COPD subjects may have specific patterns of symptom clusters. The symptom clusters are related with clinical characteristics and had a negative impact on QOL. To enhance symptom management and QOL, approaches and interventions based on symptom clusters, rather than independent intervention for each symptom, may be more effective. Understanding COPD symptom clusters may help successful symptom management, which can improve QOL for COPD patients.

Since type D personality is associated with job stress and job satisfaction, identifying personalities vulnerable to stress would help to address job stress and to enhance job satisfaction when nurses have a high level of compassion fatigue and burnout and a low level of compassion satisfaction. The development of interventions that can reduce negative affect and social inhibition of nurses with type D personality and investigation of methods to decrease their compassion fatigue and burnout and to increase compassion satisfaction should be encouraged.

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Aim: To evaluate the effects of an integrated self-management program using a mobile application, a short message service using a smartphone, and face-to-face counseling and education among hemodialysis patients. Methods: A quasi-experimental study design was used. The participants of this study were 84 hemodialysis patients (42 in the experimental group and 42 in the control group). The experimental group received the integrated self-management program for 8 weeks. The data were analyzed by using the independent t-test and Mann-Whitney U test to identify differences in self-efficacy, treatment compliance, the ratio of interdialytic weight gain to dry weight, and serum potassium and phosphorus levels between the experimental group and the control group at the end of the program. Results: The scores for self-efficacy and treatment compliance were significantly higher in the experimental group than in the control group. The ratio of interdialytic weight gain to dry weight significantly decreased in the experimental group, compared to the control group. The serum potassium and phosphorus levels in the experimental group were not significantly lower than those of the control group. Conclusion: The findings suggest that the integrated self-management program that was implemented in this study could be a potentially effective intervention to improve the self-management of hemodialysis patients. Further research on various nursing intervention programs is warranted, including a mobile application program to improve hemodialysis patients' self-management.

Aims and objectives: The purpose of this study was to examine the magnitude of cancer stigma, social support, coping strategies and psychosocial adjustment among breast cancer survivors and to identify the factors associated with patients' psychosocial adjustment. Background: Few studies have examined the association between cancer stigma and adaptation outcomes, which are considered interpersonal stressors for breast cancer survivors. Design: A correlational, cross-sectional research design was used. Methods: This study was designed based on the stress-coping theory of Lazarus and Folkman. This descriptive cross-sectional study included 158 breast cancer survivors who visited a Korean tertiary hospital. Data collection was performed using a structured questionnaire and electronic medical records between March-May 2018. Data analyses included descriptive statistics, independent t test, one-way ANOVA, Kruskal-Wallis test, partial correlation analysis and hierarchical regression analysis and were performed with the SPSS WIN 25.0 program. This study adheres to STROBE guidelines. Results: Cancer stigma had the strongest association with psychosocial adjustment among Korean breast cancer survivors, followed by social support and coping strategies. These variables accounted for approximately 44% of the variance in psychosocial adjustment. Conclusion: Cancer stigma had the strongest association with psychosocial adjustment. Healthcare professionals should assess patients' cancer stigma to develop patient-tailored stigma management programmes. Relevance to clinical practice: Interventions to alleviate cancer stigma should be developed, and social support and coping strategies for breast cancer survivors should be considered in clinical oncology settings.

Purpose The reported prevalence of malnutrition and related factors in gynecologic cancer varies. We aimed to describe nutritional status and to identify demographic, clinical, psychological, and nutritional factors contributing to malnutrition in gynecologic cancer patients. Methods We used a descriptive cross-sectional design. A total of 129 subjects were enrolled. Subjects agreed to undergo a face-to-face interview, including measurement of body mass index (BMI) and administration of structured questionnaires including the Patient-Generated Subjective Global Assessment (PG-SGA), the Beck Depression Inventory (BDI), and the Simplified Nutritional Appetite Questionnaire (SNAQ). Results Mean BMI was 23.4 kg/m 2 (range, 14.6-36.7 kg/m 2 ) and median body weight was 55.0 kg (range, 38.5-91.3 kg). Sixty-nine (53.5 %) of 129 patients reported severe malnutrition according to the PG-SGA. Malnutrition among patients who had received chemotherapy was more common than among patients who had not received chemotherapy within 6 months. Depression and appetite were significant factors predicting malnutrition in patients with gynecologic cancer. However, malnutrition was not related to age, marital status, level of education, or annual income among demographic factors, nor age at onset of cancer, cancer type, stage, or duration of cancer among clinical factors.Conclusions Assessment of nutritional status should be considered along with depression and appetite in patients with gynecologic cancer. In addition, regular and consistent nutritional assessment is essential in gynecologic cancer patients because of the high prevalence of malnutrition in these patients.

Aims and objectives: This study aimed to establish and test a predictive model for explaining the health-related quality of life of young adult patients with stroke. Background: Individual characteristics, biological and physiological variables, social support, emotional and cognitive symptoms, physical function disability and general health perception may be interrelated and may directly or indirectly affect the healthrelated quality of life of young adult patients with stroke. Design: A cross-sectional study. Methods: 237 young outpatients with stroke were recruited and surveyed. Data collection used a structured questionnaire from July-November 2018. The collected data were analysed using SPSS version 25.0 ® and AMOS 23.0. This study is based on STROBE guidelines. Results: The hypothetical model's fit indices were adequate. Stroke severity, social support, fear of stroke recurrence, physical function disability and general health perceptions directly affected the health-related quality of life. Additionally, stroke severity, depression and fear of stroke recurrence also indirectly affected it. These variables explained 60.3% of the variance in this quality.Conclusions: Variables such as severity of stroke, depression, fear of stroke recurrence, social support, physical function disability and general health perception were found to be related to the HRQoL of young adult patients with stroke.Relevance to clinical practice: A variety of physical, psychological, functional and social factors related to health-related quality of life should be systematically monitored. Furthermore, nurses need to develop and apply detailed nursing interventions that take into account all these variables.

We investigated the symptom clusters and effects of symptom clusters on the quality of life of Korean breast cancer survivors. We recruited 241 breast cancer survivors and collected cross‐sectional data on their symptoms. To determine inter‐relationships among symptoms, a principal component analysis with varimax rotation was performed based on the patient’s symptoms (fatigue, nausea/vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, anxiety, depression, systemic therapy side effects, breast symptoms and arm symptoms). The first symptom cluster consisted of psychological (anxiety and depression) and general (appetite loss, fatigue, insomnia and dyspnoea) symptoms, whereas the second symptom cluster consisted of physical (arm symptom, breast symptom, pain and systemic therapy side effects) and gastrointestinal (nausea/vomiting and constipation) symptoms. Subgroup cluster analysis showed that breast cancer survivors with higher‐scoring symptoms had significantly poorer quality of life in both psychological–general symptom cluster and physical–gastrointestinal symptom cluster subgroups, with subgroup‐specific patterns. The symptom clusters differed depending on stage and functional status of breast cancer survivors. Breast cancer survivors may have a specific pattern of symptom clusters. Some symptom clusters may have a negative impact on the quality of life. Identifying symptom clusters of breast cancer survivors may have clinical implications by improving symptom management.