Effect of Educational Nurse Practitioners at Comprehensive Nursing Care Service Units / 임상간호연구

Purpose@#This study aimed to investigate the effect of educational nurse practitioners at comprehensive nursing care service units by comparing the educational satisfaction of general nurses and the occupational stress of preceptor nurses before and after education by educational nurse practitioners. @*Methods@#Participants were 71 general nurses and 71 preceptor nurses working at comprehensive nursing care service units of G University hospital in I City. The level of educational satisfaction of general nurses and occupational stress of preceptor nurses were measured and compared. The differences in educational satisfaction and occupational stress before and after the education program were verified by paired t-test and one-way ANOVA using SPSS/WIN 27.0 statistical program. Differences before and after the education program according to the general characteristics were analyzed with repeated measure analysis of variance after Sapiro-Wilks normality test, and post-hoc analysis was conducted using Scheffé test. @*Results@#It was inferred that there was a significant difference (t=-9.32, p <.001) in the educational satisfaction of general nurses, with an average of 3.72±0.77 before the education and 4.47±0.60 after the education. However, there was no significant difference in occupational stress in the preceptor nurses. @*Conclusion@#It could be concluded that introduction of educational nurse practitioners at comprehensive nursing care service units has a positive effect on the educational satisfaction of general nurses. This result will serve as basic data to implement educational nurse practitioners for general nurses in all medical institutions as well as comprehensive nursing care service units.

Effect of Educational Nurse Practitioners at Comprehensive Nursing Care Service Units / 임상간호연구

Purpose@#This study aimed to investigate the effect of educational nurse practitioners at comprehensive nursing care service units by comparing the educational satisfaction of general nurses and the occupational stress of preceptor nurses before and after education by educational nurse practitioners. @*Methods@#Participants were 71 general nurses and 71 preceptor nurses working at comprehensive nursing care service units of G University hospital in I City. The level of educational satisfaction of general nurses and occupational stress of preceptor nurses were measured and compared. The differences in educational satisfaction and occupational stress before and after the education program were verified by paired t-test and one-way ANOVA using SPSS/WIN 27.0 statistical program. Differences before and after the education program according to the general characteristics were analyzed with repeated measure analysis of variance after Sapiro-Wilks normality test, and post-hoc analysis was conducted using Scheffé test. @*Results@#It was inferred that there was a significant difference (t=-9.32, p <.001) in the educational satisfaction of general nurses, with an average of 3.72±0.77 before the education and 4.47±0.60 after the education. However, there was no significant difference in occupational stress in the preceptor nurses. @*Conclusion@#It could be concluded that introduction of educational nurse practitioners at comprehensive nursing care service units has a positive effect on the educational satisfaction of general nurses. This result will serve as basic data to implement educational nurse practitioners for general nurses in all medical institutions as well as comprehensive nursing care service units.

A Case of Neonatal Hydrometrocolpos Accompanying Urinary Tract Obstruction / 소아과

Neonatal hydrometrocolpos is the cystic dilatation of the vagina and uterus, which is caused by the combination of vaginal obstruction such as imperforate hymen, transverse vaginal septum, or vaginal atresia, and glandular secretion by maternal estrogenic stimulation. Although hydrometrocolpos is a rare congenital abnormality unlike pubertal hematocolpos, it is one of the relatively common abdominal masses in neonates. In typical cases the diagnosis may be determined easily by the combination of a pelvic mass, upper urinary tract dilatation and a bulging membrane in the vaginal introitus. The presense of a lower abdominal mass in a female infant should always arouse suspicion of hydrometrocolpos and lead to careful examination of the vagina. We report a case of neonatal hydrometrocolpos due to imperforate hymen which was initially presented as a large abdominal mass and a bulging membrane in the vaginal introitus. For 72 hrs, the abdominal mass increased rapidly, accompanied by urinary tract obstruction. It was relieved by a simple incision of the imperforate hymen and drainage of 300 cc of whitish mucoid vaginal fluid, and by Foley catheter drainage of 750 cc urine. No other anomaly was observed.

Effect of the Exchange of Saline Used in Surgical Procedures on Surgical Site Infection / 간호학회지

PURPOSE: The purpose of this study was to identify the effect of the exchange of saline used in surgical procedures on surgical site infections. METHOD: Patients with stomach cancer were assigned to the experimental group or to the control group by random sampling, respectively. The experimental group received an exchange of saline during the operation right after the excision of the stomach in a gastrectomy but the control group did not. Data were collected from the medical charts of 34 patients from Dec. 1, 2002 through May 31, 2003. RESULT: The surgical site infection rate of the experimental group was 5.9% while surgical site infection rate of the control group was 17.6%. In total, the surgical site infection rate was 11.8%. The experimental group maintained a normal level of WBC on post operative day 3; however, the control group, showed an increase of WBC on post operative day 3. CONCLUSION: The exchange of saline used in an operation immediately after the excision of the stomach in a gastrectomy decreases the contamination level of saline used in the operation, and can prevent surgical patients from a surgical site infection.

A Clinical Study and Sonographic Findings of Neonatal Adrenal Hemorrhage / 소아과

PURPOSE: This study was performed to present out experience of neonatal adrenal hemorrhage (NAH) and to help diagnosis and management of NAH. METHODS: We conducted a retrospective study on 14 neonates diagnosed as NAH from January 1993 to August 2002 at Hallym Medical Center. Their clinical manifestations, risk factors, sonographic findings and progression of NAH were evaluated using medical records. RESULTS: There were 12 male cases and two female cases. All cases were full-term babies. In terms of method of delivery, there were 13 cases of vaginal delivery and one case of cesarean section. The most common symptom was jaundice(10 cases). Poor feeding, vomiting, anemia, scrotal swelling with bluish discoloration, abdominal distension and cyanosis were also noted. The risk factors included perinatal asphyxia(five cases), large baby(three cases), sepsis(one case) and birth trauma(one case). Twelve cases(85.7%) involved the right adrenal gland, one case(7.1%) the left side and one case(7.1%) bilateral. In abdominal sonography, hemorrhage was seen as an isoechoic mass with central anechoic portion(35.7%), a central hypoechoic mass with peripheral hyperechoic portion(28.6%), an anechoic cystic mass(28.6%) and a heterogeneous hyperechoic mass(7.1%). Only a conservative treatment was sufficient in all cases. In the 12 cases(85.7%) followed up, size of hemorrhage was reduced in repetitive sonography without any complications. CONCLUSION: The review of these patients emphasizes the subtle and diverse clinical presentation of adrenal hemorrhage in neonates and stresses the importance of repetitive abdominal sonography in establishing the diagnosis.

A Clinical and Radiologic Study of Acute Focal Bacterial Nephritis in Children

PURPOSE: To raise awareness of the clinical importance of, and the need for proper management of acute focal bacterial nephritis(AFBN), we analyzed 22 AFBN patients and 22 other upper urinary tract infection patients by use of comparative studies. METHODS: From January 2000 to May 2002, 22 AFBN patients aged from 1 month to 12 months were selected. As a control group, 22 UTI patients with no radiologic abnormalities were selected and matched by age and sex. RESULTS: The incidence of AFBN was more common in boys than in girls. Since both groups had similar symptoms, it was difficult to diagnose AFBN by clinical presentations alone. ESR and CRP were significantly higher in AFBN patients. The most common causative organism was E. coli in both groups. On the sonographic findings, the most lesions were seen on the upper lobe of the kidney; more frequently, on left kidney. The lesions showed globular or wedge-shaped increased echogenecity. 99mTc-DMSA scan showed the complete coincidence of the location, size and shape in all cases compared to the findings of renal sonography. CONCLUSION: The roles of renal sonography and DMSA scan were very important, and ultrasonography was an excellent initial tool in diagnosing AFBN. Since the degree of infection in AFBN is more severe than other urinary tract infections and evollution into a renal abscess is possible, early diagnosis and appropriate antibiotics therapy is essential.

Five Cases of Shaken Baby Syndrome

Shaken baby syndrome is a serious form of child abuse, mostly involving children younger than 2 years. It results from extreme rotational cranial acceleration induced by violent shaking. The characteristic injuries include subdural hemorrhage, retinal hemorrhage, and fracture of ribs or long bones. If physicians have no recognition of, or suspicion about, shaken baby syndrome, this syndome is difficult to diagnosis because of a lack of obvious external signs and failure of the abuser to admit his or her actions. In addition to the high mortality, 60% of survivors have significant long term neurologic and developmental abnormality. The authors experienced five cases of shaken baby syndrome presented with seizures or vomiting, without external signs of trauma. All of these cases had subdural hemorrhages, and four cases had retinal hemorrahges. In our follow up, two children were found to have sequelae such as quadriplegia, monoplegia, and developmental delay. We emphasize that early recognition and prompt treament are key to overall success of case management. The incidence of shaken baby syndrome can be reduced through public awareness and education of parents not to shake a babies.

A Clinical Study of Acute Symptomatic Seizures in Children

PURPOSE: The present study was designated to sex, age, etiology of acute symptomatic seizures, which refer to the seizure caused by specific and transient pathophysiologic abnormalities in the central nervous system and other systems, and furthermore to analyze the incidence of acute symptomatic seizures before and during hospitalization. METHODS: The medical records of six hundred and ten convulsive children under fifteen years of age, who visited the Hallym University Sacred Heart Hospital from January 1999 to May 2001, were reviewed. One hundred and fourteen cases out of them were analyzed, and febrile seizures and unprovoked seizures were excluded. RESULTS: Among six hundred and ten children who had seizure during hospitalization, one hundred and fourteen(18.7%) had acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures. The ratio of male to female was 1:2.1 and the peak age was three or less, accounting for 93.9%. Acute symptomatic seizures were caused by acute gastroenteritis(42.0%), metabolic/toxic disturbances(34.1%), cerebrovascular diseases(8.8%), CNS infections(8.0%), hypoxemia(4.4%), brain tumors(1.8%), and others(0.9 %). Remarkably, hypocalcemia and shaken baby syndrom were up to 82.1% of metabolic/ toxic distubances and 30.0% of cerebrovascular diseases, respectively. Among the one hundred and fourteen patients, 41.2% suffered from seizures before and during hospitalization and 11.4% did not before but did during hospitalization. CONCLUSION: Eighteen point seven percent of the cases of convulsions reviewed were classified into acute symptomatic seizures exclusive of febrile seizures and unprovoked seizures with the male to female ratio of 1:2.1 and high incidence age of three or less years. The leading causes of acute symtomatic seizures were acute gastroenteritis and hypocalcemia, comprising 70%. Shaken baby syrome and hyponatremia due to water intoxication can be prevented by public education about the danger, and central nervous system infection can be reduced by vaccine development and nationwide vaccination against the bacteria causing the central nervous system infection. In addition, appropriate prevention and management of seizure attacks are required for the patients with acute symptomatic seizures during hospitalization.