The effectiveness of metacognitive training on impairments in social cognition in patients with schizophrenia: mental health nursing practice in a community mental health center.

BACKGROUND: Social cognition is an independent structure from the positive symptoms of schizophrenia and contributes to negative symptoms, neurocognitive impairment, and social functioning. AIM: To examine the effectiveness of the metacognitive training intervention on social cognition in people with schizophrenia. DESIGN: This study was conducted as a randomized quasi-experimental (pre-test/post-test and follow-up) design with a control group. METHODS: Thirty-nine patients with schizophrenia were enrolled and randomly assigned to either the control group (n = 19) or the metacognitive training group (n = 20). A 10-week metacognitive training program was offered to the intervention group. The study involved a pre-test/post-test design with a 3-month follow-up assessment. The primary outcome was social cognition, as measured by the Facial Emotion Discrimination/Identification Tests, Reading the Mind in the Eyes Test, and Attributional Style Questionnaire. The secondary outcome was measured by the metacognitive training subjective efficacy form. RESULTS: Completion at follow-up was high (92.3%). The results show that the changes over time in the False Belief Task 1st level, Attributional Style Questionnaire negative events global-specific dimension, and positive events stable-unstable dimension mean scores, time interaction, were statistically significant. Metacognitive Training was efficacious on the theory of mind and in performing more functional attributions. Patients in the intervention group showed high-level positive feedback. CONCLUSION: Metacognitive Training applied by psychiatric and mental health nurses demonstrated a user and practitioner-friendly, safe and effective program on social cognition. Also, the social and cultural feasibility and effectiveness of the Metacognitive Training program were shown for the first time in a Turkish population.

An examination of effects of intimate partner violence on children: A cross-sectional study conducted in a paediatric emergency unit in Turkey.

BACKGROUND: Intimate partner violence (IPV) against women causes inadequate and unbalanced nutrition in children aged 0-5 years and adversely affects their growth. AIM: To examine the impact of intimate partner violence on a child's growth regarding the medical diagnosis in paediatric patients under 5 years of age, growth of the child, and the mother's exposure to intimate partner violence. METHODS: This descriptive cross-sectional study included 166 children admitted to a paediatric emergency department, and their mothers. RESULTS: Women exposed to emotional violence and controlling behaviour during pregnancy had children prone to being overweight and obese. A mothers lifetime exposure to physical violence had an adverse effect on their children's wasting and moderate wasting. In contrast, mothers' exposure to emotional violence had a direct impact on a child's wasting and moderate wasting. CONCLUSION: The lifetime effect of domestic violence may begin at birth. This vulnerability leads to negative outcomes in both children and women regarding biopsychosocial development. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses and midwives in primary health care services and one-on-one care should be trained to evaluate prospective mothers and children aged 0-5 regarding violence and its effects on the child's growth.

A retrospective examination of the content of violence in headlines of news related to individuals with mental disorders.

BACKGROUND: Headlines are usually read first. Since headlines are designed to be remarkable and memorable in terms of form and meaning, their impact on the positive or negative attitudes of the society towards individuals with mental illness may be greater than the news texts. AIMS: This study aimed to retrospectively examine and analyze the content of violence headlines related to people with mental disorders. METHOD: The study was designed to examine headlines retrospectively. Six-hundred-ten headlines on the websites of four nationally published newspapers in Turkey were reviewed. Headlines mentioned people with mental disorders and violent events. The News Headline Review Form was used to evaluate the headlines. Descriptive statistics, the chi-square test and logistic regression analysis were used in data analysis. RESULTS: It was determined that violent events in headlines were mostly associated with homicidal behaviors (72%; n = 439), self-harming behaviors (20.2%; n = 123) and exploitation by others (7.8%; n = 40), respectively. The most common actions in headlines were, within the homicidal behaviors, "murder" (30.4%; n = 186); within the self-harming behaviors, "commit suicide" (13.6%; n = 83) and within the exploitation-by-others category, "being murdered" (4.4%; n = 27). People with mental disorders were in an active position in three fourths of the headlines on violence/aggression (77.3%; n = 471). CONCLUSION: Headlines have the effect of normalizing the relationship between violence and mental disorders, which already exists in society. Portraying violence as a typical part of a mental disorder could create social perceptions that it is the nature of these individuals to exhibit violent behavior.

Evaluation of the Effectiveness of Psychoeducation Given to Children with Parental Psychiatric Disorders.

This study was aimed to determine the effectiveness of psychoeducation program which was developed to improve the coping skills and to increase the psychological resistance of 12-18 years children/adolescents whose parents' have psychiatric disorders. The study was carried out between May 2018 - November 2019 with children of patients who applied to the outpatient clinic and inpatient treatment at Istanbul University - Cerrahpasa, Cerrahpasa Faculty of Medicine Department of Psychiatry. Total of 40 children (experiment = 20 and control = 20), participated in the study. Data were collected using Personal Information Form, Adolescent Psychological Resilience Scale and Kidcope. The mean age of the children/adolescents in the experimental group was 14.05 ± 1.90, 50% was male and the mean age of the control group was 15.35 ± 2.08, and 55% were male. It was determined that the mean duration of psychiatric disorders were 11.50 ± 6.39 years and 40% of the psychiatric diagnosis was schizophrenia in the experimental group, and the mean duration psychiatric disorders were 6.10 ± 5.16 years and 30% of the psychiatric diagnosis was a depression in the control group. After psychoeducation, the total scores of scales in the experimental group showed an increase compared to the control group and a significant difference in a statistical context. It was found that children/adolescents participating in the psychoeducation program had increased psychological resilience levels and improved coping skills. This result shows that the psychoeducation program for children/adolescents with psychiatric disorders in their parents is effective.

Risk predictions of physical aggression in acute psychiatric wards: Findings of a prospective study.

This study was conducted using prospective methods to analyze predictions of the risk of physical aggression from patients with a mental illness and the variables used in these predictions. A total of 252 individuals participated in the study, all of whom were inpatients in acute psychiatric wards. Data were collected using a questionnaire consisting of two questions designed to determine the nature of predictions of the risk of physical aggression from mental health patients at admission and the variables used to make these predictions. Descriptive statistics and χ2 -tests were used for the data analysis. For approximately two thirds of the patients (61.9%, n = 156), a low-level risk was predicted. The rate of patients predicted to demonstrate physical aggression was significantly higher. Nurses were better able to predict non-aggressive behavior than risks of aggressive behavior. To improve the accuracy of predicting which patients with a mental illness will show aggressive behavior, a risk assessment should be conducted during hospitalization. Using a person-centered approach, administrators in psychiatric settings should adopt an integrative perspective, considering individual and environmental factors, via a multi-disciplinary approach.

Physical Healthcare of People with Serious Mental Illness: A Cross-Sectional Study of Nurses' Involvement, Views, and Current Practices.

Background: Based on the poor physical health and unhealthy lifestyle behaviors, people with serious mental illness (SMI) have a high risk for long-term disorders such as diabetes, cardiovascular and respiratory diseases. Aims: This study examined nurses' current practices and views regarding the physical health of people with SMI. Methods: Cross-sectional study was conducted among nurses working in acute wards in large mental health hospital in Istanbul, Turkey. Convenience sample of 184 nurses agreed to participate in the study. Data collection was based on the self-reported responses. Descriptive statistics and comparison tests were used to describe the sample's characteristics and identify associations amongst the participants' characteristics. Findings: The results showed that nurses considered the patients' physical health important, particularly female nurses. Monitoring blood pressure, assessing physical health status at admission, and helping self-care needs were common practices. Believing in the importance of physical health was correlated with high knowledge and self-confidence levels in delivery of physical healthcare. Discussion: These findings are useful for implementing integrated nursing care in acute psychiatric care and improving patients' mental and physical well-being.

The relationship between attachment styles and childhood trauma: a transgenerational perspective - a controlled study of patients with psychiatric disorders.

AIMS AND OBJECTIVES: This study had two aims. The first aim was to compare attachment styles and traumatic childhood experiences of women with psychiatric disorders and their children to a control group. The second aim was to determine the relationship between attachment styles and traumatic childhood experiences both in mothers and their children. BACKGROUND: According to attachment theories, trauma in an early relationship initiates a developmental cascade in which insecure attachments may occur. DESIGN: A cross-sectional, descriptive study which, employed a case-control design, was performed between May 2013-March 2014. METHODS: This study was conducted in 63 women with psychiatric disorders and their children. The control group consisted of 63 women without any psychiatric disorders and their children. Data were collected using questionnaire forms, including the Adult Attachment Style Scale and the Childhood Trauma Questionnaire for both mothers and children. Descriptive statistics, a Pearson correlation and comparative statistics were used to analyse data. RESULTS: The childhood trauma scores of both the women with psychiatric disorders and their children were higher than the control group scores. Compared to the control group, the mothers with psychiatric disorders and their children were found to have less secure attachment styles. It was determined that the mothers and children with insecure attachment were more likely to have been abused. CONCLUSION: These results point to a relationship between trauma in childhood and attachment style. They also suggest that this relationship may undergo intergenerational transfer. RELEVANCE TO CLINICAL PRACTICE: This study contributes to the existing literature on the relationship between childhood traumas and attachment. Psychiatric nurses should focus not only on psychiatric disorders but also on the difficulties a patient faces regarding being a parent.

Student nurses' perceptions of aggression: An exploratory study of defensive styles, aggression experiences, and demographic factors.

Throughout the clinical learning process, nursing students' perception of aggression might have implications in terms of their future professional behavior toward patients. Using a descriptive cross-sectional design, we investigated the relationships between student nurses' perceptions of aggression and their personal characteristics, defense styles, and a convenience sample of 1539 experiences of aggressive behavior in clinical practice. Information about the students' personal features, their clinical practice, and experiences of aggressive behavior was obtained by questionnaire. The Turkish version of the Perception of Aggression Scale and Defense Styles Questionnaire-40 were also used. Students were frequently exposed to verbal aggression from patients and their relatives. And perceived patient aggression negatively, perception of aggression were associated with sex, defense styles, feelings of safety, and experiences of aggressions during clinical practice. Of interest is the reality that student nurses should be prepared for untoward events during their training.

Nurses' attitudes towards professional containment methods used in psychiatric wards and perceptions of aggression in Turkey.

AIMS AND OBJECTIVE: The aim of this study was to determine nurses' attitudes towards professional containment methods and to explore the relationship between those attitudes and nurses' perception of aggression. BACKGROUND: Different containment methods are used in psychiatric wards when patients behave aggressively towards others or exhibit self-harm. It is known that in addition to patient-specific and environmental influences, many factors related to the staff influence the choice of containment method. One of these factors is the perception of aggression. DESIGN: A cross-sectional descriptive design was used and the sample consisted of 144 nurses who are employed in a psychiatric hospital in Istanbul and who volunteered to participate in the study. METHOD: Data were collected using a questionnaire addressing the socio-demographic and professional features of nurses and using the attitudes to professional containment methods and Perception of Aggression Scale. RESULTS: While pro re nata medication was used commonly, time-out was infrequently used in the wards. Intermittent observation, pro re nata medication and containment in the psychiatric intensive care unit were the most approved methods. The use of net beds was the least approved method. Nurses who perceive aggression as dysfunctional/undesirable are more likely to approve compulsory intramuscular medication and mechanical restraint. CONCLUSION: These results showed that nurses' perception of aggression is an important factor influencing the choice of a professional containment method. RELEVANCE TO CLINICAL PRACTICE: This study might lead to closer critiquing of psychiatric ward nurses' attitudes towards professional containment methods, leading to a decrease in the usage of these methods.

A comparison of spinal anesthesia characteristics following intrathecal bupivacaine or levobupivacaine in lumbar disc surgery.

PURPOSE: While bupivacaine is the most frequently used local anesthetic for spinal anesthesia, use of levobupivacaine in clinical practice has advanced recently. The aim of our study was to compare the clinical and anesthetic effects of isobaric bupivacaine and isobaric levobupivacaine when administered intrathecally in patients undergoing lumbar disc surgery. METHODS: ASA I-III, 60 patients were enrolled in this study. Only patients with unilateral single-level (L4-5) lumbar disc hernia were selected and operated in each group and all were operated by the same surgeon. Patients were randomized into two groups, as group B (n = 30): 15 mg 0.5% isobaric bupivacaine, or group L (n = 30): 15 mg 0.5% isobaric levobupivacaine received intrathecally. The level of sensory block dermatome, degree of motor block, intraoperative sensory and motor block characteristics, and postoperative recovery times of spinal anesthesia were evaluated. The satisfaction scores of the surgeon and patients, intraoperative hemodynamic changes, intraoperative and postoperative complications were recorded. RESULTS: The maximum level of sensory blockade was significantly higher in the levobupivacaine group (group L 7 ± 1.63, group B 8.6 ± 1.76 thoracic dermatome, p < 0.05). There was no significant difference in the onset time of sensory (group L 6 ± 3 min, group B 9 ± 4 min) and motor (in group L 7 ± 3 min, in group B 10 ± 4 min) blockade (p > 0.05). There was no significant difference between the groups regarding duration of operation (group L 49 ± 7.3 min, group B 52 ± 8.1, p > 0.05). Recovery times of sensory (175 ± 57 min) and motor (216 ± 59 min) blockade were significantly shorter in the levobupivacaine group (p < 0.05). Mobilization was also earlier in the levobupivacaine group (339 ± 90 min, p < 0.05). Patients' satisfaction and intraoperative, postoperative complications were similar between the two groups. CONCLUSIONS: Our results showed that block recovery time was shorter in the levobupivacaine group, this may be a disadvantage for longer operative procedures. But with proper patient selection this can be eliminated. Recovery time was shorter in levobupivacaine group. Therefore, postoperative neurological examination can be done earlier. In addition, early mobilization can be an advantage for postoperative recovery.

Reproductive health in women with serious mental illnesses.

AIMS AND OBJECTIVES: To determine what problems female psychiatric patients have in terms of reproductive health. BACKGROUND: The reproductive health problems faced by female psychiatric patients are matters that have been neglected in the areas of both psychiatry and women's health. This study aims to make a contribution from Turkey to the literature in this neglected field. DESIGN: The study is descriptive and was conducted with 292 female patients treated in an acute inpatient psychiatric ward. METHODS: Data were collected through face-to-face interviews and a questionnaire based on the literature and prepared by the researchers which was designed to determine the kinds of reproductive health issues the patients were experiencing. RESULTS: It was found that compared with healthy women, the distinctive features of the participants in terms of sexuality were more negative; in particular, patients diagnosed with bipolar disorder were more likely to have been forced by their partners to have sex, they had suffered from rape or sexually transmitted diseases, the majority of those who had previous sexual experience had tried to use contraceptives but had been unable to continue using them, they were most likely to choose the method of withdrawal for contraception, their rates of pregnancy and abortion were high, they received less antenatal care, and they were more likely to have smoked during pregnancy. CONCLUSIONS: It was found that female patients with psychiatric disorders had more negative attributes with regard to marriage, sexuality, family planning, maternal characteristics and pregnancy, compared with a corresponding healthy population. RELEVANCE TO CLINICAL PRACTICE: The results of this study may be useful for nurses in the clinical field for calling an attention and raising an awareness of the reproductive health problems of women with psychiatric disorders, taking the necessary preventive measures, and developing damage-reducing strategies.

Student nurses' attitudes towards professional containment methods used in psychiatric wards and perceptions of aggression.

The aim of this study was to determine student nurses' attitudes towards professional containment methods used in psychiatric wards and its relation to their perception of aggression. We employed a cross-sectional descriptive design to evaluate nurses' attitudes. Participants included 120 student nurses who were enrolled in psychiatric nursing during their fourth (final) year of education. The 'Attitude to Containment Measures Questionnaire' and 'The Perception of Aggression Scale' were used for assessments. Student nurses exhibited positive attitudes toward 'intermittent observation', 'Pro re nata Medication' and 'Psychiatric Intensive Care Unit', respectively. The least approved method was 'net bed'. The data showed a negative correlation between approval of 'Intra-Muscular Medication' and 'mechanical restraint' with the perception that aggression was dysfunctional/unacceptable. Student nurses who believed that professional containment methods were effective also perceived aggression as less functional/acceptable. These results emphasize the importance of health care perceptions of aggression towards patients and their experience with containment measures.

Factors and Processes Facilitating Recovery from Coercion in Mental Health Services-A Meta-Ethnography.

BACKGROUND: Being subjected to or witnessing coercive measures in mental health services can have a negative impact on service users, carers and professionals, as they most often are experienced as dehumanising and traumatic. Coercion should be avoided, but when it does happen, it is important to understand how the experience can be processed so that its consequences are managed. METHOD: A systematic review and meta-ethnography was used to synthesise findings from qualitative studies that examined service users', staff's and relatives' experiences of recovery from being exposed to coercive measures in mental health care settings. We identified, extracted and synthesised, across 23 studies, the processes and factors that were interpreted as significant to process the experience. RESULTS: Recovery from coercion is dependent on a complex set of conditions that support a sense of dignity and respect, a feeling of safety and empowerment. Being in a facilitating environment, receiving appropriate information and having consistent reciprocal communication with staff are the means through which these conditions can be achieved. People employ strategies to achieve recovery, both during and after coercion, to minimise its impact and process the experience. CONCLUSIONS: The findings point to the importance of mental health care settings offering recovery-oriented environments and mental health professionals employing recovery-oriented practices, that would empower service users to develop strategies for managing their mental distress as well as their experiences in mental health care in a way that minimises traumatisation and fosters recovery.

Retrospective Investigation of Difficult Airway Cases Encountered in Bursa Uludag˘ University Medical Faculty Operating Room.

OBJECTIVE: Ensuring airway patency and proper management of ventilation by anticipating difficulties that can occur in airway control are vital in preventing anaesthesia-related complications. We aimed to determine the role of preoperative assessment findings in difficult airway management. METHODS: In this study, critical incident records of difficult airway patients between 2010 and 2020 in the operating room of Bursa Uludag˘ University Medical Faculty were retrospectively analysed. A total of 613 patients, whose records were fully accessible, were grouped as paediatric (under 18 years old) and adult (18 years and over). RESULTS: The success rate for maintaining an airway in all patients was 98.7%. Pathological situations which cause difficult airways were head and neck region malignancies in adult patients and congenital syndromes in paediatric patients. Anatomical reasons that cause difficult airway were anterior larynx (31.1%) and short muscular neck (29.7%) in adult patients and small chin (38.0%) in paediatric patients. A significant statistical relationship was found between difficult mask ventilation and increased body mass index, male gender, modified Mallampati class 3-4, and thyromental distance <6 cm (P = .001, P < .001, P < .001, and P < .001, respectively). The correlation of Cormack-Lehane grading with modified Mallampati classification, upper lip bite test, and mouth opening distance was statistically significant (P < .001, P < .001, and P < .001, respectively). CONCLUSION: In male patients with increased body mass index, modified Mallampati test class of 3-4 and thyromental distance of < 6 cm should suggest the possibility of difficult mask ventilation. In modified Mallampati classification and upper lip bite tests, the possibility of difficult laryngoscopy should be considered as class increases and mouth opening distance becomes shorter. Preoperative assessment, including a good history taken from the patient and a complete physical examination, is crucial to provide solutions for difficult airway management.

Contributing factors to aggressive behaviors in high school students in Turkey.

Violence among young people is an important public health topic as a universal problem. One of the recent issues concerning both the media and parents is the aggressive behavior among the high school students in Istanbul and the worldwide. The aim of this study was to investigate the types and rates of aggressive behavior and the contributing factors to this behavior among high school students. Sample was composed of 805 students of 14-18 ages attending five high schools in Istanbul. The most common aggressive behavior among the students was found to be "beating others," 34.5% (n = 278). Past experiences of violence of high school students (direct exposure to violence/witnessing violence/exposure to/witnessing attack with knife/gun) were determined as the most contributing factor to aggressive behavior. The present study investigated the nature of violent behaviors and associations between violent behaviors and contributing factors among high school students from Turkey.

The moderating role of resilience in the relationship between peer pressure and risky behaviors among nursing students.

PURPOSE: To examine the moderating role of resilience in the relationship between peer pressure and risky behaviors among nursing students. DESIGN AND METHODS: A cross-sectional correlational study carried out with 512 students. FINDINGS: The mean age was 20.90 ± 1.66. Of the students, 82.4% were females 99.0% were single, 71.5% had moderate socioeconomic status. While peer pressure directly made an effect on whole subdimensions for risky behaviors (p < 0.001), resilience had an effect on antisocial behavior, dropout, eating habits, and suicidal tendency (p < 0.001). Moderation was supported as the relationship between peer pressure and substance use varied by resilience level (p < 0.001). PRACTICAL IMPLICATIONS: Students with high levels of resilience are less prone to exhibit some risky behaviors based on peer pressure. Resilience-building strategies should be incorporated into the curriculum.

Trauma Recovery Rubric: A Mixed-Method Analysis of Trauma Recovery Pathways in Four Countries.

Research is beginning to examine gender-based violence (GBV) survivors' recovery, but little is known about diverse recovery trajectories or their relationships with other distress and recovery variables. This interdisciplinary, international multisite mixed-method study developed and used the TRR to identify and classify survivors' trauma pathways. This study describes the phases of the initial development of the preliminary TRR (Phase 1), refines and calibrates the TRR (Phase 2), and then integrates the TRR into quantitative data from four countries (Phase 3). Seven recovery pathways with six domains emerged: normalizing, minimizing, consumed/trapped; shutdown or frozen, surviving, seeking and fighting for integration; finding integration/equanimity. Depression scores were related to most recovery domains, and TRR scores had large effect sizes. At the same time, PTSD was not statistically related to TRR scores, but TRR had a medium effect size. Our study found that the TRR can be implemented in diverse cultural settings and promises a reliable cross-cultural tool. The TRR is a survivor-centered, trauma-informed way to understand different survivorship pathways and how different pathways impact health outcomes. Overall, this rubric provides a foundation for future study on differences in survivor healing and the drivers of these differences. This tool can potentially improve survivor care delivery and our understanding of how to meet best the needs of the survivor populations we intend to serve.

Adapting the Geriatric Institutional Assessment Profile for different countries and languages: A multi-language translation and content validation study.

BACKGROUND: Hospitalization can be hazardous for older people, but most hospitals in Europe are not prepared to meet the unique needs of older adult inpatients. Adaptations of the physical environment, care processes, and staff knowledge and skills in geriatric care are essential to improve the quality of care for older people. An assessment of baseline organizational approaches to older adult care is an important first step toward recognizing the challenges organizations face when delivering acute care services to older adults and attempting to improve them. The Geriatric Institutional Assessment Profile could be a promising tool for this endeavor. OBJECTIVES: To describe a systematic process implemented across seven countries and languages that sought to develop valid and culturally-appropriate translations of the Geriatric Institutional Assessment Profile. DESIGN: Cross-cultural instrument translation and content validation study. SETTING AND PARTICIPANTS: Expert review panels comprised of 68 practicing nurses from seven European or EU associated countries (Austria (German), Belgium (Dutch), Denmark (Danish), Israel (Hebrew), Poland (Polish), Switzerland (German, French), and Turkey (Turkish)) evaluated cross-cultural relevance, including translation, of the Geriatric Institutional Assessment Profile. METHOD: A systematic approach to translating and validating a cross-cultural survey instrument, including back-to-back translation, adaptation, and evaluation of content validity using content validity indexing (CVI) techniques for each country and language, assessing translation and relevance content validity separately. The item, subscale and domain content validity index scores were calculated and adjusted for chance agreement among raters for all parts of the Geriatric Institutional Assessment Profile: the four subscales of geriatric care environment, the general knowledge about older adults subscale, and the clinical geriatric knowledge subscale. Consensus discussions among the raters then finalized translations. RESULTS: CVI scores for relevance and translation were all in the "good" to "excellent" range. The geriatric care environment scale's CVI scores were 0.84 to 0.94 for relevance and 0.82 to 0.98 for translation. The clinical geriatric knowledge subscale's CVI scores were 0.83 to 0.97 for relevance and 0.94 to 0.98 for translation. The general knowledge about older adults subscale received high translation agreement (0.93 to 0.99) but slightly lower scores for relevance, ranging from 0.46 to 0.94. CONCLUSION: Study results provided preliminary evidence of the applicability and validity of a multi-factor measure of age-friendly care in diverse health care systems, in German, Dutch, Danish, Hebrew, Polish, French, and Turkish languages.

The use of expressive methods for developing empathic skills.

Empathy is one of the fundamental concepts in nursing, and it is an ability that can be learned. Various education models have been tested for improving empathic skills. Research has focused on using oral presentations, videos, modeling, practiced negotiation based on experiences, and psychodrama methods, such as role playing, as ways to improve empathy in participants. This study looked at the use of expressive arts to improve empathic skills of nursing students. The study was conducted with 48 students who were separated into five different groups. All groups lasted for two hours, and met for 12 weeks. Expressive art and psychodrama methods were used in the group studies. The Scale of Empathic Skill was administered to participants before and after the group studies. Before the group study took place, the average score for empathic skill was 127.97 (SD = 21.26). After the group study, it increased to 138.87 (SD = 20.40). The average score for empathic skill increased after the group (t = 3.996, p = .000). Results show that expressive methods are easier, more effective, and enjoyable processes in nursing training.

Experiences of Minority Stress and Intimate Partner Violence Among Homosexual Women in Turkey.

Intimate partner violence (IPV) has been recognized as an important public health problem over the past two decades, and increased attention to violence in intimate relationships has been given to heterosexual couples. Although the vast majority of literature has determined the rate of IPV among lesbian, gay, bisexual couples, and relationship quality, few studies investigated how stress specific to living as a lesbian or bisexual woman might correlate with IPV in these relationships. For this reason, the purpose of this descriptive study was to determine the experiences of minority stress and IPV among homosexual women (n = 149) in Turkey. Data were collected using convenience and snowball sampling. Participants completed an interviewer-administered survey. Results indicated that victimization and perpetration of all the forms of IPV occur but the most prevalent was perpetration (66.4%) and victimization (63.1%) of psychological violence. The mean score of participants' total level of outness was found 4.78 ± 2.15 (0-10). Most participants (74.5%) reported being often exposed to discrimination in the public area and reported moderate level of internalized homophobia (2.72 ± 0.87). Participants' level of outness associated with psychological (Victimization r = .319, p = .00; Perpetration r = .421, p = .00), physical (Victimization r = .184, p = .025; Perpetration r = .209, p = .010), and sexual (Victimization r = .263, p = .001; Perpetration r = .372, p = .00) violence perpetration and victimization. It is also founded that there was relation between internalized homophobia level and sexual violence perpetration (r = .164, p = .045)/victimization (r = .189, p = .021). These findings demonstrate a need for health care staff to be aware of the prevalence of IPV and minority stress that affected this population. Mental health of homosexual individuals is under the risk due to minority stress and IPV experiences. Furthermore, this finding illustrated that need for additional empirical research improved interpersonal relationship among these women. Also, policies need to be developed to reduce the minority stress experienced by these individuals and provide integration with the society.