Evaluating the Effectiveness of a Training on Ergonomic Risks of Measuring Blood Pressure.

Background: Musculoskeletal disorders (MSDs) occur as a result of long-term exposure to inappropriate working postures and repetitive use of body postures, leading to harmful consequences for patients, employees, and employers. Evaluating distinct working postures can contribute to effective interventions. Purpose: The aim of this study was to determine ergonomic risks of MSDs during repeated blood pressure measurement processes and to evaluate the effectiveness of a training on this topic. Methods: A pretest/posttest quasi-experimental design studied 64 nurses in a training and research hospital in Turkey. Participants were evaluated for the prevalence and risk of MSDs using the Nordic Musculoskeletal Questionnaire Extended Version and the Rapid Entire Body Assessment (REBA) Checklist, and by photographing them performing the procedure. Nurses with high risk for MSDs received an ergonomics training program and were followed up twice in 3 months. Results: Reduction in prevalence of MSDs in neck, shoulder, and hip/thigh areas, and in mean REBA scores after the training were statistically significant. Conclusion: Nurses should be trained about correct posture for specific high-risk activities that may cause MSDs, and offered exercise programs that support the musculoskeletal system.

Assessment the effect of diabetes education on self-care behaviors and glycemic control in the Turkey Nursing Diabetes Education Evaluating Project (TURNUDEP): a multi-center study.

BACKGROUND: Diabetes education in Turkey is provided by diabetes nurse educators in almost all healthcare organizations. However, the education is not standardized in terms of learning content, duration, and methods. This multi-center study was performed to assess the self-care behaviors and glycemic control following education provided to the patients with type 2 diabetes mellitus by diabetes nurse educators. METHODS: This was a descriptive and cross-sectional study and included 1535 patients admitted to 28 public hospitals for the treatment of type 2 diabetes mellitus. The education was assessed by using a Patient Identification Form and Self-care Scale. RESULTS: The proportion of individuals who received diabetes education within the last year was 78.5%, with 46.7% of them having received it once. Of the patients, 84.8% reported that they received diabetes education individually. It was found that the proportion of individuals who received education about oral antidiabetics (78.5%) and glucose testing at home (78.5%) was higher than the proportion of individuals who received education about exercise (58.8%) and foot care (61.6%). The status of diabetes education, education intervals, and the correlation of the education method with self-care and glycemic control was evaluated. Self-care and glycemic control levels were better among the patients who received diabetes education thrice or more and in patients who received education both individually and in a group (p < 0.05). CONCLUSIONS: Approximately three-quarters of individuals with type 2 diabetes mellitus received education by diabetes nurse educators in Turkey. Diabetes education is positively correlated with self-care and glycemic control levels among patients with type 2 diabetes mellitus. Efforts for generalization and standardized education for all diabetes patients are necessary.

The Predictors of Painful Diabetic Neuropathy and Its Effect on Quality of Life.

BACKGROUND: Knowing the prevalence and predictors of neuropathic pain and its impacts on the quality of life (QoL) using measurement tools is important for good diabetes management. In Turkish society, neuropathic pain, its predictors and its impact on the quality of life of diabetics are not considered enough. OBJECTIVES: This study examined the prevalence and predictors of neuropathic pain and its impacts on the quality of life in diabetics in Rize Province, Turkey. DESIGN: This study was designed as a cross-sectional, correlational study. SETTING: Data collected through face-to-face interviews. The sample size was determined using the formula [n= N t2pq / d2 (N-1) + t2pq]. PARTICIPANT: The sample of the study consisted of 122 people with diabetes who visited the diabetes outpatient clinic of the hospital. METHODS: A Personal Information Form, Douleur Neuropathique en 4 questions (DN4), and Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) were used to collect data. Pain intensity was measured using Visual Analogue Scale (VAS) RESULTS: The prevalence of the diagnosed painful diabetic polyneuropathy (PDPN) was found to be 22.9%. On the other hand, the prevalence of the undiagnosed PDPN was found to be 44.3% according to DN4 and 27.9% according to LANSS. The VAS pain score was determined as 1.99±1.20 (range: 1-5). In the people with PDPN, nephropathy was seen 4.514 times more frequently according to DN4 and 7.217 times more frequently according to LANSS. Painful diabetic peripheral neuropathy had negative effects on all dimensions of QoL except for social function and mental health (p <0.05). CONCLUSIONS: It is important for nurses to determine the prevalence and predictive factors of PDPN in their region and to evaluate the effect of pain on the quality of life of diabetics. Nurses should attempt to increase the quality of life of people with diabetes by reducing the predictors affecting pain.

Turkish Insulin Injection Techniques Study: Complications of Injecting Insulin Among Turkish Patients with Diabetes, Education They Received, and the Role of Health Care Professional as Assessed by Survey Questionnaire.

INTRODUCTION: Using the Turkish and rest of world (ROW) Injection Technique Questionnaire (ITQ) data we address key insulin injection complications. METHODS: Summarized in first ITQ paper. RESULTS: Nearly one-third of Turkish insulin users described lesions consistent with lipohypertrophy (LH) at their injection sites and 27.4% were found to have LH by the examining nurse (using visual inspection and palpation). LH lesions in the abdomen and thigh of Turkish patients are slightly smaller than those measured in ROW but more than half of Turkish patients who have LH continue to inject into them at least daily. More than a quarter of Turkish patients have frequent unexplained hypoglycemia and nearly 2 out of 5 have glycemic variability, both of which have been linked to the presence of LH and the habit of injecting into it. Nearly half of Turkish injectors report having pain on injection. Of these, just over half report having painful injections only several times a month or year (i.e., not with every injection). In Turkey the diabetes nurse has by far the major role in teaching patients how to inject. Nearly 40% of Turkish injectors get their sites checked at least annually, and a larger proportion than ROW had received recent (within the last 12 months) instruction on how to inject properly. CONCLUSION: Turkish patients and professionals have clearly made progress in injection technique, but there are still considerable challenges ahead which the new Turkish guidelines will help address. FUNDING: BD Diabetes Care.

Turkish Insulin Injection Technique Study: Population Characteristics of Turkish Patients with Diabetes Who Inject Insulin and Details of Their Injection Practices as Assessed by Survey Questionnaire.

INTRODUCTION: Over 7 million people in Turkey have diabetes. Of the 1 million who inject insulin little is known of their habits and injection techniques. METHODS: We conducted an Injection Technique Questionnaire (ITQ) survey throughout Turkey that involved 1376 patients from 56 centers. Turkish values were compared with those from 41 other countries participating in the ITQ, known here as Rest of World (ROW). RESULTS: The majority (50.4%) of Turkish insulin users give four injections/ day as opposed to ROW, where only 30.9% do. The abdomen is the most common injection site used by Turkish patients, but they also inject insulin in multiple body sites more often than do patients in ROW. Body mass index values in Turkey were 0.75 units higher than those in ROW as was the mean total daily dose (average daily dose [ADD]) of insulin (54.0 IU in Turkey vs. 47.4 IU in ROW). Mean glycated hemoglobin (HbA1c) in Turkey was 9.1%, which is higher than in ROW and possibly related to the higher BMI and ADD. Turkish patients use insulin analogs (short and long-acting) more frequently than do patients in ROW. The shortest pen needles (4 mm) are used by about one-third of patients in Turkey, but the longer ones (8 mm) are equally common. Needles are reused in Turkey at a rate of 3.4 injections/single needle. However, needle reuse, whether with pens or syringes, is lower in Turkey than ROW, as is the number of times a reused needle is used. More than 75% of used sharps in Turkey go into the rubbish, with nearly 6% having no protection of the tip. CONCLUSION: The continued use of 8-mm needles raises the risk of intramuscular injections in Turkish patients. Despite full reimbursement, needle reuse still remains an important issue. More focus needs to be given to dwell times under the skin, reconstitution of cloudy insulant, correct use of skin folds and safe disposal of sharps. FUNDING: BD Diabetes Care.

Determining type 2 diabetes risk factors for the adults: A community based study from Turkey.

AIMS: This study aimed to determine risk factors for type 2 diabetes among adults who were not diagnosed with diabetes. METHODS: Adults were included in this study within the public activities performed on World Diabetes Day (n=1872). Data were collected using the FINDRISC questionnaire and a short questionnaire. RESULTS: Participants' mean age was 39.35±10.40. The mean FINDRISC score was 7.46±4.62, women's mean score was higher than that for men. The FINDRISC score indicates that 7.4% of the participants were in the highrisk group. Among participants, BMI value of 65.1% was 25kg/m2 and higher, waist circumference of 58% was over the threshold value; and 50.7% did not engage in sufficient physical activity. Of the participants, 9.5% had a history of high blood glucose, families of 38.9% had a history of diabetes. The mean FINDRISC score was in the slightly high category, 121 participants were found likely to be diagnosed with diabetes within ten years if no action was taken. CONCLUSIONS: It is recommended the risk screening studies to be conducted and the FINDRISC tool to be used in Turkey, where diabetes prevalence is increasing rapidly, to determine diabetes risks in the early period and to raise social awareness for diabetes.

Do problem-solving skills affect success in nursing process applications? An application among Turkish nursing students.

PURPOSE: This study aimed to determine the relationship between problem-solving and nursing process application skills of nursing. METHODS: This is a longitudinal and correlational study. The sample included 71 students. An information form, Problem-Solving Inventory, and nursing processes the students presented at the end of clinical courses were used for data collection. FINDINGS: Although there was no significant relationship between problem-solving skills and nursing process grades, improving problem-solving skills increased successful grades. CONCLUSIONS: Problem-solving skills and nursing process skills can be concomitantly increased. CLINICAL REVELANCE: Students were suggested to use critical thinking, practical approaches, and care plans, as well as revising nursing processes in order to improve their problem-solving skills and nursing process application skills.

Using mobile phone text messages to improve insulin injection technique and glycaemic control in patients with diabetes mellitus: a multi-centre study in Turkey.

AIM AND OBJECTIVES: To improve the knowledge and skills of diabetic patients on insulin injections using mobile phone short message services and to evaluate the association of this intervention with metabolic outcomes. BACKGROUND: Mobile communication technologies are widely used in Turkey, which maintains a diabetic population of more than 6·5 million. However, there are a limited number of studies using mobile technologies in the challenging and complicated management of diabetes. DESIGN: A one group pretest-posttest design was used in this study. METHODS: The study sample consisted of 221 people with type 1 and type 2 Diabetes Mellitus from eight outpatient clinics in six cities in Turkey. The 'Demographic and diabetes-related information Form' and 'Insulin Injection Technique and Knowledge Form' were used in the initial interview. Subsequently, 12 short messages related to insulin administration were sent to patients twice a week for six months. Each patient's level of knowledge and skills regarding both the insulin injection technique and glycaemic control (glycated haemoglobin A1c) levels were measured at three months and six months during the text messaging period and six months later (12 months total) when text messaging was stopped. RESULTS: The mean age of the patients with diabetes was 39·8 ± 16·2 years (min: 18; max: 75). More than half of the patients were females with a mean duration of diabetes of 11·01 ± 7·22 years (min 1; max: 32). Following the text message reminders, the patients' level of knowledge and skills regarding the insulin injection technique improved at month 3 and 6 (p < 0·05). The patients' A1c levels statistically significantly decreased at the end of month 3, 6 and 12 compared to the baseline values (p < 0·05). The number of insulin injection sites and the frequency of rotation of skin sites for insulin injections also increased. CONCLUSION: This study demonstrated that a short message services-based information and reminder system on insulin injection administration provided to insulin-dependent patients with diabetes by nurses resulted in improved self-administration of insulin and metabolic control. RELEVANCE TO CLINICAL PRACTICE: Today, with the increased use of mobile communication technologies, it is possible for nurses to facilitate diabetes management by using these technologies. We believe that mobile technologies, which are not only easy to use and to follow-up with by healthcare providers, are associated with positive clinical outcomes for patients and should be more commonly used in the daily practice of diabetes management.

A comparison of three different diabetes screening methods among dental patients in Turkey.

OBJECTIVE: This study was conducted to describe the frequency of diabetes in dental patients, and to compare three different screening methods: the random finger plasma glucose (RFPG) test, the Finnish diabetes risk score (FINDRISC) survey and a special clinical guideline developed for dental patients. METHODS: The study design was cross-sectional, descriptive and comparative. The data were collected between August 2011 and February 2012. A total of 702 dental patients participated in this study. The screening tools were RFPG, FINDRISC and a clinical guideline. Data were analyzed using the Chi-squared test, the t test, analysis of variance, and the Pearson correlation test. RESULTS: The frequency of diabetes was 8.3% for the participants. The prevalence of participants at risk for undiagnosed diabetes was 20.1% according to the RFPG test, 29.9% according to the FINDRISC, and 29.8% according to the clinical guideline. Correlation analysis showed a significant positive correlation between the screening methods (p<0.001 for each). CONCLUSION: The overall frequency of diabetes was 8.3%. It was found that the three screening methods used in this study were statistically similar. However, FINDRISC and clinical guideline as the questionnaire screening tools indicated a little larger group than RFPG with respect to diabetes risk.

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.

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.

The effectiveness of nurse-led, home-based pulmonary rehabilitation in patients with COPD in Turkey.

The goal of this study was to determine the effectiveness of nurse-led, home-based pulmonary rehabilitation in patients with stage 3 or 4 chronic obstructive pulmonary disease (COPD), according to the Global Initiative for COPD (GOLD) staging system. The study consisted of 32 patients--a nurse-led, home-based pulmonary rehabilitation group (16) and a control group (16). In the rehabilitation program, patients received education about their diseases and performed breathing exercises and lower- and upper-extremity aerobic exercises at their homes during the 3-month period of the study. There was meaningful improvement in the rehabilitation group in terms of pulmonary function tests (FEV1 % predicted value), artery blood gases (PaCO2), quality of life, dyspnea, and functional capacity. On the other hand, no meaningful change was observed in the control group. The study showed that the nurse-led, home-based pulmonary rehabilitation program had positive effects on the patients with COPD.

Complementary alternative medicine use in children with type 1 diabetes mellitus in Erzurum, Turkey.

AIM AND OBJECTIVE: The aims of this study were: (i) to determine the types of complementary and alternative medicine use among children with type I diabetes mellitus as reported by parents and (ii) to describe sociodemographic and medical factors associated with the use of such treatments in families residing in Eastern Turkey. BACKGROUND: Type 1 diabetes mellitus is a tremendously challenging and complex disease for children and families to manage. Therefore, the use of complementary and alternative medicines among children with type 1 diabetes is becoming increasingly popular. DESIGN: Survey. METHOD: Parents of 100 paediatric patients (who were diagnosed with type 1 diabetes at least 6 months prior to the study) who visited the participating paediatric endocrinology multidisciplinary centres and clinics for diabetes management were included in the study. Data were collected by using a semi-structured questionnaire. Results. Fifty-two per cent of the parents reported the use of one or more complementary alternative medicine therapies. Most such users (59.6%) were using oral herbal preparations; including morus alba (leaves) aloe vera and stinging nettle. CONCLUSION: Since we found that 78.6% of those using herbals were satisfied with their results and 69.2% were planning to continue use, it is important for healthcare providers to have relevant knowledge about complementary alternative medicine use and learn about its efficacy and effects (positive and adverse) of these treatments. Relevance to clinical practice. Botanical substitute for insulin seems unlikely, but complementary alternative treatments may provide valuable clues for the development of new oral hypoglycaemic agents and simple dietary agents. It is important for healthcare providers to have up-to-date knowledge about the use and effects of complementary alternative medicines in the outpatient clinical care setting.