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
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 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.

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.

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 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 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 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 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
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 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.

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 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 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.