Perinatal outcomes following early prenatal diagnosis: insights from a single-center experience with Ebstein anomaly and tricuspid valve dysplasia.

PURPOSE: Ebstein anomaly (EA) and tricuspid valve dysplasia (TVD) represent uncommon congenital malformations of the tricuspid valve. The purpose of this study is to report on current perinatal outcomes of EA/TVD in our center and to investigate clinical and fetal echocardiographic predictors of perinatal mortality. METHODS AND RESULTS: We performed a retrospective study among fetuses diagnosed from January 2014 to December 2023. Clinical and echocardiographic data were obtained from hospital records of Research and Education Hospital. The primary outcome was perinatal mortality. Of 21 fetuses diagnosed, there were 1 lost to follow-up, 1 termination, and 7 demises. In the live-born cohort of 12 live-born patients, 2 died before discharge, yielding an overall perinatal mortality of 50%. The median gestational age at diagnosis was 23 for non-survivors and 24 weeks for survivors. Birth weight was lower in non-survivors (2430 g vs 2990 g). Tricuspid insufficiency severity varied insignificantly. Non-survivors exhibited higher rates of hydrops, functional atresia, and absent antegrade flow (p < 0.05). Two infants with severe tricuspid insufficiency and congenital abnormalities died postnatally. The limited dataset enables further analysis for a predictive model. Notably, all non-survivors displayed hydrops, functional atresia, and absent antegrade flow, hindering definitive determination of the most impactful parameter on survival estimation. CONCLUSION: Perinatal mortality remains notably elevated in fetuses with EA/TVD. The individuals at the highest risk are those with antegrade flow loss and functional atresia of pulmonary valve, this high-risk subgroup could benefit from targeted interventions, such as novel prenatal therapies or a more comprehensive perinatal approach involving optimized timing of delivery and postnatal interventional strategies.

Determination of Nursing Care Times Based on the Perroca Patient Classification Instrument in the Inpatient Oncology Unit: A Mixed Method Study.

OBJECTIVES: The aim of this study was to determine the daily nursing care times of hospitalized inpatient oncology unit patients according to degree of acuity using the Perroca Patient Classification tool. DATA SOURCES: This study used a mixed method sequential explanatory design. The "Nursing Activity Record Form" and "Perroca Patient Classification Instrument" were used for quantitative data collection, and direct observation was performed for 175 hours via time-motion study. Descriptive statistics, between-group comparison, and correlation analysis were used for data analysis. Using a semistructured questionnaire, qualitative data were collected from individual in-depth interviews with seven nurses who participated in the quantitative part of the study. Qualitative data were analyzed by thematic analysis. The reporting of this study followed GRAMMS checklist. CONCLUSIONS: As a result of the integration of quantitative and qualitative data, daily nursing care duration was determined as 2 to 2.5 hours for Type 1 patients, 2.6 to 3.5 hours for Type 2 patients, 3.6 to 4.75 hours for Type 3 patients, and 4.76 to 5.5 hours for Type 4 patients. The findings showed that in an inpatient oncology unit, nursing care hours increased as patients' Perroca Patient Classification Instrument acuity grade increased; thus, the instrument was discriminative in determining patients' degree of acuity. IMPLICATIONS FOR NURSING PRACTICE: Nurse managers can utilize this study's results to plan daily assignments that are sensitive to patient care needs. The results can also help nurse managers to identify relationships between nurse staffing and patient outcomes at the unit level, as well as to develop ways to analyze such relationships.

Assessment of the Psychometric Properties of the Online Education Student Satisfaction Scale: A Methodological Study.

Background and Purpose: Assessing student satisfaction is essential in evaluating the quality of education. The number of valid and reliable tools that measure students' satisfaction with online education is limited. This methodological study aimed to assess the psychometric properties of the online education student satisfaction scale. Methods: Eleven academicians from the nursing field provided expert opinions on content validity. Separate 25 students evaluated the language clarity of the draft scale. The study sample included 525 third- and fourth-year nursing students. Finally, a group of 30 nursing students different from the sample participated in the test-retest. The study created an item pool based on the recent literature. The researchers calculated the items' content validity rates and the scale's content validity index by taking the experts' opinions. In addition, item-total score correlation analysis, exploratory factor analysis, discrimination analysis, stability test, and internal consistency analysis were performed. Results: An item with a low-correlation value was excluded from the scale. The correlation coefficients of the remained items were between .536 and .811. In the second round of exploratory factor analysis, a five-factor structure emerged that explained 72.1% of the total variance. In addition, item discrimination, stability, and internal consistency test results ensured that the scale was valid and reliable. Conclusions: The online education student satisfaction scale with five subdimensions containing 28 items is a valid and reliable tool. Researchers, educators, and managers may use it to evaluate students' satisfaction with online education.

Effect of moral sensitivity on professional values of undergraduate nursing students: Mediating effect of empathic tendency.

BACKGROUND: The development of professional values in nursing students is an important issue for the nursing profession. However, the research on nursing students' professional values and its related factors is very limited. PURPOSE: This cross-sectional and correlational study aimed to examine the mediating effect of empathy between moral sensitivity and professional values. METHODS: This study was conducted with 328 second, third and fourth-year students. The participants completed an online survey consisting of the student information form, Modified Moral Sensitivity Questionnaire for Student Nurses, Empathic Tendency Scale and Nursing Professional Values Scale. RESULTS: The results showed that moral sensitivity affected undergraduate nursing students' professional values not only directly but also indirectly through empathic tendency. CONCLUSIONS: The results of the study show that moral sensitivity and empathic tendency support the acquisition of professional values in undergraduate nursing students. Nurse educators needs to realize that can be improved professional values by integrating moral sensitivity and empathic tendency in their curriculum.

Nurse performance: A path model of clinical leadership, creative team climate and structural empowerment.

AIMS AND OBJECTIVES: This study aimed to: (a) identify and examine the influence of clinical leadership, creative team climate (CTC) and structural empowerment (SE) on the nurse performance (NP) of clinical nurses in hospitals in Turkey, and (b) establish a model designed to verify the fit and effect of these factors. BACKGROUND: Nurse performance is a significant indicator of work efficiency, patient care quality and patient safety. Existing studies explaining the mechanisms that lead to higher nurse performance have been limited. DESIGN: This descriptive, cross-sectional study used relation prediction modelling and adhered to STROBE guidelines. METHODS: This study used an online survey to collect data from volunteered 664 clinical nurses working in hospitals in Turkey. The data were analysed using SPSS version 26.0 and the AMOS 24.0 program. Path analysis was used to verify/test the hypothetical model, and the fit was evaluated by χ2 /df, GFI, AGFI, NFI, CFI, IFI, RFI, TLI, RMR and RMSEA. RESULTS: The fit index of the modified path model was χ2 /df = 3.730, GFI = 0.904, AGFI = 0.892, NFI = 0.907, CFI = 0.923, IFI = 0.923, RFI = 0.906, TLI = 0.912, RMR = 0.078 and RMSEA = 0.064. Through creative team climate and structural empowerment, clinical leadership had the greatest standardised direct (ß = .35) and indirect (ß = .17) effects on clinical nurse performance, the final outcome variable. Creative team climate (ß = .23) and structural empowerment (ß = .19) also had a significant standardised direct effect on nurse performance. Clinical leadership, creative team climate and structural empowerment explained 39% of the total variance of nurse performance. CONCLUSIONS: This study shows that clinical nurse performance in hospitals was significantly influenced by clinical leadership, creative team climate and structural empowerment. The results suggest that intervention programmes considering these factors could be implemented to enhance nurse performance. RELEVANCE TO CLINICAL PRACTICE: Improved nurse performance requires strong clinical leadership, creative team climate and structural empowerment. Therefore, healthcare organisations may implement initiatives to enhance nurse performance by taking these factors into account.

Opinions and experiences of healthcare professionals regarding structured virtual patient visits in ICUs: A qualitative study.

OBJECTIVES: This study aimed to reveal the experiences of healthcare professionals regarding a structured Virtual Patient Visit (sVPV) program implemented in an ICU during the coronavirus disease 2019 (COVID-19) pandemic and to share the process of establishing the program. DESIGN: This qualitative, exploratory study was conducted using a semi-structured, in-depth interview method. SETTING: The study was conducted in a university hospital ICU in Turkey (where a sVPV program was implemented) and comprised one physician, eight nurses, and one clerk who volunteered to participate in the study. The data were evaluated with content analysis, and themes and sub-themes were determined. FINDINGS: Five themes and 13 subthemes were obtained: (1) an essential program during the pandemic, (2) contributing to patient's recovery, (3) family-centered care, (4) innovativeness, and (5) sustainability. CONCLUSION: The results show that the sVPV program is highly innovative and effective and contributed to positive patient outcomes and family-centered care practices during the COVID-19 pandemic. In addition, it was revealed that in order to conduct sVPVs effectively, organizational planning, such as legal processes, and the employment of experienced and competent healthcare professionals, should be well managed. CLINICAL RELEVANCE: A well-designed sVPV program specific to the setting alleviates anxiety among patients and family members, increases patient motivation and healing, and decreases the workloads of healthcare professionals. It is recommended that the sVPV program, which can be easily used during not only COVID-19 pandemics but also during other crises, be adopted in all ICUs and carried out by a dedicated nurse or healthcare provider.

Predicting work performance and life satisfaction of nurses and physicians: The mediating role of social capital on self-efficacy and psychological resilience.

PURPOSE: To examine the mediating role of social capital in the effects of self-efficacy and psychological resilience on nurses' and physicians' work performance and life satisfaction. DESIGN AND METHODS: In this cross-sectional study, data were collected using an online questionnaire. FINDINGS: Social capital had 0.04 indirect effects of general self-efficacy and psychological resilience on work performance, and accounted for 48% and 35% of the total effect, respectively. Social capital had 0.11 and 0.07 indirect effects of general self-efficacy and psychological resilience on life satisfaction, and accounted for 16% and 19% of the total effect, respectively. PRACTICE IMPLICATIONS: The study suggests the existence of social capital when nurses' and physicians' self-efficacy and psychological resilience affect their work performance and life satisfaction.

Why do nurses choose to stay silent?: A qualitative study.

AIM: This study aimed to explore nurses' views and experiences regarding remaining silent. BACKGROUND: Silence is a barrier for organizational improvement and can occur for many reasons; it cannot be simply defined as the opposite of speaking out. METHOD: An exploratory qualitative design was used for this study. Data were collected using semi-structured interviews in 2016 with 24 nurses who were recruited by using a snowball sampling method. RESULTS: Three themes emerged as a result of the thematic analysis: fear, silence climate and disengagement. The first theme contained three subthemes: avoidance of being seen as a troublemaker, financial loss and reluctance to reveal lack of ability or knowledge. The results indicated that nurses remained silent when they felt unsupported or psychologically unsafe in their work environment. CONCLUSION: Encouraging nurses to express their opinions is essential for creating a psychologically safe nursing work environment and an organizational climate that supports open communication. Because the majority of healthcare professionals are nurses, they can act as role models and change agents for other nurses if they are encouraged to share their ideas and opinions without fear of retribution.

The effect of structured virtual patient visits (sVPVs) on COVID-19 patients and relatives' anxiety levels in intensive care unit.

AIM AND OBJECTIVES: To determine the effect of structured Virtual Patient Visits (sVPVs) on the anxiety, satisfaction, hospital anxiety and depression levels of intensive care unit (ICU) COVID-19 patients and their relatives. BACKGROUND: There is no evidence regarding the direct effect of virtual patient visits in the ICU. DESIGN: The STROBE statement guided this study. This investigator-initiated, prospective and single-centre study included COVID-19 patients and their relatives in an adult ICU between July and December 2020. We implemented daily sVPVs between all patients and their relatives. The study's primary outcome was the daily anxiety levels of patients and relatives immediately before and after sVPVs. The secondary outcomes were as follows: 1) hospital anxiety (HADS-A) and depression (HADS-D) levels during admission to and after discharge from the ICU and 2) satisfaction levels regarding the ICU and sVPVs of patients' relatives. RESULTS: A total number of 301 daily sVPVs were conducted between 50 patients and their relatives. There was a significant difference between daily anxiety levels before and after sVPVs in both patients (2.97 vs. 1.49) and their relatives (5.70 vs. 3.53; p > .05). Whereas the anxiety levels of patients with basic face or high flow nasal cannula and non-invasive mechanical ventilation decreased statistically significantly more than those with IMV after a sVPV (p < .001), there was not a significant difference in decreased anxiety levels of patients' relatives according to the type of respiratory support provided to the patient (p > .05). HADS-A levels of relatives decreased statistically significantly after discharge/death. There was no statistically significant difference in HADS-A and HADS-D levels after discharge/death between the relatives of patients who died or did not die (p > .05). Furthermore, the overall ICU satisfaction rates were statistically significantly lower in relatives of patients who died than those who did not die (p < .05). CONCLUSION: Regardless of whether the patients were intubated, sVPVs reduced the anxiety levels of all patients and relatives. The sVPV programme offered emotional support to patients and family members, with high levels of satisfaction, as well as provided regular informative updates and the opportunity for daily visits or final goodbyes. RELEVANCE FOR CLINICAL PRACTICE: The sVPV programme is essential for all ICUs during the COVID-19 pandemic.

Effects of demographic, occupational, and practice environment variables on organizational silence among nurse managers.

AIM: To define nurse managers' organizational silence behaviors and examine the demographic, occupational, and practice environment factors that may influence their silence. BACKGROUND: Organizational silence is affected by organizational structures, policies and procedures, team structures, and practice environments. Whether nurse managers' behaviors affect the organizational silence and practice environment in particular has not been thoroughly studied. METHODS: This cross-sectional study was conducted using an online survey of 169 nurse managers working in a group of private hospitals in Turkey. Data were collected using the Nurse Manager Practice Environment Scale, the Organizational Silence Behavior Scale, and a questionnaire with 16 sociodemographic and job-related questions, and descriptive statistics, correlations, and regression analyses were used to analyze the data. RESULTS: Nurse managers exhibited acquiescent silence and silence for the protection of the organization. There was a negative correlation between scores on the two scales. Regression analysis showed that nurse managers' organizational silence was affected by the two subscales of nurse managers' practice environment and the ability to express opinions openly. CONCLUSION: Positive work environment and being able to express opinions comfortably decrease the level of organizational silence of nurse managers. IMPLICATIONS FOR NURSING AND HEALTH POLICY: In order to reduce organizational silence behaviors, along with open-door policies and a corporate culture where ideas can be expressed freely, health institutions should implement measures to ensure a positive work environment that empowers administrative leaders to create a culture of patient safety and culture of generativity. Regulating the roles and responsibilities of nurse managers at the institutional level and implementing appropriate nursing laws and regulations at the national level will facilitate changes to improve their management practices.

Determining nursing service management standards in Turkey: A Delphi study.

OBJECTIVE: To establish the current management standards needed by nurse managers in Turkey and to share the process of establishing standards. BACKGROUND: Relevant and utilizable nursing management standards are needed for effective and efficient nursing administration to achieve better outcomes in health care. METHODS: A three-round e-Delphi method was used in this study. First, the experts were asked an open-ended question. In the second and third rounds, data analysis measurements included item-by-item per cent agreement, standard deviation, average, median and interquartile range. RESULTS: At the end of the third round, 49 standards were obtained under five main standards for nurse managers: management and organisation; leadership; human resources management; quality management; and professionalism. CONCLUSION: The results of this study, which represent a consensus on nursing management standards drawn from the views of experts across regions and institutions in Turkey, provide a baseline to design, manage and evaluate nursing services. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management standards, which are fundamental for designing, leading and evaluating nursing services, give a framework for nurse managers to provide effective and efficient administrative practices.

The relationship between demographic and occupational variables, transformational leadership perceptions and individual innovativeness in nurses.

AIM: This study aimed to describe innovativeness among nurses and examine the impact of transformational leadership and demographic and occupational variables on individual innovativeness in nurses. BACKGROUND: Staff nurses must be innovative in order to solve problems occurring in health care environments and implement evidence-based practice. METHODS: This descriptive, correlational cross-sectional study comprised 300 nurses working in two hospitals in Turkey. The data were collected with a demographic and occupational questionnaire, the Individual Innovativeness Scale and the Transformational Leadership Scale. Data were analysed using descriptive statistics, Pearson's correlation and backward regression. RESULTS: Most nurses were categorized as "early majority" (45.3%) or "early adopter" (39.3%) for innovativeness. Education level, position, high self-perceptions of leadership skills and/or perceiving transformational leadership as a high-performance expectation were associated with high levels of individual innovativeness. CONCLUSION: Almost half of the nurses were early adopters who can be role models to other nurses in the diffusion of innovation. Having higher education levels, positions, leadership skills and expectations from management affected nurses' individual innovation more positively. IMPLICATIONS FOR NURSING MANAGEMENT: It can be helpful for nurse managers to understand the adopter categories and affective variables of innovativeness for the diffusion of innovative practices and evidence-based standards at hospitals.

The relationship between nurses' work-related variables, colleague solidarity and job motivation.

AIMS: The study was conducted to evaluate the effects of nurses' work-related variables and colleague solidarity on their job motivation. BACKGROUND: The motivation of nurses is an important measure in effective and efficient provision of health care services. METHODS: The sample of this descriptive study included 172 nurses working at a private hospital in Turkey. The Colleague Solidarity Scale for Nurses, Nurses' Job Motivation Scale, and Demographic and Work-Related Variables Questionnaire were used for data collection. Data were analysed using descriptive statistics, Pearson's correlation and backward multiple regression analysis. RESULTS: There was a positive correlation between the scores on the Colleague Solidarity Scale for Nurses and the Nurses' Job Motivation Scale (r: .56, p < .001). Of the nine independent variables evaluated in the multiple regression analysis, five had a significant effect on the job motivation of nurses (R2 : .39, p < .001, Durbin-Watson: 2.12). CONCLUSION: The results of the study show that the three sub-dimensions of the Colleague Solidarity Scale for Nurses, salary and career opportunities were important factors affecting job motivation. IMPLICATIONS FOR NURSING MANAGEMENT: In order to increase nurses' job motivation, nurse managers should work to improve collegial solidarity, create career opportunities and develop salary policies.

The transcultural adaptation and the validity and reliability of the Turkish Version of Perroca's Patient Classification Instrument.

AIM: This study examines the transcultural adaptation and the reliability and validity of the Turkish version of Perroca's Patient Classification Instrument. BACKGROUND: Nurse managers need valid and reliable patient classification tools for determining patients' acuity or dependency levels on nursing care for measuring nursing workloads. METHODS: This study was conducted in two stages in a private hospital in Istanbul, Turkey. First, the instrument was translated, and its content validation was analysed. In the second stage, data were gathered from 300 hospitalized patients and were analysed by factor analyses, Cronbach's alpha and Cohen's kappa. RESULTS: Validity testing with ten experts revealed a scale-content validity index of 0.93. Exploratory factor analysis revealed a two-dimensional instrument with distinct factor loadings and a variance of 66.97%. The confirmatory factor analysis revealed that the fit indices were satisfactory. This instrument had an overall Cronbach's alpha coefficient of .86 and Cohen's kappa coefficient of .826. CONCLUSION: The study provides evidence that the Turkish version of Perroca's Patient Classification Instrument is a valid and reliable tool to determine patients' acuity levels on nursing care. IMPLICATIONS FOR NURSING MANAGEMENT: This instrument may be used by nurse managers to determine acuity levels of patients and measure nursing workload.

Use of Team-Based Learning in a Nursing Leadership Course: An Action Research Study.

Team-based learning (TBL) is a learner-centered method widely used in health sciences education. The aim of this action research study was to determine the contribution of TBL to the learning experience of students participating in a nursing leadership course. The study was conducted in 2 cycles over 2 semesters, and TBL was embedded in regular class hours. Results suggest that TBL made positive contributions to student learning.

Intensive care units in Turkish hospitals: do they meet the minimum standards?

BACKGROUND: International and national standards for ICUs have been developed to ensure patient safety and provide effective and efficient service in these units. However, global economic crises along with shortages in professional health care staff affect the ability of ICUs to meet and maintain these standards. AIMS AND OBJECTIVES: The aim of this study was to ascertain whether the equipment and workforce in intensive care units (ICUs) in Turkish hospitals meet current ICU standards. DESIGN: This is a descriptive study based on the results of a survey questionnaire. METHODS: In total, 145 ICUs in university and private hospitals in Turkey participated in this survey. Data collection was done by means of a survey questionnaire that assessed the current equipment and workforce in these ICUs. RESULTS: We found that 97·0% of the occupied beds in the ICUs had a cardiac monitor. Crash-carts were present in every ICU. Transport monitors and transport ventilators were available in two of three and in one of two ICUs, respectively. In 82·8% of the ICUs, a physician (as a trainee level) was present at all times, while only a few ICUs had ICU-care team members such as respiratory- and physiotherapist, clinical pharmacists and dieticians available. There was a general shortage of nursing staff in ICUs. CONCLUSION: Currently, ICUs in Turkish hospitals meet the majority of standards for ICU equipment, but they fail to meet both the international and national standards for ICU workforce requirement. CLINICAL RELEVANCE: Hospital and ICU managers could use our findings to compare their facilities with others or to identify areas in need of improvement.

Turkish critical care nurses' views on end-of-life decision making and practices.

BACKGROUND: Life-sustaining treatments are increasingly used in intensive care units (ICUs) for EOL care, but the decision to use these may cause ethical issues. AIMS AND OBJECTIVES: The aim of this study was to investigate the views and practices of critical care nurses in Turkey on the end-of-life (EOL) care. DESIGN: This was a cross-sectional study. METHODS: The research was conducted in 32 second- and third-level ICUs of 19 Ministry of Health research hospitals in Turkey. The Views of European Nurses in Intensive Care on EOL Care tool was used for data collection. RESULTS: The total sample size was 602. While half of the nurses stated that the withholding and withdrawal of life support were ethically different decisions, 40% felt both decisions were unethical. The expected quality of life as viewed by the patient, the medical team, the family and the nursing team (90·4%, 85·4%, and 83·4%, respectively) was an important factor in EOL decision making. The majority of the nurses (75·7%) were not directly involved in the EOL decision making and 78·4% of nurses were committed to family involvement in EOL decisions. When withdrawing treatment, 87·2% of ICU nurses agreed that the patient and family members should perform their final religious and spiritual duties. Further results showed that after withdrawing treatment, a majority of nurses (86%) agreed to continue pressure sore prevention, effective pain relief (85·5%), nutritional support (77·6%) and hydration (64·8%). Almost half (48·2%) indicated that keeping the patients in the ICU was unnecessary. CONCLUSION: ICU nurses expressed a range of experiences and practices regarding EOL care. ICU nurses should be more involved in the decision-making process about EOL care. RELEVANCE TO CLINICAL PRACTICE: Due to their unique relationship with patients, nurses should be involved in EOL care decision making; however, patients, families or nurses are not often involved in the decision-making process in Turkey.

Planning for the Size of the Nursing Staff at an Outpatient Chemotherapy Unit.

BACKGROUND: Use of a patient classification system particular to the unit, including size of nursing staff, is required for nurses to have adequate staffing and provide high-quality nursing care in oncology units. OBJECTIVES: The study was conducted to create a planning system for nursing staff size for an outpatient chemotherapy unit at a university hospital. METHODS: The study was conducted with the nurses working in an outpatient chemotherapy unit of a university hospital and patients who received five weeks of treatment. Patients were classified by using the Magnuson Model. Data related to job analysis were collected by two independent observers who made measurements with a stopwatch, in line with safety and quality standards on the chemotherapy units. FINDINGS: A total of 1,795 patients who received care at the outpatient chemotherapy unit were classified using the model. Based on the job analysis, on average, 17.12 nurses per day were needed to care for the patients.

Nurses' perceptions of and factors promoting patient safety culture in Turkey.

This descriptive and cross-sectional study included 561 nurses in hospitals located in Istanbul, Turkey. The Patient Safety Questionnaire was used for data collection. The type of hospital and the amount of education nurses obtained about patient safety and quality improvement were positively associated with patient safety culture. Conversely, the type of work unit negatively affected workers' behaviors and adverse event reporting in terms of patient safety culture.