The effect of a pressure ulcer prevention care bundle on nursing workload costs.

AIM: This study investigated the effect of care under the guidance of a pressure ulcer prevention care bundle on pressure ulcer incidence rates and on nursing workload costs. DESIGN, SETTING, AND PARTICIPANTS: This prospective pre-post interventional study was conducted in an anesthesia and reanimation intensive care unit. The sample consisted of 16 nurses and 84 patients. METHODS: The study was conducted in two periods: (1) nursing workload of pre-care bundle period and (2) nursing workload of post-care bundle period. In the collection of data, 6 forms (the demographic data forms, the Braden scale, nurse information form, the care bundle follow-up form and nursing workload follow-up form) were administered. The main outcomes of the study; Pressure ulcer incidence rate was evaluated with Form V, and nursing workload costs were evaluated with Form VI. These forms were evaluated daily by the nurses. In the first period (15.09.2018-30.11.2018), pressure ulcer incidence rates and nursing workload costs were evaluated before training. Then, the researcher trained nurses on how to prevent pressure ulcers and use the care bundle. The care bundles components were risk assessment, skincare, activity, in-service training, nutrition, wetness/incontinence and support surface management, and keeping records. In the second period (01.12.2018-15.02.2019), pressure ulcer incidence rates and nursing workload costs were evaluated after the training. The outcomes of the two periods regarding the incidence of pressure ulcers and nursing workload costs were compared. RESULTS: The pressure ulcer incidence rates before and after the care bundle were 22.1 and 13.0 per 100 patient-day, respectively. There was a decrease in pressure ulcer incidence rates after the care bundle, but it wasn't significant (p = 0.138). The total workload cost of pressure ulcer prevention was significantly lower after the care bundle than before (p = 0.001). CONCLUSION: The pressure ulcer incidence rates were lower after the care bundle than before, albeit insignificantly. The total pressure ulcer prevention workload costs were significantly lower after the care bundle than before. The reduction in pressure ulcer incidence and workload cost indicates that the use of care bundle is effective. Healthcare professionals in intensive care units should use a pressure ulcer prevention care bundle more often.

Effectiveness of a Pressure Injury Prevention Care Bundle; Prospective Interventional Study in Intensive Care Units.

PURPOSE: The purpose of this study was to assess the effectiveness of a pressure injury prevention care bundle. DESIGN: Prospective interventional study. SUBJECTS AND SETTING: Participants were 13 nurses and 104 patients cared for in the intensive care unit for at least 24 hours in a university hospital in Ankara, Turkey. METHODS: The study was conducted in 2 stages: the pre-care and post-care bundle stages. In the pre-care bundle stage, the pressure injury incidence of the patients was followed by the nurses. At the end of the third month, the researcher held a 1-day training program for the nurses about the care bundle use to promote correct implementation. In the post-care bundle stage, the nurses provided care according to the bundle. Compliance with the care bundle was assessed. Pressure injury incidence rates in the pre- and post-care bundle stages were compared. RESULTS: The incidence of stage 1 pressure injury was 15.11 (1000 patient-days) in the pre-care bundle stage and 6.79 (1000 patient-days) in the post-care bundle stage; this reduction was not statistically significant. CONCLUSIONS: A pressure injury prevention bundle was implemented in an intensive care unit, resulting in a decline in stage 1 pressure injuries.

Effects of Information, Motivation, Behavioral Skills Model on Urinary Incontinence in Men With Overactive Bladder and Urge Incontinence: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to evaluate the effect of an intervention based on and information, motivation, behavioral skills (IMB) model on urinary incontinence symptoms, impact on daily activities, and incontinence-specific quality of life in men with overactive bladder dysfunction (OAB) and urge incontinence. DESIGN: Parallel-group, open-label, randomized-controlled clinical trial. SUBJECTS AND SETTING: The sample comprised 60 male patients admitted to the urology clinic of a training and research hospital in Ankara, Turkey. Inclusion criteria were adult men older than 18 years and diagnosed with OAB and urge incontinence. METHODS: Data were collected from February 2018 to February 2019. Participants were randomized into 2 equal groups. The intervention group (n = 30) received a structured intervention based on the IMB model, and a control group (n = 30) received standard OAB management. The primary outcome was severity of urge incontinence measured by the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Secondary outcomes were mean scores on the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire-7 (IIQ-7), and Urinary Incontinence Information Rating. All outcome measures were evaluated before and 6 months after the training. RESULTS: Following the intervention, mean ICIQ-SF scores were significantly lower in the IMB model group as compared to the control group. Analysis revealed a significant increase in knowledge scores in both groups when baseline scores were compared to postintervention scores (P = .000 for the intervention group and P = .004 for the control group). The intervention group participants also had a higher postintervention scores when compared to control group subjects (P = .000). CONCLUSIONS: A structured behavioral intervention based on the IMB model significantly alleviated the severity of bothersome lower urinary tract symptoms in adult males with OAB and urge incontinence when compared to standard care.

An Investigation of Pain Beliefs, Pain Coping, and Spiritual Well-Being in Surgical Patients.

This study investigated pain beliefs, pain coping, and spiritual well-being in surgical patients. The study adopted a cross-sectional, descriptive, and correlational research design. The sample consisted of 213 voluntary patients admitted to a surgery clinic between April and November 2019. Data were collected using a demographic characteristics questionnaire, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale-12 item (FACIT-Sp-12), the Pain Beliefs Questionnaire (PBQ), and the Pain Coping Questionnaire (PCQ). Number, percentage, mean, and Spearman's correlation were used for analysis. Participants had a total FACIT-Sp-12 score of 25.99 ± 8.43. They had a mean PBQ "organic beliefs" and "psychological beliefs" subscale score of 4.44 ± 0.64 and 4.96 ± 0.68, respectively. They had a mean PCQ "self-management," "helplessness," "conscious coping attempts," and "medical remedies" subscale score of 15.83 ± 6.15, 9.41 ± 4.63, 8.72 ± 3.66, and 7.46 ± 5.33, respectively. Spiritual well-being was weakly and positively (r = 0.445, p < 0.000) correlated with self-management and moderately and negatively correlated (r = - 0.528, p < 0.000) with helplessness. Participants with higher organic and psychological beliefs had lower spiritual well-being. The results indicate that nurses should evaluate both pain and spiritual well-being in patients.

The impact of standardized patient interactions on nursing students' preventive interventions for pressure ulcers.

AIM: This study was performed as a quasi-experimental study using a standardized patient simulation program in order to explore the effects of education on the performance and knowledge of undergraduate nursing students with respect to pressure ulcer prevention. METHODS: The study sample consisted of 38 students who completed the study. After the theoretical education portion, the students first knowledge and performance scores were evaluated with the standardized patient program. Demonstration education with the standardized patient and a second standardized patient practice were then performed. Afterwards, a debriefing session was held under the supervision of the researcher. After three months, the second knowledge and performance score evaluation was performed with the standardized patient. Knowledge and performance scores were compared after theoretical training and three months after simulation training. RESULTS: The mean score of 38 students were 43.68 ± 9.06 and 75.92 ± 16.84 on the pre- and post-tests, respectively. Preliminary points were significantly lower than post-test points (p < 0.001). The median performance score was 7.89 (min-max: 0-73.68) in the first simulation and 86.84 (min-max: 63.16-100.00) in the second simulation. There was a statistically significant change between the two performance scores (p < 0.001). CONCLUSION: In this study, it was determined that the level of knowledge and performance persisted in the evaluations after comprehensive training using standardized patient simulations. This study confirmed standardized patient practice as an efficient learning modality for nursing students in the long-term.

Investigation of Nursing Students' Attitudes Towards Death and Their Perceptions of Spirituality and Spiritual Care.

Nurses are responsible for meeting the care needs of dying patients and their families, including their physical, psychological, emotional and spiritual assessment and care. The aim of this descriptive study was to investigate nursing students' attitudes towards death and their perceptions of spirituality and spiritual care. The study sample consisted of 237 second-, third- and fourth-grade nursing students. Data were collected using a "Personal Information Form", the "Spirituality and Spiritual Care Rating Scale (SSCRS)" and "Death Attitude Profile-Revised (DAP-R)". Number, percentage, mean, standard deviation and Spearman's correlation analysis were used for analysis. Participants stated that they had witnessed death before (73.8%), that spiritual care of dying patients and their families should be given special importance (93.7%) and that they feel incompetent in providing spiritual care (86.1%). Participants had a mean SSCRS score of 3.45 ± 0.43. They had the highest and lowest scores on the DAP-R subscales of "fear of death" (4.48 ± 0.83) and neutral acceptance (3.71 ± 1.21), respectively, indicating that they have a high fear of death and above average perceptions of spirituality and spiritual care. It is recommended that different teaching methods be integrated into the curriculum to help nursing students develop more positive attitudes towards death and improve their perceptions of spiritual care.

Resilience in nurses in terms of perceived social support, job satisfaction and certain variables.

AIM: This study investigated the resilience of nurses, the factors that contribute to resilience, and its relationship with perceptions of social support and job satisfaction. BACKGROUND: Resilience plays an important role in how nurses cope with work-related stressors. METHODS: A descriptive study was conducted with 242 nurses working at three public hospitals in Turkey. Data were collected using a descriptive data form, the Resilience Scale for Adults (RSA), the Multidimensional Scale of Perceived Social Support (MSPSS) and the Minnesota Job Satisfaction Scale (MJSS). RESULTS: Nurses' mean scores on the RSA, MSPSS, and MJSS were 99.80 ± 4.43, 66.66 ± 13.30, and 3.31 ± 0.72, respectively. Statistically significant relationships were detected between resilience and five factors: age, gender, mother's educational level, work experience and working hours (p < 0.05). A statistically significant positive correlation was also observed between MJSS score and both total RSA and family support subscale scores (p < 0.05). CONCLUSION: The resilience, perceived social support, and job satisfaction of participating nurses were moderate. Significant factors in their resilience were age, gender, mother's educational level, work experience, working hours, perceived social support and job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers can use the results to plan interventions that improve resilience among nurses.

Care under the guidance of pressure injury prevention protocol: a nursing home sample.

Pressure injury is a healthcare problem frequently encountered in nursing homes. This study evaluated the effects of the care delivered under the guidance of a protocol for pressure injury prevention at a nursing home. It was implemented in four phases. In the pre-protocol period, the pressure injury incidence and nurses' care practices were evaluated. In the second phase, nurses were trained to use the protocol. In the third phase, the nurses provided care under the guidance of the protocol (post-protocol period). In the fourth phase, the incidence of pressure injury and nurses' care practices were compared between the pre- and post-protocol periods. The average age of the older residents was 78.40±7.12 years, and all were at high or very high risk of pressure injury according to the Braden scale scores. Some 30% were bed bound; 90% had faecal and urinary incontinence; and 70% had malnutrition. The results showed that the pressure injury incidence reduced from 17.39% in the pre-protocol period to 10.87% in the post-protocol period, while the nurses' care practices improved in the post-protocol period. Thus, use of pressure injury-prevention protocols can reduce the incidence of these injuries in vulnerable care home residents.

Does the smartphone use affect the determination of daily goals: A nursing students' example?

PURPOSE: To examine how the risky use of smartphone in nursing students affects their daily goals. DESIGN AND METHODS: A total of 419 nursing students participated in this study. A Descriptive Data Form, Smartphone Addiction Scale-Short Version, and Daily Goals Scale were used to collect the data. FINDINGS: According to our study results; students who are afraid of forgetting or losing their phone have a higher risk of being smartphone addiction. As the risks of students' smartphone addiction increase, their daily goal setting levels decreased. PRACTICE IMPLICATIONS: The risky use of smartphone effects negatively daily goals setting. Education and counseling programs that will prevent the risky use of smartphones and the associated risk of addiction should be provided for nursing students.

Effect of Reflexology on the Constipation Status of Elderly People.

BACKGROUND: The current literature shows that one of the alternative therapies used to control constipation is reflexology. This study was conducted to assess the effect of reflexology on the constipation status of elderly people. METHODS: This study was randomized clinical trial conducted from at the private nursing home in the Ankara Province. At the nursing home, 60 eligible elderly people were randomly assigned into experimental (n = 30) and control (n = 30) groups. The experimental group received foot reflexology massage for 1 month three times per week for 30 min. Reflexology was initiated from the patient's right foot. The foot was relaxed primarily by applying effleurage followed by shaking, rotation, and stretching methods. The practice ended by applying solar plexus pressure on both feet. For elderly people in the control group foot surface massage without pressure was applied to simulate the interventions similar to the experimental group. The scale scores before and after reflexology were noted for the experimental group, and those for the control group, which did not receive any reflexology massage, were also determined. RESULTS: After the implementation of reflexology, the rate of emptying bowels on alternate days increased in the experimental group as opposed to that in the control group (P < 0.001). In this study, reflexology was found to improve the quality of life of the elderly and decrease the severity of constipation. CONCLUSION: Foot reflexology massage was found to be effective in relieving the constipation of elderly people. Therefore, reflexology is recommended as part of nursing care to reduce the constipation status of elderly people.

Pressure Ulcer Prevention Care Bundle: A Cross-sectional, Content Validation Study.

A care bundle is an organized set of interventions that encourages compliance with guidelines designed to improve quality of care. PURPOSE: This study was conducted to determine the content validity of a previously developed pressure ulcer prevention care bundle. METHODS: A cross-sectional study was performed in a university hospital in Turkey among 95 nurses employed in 8 intensive care units (ICUs) who were invited to use and assess a care bundle based on pressure ulcer guidelines found in the literature and developed by researchers. The care bundle included 48 statements divided into 8 categories. Participants in the care bundle content validation completed 3 paper-and-pencil instruments: a nurse demographic information tool, an item-by-item content validation of the care bundle rated on a 4-point Likert scale, and an evaluation of the care bundle's pressure ulcer prevention capabilities using I agree, I do not agree responses to statements regarding comprehensiveness, ability to prevent pressure ulcers, feasibility, implementation, and complexity. Data were collected to a paper form and analyzed using descriptive statistics, mean scores, and the content validity index (CVI). RESULTS: Of a total of 95 potential nurse participants, 68 completed the survey instruments (62 [91.2%] women, overall average age 29.9 ± 5.7 years), for a response rate of 71.6%; 57 (83.8%) had bachelors degrees, 36 (52.9%) had between 5 and 10 years of experience, 24 (35.3%) had participated in a pressure ulcer education program, and 41 (69.3%) cared for patients with 1 to 2 pressure ulcers per week. The care bundle's overall mean content validation score was 3.9 ± 0.1; this was deemed valid and appropriate after minor wording modifications on 2 items. Nurses rated the care bundle as comprehensive, feasible, necessary, and helpful for making clinical decisions; 12 participants had concerns regarding its complexity and implementation. CONCLUSION: The care bundle may help nurses develop appropriate interventions for patients. Future research should include assessment using larger groups of nurses and construct validation studies.

The effects of using high-fidelity simulators and standardized patients on the thorax, lung, and cardiac examination skills of undergraduate nursing students.

BACKGROUND: Existing research literature indicates that the use of various simulation techniques in the training of physical examination skills develops students' cognitive and psychomotor abilities in a realistic learning environment while improving patient safety. OBJECTIVES: The study aimed to compare the effects of the use of a high-fidelity simulator and standardized patients on the knowledge and skills of students conducting thorax-lungs and cardiac examinations, and to explore the students' views and learning experiences. DESIGN: A mixed-method explanatory sequential design. SETTINGS: The study was conducted in the Simulation Laboratory of a Nursing School, the Training Center at the Faculty of Medicine, and in the inpatient clinics of the Education and Research Hospital. PARTICIPANTS: Fifty-two fourth-year nursing students. METHODS: Students were randomly assigned to Group I and Group II. The students in Group 1 attended the thorax-lungs and cardiac examination training using a high-fidelity simulator, while the students in Group 2 using standardized patients. After the training sessions, all students practiced their skills on real patients in the clinical setting under the supervision of the investigator. RESULTS: Knowledge and performance scores of all students increased following the simulation activities; however, the students that worked with standardized patients achieved significantly higher knowledge scores than those that worked with the high-fidelity simulator; however, there was no significant difference in performance scores between the groups. The mean performance scores of students on real patients were significantly higher compared to the post-simulation assessment scores (p<0.001). CONCLUSIONS: Results of this study revealed that use of standardized patients was more effective than the use of a high-fidelity simulator in increasing the knowledge scores of students on thorax-lungs and cardiac examinations; however, practice on real patients increased performance scores of all students without any significant difference in two groups.