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

OBJECTIVES: The purpose of this study was to evaluate the characteristics of religious orientation and religious life pattern in schizophrenic patients and their relationships to the types and themes of delusion. METHODS: Subjects were 120 schizophrenic patients. Diagnostic criteria used in this study was DSM-III-R. Religious orientations were assessed with the Intrinsic and Extrinsic Religious Orientation Scale. Demographic data, religious data and contents of delusion were also analyzed. RESULTS: 1) Distribution and prevalence of religious affiliations were similar to those of general population in Korea. 2) Religious orientations of the schizophrenic patients changed from the "extrinsic" attitude to the "proreligious" attitude as time passed. 3) Prominent religious orientations were different according to religious affiliation. The "proreligious" orientation and the "intrinsic" orientation were dominant in the religious group, whereas the "extrinsic" orientation and "antireligious" orientation were dominant in the nonreligious group. 4) Religious orientations were different according to the types of religions. The "intrinsic" orientation was dominant in Protestantism and Catholicism, the "extrinsic" orientation was dominant in Buddhism and the "proreligious" orientation was dominant in other type of religious group. 5) Schizophrenic delusion and religious factors showed several characteristic relations First, it was suggested that religion facilitated the psychological maturation and served as a ventilating pathway of guilty feeling. Second, schizophrenic delusion seemed to be affected by the types of the religions. Buddhism group dominantly presented delusion of reference and of guilt, whereas Protestant and Catholic groups dominantly presented delusion of being controlled. Other groups of religion dominantly presented somatic delusion. Third, delusion of guilt was most prevalent in the "extrinsic" attitude and 1311owe4 by the "proreligious" and "intrinsic" attitudes. It was similar to the previous study that guilty feeling was most prevalent in the "extrinsic" attitude in the orders of the "antireligious" , the "proreligious" , and the "intrinsic" attitude. Fourth, religious and supernatural themes of delusion were most dominant in the "intrinsic" attitude, whereas realistic themes of delusion were most dominant in the "extrinsic" attitude. CONCLUSION: These results suggest that religious orientation and other religious factors seem to affect delusion formation and mental health in schizophrenic patients.
Buddhism ; Catholicism ; Delusions* ; Guilt ; Humans ; Korea ; Mental Health ; Prevalence ; Protestantism ; Schizophrenia

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

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

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

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*

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*

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

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