Purpose
This study examined the knowledge structure and thematic characteristics of health literacy research in Korea through keyword network analysis and topic modeling.
Methods
Keyword frequency and co-occurrence network analyses included 637 articles. For latent Dirichlet allocation, English abstracts were combined with standardized author keywords. After preprocessing and document-frequency filtering, 636 articles remained in the effective latent Dirichlet allocation corpus. Models with 3–10 topics were evaluated across 10 random seeds according to log-likelihood, perplexity, semantic coherence, topic distinctiveness, cross-seed stability, and interpretability of representative documents. A five-topic solution was selected, and the final model was estimated using seed 2026. An abstract-only sensitivity analysis was conducted with 633 articles.
Results
Health literacy occupied the most central position in the network, as expected because it was the core search concept. Among the remaining keywords, older adults, eHealth literacy, self-efficacy, health behavior, and self-care had the highest degree centrality. Louvain clustering identified six thematic communities. The five latent Dirichlet allocation topics were Health Literacy Measurement, Mental Health Literacy, Health Information and Communication, Digital Health Literacy, and Disease-Specific Health Literacy. Topic prevalence ranged from 17.1% to 21.4%. Disease-Specific Health Literacy was the largest topic (21.4%, n=136), followed by Digital Health Literacy (21.2%, n=135) and Mental Health Literacy (21.1%, n=134). The sensitivity analysis produced a broadly comparable five-topic structure.
Conclusion
This study systematically mapped the knowledge structure of Korean health literacy research. The findings shed light on major research themes and their relationships and may help inform future research priorities.

Purpose
This study examined sociodemographic, clinical, and symptom-related factors associated with current employment among cancer survivors and described sex-based differences in occupational continuity.
Methods
This cross-sectional study used data from the 2019 and 2021 Korea National Health and Nutrition Examination Survey. The sample included cancer survivors aged 19 to 65 years who did not have multiple primary cancers or missing data (n=289). Employment status was categorized as employed or non-employed. Sociodemographic factors (age, sex, education, marital and household characteristics, household income, and private insurance), clinical factors (time since diagnosis, cancer type, current cancer status, and comorbidity), and symptom-related factors (pain, fatigue, depression, memory problems, and sleep difficulties) were evaluated using hierarchical logistic regression. Weighted descriptive analyses were performed to examine sex-based differences in occupational continuity.
Results
Overall, 56.6% of participants were employed. In the final model, male sex was associated with higher odds of employment (odds ratio [OR], 4.69; 95% confidence interval [CI], 2.21–9.94; p<.001), whereas monthly household income below 3 million Korean won was associated with lower odds of employment (OR, 0.41; 95% CI, 0.19–0.88; p<.05). Sleep difficulties were non-significantly associated with lower odds of employment (OR, 0.64; 95% CI, 0.41–1.00; p=.051). No clinical factor was significantly associated with employment. Male participants were more likely than female participants to retain their longest-held occupation (58.3% vs. 30.9%).
Conclusion
Employment among cancer survivors was associated with sex and household income, and occupational continuity differed by sex. Although sleep difficulties were not statistically significant in the final model, sleep assessment and sex-sensitive vocational support may be useful components of survivorship nursing care.

Purpose
Guided by Kolcaba’s Comfort Theory, this study aimed to identify predictors of comfort among patients with hepatocellular carcinoma after liver resection.
Methods
This cross-sectional predictive correlational study included 132 patients with hepatocellular carcinoma who underwent liver resection in Wenzhou, China. Demographic and clinical characteristics, including age, were collected. Comfort, pain severity, pain interference, perceived social support, and early mobilization were assessed using validated instruments. Data were analyzed using descriptive statistics, the independent-samples t-test, one-way analysis of variance, Pearson correlation coefficients, and standard multiple linear regression.
Results
Participants reported a moderate overall level of comfort. In the multiple regression model, pain interference (β=−.25, p=.008) and perceived social support (β=.39, p<.001) were significant predictors of comfort, with perceived social support emerging as the strongest predictor. Pain severity (β=−.09, p=.287), age (β=−.09, p=.264), and early mobilization (β=.01, p=.909) were not significant predictors. The regression model was statistically significant and explained 27% of the variance in comfort (R²=.27, F=9.20, p<.001).
Conclusion
Perceived social support and pain interference were independently associated with postoperative comfort among patients with hepatocellular carcinoma following liver resection. These findings highlight the importance of comprehensive pain management and nursing strategies that strengthen social support; such interventions may help improve postoperative comfort and recovery.

Purpose
This study evaluated the immediate and sustained effects of a clinical decision-making program based on Simon’s decision-making model on medication safety competency among advanced-beginner nurses in intensive care units.
Methods
This nonequivalent control group pretest-posttest study used a time-lagged design and included 18 intensive care unit nurses at a tertiary hospital, with 12 assigned to the intervention group and six to the control group. The intervention group participated in a 2-week clinical decision-making program that integrated case-based learning and high-fidelity simulation, whereas the control group received lecture-based education. Clinical decision-making ability, medication safety competency, and safety motivation were measured at baseline and at 2 and 4 weeks after baseline. Near-miss medication error experiences were assessed at baseline and at 4 and 10 weeks. Data were analyzed using the independent t-test, Mann-Whitney U test, and linear mixed models.
Results
Clinical decision-making ability (F=3.94, p=.026), medication safety competency (F=4.97, p=.011), safety motivation (F=5.20, p=.009), and near-miss medication error experiences (F=14.28, p<.001) showed significant group-by-time interaction effects, indicating that outcome trajectories differed between the intervention and control groups.
Conclusion
These findings suggest that the program may be an educational strategy for strengthening nurses’ clinical decision-making during medication administration and improving medication and patient safety in intensive care unit settings.

Purpose
Stroke is a leading cause of morbidity and mortality worldwide, and rapid early detection is essential. Although screening tools such as FAST (face, arm, speech, and time) are widely used, they may miss posterior strokes, whereas BE-FAST (balance-eyes, face, arm, speech, and time) demonstrates greater sensitivity. However, its implementation in digital formats remains limited. This study aimed to develop, validate, and implement BE-ALERT (balance-eyes-arm weakness-language difficulties-extreme headache-reaction slowed or confusion-time to response) as a community-based early stroke detection application.
Methods
This research and development study consisted of development, validation, diagnostic accuracy testing, and community implementation. The development and validation phase included 160 family caregivers of patients with stroke who were aged ≥18 years. The diagnostic accuracy phase included 500 family caregivers who accompanied consecutive patients with suspected stroke in the emergency department. Family caregivers completed the BE-ALERT assessment while accompanying the patients, and their assessment results were compared with neurologist-confirmed diagnoses.
Results
Validation showed a content validity index of 0.95 and a Cronbach α reliability coefficient of .82. Community implementation among 160 participants was associated with higher stroke knowledge scores (82.1) and stronger intention to seek immediate treatment (4.5). Receiver operating characteristic curve analysis yielded an area under the curve of 0.836, indicating good diagnostic accuracy. BE-ALERT showed a sensitivity of 85.0%, specificity of 82.1%, negative predictive value of 94.5% and System Usability Scale score of 74.
Conclusion
BE-ALERT is a practical, accurate, and well-accepted tool for community-based early stroke detection. It may support stroke screening, public education, and timely treatment-seeking behavior.

Purpose
This scoping review identified the core components of nursing competence required for general ward nurses to recognize and manage clinical deterioration and examined how this competence has been conceptualized in previous studies. It also synthesized individual- and system-level factors associated with competence and identified research gaps relevant to nursing education, future research, and patient safety initiatives.
Methods
This scoping review was conducted using Arksey and O’Malley’s framework and reported in accordance with the PRISMA-ScR guidelines. Six databases—PubMed, CINAHL, Embase, the Cochrane Library, Scopus, and Web of Science—were searched for studies published between January 2016 and December 2025 using search terms related to clinical deterioration and nursing competence.
Results
Twenty-one studies met the inclusion criteria. The findings were organized into two domains: nursing competencies and factors associated with competence. Technical competencies included physical assessment, vital-sign monitoring, surveillance, information analysis, and application of escalation protocols. Non-technical competencies included situational awareness, clinical decision-making, intuition, leadership, interprofessional communication, and teamwork. Individual-level factors included clinical experience, self-confidence, skill acquisition, and clinical judgment. System-level factors included education and training, relationship-building with physicians, supportive work environments, electronic tools, organizational support, and teamwork culture.
Conclusion
Nursing competence in managing clinical deterioration is multidimensional and reflects the interaction of individual capabilities with system-level supports. Future research should develop educational strategies that strengthen both technical and non-technical skills while reinforcing organizational systems that support timely and effective responses to deterioration.

Purpose
This scoping review examined the characteristics and educational effects of simulation-based disaster nursing education programs for nursing students and nurses and aimed to provide foundational evidence for future curriculum design and research.
Methods
Following Joanna Briggs Institute methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, we searched four international and four Korean databases for studies published between January 2010 and December 2025. Studies were selected using the population, concept, and context framework and were limited to simulation-based educational interventions for disaster situations that reported quantitative learning outcomes. Twenty-four experimental or quasi-experimental studies with control groups met the inclusion criteria and were analyzed.
Results
Most studies included nursing students, although several involved practicing nurses. Simulation modalities included online and virtual simulations, high-fidelity manikins, standardized patients, tabletop exercises, and blended formats, and addressed scenarios such as earthquakes, mass-casualty incidents, hazardous events, and infectious disease outbreaks. Educational outcomes were grouped into cognitive, affective, and performance domains. Across studies, improvements were frequently reported in disaster-related knowledge, self-efficacy, performance competency, and learning motivation; however, evidence for long-term retention, teamwork, and interprofessional collaboration remained limited.
Conclusion
Simulation-based disaster nursing education may strengthen integrated disaster response competencies among nursing students and nurses. Structured programs incorporating pre-learning, scenario-centered practice, debriefing, and opportunities for repeated exposure may support competency development. Further research is needed to evaluate long-term and team-based outcomes and to develop multidisciplinary programs that more closely reflect real-world disaster contexts.

Purpose
Inadequate bowel preparation compromises the efficacy of colonoscopy. This study aimed to develop and evaluate a patient-tailored bowel preparation program designed to improve bowel preparation quality, medication adherence, and dietary adherence among patients undergoing colonoscopy.
Methods
The program consisted of four phases: (1) patient-specific assessment using a checklist; (2) personalized instructional videos; (3) short message service reminders; and (4) nurse-led counseling. A quasi-experimental, nonconcurrent nonequivalent control group, posttest-only design was used, with the control group recruited first. The study was conducted from April to July 2024 at a tertiary hospital in South Korea and included 80 adult outpatients scheduled for colonoscopy (40 control and 40 experimental participants). Outcomes included bowel preparation quality assessed using the Aronchick Bowel Preparation Scale, medication knowledge and adherence, and dietary knowledge and adherence.
Results
The experimental group demonstrated significantly higher bowel preparation quality than the control group (Z=8.13, p<.001, r=0.91). Medication knowledge and adherence were also significantly higher in the experimental group than in the control group (Z=3.54, p<.001, r=0.40; Z=6.50, p<.001, r=0.73; respectively). Similarly, dietary knowledge and adherence improved significantly in the experimental group compared with the control group (Z=5.28, p<.001, r=0.59; Z=5.32, p<.001, r=0.60; respectively).
Conclusion
The patient-tailored bowel preparation program effectively improved bowel preparation outcomes for colonoscopy. Future research should focus on integrating the program into electronic health records to enable automated delivery and improve efficiency and scalability in clinical practice.

Purpose
This study examined the association between family functioning and environmental mastery among breast cancer survivors. Specifically, it tested a serial mediation model involving autonomous motivation and healthy behaviors and compared this pathway with the potential role of controlled motivation.
Methods
A cross-sectional survey was conducted with 192 community-dwelling Korean breast cancer survivors recruited from an outpatient breast clinic. Participants completed a structured self-administered questionnaire assessing family functioning, autonomous and controlled motivation for self-management, engagement in healthy behaviors, and environmental mastery. Serial mediation was tested using a regression-based bootstrapping approach implemented with Hayes’ PROCESS macro.
Results
Family functioning was positively associated with both healthy behaviors and environmental mastery. The serial indirect effect through autonomous motivation and healthy behaviors was significant (standardized indirect effect, 0.03; 95% bootstrapped confidence interval [BootCI], 0.00–0.06). In addition, healthy behaviors independently mediated the association between family functioning and environmental mastery (standardized indirect effect, 0.11; 95% BootCI, 0.05–0.17). Controlled motivation was not significantly associated with family functioning and did not contribute to indirect effects.
Conclusion
Supportive family functioning may enhance environmental mastery primarily through greater engagement in healthy behaviors, including a significant sequential pathway involving autonomous motivation. These findings support family-centered, autonomy-supportive approaches that strengthen healthy behaviors to promote psychological adjustment during breast cancer survivorship.

Purpose
This study aimed to identify predictors of quality of life (QoL), including self-efficacy, social support, illness perceptions, and resilience, among colorectal cancer patients during the first 1 to 6 months after stoma surgery.
Methods
A predictive correlational design was used with 142 adult patients who had undergone stoma surgery within the preceding 1 to 6 months. Data were collected using validated instruments measuring QoL, self-efficacy, social support, illness perceptions, and resilience. The data were analyzed using descriptive statistics, the independent t-test, one-way analysis of variance, the Games-Howell post-hoc test, Pearson correlation coefficients, and hierarchical multiple linear regression analysis.
Results
The participants had a mean age of 56.15 years (standard deviation, 6.51 years); 67.6% were male, and 57.0% had a temporary stoma. In model 1, the method of paying medical expenses significantly predicted QoL, explaining 6.0% of the variance (adjusted R²=.06, p=.006), with self-financed patients reporting lower QoL than insured patients. In model 2, the addition of psychosocial variables (self-efficacy, social support, illness perceptions, and resilience) substantially improved the model, explaining 70.0% of the variance (adjusted R²=.70, p<.001). In the final model, illness perceptions (β=−.61), social support (β=.32), resilience (β=.20), and self-efficacy (β=.19) were significant predictors (all p<.001), whereas method of paying medical expenses was no longer significant.
Conclusion
This study provides evidence to support the development of interventions targeting illness perceptions, social support, resilience, and self-efficacy to improve QoL among stoma patients during the early postoperative period.

Purpose
This study examined the relationships among nurses’ readiness for artificial intelligence (AI), attitudes toward AI, and behavioral intention to use AI, focusing on clinical nurses in a tertiary hospital setting.
Methods
A cross-sectional descriptive study was conducted using an online self-report survey of 218 clinical nurses recruited through convenience sampling from a tertiary hospital in South Korea. AI readiness was measured using the Medical Artificial Intelligence Readiness Scale, attitudes toward AI were assessed using the Korean version of the General Attitudes toward Artificial Intelligence Scale, and behavioral intention was measured using items adapted from the Unified Theory of Acceptance and Use of Technology. Open-ended responses were summarized descriptively to explore expected AI applications.
Results
Clinical nurses demonstrated varying levels of AI readiness, attitudes toward AI, and behavioral intention to use AI, and these variables were positively correlated. Among AI readiness dimensions, ability and ethics tended to show stronger bivariate correlations with behavioral intention than vision. Hierarchical regression analysis indicated that attitudes toward AI were strongly associated with behavioral intention (β=.61, p<.001), whereas AI readiness factors showed weaker associations after attitudes were included. Open-ended responses suggested potential AI applications in both direct and indirect nursing care.
Conclusion
Attitudes toward AI were strongly associated with nurses’ behavioral intention to use AI. AI readiness dimensions, particularly ability and ethics, were also associated with behavioral intention in correlation analyses, underscoring the importance of practical competence and ethical awareness. These findings provide empirical evidence to inform AI-related education, clinical integration, and organizational support strategies in nursing.

Citations

• Nurses' knowledge, attitudes, literacy, anxiety, and readiness towards artificial intelligence in clinical practice: An international scoping review
  Aanuoluwapo Clement David-Olawade, Adewoyin A. Osonuga, David B. Olawade
  Applied Nursing Research.2026; 91: 152135.     CrossRef

Purpose
This study analyzed publications from the past decade in the Korean Journal of Adult Nursing (KJAN) to examine patterns in research design and thematic trends using both manual coding and topic modeling approaches.
Methods
A retrospective review was conducted of research articles published in KJAN between 2015 and 2024. Study designs and methodological characteristics were classified using a structured coding framework and analyzed with descriptive statistics. A text-mining approach incorporating keyword network analysis and latent Dirichlet allocation topic modeling was applied to examine thematic patterns.
Results
Over the past decade, quantitative research was the predominant methodological approach, accounting for more than 70% of the 544 studies. The proportion of qualitative research decreased, whereas literature reviews increased. Within quantitative research, experimental studies declined, while secondary-data analyses and online surveys increased substantially. Keyword and topic analyses consistently highlighted psychological health, quality of life, chronic illness, and older adults as central research domains. Topic modeling further identified five major themes: (1) clinical interventions and symptom management; (2) disease management and health literacy; (3) psychological health, quality of life, and family/social support; (4) health behavior and functional/physical health; and (5) clinical practice, nursing workforce, and work environment.
Conclusion
Adult nursing research in South Korea demonstrates both continuity and change, with sustained emphasis on psychosocial and chronic illness–related topics and increasing attention to workforce issues. To strengthen future scholarship, greater efforts are needed to ensure that findings derived from diverse research designs are reported in a coherent and integrated manner.

Purpose
This systematic review aimed to evaluate electrocardiogram interpretation competency among emergency and critical care nurses and to examine the diagnostic performance, benefits, and limitations of computerized and artificial intelligence–based electrocardiogram interpretation systems.
Methods
This systematic review was conducted in accordance with PRISMA 2020 guidelines and registered in the International Prospective Register of Systematic Reviews under registration number CRD420251169307. Six electronic databases and additional sources were searched for studies published between January 2020 and October 2025, with the final search conducted in October 2025. Studies were included if they involved registered nurses interpreting electrocardiograms in acute care settings or evaluated computerized electrocardiogram interpretation systems using adult datasets. Methodological quality was assessed using validated tools appropriate to study design, including the Joanna Briggs Institute critical appraisal tools, ROBINS-I, and QUADAS-2.
Results
Mean electrocardiogram interpretation scores among nurses ranged from 43% to 68%, with fewer than 40% of participants meeting predefined competency thresholds. Performance was strongest for asystole recognition and weakest for tachyarrhythmias, myocardial ischemia, and conduction abnormalities. Artificial intelligence–based systems demonstrated high diagnostic accuracy, with area under the curve values ranging from 0.91 to 0.97 and sensitivity exceeding 94% across major diagnostic tasks.
Conclusion
Emergency and critical care nurses demonstrated insufficient electrocardiogram interpretation competency in several safety-critical domains. Computerized and artificial intelligence–based systems showed high diagnostic accuracy and may serve as effective complementary tools when integrated with ongoing nurse education and appropriate clinical oversight.

Purpose
This systematic review and meta-analysis examined the effects of shared decision-making (SDM)-based self-management interventions on health outcomes in patients with chronic obstructive pulmonary disease (COPD).
Methods
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, three databases were searched in July 2022, supplemented by gray literature and citation searching. Randomized controlled trials that integrated SDM components into COPD self-management programs were included. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. Random-effects models were used to pool odds ratios (ORs) for dichotomous outcomes and standardized mean differences (SMDs) for continuous outcomes, with 95% confidence intervals (CIs). Outcomes included hospital readmission, health-related quality of life (HRQoL), functionality, physical symptoms, psychological symptoms (depression and anxiety), and self-efficacy.
Results
Seven studies (n=1,028) met the inclusion criteria. SDM-based interventions showed no statistically significant difference in hospital readmission (OR=1.59, 95% CI, 0.79 to 3.19; I²=49.1%) and no significant improvement in HRQoL (SMD=0.19, 95% CI, –0.14 to 0.51; I²=98.3%). Depression showed no significant effect (SMD=–0.01, 95% CI, –0.39 to 0.38; I²=98.1%). Self-efficacy improved slightly (SMD=0.12, 95% CI, 0.01 to 0.23; I²=89.4%), with substantial heterogeneity. Evidence for other secondary outcomes was inconsistent.
Conclusion
SDM-based self-management interventions did not demonstrate clear benefits for hospital readmission or HRQoL in patients with COPD. Given the heterogeneity across studies, these findings should be interpreted cautiously. Future trials should use standardized SDM frameworks, assess implementation fidelity, and apply consistent outcome measures to clarify the role of SDM in COPD management.

Purpose
Stage 3 chronic kidney disease (CKD) is highly prevalent and often progresses to end-stage renal disease without effective self-management. This study examined the effects of an Individual and Family Self-Management Program delivered via a mobile communication application on self-management behaviors and clinical outcomes among patients with stage 3 CKD.
Methods
A 12-week quasi-experimental study with a pretest-posttest control group design was conducted among 50 patients with stage 3 CKD at a tertiary hospital in Thailand, between January and May 2024. The intervention group received a self-management program grounded in Individual and Family Self-Management Theory and delivered via the LINE chatbot. The program included educational content, self-regulation strategies, and structured family support, while the control group received usual care. Outcomes included self-management behaviors, estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and hemoglobin A1c (HbA1c). Analysis of covariance was used to adjust for baseline differences.
Results
After adjustment for baseline values, the intervention group showed significantly greater improvements in self-management behaviors (F=7.92, p<.05) and eGFR (F=52.92, p<.001) compared with the control group. Significant reductions were also observed in SBP (F=26.84, p<.001), DBP (F=12.61, p<.05), and HbA1c levels (F=7.74, p<.05).
Conclusion
A mobile-based Individual and Family Self-Management Program effectively improved self-management behaviors and key clinical outcomes among patients with stage 3 CKD, supporting the integration of family engagement and digital technology in chronic disease care.

Purpose
While capability and opportunity factors in dementia prevention have been extensively studied, the motivational mechanisms that translate these resources into behavior remain relatively underexplored. This study examined the mediating effect of self-efficacy on the relationships between instrumental activities of daily living (IADL), social networks, and dementia-prevention behaviors among community-dwelling older adults, guided by the capability, opportunity, motivation-behavior (COM-B) theoretical framework.
Methods
A cross-sectional study was conducted with 205 community-dwelling adults aged 65 years and older residing in Gyeongsangnam Province, South Korea. Data were collected between July and September 2024 using validated instruments, including the Korean Instrumental Activities of Daily Living, Social Network Measurement Scale, General Self-Efficacy Scale, and Korean Health Behavior for Dementia Prevention Scale. Mediation analysis was performed using Hayes’ PROCESS macro (model 4) with bootstrap resampling (5,000 iterations) to estimate indirect effects, while controlling for demographic and health-related covariates.
Results
Self-efficacy significantly mediated both the IADL–dementia-prevention behavior relationship (indirect effect, −0.33; 95% confidence interval [CI], −0.61 to −0.12) and the social network– dementia-prevention behavior relationship (indirect effect, 0.08; 95% CI, 0.002 to 0.19). The mediation models explained 40.7% and 48.5% of the variance in dementia-prevention behaviors, respectively. Bootstrap CIs confirmed significant partial mediation effects in both pathways.
Conclusion
These findings provide empirical support for the COM-B model’s theoretical proposition that motivation serves as a critical bridge linking capability and opportunity factors to actual behavior. Nursing interventions should therefore integrate self-efficacy–enhancement strategies alongside traditional capability-building and opportunity-provision approaches to maximize the effectiveness of dementia-prevention programs for older adults.

Purpose
Concern about graft rejection is a major issue among kidney transplant recipients. However, integrated studies that examine diverse factors influencing the perceived threat of the risk of graft rejection (PTGR) remain rare. This study explored levels of PTGR and the factors associated with PTGR in kidney transplant recipients.
Methods
A cross-sectional study was conducted with 194 kidney transplant recipients recruited from a tertiary hospital in South Korea. The PTGR scale assesses graft-related threat, intrusive anxiety, and lack of control, and was administered alongside measures of transplant-related symptoms, anxiety, depression, social support, and self-efficacy.
Results
Approximately 70.1% of participants reported strong graft-related threat beliefs, 57.2% experienced high intrusive anxiety, and 46.9% reported a low sense of control related to PTGR. Demographic factors (age, gender, education level, and kidney donor), clinical factors (transplant complications, posttransplant duration, and symptoms), and psychosocial factors (anxiety, depression, and social support) were associated with PTGR. Women, higher education levels, longer posttransplant duration, and donor relationship predicted graft-related threat, whereas anxiety and donor relationship predicted intrusive anxiety.
Conclusion
Many kidney transplant recipients experience high levels of PTGR, which are associated with demographic, clinical, and psychosocial factors. Healthcare providers should consider these factors when assessing PTGR and incorporate them into targeted interventions to support kidney transplant recipients.

Purpose
This study aimed to identify a clinically meaningful cut-off score on the Pressure Ulcer Scale for Healing tool for objectively determining healing in adult inpatients with pressure injury.
Methods
A retrospective analysis was conducted using electronic health records from adult inpatients at a tertiary hospital in South Korea. Pressure Ulcer Scale for Healing scores were calculated based on wound size, exudate amount, and tissue type. Receiver operating characteristic curve analyses were performed, and optimal cut-off scores were identified using the Youden Index. Stratified analyses by pressure injury stage were also conducted to evaluate predictive performance.
Results
A total of 20,476 pressure injuries were analyzed, of which 5,873 were classified as healed. Although all stages were initially included, stage 1 pressure injuries demonstrated limited discriminative ability (area under the curve=0.612) and were therefore excluded from cut-off derivation. For stage 2 or higher pressure injuries, the optimal cut-off score was 3.5, yielding an area under the curve of 0.721, with a sensitivity of 59.8% and a specificity of 72.0%.
Conclusion
The identified threshold for stage 2 or higher pressure injuries demonstrated meaningful discriminative ability for determining wound healing status. Application of this criterion may support more objective and consistent clinical decision-making when using the Pressure Ulcer Scale for Healing in nursing practice.

Purpose
This study aimed to examine the effects of a post-discharge tailored telephone (TATE) follow-up program for patients with low health literacy (LHL) who had undergone percutaneous coronary intervention.
Methods
This pilot study employed a non-equivalent control group pretest–posttest design to evaluate the preliminary effects of a TATE follow-up program at a university hospital in Seoul. Data were collected from July 2020 to September 2021. A total of 51 patients were recruited, and 46 completed the study. Patients were divided into three groups: an intervention group with LHL, a control group with LHL, and a control group with high health literacy. The intervention group received two 15-minute phone calls as part of the TATE follow-up program.
Results
The TATE follow-up program significantly improved disease- related knowledge in the intervention group compared with the control groups (p=.001). The intervention group also reported significantly higher satisfaction with nursing services than the other two groups (p=.006). However, there were no significant differences in changes in health behavior adherence among the groups, although the intervention group with LHL showed the greatest increase of 17.5 points after the intervention.
Conclusion
This pilot study demonstrated that the TATE follow-up program was effective and feasible for improving disease-related knowledge and satisfaction with nursing services among patients with LHL. These findings highlight the importance of tailored transitional care interventions to support cardiovascular disease management and secondary prevention.

Purpose
This study investigated the relationships of autonomy, self-efficacy, and social support with rehabilitation motivation in patients who had undergone acute stroke management. Methods: A cross-sectional descriptive correlational study was conducted at a tertiary university hospital in Suwon, South Korea. Data were collected from June 1, 2023, to June 1, 2024, using structured self-reported questionnaires administered to patients scheduled for discharge after their first-ever acute stroke management. A total of 231 patients diagnosed with stroke participated in the study. Hierarchical multiple regression analysis was performed to identify predictors of rehabilitation motivation. Results: Positive bivariate relationships were observed between autonomy (r=.26, p<.001), self-efficacy (r=.26, p<.001), social support from family (r=.22, p<.001), social support from medical teams (r=.26, p<.001), and rehabilitation motivation. In the hierarchical multiple regression analyses, patients with paralysis (β=−.21, p=.001), higher autonomy (β=.19, p=.003), and higher social support from the medical team (β=.22, p<.001) demonstrated higher rehabilitation motivation. Conclusion: Based on these findings, nursing interventions and educational strategies that enhance patient autonomy and strengthen support from medical teams should be developed and implemented to improve rehabilitation motivation, engagement, and health outcomes in acute stroke care.

Purpose
This study aimed to investigate the frequency and perceived importance of 52 clinical research nursing activities in Korea and to apply importance–performance analysis (IPA) to identify areas requiring improvement.
Methods
A descriptive survey was conducted among 96 clinical research nurses (CRNs) with ≥2 years of experience. Data were collected online in May 2022 using a questionnaire addressing 14 general characteristics and 52 clinical research nursing activities across five dimensions: clinical practice (CP), study management (SM), care coordination and continuity, human subjects protection, and contributing to the science (CS), as defined by the US National Institutes of Health (NIH). Frequency and importance were evaluated on a 6-point Likert scale. Analyses included descriptive statistics, Pearson correlation coefficients, the t-test, analysis of variance with Duncan post hoc tests, and IPA.
Results
The mean frequency and importance scores for the 52 activities were 2.02±1.27 and 2.91±1.24, respectively. CP activities were performed most often and rated as most important, whereas CS activities were performed least often and rated as least important. Higher education, certification, and professional association membership were associated with higher CS activity frequencies. IPA revealed strengths in CP and core SM activities, while regulatory reporting, data integrity assurance, and site audits were underperformed despite being highly important.
Conclusion
Korean CRNs play essential roles in CP and SM but require enhanced education, institutional support, and clearer role delineation in regulatory and quality-assurance activities. These findings provide evidence to guide CRN education, policy development, and the strengthening of professional identity among CRNs in Korea.

Purpose
This study examined the associations between sociodemographic characteristics, knowledge, self-efficacy, social support, comorbidities, and self-care quality among CAPD patients in Central Java, Indonesia.
Methods
This cross-sectional study included CAPD patients recruited from two tertiary referral hospitals in Central Java (Dr. Kariadi Hospital and Dr. Moewardi Hospital). Data were collected from April to May 2025, with a total sample of 72 patients. The study instruments comprised the Self-care Scale for Peritoneal Dialysis Patients, a knowledge questionnaire, the Duke-UNC Functional Social Support Questionnaire, and the General Self-Efficacy Scale. Data analysis was performed using the chi-square test, Spearman’s rank correlation, and univariate logistic regression.
Results
Univariate logistic regression analysis demonstrated that the presence of comorbidities was associated with significantly lower odds of good self-care quality (odds ratio [OR], 0.05; 95% confidence interval [CI], 0.01–0.18; p<.001). Higher levels of knowledge (OR, 1.45; 95% CI, 1.19–1.78; p<.001), self-efficacy (OR, 1.27; 95% CI, 1.14–1.42; p<.001), and social support (OR, 1.38; 95% CI, 1.16–1.64; p<.001) were significantly associated with better self-care quality. Sociodemographic factors showed no statistically significant associations with self-care quality (all p>.05).
Conclusion
Among CAPD patients in Central Java, higher levels of knowledge, self-efficacy, and social support were associated with better self-care quality, whereas the presence of comorbidities was associated with factors hindering optimal self-care. Sociodemographic variables did not demonstrate clear associations with self-care quality, which may be partly attributable to limited statistical power in this sample.

Purpose
Metabolic syndrome (MetS) patients have a higher risk of cardiovascular disease (CVD) incidence and mortality than those without MetS. The effects of non-pharmacological exposures may help improve the management of CVD. This study aimed to assess the long-term effects of non-pharmacological exposures on CVD in MetS patients through a meta- analysis of cohort and case-control studies.
Methods
Searches were conducted in seven databases (PubMed, Embase, CINAHL, Cochrane, RISS, NDSL, and KoreaMed) between August 7, 2024 and December 1, 2024. The quality of the included studies was assessed using the Newcastle-Ottawa Scale. The meta-analysis was conducted using the RevMan 5.4 program and RStudio 2022.12.0. A total of nine studies were included in the systematic review, with eight studies analyzed in the meta-analysis (PROSPERO CRD42024584658).
Results
A total of nine studies were included in the systematic review, of which eight were eligible for meta-analysis to evaluate the effects of non-pharmacological exposures. Eight studies were included for meta-analysis to investigate the effect of non-pharmacological exposures. The quality of individual studies was rated “good” for eight studies and “poor” for one. Non-pharmacological exposures in MetS patients were effective in reducing CVD-related mortality (relative risk [RR]=0.81, 95% confidence interval [CI], 0.73–0.91) and all-cause mortality (RR=0.80, 95% CI, 0.75–0.85).
Conclusion
Interventions and education on non-pharmacological exposures in MetS patients are associated with reduced CVD. As evidence continues to emerge, future studies should explore the long-term effects of diet, smoking, and sleep by assessing their individual impacts on CVD outcomes in individuals with MetS.

Purpose
This review presents a comprehensive overview of the utilization of educational technology for formative assessment in nursing education and proposes directions for its future application.
Methods
Arksey and O'Malley’s scoping review design was adopted. A total of 509 articles were retrieved in February 2025 from the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, Embase, Education Resources Information Center, Scopus, PubMed, PsycINFO, and Web of Science databases.
Results
Twenty-five articles that conducted formative assessments utilizing educational technology among nursing students and nurses were analyzed. The analysis identified three key themes: educational technology, formative assessment, and educational feedback. Online platforms were the most frequently employed educational technology, while mobile applications have gained prominence since 2020. Formative assessment primarily evaluated knowledge in theoretical courses but has increasingly been used to evaluate skills in practicum settings since 2020. Immediate constructive feedback was provided by educators, peer learners, and non-human agents. Since 2020, feedback delivery has increasingly been automated through non-human agents, including artificial intelligence-based non-human agents.
Conclusion
This review, which focused on the implementation of educational technology-based formative assessment in nursing education, highlights the increasing adoption of non-human agents for delivering educational feedback in practicum courses. To strengthen educators’ competency in providing immediate and constructive educational feedback, sustained support from policymakers and educational institutions is required.

Citations

• Academic Performance in Nursing Education Through Digital Competencies and AI Integration: A Systematic Review
  Lorena Espina-Romero, Jorge Izaguirre Olmedo, Angélica Ochoa-Díaz, Omar El Kadi Janbeih, Karla Rojas Jimenez, Hugo Benzaquen Hinope
  Encyclopedia.2026; 6(7): 143.     CrossRef

Purpose
This study aimed to analyze the multiple mediating effects of self-esteem, depression, and crisis coping on the relationship between disability acceptance and life satisfaction among older adults with disabilities, comparing periods before and during the coronavirus disease 2019 pandemic. Methods: This study employed a longitudinal comparative design, using data from waves 1–5 of the Disability and Life Dynamics Panel. The sample was divided into pre-pandemic (2018–2019) and pandemic (2020–2022) periods. Roy’s adaptation model served as the theoretical framework. Multiple mediation effects were examined using the PROCESS macro (Model 6). Results: Both the direct and indirect effects of disability acceptance on life satisfaction were significant, indicating partial mediation. In the pre-pandemic period, approximately 60% of the total effect was attributable to the direct effect and 40% to the indirect effect. During the pandemic, the proportion shifted, with the direct effect decreasing to 49% and the total indirect effect increasing to 51%. Conclusion: In crisis situations such as a pandemic, self-esteem, depression, and crisis coping play crucial roles in improving life satisfaction among older adults with disabilities. These findings highlight the need for policy approaches that consider diverse socio-psychological factors to increase life satisfaction among older adults during pandemics.

Citations

• Exploring differences in conceptual models of general self-efficacy between employed and non-employed adults with physical impairments
  Byungmo Ku, Jung-Min Lee, Justin Haegele
  Journal of Health Psychology.2026;[Epub]     CrossRef

Purpose
This study aimed to examine the influences of online health information-seeking behavior and e-health literacy on self-management among patients undergoing hemodialysis. Methods: A correlational survey was conducted with 150 adult hemodialysis patients who had been receiving dialysis for at least three months. Data were collected from July to November 2023 using structured questionnaires. The variables measured included online health information-seeking behavior, e-health literacy, and self-management. Data were analyzed using descriptive statistics, the independent t-test, one-way analysis of variance, Pearson correlation coefficients, and hierarchical multiple regression with IBM SPSS/WIN 28.0. Results: Participants demonstrated moderate to high levels of online health information-seeking behavior, e-health literacy, and self-management. Self-management was positively correlated with online health information-seeking behavior (r=.34, p<.001) and e-health literacy (r=.45, p<.001). Hierarchical multiple regression analysis identified e-health literacy (β=.30, p<.001), regular exercise during the past year (β=.27, p<.001), and alcohol consumption during the past year (β=−.22, p=.002) as significant predictors of self-management, explaining 32% of the variance. Conclusion: E-health literacy, regular exercise, and alcohol consumption significantly affect self-management among hemodialysis patients. Therefore, nursing interventions should focus on enhancing e-health literacy and promoting healthy lifestyle habits to strengthen self-management capabilities in this population.

Purpose
This study aimed to identify key predictive factors influencing adherence to physical exercise rehabilitation among adults during the first three months following a first-onset ischemic stroke in China. Methods: A cross-sectional descriptive study was conducted among 137 adults who attended clinical follow-up appointments within the first three months after experiencing a first-onset ischemic stroke. Predictors included family support, coping with role transition, depression, self-efficacy, and body image. Hierarchical multiple regression analysis was performed. Results: The mean adherence score for physical exercise rehabilitation was 39.58 (standard deviation=6.71), indicating a moderate adherence level (70.6%). In model 1, male sex (β=.20, p=.017) and post-stroke duration of 2 months (β=.31, p=.015) and 3 months (β=.39, p=.002) were significant predictors of adherence to physical exercise rehabilitation. Adding main predictors in model 2 resulted in a significant increase in explained variance (ΔR²=.418, p<.001), accounting for 51.5% of the total variance (R²=.515, adjusted R²=.484). Male sex (β=.15, p=.017), family support (β=.43, p<.001), self-efficacy (β=.26, p<.001), depression (β=–.24, p=.001), and coping with role transition (β=.16, p=.033) were significant predictors. Body image and post-stroke duration were not significant after adjustment. Conclusion: Efforts to promote adherence to physical exercise rehabilitation should prioritize family support, depressive symptoms, self-efficacy, and coping with role transition. Furthermore, body image may warrant attention when developing sex-specific intervention strategies.

Purpose
This study examined the 16-year longitudinal impact of social frailty on quality of life (QoL) and health-related quality of life (HRQoL) among middle-aged and older adults. Methods: Data were obtained from the Korean Longitudinal Study of Aging (2006–2022), comprising 9,905 participants (6,003, aged 45–64 years; and 3,902, aged ≥65 years). Social frailty was assessed using five components: social support, social activity, social network, loneliness, and living alone. QoL and HRQoL were measured using self-reported satisfaction scales. Generalized estimating equations were applied to adjust for covariates. Results: Social frailty was prevalent among both middle-aged (44.6%) and older adults (60.1%) and was significantly associated with lower QoL and HRQoL. In longitudinal analyses, declines in QoL and HRQoL persisted throughout the follow-up period in older adults, whereas in middle-aged adults, the declines were significant only during the earlier years. In middle-aged adults, current smoking exerted a stronger negative impact on QoL and HRQoL (QoL: β=–4.33, p<.001; HRQoL: β=–2.89, p<.001), while in older adults, lack of regular exercise had a greater effect on HRQoL (β=–3.84, p<.001). Conclusion: Social frailty was associated with lower QoL and HRQoL across both age groups, with stronger and more persistent effects among older adults. Early interventions are needed during midlife, while sustained strategies are essential in later life. Age-specific approaches are crucial to promoting healthy aging.

Citations

• Longitudinal course of depressive symptoms and the risk of all-cause mortality in a nationally representative cohort of middle-aged and older adults in South Korea: exploring the mediating role of social frailty
  Seong-Uk Baek, Jin-Ha Yoon
  GeroScience.2026;[Epub]     CrossRef
• Association between social frailty and problematic alcohol use among middle-aged and older adults: findings from a longitudinal study in South Korea
  Seong-Uk Baek, Jin-Ha Yoon
  Archives of Gerontology and Geriatrics.2026; 148: 106282.     CrossRef
• Longitudinal trajectories of social frailty and the risk of all-cause mortality among older adults in South Korea: exploration of the mediating role of cognitive functioning
  Seong-Uk Baek, Jin-Ha Yoon, Qian-Li Xue
  The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences.2026;[Epub]     CrossRef

Purpose
Person-centered care emphasizes the therapeutic relationship between medical staff and patients, founded on mutual trust and understanding. In intensive care settings, there is growing recognition of the need to improve the care environment and promote patient-focused nursing. This study aimed to construct and validate a predictive model explaining person-centered care in intensive care units. Methods: This study employed a cross-sectional design involving 230 intensive care unit nurses working in a tertiary hospital, each with more than one year of direct patient care experience. Data were collected online between March 2 and March 30, 2023. Data analysis was conducted using IBM SPSS ver. 26.0 and AMOS ver. 25.0. Results: Statistically significant pathways were identified from nursing competency to the nursing work environment and person-centered care; from communication competence to teamwork and person-centered care; from nursing professionalism to teamwork and the nursing work environment; and from the nursing work environment to person-centered care. Nursing professionalism indirectly influenced person-centered care through teamwork and the nursing work environment. Conclusion: Enhancing person-centered care in intensive care units requires recognizing the critical roles of communication competence, nursing competency, and the nursing work environment. Developing and implementing educational programs that strengthen communication and nursing competencies, alongside initiatives that improve the nursing work environment, are essential.

Purpose
This study investigated differences in the use of life-sustaining treatments during the last six months of life between older adults covered by the National Health Insurance (NHI) and those enrolled in the Medical Aid (MA) program. Methods: A retrospective cohort design was applied using national claims data from the National Health Insurance Service. The study population included individuals aged ≥65 years who died in 2023, with 286,319 decedents (247,935 with NHI and 38,384 with MA) analyzed. We compared hospitalization frequency and duration, intensive care unit (ICU) stays, and the use of life-sustaining treatments, including cardiopulmonary resuscitation, mechanical ventilation, hemodialysis, chemotherapy, transfusions, and vasopressors, between NHI and MA groups. Logistic regression analyses were conducted with adjustments for age, sex, comorbidities, place of death, and advance care planning status. Results: Completion rates of advance directives and physician orders for life-sustaining treatment were lower in MA than in NHI decedents. MA decedents had fewer admissions but significantly longer hospital and ICU stays than NHI decedents. They were less likely to receive mechanical ventilation, chemotherapy, transfusion, and vasopressors but more likely to undergo hemodialysis. Conclusion: Substantial disparities exist in end-of-life care by insurance type, suggesting that socioeconomic inequalities and reimbursement structures influence patterns of intensive care near the end of life. Targeted interventions are needed to ensure equitable, patient-centered end-of-life care for socioeconomically vulnerable older adults.

Purpose
This study investigated health-related quality of life (HRQoL) and aimed to identify factors influencing HRQoL for patients with rotator cuff tears (RCTs). Methods: We conducted a descriptive correlational survey with 118 outpatients diagnosed with RCTs at a tertiary general hospital in Seoul. Data were collected between February and June 2021 using structured self-report questionnaires, including the numeric rating scale, Korean version of the Shoulder Pain and Disability Index, Verran and Snyder-Halpern Sleep Scale, and the World Health Organization Quality of Life Instrument, Short Form. Results: HRQoL showed significant positive correlations with sleep quality (r=.64, p<.001) and the frequency of shoulder-intensive sports activities (r=.24, p=.008). It was negatively correlated with symptom days per week (r=–.32, p<.001), symptom hours per day (r=–.51, p<.001), pain (r=–.21, p=.025), functional disability (r=–.49, p<.001), and depression (r=–.60, p<.001). Stepwise regression analysis indicated that sleep quality (β=.36, p<.001) was the strongest predictor of HRQoL, followed by occupation (β=.26, p<.001), depression (β=–.24, p=.010), and symptom hours per day (β=–.19, p=.013). Conclusion: Sleep quality was the most influential factor affecting HRQoL in patients with RCTs. These findings underscore the need for comprehensive nursing interventions that address sleep disturbances, provide psychological support for depressive symptoms, consider occupational demands, and promote early management of prolonged symptoms to enhance HRQoL in this population.

Purpose
This study aimed to examine the influence of health literacy and autonomy support on health behavior adherence among patients with premature coronary artery disease (PCAD), defined as onset before age 55 years in males and 65 years in females. Methods: A descriptive, cross-sectional design was employed. Data from 153 patients were collected at a hospital in Seoul, South Korea, between January and March 2023. Statistical analyses included the independent t-test, one-way analysis of variance, Pearson correlation coefficients, and hierarchical multiple regression, conducted using IBM SPSS WIN ver. 27.0. Results: Health literacy (β=.36, p<.001) was the strongest determinant of health behavior adherence. A disease duration of more than one year (β=.17, p=.016) was positively associated with adherence, while male sex (β=–.16, p=.039) and the absence of comorbidities (β=–.17, p=.011) showed significant negative associations. Autonomy support from healthcare providers was not significantly associated with health behavior adherence. Conclusion: Healthcare professionals should prioritize improving patient health literacy through tailored communication and educational strategies. Male patients and those newly diagnosed should be recognized as vulnerable groups for low adherence. Targeted interventions should be designed to meet their specific needs. Furthermore, patients with PCAD should be guided to increase their awareness and understanding of their condition.

Purpose
This study aimed to examine the relationship between stigma and self-management among patients undergoing hemodialysis and to identify the key factors influencing their self-management practices. Methods: A convenience sample of 139 hemodialysis patients, aged 18 years or older with an arteriovenous fistula, was recruited from online websites designed for patients undergoing hemodialysis in South Korea. Data were collected using a self-reported questionnaire that assessed demographic and clinical characteristics, self-management behavior, and stigma. Data analysis included descriptive statistics, the independent t-test, one-way analysis of variance, Pearson r correlations, and hierarchical regression analysis to evaluate the influence of stigma on self-management. Results: Hierarchical regression analysis showed that demographic and clinical characteristics accounted for 25.1% of the variance in self-management, and the inclusion of stigma increased the explained variance to 31.4%. Significant predictors included the number of hemodialysis sessions per week (≥3) (β=–.38, p<.001), stigma (β=–.27, p<.001), monthly household income (≥4 million won) (β=.24, p=.014), and marital status (single) (β=–.18, p=.028). Conclusion: The findings highlight the substantial impact of stigma and treatment burden on self-management, while socioeconomic status and marital support serve as protective factors. Targeted interventions that reduce stigma and strengthen support systems are warranted.

Purpose
This study aimed to develop and evaluate the effectiveness of a therapeutic communication program based on King’s goal attainment theory, specifically designed for nurses providing care to patients with hematological oncology in a tertiary hospital setting. Methods: A non-equivalent control group design was employed, involving 59 nurses (intervention group: 29, control group: 30) with experience in hematological cancer care. The therapeutic communication program, developed according to the theoretical constructs of King’s theory, consisted of eight weekly sessions. Outcome variables included problem-solving ability, communication self-efficacy, and interaction satisfaction. The effects of the intervention were analyzed using the independent- and paired-samples t-test as well as a Wilcoxon signed-rank test. Results: In between-group comparisons of pre–post changes, communication self-efficacy increased significantly more in the intervention group than in the control group (p=.027). However, no significant between-group differences were found for problem-solving ability or interaction satisfaction. These findings suggest that the program effectively enhances therapeutic communication competencies among nurses in hematological oncology wards. Conclusion: The therapeutic communication program significantly improved problem-solving ability, communication self-efficacy, and interaction satisfaction among nurses in the intervention group within the hematological oncology ward. This theory-based intervention provides an evidence-based framework for strengthening clinical nursing practice and education.

Purpose
This study aimed to examine the level of fear of cancer recurrence (FCR) among adult breast cancer survivors and to identify factors influencing it. Methods: This cross-sectional study included 104 adult breast cancer survivors who were no longer receiving active treatment. Data were collected through self-report questionnaires addressing FCR, depression, anxiety, distress, fatigue, coping with cancer, social support, subjective health status, subjective quality of life, demographic characteristics, and disease-related characteristics. Surveys were administered both face-to-face and online between March and September 2024. Data analysis was conducted using descriptive statistics, frequencies, the independent t-test, one-way analysis of variance, Pearson’s correlation, and multiple regression. Results: The mean total FCR score was 78.83±25.71 (range, 0–168), reflecting a moderate level. Among participants, 22.1% scored above the cutoff for depression, 34.6% for mild anxiety, and 27.9% for severe distress. More than 70% of participants reported fatigue. Levels of coping with cancer, social support, subjective health status, and subjective quality of life were moderate or higher. Anxiety (β=.56, p<.001), fatigue (≤34) (β=.18, p=.019), and subjective quality of life (β=–.18, p=.022) significantly influenced FCR. Conclusion: Ongoing assessments and tailored interventions are essential to address FCR and to promote psychological well-being in breast cancer survivors following completion of active treatment.

Citations

• Rebuilding life after breast cancer treatment among Korean breast cancer survivors: an integrative review
  Rina Kim, So-Young Choi
  Women's Health Nursing.2026; 32(2): 104.     CrossRef

Purpose
This scoping review aimed to explore the characteristics and educational effects of game-based virtual reality (VR) programs used in nursing education, providing foundational insights for future instructional design and research. Methods: Following the Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist, a comprehensive literature search was conducted across eight databases for studies published between April 2014 and March 2025. Studies were screened and selected using the population, concept, context framework. Twenty-four studies met the inclusion criteria and were analyzed. Results: Most of the 24 included studies targeted nursing students, with some involving practicing nurses. Interventions primarily employed immersive VR head-mounted displays and incorporated diverse game elements such as mission-based scenarios, challenges, feedback loops, and virtual patient interactions. Educational effects were categorized into cognitive, affective, and psychomotor domains. Improvements in knowledge acquisition, self-efficacy, learning motivation, and skill performance were consistently reported. Additionally, most studies reported enhanced learner satisfaction, engagement, and emotional immersion. However, limited evidence was found regarding teamwork and communication skills. Conclusion: Game-based VR programs show substantial potential as effective instructional strategies in nursing education. Their design features—including immediate feedback, repeatable immersive scenarios, and engaging game mechanics—support learner-centered and self-directed learning. Nevertheless, the current evidence base largely focuses on nursing students and short-term outcomes. Future studies should encompass diverse nursing populations and assess long-term effects and real-world applicability, particularly in team-based and clinical practice contexts.

Citations

• Design and usability of an immersive virtual reality simulation in orthopaedic nursing education: A pilot study
  Carla Sílvia Fernandes, Ana Galvão, Cris Renata Grou Volpe, Marta Campos Ferreira
  International Journal of Orthopaedic and Trauma Nursing.2026; 61: 101286.     CrossRef

Purpose
This review aimed to analyze the use of behavior change techniques (BCTs) and the degree of theory implementation using a theory coding scheme (TCS) in mobile self-management interventions for type 2 diabetes mellitus (T2DM). Methods: In this scoping review, four electronic databases (PubMed, EMBASE, CINAHL, and CENTRAL) and gray literature sources were searched. Studies were independently screened according to predefined criteria. The BCT taxonomy was used to categorize techniques, and the TCS was applied to evaluate the quality of theory implementation. Results: Seventeen randomized controlled trials were included. Twenty-five unique BCTs were identified (mean, 8.1 per study). Commonly used BCTs included social support (unspecified) (n=14), instructions on how to perform a behavior (n=14), feedback on behavior (n=11), and prompts/cues (n=11). Techniques related to capability, such as habit formation, rewards, framing/reframing, and verbal persuasion, were rare (n=1 study each). TCS scores ranged from 5 to 15 (mean, 10.3). All included studies cited a theory, used it to select intervention techniques, and employed randomization. However, no study used the findings to refine the theory, and only one conducted a mediational analysis of theoretical constructs. Conclusion: Mobile T2DM self-management interventions commonly rely on a limited range of BCTs and show restricted theoretical application beyond basic implementation. Future interventions should employ a broader array of BCTs and apply theories more rigorously, including tailoring interventions, empirically testing theoretical mechanisms, and refining theories based on results to increase their effectiveness.

Purpose
This scoping review aimed to comprehensively examine environmental and individual factors contributing to clinical practice stress among nursing students in South Korea and to provide evidence-based recommendations for improving the clinical education environment. Methods: A scoping review was conducted following Arksey and O’Malley’s five-stage framework and the PRISMA-ScR guidelines. Relevant studies published between January 2016 and March 2025 were identified through searches of domestic databases (KCI, RISS) and international databases (PubMed, CINAHL) using predefined keywords. A total of 18 studies met the inclusion criteria. Data were extracted using a standardized template and categorized by study characteristics, methodological features, and stress-related variables. Results: Most included studies were conducted after 2022 and involved students from multiple institutions. Environmental stressors identified included poor clinical setting quality, lack of instructor support, interpersonal challenges, limited educational infrastructure, and disruptions caused by new infectious diseases. At the individual-level, resilience, coping strategies, and emotional regulation were the most frequently studied variables. Among these, resilience was consistently reported as a protective factor against stress, while incivility emerged as the most prominent environmental stressor. Multiple regression models indicated that stress-related factors explained between 18.0% and 75.6% of the variance in outcomes. Conclusion: Clinical practice stress in nursing students results from a dynamic interaction between environmental and individual factors. Nursing education programs should incorporate resilience-enhancing interventions, strengthen collaboration with clinical sites, and adopt flexible educational methods, such as simulation-based training, particularly during periods of restricted clinical access.

Purpose
Person-centered care is essential to improving patient outcomes, yet the factors that influence it require further investigation. This study examines the relationships among nurses’ compassion competence, cultural competence, intercultural communication skills, and person-centered care, and it identifies key predictors of person-centered care. Methods: A descriptive survey was conducted among 191 nurses from two general hospitals using convenience sampling between April 1 and April 22, 2024. Data collection included measures of compassion competence, cultural competence, intercultural communication skills, and person-centered care. Statistical analyses involved descriptive statistics, the independent t-test, analysis of variance, Pearson’s correlation coefficient, and stepwise multiple regression. Results: Of the 191 participants, 172 (90.1%) were females and 19 (9.9%) were males, with an average clinical experience of 8.89 years. Person-centered care showed significant positive correlations with compassion competence (r=.58, p<.001), cultural competence (r=.62, p<.001), and intercultural communication skills (r=.63, p<.001). Key predictors of person-centered care included intercultural communication skills (β=.29, p=.001), compassion competence (β=.27, p<.001), cultural competence (β=.20, p=.024), and non-shift work status (β=.12, p=.031). The model explained 47.9% of the variance in person-centered care (F=44.76, p<.001). Conclusion: In this study, person-centered care among nurses was influenced by compassion competence, cultural competence, intercultural communication skills, and work type. Further research is warranted on the delivery of person-centered care among nurses who provide care to patients from diverse cultural backgrounds.

Purpose
Colorectal cancer (CRC) survivors face significant challenges after completing treatment, including returning to work, concerns about the future, and financial difficulties. Understanding how inner strength developed after treatment affects survivors’ lives is crucial for informing patient-centered care. This study explored the unique inner strength exhibited by CRC survivors during their transition to a “new normal.” Methods: We recruited 16 patients from Korea who had completed treatment, to explore their experiences of managing their health. We conducted a qualitative study from July 4, 2022 to July 25, 2022 using individual interviews and directed content analysis. Transcribed interview data were analyzed to interpret meaning from the data, consistent with the naturalistic paradigm. Results: Participants described their transition to a new normal by reframing the cancer experience, struggling to return to normal life, experiencing growth promoted by supportive relationships, and encountering both positive and negative life changes. Throughout these experiences as survivors, inner strength played a critical role in adapting to a new normal. Conclusion: Our findings suggest that inner strength serves as a dynamic psychological resource, enabling CRC survivors to reframe their illness, regain disrupted roles, and reconstruct a meaningful life despite ongoing physical and emotional challenges. In doing so, inner strength facilitates their adaptation to a new normal.

Purpose
This study examined the effects of cognitive function, health literacy, and social support influence the risk of self-care non-adherence among older adults with chronic kidney disease. Methods: A cross-sectional survey was conducted using structured questionnaires. The study included 105 older adults (≥65 years) in the pre-dialysis stage, all of whom were receiving regular follow-up at a nephrology outpatient clinic in Jeonju, Jeollabuk-do, Korea. Data were collected through one-on-one interviews from April to May 2024 and analyzed using SPSS version 26.0. Predictive factors were assessed using hierarchical multiple regression analysis. Results: The risk of self-care non-adherence was significantly correlated with cognitive impairment (r=.61, p<.001), lower social support from healthcare providers (r=–.36, p<.001), and reduced health literacy (r=–.42, p<.001). Multiple regression analysis indicated that decreased physical activity (β=.25, p=.002), greater cognitive impairment (β=.29, p<.001), and lower support from healthcare providers (β=–.26, p=.008) were significant predictors of increased risk of self-care non-adherence. The model explained 46% of the variance in the risk of self-care non-adherence. In contrast, family support and health literacy were not significant predictors. Conclusion: To reduce the risk of self-care non-adherence in older adults with chronic kidney disease, routine cognitive screening and tailored education for those with cognitive impairment should be implemented in outpatient care. Promoting physical activity and strengthening support from healthcare providers are also key strategies to improve adherence in this population.

Purpose
This study developed a self-management program for patients undergoing lumbar spinal stenosis surgery utilizing the information-motivation-behavioral skills (IMB) model. Methods: This study employed a quasi-experimental design with a nonequivalent control group and pretest–posttest design. Data were collected from August 11, 2022, to March 31, 2023, at a general hospital in South Korea. A total of 58 patients participated in the study (30 experimental, 28 control group). The experimental group received a six-session self-management program based on the IBM model, whereas the control group received usual education and information. Data were analyzed with SPSS/WIN 23.0 using the independent t-test, chi-square test, Fisher’s exact test, Shapiro-Wilk test, and Mann-Whitney U test. Results: Significant differences were observed in self-management information (p<.001), personal motivation (p=.002), social motivation (p=.002), behavioral skills (p=.002), behaviors (p=.003), health-related quality of life (p<.001), and disc height (p=.006) in the experimental group following program implementation, compared to the control group. However, no significant differences were found in lower extremity muscular strength, lumbar lordotic angle, or the visual analog scores for low back pain and leg pain between the two groups. Conclusion: The self-management program developed in this study, based on the IMB model, was effective in improving self-management information, motivation, behavioral skills, behaviors, health-related quality of life, and self-management health outcomes in patients undergoing lumbar spinal stenosis surgery. Nevertheless, future research should aim to verify the long-term effects of such self-management programs by extending the intervention period.

Purpose
Emerging evidence indicates that eating patterns—particularly skipping meals and eating alone—are associated with excess body weight. However, few studies have assessed whether these behaviors contribute to weight gain across different age groups. This study examined the associations of skipping breakfast or dinner, and of eating those meals alone, with overweight or obesity among Korean adults compared to children and adolescents. Methods: This cross-sectional secondary analysis used data from the 2019 Korea National Health and Nutrition Examination Survey. Information on skipping meals, eating alone, and sociodemographic characteristics was obtained via self-report for adults and proxy report for participants under 12 years of age. Overweight or obesity was determined from measured height and weight. Multivariable logistic regression analyses were performed separately by age group. Results: Among adults, eating dinner alone was associated with higher odds of obesity (odds ratio [OR]=1.27, 95% confidence interval [CI]=1.06–1.52). Among adolescents, skipping dinner three or more times per week was associated with higher odds of obesity (OR=2.60, 95% CI=1.04–6.54). No significant associations were observed in children. Skipping breakfast or eating breakfast alone was not significantly associated with overweight or obesity in any age group. Conclusion: Although the cross-sectional design precludes causal inference, the findings suggest age-specific links between eating behaviors and weight status. For adults, reducing solitary dinners may help prevent obesity, whereas for adolescents, preventing frequent dinner skipping could be beneficial. Nursing strategies promoting shared mealtimes in adults and regular dinners in adolescents may help address obesity in Korea.

Citations

• An Exploratory Indirect Association Analysis of Dietary Supplement Use and Metabolic Risk in Korean Adolescents: A Cross-Sectional Study
  Jeoungmi Kim, Vasuki Rajaguru
  Foods.2026; 15(14): 2554.     CrossRef

Purpose
This study aimed to identify sex-specific predictors of microalbuminuria in patients with type 2 diabetes mellitus. Recognizing sex-based differences in risk factors may facilitate the early detection and prevention of diabetic kidney disease. Methods: A cross-sectional analysis was performed using data from the Korea National Health and Nutrition Examination Survey. Microalbuminuria was defined as a urinary albumin-to-creatinine ratio ≥30 mg/g. Multivariable complex sample logistic regression analyses were conducted separately for male and female. Independent variables included age, duration of diabetes, glycated hemoglobin (HbA1c), fasting blood sugar (FBS), triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C), TG, HDL-C, waist circumference, and systolic blood pressure (SBP). Results: The prevalence of microalbuminuria was higher in male than in female. In both sexes, longer diabetes duration and elevated SBP were associated with microalbuminuria. Among male, FBS, TG/HDL-C ratio, TG, and low HDL-C were significant predictors. In female, HbA1c showed the strongest association, followed by age and diabetes duration. Conclusion: Sex-specific differences were identified in the predictors of microalbuminuria among patients with type 2 diabetes. Incorporating these differences into early screening and individualized care strategies may help improve the prevention of diabetic kidney complications.

Purpose
The purpose of this study was to examine the experiences of nurse managers in clinical nursing education during an emerging infectious disease outbreak. Methods: Individual semi-structured interviews were conducted with 12 nurse managers from seven general or tertiary hospitals, each with 300 or more beds, in South Korea. Data were collected between February 17 and June 10, 2023, and analyzed using qualitative content analysis. Results: Four themes and 11 subthemes were identified. Nurse managers faced significant challenges in departmental management during the infectious disease outbreak, encountered a wide range of student attitudes toward learning, adapted their teaching methods flexibly in response to changing infectious disease conditions, and ultimately found meaning in the irreplaceable value of clinical practice education. Conclusion: During the emerging infectious disease outbreak, nurse managers not only encountered substantial difficulties but also experienced professional growth as clinical nursing educators. To enhance clinical nursing education in such challenging environments, it is essential to minimize uncertainty caused by infectious diseases and foster positive perceptions among nursing students regarding clinical practice education under restrictive circumstances. Institutional support is also necessary to reduce the work burden on nurse managers.

Purpose
The incidence of gynecological cancers is increasing, presenting significant challenges for patient care and outcomes. Perceived stress and negative affect can impede self-care behaviors and reduce health-related quality of life (HRQoL). This study examined the mediating effects of negative affect and cancer coping on the relationship between perceived hospital stress and HRQoL among patients with gynecological cancer. Methods: A cross-sectional mediation analysis was conducted with 118 gynecological cancer patients recruited from the outpatient clinic of a university hospital (October 2023 to February 2024). Participants completed validated instruments assessing perceived stress, negative affect, cancer coping, and HRQoL. Data were analyzed using Spearman’s correlations and the PROCESS macro (Model 4) with 95% bootstrap confidence intervals (CIs). Results: Perceived stress was significantly correlated with negative affect (r=.58, p<.001), cancer coping (r=.23, p=.012), and HRQoL (r=–.45, p<.001). Negative affect was correlated with HRQoL (r=–.59, p<.001). Furthermore, negative affect and cancer coping mediated the relationship between stress and HRQoL (B=–0.18, 95% CI=–0.27 to –0.11 and B=0.04, 95% CI=0.01 to 0.08, respectively). Conclusion: Negative affect and cancer coping significantly mediated the relationship between hospital stress and HRQoL. Targeted interventions aiming to reduce stress and strengthen emotional and coping strategies could enhance HRQoL among gynecological cancer patients.

Purpose
This study aimed to examine the relationships among death anxiety, attitudes toward death, and burnout in nurses working in hemodialysis units. Methods: A cross-sectional, self-report questionnaire-based survey was conducted. Eighty-six nurses, each with more than one year of experience in hemodialysis units across six general hospitals, participated. Data were collected from July to December 2021. Statistical analyses included Pearson correlation coefficients and multivariate linear regression. Results: The mean death anxiety score was 2.71±0.73 out of 5. Among attitudes toward death, neutral acceptance was most prevalent, with a mean score of 5.48±1.07 out of 7. The average burnout score was 3.94±0.77 out of 7. Death anxiety showed a significant negative correlation with neutral acceptance of death (r=–.33, p=.002) and a significant positive correlation with fear of death attitudes (r=.65, p<.001). Multiple regression analysis identified marital status (being married) (β=–.35, p=.005) and the death attitude of escape acceptance (β=.37, p=.002) as significant predictors of burnout, together explaining 22.3% of the variance (F=2.43, p=.005). Conclusion: Attitudes toward death among hemodialysis nurses may be linked to burnout. Burnout management programs for nurses in hemodialysis units should provide opportunities for neutral discussions and emotional expression regarding death, and should address strategies to mitigate escape acceptance attitudes.

Citations

• “It’s more than connecting tubes”: a qualitative inquiry into nurses’ emotional labor in dialysis units
  Mohammed Yousef Almulhim, Samah Anwar Shalaby
  BMC Nursing.2026;[Epub]     CrossRef

Purpose
Self-rated health in individuals with chronic diseases is influenced by various factors, including dietary adherence and physical activity. However, limited research has investigated how these factors relate to self-rated health among people with chronic kidney disease. Therefore, this study aimed to describe self-rated health and identify its associated factors in this population. Methods: This cross-sectional, secondary data analysis utilized datasets from the seventh Korea National Health and Nutrition Examination Survey, which were collected between 2016 and 2018. A total of 557 participants (mean age=74.8 years) with a glomerular filtration rate of <60 mL/min/1.73 m² were included. Data from health interviews and examinations were analyzed to assess self-rated health, dietary adherence, and physical activity. Descriptive and inferential statistical methods were employed for analysis. Results: Among the 557 participants, 42.6% rated their health as poor. Factors such as sex, age, income, smoking history, anxiety/depression, number of comorbidities, glomerular filtration rate, and physical activity were significantly associated with self-rated health. In contrast, dietary adherence did not exhibit a significant association. Conclusion: Understanding the factors associated with self-rated health can inform the development of nursing interventions aimed at improving self-rated health among patients with chronic kidney disease.

Purpose
This study aimed to develop and evaluate the effectiveness of a health management program using a mobile application for middle-aged men experiencing andropause. Methods: A quasi-experimental design with a non-equivalent control group pretest-posttest structure was employed. The study took place from June 27 to August 30, 2024, with participant recruitment occurring from June 27 to July 10, 2024. In total, 61 participants (30 in the experimental group and 31 in the control group) participated from July 15 to August 20, 2024. The experimental group received an application-based health management program, while the control group did not. Results: The experimental group showed significant improvements in subjective quality of life, health-promoting behaviors, and subjective health status compared to the control group (p<.001). Conclusion: This study confirms that mobile applications can effectively manage health during andropause in middle-aged men. Further research with a larger sample size is recommended to validate these findings.

Purpose
This study aimed to clarify the concept of nursing competence in coping with clinical deterioration by employing Rodgers’ evolutionary concept analysis, which reflects both sociocultural and temporal dimensions. Methods: A six-step concept analysis was conducted following Rodgers’ methodology. A systematic literature review was performed using PubMed, Embase, CINAHL, and Google Scholar, yielding 35 relevant studies published between 2000 and 2025. Data extraction followed the Joanna Briggs Institute template, and quality was appraised using the STROBE checklist. Results: Four key attributes of nursing competence were identified: technical skills in patient monitoring, situational awareness and clinical intuition, decision-making regarding escalation of care, and communication and teamwork to ensure timely intervention. Antecedents included formal education, clinical experience, and institutional support. Consequences encompassed enhanced patient safety, increased nurse confidence, and greater professional autonomy. The concept was demonstrated to be dynamic and influenced by healthcare policies, such as the implementation of rapid response systems. Conclusion: Nursing competence in managing clinical deterioration is a multidimensional and evolving concept that is essential for patient safety. Clarification of this concept can inform the development of assessment tools and simulation-based education. Further research should explore its application across diverse healthcare contexts and address challenges related to escalation of care.