PURPOSE: Clinical training for nursing students is limited to rudimentary skills to avoid potential risks. Simulation-Based Training (SBT) can overcome the shortcomings of clinical training. We evaluated the educational effect of SBT for obstetrical nursing students using high-fidelity simulation courses. METHODS: We developed a simulation program for obstetrical nursing students to practice nursing skills that are necessary to provide quality care. The program consisted of four sessions. 1st: An orientation and a preliminary test. 2nd: Learning core skills required in obstetrical nursing. 3rd: Testing each student with scenario. 4th: Providing a debriefing session. At the beginning of the program, students were surveyed about their self-confidence in obstetrical nursing care, and at the end of the program, they were surveyed about the adequacy of SBT as well as self-confidence. RESULTS: Students' self-confidence showed a significant difference before and after simulation. Mean adequacy of SBT was 7.15+/-1.35 (out of 10). Most students became more interested in Women's Health Nursing after SBT. CONCLUSION: The results from evaluating the effects of simulation-based obstetrical nursing training show that SBT provides invaluable clinical experience for obstetrical nursing students by overcoming the lack of actual clinical involvement in clinical training programs.
Adult ; Attitude of Health Personnel ; Clinical Competence ; Education, Nursing, Baccalaureate ; Female ; Humans ; Male ; Obstetrical Nursing/*education ; Pregnancy ; Program Evaluation ; Students, Nursing/*psychology ; Young Adult

PURPOSE: The purpose of the study was to understand essential meanings of suffering experienced by suicide attempters. METHODS: Data were collected in 2009 through individual narrative interviews from 7 suicide attempters. Texts from literary works and movies containing suicide were also included as data. Data were analyzed using the hermeneutic phenomenology of van Manen. RESULTS: Thirteen themes were identified in four dimensions. In the dimension of 'lived body', 'unbearably sweet temptation to death', 'body surrendered by emotional damage', 'chaos in life and death', 'squashed body by the heavy weight of life', and 'loss of meaning in life' were identified. 'The black hole, one is not able to get out' represents the experience in the dimension of 'lived space', 'The moment on the edge of a profound abyss' and 'the worst present and hopeless future' represent 'lived time'. In the dimension of 'lived human relation', 'I who am alone in the world', 'fear of being abandoned', 'unbreakable relationship trap', 'I who am not recognized' and 'guilty feeling' were included. CONCLUSION: Results of the study should be helpful in developing personalized suicide prevention programs by showing the various types of suffering deeply ingrained into the personal history of suicide attempters.
Humans ; Life Change Events ; Qualitative Research ; Stress, Psychological ; Suicide* ; Suicide, Attempted

PURPOSE: As the number of infertile couples has grown, many infertile women have experienced depression during the diagnosis and treatment of their infertility. This study aimed to identify the factors related to depression in infertile women who underwent reproductive treatments. METHODS: The study subjects were 149 infertile women who underwent reproductive treatments. The data were collected by self-administered questionnaires from August 1 to December 24, 2018. The questionnaire consisted of questions about fatigue, health-promoting behavior, and depression. Analyses of the descriptive statistics, t-tests, one-way analysis of variance, correlation, and multiple regression were conducted using the SPSS 25.0 Windows program. RESULTS: Thirty-six of the women in the study (24.2%) were in the probably depressed group and 113 (75.8%) were in the definitely depressed group and 100% of the subjects experienced symptoms of depression. Depression was positively correlated with fatigue and negatively correlated with health-promoting behavior. Multiple regression analysis revealed that fatigue and interpersonal relationships were factors significantly related to depression in the model (p<.001), with an explanatory power of 42.6%. CONCLUSION: The results confirmed that fatigue and interpersonal relationships, which is a subfactor of health-promoting behavior, were factors related to depression. To alleviate depression in infertile women, efforts should be made to identify and reduce psychological and physical fatigue. In addition, minimizing relational difficulties that they experience during an infertility diagnosis and treatment and strengthening positive interpersonal relationships can be positive strategies to alleviate depression.
Depression ; Diagnosis ; Family Characteristics ; Fatigue ; Female ; Health Promotion ; Humans ; Infertility

BACKGROUND: The appropriate empirical antimicrobial choice in the treatment of community-acquired pneumonia (CAP) should be advocated by community-based information on the etiologic pathogens, their susceptibility to antimicrobials, clinical characteristics and outcomes. Jeju is a geographically isolated and identical region in Korea. However, there is no regional reference on adult CAP available. This study investigated the etiologic agents and clinical outcomes of adult patients diagnosed with CAP in Jeju, Korea, to help guide the empirical antimicrobial choice. METHODS: A prospective observational study for one year in a referral hospital in Jeju, Korea. Patients diagnosed with CAP were enrolled with their clinical characteristics. Microbiological evaluations to identify the etiologic agents in the adult patients with CAP were performed with blood culture, expectorated sputum smear and culture, antibody tests for mycoplasma, chlamydophila, and antigen tests for legionella and pneumococcus. The clinical outcomes of the initial empirical treatment were analyzed. RESULTS: Two hundred and three patients with mean age of 64 and 79 females were enrolled. Ten microbials from 90 cases (44.3%) were isolated and multiple isolates were confirmed in 30. Among the microbial isolates, S. pneumoniae (36.3%) was the most common, followed by M. pneumoniae (23.0%), C. pneumoniae (17.0%), S. aureus (9.6%) and P. aeruginosa (5.9%). The initial treatment failure (23.8%) was related to the isolation of polymicrobial pathogens, elevated inflammatory markers, and the presence of pleural effusion. Among the 30 isolates of S. pneumoniae, 16 (53.3%) were not susceptible to penicillin, and 19 isolates (63.3%) to erythromycin and clarithromycin. However, 29 isolates (96.7%) were susceptible to levofloxacin and ceftriaxone. CONCLUSION:S. pneumoniae, M. pneumoniae, S. aureus, and P. aeruginosa are frequent etiologic agents of adult CAP in Jeju, Korea. The clinical characteristics and antibiotic resistance should be considered when determining the initial empirical antimicrobial choice. Respiratory quinolone or ceftriaxone is recommended as an empirical antimicrobiotic in the treatment of adult CAP in Jeju, Korea.
Adult ; Ceftriaxone ; Chlamydophila ; Clarithromycin ; Community-Acquired Infections ; Drug Resistance ; Drug Resistance, Microbial ; Erythromycin ; Female ; Humans ; Korea ; Legionella ; Mycoplasma ; Ofloxacin ; Penicillins ; Pleural Effusion ; Pneumonia ; Prospective Studies ; Referral and Consultation ; Sputum ; Streptococcus pneumoniae ; Treatment Failure

BACKGROUND: Mycobacterial identification in active pulmonary tuberculosis (APTB) is confirmative, even though successful rates using self-expectorated sputum are limited. Sputum specimens collected by hypertonic saline nebulization showed higher bacteriologic diagnostic sensitivities over those of self-expectoration, mostly studied in smear-negative or sputum-scarce patients. The efficacy of induced sputum was rarely assessed in real clinical settings. METHODS: A prospective randomized case-control study was performed in one hospital. The subjects highly suspicious of APTB were asked to provide 3 pairs of sputum specimens in 3 consecutive days. The first pairs of the specimens were obtained either by self-expectoration (ES) from the next day of the visit or sputum induction with 7% saline nebulization in clinic (SI), and the other specimens were collected in the same way. The samples were tested in microscopy, culture, and polymerase chain reaction (PCR). The outcomes of the bacteriological diagnosis were compared. RESULTS: Seventy six patients were assigned to either ES (38 subjects, median age of 51, 65.8% male) or SI (38 subjects, median age of 55, 52.6% male). APTB was clinically confirmed in 51 patients (70.8%), 27 in ES and 24 in SI. Among the APTB, more adequate specimens were collected from SI (41/65, 63.1%) than ES (34/80, 42.5%) (p=0.01). Bacteriological confirmation was achieved in 14 (58.3%) patients in SI, and 13 (48.1%) in ES (p=0.46). In the same-day bacteriological diagnosis with microscopy and PCR, there were positive results for 9 patients (37.5%) in SI and 7 patients (25.9%) in ES (p=0.37). CONCLUSION: Sputum induction improves sputum specimen adequacy. It may be useful for the same-day bacteriological diagnosis with microscopic examination and PCR.
Case-Control Studies ; Diagnosis ; Humans ; Microscopy ; Polymerase Chain Reaction ; Prospective Studies ; Saline Solution, Hypertonic ; Sputum* ; Tuberculosis, Pulmonary*

Despite the various responses of human skin to female sex hormones, cellular and subcellular targets and the mechanisms of action of estrogen and progesterone in human skin are not well understood. The detection of estrogen receptor (ER) and progesterone receptor (PR) in the skin is of great importance to understand the effect of estrogen and progesterone. In primary cultures of human keratinocytes, expression of ER and PR was monitored by immunocytochemistry and reverse transcriptase polymerase chain reaction (RT-PCR). Paraffin embedded skin tissues were stained with monoclonal antibodies to human ER and PR by immunohistochemistry. Cultured human keratinocytes expressed cytoplasmic PR protein and PR mRNA transcripts. By contrast, ER was detected only at the mRNA level. Suprabasal keratinocytes from samples of pruritic urticarial papules, plaques of pregnancy (PUPPP) and psoriasis were stained positively only for PR, while those from samples of erythema nodosum were negative for both ER and PR. Lesional epidermis of PUPPP showed positive PR immunoreactivity, while nonlesional epidermis did not. No other cells in the normal human skin were stained with ER and PR. The present study suggests that by expressing PR human keratinocytes act as targets for progesterone action.
Adolescence ; Adult ; Aged ; Cells, Cultured ; Female ; Gene Expression ; Human ; Immunoenzyme Techniques ; Infant ; Keratinocytes/metabolism* ; Keratinocytes/cytology ; Male ; Middle Age ; Receptors, Estrogen/genetics ; Receptors, Estrogen/biosynthesis ; Receptors, Progesterone/genetics* ; Receptors, Progesterone/biosynthesis ; Reverse Transcriptase Polymerase Chain Reaction ; Sequence Analysis, DNA/methods ; Skin/pathology ; Skin/metabolism ; Skin Diseases/metabolism

The mechanisms of estrogen and progesterone in human cutaneous pigmentation are largely unknown. The molecular identification of estrogen receptor (ER) and progesterone receptor (PR) in the human melanocytes is of great importance to understand the mechanisms. We performed immunocytochemistry analysis and demonstrated that ER and PR were expressed in the cytoplasms and nuclei of human melanocytes. Reverse transcriptase-polymerase chain reaction (RT-PCR) and sequence analysis confirmed the expression of ER and PR at the transcriptional level. Despite of the presence of ER and PR, the physiological and pregnant levels of estrogen and progesterone showed inconsistent effects on the proliferation and tyrosinase activity of cultured human melanocytes. These results suggest that human melanocytes express ER and PR, which have a donor-specific action in human pigmentation. Further studies are needed to elucidate the induction mechanism and functions of these receptors, and the role of estrogen and progesterone in melanocytes.
Adult ; Cells, Cultured ; Estrogens/*pharmacology ; Gene Expression ; Humans ; Melanocytes/cytology/*drug effects/metabolism ; Mitogens/pharmacology ; Organ Culture Techniques ; Progesterone/*pharmacology ; Receptors, Estrogen/genetics/*metabolism ; Receptors, Progesterone/genetics/*metabolism ; Reverse Transcriptase Polymerase Chain Reaction ; Skin/drug effects ; Skin Pigmentation/drug effects ; Tissue Donors

During the pandemic, few patients have suffered from severe pneumonia leading to acute respiratory distress syndrome (ARDS) and multiple organ dysfunction necessitating prolonged intensive care with higher mortality. Although sepsis and ARDS represent hypercoagulable states, acute pulmonary thromboembolism is rarely encountered in influenza infection. Fifty five year old female patient admitted with pneumonia associated with influenza A infection, progressed into ARDS. Pulmonary thromboembolism was detected by CT scan and treated with anticoagulants. This is the first case report of acute pulmonary thromboembolism in a patient with pandemic influenza (H1N1 2009) in Korea.
Anticoagulants ; Critical Care ; Cyclopentanes ; Female ; Guanidines ; Humans ; Influenza A virus ; Influenza, Human ; Korea ; Pandemics ; Pneumonia ; Pulmonary Embolism ; Respiratory Distress Syndrome, Adult ; Sepsis

Purpose: : The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients’ nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). Methods: : In a cross-sectional survey conducted in September 2017, 1,786 patients’ WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients’ nursing care needs were calculated. Results: : The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. Conclusion : Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients’ nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.

Purpose: : The aim of this study was to propose appropriate nurse staffing of adult intensive care units considering patients’ nursing care needs according to the Workload Management System for Critical Care Nurses (WMSCN). Methods: : In a cross-sectional survey conducted in September 2017, 1,786 patients’ WMSCN scores, surveys from 2,145 nurses, and administrative data from 118 units in 41 hospitals were analyzed. The means (standard deviations) of the aforementioned scores and nursing hours per patient day were presented. Nurse-to-patient ratios and nurse-to bed ratios for staffing to meet patients’ nursing care needs were calculated. Results: : The mean WMSCN scores were 109.50±17.17 in tertiary hospitals and 96.38±19.26 in general hospitals. Nursing hours per patient day were 12.47±2.80 in tertiary hospitals and 11.01±2.45 in general hospitals. Nursing hours per patient day correlated with WMSCN scores. Nurse-to-bed ratios required for the provision of ICU nursing care ranged from 1: 0.36 to 1: 0.48. Conclusion : Our findings provide evidence that current ICU nurse staffing is insufficient for meeting patients’ nursing care needs. We suggest adjusting the legal standards for adequate nurse staffing considering these needs.