Purpose This study involved a meta-synthesis of qualitative research concerning the experiences of women with infertility and infertility treatments. Based on an analysis of emotional changes and adaptation processes, it aimed to propose an interaction model encompassing expectation, loss, and resilience and clarify the conceptual meaning of each component.
Methods Thomas and Harden’s five-step qualitative meta-synthesis methodology was employed. A total of 22 studies published between 2014 and 2024 were comprehensively analyzed and synthesized. The findings were integrated into a model representing the experiences of women undergoing infertility and infertility treatments.
Results The meta-synthesis identified six key themes: changes in identity and inner growth; strengthening resilience through the roles of spouses, family, and peers; strategies for recovery and growth; support systems amidst economic and social burdens; life in the tension of waiting and hope; and the reconfiguration of couple and family relationships. Based on these themes, a dynamic interaction model, named the Model of Psychological Changes and Resilience (PCR Model), was developed to illustrate the interrelationships among expectation, loss, and resilience. The conceptual implications of these relationships were also explicated.
Conclusion The cyclical interplay between expectation and loss among women experiencing infertility is intensified by social ideologies and cultural contexts, while resilience is strengthened through overcoming distress and finding meaning in life. Further quantitative research is necessary to validate these relationships in clinical settings by obtaining empirical data that apply this model.
Purpose Cancer diagnosis is associated with psychological distress, which often leads to a significant reduction in adaptation and quality of life. This study aimed to identify the prevalence and related factors of psychological distress in newly diagnosed breast cancer patients. Methods The study included 138 women scheduled for surgery or neoadjuvant chemotherapy following a recent breast cancer diagnosis at a university hospital in Korea.
Psychological distress was assessed using the National Comprehensive Cancer Network Distress Thermometer and problem lists. Data collection occurred from November 1, 2021, to November 30, 2022. Descriptive statistics and logistic regression analysis were utilized for data analysis. Results The average age of the participants was 51.72 years. Among the 138 participants, 67.4% (n=93) reported moderate to severe levels of psychological distress. Multivariate logistic regression analysis identified financial burden (Odds Ratio [OR]=4.32), fears (OR=5.35), and nervousness (OR=5.50) as predictors of moderate to severe psychological distress. Conclusion Approximately two-thirds of newly diagnosed breast cancer patients experienced significant psychological distress.
Nervousness, fears, and financial burden were significant factors influencing this distress. Therefore, management of psychological distress should be implemented for patients experiencing financial burdens or emotional problems, such as nervousness and fear, from the time of diagnosis.
Purpose The purpose of this study was to investigate the level of resilience in multiple myeloma patients and to identify the impact of symptom experience, cancer coping, and social support on resilience.
Methods: Data were collected from January 2022 to May 2022 using self-report structured questionnaires administered to 162 outpatients who were undergoing chemotherapy or follow-up care after multiple myeloma treatment. The measured variables included symptom experience, cancer coping, social support, and resilience. The collected data were analyzed using SPSS/WIN 25 for descriptive statistics, the independent t-test, one-way analysis of variance, the Scheffé test, Pearson correlation coefficients, and hierarchical regression analysis.
Results: The mean resilience score of the participants was 66 out of 100 points. The levels of resilience were significantly higher in patients who had a job, recognized the importance of religion, and had a good economic status. Significantly higher levels of resilience were also observed in patients with lower physical performance status, fewer symptom experiences, more positive cancer coping, and higher support from healthcare staff.
Conclusion: Monitoring the symptom experience and physical performance ability of patients with multiple myeloma is important for enhancing their resilience. Positive coping strategies need to be developed and additional support from nurses should be provided to strengthen the personal resilience of patients with multiple myeloma.
Purpose This study was conducted to investigate the moderating effect of physical activity on the relationship between perceived stress and depression in patients newly diagnosed with ischemic heart disease.
Methods: This study had a cross-sectional design. Data were collected using a structured self-report questionnaire, which covered demographic characteristics, perceived stress, depression, and physical activity. Multiple linear regression was used to determine whether perceived stress and physical activity influenced depression, after controlling for demographic characteristics. The moderating effect of physical activity on the relationship between perceived stress and depression was analyzed using model 1 of the PROCESS macro (bootstrap sample size=5,000).
Results: The findings revealed that the level of depression was higher in women (p=.003), individuals without a spouse (p=.004), and those with an average monthly income of less than 3 million won (p=.045). The regression results showed that perceived stress was associated with a significant increase in the level of depression (β=.53, p<.001), and low physical activity was also a significant predictor of depression (β=.16, p=.013). The moderating effect of physical activity on the relationship between perceived stress and depression was confirmed, indicating that when physical activity was high, the impact of perceived stress on depression was weaker than when physical activity was low (B=-0.37, p=.038).
Conclusion: The findings suggest the need to implement a nursing program that can enhance physical activity and early screening for stress and depression in patients with ischemic heart disease.
Purpose Contrast therapy, which includes alternately applying cold and heat therapy, is an effective intervention to increase muscle elasticity and reduce musculoskeletal edema and pain. This study aimed to confirm the effects of contrast therapy by using flexible Thermoelectric Devices (TEDs) — that not only maintain a constant temperature but can also change the temperature in a short time — on lower extremity edema, pain, muscle fatigue, and stress among nursing home workers. Methods This randomized controlled pre-post experimental study used a flexible thermoelectric element to administer contrast therapy in nursing home workers to compare its impact on lower extremity swelling, pain, muscle fatigue, and stress. As an intervention method, 4 minutes of heat therapy and 1 minute of cold therapy were repeated for a total of 30 minutes. Results The experimental group displayed a significant difference of -2.53 points, and the control group displayed a significant difference of -0.94 points (t=2.65, p<.050) as a result of an analysis comparing the two groups’ pain levels before and after the experimental treatment. The experimental group also displayed a statistically significant reduction in the degree of lower extremity edema (t=3.91, p=.001). Furthermore, the experimental group’s lower extremity stress index decreased significantly (t=2.87, p=.049). Conclusion The findings of this study indicated that contrast therapy by using flexible TEDs alleviated stress, leg pain, and swelling in nursing home workers and could be used as an intervention to alleviate musculoskeletal problems in healthcare workers.
Purpose This study aims to confirm the influence of type D personality and health literacy on resilience of patients hospitalized for Cardiovascular Diseases (CVDs), and provide basic information for improving resilience as a post-discharge strategy to promote self-care among patients with chronic diseases.
Methods A questionnaire-based survey was carried out in this cross-sectional study. The subjects were 142 patients who were being treated at a tertiary general hospital for CVDs such as coronary artery disease, arrhythmia, and heart failure. Data were collected from July to October 2022 using a structured questionnaire, and then analyzed using the SPSS program version 26.0.
Results 75.3% of the study subjects (n=107) had type D personalities, and the average health literacy and resilience scores were 48.96±9.13 points and 68.27±13.02 points, respectively, indicating relatively low grades. Following a hierarchical regression analysis, low monthly income (β=-.62, p<.001), current smokers (β=-.23, p=.010), patients with type D personality (β=-.24, p=.001), and patients with low health literacy (β=.27, p<.001) were identified as significant predictors of resilience (Adjusted R2=.57, F=14.32, p<.001).
Conclusion In order to increase the resilience of patients hospitalized for CVD, it is necessary to identify and take into account smokers with low socioeconomic status, poor health literacy, and type D personality. We advise doing a follow-up study to ascertain if the resilience of patients hospitalized for CVD influences post-discharge self-care and clinical outcomes.
Purpose This study aimed to synthesize evidence for the association of psychological stress with Telomere Length (TL)-a potential biomarker of cellular aging. Methods: A systematic literature search was conducted to identify eligible studies in the Cochrane Library, PubMed, Embase, and CINHAL. In this review, we included all papers published since the initiative's inception and summarized results as of March 2022. Studies that investigated subjective stress using questionnaires and objective stress using biomarkers of adults (aged≥18 years) were included. Ultimately, 20 studies met our selection criteria. The risk of bias was assessed using the Newcastle-Ottawa Scale. Results: Fifteen of the twenty studies (75.0%) reported that individuals with higher psychological stress levels had shorter TL. Eleven of sixteen studies (68.8%) measuring subjective stress and five of eight studies (62.5%) measuring objective stress showed significant associations of psychological stress with TL. However, five studies reported no association between psychological stress and TL shortening. Although the heterogeneous studies limited the ability to draw clear conclusions, it is suggested that psychological stress might accelerate the erosion of telomere ends. Conclusion Our findings indicate that TL could be a useful emerging biomarker for measuring stress-related health outcomes in nursing. Further large-scale longitudinal studies using TL as a genetic biomarker with multidimensional stress measurements are needed to investigate the association between psychological stress and cellular senescence.
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Purpose This study aimed to identify the relationship among post-traumatic stress disorder (PTSD), resilience, and retention intention in nurses who had experienced a traumatic event during hospital work.
Methods A structured questionnaire, was administered online from September 10 to September 22, 2021 to 198 nurses who had experienced a traumatic event during work at a university hospital in G metropolitan city. Data were analyzed using three-step mediated regression analysis.
Results Of the total participants, 70.7% had a high risk of PTSD. PTSD (β=-.20, p=.002) and resilience (β=.47, p<.001) had a direct effect on retention intention, and the explanatory power was 27.0%. However, the mediating effect of resilience on the relationship between PTSD and retention intention was not supported, which indicates that the relationship between post-traumatic stress and resilience was not significant (β=-.09, p=.232).
Conclusion Although there was no mediating effect of resilience, PTSD and resilience are considered to be important in order to improve nurses’ retention intention. It is needed to develop strategies to prevent the occurrence of traumatic events and to formulate policies and conduct programs for stress symptom management, aimed at increasing nurses’ resilience.
Purpose This study aimed to confirm the relationship between supportive care needs and resilience of female genital cancer patients, and to investigate the mediating effect of resilience in the relationship between supportive care needs and quality of life. Methods This study was conducted with 105 outpatients and inpatients who were receiving treatment for female genital cancer at K University Hospital in B City. Data were collected from July 22, 2021 to August 17, 2021 and analyzed by using the SPSS/WIN 23.0 program. The correlation between the patients’ supportive care needs, resilience, and quality of life was analyzed by Pearson's correlation coefficients, and SPSS Process Macro was used for the significance of parameter indirect effects. Results The quality of life of female genital cancer patients showed a significant negative correlation with supportive care needs (r=-.68, p<.001), and a significant positive correlation with resilience (r=.53, p<.001). Moreover, resilience partially mediated the relationship between supportive care needs and quality of life (95% CI -0.009~-0.032). Conclusion Based on the results of this study, improving the resilience of female genital cancer patients may act as an additional coping strategy to reduce supportive care needs and establish an enhanced quality of life.
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Purpose This study aimed to evaluate distress, family resilience, and Quality of Life (QoL) among family caregivers of cancer patients undergoing chemotherapy and explore whether family resilience moderates the association between distress and QoL. Methods This is a cross-sectional study. One hundred seventeen family caregivers of cancer patients undergoing chemotherapy were recruited through the oncology outpatient clinic and two oncology wards at a tertiary university hospital. The participants completed self-reported questionnaires, including the Hospital Anxiety and Depression Scale, Family Resilience Scale-Cancer, and Caregivers’ Quality of Life Index-Cancer. Descriptive statistics, independent t-tests, one-way Analysis of Variance (ANOVA), and hierarchical regression analysis were used for statistical analysis. Results The mean distress score was 15.31±6.91, the mean family resilience score was 112.71±14.11, and the mean QoL score was 71.19±18.90. After controlling for potential covariates, distress was found to be negatively associated with QoL (β=-.45, p<.001), whereas family resilience was positively associated with QoL (β=.49, p<.001), explaining 62.8% of the variance. However, family resilience did not moderate the association between distress and QoL in this study. Conclusion Distress and family resilience are crucial factors associated with QoL in the caregivers of cancer patients undergoing chemotherapy. This finding indicates that oncology nurses should develop interventions to relieve distress and enhance family resilience to improve family caregivers’ QoL. Further studies are required to confirm the moderating role of family resilience.
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Purpose This study aimed to construct and test a hypothetical model which explains the psychosocial adjustment of breast cancer survivors using the family resilience model suggested by McCubbin and McCubbin. Methods The study participants were 242 breast cancer survivors who had finished active treatments within the past five years. Data were collected from September to October 2017 from an offline breast cancer self-help group survey and an online breast cancer support group. Data were analyzed using SPSS version 22.0 and AMOS version 23.0. Results The model fit indices for the modified hypothetical model were suitable for the recommended level: x2 =223.80 (df=88, p<.001), x2 /df=2.54, RMR=.04, GFI=.90, IFI=.93, CFI=.93, and RMSEA=.08. Symptoms and posttraumatic growth directly affected psychosocial adjustment. Symptoms were found to be the most influential factors in the psychosocial adjustment. All three family resilience factors-family hardiness, problem-solving communication, and problem-solving coping-directly affected posttraumatic growth and indirectly affected psychosocial adjustment through posttraumatic growth. These variables explained 81.2% of breast cancer survivors’ psychosocial adjustment. Conclusion Health care professionals need to continue to provide interventions for symptom relief and support to improve the psychosocial adjustment of breast cancer survivors. Additionally, practical nursing interventions should be prepared for individuals and families of breast cancer survivors to promote recovery and reinforce family resilience. This will ultimately improve the quality of life for breast cancer survivors and their families.
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Purpose The purpose of this study was to compare and verify the effects of aroma essential oil inhalation and music listening on stress response, vital signs, and bispectral index.
Methods In a randomized controlled trial design, the participants consisted of healthy adults aged 20~50 years who were randomly assigned to the Aroma essential oil inhalation Group (AG), Music Listening Group (MLG), or control group. The AG inhaled aroma essential oil for 10 minutes, the MLG listened to music for 10 minutes, and the control group took a break for 10 minutes. Stressors introduced to the participants included 70 dB of white noise and an arithmetic calculation.
Results The perceived stress was significantly different between three groups at 10 minutes and 30 minutes after the intervention. The stress responses of the AG and MLG were significantly lower than that of the control group. At 10 minutes and 30 minutes after the intervention, there were significant differences in the Bispectral index (BIS) between three groups, and the BIS of the AG and MLG were significantly lower than that of the control group. At 30 minutes after the intervention, the stress index, systolic blood pressure, and heart rate were significantly different between three groups.
Conclusion Aroma essential oil inhalation and music listening are effective nursing interventions as they reduce stress, stabilize vital signs, and have sedative effects in healthy adults who perceive stress.
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Purpose This concept analysis was performed to clarify “stress in hemodialysis patients”. Methods: Walker and Avant’s methodology guided the analysis. In addition, the concept was compared with stress from other perspectives. Results: Stress in hemodialysis patients was defined in terms of “Physical”, “Psychological”, “Social ‧ Economic”, and “Behavioral” dimensions. Stress in hemodialysis patients is preceded by kidney failure, fear of treatment, and uncertainty about prognosis, after which there is often negative coping such as non-compliance with treatment, or positive coping such as maintaining the status quo, relying on medical staff, conforming to treatment, and self-management. Conclusion: It is necessary to develop a stress intervention program suitable for hemodialysis patients and a tool to identify the concept of stress in hemodialysis patients suitable for domestic situations, as well as conduct further research to identify its influencing factors.
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Purpose This study aimed to identify variables influencing the sexual adjustment of patients who underwent radical prostatectomy in order to establish a structural model and intervention strategy for improving patients’ sexual adjustment. Methods Participants were 179 patients who received follow-up care after undergoing radical prostatectomy at two university hospitals in South Korea. Data were collected from July to November, 2017 using structured questionnaires. The exogenous variables were urinary symptoms and age, and the endogenous variables were sexual function, self-esteem, depression, couple intimacy, and sexual adjustment. The collected data were analyzed using SPSS 21.0 and AMOS 21.0. Results The goodness-of-fit measures of the final hypothetical model were satisfactory, as follows: χ2 /df=2.68, GFI=.91, CFI=.90, RMSEA=.09, SRMR=.07. Sexual function, self-esteem, and couple intimacy had direct and total effects on sexual adjustment in patients who underwent radical prostatectomy, and age had only an indirect effect. These variables explained 66.5% of sexual adjustment among patients. Urinary symptoms and depression did not show any significant effects, however. Conclusion To improve sexual adjustment in patients who underwent radical prostatectomy, it is imperative to establish active and effective nursing interventions to strengthen their sexual function, self-esteem, and couple intimacy, considering their age.
Purpose This study aimed to examine health-promoting behaviors among Vietnamese students in Korea and identify the factors affecting these behaviors.
Methods: A survey using self-administered questionnaires was employed. Data were collected between October 2020 and May 2021 from 260 Vietnamese students whose stay in Korea has been for longer than six months and who agreed to participate in the study. Variables included health-promoting behaviors (physical activity, nutrition, stress management, and health risk behavior), self-esteem, acculturative stress, and social support. A multiple regression analysis was performed to assess the factors that might influence health-promoting behaviors.
Results: Of the total participants, 56.9% were women, and the mean age was 24.60±2.58 years. The mean score of the participants on total health-promoting behaviors was 2.64±0.36, on self-esteem 2.96±0.35, on acculturative stress 2.39±0.15, and on social support 2.53±0.24. Self-esteem, acculturative stress, social support, length of stay in Korea, and education level were found to affect healthpromoting behaviors, and these variables explained 76.2% of the variance.
Conclusion: There is a need to develop intervention strategies for promoting self-esteem and social support programs and coping strategies for managing acculturative stress to increase health-promoting behaviors among Vietnamese students.
Purpose This study was conducted so as to determine a hypothetical model concerning factors affecting breast cancer patients' resilience.
Methods: Data were collected via a self-administered questionnaire from 212 patients with breast cancer between July 25 and August 24, 2020. The data were analyzed using SPSS/WIN 20.0 and AMOS 21.0.
Results: The model supported 7 of the 11 presented hypotheses for all participants. Test results indicated that “hope”, “uncertainty”, and “symptom experience” all directly affected participants' resilience, and that “uncertainty” also affected participants', “depression” and “hope”. “Spiritual well-being” affected participants' sense of “hope” and “symptom experience”. Of these variables, “hope” had the strongest direct influence on resilience across all participants. “Uncertainty” was found to directly and indirectly affect participants, whereas “spiritual well-being” indirectly affected the resilience of all participants. “Uncertainty” and “spiritual well-being” indirectly affected the resilience of all participants.
Conclusion: These results suggest that management strategies to enhance breast cancer patients' resilience should address patients' uncertainty, spiritual well-being, hope, and symptom experience.
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Purpose This study aimed to examine the influence of lifestyle-related factors, such as sleep quality, eating habits, and perceived stress, on the incidence of thyroid cancer in healthy adults.
Methods: This study is a cross-sectional case-control study comparing lifestyle-related factors in thyroid cancer and healthy groups. Outpatients with thyroid cancer were recruited from 2012 to 2013, 3~6 months after thyroidectomy at a tertiary hospital in Seoul, Korea (n=468). For the control group, 935 healthy adults were recruited by propensity score matching on demographic characteristics in a 1:2 ratio from hospital health checkup data. The effect of sleep quality, eating habits, and perceived stress on the incidence of thyroid cancer was determined through multiple logistic regression analysis and backward stepwise variable selection.
Results: Sleep disturbance and mild/moderate daytime dysfunction were found to have a 1.22 and 1.66/1.77-fold influence, respectively, in patients with thyroid cancer than in healthy controls (p<.05). Coffee consumers who drink 3~6 times/day showed reduced cancer incidence than those who drink very little (odds ratio=0.53, 95% confidence interval=0.32~0.87). Perceived stress was a significant risk factor in univariate (p=.004), but not in multivariate analysis.
Conclusion: These findings highlight the need for evaluating sleep quality, especially in high-risk adults and patients with thyroid cancer. Preventive measures should be adopted to lower stress levels and improve sleep quality.
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Purpose The purpose of this study was to explore and describe the process of illness adaptation of patients with Atrial Fibrillation (AF). Methods Data were collected from December 2017 to July 2018 through individual in-depth interviews with thirteen patients with AF. Verbatim transcripts were analyzed using the grounded theory methodology developed by Corbin and Strauss. Results The core category about the illness adaptation process of patients with AF was identified as “living a life managing the silent insurrection of the heart.” The process of illness adaptation of patients with AF consisted of four phases: “withdrawal”, “transition”, “practice”, and “adeptness”. Conclusion An in-depth understanding of the illness adaptation process of patients with AF will guide nurses in proactively developing and implementing effective nursing interventions to better support patients with AF in Korea.
Purpose The purpose of this study was to investigate the roles of the perception of aging symptoms in mediating and moderating the relationship between family function and stress in middle-aged adults. Methods This was a cross-sectional correlational study of 244 middle-aged men and women. Self-administered surveys were conducted using the Family APGAR, stress index, and symptom management beliefs questionnaire. The data were analyzed using descriptive statistics, independent t-test, Pearson’s correlation coefficient, hierarchical multiple regression analysis, and PROCESS macro using SPSS 23.0. Results A significant interaction between family function and the perception of aging symptoms in predicting stress was found, indicating a moderating effect of the perception of aging symptoms on the relationship between family function and stress. An indirect effect of family function on stress through the perception of aging symptoms was not significant, indicating an insignificant mediating effect of the perception of aging symptoms. Conclusion The relationship between family function and stress differed depending on participants’ perceptions of aging symptoms. Individuals with negative perceptions of aging symptoms may be vulnerable to stress caused by poorer family function. It is necessary to develop programs to help modify negative perceptions of aging as well as strengthen family function to decrease the stress of middle-aged adults.
Purpose This study aimed to identify the effects of psychological insulin resistance, diabetes distress, and diabetes self-efficacy of patients and their spouses on insulin therapy adherence of patients with type 2 diabetes. Methods A path analysis based on the actor-partner interdependence model, a couple analysis method, was used to identify the actor and partner effects of psychological insulin resistance, diabetes distress, diabetes self-efficacy on the insulin therapy adherence of patients with type 2 diabetes. Data were collected between February 25 and May 1, 2019, from 200 patients with type 2 diabetes and their spouses. Results The psychological insulin resistance of the patient had an actor effect on the diabetes self-efficacy of the patient and a partner effect on the diabetes self-efficacy of the spouse, and the patient’s diabetes distress had a partner effect on the diabetes self-efficacy of the spouse. The psychological insulin resistance of the spouse had an actor effect on the diabetes self-efficacy of the spouse, and the diabetes self-efficacy of the patient and spouse were found to affect the insulin therapy adherence of the patient directly. Conclusion This study provided basic data for the development of programs that can enhance insulin therapy adherence in patients with type 2 diabetes, focusing on the perspectives of both the patient and spouse.
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PURPOSE The purpose of the study was to evaluate the influence of patient activation on diabetes self-care activities and diabetes-specific distress among patients with type 2 diabetes mellitus. METHODS This cross-sectional correlational study was a secondary data analysis, utilizing data collected from September 2016 to July 2017, for 151 adults diagnosed with type 2 diabetes in ambulatory endocrinology units of two tertiary hospitals in a metropolitan city. The instruments used for data collection included the Summary of Diabetes Self-Care Activities Questionnaire, the Patient Activation Scale, and the Brief Diabetes Distress Screening Instrument. Hierarchical multiple linear regression analyses were conducted to test the influence of patient activation levels on self-care activities and diabetes-specific distress, after controlling for demographic and clinical variables. RESULTS The average patient activation level was 67.8±16.72 (with the possible range from 0 to 100), and the average diabetes-specific distress level was 6.91±2.69 (with the possible range from 2 to 12). Diabetes self-care activities scores were highest in medication adherence and lowest in glucose self-monitoring. Patient activation was the significant factor influencing self-care activities, after controlling for demographic and clinical variables, but showed no significant influence on diabetes-specific distress. Oral hypoglycemic agents and insulin medications were the significant factors influencing diabetes-specific distress. CONCLUSION These findings indicate the importance of nursing interventions to improve patient activation and to alleviate diabetes-specific distress. Therefore, in order to improve diabetes self-care activities, it is necessary to facilitate patient activation for diabetes care.
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