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Objective To compare pressure injury (PI) incidence based on repositioning intervals and support surfaces in acute care settings. Methods This pragmatic, quasi-experimental trial recruited a total of 251 critically ill patients who were at low or moderate risk for PI development. Participants were assigned to three interventions: a 2-hour repositioning interval using an air mattress, a 2-hour repositioning interval using a foam mattress, or a 3-hour repositioning interval using a foam mattress. Data were collected by nurses every shift over the course of 14 days. Pressure injury incidence was analyzed using a χ2 test. Results There were no statistically significant differences in PI incidence between the groups with a 2-hour repositioning interval. However, the PI incidence in the group using a foam mattress with a 3-hour repositioning interval was significantly lower than in the group using an air mattress with a 2-hour repositioning interval (odds ratio, 0.481; 95% confidence interval, 0.410-0.565). Conclusions The findings showed that PIs decreased when the repositioning interval was extended from every 2 hours to every 3 hours while using foam mattresses. This study suggests that a 3-hour repositioning interval using a foam mattress could be applied to reduce the risk of PI development for patients at low or moderate risk.

BackgroundMany older adults prefer to live alone in their own homes, with age-related issues in physical movement, regardless of their cultural background. Importantly, however, to identify the features of successfully ageing in place (AIP), and foster independent living among these individuals, this study explored their level of self-confidence to live alone and its related factors.MethodsWe conducted a cross-sectional study using secondary data from an earlier study with older adults living alone in South Korea recruited by convenience sampling methods (N = 936, mean age = 77.1 years, 76.1% female). Data regarding the general, health-related, and social characteristics as well as self-confidence to live alone were collected via face-to-face interviews in 2019. Self-confidence to live alone was measured with a numeric rating scale of 0 to 10.ResultsThe average self-confidence score to live alone was 6.59. A regression analysis showed that mould exposure at home, depression, emergency department visits, and loneliness hinder self-confidence to live alone. Meanwhile, such self-confidence was facilitated by independency in instrumental activities of daily living (IADL), interactions with family members, social service utilisation, and social support.ConclusionsThis study suggests that healthcare providers need to consider the importance of self-confidence to live alone and influencing functional, mental, social, and environmental factors to promote quality of life as well as successful AIP for older adults living alone. Further, self-confidence to live alone could be a new practical index in the field of health and ageing to screen the successful AIP of older adults living alone.

Background Irritable bowel syndrome is a common functional gastrointestinal disorder that negatively affects all aspects of life. With the widespread use of the internet, internet-delivered cognitive behavioral therapy has been developed and applied to control symptoms and improve the quality of life of those with irritable bowel syndrome. However, few studies have systematically reviewed the effectiveness of internet-delivered cognitive behavioral therapy on irritable bowel syndrome. Objective This study aimed to systematically review studies that examined the use of internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome and to evaluate the effects of internet-delivered cognitive behavioral therapy on the improvement of symptom severity, quality of life, psychological status, and cost-effectiveness. Methods This meta-analysis involved the search of 6 databases for relevant publications. From the 1224 publications identified through database searches, 9 randomized controlled trials were finally included in the analysis. Results The internet-delivered cognitive behavioral therapies including exposure-based cognitive behavioral therapy, cognitive behavioral therapy for self-management, and cognitive behavioral therapy for stress management were provided in 5 to 13 sessions for 5 to 10 weeks. Internet-delivered cognitive behavioral therapy had medium-to-large effects on symptom severity (standardized mean difference [SMD] –0.633; 95% CI –0.861 to –0.4304), quality of life (SMD 0.582; 95% CI 0.396-0.769), and cost-effectiveness (–0.372; 95% CI –0.704 to –0.039) at postintervention. The effects on symptom severity remained over time even after the intervention, short-term follow-up (SMD –0.391; 95% CI –0.560 to –0.221), and long-term follow-up (SMD –0.357; 95% CI –0.541 to –0.172). There was no significant difference in psychological status, including anxiety and depression, in those with irritable bowel syndrome compared to the controls during the postintervention period. Conclusions This review demonstrates that internet-delivered cognitive behavioral therapy could be a cost-effective intervention for improving symptoms and the quality of life in patients with irritable bowel syndrome. However, studies are still insufficient regarding the use of internet-delivered cognitive behavioral therapy in these patients; therefore, more high-quality studies are required in the future.

Visual impairment can lead to limited accessibility and activities and a decreased quality of life. This study aimed to test a hypothetical model based on the International Classification of Functioning, Disability, and Health to predict the health-related quality of life (HRQOL) of people with visual impairment. Data from 202 people with visual impairment were collected from August 2020 to November 2020 via telephone or e-mail. The overall fitness indices of the model for physical HRQOL (Normed χ2=2.076, GFI=.878, TLI=.900, CFI=.928, RMSEA=.073) and the model for mental HRQOL (Normed χ2=2.232, GFI=.884, TLI=.904, CFI=.932, RMSEA=.078) complied with the recommended criteria of structural equation model fitness, indicating that the models were appropriate for predicting the HRQOL of people with visual impairment. The socioeconomic status, multimorbidity, perceived environmental barriers, and activity limitation/participation restriction directly affected the participants’ physical HRQOL. Moreover, depression, disability identity, and activity limitation/participation restriction directly affected participants’ mental HRQOL. Age, socioeconomic status, depression, social support, and perceived environmental barriers affected the participants’ physical and mental HRQOL by means of activity limitation/participation restriction. The findings of the study suggest that the strategies aimed at increasing the activity/participation of people with visual impairment will be helpful in improving their HRQOL. Based on the results of this study, nursing intervention programs and services for people with visual impairment should be developed and implemented to provide more comprehensive care for this group and expand nursing science.

Background Frailty is a health challenge related to adverse health outcomes in older adults. Older women are more likely to be frail than older men. However, few studies have reviewed the effectiveness of interventions for older women with frailty is scant. Objective: This systematic review aimed to explore the properties of interventions and to investigate their effectiveness in preventing the progression of frailty in older women with pre-frailty or frailty. Methods Narrative synthesis was conducted to identify the contents, outcome variables, and findings of the interventions. Then, a meta-analysis was performed to evaluate the effectiveness of exercise interventions on grip strength, sit-and-reach, sit-to-stand, and timed up and go tests. Results Twenty-six studies were selected, including 14 randomized controlled trials and 12 quasi-experimental studies. These studies implemented exercise (96.2%), nutrition (15.4%), hormone replacement (7.7%), toileting strategies (3.8%), and laughter interventions (3.8%). The selected studies assessed physical, psychological (11.5%), and cognitive health (11.5%), as well as quality of life (19.2%). The meta-analysis found significant effects of aerobic and resistance exercise interventions on the sit-to-stand (SMD = 1.30, 95% CI [0.70, 1.90], p < 0.001) and timed up and go scores (SMD = -0.56, 95% CI [-0.93, -0.19], p = 0.003). Conclusion Exercise interventions are essential to improve physical health, in particular mobility, in older women with pre-frailty or frailty. Future studies should consider theoretical frameworks and evaluate psychological and cognitive health as well as quality of life to develop and provide effective interventions to prevent the progression of frailty in older women.

Diabetes requires self-management, such as the use of insulin, oral antidiabetic drugs, diet, and exercise, for maintaining blood glucose. To promote self-management of older people with diabetes, family support is considered an important factor. However, older people living alone lack family support and have a lower health-related quality of life (HRQOL) than those living in families. The purpose of this study was to assess HRQOL and the factors that affect it between older people with diabetes living alone and those living in families. We performed secondary data analysis using the data of Korea National Health and Nutrition Examination Survey (KNHANES) 2017–2019. In total, 973 people with diabetes aged 65 years or older answered all questions about HRQOL. Complex sample analysis was performed. Each dimension of HRQOL was significantly lower in people living alone than those living in families. Restricted activity, bedridden, number of comorbidities, and perceived health status significantly predicted HRQOL in patients living alone. Health insurance, age, economic activity, unmet medical service needs, restricted activity, bedridden, number of comorbidities, perceived health status, and suicidal ideation significantly predicted HRQOL in patients living in families. This study indicated how differences in HRQOL exist between older patients with diabetes living alone and those living in families. This data will be useful in developing educational programs in the future, and it will be helpful when dealing with people living alone who have diabetes.

Background Chronic pain is one of the most common health problems for older adults worldwide and is likely to result in lower quality of life. Living in a different culture may also influence chronic pain and quality of life in older adults. The purpose of this study was to explore how multifaceted elements affect chronic pain and quality of life in older Koreans living in Korea and in older Korean–Americans (KAs) living in the USA. Methods We conducted a secondary data analysis of data from 270 adults aged 65 years or over (138 Koreans and 132 KAs). We compared the effects of multifaceted elements on pain and quality of life by testing structural equation models (SEMs) for each group, using a maximum likelihood estimation and bootstrapping. Results SEMs for both Korean and KAs showed that age and depressive symptoms directly affected quality of life. The number of comorbidities and depressive symptoms had mediating effects on quality of life through chronic pain in both groups. In older Koreans only, perceived financial status directly affected quality of life. In older KAs only, sleep quality indirectly affected quality of life through chronic pain. Conclusion The data showed that multimorbidity and depressive symptoms play critical roles for explaining chronic pain in older Koreans and KAs and ultimately negatively influence quality of life. Future intervention program to improve quality of life in older adults with chronic pain should consider the different cultural aspects affecting quality of life for Koreans and KAs.

The number of elderly people living alone worldwide is increasing, and the responsibility of the state in this context is emerging. This study aimed to develop a community-based integrated service (CBIS) model of health and social care for older adults living alone. The model was designed based on a literature review of previous community care models and per older adults&rsquo, health and daily life needs. Thereafter, feedback on the integrated model was taken from older adults living alone by conducting a survey (n = 1023) and focus group interviews, after which the opinions of the Public type Health Management Promotion Council were considered and content validity was confirmed. The model, comprising eight healthcare services and five social care services, was tested on 22 older adults for two weeks to assess its feasibility and preliminary efficiency. Each service included screening, assessment, providing service, evaluation, and quit. Participants rated their overall satisfaction with the services as 9 out of 10. Care navigators reported feeling comforted and discovered their own sense of being while providing the services. We believe that the CBIS model may foster independence among community-dwelling older adults living alone, thereby improving their quality of life through &ldquo, aging in place.&rdquo

Pain catastrophizing is a notable concept associated with change in chronic pain interference and depression. Sleep quality is also one of the important factors affecting geriatric depression. This study examined the mediating effects of chronic pain interference and sleep quality on the relationship between pain catastrophizing and depression. This study is a secondary data analysis that analyzed a total of 138 older Korean adults with chronic pain. The participants were selected from a single elderly daycare center in a city in South Korea. Also, the multiple regression analysis and PROCESS macro with bootstrapping were used. The results revealed that chronic pain interference and sleep quality mediated the relationship between pain catastrophizing and depression, respectively. Furthermore, chronic pain interference and sleep quality sequentially and dually mediated the effect of pain catastrophizing on depression. In the management of depression in the elderly, persistent complaints of pain should not be disregarded, irrespective of the intensity of their chronic pain. Psychological intervention is needed to alleviate negative thoughts about chronic pain and to increase the ability to cope with chronic pain. In addition, it is important to assess sleep patterns and to develop interventions to improve sleep quality, because depression in the elderly could appear as a symptom of a sleep problems.

Purpose This study aimed to understand and describe the diabetes self-management experience of visually impaired people with diabetes. Methods Ten participants were recruited through a website used by the visually impaired from February to March 2020. Data were collected through two focus group interviews conducted in June 2020; each group consisted of five participants. All interviews were recorded with the consent of the participants and transcribed verbatim. The transcribed data were analyzed using qualitative content analysis. Results Seven categories were as follows; a two-faced, lifelong companion, an unprepared encounter, struggle to live, love-hate relationship with family, strategies to adapt, lessening attention to self-management, the desire to learn properly. Conclusion It can be concluded that the visually impaired have fewer opportunities for receiving diabetes self-management education than general diabetic patients. Consequently, plans to improve the education available to such patients are required. Additionally, psychological counseling and diabetes education for patients' families are necessary, and improving the perception of medical workers regarding the visually impaired will be prove useful.

This study explored the psychosocial risk profiles and various characteristics associated with profile membership among Korean older adults living alone.Our analyses were based on a cross-sectional cohort of 1030 community-dwelling older adults (≥ 65 years) living alone in one Korean city. Latent profile analysis was used to identify psychosocial risk profiles across a wide range of psychosocial dimensions (depressive symptoms, suicidal ideation, cognitive dysfunction, loneliness, and perceived social support). We then explored the characteristics associated with distinct profiles by conducting bivariate and regression analyses.The three-profile was selected as the best solution: a group with high cognitive dysfunction, high loneliness, and low social support (profile 1), a group with low psychological risks and high social support (profile 2), and a group with high depression and high suicidal ideation (profile 3). Regression analyses showed that a lower frequency of interaction with neighbors or families, a greater frailty score, and lower quality of life were significantly associated with profile 1 or profile 3 than with profile 2 (p.05). Further, being male and having a poorer nutritional status was more significantly related to profile 3 than profile 2 (p.05).Findings provide evidence for healthcare professionals when developing interventions to prevent and reduce these psychosocial risks for older individuals living alone. In particular, factors associated with profile membership identified in the study may facilitate more tailored interventions.

Objectives The aim of this study was to identify gender differences in the health status, community service needs, and quality of life of older adults living alone in an urban city in South Korea. Methods A cross-sectional descriptive correlational design was used. The study sampled 1023 older adults (≥65 years) living alone in S* City, during the period from August to October in 2018. Trained interviewers conducted face-to-face interviews with the participants, using the UCLA Loneliness Scale, Short Form Geriatric Depression Scale – Korean version, ENRICHD Social Support Instrument (ESSI), the Mini-Mental State Examination Standard Version (MMSE-2SV), and Health-Related Quality of Life (EQ-5D). Results 77.8% were women and the mean age was 77.38 years (men = 74.65, women = 78.16). Women had lower socioeconomic and health status than men. Men felt more lonely, depressed, and had suicidal thoughts more frequently than women. Women had more needs regarding care, residential environment, movement, connection, and emergency services than men. In men, depressive symptoms, suicidal thoughts, loneliness, and right-hand grip strength were identified using the EQ-5D. The EQ-5D was also used to explain depressive symptoms, suicidal thoughts, cognitive function, and physical activity in women. Conclusion Health status and community service needs were dependent on gender; therefore interventions should be tailored according to gender. Our research found that to decrease depression and suicidal thoughts, improve physical health, and enhance quality of life for older adults living alone, interventions need to be designed to decrease male loneliness and to enhance female cognitive function.

The purpose of the present study was to examine the relationships of multiple factors to menopausal symptoms in different racial/ethnic groups of midlife women. This secondary analysis was conducted with the data from 980 midlife women that were collected from 2005 to 2013 using the Midlife Women’s Symptom Index. Structural equation modeling was used to analyze the data. The model had the highest fit indices for Non-Hispanic (NH) White midlife women, and prominent racial/ethnic differences were observed in the relationships of multiple factors to menopausal symptoms. In all racial/ethnic groups (except in Hispanic women), perceived health status was significantly associated positively with menopausal symptoms (β=−0.149 for NH African American; β=−0.207 for NH Asians; β=−0.162 for NH Whites). Body mass index was significantly positively associated with menopausal symptoms only in NH Asians (β=0.118) and Hispanics (β=0.210). The racial/ethnic differences in the relationships of multiple factors to menopausal symptoms could have resulted from the different cultural contexts in which women undergo during their menopausal transitions. Further cultural studies on the associations of racial/ethnic-specific factors with menopausal symptoms would help in understanding possible causes for racial/ethnic differences in the factors significantly associated with menopausal symptoms.

Objective To evaluate the psychometric properties of the Midlife Women's Symptom Index (MSI) among four racial/ethnic groups of midlife women in the United States. Design A secondary data analysis. Setting Internet communities/groups. Participants A total of 494 midlife women with symptoms of menopause who self-reported using an Internet survey and completed all sections of the MSI questionnaire. Methods Data were collected from January 1, 2008 to December 31, 2010. The psychometric properties of the MSI were evaluated using measures of internal consistency, item-total correlation coefficients, and discriminant validity. Results There were statistically significant differences in marital status, employment, income, religion, country of birth, level of education, diagnosed disease, and self-reported health status across the four racial/ethnic groups. The Kuder-Richardson Formula 20 (KR-20) coefficients for the three subscales of the MSI prevalence section (i.e., physical, psychological, and psychosomatic) ranged from 0.58 (psychosomatic symptoms in Whites) to 0.91 (psychological symptoms in Asian Americans). The Cronbach's alpha coefficients for the three subscale scores ranged from 0.60 (psychosomatic symptoms in Whites) to 0.93 (psychological symptoms in Asian Americans). The mean scores of the MSI differed significantly by race/ethnicity among midlife women of each menopausal status, except for the prevalence section of the psychosocial symptoms. Conclusion The MSI has demonstrated an acceptable reliability and appropriate discriminant validity across the four racial/ethnic groups, except in the domain of psychosomatic symptoms. Health care providers as well as researchers could use the MSI to assess the symptoms of menopause of midlife women from diverse racial/ethnic backgrounds.

The purposes of the study were to develop a theoretical model to explain the relationships between immigration transition and midlife women’s physical activity and test the relationships among the major variables of the model. A theoretical model, which was developed based on transitions theory and the midlife women’s attitudes toward physical activity theory, consists of 4 major variables, including length of stay in the United States, country of birth, level of acculturation, and midlife women’s physical activity. To test the theoretical model, a secondary analysis with data from 127 Hispanic women and 123 non-Hispanic (NH) Asian women in a national Internet study was used. Among the major variables of the model, length of stay in the United States was negatively associated with physical activity in Hispanic women. Level of acculturation in NH Asian women was positively correlated with women’s physical activity. Country of birth and level of acculturation were significant factors that influenced physical activity in both Hispanic and NH Asian women. The findings support the theoretical model that was developed to examine relationships between immigration transition and physical activity; it shows that immigration transition can play an essential role in influencing health behaviors of immigrant populations in the United States. The NH theoretical model can be widely used in nursing practice and research that focus on immigrant women and their health behaviors. Health care providers need to consider the influences of immigration transition to promote immigrant women’s physical activity.

Purpose: The practice of enteral nutrition with gastric residual volumes (GRVs) as a clinical indicator is poorly standardized in intensive care units. This study aims to summarize the results from studies that evaluated the clinical outcomes related to the GRVs. Methods: This systematic review study analyzed 11 studies consisting of four randomized controlled trials, one non-randomized controlled trial, and six observational studies. Results: No consistent relationship between GRV thresholds and clinical outcomes was observed. Higher GRVs were not consistently correlated with clinical outcomes such as higher gastrointestinal complications, aspiration pneumonia, or mortality. Higher GRVs significantly generate complications more often. Findings show that a single GRV more than 200 mL or two consecutive GRVs more than 150 mL should raise concern about negative consequences. Conclusion: Critical care nurses need to monitor GRVs closely during their practice of enteral nutrition. For critically ill patients receiving enteral nutrition, a GRV threshold of 200 ml would be a desirable limit to provide safe and adequate nutrition with a conservative approach.

Purpose: This study systematically reviewed research on behavioral interventions based on the information-motivation-behavioral skills (IMB) model to investigate specific intervention strategies that focus on information, motivation, and behavioral skills and to evaluate their effectiveness for people with chronic diseases. Methods: A systematic review was conducted in accordance with the guidelines of both the National Evidence-based Healthcare Collaborating Agency and Im and Chang. A literature search was conducted using electronic databases. Randomized controlled trials that tested behavioral interventions based on the IMB model for promoting health behaviors among people with chronic diseases were included. Four investigators independently reviewed the studies and assessed the quality of each study. A narrative synthesis was used. Results: A total of 12 studies were included in the review. Nine studies investigated patients with HIV/AIDS. The most frequently used intervention strategies were instructional pamphlets for the information construct, motivational interviewing techniques for the motivation construct, and instruction or role playing for the behavioral skills construct. Ten studies reported significant behavior changes at the first post-intervention assessment. Conclusion: This review indicates the potential strength of the IMB model as a theoretical framework to develop behavioral interventions. The specific integration strategies delineated for each construct of the model can be utilized to design model-based interventions.

The purpose of this study was to explore the relationships between immigration transition and depressive symptoms among 1,054 midlife women in the United States. This was a secondary analysis of the data from two national Internet survey studies. Questions on background characteristics and immigration transition and the Depression Index for Midlife Women were used to collect the data. The data were analyzed using inferential statistics including multiple regressions. Immigrants reported lower numbers of symptoms and less severe symptoms than nonimmigrants (p

Background: Although the concept of family resilience has had increased popularity in recent studies, conceptual and methodological issues need to be addressed. Aim: The purpose of this paper is to analyze the current status of the concept of family resilience in research and to suggest future needed directions for research. Methods: The structure of the analysis derives from Rodgers’ evolutionary concept analysis. Data for the analysis were retrieved using six electronic databases through phrasal search with “family resilience” as search terms. 38 were included in the current review. Results: Six dimensions of family resilience were identified: 1) collective confidence; 2) interconnectedness; 3) positive life view; 4) resourcefulness; 5) open communication patterns; and 6) collaborative problem-solving. Three possible antecedents of family resilience were identified: 1) perceived sense of disequilibrium; 2) spirituality/shared belief systems or religious beliefs; and 3) families’ strong will to overcome adversities. Consequences of being resilient include: 1) acceptance of the situation; 2) change in life perspectives; 3) enhanced relationship qualities; 4) reinforcement of resilient properties; and 5) improved health-related outcomes. Conclusion: Although the concept of resilience has been adopted as a useful strength-based perspective to understand family adaptation in the presence of adversity, it still needs further conceptual and methodological refinements. Multiple dimensions, cultural differences and variations of the concept within longitudinal designs should be examined with data gathered from multiple family members in order to improve family resilience research and its application to nursing practice. Implications for future research and intervention are suggested.

Although the internet is helpful and considered a preferred channel to get health information, some vulnerable populations such as the elderly have a digital divide. The purpose of this study was to test the development and intervention of the eHealth program based on the Information-Motivation-Behavioral Skills (IMB) model for improving internet health information seeking, understanding and utilization behaviors in the elderly. This study was a single group pretest-posttest design, and the eleven elderly aged 67-87 (mean74.6, SD 6.9) participated in 5 session program at a senior welfare center from 25 January to 22 February 2019. Each theory-based constructs of IMB model such as computer/web knowledge (p

현재 간호학에서 기초간호자연과학은 해부학, 생리학, 약리학, 병리학, 미생물학, 생화학 등으로 분리되어 있거나 일부대학은 통합되어 있으며, 교과목의 필요성과 중요성에 대한 요구가 증가하면서 교과내용과 교육목표의 표준화를 위하여 노력하고 있다(Choe & Shin, 1997; Yoo, Ahn, Yeo, & Chu, 2008). 기초간호자연과학 과목은 방대한 개념 및 내용에 비하여 제한된 강의 시간수와 강의를 기본으로 한 이론위주의 교육으로 인해 간호학생들이 이해하는 데 어려움이 있으며, 새롭게 개편된 고등학교 교과과정에서 생물 및 화학을 이수하지 않는 학생들이 증가하면서 효과적인 강의의 전달이 이루어지지 못하고 있다(Yoo et al., 2008). 특히 미생물학의 경우 다른 기초간호과학 교과목보다 간호대학이나 간호학과 전임교수가 담당하는 것보다, 의대지원이나 외부강사에 의해 강의위주의 교육이 이루어지고 있는 실정이며(Choe & Shin, 1997), 2007년 간호대학 평가순위 상위 5개 대학의 경우 실습과정을 운영하고 있는 대학은 1개에 불과하였다(Yoo et al., 2008). 실제로 임상간호사가 필요로 하

Aims To explore the effect of diverse types of women's physical activity on menopausal symptoms among multiethnic groups of midlife women in the USA. Background Although physical activity is one of the most widely used non-pharmacological methods for managing menopausal symptoms, there is a paucity of clinical guidelines for women and healthcare providers because the relationship between physical activity and menopausal symptoms has been found inconsistent in previous studies. Design A secondary analysis of the data from a lager Internet survey study conducted in 2008–2010. Methods A total of 481 midlife women among four ethnic groups were selected from the original study. The data were collected using the Kaiser Physical Activity Survey and the Midlife Women's Symptom Index. Bivariate correlation analyses and hierarchical multiple regression analyses were used to analyse the data. Results/Findings The household/caregiving activity index was positively associated with the prevalence scores of the psychological symptoms in both non-Hispanic Asians and non-Hispanic African Americans. The increased sports/exercise activity index was negatively associated with the severity scores of the physical symptoms in both Hispanics and non-Hispanic Whites. The occupational activity index and the active living activity index significantly predicted the severity scores of the psychosomatic symptoms in Hispanics and non-Hispanic African Americans, respectively. Conclusion Nurses who take care of multiethnic groups of midlife women who experience menopausal symptoms should be aware of diverse types of women's physical activities within the cultural context.

Purpose: The purpose of this study was to test the validity and reliability of the Diabetes Self-Care Barriers Assessment Scaler for Older Adults (DSCB-OA) in Korean older adults with type 2 diabetes. Method: To develop Korean version DSCB-OA used translation and back- translation method. Then, Korean version DSCB-OA was analyzed using data of 278 older adults with type 2 diabetes. Cronbach's alpha coefficient, item to total correlation and test-retest reliability was used for the reliability test, and factor analysis was used for the construct validity. Results: Cronabach's alpha of the DSCB-OA was .77, and item to total correlation coefficient ranged from -.13 to .56 . The results of factor analysis showed DSCB- OA consisted of four factors(diet, exercise, blood sugar test, treatment) which explained 62.8% of total variance. Conclusion: The Diabetes Self-Care Barriers Assessment Scaler for Older Adults (DSCB-OA) was confirmed helpful tool for Korean older adults with type 2 diabetes.

The purpose of this study is to compare the pathways through which multiple contextual factors influence the quality of life in Asian American and White women living with cancer. This is a secondary analysis of the data from 95 Asian American women and 113 White women. The data were analyzed using hierarchical multiple regression analyses and structural equation modeling. Multiple factors explained higher percent of total variances of the quality-of-life scores in Whites compared with that in Asian Americans.

Purpose: The purpose of the study was to identify factors influencing physical activity among community-dwelling older adults with type 2 diabetes. The study design was based on the Theory of Triadic Influence. Methods: A total of 242 older adults with type 2 diabetes participated in this study. Six variables related to physical activity in older adults, including self-efficacy, social normative belief, attitudes, intention, experience, and level of physical activity, were measured using reliable instruments. Data were analyzed using descriptive statistics, Pearson’s correlation analyses, and a path analysis. Results: The mean physical activity score was 104.2, range from zero to 381.21. The path analysis showed that self-efficacy had the greatest total effect on physical activity. Also, experience had direct and total effects on physical activity as well as mediated the paths of social normative beliefs to attitudes and intention to physical activity. These factors accounted for 10% of the total variance, and the fit indices of the model satisfied the criteria of fitness. Conclusion: The findings of the study reveal the important role of self-efficacy and past experience in physical activity in older adults with type 2 diabetes.

Purpose The aims of this cross-sectional study were to explore and evaluate the impact of adjuvant chemotherapy on quality of life in breast cancer patients according to the survival time from surgery. Methods Completed questionnaires were collected from 534 women with breast cancer. Clinical and sociodemographic characteristics were reviewed and Functional Assessment of Cancer Therapy-Breast cancer instrument, global quality of life, Beck Depression Inventory, and unmet sexuality needs were administered. Descriptive statistics, t-tests, chi-square tests and multiple analysis of covariance were performed while controlling for confounding variables. Results Statistically significant differences were found between chemotherapy and no chemotherapy group on depression (p=0.026), unmet sexuality needs (p=0.010), breast cancer specific concerns (p=0.010), physical well-being (p=0.001), and emotional well-being (p=0.028). Chemotherapy effects also varied according to survival time since surgery such as for group 1 (3 years since surgery) on depression (p=0.019) and physical well-being (p=0.028) respectively; however, there were no significant differences between chemotherapy and no chemotherapy group for group 2 (1-3 years since surgery). Conclusion As expected, breast cancer patients who underwent adjuvant chemotherapy experienced significantly worse quality of life than those who did not receive chemotherapy. Furthermore, the adverse chemotherapy effects on the quality of life appear to vary according to the time since surgery. These results suggest that health care professionals may need to address long-term as well as short-term chemotherapy side-effects and intervene accordingly to enhance quality of life of breast cancer patients.