Pressure injuries in the operating room: who are at risk?

OBJECTIVE: Operating room (OR)-related pressure injuries (PIs) constitute the majority of all hospital-acquired PIs. The aim of this study is to reveal the prevalence and risk factors of OR-related PIs. METHOD: This study used a cohort design. The data were collected at Acibadem Maslak Hospital in Istanbul between November 2018 and May 2019. The study population consisted of all patients undergoing surgery between these dates (n=612). The haphazard sampling method was used following application of the inclusion criteria. A patient identification form, the 3S intraoperative pressure ulcer risk assesment scale and the Braden Scale were used to collect data. RESULTS: Within the scope of the study, data were collected from 403 patients, of which 57.1% (n=230) were female and 42.9% (n=173) were male; mean age was 47.90±18.15 years. During surgery, PIs were detected in 8.4% of patients. In total, 42 PIs were detected in patients in the study; 92.8% were stage 1 and 7.2% were stage 2. It was determined that the PIs observed in 11.8% (n=4) of the patients were related to device/instrument use and 23.5% (n=8) were related to the positioning device. Risk factors found to be significant in the development of PIs were sex (male) (p=0.049), large amount of bleeding during surgery (p=0.001), dry (p=0.020) and lighter skin (p=0.012), duration of surgery (p=0.001), type of anaesthesia (p=0.015), and medical devices used (p=0.001). CONCLUSION: Early identification of risk factors may reduce OR-related PIs. Guidelines and procedures that focus on preoperative, intraoperative and postoperative evaluation can be developed to reduce and prevent surgery-related PIs and to standardise care.

The effects of milking and suction drain management methods in paediatric patients after cardiac surgery.

AIM: The aim of this study is to determine the effects of milking and suction methods on maintaining drain patency following cardiac surgery in paediatric patients. METHODS: This was a randomized controlled trial. The patients were assigned to three groups (suction method, milking method, and control group) between July 2018 and December 2019. RESULTS: The most frequent medical diagnoses were tetralogy of Fallot (34.4%, n = 31) and ventricular septal defect (14.4%, n = 13). Heart rate may increase unless a method was chosen to maintain drain patency (F: 4.450, p = 0.003); suction (F: 0.528 p = 0.781) and milking (F: 2.281 p = 0.070) methods did not significantly increase the heart rate. The use of a manipulation method for maintaining drain patency maintained stability of the blood pressure values and did not affect haemodynamic stability, oxygen saturation, and body temperature. There was no statistically significant difference within and among the groups (p > 0.05) in relation to the volume of bleeding between admission until the sixth hour, although there was greater bleeding with the milking method (2.67 ± 15.30 ml) and less bleeding (-5.00 ± 23.30) with the suction method. CONCLUSION: The milking and suction methods used to maintain drain patency can be employed and will assist with maintaining the stability of the patient within the first critical 6 h. Further studies need to be conducted in order to clarify that the recommendations can be generalized to all children with congenital heart disease.

Effect of simulation-based learning on first clinical day stress and anxiety levels of nursing students in Turkey.

OBJECTIVES: To determine the effect of simulation-oriented skills training on first clinical day stress and anxiety levels in nursing students. METHODS: The quasi-experimental study was conducted from April to June, 2016, in Istanbul, Turkey, and comprised first year nursing students who were divided into two groups. In Group 1, students measured vital signs on simulated patients before their first clinical practice. In Group 2, the students performed this application on each other. Then, on the first day of their clinical practice, the students evaluated the vital signs and then filled out Clinical Stress Questionnaire and the State-Trait Anxiety Inventory. Data was analysed using Number Cruncher Statistical System version 2007. RESULTS: Of the 41 subjects, 16(39%) were in Group 1 with a mean age of 19.31±3.2 years, and 25(61%) were in Group 2 with a mean age of 18.92±0.86 years (p>0.05). There was no significant differences in state-trait anxiety inventory and clinical stress questionnaire scores between the groups (p>0.05). There was a significant difference with respect to benefit subscale of the clinical stress questioaanire (p=0.049). CONCLUSIONS: The use of simulation in nursing education provided relief and confidence during clinical practice.

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.

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..

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.

The Effect of Exaggerated Lithotomy Position on Shoulder Pain after Laparoscopic Cholecystectomy.

BACKGROUND: The exaggerated lithotomy position with the expertise of nurses can be successful solution for the patients who have the postoperative shoulder pain after laparoscopic cholecystectomy. AIMS: This study aimed to determine the effect of applying an exaggerated lithotomy positions to patients who had laparoscopic cholecystectomy to relieve shoulder pain. The study was conducted on nonrandomized groups and made as a semiexperimental study with a pretest/post-test control group design. Design, Settings, and Subjects/Participants: The study was conducted on 102 patients who had elective laparoscopic cholecystectomy and agreed to participate in this study after they met the inclusion-exclusion criteria in the general surgery clinic of a training and research hospital in Istanbul between December 12, 2012, and June 30, 2013. METHODS: The pain levels (10 minutes before and after positioning) and peripheral oxygen saturation (SPO2) levels (1 minute, 5 minutes, and 10 minutes before and after positioning-total 6 times) of the patients were measured using a visual analog scale and pulse oximetry, respectively. The pain levels and the analgesic (pethidine hydrochloride and diclofenac sodium) usage of the patients in both the experimental and the control group were compared. RESULTS: The exaggerated lithotomy position appreciably lowered the shoulder pain of the patients in the experimental group (t = 12.663; p = .000 < .001). It also increased peripheral saturation levels of the patients more rapidly compared with those in the control group receiving analgesics (t = 17.693; p = .000 < .005). In addition, it decreased the need to use additional analgesics and opioids (t = 2.14; p = .037). CONCLUSIONS: In this study the exaggerated lithotomy position was found to be fast and effective for relieving shoulder pain after laparoscopic cholecystectomy, decreased the need to use additional analgesics and opioids, and, in conjunction with pain control, also contributed to improvements in respiratory functions.

Relationship between student nurses' self-efficacy and psychomotor skills competence.

This study aimed to determine the general self efficacy levels of students studying for undergraduate degree in nursing and to examine the relationship between skills development and self efficacy. The research was conducted in a descriptive way. The sample consisted of 100 students. Data were collected via the use of a student introduction form, Self-Efficacy Scale (SES) and an intramuscular (i.m.) injection procedure checklist; the forms were filled in by 100% of the nursing students. The mean general self-efficacy score of the students in the study was high. the self-efficacy levels of our students were high, and no correlation was observed between personal characteristics and self-efficacy; therefore, education in injection technique had the same influence on all students' self-efficacy.

Image of nursing held by nursing students according to gender: a qualitative study.

This paper is a report of a study to determine the nursing images of female and male nursing students. The study used a qualitative research design to determine nursing images of male (n = 20) and female (n = 20) nursing students. To analyse the data, the method used content analysis. Statements were organized under three categories and seven themes after content analysis. The first category, nursing concept, incorporates the two themes of: (i) female or sister; (ii) job definition. The second category, choosing, incorporates the four themes of: (i) Desire of Others; (ii) Guarantee of Work; (iii) Being Helpful to Others; and (iv) Limited to Academic Achievement. The third category, Gender, incorporates the one theme of: (i) Gendered Approach. Male students have started to take part in nursing programs relatively recently; therefore, more research is needed in the fields of academic accomplishments of male students.

Care plans using concept maps and their effects on the critical thinking dispositions of nursing students.

It is expected that nursing education improves abilities of students in solving problems, decision making and critical thinking in different circumstances. This study was performed to analyse the effects of care plans prepared using concept maps on the critical thinking dispositions of students. An experimental group and a control group were made up of a total of 80 freshman and sophomore students from the nursing department of a health school. The study used a pre-test post-test control group design. The critical thinking dispositions of the groups were measured using the California Critical Thinking Disposition Inventory. In addition, the care plans prepared by the experimental group students were evaluated using the criteria for evaluating care plans with concept maps. T-test was used in analysing the data. The results showed that there were no statistically significant differences in the total and sub-scale pre-test scores between the experimental group and control group students. There were also significant differences in the total and sub-scale post-test scores between the experimental group and control group students. There were significant differences between concept map care plan evaluation criteria mean scores of the experimental students. In the light of these findings, it could be argued that the concept mapping strategy improves critical thinking skills of students.

[The impact of visits on vital signs of the patients in surgical intensive care unit: a pilot study]. / Cerrahi yogun bakim hastalarinda ziyaretin yasam bulgulari üzerine etkisi: Pilot çalisma.

BACKGROUND: This research was conducted to analyze the impact of visiting patients in the intensive care unit on the vital signs of the patients. METHODS: This descriptive study was conducted at the emergency surgical intensive care unit of a university hospital in Istanbul. The sample consisted of 43 patients aged 18 and above, who stayed at the unit for more than 24 hours. Data collection included the demographic features of the patients as well as the information and evaluation form including the vital signs of patients before, during and after visits. Data were measured before, during and after visits. RESULTS: 39.5% (n=17) of the patients were female and 60.5% (n=26) were male. Values before and after visits, respectively, were as follows: Mean fever 36.7±0.81 and 36.8±.94; pulse 97.3±26.4 and 98.4±26.1; mean respiration 23.76±4.55 and 24.30±4.53; systolic pressure 113.4±25.86 and 120.4±21.15; and diastolic pressure 64.81±8 and 67.30±3. CONCLUSION: This study, carried out as a pilot study, found that visiting patients in intensive care units affects the patients; however, this effect does not cause a serious physiological change in the vital signs of the patient.

Prevalence of cancer pain in outpatients registered to a cancer therapy center in Turkey.

INTRODUCTION: Although the World Health Organization (WHO) has stated that cancer pain can be controlled in 85-97% of cases with knowledge and technology available today, effective pain control is about 40%. This situation emphasizes the necessity of discussing cancer pain again. OBJECTIVE: This descriptive study was conducted with the aim of determining prevalence, severity, region and frequency of cancer pain in patients registered to a cancer treatment center. MATERIALS AND METHODS: A total of 256 patients who were treated in the outpatient clinic of a cancer center in Istanbul in 2010 constituted the study population and 99 cancer patients who agreed to participate in the study and could be reached constituted study sample. The study was completed with 49 (49.5%) patients as 50 (50.5%) out of 99 patients who were reached did not report pain. RESULTS: Of the patients with cancer pain, 30.6% (n=15) had colon/rectum cancer, 24.5% (n=12) had lung cancer and 51% (n=25) had metastasis. Pain was in lower extremities in 34.3% (n=35), 57.1% (n=28) had moderate pain, 24.5% (n=12) had severe pain and pain was constant in 28.6% (n=19). Additionally, 20.4% (n=10) were not receiving pain treatment. Usually opioids, nonsteroidal anti-inflammatory drugs (NSAIDs) and adjuvant analgesics were being used in combination for pain treatment. CONCLUSION: The fact that 20.4% (n=10) of 49 patients were not receiving pain treatment and half of the cancer patients under control are experiencing pain is bothersome and thought provoking.

Crisis management: the activities of nurse managers in Turkey.

Crisis management is the process of preventing the organization from getting into a crisis and taking the organization out of the situation with minimum costs and losses in sudden crisis situations. A descriptive study design was used to determine the activities of nurse managers regarding crisis management. The most common type of crisis encountered at hospitals was natural disasters such as earthquakes. To cope with stress regarding crises, 71.6% of nurse managers stated they leave the resolution of crises to the top management, 64.7% noted they increase the number of the staff members, and 58.1% said they ignore crises. It was concluded nurse managers were partially prepared for crises or crisis management. Activities of nurse managers for more efficient crisis management in hospitals can be restructured according to the results and suggestions of the research. Crises can be coped with, turned into opportunities, and negative effects of crises can be minimized.

The relationship among pressure ulcers, oxygenation, and perfusion in mechanically ventilated patients in an intensive care unit.

PURPOSE: We examined the relationships among oxygenation, tissue perfusion, and other comorbid conditions not incorporated into the Norton Scale, and pressure ulcer (PU) development in subjects receiving mechanical ventilation. DESIGN: Descriptive, observational study. SETTING AND SUBJECTS: The setting was our university hospital's surgical/emergency intensive care unit in Istanbul province, Turkey. The sample comprised 30 patients who were older than 18 years, did not have a PU on admission, and had been mechanically ventilated for more than 24 hours when data collection began. METHODS: Skin integrity and a PU risk, using the Norton Scale, were administered twice daily. In addition, serum blood testing, vital signs, and data regarding ventilation and oxygenation status were obtained from the patient's electronic medical records. RESULTS: Slightly less than half of subjects were women (n = 14, 46.7%). Their mean age was 54.36 years (SD = 20.68). Pressure ulcers developed in 5 patients (16.7%); all PUs were located on the heel. All ulcers were initially observed as stage I lesions; 1 progressed to a stage II ulcer and 1 progressed to a stage III ulcer. Patients who developed pressure ulcers have higher serum glucose levels (z = -2.198; P = .028), higher serum pH levels (z = -2.031; P = .028), and lower diastolic blood pressures (z = 0.055; P = .057) than those who remained ulcer free. CONCLUSION: Our results demonstrate that mechanically ventilated patients who develop PUs were more likely to have significantly higher blood glucose levels, significantly lower diastolic blood pressure values, and significantly higher serum pH values than were patients who remained free of PUs. Nurses who care for mechanically ventilated patients should recognize these factors and initiate preventive interventions as indicated.

Change in the health promoting lifestyle behaviour of Turkish University nursing students from beginning to end of nurse training.

In light of developments in science and technology, content has been added to the nursing curriculum to support and improve students' healthy lifestyle behaviours. The aim of this study was to determine whether any difference was observed in the behaviour of nursing students. This longitudinal and descriptive study was conducted with 57 students during 2002-2006 academic years Marmara University, School of Nursing. The "health promotion lifestyle profile" developed in 1987 by Pender et al. was evaluated as to its validity and reliability in Turkey by the HPLP (healthy lifestyle behaviour scale) adapted by Esin. Percentage, variance analysis, Cronbach alpha coefficient and the t-test were used in the analysis of data. The findings indicated that healthy lifestyle behaviours of nursing students changed over time, from when they began and at the end of every year during their nurse training.