025;[Epub]     CrossRef
• Comparative study between high-fidelity simulation and medium-fidelity simulation in decision-making of nursing students: experimental study
  Hugo Miguel Santos Duarte, Joana Antunes Castanheira, Ana Sofia Ferreira Pereira, Ângela Pragosa, Edna Tatiana Prazeres Santos, Maria dos Anjos Dixe
  Revista Latino-Americana de Enfermagem.2024;[Epub]     CrossRef
• Estudio comparativo entre simulación de alta fidelidad y simulación de mediana fidelidad en la toma de decisiones de estudiantes de enfermería: estudio experimental
  Hugo Miguel Santos Duarte, Joana Antunes Castanheira, Ana Sofia Ferreira Pereira, Ângela Pragosa, Edna Tatiana Prazeres Santos, Maria dos Anjos Dixe
  Revista Latino-Americana de Enfermagem.2024;[Epub]     CrossRef
• Using "board games" to improve the effectiveness of extracorporeal membrane oxygenation care for nurses in intensive care unit
  Hsin-Yi Wang, Chu-Yu Huang, Sophia H. Hu, Su-Fen Cheng
  Nurse Education in Practice.2024; 75: 103895.     CrossRef
• The effect of simulation-based learning on nursing students' clinical decision-making skills: Systematic review and meta-analysis
  Selçuk Görücü, Gülengün Türk, Zekiye Karaçam
  Nurse Education Today.2024; 140: 106270.     CrossRef
• Estudo comparativo entre simulação de alta-fidelidade e simulação de média-fidelidade na tomada de decisão de estudantes de enfermagem: estudo experimental
  Hugo Miguel Santos Duarte, Joana Antunes Castanheira, Ana Sofia Ferreira Pereira, Ângela Pragosa, Edna Tatiana Prazeres Santos, Maria dos Anjos Dixe
  Revista Latino-Americana de Enfermagem.2024;[Epub]     CrossRef
• Effect of high-fidelity simulation airway management training program on nursing students’ performance, satisfaction, and self-confidence in Palestine
  Ahmad Mohammad Sati Hodrob, Malakeh Z. Malak, Ahmad Ayed
  Interactive Learning Environments.2024; 32(1): 325.     CrossRef
• Impact Of Simulation Design Elements on Undergraduate Nursing Education: A Systematic Review
  Matthew Jackson, Lauren McTier, Laura A. Brooks, Rochelle Wynne
  Clinical Simulation in Nursing.2024; 89: 101519.     CrossRef
• Student Nurses’ Perceptions of the Role of High-Fidelity Simulation in Developing Decision-Making Skills for Clinical Practice: A Qualitative Research Study
  Naim Abdulmohdi, Andrew McVicar
  SAGE Open Nursing.2024;[Epub]     CrossRef
• Effectiveness of Simulation-Based Education for Caring Patients with COVID-19
  Min Hye Lee, Eun-Young Noh
  Journal of Korean Academy of Nursing.2023; 53(4): 397.     CrossRef
• Assessment of Clinical Reasoning While Attending Critical Care Postsimulation Reflective Learning Conversation
  Emad Almomani, Jacqueline Sullivan, Jisha Samuel, Ahmed Maabreh, Natalie Pattison, Guillaume Alinier
  Dimensions of Critical Care Nursing.2023; 42(2): 63.     CrossRef
• Development and assessment of a curriculum model for virtual simulation in nursing: curriculum development and pilot-evaluation
  Hyunsook Shin, Dahae Rim
  BMC Medical Education.2023;[Epub]     CrossRef
• Influence of simulation design on stress, anxiety and self‐confidence of nursing students: Systematic review with meta‐analysis
  George Oliveira Silva, Flavia Silva e Oliveira, Alexandre Siqueira Guedes Coelho, Luciana Mara Monti Fonseca, Flaviana Vely Mendonça Vieira, Suzanne Hetzel Campbell, Natália Del Angelo Aredes
  Journal of Clinical Nursing.2023; 32(17-18): 5668.     CrossRef
• The Use of Simulation in Audiology Education: A Systematic Review
  Ahmad A. Alanazi, Nannette Nicholson
  American Journal of Audiology.2023; 32(3): 640.     CrossRef
• Development and psychometric testing of a clinical reasoning rubric based on the nursing process
  Nargess Ramazanzadeh, Akram Ghahramanian, Vahid Zamanzadeh, Leila Valizadeh, Saeideh Ghaffarifar
  BMC Medical Education.2023;[Epub]     CrossRef
• Curricular Quality Improvement in Midwifery: Simulating Unexpected Perinatal Loss
  Susan D. Altman, Charles P. Tilley, Rebecca Feldman, Mary Brennan, Dorothy Wholihan
  Journal of Midwifery & Women's Health.2023; 68(4): 523.     CrossRef
• Yüksek Gerçeklikli Simülasyon Yönteminin Hemşirelik Öğrencilerinin Anjinalı Hastanın Hemşirelik Bakımına Yönelik Bilgi ve Klinik Karar Verme Düzeyine Etkisi
  Gülcan Coşkun, Şerife Karagözoğlu
  Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi.2023; 10(2): 135.     CrossRef
• The effectiveness of high-fidelity simulation on undergraduate nursing students' clinical reasoning-related skills: A systematic review
  Fadiyah D. Alshehri, Sophie Jones, Denise Harrison
  Nurse Education Today.2023; 121: 105679.     CrossRef
• Clinical reasoning in emergency medical technicians and its compliance with the illness script theory: A pilot study
  Hamidreza Miri, Elham Boushehri, Maryam Hoseini-Abardeh, Shahram Yazdani
  Journal of Education and Health Promotion.2023;[Epub]     CrossRef
• Implementation Methods of Virtual Reality Simulation and the Impact on Confidence and Stress When Learning Patient Resuscitation: An Integrative Review
  Jessica Wood, Lyn Ebert, Jed Duff
  Clinical Simulation in Nursing.2022; 66: 5.     CrossRef
• Effect of simulation on stress, anxiety, and self-confidence in nursing students: Systematic review with meta-analysis and meta-regression
  George Oliveira Silva, Flavia Silva e Oliveira, Alexandre Siqueira Guedes Coelho, Agueda Maria Ruiz Zimmer Cavalcante, Flaviana Vely Mendonça Vieira, Luciana Mara Monti Fonseca, Suzanne Hetzel Campbell, Natália Del Angelo Aredes
  International Journal of Nursing Studies.2022; 133: 104282.     CrossRef
• Comparing the Stress, Anxiety, and Learning Effects of Leaders and Team Members in High Fidelity Nursing Simulation
  Eun Jeong Ko, Eun Jung Kim
  Clinical Simulation in Nursing.2022; 70: 14.     CrossRef
• Effects of preobserving peers’ performance on students’ anxiety, perceived competency, and satisfaction during a clinical simulation: A quasiexperimental study
  Sun-Hee Kim, Eun Jung Kim
  Nurse Education in Practice.2022; 62: 103384.     CrossRef
• Development and evaluation of virtual reality simulation education based on coronavirus disease 2019 scenario for nursing students: A pilot study
  Younhee Jeong, Hanna Lee, Jeong‐Won Han
  Nursing Open.2022; 9(2): 1066.     CrossRef
• Impact of Virtual Simulation on Nursing Students’ Self-Efficacy
  Louise Comer
  SSRN Electronic Journal .2021;[Epub]     CrossRef
• An integrative review of simulation, senior practicum and readiness for practice
  Michele Ragsdale, Jenny B. Schuessler
  Nurse Education in Practice.2021; 55: 103087.     CrossRef
• Exploring perceptions and barriers in developing critical thinking and clinical reasoning of nursing students: A qualitative study
  Su Hui Valynn Wong, Yanika Kowitlawakul
  Nurse Education Today.2020; 95: 104600.     CrossRef
• Neurological Assessment Using a Physical-Virtual Patient (PVP)
  Laura Gonzalez, Salam Daher, Greg Welch
  Simulation & Gaming.2020; 51(6): 802.     CrossRef
• ‘Ward for the day’: A case study of extended immersive ward-based simulation
  Hugh Davies, Rebecca Schultz, Deb Sundin, Elisabeth Jacob
  Nurse Education Today.2020; 90: 104430.     CrossRef
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  Rita Payan-Carreira, Gonçalo Cruz, Ioanna V. Papathanasiou, Evangelos Fradelos, Lai Jiang
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• Effect of case study versus video simulation on nursing students' satisfaction, self-confidence, and knowledge: A quasi-experimental study
  Elizabeth K. Herron, Kelly Powers, Lauren Mullen, Brandi Burkhart
  Nurse Education Today.2019; 79: 129.     CrossRef
• Creating a Simulation Experience to Promote Clinical Judgment
  Melody D. Reibel, Melanie Cason, Sarah Screws
  Teaching and Learning in Nursing.2019; 14(4): 298.     CrossRef
• Effects of Simulation-Based Education before Clinical Experience on Knowledge, Clinical Practice Anxiety, and Clinical Performance Ability in Nursing Students
  Eun Jeong Ko, Eun Jung Kim
  Journal of Korean Academic Society of Nursing Education.2019; 25(3): 289.     CrossRef
• Comparison of the effects of two different teaching methods in blood pressure measurement training: a randomized controlled study
  Banu Terzi, Eylem Topbaş, Gülay Bingöl, Saadet Gonca Mavi Aydoğdu
  Blood Pressure Monitoring.2019; 24(6): 294.     CrossRef
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  Eunsook Kim
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  Kristine Haddeland, Åshild Slettebø, Patricia Carstens, Mariann Fossum
  Clinical Simulation in Nursing.2018; 21: 1.     CrossRef
• Evaluating Changes in Clinical Decision-Making in Physical Therapy Students After Participating in Simulation
  Kelly Macauley
  Health Professions Education.2018; 4(4): 278.     CrossRef
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  Melva Craft-Blacksheare, Youvalanda Frencher
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• Clinical Simulation for Practicing Labor and Delivery Nurses: Advancing Competency through Simulated Nursing Practice
  Lynn C. Parsons, Teresa D. Ferguson, Teresa L. Howell
  POJ Nursing Practice & Research.2017; 1(3): 1.     CrossRef
• Effect of Team Debriefing in Simulation-based Cardiac Arrest Emergency Nursing Education
  SangJin Ko, Eun-Hee Choi
  Korean Journal of Adult Nursing.2017; 29(6): 667.     CrossRef
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PURPOSE
The purpose of this study was to validate the Korean version of shortened Nursing Decision-Making Instrument developed by Lauri & Salantera(2002).
METHODS
The subjects were 247 nurses working in eight hospitals of Korea. Data were collected by questionnaires from June to July, 2012 and were analyzed by Principal Component Analysis for construct validity and Cronbach's . coefficient for reliability.
RESULTS
Factor loadings of the four subscales ranged from .32 to .73. The explained variance from the four factors was 48.54% of the total variance. The factors were named 'implementation of plan, monitoring and evaluation', 'plans of action', 'data collection', and 'data processing and identification'. The first factor consisted of 6 items which explained 13.21% of the total variance and the second factor contained 8 items. The Cronbach's alpha coefficients of the four subscales were from .64 to .81.
CONCLUSION
The Korean version of the shortened Nursing Decision-Making Instrument has satisfactory construct validity and reliability. However, that the scores of the analytic items weren't reversed unlike the analysis method of the original tools is the biggest limitation of this study. In addition, based on the fact that there were several discrepancies for item interpretation of Korean comparing to the findings of the instrument development study, repetitive researches would be suggested.

Citations

• Development of a Korean clinical decision-making ability scale for hospital nurses
  Sunyoung Oh, Minkyung Gu, Sohyune Sok
  BMC Nursing.2025;[Epub]     CrossRef
• Cultural Adaptation and Psychometric Evaluation of the Nursing Decision-Making Instrument Into European Portuguese
  Ivo Cristiano Soares Paiva, Teresa Margarida Almeida Neves, Filipa Isabel Quaresma Santos Ventura, António Carlos Lopes Vilela, Isabel Maria Pinheiro Borges Moreira
  SAGE Open Nursing.2024;[Epub]     CrossRef
• Communication training program for nurses caring for patients with aphasia: a quasi-experimental study
  Yujin Hur, Younhee Kang
  BMC Nursing.2024;[Epub]     CrossRef
• Work climate from the perspective of nurses: qualitative research
  Justyna Kosydar-Bochenek, Sabina Krupa, Tomasz Semań, Wioletta Mędrzycka-Dąbrowska
  Frontiers in Medicine.2023;[Epub]     CrossRef
• A Concept Analysis of Nurses’ Clinical Decision Making: Implications for Korea
  Sunyoung Oh, Minkyung Gu, Sohyune Sok
  International Journal of Environmental Research and Public Health.2022; 19(6): 3596.     CrossRef
• Canonical correlations between individual self-efficacy/organizational bottom-up approach and perceived barriers to reporting medication errors: a multicenter study
  Myoung Soo Kim, Chul-Hoon Kim
  BMC Health Services Research.2019;[Epub]     CrossRef

PURPOSE
The aim of this study was to identify the process of experience toward decision making to donate organs.
METHOD
Eleven subjects who registered at the Association for Organ Sharing in Korea were recruited. Using in-depth interviews and tape-recordings, data was collected from Jun. 2001 to Feb. 2002 and the contents of these were analyzed by Glaser's grounded theory analysis method.
RESULT
Basic Social- Psychological Problem(BSPP) of subjects were 'attachment to body' and the core theme, that is Basic Socialization Progress(BSP) were discovered to 'find out what is the meaning of life'. Also it consisted of four steps: 1st 'hesitate', 2nd 'look into self', 3rd 'realize the tie up to self' and last 're-find the meaning of life'.
CONCLUSION
These findings indicate the Korean's Basic Socialization Progress of decision making regarding organ donation, so possible development of promoting decision making is necessary strategies for people who is having his/her potential of organ donation in mind.

PURPOSE
The purpose of this study was to examine the differences of the process of change, decision making, self-efficacy and perception of subjective health according to the stages of exercise behaviors suggested by transtheoretical models among older adults.
METHOD
The subjects consisted of 291 older adults. Trained research assistants interviewed the older adults using structured questionnaires. ANOVA analyses with post hoc test were used to examine the mean differences for each stage of exercise behavior using SPSS for windows.
RESULT
The subjects were divided into five stages of exercise behavior: 24.4% pre-contemplation, 12.4% contemplation, 17.9% preparation, 12.4% action, 33.0% maintenance stage. There were significant differences in process of change, decision making, self-efficacy and subjective health perception according to the exercise stage of change. 'Self-liberation' and 'stimulus control' were important strategies for intention of exercise, while 'reinforcing management' for the actual practice of exercise. 'Self-efficacy' was an effective strategy to change older adults from pre-contemplation to preparation stage.
CONCLUSION
For exercise intervention, older adults should be classified into groups according to their stages of exercise behaviors and provided effective individualized intervention depending on their stage.

The purpose of this study was to understand how living-related kidney donors experience to donate a kidney using the Grounded Theory method. Total of 11 kidney donors were participated in the study. Semi-structured individual interviews were utilized to gather data. All interviews were audiotaped and transcribed verbatim. Constant comparative analysis was employed using the NUDIST4.0 software program. As a result of analysis "process of decision making" was identified as a core category and the process consists of three stages; the initial, the intermediary, and the last stages. Ten subcategories emerged as important in this process; 1) preceding factors, 2) direct factors, 3) indirect factors, 4) donor characteristics I, 5) wish to give (a kidney), 6) motives and momentums to donate, 7) interfering factors, 8) facilitating factors, 9) donor characteristics II and the 10) final decision to donate. During the initial stage, the donors recognize their wish to give a kidney to the recipient, and the first five subcategories were related to this stage. The intermediary stage is an action stage which involves taking the tests of tissue compatibility with the recipient. The next four categories were related to the intermediary stage. The last stage starts when the donors finally decide to donate a kidney and ends with the operation. The results of this study highlight difficulties and problems, as well as motives and other facilitating factors that people experience to donate a living-related kidney. The results of this study might help nurses and other health care workers make effective interventions to facilitate the decision making process for living-related kidney donors. They might also help in establishing appropriate standards and criteria for the psychosocial aspects of living-related kidney donations.