With the demanding level of care needed for people with dementia, more Korean families are institutionalizing their relatives with dementia. This presents particular concerns for the Korean culture that values family responsibility for elder care. The purpose of this study was to describe Korean family members' perceptions of stress and satisfaction with care, the caregiving role, the family-staff relations. A purposive sample of 94 family members in 10 long-term care dementia care facilities in Korea participated in the study. Family Perceptions of Care Tool and Family Perceptions of Caregiving Role developed by Maas and Buckwalter (1990) were used to investigate Korean family caregivers' perceptions of care. Findings from the study can be summarized as follows: a) family caregivers showed the lowest satisfaction level for staff management effectiveness, especially for facility's resources available for care, and (b) family caregivers showed the highest stress from staff members' control on caregiving, feeling the same responsibilities after placement, and guilt over their placement. The results contribute to the understanding of Korean family caregivers' perceptions of caregiving and the care relationship after institutionalizing their elderly persons with dementia.
Aged ; Caregivers ; Dementia* ; Guilt ; Humans ; Korea ; Long-Term Care

PURPOSE: The purpose of this study was to explore the experiences of bereavement for main family members who had made and followed DNR decision for their family members. METHOD: This qualitative study was based on a grounded theory, and used in-depth interview techniques with the bereaved 10 main family members who had been treated and died under DNR order. RESULTS: The causal condition of the family member was 'Releasing', and the main consequent phenomenon were 'Blaming self and ruminating'. The contextual condition was 'The memory of the deceased'. The action/reaction strategy was 'Purifying'. The intervening condition was 'Supporting system', and the consequence was 'Acceptance'. The experience after bereavement of the family member on DNR decision were rational processes that purified themselves and healed the guilt feeling about the decision from reflective assessment and response about DNR decision. Based on this results, the substantive theory 'Reflective self healing' was derived. CONCLUSION: The main family members in following DNR decision are more likely to have unhealthy emotional condition than others in normal bereavement process. But they overcame the grief of bereavement through reflective self healing process.
Bereavement ; Grief ; Guilt ; Humans ; Memory ; Qualitative Research ; Resuscitation Orders

PURPOSE: This study was done to discover the structure of the lived experiences of unresolved suffering of college students and to gather information to develop therapeutic educational interventions for nursing students. METHODS: The research question, 'What is the structure of the lived experience of unresolved suffering?' was examined based on Parse's Human becoming research method. Twelve nursing students were recruited from K University. From May, 1 to June 30, 2009, Data were gathered from writings and engagement in dialog. RESULTS: The structure found in the college students' lived experiences of suffering was as follows: negative self-concept from being discriminated and ignored by parents, feelings against people and difficulties in interpersonal relations, feelings of isolation, betrayal, guilt, and loss. Their suffering was emotional grief and social withdrawal from damaged human dignity and low self-esteem from psychological trauma. Conceptual integration found to be in process of transferring the enabling-limiting, connecting-separating values. CONCLUSION: It is necessary to develop therapeutic educational interventions for college students for further development as individuals and future health professional by developing awareness of the structure and the meaning of their suffering experience.
Grief ; Guilt ; Health Occupations ; Humans ; Interpersonal Relations ; Parents ; Personhood ; Students, Nursing

Traditional nutrition education has not been shown to consistently produce behavior change. While it has been suggested that using emotion-based messages may be a better way to influence nutrition behavior change, this has not been well tested. Producing emotion-based messages is a multi-step process that begins with exploring subconscious barriers to behavior change rather than the more obvious and typically reported barriers. The purpose of this research was to uncover the emotional reasons, sometimes referred to as emotional pulse points, for mothers' choosing or not choosing to have more family meals. This would then serve as the first step to developing emotion-based messages promoting the benefits of family meals. Five focus group interviews were conducted with 51 low-income Black (n=28) and white (n=23) mothers. Metaphorical techniques were used to determine underlying feelings toward family and family meals. Discussions were video-taped, transcribed, and manually analyzed using a content-driven, immersion/crystallization approach to qualitative data analysis. Four themes emerged around the definition of family: acceptance, sharing, chaos, and protective/loyal. Some mothers felt mealtime was merely obligatory, and described it as stressful. Some reported a preference for attending to their own needs instead of sitting down with their children, while others felt that mealtime should be used to interact with and educate children and felt guilty when they were not able to provide family meals. Three themes emerged around feelings towards having or not having family meals: unimportant, important, and guilty. When explored further, mothers indicated that using the feeling of guilt to encourage family meals might be effective. Data obtained are being used to develop innovative, emotion-based messages that will be tested for effectiveness in promoting family meals.
Child ; Focus Groups ; Guilt ; Humans ; Meals ; Metaphor ; Mothers ; Resin Cements ; Statistics as Topic ; Unconscious (Psychology)

PURPOSE: The purpose of this study was to discover the structure of the lived experience of suffering of families with cancer patients to develop a theoretical foundation that can be used to reinforce nursing practice for cancer patients and their families. METHODS: A qualitative study was performed using Parse's research method. Participants were four families with cancer patients. From February 2009 through April 2010, data were collected via dialogicalengagement between participants and the researcher and analyzed through the extraction-synthesis and heuristic interpretation processes. RESULTS: The structure was identified as follows. The families' lived experience of suffering was a process through which they experienced a psychological shock of cancer diagnosis and difficulties associated with reshuffled roles among family members, and made efforts to care for the patients. CONCLUSION: Amidst sadness, pain, anxiety, guilt, fear and agony, the families focused on the human-health-universe aspect and found meanings of their experiences as love, triumphant, responsibility and hope. As such, the study results suggest that the suffering of families with cancer patients is a human becoming process of positive transformation.
Anxiety ; Diagnosis ; Guilt ; Heuristics ; Hope ; Humans ; Humans* ; Love ; Methods* ; Nursing ; Qualitative Research ; Shock ; Stress, Psychological

OBJECTIVES: We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI). METHODS: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them. RESULTS: There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI. CONCLUSIONS: The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.
Disclosure* ; Education ; Guilt ; Humans ; Intention ; Mass Screening ; Medical Errors ; Patient Safety* ; Punishment

This study aimed to ascertain whether medical students would enter a closed area where there was a raging epidemic of an infectious disease with a high fatality rate, and includes reasons for the students entering or refusing to enter. Participants included 50 second-year medical students. They were assigned to read a novel entitled 28, written by Youjeong Jeong, and discuss it in groups. Using their book reports, their decisions of whether or not to enter Hwayang, the city from the novel, and the reasons for their decisions were analyzed; we furthermore investigated the factors affecting their decisions. Among the 50 respondents, 18 students (36%) answered that they would enter, and the remaining 32 students (64%) answered that they would not enter the zone. The reasons given for entering were responsibility (44%), sense of ethics (33%), social duty (17%), and sense of guilt (6%). The reasons the students provided for not entering were inefficiency (44%), worry regarding family (28%), needlessness of sacrifice (19%), and safety not ensured (9%). Students who had four or fewer family members were more likely to enter Hwayang than were students who had five or more family members (odds ratio, 1.85). Students who had completed over 100 hours of volunteer work were more likely to enter Hwayang than were students who had volunteered less than 100 hours (odds ratio, 2.04). Owing to their "responsibility" as a doctor, 36% of medical students answered that they would enter an exclusion zone in an infected district with a high fatality rate. However, 64% answered they would not enter because of "inefficiency." For the medical students it is still a question 'To enter or not to enter?'
Communicable Diseases ; Surveys and Questionnaires ; Ethics ; Guilt ; Humans ; Mortality* ; Odds Ratio ; Rage ; Students, Medical* ; Volunteers ; Writing

OBJECTIVE: Several tests can be used to screen for alcohol dependence (AD), a prevalent disease with a heterogeneous etiology. As some patients with AD have a strong familial tendency in this regard, a family history of alcohol use disorders can affect the outcomes of screening tests and diagnostic evaluations for AD. In this study, we evaluated associations between a family history of alcohol use disorders and evaluations using the Cut down, Annoyed, Guilty, Eye-opener (CAGE) test, Alcohol Use Disorder Identification Test (AUDIT), and Diagnostic and Statistical Manual of Mental Disorders-fourth edition (DSM-IV) diagnostic criteria among patients with AD. METHODS: We recruited 487 male patients with AD from eight hospitals in Korea. Patients were evaluated using the CAGE, AUDIT, and DSM-IV diagnostic criteria. Patients with and without family histories were compared in terms of these assessment tools. RESULTS: Drinking initiation, uncontrollable drinking, and problem drinking occurred earlier and CAGE "annoyed" scores were higher in patients with a family history. Alcohol problems before the age of 25 years, frequency of spontaneous or compulsive alcohol-seeking behavior, and frequencies of psychological dependence and guilt related to alcohol use were also higher. CONCLUSION: Earlier drinking problems, higher scores on specific items of the CAGE, and AUDIT, and meeting more diagnostic criteria indicate more dependent, harmful drinking by patients with AD who have a family history of this condition. Clinicians should consider patients' family history of alcohol use disorders when screening for AD to identify the correct diagnosis and develop appropriate treatment plans for these patients.
Alcoholism ; Diagnostic and Statistical Manual of Mental Disorders ; Drinking ; Guilt ; Humans ; Korea ; Male ; Mass Screening

OBJECTIVES: This study aimed to identify the characteristics of depression in early dementia and mild cognitive impairment patients. METHODS: We included 412 community-dwelling elderly. They were assessed with Mini-Mental Status Examination in the Korean version of the CERAD Assessment Packet (MMSE-KC), Clinical Dementia Rating Scale (CDR), Korean version of Geriatric Depression Scale (GDS) and Korean version of Hamilton Depression Rating Scale (HDRS). All patients were divided three groups, nondemented group (ND), mild cognitive impairment group (MCI), and early dementia group (ED). We compared depressive symptoms between three groups using each items of HDRS. RESULTS: Prevalence of depression (GDS> or =16) was 24.6% in ND, 33.3% in MCI and 41% in ED. Several items of HDRS, depressed mood, feeling of guilt, loss of work & interests, psychomotor retardation, psychomotor agitation, psychic anxiety, somatic anxiety, and gastrointestinal symptoms, were significantly associated with cognitive decline in all subjects. However, no item of HDRS was significantly associated with cognitive decline in depressive patients. CONCLUSION: This study suggests that the prevalence of depression may increase as cognitive function declines. There was no difference in depressive symptoms between three groups.
Aged ; Alzheimer Disease* ; Anxiety ; Dementia ; Depression* ; Guilt ; Humans ; Mild Cognitive Impairment* ; Prevalence* ; Psychomotor Agitation

The clinical features of elderly depression are similar to those of younger's, but there are some differences in frequency. First, compared with younger adults, elderly depressive patients are more likely to show melancholic feature. They complain more physical symptoms rather than depressive mood, so they are occasionally regarded as having "atypical depression". Second, geriatric depression frequently has psychotic feature, especially delusion of guilt or nihilism. Finally sometimes they may have decline of cognitive functions, i.e. pseudodementia, so it is important and hard to distinghush it from dementia. In the case that have longer duration of episode, severe depression, non-melancholic symptoms, or delusion, illness is prone to be chronic and develop dementia. Bipolar disorder in elderly is also similar to that in adults in overall clinical manifestation, but has some differences in the following ponits;fewer hyperactivity, fewer thought problem, and less association with life-event. Also, manic delirium is frequent in elderly. The prognosis of elderly mania is various.
Adult ; Aged* ; Bipolar Disorder ; Delirium ; Delusions ; Dementia ; Depression ; Factitious Disorders ; Guilt ; Humans ; Mood Disorders* ; Prognosis*