PURPOSE: This study was conducted to expand nurse's experience of harmful work environments. METHODS: Data were collected through in-depth dividual interviews and analyzed using Colaizzi phenomenological analysis methodology. RESULTS: Harmful work environments experienced by nurses were categorized as followed: ‘Neglect concerning infections’, ‘Being thrown into a violent working environment’, ‘The hard times of being alone’, ‘Struggling with the harmful work environments’. CONCLUSION: The results of this study provide a deep understanding of the harmful work environments. It is necessary to create safe work environments and it is important to improve awareness in the system of organizations as well as individuals. Also, it is necessary to develop tools to measure work environment including risk factors.
Risk Factors

Purpose: This study aimed to develop a nursing work environment scale for clinical nurses and to verify its validity and reliability. Methods: The initial items comprised individual interviews with eleven clinical nurses. The content validity of the initial items was evaluated twice by nine experts, while 37 preliminary items were reviewed through pilot tests with 20 nurses and cognitive interviews with five nurses. The survey data were collected from 353 clinical nurses working at general hospitals. Results: In the exploratory factor analysis, the number of factors was determined through parallel analysis, scree test, and cumulative variance ratio. Consequently, 23 items and three factors were thus composed, yielding a total cumulative variance ratio of 91.3%. The finalized 20 items of the final three factors were subjected to a confirmatory factor analysis, which led to the validation of the three subscales model. The three sub-factors were composed of nurse manager competency, nurse safety management system, and a nurse support system. Conclusion This scale is expected to be useful for evaluating the nursing work environment of clinical nurses by verifying its reliability and validity through various methods.

Purpose: The purpose of this study was to identify the mediating effect of the nursing work environment in the relationship between job embeddedness and turnover intention of nurses working in long term care hospital. Methods: The study was conducted with 183 nurses working in long term care hospitals. Results: There were significant negative relationships between job embeddedness and turnover intentions. There were significant positive relationships between job embeddedness and nursing work environment. Nursing work environment had a partial mediation effect in job embeddedness and turnover intentions. Conclusion In this study, the nursing work environment had a partial mediated effect in the relationship between job embeddedness and turnover. In order to reduce turnover intention of nurses working in long term care hospital, it is necessary to improve job embeddedness and the nursing work environment.

A 78-year-old woman presented to our hospital with progressive dyspnea (NYHA class I-II) and epigastric discomfort that had developed after a traffic accident. She had a history of hypertension and cerebral infarction, but no history of cardiovascular disease. Her blood pressure was 130/70 mmHg and her heart rate was 66 beats/min and regular. The electrocardiogram showed normal sinus rhythm. The chest X-ray revealed bilateral pleural effusions. Transthoracic echocardiography (TTE) demonstrated an aneurysm of the descending thoracic aorta compressing the left atrium (LA). Left and right ventricular systolic function was preserved. Whole-body computed tomography (CT) angiography revealed that a focal 40-mm-diameter saccular aneurysm in the descending aorta at the level of T7-8, with an intramural hematoma, was compressing the LA and left pulmonary vein. After surgical management, follow-up TTE and CT showed decompression of the LA and left pulmonary vein.
Accidents, Traffic ; Aged ; Aneurysm* ; Angiography ; Aorta, Thoracic* ; Aortic Aneurysm ; Blood Pressure ; Cardiovascular Diseases ; Cerebral Infarction ; Decompression ; Dyspnea ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Atria* ; Heart Rate ; Hematoma ; Humans ; Hypertension ; Pleural Effusion ; Pulmonary Veins ; Thorax

Laminar flow within large vessels or organs can cause artifact that may simulate thrombus during computed tomographic study. The degree of venous enhancement depends on the size of blood pool and cardiac output in relation to the time of scanning. When venous structures are scanned too fast after injection of contrast material, poor mixing of enhanced and unenhanced blood creates flow artifact that gives an appearance of deep venous thrombosis. As compared with dynamic computed tomography (CT), because of a shorter acquisition time of spiral CT, vascular and organ enhancement on spiral CT scan are more dependent on factor that affect delivery of contrast material into the blood stream. Differentiation from true thrombus can be made by use of delayed scan as well as increased density and finding of relatively poor margination of artifact. In addition, both angiography and echocardiography could complement CT to assure that false-positive results are minimized. We experienced a case of artifact mistaken for intracardiac mass on spiral CT, but it was not noted on echocardiography.
Angiography ; Artifacts* ; Cardiac Output ; Complement System Proteins ; Echocardiography ; Heart Neoplasms* ; Rivers ; Thrombosis ; Tomography, Spiral Computed ; Venous Thrombosis

PURPOSE : Clinical manifestations and pathologic findings of thin glomerular basement membrane disease, recognized as a common underlying disease of benign, familiar and asymptomatic hematuria has not been reported systemically in Korea. We analyzed clinical and pathologic findings of patients who were diagnosed as thin glomerular basement membrane disease. METHODS : We analyzed clinical and pathologic findings of twenty-six patients who were diagnosed as thin glomerular basement membrane disease by renal biopsy among who complained asymptomatic hematuria from 1990 to 2000. RESULTS : The subjects were aged 9.4+/-3.2 (3.0-15.8) years-old at onset of hematuria, and 11.1+/-2.2 (4.7-16.3) years-old at renal biopsy. Sexual discrepancy was more common in girls (eight boys and eighteen girls). A family history of hematuria was found in 8 patients(30.7%). Major clinical manifestation on admission was microscopic hematuria according to the findings of 3cases(11.5%) of gross hematuria, 23cases(88.5%9) of microscopic hematuria, and 1case(3.8%) of proteinuria. Microscopic hematuria persisted in all cases. Kidney biopsy showed few changes by light microscopy, but IgM, C3 and fibrinogen deposit in mesangium was found by immunofluorescent microscopy in a few cases. Electron microscopic findings have revealed thinning of the glomerular basement membrane varied from 180.9+/-35.8nm. CONCLUSION : Thin glomerular basement membrane disease might be a common cause of microscopic hematuria of children and family history was revealed in about 30%. Clinical progression was good in majorities.
Biopsy ; Child* ; Female ; Fibrinogen ; Glomerular Basement Membrane* ; Hematuria ; Humans ; Immunoglobulin M ; Kidney ; Korea ; Microscopy ; Proteinuria

BACKGROUND: To evaluate the effects of severe hypoglycemia without hypokalemia on the electrocardiogram in patients with type 2 diabetes in real-life conditions. METHODS: Electrocardiograms of adult type 2 diabetic patients during the episodes of severe hypoglycemia and the recovered stage were obtained and analysed between October 1, 2011 and May 31, 2012. Patients who maintained the normal serum sodium and potassium levels during the episodes of severe hypoglycemia were only selected as the subjects of this study. Severe hypoglycemia was defined, in this study, as the condition requiring active medical assistance such as administering carbohydrate when serum glucose level was less than 60 mg/dL. RESULTS: Nine type 2 diabetes patients (seven men, two women) were included in the study. The mean subject age was 73.2+/-7.7 years. The mean hemoglobin A1c level was 6.07%+/-1.19%. The median duration of diabetes was 10 years (range, 3.5 to 30 years). Corrected QT (QTc) intervals were significantly increased during the episodes of severe hypoglycemia compared to the recovered stage (447.6+/-18.2 ms vs. 417.2+/-30.6 ms; P<0.05). However, the morphology and the amplitude of the T waves were not changed and ST-segment elevation and/or depression were not found during the episodes of severe hypoglycemia. CONCLUSION: In this study, QTc interval prolongation during the episodes of severe hypoglycemia was observed without hypokalemia. Therefore, the distinct alterations in cardiac repolarization during the episodes of severe hypoglycemia may not be associated with hypokalemia.
Adult ; Depression ; Diabetes Mellitus, Type 2 ; Electrocardiography ; Glucose ; Hemoglobins ; Humans ; Hypoglycemia ; Hypokalemia ; Male ; Medical Assistance ; Potassium ; Sodium

Spontaneous pneumomediastnum is a very rare complication of systemic autoimmune diseases. The precise mechanism of pneumomediastinum in dermatomyositis is not well known. Pulmonary alveoli rupture secondary to interstitial pneumonitis or pulmonary infarctions consequent upon vasculitis are the suggested mechanisms. Among the idiopathic inflammatory myopathies, dermatomyositis and polymyositis show similar clinical manifestations except skin lesions. But pneumomediastinum occurs exclusively in cases with dermatomyositis, not in case with polymyositis. In a literature review, patients with dermatomyositis and pneumomediastinum had some characteristic features. As compared with dermatomyositis without pneumomediastinum, CK level was normal in about half and concomitance of interstitial lung disease and cutaneous vasculitis were very frequent. We experienced a case of dermatomyositis with spontaneous pneumomediastinum and subcutaneous emphysema. Thus we report that with a review of the literature and analysis of reported cases.
Autoimmune Diseases ; Dermatomyositis* ; Humans ; Lung Diseases, Interstitial ; Mediastinal Emphysema* ; Myositis ; Polymyositis ; Pulmonary Alveoli ; Pulmonary Infarction ; Rupture ; Skin ; Subcutaneous Emphysema* ; Vasculitis

PURPOSE: This study was conducted to develop Web-based multimedia contents for supporting student nurses' clinical practice on critical care, and to evaluate learners' responses. METHODS: Based on the steps of Assessment, Design, Development, Implementation, & Evaluation(ADDIE) model, a total of 13 self-directed learning modules including live lectures and real video clips were developed through faculty collaboration of nine nursing colleges in Gwangju and Chonnam province. The finally developed multimedia contents were published on the Web of the learning management system at a local e-learning center. RESULTS: The Web contents were evaluated after self-learning by 81 junior college nursing students who were encouraged to study it at their own pace during their two-week clinical practice at a medical or surgical intensive care unit of a university hospital and two hospitals. The knowledge (t = -27.66, p < .001) and self-evaluated clinical performance level(t = 7.54, p < .001) were significantly increased after learning of the Web contents and clinical practice, and satisfaction level that measured post-test only was 4.0 out of 5 point. CONCLUSION: The use of Web contents for critical care need to be extended as a complimentary material in a class room lecture or clinical practice of students to increase their self-learning ability and understandings of clinical knowledge and situation.
Computer-Assisted Instruction ; Cooperative Behavior ; Critical Care ; Humans ; Critical Care ; Learning ; Lectures ; Multimedia ; Students, Nursing

PURPOSE: Axillary lymph node metastases (ALNM) are the most important prognostic indicator in breast carcinoma. Because of relatively low incidence of axillary metastasis in the patients with Tl breast carcinoma, axillary lymph node dissection is now no longer considered to be the standard treatment. A reliable prediction of ALNM.may reduce the need for axillary lymph node dissection and may facilitate to select appropriate treatment modality. We have attempted to identify histopathologic/immunohistochemical factors correlated with ALNM in the patients with Tl breast carcinoma. MATERIAL AND METHODS: Forty-one patients with Tl breast carcinoma who underwent modified radical mastectomy and axillary dissection between January 1993 and February 1999 were studied. We investigated the relationship between ALNM and the histopathologic/immunohistochemical factors (size, lymphatic-vascular invasion (LVI), histologic grade, age, estrogen receptor (ER) status, progesterone receptor (PR) status, p53 protein, cathepsin D (CD), vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), transforming growth factor (TGF)- B 2, and microvessel density (MVD)). RESULTS: Fourteen (34.2%) out of the 41 patients with Tl breast carcinoma had ALNM. There are five statistically significant factors correlated with ALNM; lymphatic-vascular invasion (P=0.002), histologic grade (P 0.047), immunohistochemical expression of CD (P=0.005) and TGF- B 2 (P=0.004), and microvessel density (P=0.002). CONCLUSION: The histopathologic/immunohistochemical features of the primary breast tumor, such as LVI, increase in MVD, TGF- B 2 and CD expression, and histologic grade might be useful predictors of ALNM in patients with Tl breast carcinoma.
Breast Neoplasms* ; Breast* ; Cathepsin D ; Estrogens ; Fibroblast Growth Factor 2 ; Humans ; Incidence ; Lymph Node Excision ; Lymph Nodes* ; Mastectomy, Modified Radical ; Microvessels ; Neoplasm Metastasis* ; Receptors, Progesterone ; Transforming Growth Factors ; Vascular Endothelial Growth Factor A