Purpose:This study aimed to address the shift toward competency-based education and the planned 2028 "Integrated Nursing" National Licensing Examination (NLE), this study aimed to establish structural alignment among NLE domains, the seven integrated nursing competencies (INCs), and curriculum goals, with a particular focus on implementing symptom-based clinical reasoning (SBCR). Methods:This Delphi-based methodological study included seven content experts for content validity index (CVI) assessment and 24 nursing education experts who participated in a consensus workshop. The item-level CVI and the scale-level CVI/average were calculated to confirm the linkage between INCs and NLE domains. In addition, qualitative analysis of workshop materials and meeting records was conducted to derive 10 integrated learning topics and to develop an SBCR educational model for the key symptom of headache, grounded in Miller's Clinical Competence Pyramid (levels 2-4). Results:The analysis confirmed the validity of integrating the INCs within the overall curriculum structure. The resulting framework delineates staged learning objectives and core clinical questions designed to systematically enhance clinical reasoning, promote safe nursing practice, and support professional reflection within a unified curriculum. Conclusion:This study provides a practical foundation for nursing curriculum redesign by facilitating a transition from fragmented, subject-based instruction to a holistic, patient-centered SBCR model. This approach aligns with the requirements of the integrated NLE and is expected to contribute to meaningful improvements in actual clinical competency.

BackgroundMoral distress involves psychological suffering when actions conflict with personal ethical values due to institutional constraints. This distress erodes professional integrity and significantly undermines the quality of nursing work life. Addressing this conflict is essential for clinical workforce sustainability.AimThis study aimed to investigate the impact of moral distress on the quality of nursing work life (QNWL) among clinical nurses and to verify the serial mediating effects of compassion fatigue and resilience in this relationship.Research designThis was a descriptive correlational study.Participants and research contextWe conducted a descriptive survey with 289 clinical nurses with at least 3 years of experience. Data were collected using the Korean version of the Moral Distress Scale-Revised (KMDS-R), the Professional Quality of Life Scale (ProQOL) for compassion fatigue, the 10-item Connor-Davidson Resilience Scale (CD-RISC-10), and the Korean version of the Quality of Nursing Work Life (K-QNWL). Data were analyzed using descriptive statistics, Pearson's correlation coefficients, and the PROCESS macro (Model 6).Ethical considerationsThis study was approved by the institutional review board. Informed consent was obtained from participants prior to data collection.ResultsMoral distress was positively correlated with compassion fatigue and negatively correlated with resilience and QNWL. Serial multiple mediation analysis revealed that moral distress had a significant direct effect on QNWL. Furthermore, the serial mediation path of moral distress → compassion fatigue → resilience → QNWL was statistically significant (indirect effect = -0.051, 95% CI [-0.081, -0.032]). However, the simple mediation effect through resilience alone was not significant.ConclusionsThe findings demonstrate that moral distress significantly reduces the quality of nursing work life through the sequential mediation of compassion fatigue and resilience. This suggests that moral distress induces compassion fatigue, which subsequently erodes resilience and professional well-being. Organizational strategies should prioritize early intervention and integrated support systems.

Objective:Breast cancer survivors experience significant physical and psychosocial changes after mastectomy, making them vulnerable to mental health challenges such as depression, anxiety, and social dysfunction. This study identifies factors influencing the mental health of breast cancer survivors using Roy's Adaptation Model (RAM), which provides a framework for understanding adaptation processes and their impact on health outcomes. Methods:A cross-sectional structural equation modeling (SEM) study was conducted to develop and validate a hypothetical model based on RAM. Data were collected through an online survey administered from February 1 to 28, 2023, to female breast cancer survivors who had undergone mastectomy at least one year but less than five years before the commencement of the study. A total of 346 participants from an online community of patients with breast cancer were included in the final analysis. Statistical analyses were performed using IBM SPSS 26.0 and AMOS 28.0. Results:The goodness-of-fit indices for the structural model indicated acceptable fit (goodness-of-fit index [GFI] ​= ​0.82; RMR ​= ​0.05; comparative-fit-index [CFI] ​= ​0.85; root mean square error of approximation [RMSEA] ​= ​0.09). Seven of the eight hypothesized paths were significant. Coping and adaptation processes directly influenced symptom experience, body image, role performance, and social support and indirectly affected mental health. Body image, role performance, and social support collectively explained 88% of the variance in mental health outcomes. Multigroup SEM analysis revealed differences in the structural paths based on breast reconstruction status. Conclusions:Effective mental health assessment and intervention for breast cancer survivors undergoing mastectomy requires an integrated approach that considers coping processes, body image, role performance, and social support. Nurses should focus on strengthening adaptive coping strategies, fostering a positive body image, managing role-related stress, and enhancing social support systems to improve survivors' overall mental well-being.

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.

Background: Chemotherapy, a fundamental treatment modality for acute leukemia, is linked to significant adverse effects such as oral mucositis, nutritional decline, and depression, all of which markedly impact patient outcomes. Objective: This study aimed to evaluate the progression of chemotherapy‐induced oral mucositis and its impact on nutritional status and depression in patients with acute leukemia. Methods: In this prospective descriptive study, 123 patients aged 19–70 years diagnosed with acute leukemia were recruited from a tertiary hospital through convenience sampling. These patients were scheduled for remission‐induction, consolidation, or reinduction chemotherapy. Initially, 140 patients were enrolled, with 123 participants included in the final analysis after accounting for incomplete responses and dropouts. Oral mucositis, nutritional status, and depression were assessed using validated scales, with follow‐up evaluations conducted 10 days post‐chemotherapy. Oral mucositis was assessed using the WHO Mucositis Grading Scale, symptom experiences were measured with the MD Anderson Symptom Inventory, nutritional status was evaluated with the Patient‐Generated Subjective Global Assessment (PG‐SGA), and depression was assessed using the 10‐item Center for Epidemiological Studies Depression Scale (CES‐D‐10). Statistical analyses included paired t ‐tests, ANOVA, and multiple regression. Results: Compared to baseline, all the variables evaluated—oral mucositis, symptoms experiences, nutritional status, and depression—were significantly worsened on day 10 after chemotherapy. Regression analysis identified muscle weakness and skin problems as significant factors of depression. Additionally, patients receiving remission‐induction therapy presented significantly worse depression than those receiving consolidation therapy. Conclusion: This study highlighted the rapid deterioration of symptoms after chemotherapy in patients with acute leukemia. This underscores the need for a multidisciplinary approach that emphasizes nutritional support, emotional support, and evidence‐based nursing interventions tailored to specific groups of symptoms. Future research should explore the educational interventions delivered during initial hospitalization and their effectiveness, particularly in patients receiving remission‐induction therapy.

AIM(S):To investigate job characteristic profiles based on the job demands-resources (JD-R) model and the association between job characteristic profiles and presenteeism. DESIGN:Cross-sectional study. METHODS:Data were collected from shift nurses in South Korea in January 2023 using an online survey. This study included 544 nurses working in tertiary and general hospitals in South Korea. The participants were classified into four job characteristic profiles based on the JD-R model using latent profile analysis. Multiple logistic and linear regression analyses were performed to examine the association between job characteristic profiles and presenteeism. RESULTS:Four profiles were derived from the latent profile analysis: low strain-low motivation, high strain-low motivation, low strain-high motivation and high strain-high motivation. The high strain-low motivation, low strain-high motivation and high strain-high motivation groups were 1.74, 1.37 and 3.51 times more likely to experience presenteeism than the low strain-low motivation group respectively. The number of days worked while sick and the level of reduced job productivity was also the highest in the high strain-high motivation group. In addition, general health, multimorbidities and insomnia were significant factors affecting presenteeism, number of days worked while sick and productivity loss among shift nurses. CONCLUSIONS:This study found that even with higher levels of job resources, work environments with high levels of job demands were associated with higher rates of presenteeism. IMPACT:Study findings suggest that various strategies are needed to improve the physical and mental health of shift nurses, and create a healthy organisational environment by reducing excessive job demands to reduce presenteeism and increase productivity. REPORTING METHOD:STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

Abstract Background This study aimed to investigate the differences in inner strength, multiple identities, and quality of life among colorectal cancer survivors, with a focus on gender. Additionally, the study aimed to identify the factors that influence their quality of life. Methods This cross-sectional study included 170 colorectal cancer survivors in Korea. Participants were recruited from an online self-help group for colorectal cancer survivors. Participants were recruited from an online self-help group for survivors of colorectal cancer. Participants were divided into specific groups based on gender for the purpose of examining the differences in study variables, and additional analyses were conducted. The factors influencing their quality of life were identified through multiple regression analysis, without dividing the participants. Results The quality of life for male colorectal cancer survivors was higher than that of female survivors. In terms of inner strength, ‘anguish and searching' was higher in male while ‘connectedness' was higher in female. Inner strength was found to be the most powerful influencing factor on quality of life, after controlling for age and gender. Conclusions This study aimed to determine the significance of inner strength in survivors of colorectal cancer. It enabled a more comprehensive understanding of the quality of life in colorectal cancer survivors by not only focusing on the factors that impact quality of life, but also by examining how these impacts vary based on gender. To improve the quality of life for survivors of colorectal cancer, it is crucial to understand the impact of factors such as gender and inner strength. Additionally, it is crucial to establish personalized interventions that specifically target their unique characteristics. The inner strength plays an important role in improving the quality of life for survivors of colorectal cancer. This study suggests that inner strength is applicable to male cancer survivors and supports the inner strength theory.

Purpose: This study investigates the relationships between professional self-concept, patient safety culture, and burnout among cancer hospital nurses. It further aims to identify factors influencing burnout in this population. Methods: This cross-sectional study surveyed 160 nurses at a cancer center. The participants completed self-reported questionnaires on professional self-concept, patient safety culture, and burnout. Results: Pearson's correlation analysis revealed a negative association between patient safety culture and emotional exhaustion and depersonalization. Conversely, a positive association was found between patient safety culture and personal accomplishment and professional self-concept. Regression analysis identified gender (beta=-.18, p=.013), total years of work experience (beta=.27, p=.008), and professional self-concept (beta=-.43, p<.001) as significant factors influencing emotional exhaustion. Similarly, professional self-concept emerged as a significant factor influencing both depersonalization (beta=-.38, p<.001) and personal accomplishment (beta=.54, p<.001). Conclusion: To mitigate emotional exhaustion and depersonalization and enhance personal accomplishment, establishing a program aimed at improving nurses' professional self-concept is essential. The levels of emotional exhaustion and depersonalization among nurses in cancer hospitals are high. Therefore, it may be necessary to develop emotional care programs and provide education on oncology emergencies to prevent and mitigate these issues.

Objective:Bladder cancer survivors with neobladder experience changes in role performance and quality of life (QoL) due to various symptoms and problems, but related studies are limited. Therefore, this study attempted to explore the QoL and factors influencing it in bladder cancer survivors with neobladder.Methods:A cross-sectional descriptive design was used. Data were collected from 100 bladder cancer survivors with a neobladder using the European Organisation for Research and Treatment of Cancer QLQ-C30 and Muscle-Invasive Bladder Cancer Module, the Patient Activation Measure 13, the Enforced Social Dependency Scale, and the Multidimensional Scale of Perceived Social Support. Factors affecting the QoL were identified using multiple regression analysis.Results:QoL significantly differed by daily pad usage, need for clean intermittent catheterization, and role performance. QoL was correlated with urinary symptoms and problems, future perspective, abdominal bloating and flatulence, body image, role performance, and social support. Role performance, body image, and the need for clean intermittent catheterization were identified as the factors affecting QoL.Conclusions:The study highlights the importance of bladder cancer survivors continuing their roles at home, at work, and in society after neobladder reconstruction. Specifically, continuing recreational and social activity positively affects QoL, even if the activity range is modified. To help with their role performance, institutional support and changes in social perception are needed. Additionally, education and interventions, including body image enhancement, symptom management, and self-care, should be developed and applied to improve their QoL.

Purpose: This study aimed to evaluate the effectiveness of a combined management of lymphedema education (CMLE) program which was designed for the prevention of breast cancer related lymphedema. Methods: We applied a quasi-experimental study, pre-test, and posttest design with a non-equivalent control group. Breast cancer survivors with partial or total mastectomy and axillary lymph node dissection were recruited and assigned to either an intervention or control group at S hospital in Seoul. The outcomes were measured using the Breast Cancer Lymphedema Symptom Experience Index, Lymphedema Risk Reduction Behavior Check-list, Patients Activation Measure 13, Functional assessment of cancer therapy-General, and Disabilities of the Arm, Shoulder and Hand. The circumferences of both arms were measured by a nurse. These measurements were conducted and compared at baseline and two weeks after completing the (CMLE) program. Results: There were statistically significant changes in quality of life, physical wellbeing, and lymphedema risk behaviors in both groups after the CMLE program. There were significant differences in the cir-cumference of right forearm, elbow, and upper arm between the two groups. Conclusion: It can be concluded that the CMLE pro-gram is viable tool to prevent and manage breast cancer related lymphedema and is effective in improving the quality of life in breast cancer survivors with axillary lymph node dissection.

AbstractAimTo assess differences in social group memberships and burnout levels by work tenure among new nurses and identify factors associated with their subjective well‐being.DesignA cross‐sectional study.MethodsParticipants were 356 registered nurses who had fewer than 3 years of work tenure. Data were collected from February–March 2021. Participants' social identity, burnout, and subjective well‐being were assessed using validated questionnaires. STROBE checklist was applied.ResultsMultiple group membership was positively associated with life satisfaction and positive affect and negatively with burnout. Burnout influenced new nurses' negative effect in their life transition period. To improve new nurses' subjective well‐being, it is essential to focus on their social group membership, encourage participation in group activities, and improve access to sociopsychological resources that can help them take their first steps as professional staff and develop as healthy members of society, which will foster sustainable healthcare systems.

Purpose: Sleep disturbance is among commonly reported symptoms associated with leukemia and its treatment. The purpose of this study was to identify the symptom experience, anxiety and depression, and sleep disturbance in patients with acute leukemia undergoing chemotherapy. Methods: A total of 82 patients with acute leukemia who were undergoing chemotherapy were recruited. Data were collected using a self-reported questionnaire, which included the M. D. Anderson Symptom Inventory, the Hospital Anxiety Depression Scale, the Pittsburgh Sleep Quality Index, and the Patient Activation Measure 13. Results: Sleep disturbance and symptom experience, and anxiety and depression were shown to be positively correlated, and patient activation was shown to be negatively correlated. Use of sleeping pills and symptom severity were significantly associated with sleep disturbance. Condusion: The psychological and physical symptoms patients experience during treatment should be accurately identified, and effective nursing interventions should be provided. In addition, patient activation in patients with acute leukemia under inpatient treatment was not correlated with symptoms. However, supportive care should be provided to develop and accurately measure patient activation tools suitable for disease characteristics to increase patient activation.

PURPOSE:This study describes Korean nurses' work schedule characteristics and identifies their components to investigate associations of work schedule components with missed nursing care and organizational commitment.DESIGN:This cross-sectional secondary analysis used survey data of 1,057 nurses in 111 units at six hospitals in South Korea. Data were collected between April 2017 and March 2018.METHODS:A self-administered survey, including seven work schedule characteristic items, the Korean version of the MISSCARE Survey, and the Korean version of the Organizational Commitment Questionnaire, was employed. To construct independent components of work schedule characteristics, a principal component analysis was performed. The associations of work schedule components with missed nursing care and organizational commitment were analyzed using multiple linear regression models with generalized estimating equation methods.FINDINGS:The average number of daily work hours was 9.7. Nearly half of the study population worked while sick once or more per month. The two components of nurses' work schedule characteristics were "long work hours" and "lack of rest," and these components showed variations between units. Unhealthy work schedule components were linked to frequently missed nursing care and decreased organizational commitment.CONCLUSIONS:This study showed that proper work hours and adequate rest are important to reduce missed nursing care tasks and enhance organizational commitment, both of which are critical for better patient care and organizational outcomes.CLINICAL RELEVANCE:Healthcare organizations should provide adequate nursing staff and assign reasonable workloads. Furthermore, hospitals should periodically monitor the work schedule characteristics of nurses and actively intervene in cases of scheduling issues to resolve them.

Purpose To identify the perceived level of lung cancer stigma, resilience, and happiness among advanced lung cancer patients during treatment, and to analyze the mediating effect of resilience in the relationship between stigma and happiness. Methods A cross-sectional study design was used. A total of 184 patients diagnosed with advanced lung cancer were recruited from the National Cancer Center in Korea. Lung cancer stigma, resilience, and happiness were measured using questionnaires. Results Findings indicate that whereas lung cancer stigma had a negative correlation with resilience and happiness, resilience had a positive correlation with happiness. There was a significant indirect effect of stigma on happiness through resilience, indicating a mediating effect of resilience. Conclusions The results make significant contributions, like the importance of encouraging patients with non-judgmental approach, to clinical practices related to happiness of individuals with advanced cancer. It suggests that the stigma of advanced lung cancer patient can be overcome with enough resilience, and patients may experience happiness during treatment.

Background Cervical cancer is the seventh most common cancer in Korean women. Human papillomavirus infection is the major reason for cervical cancer, which can be prevented by vaccination. Aim The purpose of study was to investigate factors affecting college students’ human papilloma vaccination behaviour. Methods A cross-sectional study was conducted. The participants comprised 381 male and 397 female college students. We measured knowledge related to the human papillomavirus, infection prevention behaviour, and the theory of planned behaviour. Data were analysed using Pearson’s correlations and a hierarchical logistic regression. Findings Women showed higher scores (mean = 2.56, SD = .41) in infection prevention behaviour than men (mean = 2.49, SD = .47). Self-efficacy and subjective norm, or social pressure and opinions that influence behaviour, positively affected vaccination intentions, whereas positive vaccination attitudes reduced behaviour. Discussion Vaccination intentions were higher when attitude, self-efficacy, and subjective norm were also high. Self-efficacy and subjective norm resulted in increased vaccination behaviour; however, positive vaccination attitudes resulted in decreased vaccination behaviour in college students. Conclusion Self-efficacy and subjective norm led to increased HPV vaccination behaviour, while positive attitude toward HPV vaccination negatively influenced vaccination behaviour. Self-efficacy is an individual aspect, while attitude and subjective norm relate to culture. Therefore, promoting college students’ self-efficacy regarding vaccination is the most effective way to increase their HPV vaccination behaviour.

Purpose: This study aimed to examine associations among inner strength, mood status, symptom experience, and quality of life in women with lung cancer and to investigate whether inner strength has a moderating effect on these relationships. Methods: This study used a cross-sectional design to analyze 106 women with lung cancer in the National Cancer Center. A hierarchical regression analysis was conducted on the influence of quality of life. For the moderating effects, the Johnson-Neyman methods were applied using the SPSS PROCESS macro. Results: The significant factors of quality of life were inner strength, symptom experiences, total mood disturbance, accounting for 70.7% of the variance. Inner strength had a moderating effect on the relationship between total mood disturbance and quality of life. This means that when women have higher inner strength, there is a significantly less negative effect of total mood disturbance on quality of life. Conclusion: Female patients with lung cancer who experienced inner strength can improve the quality of life as well as reduce the negative impact of mood status on the quality of life. Therefore, these findings support the theory of inner strength and provide nurses with an opportunity to foster the development of this theory in female cancer survivors.

AIMS:To investigate the relationship between the unit work environment and psychological empowerment of nurses and their perceptions of patient activation.BACKGROUND:Nurses' support for active patient roles in the care process is critical for better patient outcomes. The factors influencing nurses' support for patient activation should be thoroughly investigated.METHODS:This study was a cross-sectional secondary data analysis using the survey data of 1,042 nurses in 98 units at six hospitals in Korea.RESULTS:Nurses with perceptions that their work was valuable and autonomy in their work were more likely to work in units where managers had greater managerial and leadership skills and staffing and resources were sufficient. Those with confidence in their work were more likely to work in units with adequate staffing and resources. Nurses who worked with adequate staffing and resources and considered their work meaningful were more likely to perceive patient activation as more important.CONCLUSION:Favourable work environments at unit level and psychological empowerment at nurse level can strengthen nurses' support for patient activation.IMPLICATIONS FOR NURSING MANAGEMENT:To strengthen nurses' support for active patient roles, organisations should ensure optimal staffing and resources to each unit and help nurses find value in their work.