Effects of a Mobilization Program Applied to Bariatric Surgery Patients on Preventing Gastrointestinal Complications: a Quasi-Experimental Study.

PURPOSE: To investigate the effects of a planned early targeted mobilization program applied to patients that underwent bariatric surgery with the laparoscopic sleeve gastrectomy method on gastrointestinal complications (nausea-vomiting, abdominal distention, delayed flatus-defecation, and intolerance of early oral intake). MATERIALS AND METHODS: This prospective, controlled group, quasi-experimental design study was conducted between July 2019 and March 2020 in the general surgery clinic of a training and research hospital with 70 patients who underwent sleeve gastrectomy and met the inclusion criteria. The prepared mobilization program was applied to the patients on the 0th, 1st, and 2nd postoperative days, and the gastrointestinal functions of the patients were monitored. RESULTS: The intervention group had a significantly shorter time to first flatus, defecation, and oral intake; higher frequency of defecation; lower pain, abdominal distention, and nausea; better tolerance of oral intake; and higher total oral intake compared to the control group (p < 0.05). CONCLUSION: Planned, early, and targeted mobilization was determined to be a feasible, safe, and cost-effective nursing intervention to prevent gastrointestinal complications in patients undergoing sleeve gastrectomy.

Effect of Protective Padding in Pneumatic Tourniquet Applications on the Prevention of Skin Complications.

The use of pneumatic tourniquets in orthopaedic surgery has become essential as they create a bloodless surgical field in lower and upper limb applications and allow the anatomical structures to be better visualized. This aim of this study, which was conducted on 60 patients, was to determine the effect of protective padding on preventing skin complications in pneumatic tourniquet applications. Patients were divided into 3 groups of cotton-cast padding, protection sleeve, or no/without protective padding underneath the tourniquet cuff. Mean values were as follows: age: 27.7 ± 6.9 years, tourniquet pressure: 307.5 ± 31.7 mmHg, and tourniquet duration: 87.8 ± 15.3 minutes. There was a significant difference between the groups in terms of the rate of skin complications (p < .05) immediately after survey, 30 minutes after surgery, and 180 minutes after surgery. Protective padding underneath pneumatic tourniquet cuff can be recommended during anterior cruciate ligament reconstruction.

The Effect of Reflexology on Low Back Pain in Operating Room Nurses.

Operating room nurses often face acute or chronic back and low back pains, shoulder and neck injuries. In recent years, the use of complementary and alternative treatment methods has been increasing due to the fact that pharmacological treatment cannot control the pain in general, and its various side effects and cost. The aim of this study was to investigate the effect of foot reflexology on low back pain of operating room nurses. This quasiexperimental study was conducted with 38 operating room nurses. The nurses in the experimental group were given a 30-minute reflexology protocol once a week for 4 weeks and their pain levels were assessed again at week 5. The control group nurses did not receive any intervention. Data were collected using a demographic information form and a visual analog scale (VAS). The low back pain of the nurses in the reflexology group decreased significantly at week 5 compared with week 1, whereas the severity of low back pain of the nurses in the control group did not change between weeks 1 and 5. There were no statistically significant differences between the groups in terms of the mean VAS pain score at week 1. However, the nurses in the reflexology group had significantly lower VAS pain mean scores at week 5 than the control group. In this study, reflexology significantly reduced the pain of nurses who had low back pain. Therefore, reflexology might be useful in controlling low back pain of operating room nurses.

Evaluation of Nursing Care Satisfaction of Patients Who Underwent Open Heart Surgery.

AIM: This study aimed to determine the nursing services satisfaction level of patients who underwent open heart surgery. METHOD: One hundred forty patients who were hospitalized for at least 2 days between the dates 20 November 2013 and 20 January 2014 in the cardiovascular clinics of three different public hospitals were included in this descriptive research. To collect data, a survey of 13 questions about individuals' sociodemographic and informative features and the Newcastle Satisfaction with Nursing Scale that consists of 19 clauses was used. The data were analyzed using the statistical tests of number, percentage, average, standard deviation, minimum, maximum, Mann-Whitney U-test for two groups, Kruskal-Wallis for more than two groups, chi-square and chi-square trend for comparison of categorical variables. RESULTS: The nursing care satisfaction level of patients who underwent an open heart surgery was determined to be high at the rate of 77.77 ± 15.93. Satisfaction status of the patients included in the study was comparatively analyzed with age, sex, marital status, level of income, health insurance, level of education, employment status, number of hospitalization, and length of hospitalization. Results indicate that variables did not have any effect on satisfaction scores. CONCLUSION: The nursing services satisfaction level of patients who underwent open heart surgery was determined to be high.

Experiences of Women After Breast Cancer Surgery.

AIM: This study was carried out to determine the experiences women go through after breast cancer surgery. METHOD: The research was planned by using qualitative method of phenomenological type The sampling of this study consisted of 20 women with breast cancer who had undergone mastectomy in the general surgery clinic of a university hospital between January 2013 and December 2013. In sampling selection, purposeful sampling method was adopted. Women who were literate, able to communicate, willing to participate in the research, and those who had undergone mastectomy between six months and five years ago with no history of psychiatric illnesses were selected in sampling. Face-to-face interview technique was used to gather research data. The interview data were deciphered by the researcher and content analysis was done by using the N-Vivo7 program. RESULTS: Women participating in the study had an average age of 41.1±7.3 years, 90% (n=18) were married, 55% (n=11) were primary school graduates, they all have children, 80% (n=16) had their first child between 20 and 30 years of age, they all breastfeed their children (n=20) breastfed their children, 90% (n=18) had their first menstruation between 12 and 14 years of age, 65% (n=13) had regular menstruation cycles, and 70% (n=14) did not use contraceptive pills. In qualitative findings, themes of first reaction regarding diagnosis, deterioration of body image, deterioration of sexual life, fear, and ways to cope with illness were defined. CONCLUSION: It was determined that breast cancer affects women substantially psychologically; and therefore, providing psychological support before and after surgeries is advised.

Effects of nurse-led clinical pathway in coronary artery bypass graft surgery: A quasi-experimental study.

AIMS AND OBJECTIVES: To develop and evaluate the effects of a nurse-led clinical pathway for patients undergoing coronary artery bypass graft surgery. BACKGROUND: A clinical pathway is a multidisciplinary care plan, based on evidence and guidelines to provide consistent, quality care to patients and improve outcomes. DESIGN: Prospective, quasi-experimental design. METHODS: Patients hospitalised for coronary artery bypass graft between April 2014-November 2015 in a hospital in Turkey were studied. First 42 usual care patients were enrolled to determine outcomes and plan for the development of the clinical pathway followed by 40 patients in the newly developed clinical pathway. The primary outcome was length of stay and secondary outcomes related to recovery from surgery (e.g., time to extubation, first feeding). RESULTS: The mean age for the clinical pathway group was 60 and for usual care was 63 years. Most were male (CP = 78%, UC = 69%). There were significant differences between groups for the primary outcome. Length of stay in the intensive care unit was 38.9 hr for CP and 50.7 hr for usual care patients p < .01. Total hospital time was 144.4 hr for clinical pathway and 162.2 hr for usual care, p < .05. For secondary measures, the following times were less for the clinical pathway group than for the usual care: time to extubation and nasogastric tube removal (5.7 vs. 8.6 hr, p < .01), first oral feeding (4.7 vs. 10.9 hr, p < .001), first mobilisation (8.4 vs. 22.9 hr, p < .001) and first bowel movement (69.8 vs. 85.9 hr, p < .01). There were no statistically significant differences in the 3-month readmission rates and complication rates between the groups, except the renal complication rates were higher in the usual care (n = 16, 38%) than in the clinical pathway (n = 7, 17.5%) (p < .05). CONCLUSION: The nurse-led clinical pathway was effective in improving length of stay in both the ICU and hospital as well as the secondary outcomes. RELEVANCE TO CLINICAL PRACTICE: This study contributes to previous studies supporting clinical pathway use can improve the length of stay and quality of care in patients undergoing coronary artery bypass graft surgery.

The effect of mirror therapy on the management of phantom limb pain.

OBJECTIVES: In the last two decades, mirror therapy has become a frequently used method of managing phantom limb pain (PLP). However, the role of nurses in mirror therapy has not yet been well defined. This study examined the effect of mirror therapy on the management of PLP, and discusses the importance of mirror therapy in the nursing care of amputee patients. METHODS: This quasi-experimental study was conducted in the pain management department of a university hospital and a prosthesis clinic in Istanbul, Turkey, with 15 amputee patients who had PLP. Forty minutes of practical mirror therapy training was given to the patients and they were asked to practice at home for 4 weeks. Patients were asked to record the severity of their PLP before and after the therapy each day using 0-10 Numeric Pain Intensity Scale. RESULTS: Mirror therapy practiced for 4 weeks provided a significant decrease in severity of PLP. There was no significant relationship between the effect of mirror therapy and demographic, amputation or PLP-related characteristics. Patients who were not using prosthesis had greater benefit from mirror therapy. CONCLUSION: Mirror therapy can be used as an adjunct to medical and surgical treatment of PLP. It is a method that patients can practice independently, enhancing self-control over phantom pain. As mirror therapy is a safe, economical, and easy-to-use treatment method, it should be considered in the nursing care plan for patients with PLP.

Foot massage: effectiveness on postoperative pain in breast surgery patients.

The aim of this study was to determine the effect of foot massage on pain after breast surgery, and provide guidance for nurses in nonpharmacologic interventions for pain relief. This was a quasiexperimental study with a total of 70 patients who had undergone breast surgery (35 in the experimental group and 35 in the control group). Patients in the control group received only analgesic treatment, whereas those in the experimental group received foot massage in addition to analgesic treatment. Patients received the first dose of analgesics during surgery. As soon as patients came from the operating room, they were evaluated for pain severity. Patients whose pain severity scored ≥4 according to the Short-Form McGill Pain Questionnaire were accepted into the study. In the experimental group, pain and vital signs (arterial blood pressure, pulse, and respiration) were evaluated before foot massage at the time patients complained about pain (time 0) and then 5, 30, 60, 90, and 120 minutes after foot massage. In the control group, pain and vital signs were also evaluated when the patients complained about pain (time 0) and again at 5, 30, 60, 90, and 120 minutes, in sync with the times when foot massage was completed in the experimental group. A patient information form was used to collect descriptive characteristics data of the patients, and the Short-Form McGill Pain Questionnaire was used to determine pain severity. Data were analyzed for frequencies, mean, standard deviation, chi-square, Student t, Pillai trace, and Bonferroni test. The results of the statistical analyses showed that patients in the experimental group experienced significantly less pain (p ≤ .001). Especially notable, patients in the experimental group showed a decrease in all vital signs 5 minutes after foot massage, but patients in the control group showed increases in vital signs except for heart rate at 5 minutes. The data obtained showed that foot massage in breast surgery patients was effective in postoperative pain management.

Nurses' sociodemographic background and assessments of individualized care.

AIM: The aim of this study was to explore the association between nurses' characteristics (educational level, country, work title, gender, type of work, age, and length of working experience) and their assessments of individualized care. DESIGN: A cross-sectional comparative survey using questionnaires was employed to sample nurses from seven countries. METHODS: Data were collected from orthopedic and trauma nurses from Cyprus, Finland, Greece, Portugal, Sweden, Turkey, and the United States (N= 1,163, response rate 70%) using the Individualized Care Scale-Nurse (ICS-Nurse) and a sociodemographic questionnaire in 2008. Data were analyzed using descriptive statistics and general linear models. RESULTS: When compared with practical nurses, registered nurses, length of working experience, and the country of the nurses were associated with assessments of the support of patient individuality in specific nursing activities (ICS-A-Nurse) and country assessments of individuality in the care provided (ICS-B-Nurse). The background and experience within nursing teams together with the country affect the delivery of individualized care. CONCLUSIONS: Overall, our findings suggest that nurses' personal attributes have important effects on their assessments of individualized nursing care that will be useful when making context-dependent recruitment decisions. CLINICAL RELEVANCE: The characteristics of nurses contribute to the care delivered in healthcare organizations. Recognition of these nurse-related factors may help nurse leaders in the development and management of clinical practice.

A seven country comparison of nurses' perceptions of their professional practice environment.

Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D. & Suhonen R. (2011) Journal of Nursing Management A seven country comparison of nurses' perceptions of their professional practice environment Aims To describe and compare nurses' perceptions of their professional practice environment in seven countries. Background There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses' ability to perform and are linked to differing nurse and patient outcomes. Methods A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions Although between-country differences in nurses' professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management The results support investment to improve nurse's work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.

Nurses' perceptions of individualized care: an international comparison.

AIM: This paper is a report of a study of internationally-based differences in nurses' perceptions of individualized care in orthopaedic surgical in-patient wards. BACKGROUND: Individualized care is valued in healthcare policy, practice and ethical statements as an indicator of care quality. However, nurses' assessments of individualized care are limited and comparative cross-cultural studies on individualized nursing care are lacking. METHODS: A descriptive comparative survey was used to sample orthopaedic surgical nurses (n = 1163) working in 91 inpatient wards in 34 acute hospitals in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and the United States of America. Data were collected between March and November 2009 using the Individualized Care Scale-Nurse and analysed using descriptive and inferential statistics. RESULTS: Nurses in different countries perceived that they supported patients' individuality generally and provided individualized care during nursing activities. Although the highest scores were in support of patients' individuality in the clinical situation both through nursing provision and nurses' perceptions of individuality, there were between-country differences within these scores. Generally, the Greek and American nurses gave the highest scores and the Turkish, Cypriot and Portuguese nurses the lowest. CONCLUSIONS: Between-country differences found may be attributed to differing roles of nurses, care processes, healthcare systems and/or the ways nursing care is defined and organized. As this was the first time the Individualized Care Scale-Nurse was used in an international context, the results are formative and indicate the need to continue studies in this area.

Reasons for nursing telephone counseling from individuals discharged in the early postoperative period after breast surgery.

UNLABELLED: The aim of this study was to determine the rate of and causes of asking for telephone counseling in patients undergoing modified radical mastectomy (MRM) and breast-conserving surgery (BCS), and discharged one night after surgery. METHOD: This is a randomized descriptive study. This study was conducted on surgery service of a university hospital in Istanbul, Turkey, with MRM and BCS patients. This study sample included 174 patients. Inclusion criteria were staying in hospital for one night and being discharged, ability to talk on the phone, and being a candidate for MRM or BCS. Data were collected on a form that was developed by the researcher after consultation with experts, reviewing THE related literature, and clinical observations. The patients were given two mobile telephone (for two of the researchers) and home telephone number (for two of the researchers) that had an answering machine and were encouraged to call or leave a message for health problems they experienced at home. RESULTS: A higher rate of the patients undergoing mastectomy asked for telephone counseling. The rate of the women asking for telephone counseling was very high within the first 6 weeks of discharge. The leading causes of asking for telephone counseling were wound problems, arm exercises, and difficulties in adapting to daily living activities. The women also had a psychological problem: fear of inability to recover. CONCLUSIONS: The study found that home follow-up of patients undergoing mastectomy was particularly important.

Comparison of complications and procedural activities of pulmonary artery catheter removal by critical care nurses versus medical doctors.

BACKGROUND: None of the nursing studies on PA catheter removal pointed out any differences in complications after removal and procedural activities for removal of PA catheter by CCNs vs MDs in Turkey. AIMS: This quasi-experimental study was conducted to determine the occurrence and type of complications and to indicate the differences between CCNs and medical doctors' (MDs) activities for removal of PA catheter. METHODS: Totally, 60 critical care unit patients were scheduled as a sample, and they were assigned randomly to the CCN (n = 30) or to the MD (n = 30) groups. For the comparison purposes of the different activities and complications of PA catheter removal procedure between the two groups, 'Instruction Form' was followed step by step. The differences in the prevalence of variables were tested using Student's t statistics. For categorical data, Fisher's exact test was used. Significance was declared by P value of <0.05. RESULTS: Preprocedural activities like patient positioning (P < 0.001) and instructing the patient for breathing (P = 0.001) demonstrated statistically significant differences between the two groups. The PA catheters were removed properly in both groups (P > 0.05). The majority of postprocedural activities were completed successfully. The complications of the catheter removal were documented more carefully by nurses compared with doctors (P < 0.01). Additionally, singular premature ventricular complexes were observed on electrocardiogram in both groups (P > 0.05). CONCLUSION: Instructing CCNs to remove a PA catheter has been highlighted in keeping the number of complications associated with removal procedure of PA catheter.

A current conflict: use of isotonic sodium chloride solution on endotracheal suctioning in critically ill patients.

The use of isotonic sodium chloride on endotracheal suctioning is still commonly performed in intensive care units (ICUs). According to the studies, isotonic sodium chloride instillation may decrease oxygen saturation, increased intracranial pressure, arterial blood pressure, and cause cardiac dysrhythmias, cardiac arrest, respiratory arrest, and nosocomial infection. Endotracheal suctioning should not be used as a routine or standard clinical practice because of these negative effects. This article reviews effects of isotonic sodium chloride solution before endotracheal suctioning of mechanically ventilated patients.