How Should We Approach Nurse Suicide in Korea: With the Aspect of Prevention-InterventionPostvention Management

Recently, nurse suicide has emerged as one of the major issues. We tried to review the status of nurse suicide and its management in Korea through inspecting related web sites, news articles, and research. However, there were no sufficient reports or statistics along with the research throughout the country. Moreover, there were no organized nurse suicide management systems or programs including suicide prevention, suicide intervention, suicide postvention management. In other countries, there were various trials and successful experiences about nurse suicide programs, and those have been managed in organized and integrated ways. It gave us a lot of implications. To effectively prevent and manage the nurse suicide in Korea, nursing workforce, nursing managers, and nursing researchers should be concerned about nurse suicide. Furthermore, discussions and the research must be made actively. Based on such efforts, appropriate programs, organized manage systems, and policies must be devised at institution and national level.

How Should We Approach Nurse Suicide in Korea: With the Aspect of Prevention-InterventionPostvention Management

Recently, nurse suicide has emerged as one of the major issues. We tried to review the status of nurse suicide and its management in Korea through inspecting related web sites, news articles, and research. However, there were no sufficient reports or statistics along with the research throughout the country. Moreover, there were no organized nurse suicide management systems or programs including suicide prevention, suicide intervention, suicide postvention management. In other countries, there were various trials and successful experiences about nurse suicide programs, and those have been managed in organized and integrated ways. It gave us a lot of implications. To effectively prevent and manage the nurse suicide in Korea, nursing workforce, nursing managers, and nursing researchers should be concerned about nurse suicide. Furthermore, discussions and the research must be made actively. Based on such efforts, appropriate programs, organized manage systems, and policies must be devised at institution and national level.

Home-Based Hospice Care Provided by a Free-Standing Hospice Center: Patients' Characteristics and Service Conditions / 한국호스피스완화의료학회지

PURPOSE: This study was conducted to investigate patients' characteristics and actual conditions of home-based services offered by a free-standing hospice center. METHODS: A retrospective review was performed with the medical records of 75 patients who received home-based hospice care from a free-standing hospice center from January 2014 through December 2014. RESULTS: Most patients (54.7%) were enrolled via self-directed referral. The reason for the service termination was death at home 25.3%, admission to a hospice ward 50.7%, hospitalization 22.6% and patients' refusal 2.7%. Seventy three patients had cancer, and two patients had ALS. Among all, 58.7% were in a dying phase, and 34.7% were almost completely bedfast at the time of their enrollment in this study. When they enrolled, the patients' physical symptoms were characterized as pain (89.4%), sleep disturbance (71.2%), urinary difficulties (35.8%) and defecation difficulties (47.8%). Among all, 77.4% terminated the home visit service within one month. The mean frequency of the home visits was 3.25 (±3.98), and less than five in 82.7% of patients. The mean frequency of the phone service was 3.40 (±3.12). The frequency of doctor's home visits was 1.21±0.79 on average, and the figure increased when patients' conditions turned unstable. CONCLUSION: It is necessary to develop a home-based hospice care model with consideration of patients' characteristics and the actual service conditions delivered by free-standing hospice facilities.

Negative Pressure Wound Therapy of Chronically Infected Wounds Using 1% Acetic Acid Irrigation

BACKGROUND: Negative-pressure wound therapy (NPWT) induces angiogenesis and collagen synthesis to promote tissue healing. Although acetic acid soaks normalize alkali wound conditions to raise tissue oxygen saturation and deconstruct the biofilms of chronic wounds, frequent dressing changes are required. METHODS: Combined use of NPWT and acetic acid irrigation was assessed in the treatment of chronic wounds, instilling acetic acid solution (1%) beneath polyurethane membranes twice daily for three weeks under continuous pressure (125 mm Hg). Clinical photographs, pH levels, cultures, and debrided fragments of wounds were obtained pre- and posttreatment. Tissue immunostaining (CD31, Ki-67, and CD45) and reverse transcription-polymerase chain reaction (vascular endothelial growth factor [VEGF], vascular endothelial growth factor receptor [VEGFR]; procollagen; hypoxia-inducible factor 1 alpha [HIF-1-alpha]; matrix metalloproteinase [MMP]-1,-3,-9; and tissue inhibitor of metalloproteinase [TIMP]) were also performed. RESULTS: Wound sizes tended to diminish with the combined therapy, accompanied by drops in wound pH (weakly acidic or neutral) and less evidence of infection. CD31 and Ki-67 immunostaining increased (P<0.05) post-treatment, as did the levels of VEGFR, procollagen, and MMP-1 (P<0.05), whereas the VEGF, HIF-1-alpha, and MMP-9/TIMP levels declined (P<0.05). CONCLUSIONS: By combining acetic acid irrigation with negative-pressure dressings, both the pH and the size of chronic wounds can be reduced and infections be controlled. This approach may enhance angiogenesis and collagen synthesis in wounds, restoring the extracellular matrix.

A Design for and Evaluation of a Critical Thinking Class for New Community Health Practitioners / 한국간호교육학회지

PURPOSE: This study was carried out to describe the process and evaluation of a critical thinking class for new community health practitioners. METHODS: The case study design was used to develop and evaluate a critical thinking class for 46 participants in the community health practitioners training program. The class was held two hours a week for 8 weeks. Critical thinking disposition was tested before and after the class and critical skill was graded according to the final test score. Data analysis was performed using descriptive statistics and paired t-tests using SPSS WIN 20.0. RESULTS: Clinical critical thinking competences were identified through the literature review. The case situations with questions guiding the problem-solving process were developed and used for group discussion. Critical thinking disposition of participants was determined to have increased slightly after having taken the class. 17.4% of the participants had a competency level high enough to solve a problem and half of them stayed at the level of understanding of critical thinking. Compared with the class's satisfaction with the relevance to their jobs, the satisfaction with the learning method and instructor was high. CONCLUSION: The findings of this research will serve as the basis for developing critical thinking classes for community health nurses in order to improve their critical thinking competence.

Job Competencies and Educational Needs Perceived by New Community Health Practitioners

PURPOSE: This study was performed to identify job competencies and needs for job education perceived by new community health practitioners. METHODS: This study used a qualitative research design. Eight new community health practitioners participated in this study. Data were collected through in-depth interviews and analyzed using content analysis. RESULTS: Five job competencies were identified in this study, including primary care, public health management, interpersonal relationship, teaching and counseling, and leadership. The contents of job education that they needed were management of major symptoms and chronic diseases, understanding and prescription of medications, emergency responses and care, management of endemic diseases, planning and management of public health programs, writing official documentsand computer works, and leadership training. The learning methods they preferred were connecting theory and practice, situation- or case-based learning, skill- or practice-based learning, and increased opportunities of clinical practice. CONCLUSION: The findings of this study provided the direction of job education for new community health practitioners. Job education for new community health practitioners needs to consider the job competencies and educational needs identified in this study.

Reply: Multiple Large Cysts Arising from Nevus Comedonicus

No abstract available.

Multiple Large Cysts Arising from Nevus Comedonicus

Nevus comedonicus is a type of hamartoma that arises from a developmental anomaly of the mesodermal part of the pilosebaceous gland. In most cases of nevus comedonicus, an acne-like skin condition develops. Repeated inflammation can cause a morphological change to the cyst, papule, to abscess. We experienced a case of congenital nevus comedonicus, which led to the formation of large multiple cysts. A 50-year-old man was referred with a 12.5x10 cm lobulated mass on the posterior neck and upper back. The patient had a widespread presence of nevus comedonicus in the region ranging from the right superior chest to the posterior neck. The patient had a 30-year history of six prior excisions. A magnetic resonance imaging review led to a diagnosis of nevus comedonicus. Surgical treatment consisted of excision of the mass and wide excision for the patch type of nevus comedonicus around the neck. On histopathology, multiple masses were diagnosed as typical cysts containing keratinized tissue. The diffuse comedone lesions were diagnosed as nevus comedonicus. This case shows that large, multiple cysts can occur as a long-term complication of nevus comedonicus, and also highlights the importance of radical resection to prevent its further invagination.

A Case of Tuberous Sclerosis with Multiple Fibroma on Scalp and Extremity

PURPOSE: Tuberous sclerosis is an autosomal dominant multisystemic neurocutaneous syndrome characterized by the development of multiple hamartoma distributed through the body, skin, brain, heart, kidney, and lung. The classic triad is seizure, mental retardation, and facial angiofibroma. We experienced a case of a tuberous sclerosis associated with the facial lesion and multiple masses on scalp, forehead, and right lower extremity. METHODS: This a 34-year-old male patient had subependymal giant cell astrocytoma in brain and multiple angiomyolipoma in both kidneys. Tangential excision with razor blade and dermabrasion were done on the centrofacial area. We excised other lesions and the mass on scalp was excised and covered with split thickness skin graft. RESULTS: The histopathological finding revealed that the facial lesion was angiofibroma and the others were multiple fibroma. CONCLUSION: In our case of tuberous sclerosis, we chose the tangential excision to remove the large nodules of angiofibroma, and then dermabrasion was used to smooth the final contour. The patient appeared to have a good results from this treatment modality. But, tuberous sclerosis is an disease that needs long term follow-up to check up the recurrence of skin problem.