Performance and Importance of Nursing Jobs in General Hospitals according to Levels of Work Experience of Nursing Staff / 기본간호학회지

PURPOSE: In this study differences in levels of performance and importance of nursing jobs were explored in relation to levels of work experience. METHOD: The sample was chosen by convenient sampling (N=363) and a cross-sectional study design was used. Frequencies and percentages were used for descriptive statistics. ANOVA was utilized to examine differences in performance and importance of nursing jobs among three groups of nurses, divided based on levels of work experience (less than 1 year, 1 to 4 years, and 5 or more years). RESULTS: Regarding performance of nursing jobs, novice nurses provided more support for patients, but provided less assessment of patients (i.e., investigation of levels of nutrition and exercise, and observation of verbal, and non-verbal behavior, and levels of cognition). Regarding the importance of nursing jobs, nursing linked to exercise and activities, and post-operative and excretion care were considered to be less important among novice nurses than among experienced nurses. CONCLUSION: Different training programs should be developed and provided to nurses according to levels of work experience. By doing so, it will be feasible to minimize differences in quality of nursing care triggered by different levels of work experience.

Effects and Development of Clinical Competency Evaluation using Standardized Patients among Nursing Students: Based on Abdominal Surgical Patients / 성인간호학회지

PURPOSE: This study was to develop the clinical competency evaluation, and to examine the effects of the developed evaluation by comparing it with existing evaluation on clinical competency, communication skill, and self-efficacy of nursing students. METHODS: Design was a randomized control group post-test design. The subjects were 102 senior nursing students(Experimental group: 48, Control group: 54) at K university in seoul, Korea. The experimental group took the clinical competency evaluation using standardized patients and the control group took the existing evaluation using a doll. The clinical competency and communication skills were measured by evaluators, and self-efficacy was self reported by the nursing students. RESULTS: The experimental group had higher scores in clinical competency, communication skills, and self-efficacy than those in the control group. CONCLUSION: Through these results, practice education of nursing education programs need to activate the clinical competency evaluation using standardized patients.

Comparative Study on Parenting Stress, Guilt, Parenting Attitude, and Parenting Satisfaction Between Mothers with a Hemophilic Child and a Healthy Child / 여성건강간호학회지

PURPOSE: Although Hemophilia is a relatively rare hereditary disease, and is treatable with blood products, the parenting stress and guilt of hemophilic patients and their mothers are always high. This study was done to assess the extent of parenting stress, guilt, parenting attitude and parenting satisfaction of mothers with a hemophilic child. METHOD: The participants in this study were 119 mothers with a hemophilic child who were registered members of the Korea Hemophilia Foundation, and 287 mothers with a healthy child. In order to measure the dimensions related to parenting stress, guilt, parenting attitude and parenting satisfaction, the Questionnaire on Parenting Stress Index, Maternal Guilt Scale, Parenting Attitude Scale & Parenting Satisfaction Scale were administered. We analysed the differences between mothers with a hemophilic child and a healthy child in the questionnaire scores using the SPSS program. RESULT: Parenting stress and guilt of mothers with a hemophilic child were higher than with a healthy child. Parenting attitude and parenting satisfaction of mothers with a hemophilic child were lower than with a healthy child. CONCLUSION: The results may help medical professionals understand mothers with a hemophilic child and give basic assistance to develop a nursing intervention by exploring possible ways to alleviate such parenting stress and guilt.

A Study of Relationship Knowledge, Depression and Quality of Life of Mothers with Hemophilic Children / 여성건강간호학회지

PURPOSE: This study was conducted to survey knowledge, depression, and quality of life of mothers with hemophilic children, and to provide basic data for a health promoting intervention improving their quality of life. METHOD: The subjects of this study were 140 mothers of hemophilic children by convenience sampling. The collected data were processed using SPSS program and analyzed using descriptive statistics, and Pearson correlation. RESULT: The knowledge of mothers with hemophilic children was 2.8 points out of 4 points. The depression of the subjects was 2.1 points out of 4 points. The quality of life of the subjects was 3.2 points out of 5 points. Results also showed a positive relationship between quality of life and knowledge (r=.45, p<.001) and a negatives relationship between quality of life and depression (r=-.41, p<.001). CONCLUSION: Knowledge and depression affect quality of life of mothers with hemophilic children. Therefore, it is necessary to develop a nursing intervention with these variables to increase the quality of life for mothers with hemophilic children.

Turnover Experience of Hospital Nurses in Korea / 성인간호학회지

PURPOSE: The purpose of the study was to explore how hospital nurses decide to quit working as professional nurses using the grounded theory method. METHOD: The data was collected by individual in-depth interviews with 12 hospital nurses who recently resigned from work and it was analyzed using 'constant comparative analysis.' RESULT: The core category that emerged was "in search of new balance with self, work, and family". Three stages were identified: 1) "unconditionally accepting the working situation of itself," 2) "weighing advantages and disadvantages of working as a hospital nurse", and 3) "redesigning a future". Each stage contains three major strategies. The major strategies of the first stage are "maintaining a learning attitude", "enduring physical burnout," and "enduring unfair interpersonal relationships". The second stage contains "identifying advantages of working", "identifying disadvantages of working", and "comparing the advantages with the disadvantages". Lastly, the third stage includes "reassessing the aim of life", "beginning to construct an alternative life", and "deciding to quit working at a certain point". CONCLUSION: The results of the study will help nursing administrators in designing and implementing an effective turnover prevention program for nurses by understanding more deeply the process of turnover phenomenon among hospital nurses.

Psychosocial Adjustment of Young Adult to Hemophilia: Living like a Normal Person / 간호학회지

PURPOSE: To explore how young adults in their 20s adjust to hemophilia. METHOD: Grounded theory method guided the data collection and analysis. A purposeful sample of 15 young adults with hemophilia participated during the period of 2000-2001. The data were collected by semi-structured individual interviews, focus group interviews, and participant observations. All interviews were audio taped and transcribed verbatim. Constant comparative analysis was employed to analyze the data. RESULT: "Living like a normal person" emerged as the basic social-psychological process. Two dimensions of the self were identified: normal self and abnormal self. "Living like a normal person" means conscious effort to focus on normal self rather than abnormal self. Five subcategories were identified : 1) pretending as if he is not hemophiliac; 2) relieving the burden; 3) maintaining best physical conditions; 4) becoming independent; and 5) reconciliating with their mothers. CONCLUSION: The results of this study indicate that young adults with hemophilia strive for living a life as a normal person. But there is a question whether it is good for their ultimate quality of life. The results indicate that our society needs to be more tolerant to differences that hemophiliacs have.

Changes in the Image of the Nurse for Student Nurses before and after their First Clinical Experience / 기본간호학회지

PURPOSE: This study was done to identify changes in the image of the nurse for student nurses before and after their first clinical experience. METHOD: The participants were 108 nursing students who had not had any clinical experience. All participants had their first clinical experience for 1 week, and the image of the nurse was measured before and after the clinical experience. RESULT: 1) Before the first clinical experience, the scores on the image of the nurse that was the highest for the student nurses was in the professional dimension, followed by traditional, personal, and social in that order. After the clinical experience, the score on the image of the nurse was still the highest in the professional dimension, but this time, it was followed by personal, traditional and social dimension in that order. 2) Difference in the image of the nurse before and after the clinical experience showed statistical significance. The factors influencing this change were the degree of satisfaction with their major, whether the students had ever been hospitalized, and the type of wards where they had their clinical experience. CONCLUSION: In summary, the first clinical experience should be ideal in order to promote the image of the nurse. Therefore an improvement in the environment for clinical experience is important.

Effectiveness of Medication Videos as Educational Instruments in the Education of Fundamental Nursing Skills / 기본간호학회지

The effectiveness of dedication video tapes in teaching fundamental nursing skills was investigated using experimental research methodology. Data was collected from 153 students attending fundamental nursing practice classes of two junior colleges and two universities. The subjects were randomly assigned to two groups, one was an experimental group of 74 subjects and the other was a control group of 79 subjects. The in dependent variable was learning type and the dependent variables were the degree of knowledge achievement and nursing skills achievement regarding medication. The research hypotheses of this study were as follows : 1) There will be a significant difference between the experimental group and the control group in the degree of knowledge achievement about medication. 2) There will be a significant difference between the experimental group and the control group in the nursing skills achievement about medication. The data was analyzed with the SPSSWIN program and the t-test, number of subjects and percentiles were then examined. The findings of this study are as follows : 1) There was a significant difference between the experimental group and the control group in the knowledge achievement about medication using P<.05. 2) There was no significant difference between the experimental group and the control group in the nursing skill achievement about medication using P<.05. 3) This study suggests that medication video tapes in the education of fundamental nursing skills are effective for knowledge achievement. As a result, medication video tapes can be effectively utilized for the education of nursing skills regarding medication.

Anesthetic Management for Reconstructive Carotid Surgery Using of Electroencephalography / 대한마취과학회지

A 39 years old, ASA PS I. healthy female patient was scheduled for surgical resection of a paraganglioma surrounding right carotid artery bifurcation area. Anesthesia was induced with thiopental and sucinylcholine and maintained with 0.75-1.25 Vo1% halothane in 50% nitrous oxide in oxygen. Reconstructive carotid artery surgery with intraluminal shunt was performed due to laceration of carotid artery bifurcation area during wide dissection of tumor mass. Duration of the carotid artery clamp and release was 35 minutes and any significant changes in vital signs and EEG were not found. Soon after the patient was recovered from anesthesia. She was delivered to recovery room and then she was transferred to intensive care unit. She was discharged from hospital without any neurologic sequelae on the 13th postoperative day.

The Effects of Changes in Acid - Base Balance on Neuromuscular Blockade by Org NC 45 / 대한마취과학회지

The sudden onset of respiratory acidosis or alkalosis due to inadequate ventilation during general inhalation anesthesia may influence the action of neuromuscular blocking agents. In virtro animal studies by Funk et al.(1980) suggested that the neuromuscular blocking action of Org NC 45(NC) was minimally depressed above pH 7.68 and significantly potentiated under acidotic conditions(pH 7.05). They proposed that this was the result of an increase in NC metabolism by alkaline hydrolysis in the alkalotic state and greater molecular stability during acidosis. This study was performed to determine the effects of the neuromuscular blocking action of NC during respiratory acidosis and alkalosis. The patients were divided in to 3 groups: 1, ll & lll and experienced normocarbia, hypocarbia and hypercarbia, respectively. Hypocarbia was induced by hyperventilation and hypercarbia by adjustment of a rebreathing valve in the CO2 absorber in the semiclosed system. Simultaneously, arterial blood samples were collected from radial arteries for arterial blood gas analysis including pH and pCO2. Following the administration of succinylcholine(SCC) and the recovery of a 75% twitch height, ED95 of NC was given to the patient and the results were recorded by an evoked electromyograph (NMT, Datex). The results are follows: 1) The number of patients in groups l, ll and lll were 22, 13 and 8, respectively. The patients in each group were evenly distributed with respect to age, body weight and anesthesia. 2) The end-tidal CO2 tension in group l, ll and lll group was 38.86+/-4.62, 20.23+/-2.42 and 52.00+/-4.86mmHg, and the arterial pCO2(pH) was 37.36+/-5.71(7.461+/-0.054), 23.00+/-1.51(7.649+/-0.032) and 53.29+3.35 mmHg(7.314+/-0.026), resptectively. The end-tidal CO2 tension, arterial CO2 tension and pH in group ll and lll were significantly different from those of group l(p<0.05). 3) The onset time of SCC in group ll and lll was shorter than that in group l (p<0.05), but within 1 min in all groups. The duration of SCC in group lll(19.56+/-6.15min) was longer than that in group l (14.74+/-4.56min) (p<0.05). 4) Although there was no significant difference among the groups with respect to onset time and duration, the recovery index in group ll(10.29+/-2.21min) was significantly different from group l and lll(14.76+/-5.26 and 13.50+/-13.67 min, respectively) (p<0.05). After administration of NC in 5 min intervals, twitch tension was measured and the results were inserted into a regression equation which emphasized the delayed recovery in group lll(r=0.87). In conclusion, the recovery index in alkalosis shortened and the initial twitch tension in acidosis following NC administration was delayed compared to that in normocapnis and alkalosis. Patients with alkalosis may require more frequent doses of NC and continuous monitoring following repeated or continuous infusion in acidosis.

A Clinical Study of Endotracheal Intubation in Infants / 대한마취과학회지

The relationship between the adequate endotracheal tube size, depth of tube fixation and incisor canina distance according to age(month) and body weight(kilogram) was studied in 148 infants. Intubation was proceeded by injection of thiopental sodium 4mg/kg and succinylcholine 1.5mg/kg in infants older than two months, whereas conscious intubation was used for infants less than two months of age. The relation coefficiency between tube size and body weight(0.83) was greater than that of age(0.76). The relation coefficiency between the depth of tube fixation and body weight(0.83) was greater than that of age(0.75) or tube size(0.77). The relation coefficiency between incisor carina distance and body weight(0.87) was greater than that of age(0.78) or tube size(0.80). Endobroncheal intubation was tried intentionally to evaluate the incidence of left broncheal intubation. Only one infant among 148 exhibited left broncheal intubation. This baby was full term, weighed 2.6kg with gastroschisis. With the above results we assume that body weight is the most important determinant factor for adequate tube size, depth of tube fixation and incisor carina distance. Attention should be paied to unintentional left broncheal intubation in infants less than one month old especially in low birth weight babies.

Application of HFJV in Tracheal Stenosis / 대한마취과학회지

Due to the increased use of tracheostomy and intermittent positive pressure ventilation, patients with trscheal stenosis have become more frequent. Recently we experienced a patient with tracheal stenosis who was tracheostomized upon admission, but unfortunately the stenotic lesion was located below the end of the tracheostomy tube. The stenotic lesion was l.6cm above the carina, its diameter was 0.5 cm, and the length of the stenotic segment was about 2cm, A3,5 mm(I.D.) endotracheal tube was passed through the stenotic lesion via the tracheostomy site, and high frequency jet ventilation was applied with a swivel connector. Immediately after the start of surgery, CO2retention occurred and the driving gas pressure increased from 4p to 5p psi, the I:E ratio from 1:2 to 1: 3, but the respiration rate (100 bpm) was maintained as before. CO2retention was relieved soon. Following end to end anastomosis a 6. 0 mm(I.D.) cuffed endotracheal tube was intubated orally and inhalation anesthesia using N2O-O2-Halothane was maintained until the surgery was completed.

Estimation of Fentanyl Concentrations Based on a Pharmacokinetic Model / 대한마취과학회지

Anesthetic doses of fentanyl are sometimes determined empirically by repetetive doses which are accompanied by fluctuating concentrations. If a constant plasma concentration can be maintained the analgesis and anesthesia can be guaranteed for the duration of surgery. After an I.V. bolus injection (3mcg/kg), fentanyl (2mcg/kg/kr) was continuously infused for an average length of time of 78.3minutes in a manner analogous to the safety of the administration of inhalation anesthetics. To evaluate whether this method is applicable to the clinical situation, the decay of plasma fentanyl with time was simulated based on a population pharmacokinetic model used to predict estimated concentrations in the plasma. The clinical effect of the concentrations was determined by a scoring system which consisted of 4 components, systolic blood pressure, heart rate, sweat production and lacrimation. Using a modified computer program, the mean and 68% confidence interval of the estimated fentanyl plasma concentration (peak concentration 8.5~6.8 mcg/I, maintenance concentration 1.3~0.8 mcg/I, 10 minutes after discontinuation of infusion 0.9~0.5 mcg/I and elimination half-life 267+/-15.7 minutes) were predicted, while the clinical scores were maintained under 4 points. The pharmacokinetic model based on estimation proved to be effective and valid for all patients and predicted a steady target concentration of fentanyl in the plasma.

The Effect of CSF Changes on the Action of Local Anesthetics in Pregnant Woman / 대한마취과학회지

Spinal fluid(CSF) was analyzed in ten pregnant women at term undergoing C-section with spinal anesthesia and in ten non-pregnant women undergoing gynecological operation with spinal anesthesia. The acid-base status, protein and sugar levels in the CSF of the CSF are summarized in Table-2 and Table-3. The pH was slightly higher in the pregnant group compared to that of the non-pregnant controls. The bicarbonate level and the total CO2 content were significantly lower in the pregnant group compared to non-pregnant controls. The protein and sugar level were lower in the pregnant group compared to non-pregnant controls. Acid base changes can markedly affect dissociation of the local anesthetics. More free base will be available for transfer across lipid barriers in a relatively more alkalotic medium which was found in spinal fluid of pregnant women. In addition, lower bicarbonate levels may also affect dissociation of local anesthetic and activity by changing the buffering capacity. In conclusion, our results show that pregnancy induces significant changes in the acid base balance of the spinal fluid. These changes may contribute to the facilitated spread of local anesthetics in both the epidural and subarachnoid spaces.

Clinical Experience with Bain Cireuit System / 대한마취과학회지

The Bain circuit system was first used by Bain and Spoerel in 1972. It is a type of nonrebreathing system which is a variation of the Mapleson D or E system. Its total length, diameter of the inner tube and diameter of the outer tube are 1.8m, 7mm and 22 mm respectively. It's CO2 retension and fresh gas flow requirements were already studied by Bain in 1972. This study suggested that most patients were maintained in normocarbia when fresh gas inflow of 70 ml/kg was used under controlled ventilation. This was confirmed by Henville and Adams in 1976. If the respiratory depression did not .appear, normocarbia could be maintained with the same fresh gas inflow under spontaneous ventilation. The authors performed this study using the same fresh gas inflow in order to understand he problem of fresh gas requirement and CO2 retension under controlled and spontaneous ventilation. The results of our study showed that the CO2, retension was not seen in both groups and complications were not seen during the operation and postoperative period. The Bain circuit system was used satisfactorily at all age groups using low fresh gas flow. Especially in neurosurgery and obstetric anesthesia for maintaining a normal range of PaCO2, the Bain circuit system may be valuable.

Continuous Epidural Anesthesia for Transurethral Resection and Postoperative Pain Control / 대한마취과학회지

Thirty consecutive anesthesia records of transurethral resection (TUR) have been reviewed. Patient's physical status, anesthetic management and complications were also discussed. Operations in this series were classified as follows: 25 cases of TUR for carcinoma of the prostate, 3 cases of bladder tumor. In all the thirty cases of TUR, circulatory diseases, such as hypertension were encountered most frequently. (10 cases) The patients had the highest mean age(66.5 years old) and their physical status was almost all ASA class II or III. Hypotension occurred in 1 patient during TURP. There was no death associated with anesthesia and operation in this study. Pain control after operation with epidural block was satisfactory in nearly all cases. Continuous epidural anesthesia for TUR and pain control after operation was desirable.