Risk factors for early ostomy complications in emergency and elective colorectal surgery: A single-center retrospective cohort study.

BACKGROUND AND AIMS: The clinical significance of early ostomy complications has been emphasized worldwide, and the current evidence concerning the impact of emergency or elective surgery on ostomy complications is limited. This study aimed to investigate the effect of elective and emergency colorectal surgery on early ostomy complications and the risk factors associated with specific complications. METHODS: A mandatory colorectal recording system for consecutive ostomy patients between 2012 and 2020 was reviewed retrospectively. Patient socio-demographics, ostomy-related variables, and early period ostomy complications were retrieved from the patient records. The chi-square test, t-test, analysis of variance (ANOVA), and logistic regression were used to analyze the data. RESULTS: The study cohort included 872 patients. At least one or more complications developed in 573 (65.7%) patients, 356 (63.6%) in the emergency group, and 217 (69.6%) in the elective group. When comparing emergency surgery to elective surgery, necrosis (7.4% versus 3.4%, p = 0.009), mucocutaneous separation (37.2% versus 27.1%, p = 0.002), and bleeding (6.1% versus 2.1%, p = 0.003) were more prevalent. Peristomal irritant contact dermatitis (PICD) (37.3% versus 26%, p < 0.001) was more common in elective surgery. Risk factors for PICD were comorbidity (p = 0.003), malignant disease (p = 0.047), and loop ostomy (p < 0.001) in elective surgery; female sex (p = 0.025), neo-adjuvant therapy (p = 0.024), and ileostomy (p = 0.006) in emergency surgery. The height of the ostomy (less than 10 mm) was a modifiable risk factor for mucocutaneous separation in both elective surgery (p < 0.001) and emergency surgery (p = 0.045). CONCLUSION: Early ostomy complications were more likely to occur after emergency colorectal surgery than in an elective setting. Patient- and ostomy-related risk factors for complications differed between elective and emergency surgeries.

Self-perceived competence and its related factors in nursing students at graduation: the role of self-efficacy.

OBJECTIVES: This study aimed to investigate the level of perceived competence and explore the predictors of competence in nursing students at graduation. METHODS: This cross-sectional study was conducted with students at the point of graduation (n=239). A sociodemographic form and three different scales assessing students' competence, self-efficacy, and self-reflection and insight were used to collect data. Visual Analog Scale (VAS) was used to assess students' satisfaction (i.e., the role as nursing students in the nursing program), job-related stress (i.e., perceived stress related to nursing program), and coping behaviors. The data were analyzed using descriptive statistics and hierarchical linear regression. RESULTS: The mean scores of perceived competence, self-reflection, insight, and self-efficacy were 5.25 ± 0.96 (range: 1-7), 54.51 ± 7.83 (range: 12-96), 33.36 ± 5.40 (range: 8-48), 84.13 ± 12.27 (range: 0-100), respectively. Self-efficacy was the most significant associated factor of the entire group of variables in competence. CONCLUSIONS: Scores of perceived competence of students were optimistic. Self-efficacy was the most important factor affecting competence; that is, the greater the self-efficacy, the better the perceived competence.

The effects of an ethics laboratory program on moral sensitivity and professional values in nursing students: A randomized controlled study.

BACKGROUND: Recently, moral sensitivity and professional values have become increasingly important in nursing education and have been tried to be improved. OBJECTIVES: To investigate the effects of an ethics laboratory program integrated with the fundamentals of nursing course on the moral sensitivity and professional values of nursing students. DESIGN: The present study was designed as a randomized controlled study. The 8-week ethics laboratory program was applied to the students in the intervention group. In the ethics laboratory program, interactive education methods, such as ethical scenarios, case studies, roleplay, group discussions, project papers and watching movies, were applied. Control group received the standard fundamentals of nursing curriculum. PARTICIPANTS: The sample size was determined using stratified block randomization method, and 100 nursing students were assigned to intervention (n = 50) and control group (n = 50). RESULTS: There was no baseline difference between the groups. The moral sensitivity average of the students in the intervention (82.66 ± 12.57) was lower than the average of the control group (85.64 ± 16.83) after the ethics laboratory program; however, the difference was not statistically significant (p > .05). Similarly, there were no significant differences between the intervention (132.32 ± 16.83) and the control group (131.81 ± 20.55) regarding the average score of professional values. In the responsibility sub-dimension of professional values, there was a statistically significant increase in the intervention group (p < .05). CONCLUSION: The findings suggest that the ethics laboratory program for nursing students is effective in promoting responsibility sub-dimension of professional values. However, there was no significant effect on students' moral sensitivity and other dimensions of professional values. Further refinements of interventional research in ethics education and measurement of learning outcomes should be developed.

Spiritual care needs and associated factors among patients with ostomy: A Cross-Sectional Study.

AIMS AND OBJECTIVES: To investigate the spiritual care needs and associated factors in patients with ostomy. BACKGROUND: The significance of the spiritual care needs of the patients has been emphasised across countries and cultures in the literature. DESIGN: A descriptive, cross-sectional study. METHODS: Outpatients with an ostomy (n = 127) were recruited from proctology, wound and stoma therapy unit and general surgery clinics between January and 28 March 2020. The data were collected using the Socio-demographic Characteristics Form and Spiritual Care Needs Inventory (SCNI). SCNI has two components, namely 'meaning and hope' and 'caring and respect'. Descriptive statistics, correlation, Student's t test, ANOVA and multiple linear regression analyses were used to analyse the data. The STROBE checklist was used to report the study. RESULTS: The mean scores of the spiritual care needs (65.31 ± 12.83), meaning and hope (37.35 ± 9.37), and caring and respect (27.96 ± 5.63) of the patients with ostomy were found to be moderate. The most significant factors affecting the meaning and hope component were the age, being female and decreases in the level of income. Scores of the patients who perceived the severity of the disease seriously and who practiced religious ritual regularly had more spiritual care needs for the component of caring and respect. Patients with ostomy needed interaction, respect for their privacy and dignity, to be shown concern and to be respected for their religious and cultural beliefs, which were the most salient needs. CONCLUSIONS: There is an unambiguous requirement for nurses to ensure spiritual care for patients with ostomy. Showing interest and spending time for the interaction with patients with ostomy, need-based spiritual practices and life review are key elements of spiritual care. RELEVANCE TO CLINICAL PRACTICE: Evaluating patients with ostomy spiritually requires information about how spiritual needs may arise and how to talk about spiritual needs. The result of the present study may help nurses to begin the process of maintaining spiritual care for patients with ostomy.

Ostomy Complications, Risk Factors, and Applied Nursing Care: A Retrospective, Descriptive Study.

PURPOSE: This study aimed to describe the frequency of colostomy and ileostomy complications and types of nursing interventions as well as to examine patient and ostomy variables associated with early and late complications. METHODS: The records of 572 patients who received ostomy care from a wound ostomy care (WOC) nurse between 2013 and 2017 were abstracted. Patient demographic and ostomy variables, early period (< 30 days after surgery) and late period (> 30 days after surgery) complications, as well as documented nursing interventions were retrieved. Percentages and rates, chi-square statistics, and logistic regression were used to analyze the data. RESULTS: The mean patient age was 59.1 years (standard deviation [SD], 13.86), and the majority of patients were male (302 patients; 52.8%), married (454; 79.4%), and had a temporary (438; 76.6%) end colostomy (253; 44.2%). One (1) or more complications developed in 323 patients (56.5%) in the early period and in 207 patients (36.2%) in the late period. The most common complications in the early period were peristomal irritant contact dermatitis (PICD) (181; 31.6%) and mucocutaneous separation (135; 23.6%). PICD was also the most common complication in the late period (149; 26%). The risk of PICD was significantly higher in patients with a body mass index > 24.9 kg/m2 (odds ratio [OR] = 1.547), who had an ileostomy (OR = 1.654), or a temporary ostomy (OR = 1.728). Variables associated with an increased risk of mucocutaneous separation included obstacles to ostomy care (OR = 2.222), having an end ostomy (OR = 2.171), and ostomy height < 10 mm (OR = 1.964). Complications were treated by the WOC nurse in 67.5% of patients, and the most common intervention was application of skin barrier powder and wipe layers. CONCLUSIONS: The rate of ostomy complications, especially PICD and mucocutaneous separation, in this study was high. Results confirm that patient and ostomy characteristics might significantly affect the risk of complications. The findings support the importance of outpatient follow-up by a WOC nurse. Explorative or randomized controlled studies are needed to identify optimal nursing strategies to decrease complication rates.

Examination of nursing drug administration practices via central venous catheter: An observational study.

AIM: To determine the compliance with nursing drug administration procedure steps associated with access to the central venous catheter for bolus infusion in intensive care units. METHODS: This observational study was conducted with 30 nurses working in an intensive care unit of a university hospital. The drug administrations practiced by nurses via central venous catheter were monitored simultaneously at 12:00 a.m., 02:00 p.m., and 06:00 p.m. by two observers. The data were collected using a data collection form and central venous catheter drug administration procedure steps. RESULTS: A total of 90 different drug administrations were observed in three different treatment hours from 30 nurses. The interobserver conformity was found to be moderate in two steps (kappa = 0.520-0.627, P = 0.01) and perfect in all other steps (kappa = 0.821-1.000, P = 0.000). According to the drug administration procedure steps via a central venous catheter, all nurses applied the following steps correctly during all treatment hours: drug card control, preparation of treatment materials, checking the patient's identity, and steps of drug treatment administration. The following tasks were frequently performed incorrectly or not at all: hand hygiene (before treatment 87.8%; after treatment 82.2%), scrubbing the three-way stopcock entrance with an alcohol swab (55.6%), waiting for the alcohol to dry (81.1%), and flushing the lumen with a compatible fluid (before treatment 84.4%: after treatment 75.6%). CONCLUSION: Observation of drug administration procedure steps via central venous catheter according to the treatment hours showed that the nurses performed many incomplete or inaccurate drug administration procedure steps and the mistakes increased toward the evening hours.

Relationships Among Spiritual Well-being, Adjustment, and Quality of Life in Patients With a Stoma: A Cross-sectional, Descriptive Study.

Individual spiritual preferences and adjustment to a stoma may affect quality of life. PURPOSE: This study aimed to investigate the relationship among and the factors that influence spiritual well-being, adjustment to a stoma, and quality of life in patients with a stoma. METHODS: A cross-sectional, descriptive study was conducted over 6 months among outpatients with a stoma recruited from general surgery and enterostomal therapy clinics of a university hospital in Turkey. Turkish-speaking patients who were at least 18 years of age and had a colostomy or ileostomy for at least 2 months were eligible to participate. Participants independently (or with researcher help if necessary) completed the Sociodemographic Characteristics Form; the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp) that utilized 5-point, Likert-style responses to items regarding meaning, peace, and faith (score range 0-48; higher scores indicate more spiritual well-being); the 23-item Ostomy Adjustment Scale that utilized 5-point, Likert-style responses to items regarding acceptance worry, social adjustment, and anger (score range 0-92; higher scores indicate better adjustment); and the 21-item Stoma Quality of Life Scale that used a combination of scoring methods (score range 0-100; higher scores imply better quality of life) and Likert-style questions. Data were transferred without patient names from the questionnaires directly into a software program for analysis. Descriptive statistics, correlation, and hierarchical regression analyses were applied. RESULTS: Of the 95 participants (52 [54.7%] men; mean participant age 56.54 ± 13.74 years), mean scores were 31.66 ± 7.39 for spiritual well-being, 51.73 ± 12.28 for adjustment to a stoma, and 55.27 ± 16.45 for quality of life. A statistically significant difference was found between the mean spiritual well-being and quality-of-life (r = 0.525, P <.001) and adjustment to a stoma (r = .549, P <.001) scores, and a significant relationship was noted between the mean quality-of-life and adjustment scores (r = 0.698, P <.001). Stoma adjustment and quality of life significantly correlated with the meaning and peace subscales of FACIT-Sp (P <.001). No correlation was found between faith or stoma adjustment and quality of life. Hierarchical regression analysis showed the most significant factors affecting quality of life were adjustment to a stoma (ß = .541) and spiritual well-being (ß = .190). CONCLUSION: Adjustment and spirituality are important quality-of-life factors in patients with a stoma. Clinical assessments and practices should include the meaning and peace aspects of spiritual well-being and how well the patient is adjusting to the stoma. Well-designed randomized controlled studies that evaluate the impact of the spiritual dimension of nursing care on patient outcomes as well as the effect of spiritual well-being on adjustment to stoma are suggested.

The effects of preoperative aromatherapy massage on anxiety and sleep quality of colorectal surgery patients: A randomized controlled study.

AIMS: To examine the effects of aromatherapy massage on anxiety and sleep quality in patients undergoing colorectal surgery in the preoperative period. BACKGROUND: In recent years, there has been an increase in the number of studies conducted on aromatherapy massage. It is stated that studies conducted on aromatherapy massage for anxiety and sleep quality reveal contradictory results and that more research is required on the issue. DESIGN: A randomized controlled trial. METHODS: Eighty patients undergoing colorectal surgery were randomly assigned to experimental and control group. To the experimental group (n = 40), aromatherapy massage was applied in accordance with the "Back Massage Guide" using 5% lavender oil (Lavandula Hybrida) for ten minutes before surgery and the morning of surgery. The control group received standard nursing care in compliance with the hospital procedure. Data were obtained by the State Anxiety Inventory (SAI) and Richard-Campbell Sleep Questionnaire (RCSQ). Results were analyzed using the t-test, Chi-square test or Fisher's exact test. RESULTS: There was no baseline difference between the groups. A statistically significant difference was found between the experimental and control group in terms of the SAI and RCSQ mean scores recorded on the morning of surgery. It was determined that the SAI and RCSQ mean score of the experimental group after aromatherapy massage on the morning of surgery decreased when compared to that of the evening before surgery. CONCLUSIONS: It was found that aromatherapy massage with lavender oil increased the sleep quality and reduced the level of anxiety in patients with colorectal surgery in the preoperative period.