BackgroundThis study aimed to identify the healthcare providers’ experience and perspectives toward end-of-life care decisions focusing on end-of-life discussion and physician’s order of life-sustaining treatment documentation in Korea which are major parts of the Life-Sustaining Treatment Act.MethodsA cross-sectional survey was conducted using a questionnaire developed by the authors. A total of 474 subjects—94 attending physicians, 87 resident physicians, and 293 nurses—participated in the survey, and the data analysis was performed in terms of frequency, percentage, mean and standard deviation using the (...) SPSS 24.0 program.ResultsStudy results showed that respondents were aware of terminal illness and physician’s order of life-sustaining treatment in Korea well enough except for some details. Physicians reported uncertainty in terminal state diagnosis and disease trajectory as the most challenging. Study participants regarded factors (related to relationships and communications) on the healthcare providers’ side as the major impediment to end-of-life discussion. Study respondents suggested that simplification of the process and more staff are required to facilitate end-of-life discussion and documentation.ConclusionBased on the study results, adequate education and training for better end-of-life discussion are required for future practice. Also, a simple and clear procedure for completing a physician’s order of life-sustaining treatment in Korea should be prepared and legal and ethical advice would be required. Since the enactment of the Life-Sustaining Treatment Act, several revisions already have been made including disease categories, thus continuous education to update and support clinicians is also called for. (shrink)

From the perspective of the system of systems development, system-level functional testing is required for designing subsystems. This study utilizes modeling and simulation techniques to analyze the operational behaviors of the subsystems and confirm data communication between them. The targeted system in the study is a naval combat system, which is a typical type of defense cyber-physical system. Three types of models were designed for the simulation testing of the NCS: a combat-management model for simulating the overall computational activities, physical (...) models to confirm the intrasubsystem behaviors, and data integration models to test the intersubsystem communications. These models are realized with the Model-View-ViewModel design pattern, which strongly facilitates graphical user interfaces being decoupled from model logic and data. We consider underwater combat scenarios as an application. Six significant physical subsystems within the NCS are simulated and tested: a ship-steering system, an inertial navigation system, a global navigation satellite system, a periscope, sonar systems, and a plotting board. We expect that the proposed work will play a principal role when analyzing the behaviors and communications of defense CPSs and providing an environment for functional testing as a digital twin. (shrink)

With the growing amount of clinical research, regulations and research ethics are becoming more stringent. This trend introduces a need for quality assurance measures for ensuring adherence to research ethics and human research protection beyond Institutional Review Board approval. Audits, one of the most effective tools for assessing quality assurance, are measures used to evaluate Good Clinical Practice and protocol compliance in clinical research. However, they are laborious, time consuming, and require expertise. Therefore, we developed a simple auditing process and (...) evaluated its feasibility and effectiveness. The screening audit was developed using a routine audit checklist based on the Severance Hospital’s Human Research Protection Program policies and procedures. The measure includes 20 questions, and results are summarized in five categories of audit findings. We analyzed 462 studies that were reviewed by the Severance Hospital Human Research Protection Center between 2013 and 2017. We retrospectively analyzed research characteristics, reply rate, audit findings, associated factors and post-screening audit compliance, etc. Investigator reply rates gradually increased, except for the first year. The studies were graded as “critical,” “major,” “minor,” and “not a finding”, based on findings and number of deficiencies. The auditors’ decisions showed fair agreement with weighted kappa values of 0.316, 0.339, and 0.373. Low-risk level studies, single center studies, and non-phase clinical research showed more prevalent frequencies of being “major” or “critical”. Inappropriateness of documents, failure to obtain informed consent, inappropriateness of informed consent process, and failure to protect participants’ personal information were associated with higher audit grade. We were able to observe critical GCP violations in the routine internal audit results of post-screening audit compliance checks in “non-responding” and “critical” studies upon applying the screening audit. Our screening audit is a simple and effective way to assess overall GCP compliance by institutions and to ensure medical ethics. The tool also provides useful selection criteria for conducting routine audits. (shrink)

In this paper, I propose an interpretation of the Confucian concept of li or Ritual Propriety, and suggest a new philosophy of action and mind on the basis of the concept. To achieve this aim, I fo...

In this paper, I propose an interpretation of the Confucian concept of li or Ritual Propriety, and suggest a new philosophy of action and mind on the basis of the concept. To achieve this aim, I fo...

Background Nurses providing care to patients with end-of-life or terminal illnesses often encounter ethically challenging situations leading to moral distress. However, existing quantitative studies have examined moral distress using instruments that address general clinical situations rather than those specific to end-of-life care. Furthermore, qualitative studies have often been limited to participants from a single unit or those experiencing moral distress-induced circumstances. A comprehensive and integrated understanding of the overarching process of moral distress is vital to discern the unique circumstances surrounding (...) end-of-life care and its consequential impacts. Research objectives To explore the moral distress experiences of nurses who are frequently involved in caring for patients with end-of-life or terminal illnesses and apply it to two existing theories: the model of moral distress and the ecological model. Research design A qualitative descriptive approach was employed. Participants and research context Seven focus group interviews involving 30 nurses were performed. The subsequent transcriptions underwent rigorous content analysis. Ethical considerations We obtained Institutional Review Board approval from a university. Focus group interviews were conducted with nurses who agreed to participate and signed the consent form. Findings The moral distress-inducing factors and nurses’ perceived impact of moral distress were identified and categorized based on moral distress theories and ecological models. A total of 15 categories and 30 subcategories across the following 4 domains were derived: (1) intrapersonal, (2) interpersonal, (3) organizational, and (4) structural factors. Conclusions End-of-life-specific circumstances induced moral distress among nurses, with both negative and positive impacts identified. Effective organizational and policy support is essential to manage conflicts, form a healthy organizational culture, provide training, and prevent unnecessary expenses due to the negative consequences of moral distress. (shrink)

Based on real-life intergroup animosities originating from a historical conflict, the current study examined how the perceived stance of the outgroup about the conflict affects the dehumanization of the outgroup. In Study 1, Korean undergraduates attributed more human nature to the Japanese after reading an article that the Japanese government did issue an official apology for a historical wrong. In turn, the more human nature assigned to the Japanese predicted higher expectations about positive mutual relations in the future. Similarly, in (...) Study 2, Japanese undergraduates attributed more human uniqueness to Koreans after reading an article that an official apology for a historical wrong from Japan was accepted by Koreans. The higher the perceived human uniqueness of Koreans was, the higher were the willingness to help and the expectations of a positive relationship in the future. The findings demonstrate how mutual dehumanization can be reduced as a result of the other side’s reconciliatory stances and can further contribute to improving intergroup relations. (shrink)

This article aims at an active dialogue between Ulrich Beck and East Asia with respect to cosmopolitan imagination. Beck’s cosmopolitan sociology requires a reflective cosmopolitan publicness to cope with various kinds of global risks. We therefore extract three different layers of publicness from neo-Confucianism – survival-oriented, deliberative, and ecological – and argue that Beck’s cosmopolitan vision can be better conceptualized when properly linked to, or founded upon, the Tianxiaweigong normative potentials of neo-Confucianism. In so doing our intention is to make (...) Beck’s implicit sensibilities and the implicit Asian orientations explicit, as a double process of cosmopolitan self-reflection and dialogue. We also draw attention to the analysis of the cosmopolitan actor in East Asia. Finally, we note that the cosmopolitan future of East Asia still remains uncertain and that reconciling global risk politics, national interests and cosmopolitan morality presents a big challenge to second modern transformation. (shrink)

Background:Academic ethical awareness is an important aspect especially for nursing students who will provide ethical nursing care to patients in future or try to tread the path of learning toward professional acknowledgement in nursing scholarship.Purpose:The purpose of this study was to explore academic ethical awareness and its related characteristics among undergraduate nursing students.Methods:This study commenced the survey with cross-sectional, descriptive questions and enrolled convenient samples of 581 undergraduate nursing students from three universities in South Korea. It was investigated with structured (...) questionnaires including general characteristics and academic ethical awareness related.Ethical considerations:This study was reviewed and approved by the Institutional Review Board at National University.Findings:Academic ethical awareness was the highest regarding behaviors violating the respect or confidentiality of patients and cheating on exams, while it was the lowest for inappropriate behaviors in class. From the result of general characteristics difference, male students showed higher score than female students in relative; first-year students showed higher score than other year students; the higher score was rated from students who were highly satisfied with their major than the other not satisfied with their major; and students with low academic stress showed higher ethical awareness score than persons with higher stress.Conclusion:Personal behaviors were rated with low ethical awareness in relative, but items related to public rules and actual effects on patients or others were rated with higher score. Nursing satisfaction and academic stress are main factors on ethical awareness. To improve overall ethical awareness level of nursing students, it is required to provide more education about the importance of personal behaviors in class and need to improve the understanding of how it will be connected with future situation and effect. (shrink)

The purpose of this study was to identify how older Korean people seek information and their desire to participate in decision making about their health care. A total of 165 elderly people living in Seoul, South Korea, participated in the study. Data were collected during individual interviews using the Autonomy Preference Index. The mean information-seeking score was high. The mean score for their desire to participate with a physician in decision making was lower, but this was higher when family members (...) were involved. The study indicates that many older people want to receive information about their health care. Families (or guardians), as well as older people themselves, should be included in the decision-making process. Nurses can encourage older people to express their wishes, while treating each individual with respect. (shrink)

This Korean study replicated a previously published American study. The conceptual framework and method combined ethical enquiry and phenomenology. The research questions were: (1) What is nursing students’ experience of ethical problems involving nursing practice? and, (2) What is nursing students’ experience of using an ethical decision-making model? The participants were 97 senior baccalaureate nursing students, each of whom described one ethical problem and chose to use one of five ethical decision-making models. From 97 ethical problems, five content categories emerged, (...) the largest being health professionals (69%). The basic nature of the ethical problems was the students’ experience of conflict, resolution and rationale. Using an ethical decision-making model helped 94% of the students. A comparison of the Korean and American results yields important implications for nursing ethics education, practice and research. (shrink)

This study assessed the knowledge and perception of human biological materials (HBM) and biorepositories among three study groups in South Korea. The relationship between the knowledge and the perception among different groups was also examined by using factor and regression analyses. In a self-reporting survey of 440 respondents, the expert group was found more likely to be knowledgeable and positively perceived than the others. Four factors emerged: Sale and Consent, Flexible Use, Self-Confidence, and Korean Bioethics and Biosafety Action restriction perception. (...) The results indicate that those who are well aware of the existence of biobanks were more positively inclined to receive the Sale and Consent perception. As a result of the need for high quality HBMs and the use of appropriate sampling procedures for every aspect of the collection and use process, the biorepository community should pay attention to ethical, legal, and policy issues. (shrink)

This study assessed the knowledge and perception of human biological materials (HBM) and biorepositories among three study groups in South Korea. The relationship between the knowledge and the perception among different groups was also examined by using factor and regression analyses. In a self‐reporting survey of 440 respondents, the expert group was found more likely to be knowledgeable and positively perceived than the others. Four factors emerged: Sale and Consent, Flexible Use, Self‐Confidence, and Korean Bioethics and Biosafety Action restriction perception. (...) The results indicate that those who are well aware of the existence of biobanks were more positively inclined to receive the Sale and Consent perception. As a result of the need for high quality HBMs and the use of appropriate sampling procedures for every aspect of the collection and use process, the biorepository community should pay attention to ethical, legal, and policy issues. (shrink)

The study aimed to examine the influence of personal characteristics on activity preferences using decision tree analysis and examine the effects of the variables using conventional approaches. A descriptive study was conducted with 251 nursing home residents with dementia in Korea to examine the relationship between their personal characteristics and activity preferences. Decision tree analysis was used to classify participants’ activity preferences, and preference levels were examined using logistic regression analysis. Activities were classified as either physical and social activities or (...) cognitive and affective activities. This model showed an accuracy rate of 85.7% for positively predicting physical and social activity preference and 30.3% for positively predicting cognitive and affective activity preference. Gender was the strongest determinant of activity preference. The odds of preferring physical and social activities were 3.179 times higher among women, while the odds for preferring cognitive and affective activities were 0.412 times higher among men. Notably, cognitive and affective activity preference increased to 58.8% for married male participants. This study’s findings can contribute to the development of programs to decrease behavioral and psychological symptoms among older people with dementia residing in nursing homes and provide scientific evidence for integrating these activities into long-term services for this population. (shrink)

The activities and consequences of workplace bullying and harassment have been widely explored in the literature but mainly studied within the scope of individuals or at the team level. Taking a holistic approach, we associate the concept of bullying with firm-level performance as well as stakeholders’ responses in the market. In this paper, we examine whether and how market investors react to the news of corporate harassment by top officials of publicly listed firms in Korea. Using a standard event study (...) methodology and multiple regression analysis with matched sample, we find significantly negative stock price reactions to news of corporate bullying. We also find that the impact is more salient if emotional bullying is involved and discuss both the theoretical and practical implications of these findings. (shrink)

The 1990s is perceived in Japan as a lost decade, but it also was a decade of profound political, economic and institutional transformation. Books and articles reviewed here analyze this unprecedented change from diverse angles. Authors are in agreement that Japanese political economy has undergone major transformation in the 1990s. However, over the issue of how much and in what area those changes have occurred, authors take different standpoints. Also as to what would be the shape of future political setup, (...) they provide us with divergent scenarios. (shrink)

The purpose of this study is to elucidate how the Greek concept of God influenced the formation of Platonic philosophy by examining the terms 'theios' & Theos, as used in his dialogues. In the first chapter, we have highlighted how the collective representation brought by the immediate ‘participation mystique’ with the sacred force(mana) is evolved into the notion of Daimon or Theos as a mediator which will tie the human－being with the sacred force, & how the Greek Theos evolves from (...) the Daimon as a primitive emotional personification acting as a subject of magical rituals into the Theos as a rational personification acting as a subject of selfconsciousness & free-will of the human-being. In the second chapter, we have clarified how the polysemy of the terms: Theios & Theos allows Plato to elaborate a new concept of God & to thereby successfully transform mythological story of the world into a philosophical explanation. In the third chapter, we have brought into relief the process in which Plato has formed unconsciously the concept of Idea from the notion of Theos. In fact, it seems inevitable that the philosopher attempting to construct the system of reasonable explanation of the harmonic cosmos resorts to the property of wholeness & perfectness of Theos. The fourth chapter was concentrated to scrutinize the structure of Platonic thought which describes Demiourgos as 'l'artisan du monde' who recreates or reorganizes the world order on seeing the Idea of the Good (bonum). From our examination of the influence the Greek concept, Theos, had on Platonic Philosophy, we are able to conclude that Plato transformed the religious perfectness into the philosophical & metaphysical perfectness. As a result, this study will open the way for a new understanding of the relation between the Greek Theos, & the Ideas, Demiourgos. (shrink)

Over the past few decades, cooperation between Korea and Japan has increased and deepened, but frictions continue to persist. Which direction is the relationship between Korea and Japan heading? This is the question that this article attempts to address.

This article is an attempt to identify who's who and the whereabouts of Japanese political studies in South Korea. Previous studies suggest that South Korea made a delayed start in Japanese studies because of submerged anti-Japanese feeling among the general public, and that linguistic and humanistic studies were prevalent while social scientific studies lagged behind. The second generation scholars, who actively published their academic works on Japan between the late 1970s and the early 1990s, contributed to the development of objective, (...) social scientific understanding of Japan. Their research interests included scrutinizing modern Japan, studying Korea-Japan relations, and analyzing Japanese foreign policy. The third generation scholars, which this article focuses on, have a few common characteristics: they began Japanese studies when Japan was rising; most of them were trained in Japan or the United States; most of them are fluent in Japanese; and they are publishing actively in major academic journals. The research interests of the third generation are categorized into four: (1) widening the research horizon; (2) inheriting the tradition of the previous generation; (3) synchronizing research agendas with the foreign scholarly community; and (4) opening up a new research horizon. After making a comprehensive content analysis of the works undertaken by third generation scholars, three major challenges are suggested for the upcoming generation of Japanese studies in South Korea: (1) globalizing the scholarly works with more theoretical analysis; (2) developing a uniquely Korean perspective about Japan; and (3) undertaking a systematic collaborative study with foreign scholars. (shrink)

This longitudinal study examined how nursing students' moral judgment changes after they become qualified nurses working in a hospital environment. The sample used was a group of 80 nursing students attending a university in Suwon, Korea, between 2001 and 2003. By using a Korean version of the Judgment About Nursing Decisions questionnaire, an instrument used in nursing care research, moral judgment scores based on Ketefian's six nursing dilemmas were determined. The results were as follows: (1) the qualified nurses had significantly (...) higher idealistic moral judgment scores than the nursing students; (2) the qualified nurses showed significantly higher realistic moral judgment scores than the nursing students; and (3) when comparing idealistic and realistic moral judgment scores, both the qualified nurses and the nursing students had higher scores for idealistic moral judgment. Further study is recommended to examine changes in moral judgment. (shrink)

BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

When the creationism issue rose to the surface in the late 1970s, an organized opposition to the creationist campaign came from an unexpected source. Local groups of rank and file evolution defenders, led by a retired biology teacher, organized a grassroots network of anti-creationism called the Committees of Correspondence. They basically approached the creationism issue as a political rather than a scientific problem and fought the battle on local fronts, where creationists were heavily engaged in legal campaigns to include their (...) ideas in the public schools. Grassroots anti-creationism was, however, eventually replaced by a centralized national operation with an educational emphasis. In this paper, I will document the development of this neglected part of the creation-evolution controversy and discuss related issues, namely the politics of science that became clearly visible in the course of evolutionists' disputes over anti-creation strategies. (shrink)

Background Participants' understanding of clinical trials is important in informed consent. However, little is known about what information participants really want to know. Aims To demonstrate the existence of a discrepancy between participants' understanding and their desire to know. Methods The participants in clinical trials at Seoul National University Hospital were surveyed. The survey consisted of 11 statements based on the essential elements of informed consent. The participants gave two responses to each statement on a five-point Likert scale to rate (...) their subjective understanding and desire to know, respectively. Information discrepancy was defined as the difference between these two ratings: if understanding exceeded desire to know for a particular item, it was defined as ‘over-informed’; if desire to know exceeded understanding for a particular item, it was defined as ‘under-informed’. Results Participants reported good understanding of ‘voluntariness’, ‘duration’, ‘study involves research’ and poor understanding of ‘confidentiality’, ‘compensation’, ‘benefits’, ‘procedures’ and ‘risks or discomforts’. For ‘risks or discomforts’, ‘who to contact’, ‘voluntariness’, ‘duration’ and ‘procedures’, participants reported high desire to know compared with ‘confidentiality’, ‘purpose’, ‘study involves research’ and ‘benefits’. The elements ‘study involves research’, ‘voluntariness’, ‘duration’, ‘purpose’ and ‘who to contact’ were over-informed, while ‘compensation’, ‘risks or discomforts’, ‘procedures’, ‘confidentiality’ and ‘benefits’ were under-informed. Participants over 50 years of age, those without a college education and those whose participation was less voluntary were relatively less informed about the clinical trials. Conclusions An information discrepancy was observed between the participants' understanding and their desire to know. By putting more emphasis on under-informed elements, the quality of informed consent could be improved. (shrink)

Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness (...) within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible. (shrink)

Modern schooling in Korea, which was officially established by law in 1949, is well known for its function as an engine of economic success in modern Korea. Although this fact seems to be world-wid...

Despite the wide and daunting array of cross-cultural obstacles that the formulation of a global policy on advance directives will clearly pose, the need is equally evident. Specifically, the expansion of medical services driven by medical tourism, just to name one important example, makes this issue urgently relevant. While ensuring consistency across national borders, a global policy will have the additional and perhaps even more important effect of increasing the use of advance directives in clinical settings and enhancing their effectiveness (...) within each country, regardless of where that country's state of the law currently stands. One cross-cultural issue that may represent a major obstacle in formulating, let alone applying, a global policy is whether patient autonomy as the underlying principle for the use of advance directives is a universal norm or a construct of western traditions that must be reconciled with alternative value systems that may place lesser significance on individual choice. A global policy, at a minimum, must emphasize respect for patient autonomy, provision of medical information, limits to the obligations for physicians, and portability. And though the development of a global policy will be no easy task, active engagement in close collaboration with the World Health Organization can make it possible. (shrink)

Evidentials and Modals offers an in-depth account of the meaning of grammatical elements representing evidentiality in connection to modality, focusing on theoretical/formal perspectives by eminent pioneers in the field and on recently discovered phenomena in Korean evidential markers by native scholars in particular. Evidentiality became a hot topic in semantics and pragmatics, trying to see what kind of evidential justification is provided by evidentials to support or be related to the 'at-issue' prejacent propositions. This book aims to provide a deeper (...) understanding of such evidentiality in discourse contexts in a broad range of languages such as American Indian, Korean and Japanese, Turkish and African languages over the world. In addition, an introduction to the concept of evidentiality and theoretical perspectives and recent issues is also provided. Contributors are Alexandra Y. Aikhenvald, Robert Botne, Kyung-Sook Chung, Martina Faller, Ezra Keshet, Iksoo Kwon, Chungmin Lee, Ji-Young Lee, Jungmee Lee, Dongsik Lim, Lisa Matthewson, William McClure, Elin McCready, Sarah E. Murray, Marisa Nagano, Jinho Park, Mary Shin Kim, Jaemog Song, Thomas Willett, and Kei Yoshimoto. (shrink)