PURPOSE: This study aims to develop a self-reflection program for nurses who have experienced the death of pediatric patients in the intensive care unit and to evaluate its effectiveness. METHODS: The self-reflection program was developed by means of the following four steps: establishment of the goal through investigation of an initial request, drawing up the program, preliminary research, and implementation and improvement of the program. The study employed a methodological triangulation to evaluate the effectiveness of the program. Participants were 38 nurses who had experienced the death of pediatric patients (experimental group=15, control group=23); they were recruited using convenience sampling. The self-reflection program was provided over 6 weeks (6 sessions). Data were collected from April to August, 2014 and analyzed using t-tests and content analysis. RESULTS: The quantitative results showed that changes in personal growth (t=-6.33, p<.001) and burnout scores (z=-2.76, p=.005) were better in the experimental group compared to the control group. The qualitative results exhibited two themes, namely “personal growth” and “professional growth”, and ten sub-themes. CONCLUSION: The self-reflection program developed by this study was effective in helping nurses who had experienced the death of pediatric patients to achieve personal growth through self-reflection, and it was confirmed that the program can be applied in a realistic clinical nursing setting. Furthermore, it can be recommended as an intervention program for clinical nurses.
Critical Care* ; Humans ; Intensive Care Units* ; Nursing ; Program Development

No abstract available.

PURPOSE: The purpose of this phenomenological study was to explore neonatal intensive care unit (NICU) nurses' experience in caring for infants who are approaching death and to identity the meaning and structure of their experiences. METHODS: The participants were eight nurses who had experience in caring for these infants. In-depth interviews were performed from December, 2012 to February, 2013 until data were fully saturated. Collected data were analyzed using Colaizzi's method. RESULTS: Four theme clusters were extracted from fifteen themes. The four theme clusters of the NICU nurses' experience in caring for infants who are dying were: 1) Crossroads between life and comfort of infants approaching death, 2) emotional suffering at the death of the infant, 3) adapting and coping with the death of the infant, 4) new expectations for caring for infants who are dying. CONCLUSION: The results of the study provide useful information in understanding NICU nurses' experience in caring for infants who are dying and establishing effective strategies to support these nurses.
Humans ; Infant* ; Infant, Newborn ; Intensive Care, Neonatal* ; Neonatal Nursing

PURPOSE: The purpose of this study was to identify suicidal ideation in high school students in urban and rural areas. METHODS: For this research two urban and two rural high schools in four cities were chosen. The participants were 713 students (373 in the urban area, 340 in the rural area). The survey was conducted from June 1 to July 31, 2012. Data were analyzed with chi-square test, t-test, ANOVA, and multiple regression using SPSS 18.0. RESULTS: Results showed that 19.5% of respondents had suicidal ideation within the past 1 year. There were significant differences in suicidal ideation and developmental assets between the two areas. Multiple regression analysis revealed that support, school violence, gender, family abuse, constructive use of time, and positive identity were significant predictors and explained 26% of suicidal ideation for high school students in urban areas. On the other hand, in rural areas, family abuse, gender, positive identity, smoking and empowerment were significant predictors and explained 31% of suicidal ideation. CONCLUSION: The findings indicate that implementation of a suicide prevention program in which consideration is given to these factors, and taking into account differences between urban and rural students would be helpful in reducing suicidal ideation.
Surveys and Questionnaires ; Hand ; Humans ; Power (Psychology) ; Smoke ; Smoking ; Suicidal Ideation ; Suicide ; Violence

PURPOSE: This study was performed to investigate the factors affecting postoperative pain and length of hospital stay of liver transplantation donors. METHODS: This is a retrospective study using the Electronic Medical Records (EMR) of 91 patients operated on at a tertiary hospital in Seoul, Korea in 2016. The collected data were analyzed using descriptive statistics, t-test, Mann-Whitney U test and Kruskal-Wallis test, Spearman's rank correlation, and multiple regression analysis. RESULTS: The average age of the donors was 35.7±12.2 years, and all donors were family members. PCA was applied for control pain in all patients, and 40.7% of PCA-related side effects were observed. The average length of hospital stay was 9.24±2.52 days. The factors influencing the length of hospital stay were operative methods, pain control methods, and postoperative complications. The length of hospital stay was 1.29 days shorter if donors had no complication, 1.43 days shorter when only PCA was used, and 1.19 days shorter when laparoscopic resection was performed (Adjusted R2=0.17, F=4.67, p < .05). CONCLUSION: The results of this study can be used as basic data for practical and effective postoperative nursing education and intervention of living liver donors.
Education, Nursing ; Electronic Health Records ; Humans ; Korea ; Length of Stay* ; Liver Transplantation* ; Liver* ; Living Donors ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Postoperative Complications ; Retrospective Studies ; Seoul ; Tertiary Care Centers ; Tissue Donors*

No abstract available.
Anesthesia, Epidural*

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. THE SPECIFIC OBJECTIVES WERE: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i) FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the medically supervised deliveries, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. STUDY DESIGN: The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum "package" program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and "before and after" surveys were conducted to measure the change. SERVICE INPUT: This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. METHOD OF EVALUATION: a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed. b. Neverthless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the "intergration process" itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltructure, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable. Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. SUMMARY OF FINDINGS: A) PROGRAM EFFECTS AND IMPACT. 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 78% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller. 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) & delivery care (45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregnancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) EFFECTS ON INTERACTIVE LINKAGE. 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in carrying for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, 85-90% of the services provided by the health workers were other than FP/MCH, mainly for immunization such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs. 31%) and for more combined care (45% vs. 23%). C) ORGANIZATION FACTORS (ADMINISTRATIVE INTEGRATIVE ISSUES). 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub-center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwives's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea). 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through planning practice. 2) Goal consensus in FP/MCH should be made among the health workers & administrators, especially to emphasize the need of care of "wanted" child. But there is a long way to go to realize the "real" integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (ii) there should be a health sub-center director who can provide leadership training for managing the integrated program. There is a need for "organizational support", if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the management of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Workers, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.
Abortion, Induced ; Administrative Personnel ; Child ; Child Health ; Chungcheongnam-do ; Cohort Studies ; Community Health Workers ; Consensus ; Contraception ; Cooperative Behavior ; Delivery of Health Care ; Encephalitis ; Family Characteristics ; Family Health ; Family Planning Services* ; Female ; Hand ; Health Personnel ; Health Services ; House Calls ; Humans ; Immunization ; Infant ; Infant Mortality ; Insurance Benefits ; Clinical Trial* ; Jurisprudence ; Korea* ; Leadership ; Live Birth ; Local Government ; Midwifery ; Organization and Administration ; Parturition ; Population Growth ; Postnatal Care ; Pregnancy ; Prenatal Care ; Primary Health Care ; Referral and Consultation ; Social Control, Formal ; Specialization

BACKGROUND: Minimum alveolar concentration (MAC) is decreased during pregnancy, but there are no data regarding the requirements for intravenous agents. Recently only one study showed that the requirement for thiopental in pregnant women of 7-13 weeks' gestation was less than the requirement obtained in nonpregnant women. Thus we wanted to determine whether pregnant patients needed less propofol for hypnosis and anesthesia than nonpregnant patients. METHODS: One hundred nonpregnant women having gynecologic surgery and 100 pregnant women of 5-13 weeks' gestation undergoing elective abortions were recruited. They were randomly allocated 10 groups according to the doses of propofol and each group had 10 patients. During a period of 30 seconds, one of the doses of propofol 1.0, 1.25, 1.5, 1.75, 2.0, 2.25, 2.5, 2.75, 3.0 or 3.25 mg/kg was administered. Two minutes later, patients were asked to open their eyes as a test for hypnosis. Patients who did not open their eyes were given a 10 seconds, 50-Hz, 80-mA transcutaneous tetanic electrical stimulus to the ulnar nerve as a test for anesthesia. Estimates of ED50 and ED95 for hypnosis and anesthesia were obtained by logistic regression. RESULTS: In the pregnant women, the median effective doses (ED50) (95% confidence interval) for hypnosis and anesthesia were 1.25 (1.13-1.35) mg/kg and 2.71 (2.49-3.04) mg/kg, the ED95 (95% CI) were 1.51 (1.16-1.87) mg/kg and 3.04 (2.80-3.58) mg/kg respectively. Whereas in the nonpregnant women, the ED50 for hypnosis and anesthesia were 1.27 (1.39-1.90) mg/kg and 4.12 (3.50-6.01) mg/kg, the ED95 were 1.53 (1.41-1.93) mg/kg and 4.35 (3.66-7.26) mg/kg respectively. CONCLUSIONS: In early pregnant women, the doses of propofol for hypnosis and anesthesia were 1.6% and 34.2% less compared with those in nonpregnant women.
Anesthesia ; Female ; Gynecologic Surgical Procedures ; Humans ; Hypnosis ; Logistic Models ; Pregnancy* ; Pregnant Women ; Propofol* ; Thiopental ; Ulnar Nerve

Myrmecia, a type of palmoplantar warts, are induced by human papilloma virus type 1(HPV1). They occur not only on the palms and soles, but also on the lateral aspects and tips of fingers and toes. Histologically, it is characterized by abundant eosinophilic inclusion bodies associated with HPV1 E4 gene products. We report two cases of myrmecia developing on the dorsum of finger.
Eosinophils ; Fingers* ; Humans ; Inclusion Bodies ; Papilloma ; Toes ; Warts

Purpose: This study aimed to assess exposure to traumatic events, knowledge and attitudes concerning post-traumatic stress disorder (PTSD) and the level of resilience among nurses and paramedics working in emergency departments. Methods: Data were collected from May 22 to June 12, 2022, using a self-administered survey questionnaire. The participants comprised 135 nurses and 80 paramedics working in emergency departments. The collected data were analyzed with descriptive statistics, a t-test, and an analysis of variance with Scheffé’s test. Results: Compared with emergency room nurses, paramedics were more positive about the government’s spending on job opportunities for people with PTSD. There were no significant differences in attitude regarding government strategies and people with PTSD between nurses and paramedics. Paramedics had higher scores on the effective treatment for PTSD, while emergency room nurses showed higher scores on effective psychotherapy. General knowledge of PTSD differed according to sex (t=-2.33, p=.021) and education level (F=3.21, p=.042). Resilience scores differed significantly according to sex (t=2.02, p=.045), education level (F=4.10, p=.018), self-reported economic state (F=10.34, p<.001), and self-reported health (F=11.57, p<.001). Conclusion The findings support that emergency department nurses and paramedics are in need of self-care programs to support their mental health and indicate that intervention programs should be developed to enhance resilience in emergency department professionals.