PURPOSE: The purpose of the study was to explore and describe hospice palliative nurses' experience of caring for terminal cancer patients. METHODS: Eleven hospice palliative nurses participated in the study. Data were collected through individual in-depth unstructured interviews with participants from November, 2012 to October, 2013. Theoretical sampling was used to the point of theoretical saturation. Data were analyzed using Corbin and Strauss' 'Grounded Theory Method.' RESULTS: From open coding, 25 sub-categories and 12 categories were identified. Analysis revealed that the core category was 'becoming stepping-stones between life and death enduring burdens', consisting of three phases: the phase of withdrawal, the phase of exertion, and the phase of maturity. Through this process, participants utilized various action/interactional strategies such as 'maintaining a distance', 'sharing intimate daily life', 'being a mediator for a peaceful death', 'grieving and remembering'. The consequences of these strategies were a transcendental perspective towards life and ambivalent feelings toward hospice nursing. CONCLUSION: In-depth understanding of the hospice palliative nurses' experience of caring for terminal cancer patients will guide nurse managers and policy makers to promote effective nursing strategies to better support hospice palliative nurses.
Administrative Personnel ; Clinical Coding ; Hospice and Palliative Care Nursing ; Hospices* ; Humans ; Nurse Administrators ; Nursing ; Patient Care ; Qualitative Research ; Terminal Care

PURPOSE: This study aimed to identify how an education program on palliative care affects nursing home caregivers' perception of hospice care and attitude towards terminally ill patient care. METHODS: This study was conducted using a nonequivalent control group with a pretest-posttest design. The participants were 101 certified care workers: 58 in the experimental group and 43 in the control. The experimental group completed the palliative care education program consisted of 20 hours of classroom training and 20 hours of clinical practicum. An ANCOVA was performed to compare the score changes to outcome variables. RESULTS: Compared with the control group, the experimental group showed significant pretest-posttest differences in both the perception of hospice care (F=21.09, P < 0.001) and attitude towards caring for terminally ill patients (F=13.28, P < 0.001). CONCLUSION: These results indicate that the palliative care education program for caregivers is effective in preparing participants to provide hospice/palliative care service. Further study is warranted to explore the effects of this program on palliative caregivers' performance.
Attitude to Death ; Caregivers* ; Education* ; Hospice Care ; Hospices* ; Humans ; Nurses' Aides ; Nursing Homes ; Palliative Care* ; Patient Care ; Preceptorship ; Terminally Ill

PURPOSE: This study examined the effects of a hospice palliative education program for adults on their perception of hospice, attitude towards death, and meaning of life. METHODS: This study was a quasi-experimental study with a non-equivalent control group design. Among 43 participants, 22 were assigned to the non-equivalent experimental group and 21 to the control group. The hospice palliative education program comprised 10 three-hour sessions, each given once a week. Data were analyzed by descriptive statistics, t-test and χ2-test using SPSS version 20.0. RESULTS: Significant differences between the experimental and control groups were observed in their perception of hospice (t=6.63, P < 0.001), attitude towards death (t=2.36, P=0.023), and meaning of life (t=5.06, P < 0.001). CONCLUSION: The results indicate that this education program could positively affect the perception of hospice, attitude toward death, and meaning of life in adults. More studies are warranted to explore the effects of this education program for various age groups so that it may help more people get positive understanding of hospice palliative care. The results suggest this program could help improve the negative perception of hospice, negative attitude towards death and meaning of life that are generally held by the public.
Adult* ; Attitude to Death* ; Education* ; Hospice and Palliative Care Nursing ; Hospices* ; Humans ; Non-Randomized Controlled Trials as Topic ; Palliative Care ; Program Development

PURPOSE: The purpose of this study was to identify factors with nursing students's confidence in performing fundamental nursing skills. The focus was on professionalism and self-efficacy METHOD: For the sample 258 fourth graders of nursing students were recruited in two universities located in Gyeongnam or Ulsan. Data were analyzed using t-test, Pearson's correlation coefficients, and hierarchical multiple regression. RESULTS: The mean score for confidence in performing fundamental nursing skills was 3.71±0.58. Nursing professionalism and self-efficacy were positively correlated with confidence in performing fundamental nursing skills. Analysis using multiple regression showed that 27% of factors predicting confidence in performance of fundamentals of nursing practice (F=16.43, p<.001) included nursing professionalism (β=.37, p<.001), self-expression (β=.15, p=.009), and self-efficacy (β=.14, p=.029). CONCLUSION: Findings show that nursing professionalism is one of the major factors influencing confidence in performing fundamental nursing skills. In order to improve the confidence in performing fundamental nursing skills, it is necessary to establish effective educational strategies that firmly enhance nursing professionalism and improve self-efficacy in nursing students.
Clinical Competence ; Humans ; Methods ; Nursing ; Professionalism ; Students, Nursing ; Ulsan

The coronary arteries are also subject to congenital anomalies of both minor and major consequence. Hemodynamically significant primary anomalies of the coronary arteries are those which alter myocardial perfusion. There are four major types : coronary artery fistula, origin of the left voronary artery from the pulmonary artery, congenital coronary stenosis or atresia and origin of the left or right coronary artery from the opposite sinus of Valsalva with subsequent passage of the vessel between the aorta and right ventricular infundibulum. Minor anomlies are the variation of the origin of the coronary arteries from the aorta with normal distal circulation. We can see more coronary anomalies associated with congenital cardiac anomalies, probably representing a circulatory response to the primary intracardiac defect. We present a total of 76 cases of congenital coronary anomalies, reviewing 3946 cases of angiocardiography or selective coronary arteriography, performed during last 8 years at Sejong General Hospital.
Angiocardiography ; Angiography ; Aorta ; Arteries ; Coronary Stenosis ; Coronary Vessels* ; Fistula ; Hospitals, General ; Perfusion ; Pulmonary Artery ; Sinus of Valsalva

Cryptococcus neoformans, an encapsulated fungus, is an important opportunistic pathogen that can cause meningitis in immunocompromised patients. Since patients with cryptococcemia have high mortality, it is essential to make an early diagnosis and promptly initiate antifungal therapy. However, it is often very difficult to differentiate between cryptococcal meningitis and hepatic encephalopathy in patients with liver cirrhosis, and there is delay in making the diagnosis. Therefore, these patients have a particularly grave prognosis and consequently many patients die before culture results become available. In one study, starting antifungal therapy within 48 hours of the blood culture was associated with improved survival, but patients with liver cirrhosis were significantly less likely to receive antifungal therapy within 48 hours compared to those without liver cirrhosis. Recently, the authors experience a case of a 68-year-old woman with liver cirrhosis who presented with fever and a drowsy mental status. She had a previous history of having been admitted for infection-associated hepatic encephlopathy. Cryptococcal meningitis and cryptococcemia were diagnosed by spinal puncture and culture of cerebrospinal fluid. In spite of adequate treatment, the patient developed multi-system organ failure and eventually expired. Herein, we report a case of cryptococcal meningitis mimicking hepatic encephalopathy in a patient with liver cirrhosis.
Aged, 80 and over ; Brain/radiography ; Cryptococcus/isolation & purification ; Female ; Hepatic Encephalopathy/complications/*diagnosis ; Hepatitis C, Chronic/complications/pathology ; Humans ; Liver Cirrhosis/etiology/pathology ; Meningitis, Cryptococcal/complications/*diagnosis/microbiology ; Tomography, X-Ray Computed

Oral sodium phosphate (NaP) is increasingly used to prepare patients for gastrointestinal procedures such as colonoscopy. Severe hyperphosphatemia may complicate bowel-cleansing preparation using oral NaP. The risk of hyperphosphatemia is known to increase with excessive and/or repeated doses, increased intestinal absorption, or impaired renal excretion of phosphate. Hyperphosphatemia may produce acute renal failure, but the mechanism is not yet clear. Some authors suggest that renal injury is caused by intrarenal calcium-phosphate deposition, but others suggest that direct tubular toxicity or a disturbance in renal hemodynamics may induce renal injury. A 74-year-old woman was admitted with generalized weakness after taking NaP for colonoscopy. She had no underlying diseases such as renal disease. She was hypotensive and had carpopedal spasm with hypocalcemia, severe hyperphosphatemia, metabolic acidosis, and non-oliguric acute renal failure. She was treated with aggressive hydration, calcium replacement and aluminum-containing antacid, but hyperphosphatemia was aggravated (35.6 mg/ dL). Hemodialysis was done and phophate concentration was lowered to 5.5 mg/dL. It is suggested that caution should be taken when using phosphate- containing laxatives especially for elderly patients even if they have no underlying diseases.
Acidosis ; Acute Kidney Injury ; Aged ; Calcium ; Colonoscopy ; Female ; Hemodynamics ; Humans ; Hyperphosphatemia* ; Hypocalcemia ; Intestinal Absorption ; Laxatives ; Renal Dialysis ; Sodium* ; Spasm ; Tetany*

BACKGROUND: Continuous veno-venous hemofiltration (CVVH) is one of the continuous renal replacement therapies for managing patients with refractory edema or oliguric renal failure with unstable vital signs. High-flux hemofilters are usually used for CVVH, but low-flux hemodialyzers are not used for CVVH. We tried temporary veno-venous hemofiltration (TVVH) procedures using low-flux hemodialyzers for 9 patients with acute or chronic renal failure who were on mechanical ventilation with positive end-expiratory pressure (PEEP) in the ICU. METHODS: All of the nine patients with acute or chronic oligo-anuric renal failure could not receive hemodialysis treatment in the hemodialysis room, because they were on mechanical ventilation with PEEP in the ICU due to severe fluid overload with elevated CVP and acute pulmonary edema. Low-flux hemodialyzers with effective membrane area of 1.0- 1.1 m2 and blood pumps on the discarded hemodialysis machines were used for TVVH procedures. RESULTS: Mean duration of TVVH was 17.0+/-16.7 hours and mean ultrafiltration rate was 440+/-203 mL/hour. After finishing the TVVH procedures, CVP decreased from 22.9+/-8.5 cmH2O to 6.4+/-2.4 cmH2O. Of nine patients, 6 patients (67%) were able to be off the mechanical ventilation with clinical improvement. CONCLUSION: Even if CVVH is usually done with expensive high-flux hemofilters and CVVH machines, simplified and cheaper TVVH procedures using low- flux hemodialyzers and discarded hemodialysis machines with functioning blood pumps can be done with good results and cost effectiveness, especially in institutions not equipped with facilities such as CVVH machines or portable water purification systems for hemodialysis in the ICU.
Cost-Benefit Analysis ; Edema ; Hemofiltration* ; Humans ; Kidney Failure, Chronic ; Kidneys, Artificial* ; Membranes ; Positive-Pressure Respiration ; Pulmonary Edema ; Renal Dialysis ; Renal Insufficiency ; Renal Replacement Therapy ; Respiration, Artificial ; Ultrafiltration ; Vital Signs ; Water Purification

Thrombi in the right atrium (RA) are infrequent, and are rarely diagnosed before death. In addition, right heart thrombi are frequently associated with major pulmonary thromboembolism, and carry a very high risk of mortality, and therefore, require accurate diagnosis and prompt treatment. RA thrombi are generally associated with dilatation of the atrium, a low cardiac output state, intracardiac catheters, such as endocardial pacemakers and central venous hyperalimentation catheters, recent cardiac surgery, involving the atrium, and peripheral deep vein thrombosis. In addition, some systemic diseases, such as malignant tumors, amyloidosis and nephrotic syndrome, have been shown to contribute to the formation of an intracardiac thrombus. Echocardiography is valuable in the diagnosis of RA thrombi. There are some options in the treatment of RA thrombi, such as anticoagulant therapy using heparin, thrombolytic therapy and surgical removal. However, there is still adverse criticism as to the selection of the correct treatment method. A patient with RA thrombi, who presented with sudden cardiogenic shock, was diagnosed by two-dimensional echocardiography. He had been in a prolonged bed-ridden state because of quadriparesis caused by an injury to the cervical spine. The RA thrombi were successfully treated with anticoagulant and thrombolytic agents.
Amyloidosis ; Cardiac Catheters ; Cardiac Output, Low ; Catheters ; Diagnosis ; Dilatation ; Echocardiography ; Fibrinolytic Agents ; Heart ; Heart Atria ; Heparin ; Humans ; Mortality ; Nephrotic Syndrome ; Pulmonary Embolism ; Quadriplegia ; Shock, Cardiogenic ; Spine ; Thoracic Surgery ; Thrombolytic Therapy ; Thrombosis ; Venous Thrombosis