Kyung-Ah Kang

Scopus Publications

Effects of a Meaning-Centered Spiritual Care Training Program for Hospice Palliative Care Teams in South Korea: A Nonrandomized Controlled Trial
Kyung-Ah Kang, Shin-Jeong Kim, Do-Bong Kim, Su-Jin Koh, Myung-Hee Park, and Soo-Jin Yoon
Ovid Technologies (Wolters Kluwer Health)
Background Spiritual care is an essential part and a core component of quality palliative care, as identified by the World Health Organization. However, spiritual care training for hospice palliative care teams (HPCTs) is infrequent. Objective The aim of this study was to investigate the effects of a meaning-centered spiritual care training program for HPCTs (McSCTP-HPCT). Methods This study used a nonrandomized controlled design. The McSCTP-HPCT comprised 5 modules. The participants were HPCTs working in 15 national hospice institutions and were allocated to either the experimental group (n = 33) or the control group (n = 27) based on the participating institutions’ preference. Three outcome variables were tested: spiritual care competency, spiritual care therapeutics, and compassion fatigue. Data were analyzed using descriptive statistics, χ2 test, 1-way analysis of variance, and repeated-measures analysis of variance. Results There was a significant difference in the interaction between measurement time and group assignment in spiritual care competency (P = .002) and spiritual care therapeutics (P = .038), whereas no significant difference was found for compassion fatigue (P = .716). Conclusion The McSCTP-HPCT conducted in this study shows effectiveness in increasing the spiritual care competency and spiritual care therapeutics of HPCTs and may support the importance of spiritual care training. Implications for Practice The McSCTP-HPCTs adds to the scientific evidence on spiritual care and has the capacity to improve the quality of care for patients with a life-threatening illness.

Perceptions of the meaning of life among Korean patients with advanced cancer: A mixed-methods study
Su-Jin Koh, Kyung-Ah Kang, Hyeyeong Kim, Jaekyung Cheon, Hyeon-Su Im, Jae-Hon Lee, Minsu Ock, Juhee Cho, and Eun-Hye Lee
Cambridge University Press (CUP)
AbstractObjectiveThis study aimed to explore perceptions of the meaning of life among Korean patients living with advanced cancer.MethodThe study employed a mixed-methods design, and 16 participants were included in the analysis. Qualitative data gathered from in-depth interviews were analyzed using Colaizzi's phenomenological method. Quantitative survey data were analyzed using descriptive statistics, the Mann–Whitney U test, the Kruskal–Wallis test, and Spearman's ρ correlation.ResultsParticipants experienced both the existence of meaning and the will to find meaning in terms of four categories: “interpersonal relationships based on attachment and cohesion” (three themes — family as the core meaning of one's life, supportive and dependent interconnectedness with significant others, and existential responsibility embedded in familism), “therapeutic relationships based on trust” (one theme — communication and trust between the patient and medical staff), “optimism” (two themes — positivity embodied through past experiences and a positive attitude toward the current situation), and “a sense of purpose with advanced cancer” (two themes — the will to survive and expectations for the near future). The meaning in life questionnaire (MLQ) and the purpose in life scale (PIL) showed a significant positive correlation tendency with the functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp). The patient health questionnaire (PHQ-9) showed significant negative correlation tendency with both the MLQ-presence of meaning (MLQ-PM) and PIL-Initiative (PIL-I) questionnaires.Significance of resultsFinding meaning in life helps advanced cancer patients realize their will to live. It also acts as a coping mechanism that palliates negative experiences in the fight against the disease. In particular, among advanced cancer patients in the Korean culture, the dynamics of relationships with family and medical staff was a key axis that instilled optimism and will to live. These results suggest that considering the meaning of life in advanced cancer patients by reflecting Korean culture in the treatment process improves the quality of care.

Research trends over 10 years (2010-2021) in infant and toddler rearing behavior by family caregivers in South Korea: text network and topic modeling
In-Hye Song and Kyung-Ah Kang
Korean Academy of Child Health Nursing
Purpose: This study analyzed research trends in infant and toddler rearing behavior among family caregivers over a 10-year period (2010-2021). Methods: Text network analysis and topic modeling were employed on data collected from relevant papers, following the extraction and refinement of semantic morphemes. A semantic-centered network was constructed by extracting words from 2,613 English-language abstracts. Data analysis was performed using NetMiner 4.5.0.Results: Frequency analysis, degree centrality, and eigenvector centrality all revealed the terms ''scale," ''program," and ''education" among the top 10 keywords associated with infant and toddler rearing behaviors among family caregivers. The keywords extracted from the analysis were divided into two clusters through cohesion analysis. Additionally, they were classified into two topic groups using topic modeling: "program and evaluation" (64.37%) and "caregivers' role and competency in child development" (35.63%).Conclusion: The roles and competencies of family caregivers are essential for the development of infants and toddlers. Intervention programs and evaluations are necessary to improve rearing behaviors. Future research should determine the role of nurses in supporting family caregivers. Additionally, it should facilitate the development of nursing strategies and intervention programs to promote positive rearing practices.

Healthy lifestyle interventions for childhood and adolescent cancer survivors: a systematic review and meta-analysis
Kyung-Ah Kang, Suk Jung Han, Jiyoung Chun, Hyun-Yong Kim, Yerin Oh, and Heejin Yoon
Korean Academy of Child Health Nursing
Purpose: This study investigated the effects of healthy lifestyle interventions (HLSIs) on health-related quality of life (HR-QoL) in childhood and adolescent cancer survivors (CACS).Methods: Major databases were searched for English-language original articles published between January 1, 2000 and May 2, 2021. Randomized controlled trials (RCTs) and non-RCTs were included. Quality was assessed using the revised Cochrane risk-of-bias tool, and a meta-analysis was conducted using RevMan 5.3 software.Results: Nineteen studies were included. Significant effects on HR-QoL were found for interventions using a multi-modal approach (exercise and education) (d=-0.46; 95% confidence interval [CI]=-0.84 to -0.07, p=.02), lasting not less than 6 months (d=-0.72; 95% CI=-1.15 to -0.29, p=.0010), and using a group approach (d=-0.46; 95% CI=-0.85 to -0.06, p=.02). Self-efficacy showed significant effects when HLSIs provided health education only (d=-0.55; 95% CI=-0.92 to -0.18; p=.003), lasted for less than 6 months (d=-0.40; 95% CI=-0.69 to -0.11, p=.006), and were conducted individually (d=-0.55; 95% CI=-0.92 to -0.18, p=.003). The physical outcomes (physical activity, fatigue, exercise capacity-VO2, exercise capacity-upper body, body mass index) revealed no statistical significance.Conclusion: Areas of HLSIs for CACS requiring further study were identified, and needs and directions of research for holistic health management were suggested.

Psychometric validation of the Child Healthy Lifestyle Profile in South Korea: a cross-sectional study
Kyung-Ah Kang and Shin-Jeong Kim
Korean Academy of Child Health Nursing
Purpose: This study aimed to validate the Child Healthy Lifestyle Profile as an instrument for screening healthy behaviors in school-aged children in South Korea.Methods: Self-reported questionnaires were administered to 454 students, comprising elementary-school students (n=221) and child cancer survivors (n=233). Reliability and validity were assessed using Cronbach's ⍺, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).Results: Cronbach's ⍺, as a reliability test, was 0.87. Varimax rotation yielded nine factors with eigenvalues greater than 1 in the EFA, which explained 61.0% of the total variance. In the CFA, both convergent and discriminant validities were acceptable. Therefore, the Child Healthy Lifestyle Profile was validated as an assessment tool for Korean school-aged children.Conclusion: Based on the results of this study, the Child Healthy Lifestyle Profile was identified as a reliable and valid instrument for assessing healthy lifestyles in elementary-school children in South Korea.

Initial screening of compassion fatigue in a hospice palliative care team: validation of the silencing response scale
Jiyoung Chun, Ye Jean Kim, and Kyung-Ah Kang
Informa UK Limited
Aims and Objectives: This study aimed to validate a silencing response scale (SRS) for the initial screening of compassion fatigue in hospice palliative care teams (HPCT) members. Background: The silencing response is a defense mechanism that diverts caregivers’ attention from painful and difficult situations. This is an early stage of compassion fatigue. During the silencing response stage, the ability of HPCTs to listen to patients’ requests for assistance decreases, and their professional performance related to tasks and care provision weakens. Design: This study with psychometric evaluation was designed to validate the SRS for the initial screening of compassion fatigue among HPCTs. Methods: After translation-back translation and content validity indexing, 236 HPCT members working in hospice agencies designated by the Korean Ministry of Health and Welfare participated in this survey. The data were analyzed using SPSS and AMOS software. Results: The SRS developed in this study is a self-evaluation tool that employs a five-point Likert scale with 16 items: eight for disinterest, four for situation avoidance, and four for fear. The SRS met the criteria for construct, convergent, and criterion validity. The Cronbach's α for the full SRS was .87. Conclusions: To ensure HPCT well-being, prevention rather than burnout recovery should be prioritized. The SRS developed in this study can be used to screen for compassion fatigue at an early stage to prevent burnout and severe compassion fatigue among HPCT members.

Healthy lifestyle status related to alcohol and food addiction risk among college students: a logistic regression analysis
Cheong Hoon Kim, Kyung-Ah Kang, and Sunhwa Shin
Informa UK Limited
OBJECTIVE This study aimed to determine whether low healthy lifestyle (HL) status was associated with alcohol and food addiction risks among college students. METHOD The data were gathered through an online survey questionnaire from 311 college students. The students were divided into either a lower or a higher HL status group, based on HL mean score, and the major statistical method used was a binary logistic regression. RESULTS There were significant differences in alcohol and food addiction score between the two groups. The lower HL status group showed a 3.06 times higher risk of problematic drinking and a 2.44 times higher risk of food addiction compared with the higher HL status group. CONCLUSIONS The results of this study suggest the importance of HL in the prevention of alcohol and food addiction. HL information can be used to develop health education programs aimed at preventing addiction for college students.

Nurse Spiritual Care Therapeutics Scale: Validation Among Nurses Who Care for Patients With Life-Threatening Illnesses in South Korea
Kyung-Ah Kang, Elizabeth Johnston Taylor, and Jiyoung Chun
Ovid Technologies (Wolters Kluwer Health)
Although clinical and empirical literature documents the variety of spiritual care interventions available to palliative care clinicians, the frequency with which they are provided is rarely and inadequately measured. Given the growing interest in implementing spiritual care across Asia, including South Korea, this study sought to cross-culturally validate the Korean version of the Nurse Spiritual Care Therapeutics Scale (NSCTS-K), a scale initially developed in the United States. The World Health Organization process for cross-cultural adaptation of scales and Polit and Yang's process for evaluating validation were implemented. With data from a sample of 252 Korean nurses providing care to patients with life-threatening illnesses, various statistical procedures for evaluating validity and reliability were applied during this cross-sectional, observational study. Exploratory factor analysis for the structural validity of the Korean scale generated 3 factors that accounted for 69.40% of the variance. The Cronbach α was 0.95. The NSCTS-K is one of the few scales available to determine the impact of nurse-provided spiritual care frequency on patient outcomes. Thus, this tool can quantify the frequency of spiritual care better and be used in quality improvement initiatives or palliative care research.

Content Analysis of Multifaceted Needs for Improving the Quality of Pediatric Palliative Care Among Parents of Children With Life-threatening Conditions
Kim Cho-Hee, Kim Min-Sun, Moon Yi-Ji, Shin Hee-Young, Lee Myung-Nam, and Kang Kyung-Ah
Ovid Technologies (Wolters Kluwer Health)
This study aimed to identify parental needs for pediatric palliative care and obtain their opinions on developing pediatric palliative care in South Korea. This qualitative research design used inductive and deductive methods. The data were collected through semistructured interviews. A total of 6 parents actively caring for a child with life-threatening conditions and 7 bereaved parents participated in this study. A total of 707 significant statements, 43 subthemes, and 16 themes according to 6 structured matrices (advance care planning and symptom control, psychological and spiritual care, supporting everyday lives, end-of-life care and bereavement support, delivery model of pediatric palliative care, and unmet needs within current services) on the care and bereavement experiences of parents of children with life-threatening conditions were derived. Palliative care for children is a multidisciplinary approach to evaluate, prevent, and manage multifaceted symptoms and to support children with life-threatening conditions and their families. Our findings suggest that parents of children with life-threatening conditions in South Korea present multidimensional needs across the diagnostic groups and the illness trajectories and inform policy makers and health care professionals to design a pediatric palliative care delivery model. Further studies examining the unmet needs are required to enhance the quality of pediatric palliative care.

Elementary school students' awareness of the use of artificial intelligence chatbots in violence prevention education in South Korea: a descriptive study
Kyung-Ah Kang, Shin-Jeong Kim, and So Ra Kang
Korean Academy of Child Health Nursing
Purpose: This study aimed to identify students' awareness of the use of a chatbot (A-uC), a type of artificial intelligence technology, for violence prevention among elementary school students. Methods: The participants comprised 215 students in the fourth to sixth grades in Chuncheon, South Korea, and data were collected via a self-reported questionnaire. Results: The mean A-uC score was 3.43±0.83 out of 5 points. The mean scores for the 4 sub-dimensions of the A-uC tool were 3.48±0.80 for perceived value, 3.44±0.98 for perceived usefulness, 3.63±0.92 for perceived ease of use, and 3.15±1.07 for intention to use. Significant differences were observed in A-uC scores (F=59.26, p<.001) according to the need for the use of chatbots in violence prevention education. The relationships between intention to use and the other A-uC sub-dimensions showed significant correlations with perceived value (r=.85, p<.001), perceived usefulness (r=.76, p<.001), and perceived ease of use (r=.64, p<.001).Conclusion: The results of this study suggest that chatbots can be used in violence prevention education for elementary school students.

Effects of Child Sexual Abuse Prevention Education Program Using Hybrid Application (CSAPE-H) on Fifth-Grade Students in South Korea
So Ra Kang, Shin-Jeong Kim, and Kyung-Ah Kang
SAGE Publications
The purpose of this study was to test the effects of a child sexual abuse prevention education program using a hybrid application (CSAPE-H) by examining fifth-grade students’ (a) knowledge for sexual abuse prevention and (b) self-protective behaviors against sexual abuse. A quasi-experimental, pretest /posttest design was used. Sixty-eight students from two schools participated. The intervention group ( n = 48) received six sessions in CSA prevention education using the hybrid app, whereas the control group ( n = 35) was taught using a lecture in a classroom environment. Between the two groups, there were significant differences in self-protective behaviors against CSA ( t = 2.26, p = .027). In addition, educational satisfaction was significantly higher in the experimental group than the control group ( t = 2.41, p = .019). A CSAPE-H may be effective for elementary school students, especially for self-protective behaviors.

Healthy lifestyles in childhood cancer survivors in South Korea: a comparison between reports from children and their parents
Kyung-Ah Kang, Shin-Jeong Kim, and Inhye Song
Korean Academy of Child Health Nursing
Purpose: This study investigated childhood cancer survivors' behavior related to a healthy lifestyle during their survival period by comparing reports between childhood cancer survivors and their parents.Methods: In this comparative descriptive study, a survey was conducted with a 33-item questionnaire and one open-ended question about areas for improvement. The participants comprised 69 childhood cancer survivors and 69 of their parents, for a total of 138.Results: The total mean healthy lifestyle score, on a 4-point Likert scale, reported by childhood cancer survivors was 2.97, while that reported by their parents was 3.03. No significant differences in children's healthy lifestyles were found between childhood cancer survivors' and their parents' reports (t=0.86, p=.390). For the open-ended question, the main keywords based on the results of degree and eigenvector centrality were "exercise", "unbalanced diet", and "food". These keywords were present in both the children's and parents' responses.Conclusion: Obtaining information on childhood cancer survivors' healthy lifestyles based on reports from themselves and their parents provides meaningful insights into the improvement of health care management. The results of this study may be used to develop and plan healthy lifestyle standards to meet childhood cancer survivors' needs.

Web-Based Research Trends on Child and Adolescent Cancer Survivors over the Last 5 Years: Text Network Analysis and Topic Modeling Study
Hyun-Yong Kim, Kyung-Ah Kang, Suk-Jung Han, and Jiyoung Chun
JMIR Publications Inc.
Background Being diagnosed with cancer during childhood or adolescence can disrupt important periods in an individual’s physical, psychosocial, and spiritual development and potentially reduce the quality of life (QOL) after treatment. Research is urgently required to improve the QOL for child and adolescent cancer survivors, and it is necessary to analyze the trends in prior research reported in international academic journals to identify knowledge structures. Objective This study aims to identify the main keywords based on network centrality, subgroups (clusters) of keyword networks by using a cohesion analysis method, and the main theme of child and adolescent cancer survivor–related research abstracts through topic modeling. This study also aims to label the subgroups by comparing the results of the cohesion and topic modeling. Methods A text network analysis method and topic modeling were used to explore the main trends in child and adolescent cancer survivor research by structuring a network of keyword (semantic morphemes) co-occurrence in the abstracts of articles published in 5 major web-based databases from 2016 to 2020. A total of 1677 child and adolescent cancer survivor–related studies were used for data analyses. Data selection, processing, and analyses were also conducted. Results The top 5 keywords in terms of degree and eigenvector centrality were risk, control interval, radiation, childhood cancer treatment, and diagnosis. Of the 1677 studies used for data analyses, cluster 1 included 780 (46.51%) documents under risk management, cluster 2 contained 557 (33.21%) articles under health-related QOL and supportive care, and cluster 3 consisted of 340 (20.27%) studies under cancer treatment and complications. Conclusions This study is significant in that it confirms the knowledge structure based on the main keywords and cross-disciplinary trends in child and adolescent cancer survivor research published in the last 5 years worldwide. The primary goal of child and adolescent cancer survivor research is to prevent and manage the various aspects of the problems encountered during the transition to a normal life and to improve the overall QOL. To this end, it is necessary to further revitalize the study of the multidisciplinary team approach for the promotion of age-specific health behaviors and the development of intervention strategies with increased feasibility for child and adolescent cancer survivors.

Effects of a Violence Prevention Education Program Using Empathy (VPEP-E) on Fifth-Grade Students in South Korea
Kyung-Ah Kang, Shin-Jeong Kim, SoRa Kang, and JungMin Lee
SAGE Publications
This study aimed to investigate the effects of a violence-prevention education program using empathy (VPEP-E) on elementary school students. This quasi-experimental design examined fifth-grade students’ (a) empathy level, (b) perception of violence, and (c) permissive and negligent attitudes toward violence, using a pre- and post-test design. A total of 101 students participated: the experimental group ( n = 48) received eight sessions of VPEP-E, whereas the control group ( n = 53) received violence prevention education through classroom lectures. Significant differences were observed between the groups’ empathy level ( t = 6.81, p < .001), perception of violence ( t = 2.79, p = .006), and permissive and negligent attitudes toward violence ( t = -2.21, p = .030; t = -2.02, p = .046). Thus, a school-based VPEP-E may help elementary school students. Long-term studies evaluating behavioral changes from VPEP-E implementation are needed for establishing the effects on violent behavior.

Spiritual needs among Koreans and Americans with advanced chronic illnesses: A cultural comparison
Iris Mamier, Sun Min Kim, Denise Petersen, Hye‐Jin Bae, Elizabeth Johnston Taylor, and Kyung‐Ah Kang
Wiley
AIMS AND OBJECTIVES This study aimed to measure the frequency of spiritual needs, identify the factors associated with these needs among Korean and American persons living with an advance chronic illness and compare them from a cross-cultural perspective. BACKGROUND Persons with serious or life-limiting illnesses often have spiritual needs. Unmet spiritual needs are associated with poor well-being and threaten psychological health. Little is known about how specific spiritual needs vary across cultures. DESIGN A quantitative, cross-sectional, observational cross-cultural comparison was undertaken. METHODS The study has been prepared in accordance with the STROBE guidelines. Convenience sampling was used to recruit participants from outpatient clinics in South Korea and Southern California (N = 202). Spiritual needs were measured using the Spiritual Interests Related to Illness Tool (SpIRIT); demographic and illness-related variables were also assessed using paper-and-pencil questionnaires. Data were analysed using various parametric statistical tests, including multiple regression analysis. RESULTS The findings quantify the intensity and types of spiritual needs that persons living with an advanced chronic illness experience. Furthermore, they show how the spiritual needs of religiously diverse samples of South Koreans and Americans differ. The findings also indicate that self-reported spirituality and religiosity independently explain a substantial amount of the variance in spiritual needs. CONCLUSIONS In both the samples, spiritual needs were reported and associated with spirituality and religiosity. Although all the eight domains of spiritual needs assessed by the SpIRIT were pertinent to the Korean and American samples, they were prioritised differently. RELEVANCE TO CLINICAL PRACTICE Screening patients to ascertain how important spirituality or religiosity is to them may help clinicians focus their in-depth assessments on those who report high levels of spirituality or religiosity because these patients may experience the strongest spiritual needs. The SpIRIT shows promise as a measure of diverse spiritual needs.

Correction to: A meaning-centered spiritual care training program for hospice palliative care teams in South Korea: development and preliminary evaluation (BMC Palliative Care, (2021), 20, 1, (30), 10.1186/s12904-021-00718-1)
Kyung-Ah Kang, Shin-Jeong Kim, Do-Bong Kim, Myung-Hee Park, Soo-Jin Yoon, Sung-Eun Choi, Young-Sim Choi, and Su-Jin Koh
Springer Science and Business Media LLC

A meaning-centered spiritual care training program for hospice palliative care teams in South Korea: development and preliminary evaluation
Kyung-Ah Kang, Shin-Jeong Kim, Do-Bong Kim, Myung-Hee Park, Soo-Jin Yoon, Sung-Eun Choi, Young-Sim Choi, and Su-Jin Koh
Springer Science and Business Media LLC
Abstract Background Spirituality is a fundamental, intrinsic aspect of human beings and should be a core component of quality palliative care. There is an urgent need to train hospice palliative care teams (HPCTs) to enhance their ability to provide spiritual care. This study aimed to develop and evaluate a meaning-centered, spiritual care training program (McSCTP) for HPCTs (McSCTP-HPCTs). Methods The modules’ content was informed by Viktor Frankl’s meaning-centered logotherapy with its emphasis on spiritual resources, as well as the spiritual care model of the Interprofessional Spiritual Care Education Curriculum (ISPEC). Following development, we conducted a pilot test with four nurses. We used the results to inform the final program, which we tested in an intervention involving 13 members of HPCTs. We took measurements using self-administered questionnaires at three points before and after the intervention. Using descriptive statistics, the Mann-Whitney U test, and the Kruskal-Wallis test, we analyzed the participants’ demographic and career-related characteristics, as well as the degree of variance between three outcome variables: compassion fatigue (CF), spiritual care competencies (SCCs), and spiritual care therapeutics (SCT). Results We divided the McSCTP-HPCTs into five modules. Module I: The HPCTs’ SCC evaluation, understanding the major concepts of spiritual care and logotherapy; Modules II-IV: Meaning-centered interventions (MCIs) related to spiritual needs (existential, relational, and transcendental/religious); Module V: The process of meaning-centered spiritual care. The preliminary evaluation revealed significant differences in all three outcome variables at the posttest point (CF, p = 0.037; SCCs, p = 0.005; SCT, p = 0.002). At the four-week follow-up test point, we only found statistical significance with the SCCs (p = 0.006). Conclusions The McSCTP-HPCTs is suitable for use in clinical settings and provides evidence for assessing the SCCs of HPCTs.

Hospice palliative care nurses’ perceptions of spiritual care and their spiritual care competence: A mixed-methods study
Kyung‐Ah Kang, Jiyoung Chun, Hyun Yong Kim, and Hyeon‐Young Kim
Wiley
AIMS AND OBJECTIVES To understand hospice palliative care nurses' (HPCNs) perceptions toward spiritual care and their competence to provide spiritual care. BACKGROUND Previous research has shown that many nurses lack a clear understanding of the concept of spirituality and feel inadequately prepared to assess patients' spiritual needs. Studies on competence in spiritual care are mostly descriptive, and the evidence for improving it is limited. DESIGN A mixed methods research design was used. METHODS Quantitative data were collected from 282 nurses in forty Hospice Palliative Care (HPC) institutions in South Korea and analyzed using descriptive statistics, independent t-test, one-way ANOVA with Bonferroni test, and multiple regression. Qualitative data collection involved two stages: first, an open-ended question posed to 282 nurses, and second, focus group interviews conducted with six HPC experts. Both qualitative datasets were analyzed separately using content analysis. This study followed the GRAMMS guidelines. RESULTS Of the six dimensions of spiritual care competence (SCC), the mean scores were highest in "attitude toward the patient's spirituality" and "communication," whereas the "assessment and implementation of spiritual care" and "professionalization and improving the quality of spiritual care" had the lowest mean scores. Through content analysis, 4 themes regarding the meaning of spiritual care, 3 themes regarding requirements for spiritual care, and 2 themes regarding preparedness for spiritual care were revealed. They perceived the needs of the understanding of spiritual care based on the attributes of spirituality, the education in systematic assessments and implementation for spiritual care with standardized terminology, and the opportunity to reflect on nurses' own spirituality. CONCLUSIONS Practical SCC training for HPCNs and the subsequent development of clinical practice guidelines are of vital importance. RELEVANCE TO CLINICAL PRACTICE The results of this study provide a useful resource to develop educational programs for strengthening the SCC of nurses and the entire HPC team.

Cross-cultural Validation of the Spiritual Interests Related to Illness Tool-Korean Version
Kyung-Ah Kang, Iris Mamier, Jiyoung Chun, and Elizabeth Johnston Taylor
Ovid Technologies (Wolters Kluwer Health)
Living with a terminal illness, whether as a patient or as the family member of a patient, often involves spiritual challenges. The ability to ascertain and meet the spiritual needs of terminally ill patients and their loved ones is an essential part of providing compassionate and competent whole person care. This study aimed to adapt the original Spiritual Interests Related to Illness Tool (SpIRIT) for use in Korea (SpIRIT-K) and to assess its reliability and validity as a tool to determine the spiritual needs of terminally ill Korean patients and their caregivers. After translation–back-translation and content validity indexing, SpIRIT-K was administered to 106 terminally ill patients and 105 family caregivers in 20 sites across South Korea. SPSS and AMOS were used for evaluating validity and reliability. The 37-item SpIRIT-K consisted of 8 factors (subscales), with each subscale consisting of between 3 and 8 items. Evidence for structural and convergent validity was observed. Internal reliability of the overall scale was 0.95. The findings showed patients and family caregivers reported no significant difference in 7 of the 8 subscales, demonstrating known-groups validity. The rigorous process of establishing cross-cultural validity for this scale provided evidence supporting its validity and reliability. The findings suggest that SpIRIT-K is suitable for research and for clinical purposes in palliative care settings in South Korea. This development also allows for comparisons between Korean and North American cultures in terms of spiritual needs among terminally ill patients and their caregivers.

Research trends related to childhood and adolescent cancer survivors in South Korea using word co-occurrence network analysis
Kyung-Ah Kang, Suk Jung Han, Jiyoung Chun, and Hyun-Yong Kim
Korean Academy of Child Health Nursing
Purpose: This study analyzed research trends related to childhood and adolescent cancer survivors (CACS) using word co-occurrence network analysis on studies registered in the Korean Citation Index (KCI).Methods: This word co-occurrence network analysis study explored major research trends by constructing a network based on relationships between keywords (semantic morphemes) in the abstracts of published articles. Research articles published in the KCI over the past 10 years were collected using the Biblio Data Collector tool included in the NetMiner Program (version 4), using "cancer survivors", "adolescent", and "child" as the main search terms. After pre-processing, analyses were conducted on centrality (degree and eigenvector), cohesion (community), and topic modeling.Results: For centrality, the top 10 keywords included "treatment", "factor", "intervention", "group", "radiotherapy", "health", "risk", "measurement", "outcome", and "quality of life". In terms of cohesion and topic analysis, three categories were identified as the major research trends: "treatment and complications", "adaptation and support needs", and "management and quality of life".Conclusion: The keywords from the three main categories reflected interdisciplinary identification. Many studies on adaptation and support needs were identified in our analysis of nursing literature. Further research on managing and evaluating the quality of life among CACS must also be conducted.

Comparison of Perceptions of Spiritual Care Among Patients With Life-Threatening Cancer, Primary Family Caregivers, and Hospice/Palliative Care Nurses in South Korea
Kyung-Ah Kang and Shin-Jeong Kim
Ovid Technologies (Wolters Kluwer Health)
This study aimed to compare perceptions of spiritual care among patients with life-threatening cancer, their primary family caregivers, and hospice/palliative care nurses. Data were collected using both structured and unstructured approaches. Structured questionnaire data were examined using statistical analysis methods, and unstructured data were examined using content analysis to compare the 3 participant groups. The questionnaire revealed that among all 3 groups, spiritual care was commonly perceived to relate to “having the opportunity for internal reflection,” “finding meaning,” “encouraging hope,” and “listening to and being with patients.” Content analysis of the unstructured data revealed 5 themes: “Caring with sincerity,” “Strengthening spiritual resources,” “Alleviating physical pain and discomfort” (among patients and primary family caregivers only), “Improving spiritual care service,” and “Multifaceted cooperation” (among hospice/palliative care nurses only). Our findings suggest that for patients with life-threatening illnesses such as terminal cancer, spiritual care should not be limited to religious practice but should also satisfy inner existential needs, for example, by encouraging hope, providing empathy, and helping patients find meaning in their circumstances.

Comparison of learning effects of virtual reality simulation on nursing students caring for children with asthma
Kyung-Ah Kang, Shin-Jeong Kim, Myung-Nam Lee, Mikang Kim, and Sunghee Kim
MDPI AG
With the global pandemic of the coronavirus disease, virtual reality simulation (vSim) has emerged as a simulation educational method. The purpose of this study is to examine the learning effects of vSim by comparing three different educational modalities of nursing care for children with asthma. A quasi-experimental design with three different teaching methods, vSim, high-fidelity simulation (HFS), and vSim with HFS, were used in the study. The group using vSim with HFS showed the highest scores in knowledge, confidence in practice, and performance compared to groups using vSim or HFS alone. Simulation practice using vSim combined with HFS could be an effective educational method for nursing students.

Associations between COVID-19 misinformation exposure and belief with COVID-19 knowledge and preventive behaviors: cross-sectional online study
Jung Jae Lee, Kyung-Ah Kang, Man Ping Wang, Sheng Zhi Zhao, Janet Yuen Ha Wong, Siobhan O'Connor, Sook Ching Yang, and Sunhwa Shin
JMIR Publications Inc.
Background Online misinformation proliferation during the COVID-19 pandemic has become a major public health concern. Objective We aimed to assess the prevalence of COVID-19 misinformation exposure and beliefs, associated factors including psychological distress with misinformation exposure, and the associations between COVID-19 knowledge and number of preventive behaviors. Methods A cross-sectional online survey was conducted with 1049 South Korean adults in April 2020. Respondents were asked about receiving COVID-19 misinformation using 12 items identified by the World Health Organization. Logistic regression was used to compute adjusted odds ratios (aORs) for the association of receiving misinformation with sociodemographic characteristics, source of information, COVID-19 misinformation belief, and psychological distress, as well as the associations of COVID-19 misinformation belief with COVID-19 knowledge and the number of COVID-19 preventive behaviors among those who received the misinformation. All data were weighted according to the Korea census data in 2018. Results Overall, 67.78% (n=711) of respondents reported exposure to at least one COVID-19 misinformation item. Misinformation exposure was associated with younger age, higher education levels, and lower income. Sources of information associated with misinformation exposure were social networking services (aOR 1.67, 95% CI 1.20-2.32) and instant messaging (aOR 1.79, 1.27-2.51). Misinformation exposure was also associated with psychological distress including anxiety (aOR 1.80, 1.24-2.61), depressive (aOR 1.47, 1.09-2.00), and posttraumatic stress disorder symptoms (aOR 1.97, 1.42-2.73), as well as misinformation belief (aOR 7.33, 5.17-10.38). Misinformation belief was associated with poorer COVID-19 knowledge (high: aOR 0.62, 0.45-0.84) and fewer preventive behaviors (≥7 behaviors: aOR 0.54, 0.39-0.74). Conclusions COVID-19 misinformation exposure was associated with misinformation belief, while misinformation belief was associated with fewer preventive behaviors. Given the potential of misinformation to undermine global efforts in COVID-19 disease control, up-to-date public health strategies are required to counter the proliferation of misinformation.

Comparing the learning effects of debriefing modalities for the care of premature infants
Myung‐Nam Lee, Shin‐Jeong Kim, Kyung‐Ah Kang, and Sunghee Kim
Wiley
The aim of this study was to compare the learning effects of debriefing methods used in the simulation of prematurity care by measuring: (i) academic self-efficacy; (ii) confidence in performance; (iii) self-assessed communication skills; and (iv) satisfaction. We employed a quasi-experimental design with three experimental groups that experienced instructor-directed, self-directed, and video-assisted, self-directed debriefing, respectively. Participants were 146 senior nursing students from three nursing schools. To compare learning effects, the same developed scenario for prematurity care was applied to all three groups. Significant differences were observed in the mean scores for the study variables among the three groups. The post-hoc analysis showed that the video-assisted, self-directed debriefing group obtained the highest mean score difference for confidence in performance, self-assessed communication skills, and satisfaction with the debriefing method. Thus, video-assisted, self-directed debriefing could be the most effective debriefing method for students.

Validation of a Korean Version of the Spiritual Care Competence Scale: Focused on the Hospice and Palliative Care Setting
Kyung-Ah Kang, Youngsim Choi, and Shin-Jeong Kim
Ovid Technologies (Wolters Kluwer Health)
This study aimed to examine the reliability and validity of a scale to assess the competence of Korean nurses who provide spiritual care for patients with terminal illnesses. The reliability and validity were examined using Cronbach α, item analysis, and exploratory factor analysis. The participants were 248 hospice nurses working at 40 hospices and palliative hospitals in South Korea. The results showed that the reliability was high, as indicated by a Cronbach α of .942. The exploratory factor analysis revealed 6 dimensions (assessment and implementation of spiritual care, professionalization and improvement of the quality of spiritual care, personal support and patient counseling, referral to professionals, attitude toward the patient's spirituality, and communication) with 27 items. The 6 factors explained 68.20% of the variance in the Korean version of the Spiritual Care Competence Scale. From the results, the Korean version of the Spiritual Care Competence Scale may serve as an appropriate measure for provision of spiritual care for patients with terminal illness. In addition, it may be useful in assessing hospice and palliative nurses' ability for spiritual care.

Kyung-Ah Kang

EDUCATION

Scopus Publications