PURPOSE: Mechanistic case diagram (MCD) was recommended for increasing the depth of understanding of disease, but with few articles on its specific methods. We address the experience of making MCD in the fullest depth to identify the pros and cons of using MCDs in such ways. METHODS: During problem-based learning, we gave guidelines of MCD for its mechanistic exploration from subcellular processes to clinical features, being laid out in as much detail as possible. To understand the students' attitudes and depth of study using MCDs, we analyzed the results of a questionnaire in an open format about experiencing MCDs and examined the resulting products. RESULTS: Through the responses to questionnaire, we found several favorable outcomes, major of which was deeper insight and comprehensive understanding of disease facilitated by the process of making well-organized diagram. The main disadvantages of these guidelines were the feeling of too much workload and difficulty of finding mechanisms. Students gave suggestions to overcome these problems: cautious reading of comprehensive texts, additional guidance from staff about depth and focus of mechanisms, and cooperative group work. From the analysis of maps, we recognized there should be allowance of diversities in the appearance of maps and many hypothetical connections, which could be related to an insufficient understanding of mechanisms in nature. CONCLUSION: The more detailed an MCD task is, the better students can become acquainted with deep knowledges. However, this advantage should be balanced by the results that there are many ensuing difficulties for the work and deliberate help plans should be prepared.
Education, Medical ; Humans ; Problem-Based Learning*

Background/Aims: Advance directives (ADs) in Korean patients with heart failure (HF) and the associations of attitude towards ADs and HF prognosis with ADs were initially assessed using the model of the Korean-Advance Directive (K-AD). Methods: Twenty-four patients with HF (age, 67.1 years; men, 58.3%; ejection fraction, 35.9%) participated. A pilot test to evaluate the feasibility of ADs and the possible associations of attitudes towards ADs and prognosis with end-of-life treatment preferences among patients with HF was conducted. Results: Fifteen patients (62.5%) completed the K-ADs. The major reason for incomplete K-AD was knowledge deficit. Patients valued “comfortable death” the most (45.4%), followed by “giving no burden to the family” (13.6%). Among treatment preferences, hospice care was preferred by the majority (66.7%), while cardiopulmonary resuscitation (CPR) was preferred by the minority (31.8%). Children (50.0%) were mostly appointed as a proxy, followed by the spouse (33.3%). More patients with moderately positive attitudes completed the K-ADs than their counterparts (70.0% vs. 57.1%). The 5-year survival rate was 69.2%; the patients who preferred CPR had a higher survival rate (70.6% vs. 68.5%) whereas those who preferred hospice care had a lower survival rate than their counterparts (70.7% vs. 75.2%). Conclusions The findings support the feasibility of the K-AD model, with a high acceptance rate in two-thirds of the sample. Further studies are warranted to investigate whether treatment preferences are associated with attitude towards ADs and/or HF prognosis using larger sample size.

Purpose: The aim of this study was to longitudinally compare novice nurses’ sleep disturbance, sleep hygiene, and physical activity and analyze factors affecting sleep disturbance. Methods: Data were obtained from three follow-up surveys of 178 novice nurses. The data were analyzed using SPSS 25.0 to calculate descriptive statistics. A repeated measures ANOVA and Cochran’s Q test were performed, and a logistic regression analysis was conducted using generalized estimation equations. Results: The sleep disturbance rate increased significantly over time in the following order: before the start of shift work, after six months of shift work, and after 18 months of shift work (T=98.67, p<.001). Sleep hygiene significantly deteriorated over time after the start of shift work (F=127.95, p<.001). Arousal behavior (OR=10.34, p<.001) and the sleep environment (OR=1.54, p=.005) in sleep hygiene, significantly influenced sleep disturbance. Stretching exercises were an influencing factor in sleep disturbance (OR=1.71, p=.039). Conclusion Sleep disturbance among novice nurses increased after the start of shift work. Sleep hygiene and stretching were influencing factors. Therefore, to prevent and reduce sleep disturbance in novice nurses, efforts are needed to improve sleep hygiene and promote stretching exercises.

Purpose: The gradual increase in the number of children with disabilities in Korea highlights the necessity for further research on the role of school health teachers in their care. This study explored the specific experiences of school health teachers in special schools through individual in-depth interviews. Methods: In this study, 11 school health teachers participated, and data were collected through individual in-depth interviews. Thematic analysis was employed to analyze the collected data. Results: The experiences of health teachers at special schools were classified into 5 themes and 13 subthemes. These included "concerns about working in special schools and attachment after working," "management of diverse diseases and ongoing, careful observation," "ambivalence regarding students with disabilities," "competences needed to care for students with disabilities," and "enhancing care education for students with disabilities: demanding institutional support." Conclusion Effective student health management depends on open communication channels and the establishment of strong connections among health teachers, school personnel, and parents of impaired students. To enhance the quality of care for children with disabilities, specialized education programs to improve teachers' healthcare competency should be developed. Additionally, specific guidelines for the range of medical treatments provided by health instructors, should be devised.

PURPOSE: The purpose of this study was to evaluate the effects of a communication course with lecture, small group activity and music therapy for nursing students, compared to a conventional lecture course. METHODS: The design of this study was a nonequivalent control group with a pre-post test. Data were collected by questionnaires from 166 nursing students from Y University, Seoul, Korea, with 92 in the experimental group and 74 in the control group. A 13 session program with lecture, small group activity and music therapy was given to the experimental group in 2008, while a conventional lecture course was given to the control group in 2007. The data were analyzed using descriptive statistics, and independent/paired t-tests. RESULTS: There were no significant differences in interpersonal communications or relationships change between the experimental and control group. We found that which area in interpersonal communication and relationships had a positive effect in each course. CONCLUSION: The results indicate a need to consider the characteristics of students and thoroughly prepare for operational difficulties in advance of effectively administering various instructional methods in communication courses for nursing students in the second year.
Evaluation Studies as Topic ; Humans ; Interpersonal Relations ; Korea ; Music Therapy ; Music* ; Surveys and Questionnaires ; Seoul ; Students, Nursing

PURPOSE: Decisional conflict is a significant and important barrier in end-of-life care planning, and it is often encountered in health professionals' discussions with patients and their families. Little is known about the measurement of decisional conflict, and existing measures are not suitable for all contexts. In this study, psychometric properties of the Decisional Conflict Scale, which was translated for the first time into Korean [Korean version of DCS (K-DCS)], were examined. METHODS: A sample of 273 community-dwelling elders was surveyed (mean age: 77.26 years; 80.2% women). Internal consistency reliability and stability reliability were tested by calculating Cronbach α and Pearson's correlation coefficients. Exploratory factor analysis and logistic regression analyses were performed to test validity. RESULTS: Reliability of the K-DCS was acceptable with Cronbach α =.87; test-retest correlation r = .76. Factor analysis showed a two-factor structure with nine items: informed/values clarity and uncertainty. Concordance between K-DCS and the four treatment directives was significant (kappa values ≥.78). Controlling for age and gender, those with decision implementation were more likely to implement their decisions on tube feeding (odds ratio = 5.15, p = .033) and hospice care (odds ratio = 2.83, p = .017). CONCLUSION: The K-DCS appears to be a valid measure to evaluate decisional conflict about advance directives in community-dwelling Korean older adults. Further validation of the K-DCS is warranted, though caution should be exercised in using subscales because of differences in decisional contexts.
Adult* ; Advance Directives ; Aged ; Enteral Nutrition ; Hospice Care ; Humans ; Logistic Models ; Psychometrics ; Uncertainty

Collagenous fibroma (desmoplastic fibroblastoma) is a rare benign fibrous soft tissue tumor. This lesion commonly presents with painless, non-tender, mobile and slowly growing mass in subcutaneous tissue or skeletal muscle at various anatomic location. On magnetic resonance image (MRI), the mass shows area of low signal intensity on both T1- and T2-weighted pulse sequences. This low signal intensity presents areas of low cellularity in a background of abundant collagen. We describe the unique case of collagenous fibroma in the shoulder joint presenting with 4-years history of long-standing pain, which is unusual clinical manifestation of this benign soft tissue tumor without previous trauma history.
Collagen ; Fibroma ; Magnetic Resonance Spectroscopy ; Muscle, Skeletal ; Shoulder ; Shoulder Joint ; Subcutaneous Tissue

PURPOSE: In Korea, most elderly with dementia receive care from family members, yet little research is available on the experience of dementia-related anxiety in middle-aged female caregivers for a family member with dementia. The purpose of this study was to describe the lived experience of dementia-related anxiety in middle-aged female caregivers for family members with dementia. METHODS: A descriptive phenomenological study was conducted. A purposive sampling strategy was used to recruit participants. Twelve middle-aged women (40-59 years, mean age = 51.90 years) who were family caregivers were interviewed from February 2014 to August 2014. Data were collected through semistructured interviews and analyzed using Giorgi's method. RESULTS: The essential structure of the phenomenon was a fear of losing self-identity. The main essence was represented by six components: keenly feeling the effects of aging because of memory deficit, continuous comparison of the family member's behavior with that of the participant's, Finding it painful to see a family member with dementia as he/she does not know how this will end, not knowing the conclusion of the disease process, reducing the risk of dementia, and trying to change one's lifestyle from what it used to be in the past. CONCLUSIONS: The study provides the essential structure of the experience on dementia-related anxiety that caregivers of a family member with dementia have. The findings could help healthcare providers and researchers have better understanding of dementia-related anxiety and give more attention to the caregivers to relieve their anxiety
Adult ; Anxiety/*etiology ; Caregivers/*psychology ; Dementia/*psychology ; Family/*psychology ; Family Relations ; Fear ; Female ; Humans ; Middle Aged ; Self Concept

PURPOSE: Child Health nurse practitioners (CHNPs) in Korea have important roles in disease management and health promotion for children and adolescents. Yet, practices of CHNPs licensed and employed in hospitals have not been adequately identified. Thus, in this study the scope of practice by CHNPs and job satisfaction and stress were investigated and compared according to the CHNPs' position in the working place. METHODS: A descriptive cross-sectional survey design was used. All 53 licensed CHNPs participated in the mail survey which included a 71-item questionnaire on job performance and job satisfaction and a job contents questionnaire. Descriptive statistics, chi2 test, independent t-test and Mann-Whitney U test were used to compare CHNPs employed as nurse practitioner (NP) and CHNPs employed as staff nurses. RESULTS: Compared to CHNPs employed as staff nurses, CHNPs employed as NPs more frequently provided education, environment management, coordination and research in their practice areas. No significant difference was found in job satisfaction between the two groups except for the administration and income subdomains. Only the physical exertion subdomain in job stress was stressful to CHNP employed as staff nurse. Conclusions: Job performance of CHNPs in Korea needs to be revised to include more practical practice in education, coordination, and research related areas. CONCLUSIONS: Job performance of CHNPs in Korea needs to be revised to include more practical practice in education, coordination, and research related areas.
Adolescent ; Child ; Child Welfare* ; Child* ; Cross-Sectional Studies ; Disease Management ; Education ; Health Promotion ; Humans ; Job Satisfaction* ; Korea ; Nurse Practitioners* ; Pediatric Nurse Practitioners ; Physical Exertion ; Postal Service ; Statistics, Nonparametric ; Task Performance and Analysis ; Workplace*

Purpose: To report a case of refractory recurrent corneal erosion that occurred after Descemet’s stripping automated endothelial keratoplasty (DSAEK) in iridocorneal endothelial syndrome.Case summary: A 62-year-old male patient with iridocorneal endothelial syndrome planned to undergo ultrathin DSAEK. At the surgery, corneal epithelial debridement was performed using a No. 15 blade to enhance the surgical field visibility. Three corneal venting incisions were made before graft insertion in the recipient eye. The corneal epithelium was healed at postoperative 1 week. However, the epithelium detached at 2 weeks postoperatively. The loosened epithelium was peeled off, and a therapeutic bandage contact lens was applied. Thereafter, the corneal epithelial detachment did not improve, despite repeated corneal epithelial debridement, prolonged therapeutic bandage contact lens wear, applications of 5% sodium chloride eyedrops and autoserum eyedrops, and intake of doxycycline, steroids, and valaciclovir. Anterior stromal puncture was performed three times, and the corneal epithelium eventually attached at postoperative 8 weeks. Although recurrent corneal erosion was not observed at postoperative 10 weeks, acute graft rejection occurred but improved with immunosuppressive treatment. The corrected visual acuity was 0.8 after cataract surgery, which was performed at 1 year after DSAEK. Conclusions Refractory recurrent corneal erosion may occur after DSAEK surgery. In such a case, an aggressive treatment including the repeated anterior stromal puncture technique may be helpful.