Adherence to adjuvant tamoxifen and associated factors in breast cancer survivors.

PURPOSE: Adjuvant endocrine therapy reduces the recurrence and mortality of early hormone receptor-positive breast cancer in both pre- and postmenopausal women. The aim of this study was to investigate adjuvant tamoxifen adherence and associated factors in breast cancer survivors. METHODS: This descriptive, prospective study was conducted in 2019-2020 with the participation of 531 women who survived breast cancer and were under follow-up at the Senology Institute of a hospital in Istanbul. Inclusion criteria were having completed treatment for early hormone receptor-positive breast cancer, being prescribed tamoxifen, and being 18 years or older. Data were collected using a patient information form and the Morisky Medication Adherence Scale-8 (MMAS-8). RESULTS: The mean age of the participants was 44.9 ± 6.5 years, and the mean duration of tamoxifen use was 834.4 ± 685.7 days. The women's mean MMAS-8 score was 6.86 ± 1.39. Medication adherence was significantly positively correlated with current age (p = 0.006) and age at diagnosis (p = 0.002). There was a statistically significant difference between tamoxifen adherence according to participants' employment status (p = 0.028), chronic disease status (p = 0.018), loss of libido (p = 0.012), treatment-related changes in mood changes (p = 0.004), and having negative effects affecting daily life (p < 0.001). CONCLUSION: Overall, breast cancer survivors in this study reported moderate adherence to tamoxifen. The women's individual characteristics and the adverse effects of treatment influenced medication adherence. Healthcare professionals can help increase adherence to this treatment, which reduces the risk of mortality, by explaining the importance of the medication, identifying and eliminating barriers to adherence, and informing women about evidence-based interventions to increase medication compliance.

Evaluating Death Anxiety and Death Depression Levels among Patients with Acute Myocardial Infarction.

This study aimed to assess death anxiety and death depression levels among patients with acute myocardial infarction. This was a descriptive correlational study, which was conducted on patients who were treated on an outpatient clinic or cardiology clinics a training and research hospital in Istanbul, Turkey between January and August 2020. The sample of study included 300 patients, who met the inclusion criteria and agreed to participate in the study. The Sociodemographic Form, Death Anxiety Scale and Death Depression Scale served as data collection tools. The patients obtained a mean score of 12.260 ± 3.315 from Death Depression Scale and a mean score of 12.506 ± 2.915 from Death Anxiety Scale. The patients had a death-related depression mood and a severe death anxiety level. The correlation between the patients' Death Depression Scale and Death Anxiety Scale mean scores was statistically significant and moderate positive (r = .590; p = 0.000). As patients' death anxiety increased, their death-related depression levels also increased was determined. The death anxiety levels of the patients were mostly severe, to the point of panic. Their depression scores were also above average.

The efficacy of acupressure in managing opioid-induced constipation in patients with cancer: A single-blind randomized controlled trial.

PURPOSE: Opioid-induced constipation is one of the heath problems with a negative impact on the quality of life. This randomized-controlled trial aimed to investigate the effects of acupressure therapy on the management of opioid-induced constipation in patients with cancer. METHODS: The trial was conducted on 140 cancer patients, who were assigned to the acupressure (n = 70) and the control groups (n = 70). In addition to routine care, patients in the acupressure group received 8-min acupressure from the Zhongwan (CV12), Guanyuan (CV4), and Tianshu (ST25) acupoints once a day for 4 weeks. The outcomes included Defecation Diary (DD), Visual Analog Scale Questionnaire (VASQ), and Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL). RESULTS: We found a statistically significant difference between the acupressure and control groups in terms of stool consistency (2.22 ± 0.49 vs 1.80 ± 0.55) (p = 0.001), straining (1.98 ± 0.71 vs 2.91 ± 0.37) (p = 0.001), incomplete evacuation (0.37 ± 0.29 vs 0.61 ± 0.43) (p = 0.001), stool amount (0.93 ± 0.14 vs 0.95 ± 0.20) (p = 0.001), and the number of defecations (0.70 ± 0.22 vs 0.46 ± 0.29), (p = 0.001) measured at the fifth week. Besides, with the exception of stool amount, the DD scores obtained by the acupressure group significantly increased in the fifth week. Inter-group comparison of the pre-test and post-test scores showed that acupressure group obtained statistically significantly lower scores from the PAC-QOL (p = 0.0001). CONCLUSIONS: Findings of this trial suggested that a 4-week acupressure was an effective way to improve the quality of life and to reduce both the subjective and the objective constipation symptoms in patients with opioid-induced constipations. CLINICAL TRIAL NUMBER: NCT04876508.

Effect of Emotional State of Nurses Working in Intensive Care on Their Attitudes Toward Death.

The purpose of this study is to investigate the effect of the emotional state of the nurses working in intensive care unit on their attitudes toward death. The study was conducted with the participation of 100 nurses working in intensive care units between July and December 2017. A positive statistically significant correlation was found between the nurses' status of approaching emotions and subscales of Death Attitude Profile (p < .05). It was observed that there was a positive significant correlation between the emotional avoidance scores and neutral acceptance and approach acceptance (r = .281), escape acceptance (r = .335), and fear of death and death avoidance (r = .490) scores (p < .05).

The Effect of Lotus Position on Dyspnoea Management in Intensive Care Unit.

OBJECTIVE: To determine the effect of lotus position on dyspnea management. METHODS: The case-control study was conducted from June to November 2016 at a training and research hospital in Istanbul, Turkey, and comprised patients with lung disease in an intensive care unit. The patients were divided into an experimental group who were exposed to lotus position for dyspnoea management, while the control group was subjected to Orthopnoeic position. Data was collected using a patient description form, and the Medical Research Council Scale. Respiratory rate, oxygen saturation, heart rate and blood pressure for all subjects were noted. SPSS 22 was used for data analysis. RESULTS: Of the 35 subjects, 17(48.5%) were cases and 18(51.4%) were controls. The overall mean age was 61.48±15.51 years. There was a significant improvement in the intra-group respiratory rate, oxygen saturation, heart rate and systolic blood pressure in both groups (p<0.05). Patients in both groups were similar in their vital signs both before and after the intervention (p>0.05). CONCLUSIONS: Both lotus and Orthopnoeic positions significantly improved dyspnoea-related variables, and lotus position was as effective as Orthopnoeic position.

A Comparison of Burnout and Job Satisfaction among Cancer Nurses in Oncology, Hematology and Palliative Care Clinics.

BACKGROUND: Increased burnout level and decreased job satisfaction in oncology nurses negatively affect the quality of life of the employees and impair the quality of nursing care, services to be provided. SUBJECTS AND METHODS: The aim of this study was to determine levels and to compare of burnout and job satisfaction among cancer nurses in oncology, hematology and palliative care clinics.The research was conducted between July 2019 - December 2019 in oncology, hematology and pallitive care clinics in three different public training and research hospitals. Each nurse completed a Sociodemographic Data Form, the Minnesota Job Satisfaction Scale and the Maslach Burnout Scale. RESULTS: Nurses were working for averagely 50.81±7.59 hours per week and averagely 200.72±29.09 hours per month. Mean weekly shift number of the nurses was 9.49±4.43. There was a statistically significant and negative correlation between the emotional exhaustion subscale scores of the nurses included in the study and their internal satisfaction scores external satisfaction scores and total satisfaction scores (p<0.001). There was a statistically significant and negative correlation between the nurses' Depersonalisation subscale scores and internal satisfaction scores, external satisfaction scores and total satisfaction scores (p<0.001). A statistically significant and positive correlation was found between the nurses' personal accomplishment subscale scores and internal satisfaction scores, external satisfaction scores and total satisfaction scores (p<0.001). CONCLUSION: Nurses in palliative care clinics had the highest emotional exhaustion. Also there is a significant correlation between the job satisfaction and burnout levels of nurses working in hemotology, oncology and palliative care clinics providing care to cancer patients. There is a significant correlation between the job satisfaction and burnout levels of nurses working in hemotology, oncology and palliative care clinics providing care to cancer patients.

Use of simulation from high fidelity to low fidelity in teaching of safe-medication practices.

OBJECTIVE: To evaluate the effects of simulation techniques on learning outcomes in the teaching of safe drug applications to first year nursing students. METHODS: The semi-experimental study was conducted from February to April 2017, and comprised nursing students of Acibadem Mehmet Ali Aydinlar University. This student satisfaction and selfconfidence in learning scale, medication practice via oral route checklist, and pre- and post-test for safe drug application knowledge Assessment were used for data collection. Following the theoretical lectures, case studies, task trainer practices and scenario with standardised patient were carried out. Baseline knowledge, during-the-scenario performanceand post-scenario level of student's satisfaction and self-confidence were evaluated. Data was analysed using SPSS 18. RESULTS: Of the 58 subjects, 51(87.9%) were female. The overall mean age of the sample was 20.69±1.02 years. There was a statistically significant difference between students' knowledge levels before and after the scenario (p<0.05). Mean performance scoreon safe medication practice was 65.70±5.83. A significant weak positive correlation was found between the students' scores on satisfaction with the simulation and knowledge levels as well as the performance and self-confidence scores (p<0.05 each). Also, there was a strong correlation between the scores on self-confidence scale and the knowledge levels (p<0.01). CONCLUSIONS: Simulation had a positive effect on learning outcomes..

Fear of COVID-19 and its influence on palliative care patients.

BACKGROUND: Fear of COVID-19 may have adverse psychological effects on palliative patients; it may also reduce their quality of life, increase physical symptoms and lead to the postponement of treatment. AIM: This study aimed to determine how the fear of COVID-19 influences factors (personal and disease-related characteristics) in palliative care patients. METHODS: A descriptive, cross-sectional design study was conducted on 110 patients. A patient information form, the 'Fear of COVID-19 scale' and the Eastern Cooperative Oncology Group performance status were used for data collection. FINDINGS: The mean score obtained from the COVID-19 scale was 20.44±5.78. There was a statistical significance between the stage of disease and the fear of COVID-19 score. The fear of COVID-19 was higher for participants who had received polymerase chain reaction testing. CONCLUSION: There was a positive and statistically significant relationship between the oxygen flow rate and fear of COVID-19 score, as well as a statistically significant relationship between the stage of disease and fear of COVID-19 score. It was determined that the COVID-19 pandemic process affected the mental health of palliative care patients.

The Effect of Coffee in the Prevention of Oral Mucositis Associated with Head and Neck Radiotherapy.

AIM: This study investigates the effect of coffee on the management of oral mucositis associated with head and neck radiotherapy. METHOD: Twenty-nine patients who underwent radiotherapy for the first time due to head and neck cancer between March 2019 and February 2020 were included in the experimental study. One cup/day of Turkish coffee (6 mg) was given to the patients in the intervention group every day for 3 weeks from the first day of radiotherapy. Data monitoring of both groups was performed once a week for 3 weeks. RESULTS: Most of the patients participating in the study were at local stage (65.2%), and 72.4% underwent head and neck radiotherapy with the diagnosis of nasopharynx and larynx cancer. Although the development rate of oral mucositis was lower in the intervention group, no statistically significant difference was determined (p > 0.05). In the repeated follow-up, the quality of life scores was found to be similar in both groups. CONCLUSION: We concluded that coffee application is not an effective approach in the prevention of oral mucositis associated with head and neck radiotherapy. Further studies with larger sample sizes are needed to determine the prophylactic effect of coffee in the management of oral mucositis.

The Correlation of Malnutrition with Mortality and Morbidity According to Global Initiative on Malnutrition Criteria in the Palliative Care Unit.

AIM: The objective of this study was to retrospectively assess the correlation of malnutrition with mortality and morbidity according to Global Initiative on Malnutrition criteria in patients with the diagnosis of lung cancer hospitalized in the palliative care unit. METHOD: The sample of the study consisted of the data of 705 patients with lung cancer, who were hospitalized in the palliative care unit in a training and research hospital between January 2018 and January 2020. All the patients' demographic characteristics, disease-related data, laboratory values, Global Initiative on Malnutrition scores, mortality in the last 3 months, and recurrent hospitalizations in the last 3 months were recorded from the patient records and automation system. RESULTS: According to the Global Initiative on Malnutrition criteria, 64 (9.2%) of the patients had malnutrition. There was a negative correlation between the ages and the admission albumin levels of patients with malnutrition who passed away in the last 3 months. CONCLUSION: No correlation was found between malnutrition and duration of mortality according to Global Initiative on Malnutrition criteria. Moreover, a difference was found between C-reactive protein and albumin levels of the patients according to the degree of malnutrition. It is recommended that nurses should start nutritional assessments of patients immediately when the patient is admitted to hospital.

Professional values and ethical sensitivities of nurses in COVID-19 pandemic.

BACKGROUND: Nurses are facing several ethical problems like the safety of the nurses, patients, co-workers, and families, allocation of scarce resources, and the changing nature of the relationships of nurses with patients and families during the COVID-19 pandemic. These have caused nurses to have feelings such as stigmatization, fear, anger, anxiety, uncertainty, work-related strain, and burnout. Identifying nurses' ethical sensitivities and professional values are highly important to ensure that nurses are placed in the right decision-making position. This descriptive correlational study was carried out to evaluate the professional values and ethical sensitivities of nurses during the COVID-19 pandemic. METHODS: A quantitative descriptive and correlational study was performed with 245 nurses in Turkey. The "personal information form," the "nurses professional values scale-revised (NPVS-R)," and the "moral sensitivity questionnaire (MSQ)" were employed for data collection. RESULTS: The nurses' 52.7% reported facing an ethical dilemma. Also, 40.3% of the nurses who had an ethical dilemma during the pandemic failed to solve it. The mean NPVS-R scores of the nurses had statistically significant negative correlations with mean scores of the overall MSQ and its autonomy, benefit, integrative approach, and orientation subscales (p < .05). The nursing staff had high levels of professional values and moral sensitivities. CONCLUSION: Professional value perceptions were enhanced, and moral sensitivities were improved. Age and professional experience were identified as factors that affected the professional value perceptions and moral sensitivities of the nurses. The results will form the basis for future studies and contribute to the resolution of ethical dilemmas experienced by nurses.

Lung Cancer-Related Dyspnea: The Effects of a Handheld Fan on Management of Symptoms.

BACKGROUND: The application of a handheld fan may reduce patients' shortness of breath and increase their activity tolerance by enabling cooling and air flow into the second and third branches of the trigeminal nerve. OBJECTIVES: The aim of the study was to assess the effects of directing a handheld fan toward the face in the management of lung cancer-related dyspnea. METHODS: Using a randomized controlled experimental design, 96 inpatients with lung cancer were evaluated, with the experimental group (n = 49) using a handheld fan to manage dyspnea for 14 days. Dyspnea, respiration rate, oxygen saturation, heart rate, and quality of life were assessed for both groups. FINDINGS: A statistically significant difference was found in dyspnea scores between groups on the first, seventh, and fourteenth days of fan application, and statistically significant differences were found between groups in dyspnea scores, respiration rates, oxygen saturation, heart rate, and quality of life on the fourteenth day of application.

The Effect of Lavender Oil on Sleep Quality and Vital Signs in Palliative Care: A Randomized Clinical Trial.

BACKGROUND: This study was conducted to determine the effect of lavender oil on sleep quality and vital signs in palliative care patients. METHODS: We examined 68 patients in a palliative care unit. Vital signs of all the patients were assessed, and also their sleep quality was evaluated using the Richards-Campbell Sleep Questionnaire. Lavender was applied to patients in the experimental group. During the intervention, vital signs of the patients were monitored at 4-h intervals throughout the night, and sleep quality was evaluated during the morning. The same evaluation processes were performed for the control group. RESULTS: It was observed in the evaluation that lavender application did not affect the vital signs of the patients but it ensured a deeper sleep on the 2nd day after the intervention, facilitated their falling asleep and sleeping again when they were awakened and enhanced sleep quality (p < 0.05). Also, this application decreased the awakening frequency on the 1st and 2nd days and enhanced overall sleep quality (p < 0.05) after the intervention. CONCLUSIONS: Lavender has no effect on the vital signs of palliative care patients but is an effective and reliable approach to enhance their sleep quality.

The Palliative Care Outcome Scale: Turkish Validity and Reliability Study.

OBJECTIVE: To examine the validity and reliability of the Turkish version of the Palliative Care Outcome Scale (POS). METHODS: This methodological study consisted of 69 patients hospitalized in the palliative care (PC) service of three hospitals between June 2016 and August 2016, 69 carers who undertook continuously primary care of these patients, and 28 staff members working in the PC service and providing care to these patients. The data of the study were collected using the Personal Diagnosis Form, the POS. The scope, structure and criterion validity and internal consistency reliability of the scale were tested. Item analysis, Cronbach's alpha analysis, content validity ratio, confirmatory factor analysis for construct validity, criterion validity, patient validity, and intraclass correlation coefficient for the adaptation of outcomes of patient, carer, and staff groups were conducted. RESULTS: The content validity ratio of the scale was found to be higher than 0.80 for patient, carer, and staff questionnaires. Item-total score correlation coefficients were determined between 0.27 and 0.72 for the items in the patient questionnaire, 0.33-0.67 for the carer questionnaire, and 0.34-0.72 for the staff questionnaire. The Cronbach's alpha reliability coefficients were determined as 0.64 for the patient questionnaire, 0.73 for the carer questionnaire, and 0.68 for the staff questionnaire. CONCLUSIONS: The Turkish version of the POS was determined to be a valid and reliable tool to be used for assessing the needs of PC patients in three dimensions in terms of the perspectives of patient, carer, and staff.

Examining Knowledge, Skill, Stress, Satisfaction, and Self-Confidence Levels of Nursing Students in Three Different Simulation Modalities.

PURPOSE: The aim of this study was to compare the effect of different simulation modalities on knowledge, skill, stress, satisfaction, and self-confidence levels of students receiving undergraduate education in three nursing schools. METHOD: This was an experimental study. Students applied the scenario of "Respiratory Sounds Assessment" which was prepared according to three different simulation modalities. In the study, the standardized patient, high-fidelity simulation, and partial task trainer were used as simulation modalities. RESULTS: An increase was observed in postpractice knowledge levels of the three groups which had similar knowledge levels before the practice. Virtual Analog Scale stress levels of the students in the standardized patient group were higher than those of others. The students' mean scores of satisfaction in learning were higher in the standardized patient group. The students in the partial task trainer group had lower scores of self-confidence in learning. Skill scores of the students were lower in the standardized patient practice than those in others. CONCLUSION: Simulation-based experiences give students the opportunity of experiencing situations they may experience in the actual practice beforehand. Therefore, this may increase their performance in real practices, as reality increases in the standardized patient group.

Example of a Simulation Design in Nursing Education: Safe Chemotherapy Administration.

Chemotherapy is one of the treatment methods increasingly used in cancer. In this article, we aimed to share our simulation experiences within the scope of the elective course of Cancer Nursing in the Nursing Internship (4th year) program in the process of teaching safe chemotherapy administration methods. Simulation-based experience should be designed to attain specified educational goals and expected results as best as possible. Scenario implementation is based on the criteria of the International Nursing Association for Clinical Simulation and Learning standards. A biologically safe drug preparation cabin in the drug preparation room of a simulation center was used, and a medium-fidelity mannequin-based simulator evaluating the vital signs was utilized as the simulator during the simulation implementation. In the patient history prepared within the scope of the scenario, the students were expected to achieve goals. An analysis was performed by a trainer who followed attentively the implementation during the scenario. In the analysis stage, sessions including 8-10 students were held using the Promoting Excellence and Reflective Learning in Simulation. A checklist was used to evaluate the skill steps of the students objectively. It is thought that this simulation scenario maintained in accordance with the standards of best practice of the International Nursing Association for Clinical Simulation and Learning would guide the readers. The simulation is considered to be an effective method for safe medications, and it is recommended to plan different scenarios according to the levels of students.

Examining the effect of simulation based learning on self-efficacy and performance of first-year nursing students.

BACKGROUND: Self-efficacy is an individual's belief in oneself and in one's own judgment and ability to be successful in a task. Strong self-efficacy allows for the achievement of success, well-being, personal development and the diversification of skills. An individual's perception of his/her self-efficacy plays a key role in adopting behaviors and initiating and sustaining change. AIMS: The first aim of this study is to evaluate the effects of simulation-based learning on the self-efficacy and performance of first-year nursing students. The second aim is to examine students' pre- and post-scenario proficiency in their self-assessment of competence in regard to scenario objectives to compare the students' self-assessment and their instructor's assessment in terms of performance evaluations. METHODS: This semi-experimental study was conducted with sixty-five first-year nursing students. A standardized patient method was used as a simulation technique. Students' self-efficacy and their perceptions of their own competence in completing skills were measured using the General Self-Efficacy Scale and the Proficiency Assessment Form, respectively. Students' actual performance was evaluated via an Objective Structured Clinical Assessment and performance evaluation checklists. RESULTS: The mean self-efficacy score of students was 52.68 (±10.19) before the scenario and 49.59 (±12.90) post-scenario (p = .001). With regard to their scenario objectives, a decrease was observed in students' proficiency in their post-scenario self-assessment of competence. This decrease was only statistically significant in the "Establishing a safe patient unit" objective (t = 2.27; p = .03). CONCLUSIONS: We observed that self-efficacy scores declined in the post-simulation scenario. Using standardized patients in simulation training allows novice nursing students to meet a real patient and to recognize their own true self-efficacy.