Effect of an Audible Alarm on the Fluid Consumption of Older Adults Living in a Nursing Home: A Randomized Controlled Trial.

The aim of the current study was to investigate the effect of an audible alarm on fluid consumption among older adults living in a nursing home. This single-blind, randomized controlled, prospective experimental study was performed between July 27, 2017, and February 1, 2018. This study comprised 100 participants (intervention group, n = 50; control group, n = 50). The amount of fluid consumed by older adults in the intervention group in relation to the audible alarm increased significantly compared to the control group, and the deficiency of fluid consumption decreased. It was determined that the wristwatch with audible alarm was effective when used as a reminder to increase fluid consumption among older adults with fluid deficiency. [Journal of Gerontological Nursing, 48(9), 39-46.].

The effect of oropharyngeal aspiration before position change on reducing the incidence of ventilator- associated pneumonia.

The aim of this study was to investigate the effect of oropharyngeal aspiration on ventilator-associated pneumonia (VAP) incidence just prior to changing patient position. This randomized controlled experimental study was conducted between July 2015 and April 2019 in anesthesiology and reanimation of intensive care unit (ICU). The patients of experimental group underwent oropharyngeal aspiration under surgical aseptic conditions before each position change. Patients of the control group received oropharyngeal aspiration only as needed. The mean age of the patients was 62.87 ± 17.33 years. The mean and median duration of stay in the ICU were 27.28 ± 30.69 and 18.00 days respectively. The mean and median of duration of the mechanical ventilation support were 26.72 ± 30.65 and 18.00 (min 4; max 168) days respectively. Thirty percent of the patients were VAP. The mean duration of VAP development was 7.50 ± 5.07 days. The rate of VAP development was 11.23/1000 mechanical ventilator days. Only 8.3% of the experimental group patients developed VAP; 91.7% of the control group patients developed VAP. The VAP rate in the control group was 16.82/1000 mechanical ventilator days and the VAP rate in the experimental group was 2.41/1000 mechanical ventilator days. Most VAP agents were multidrug resistant. Distribution of isolated microorganisms was as Acinetobacter baumannii, Pseudomonas aeruginosa, Corynebacterium striatum, Staphylococcus aureus, Providencia stuartii, Serratia marcescens, Stenotrophomonas maltophilia, and Aspergillus flavus. In our study, it was concluded that oropharyngeal aspiration performed prior to patient position change prevented the development of VAP.

Effect of polyethylene cover on the treatment of exposure keratopathy in ICU.

BACKGROUND: Exposure keratopathy may lead to serious complications such as microbial keratitis, corneal perforation, and visual impairment if not treated. AIM: To compare the effect of carbomer eye drops when used alone and in combination with polyethylene covers in the healing of exposure keratopathy. METHODS: A single blind randomized-controlled trial (RCT) in two intensive care units (ICUs) was carried out in a university hospital in Western Turkey between September 2011 and December 2012. The control group received only carbomer, eye drops while the intervention group received both carbomer eye drops and polyethylene covers. The primary outcome was the decrease or absence of corneal damage, which refers to healing. Corneal damage was followed up with a fluorescein dye test (decrease/absence of the corneal staining) by the same ophthalmologist for 10 days. RESULTS: A total of 43 corneas in 24 patients were studied. Corneal epithelial defects decreased in the intervention group by day 2 and progressed or remained unchanged in the control group every day (P = .001). Patient characteristics did not affect the grade ranges of corneal staining in the groups except for level of consciousness. CONCLUSION: Carbomer eye drops, when used in combination with polyethylene covers, were effective in managing exposure keratopathy. RELEVANCE TO CLINICAL PRACTICE: Corneal damage and further ocular complications can be reduced with the utilization of polyethylene covers in nursing care and treatment.

Effect of the Buzzy Application on Pain and Injection Satisfaction in Adult Patients Receiving Intramuscular Injections.

AIM: The aim of this study was to investigate the effect of the Buzzy application on pain and satisfaction during injections. BACKGROUND: Intramuscular injections usually cause some degree of pain at the injection site. Patients are often afraid of receiving injections because they perceive that it will be painful. DESIGN: The study was a single-blind, randomized controlled trial. METHOD: Patients (n = 65) who receive diclofenac sodium intramuscularly at a state hospital in a city in the western region of Turkey were included in the study. The study data were collected by The Patient Information Form and Visual Analog Scale (VAS). Pain intensity and injection satisfaction scores were evaluated using the VAS. RESULTS: According to the findings of this research, the post-injection pain intensity and injection satisfaction scores of patients in the application group were found to be higher than in the control group. CONCLUSION: In conclusion, the Buzzy device has the potential to reduce injection related pain in adult patients who may be fearful of receiving such injections.

Ethical Decision Making Levels of Nursing Students.

OBJECTIVE: The present study was conducted to determine nursing students' levels of ethical decision-making. METHODS: The sample of the descriptive study consisted of 240 nursing students. The data were collected using the Student Information Form and "Nursing Dilemma Test". RESULTS: It was found that Principled Thinking (PT) mean score (48.38±7.97) of nursing students was above average while their Practical Consideration (PC) mean score (17.87±4.13) was close to average. It was also determined that the nursing students participated in the study were not familiar (17.75±2.77) with the dilemmas included in the Nursing Ethical Dilemma Test. CONCLUSION: The students paid attention to consider ethical principles when making decisions about ethical dilemmas; however, they are also affected by environmental factors as well. Sex and class level were found to be influential in the process of ethical decision making.

Examination of intensive care unit patients' oral health.

BACKGROUND: Oral health problems are common complications that most intensive care unit patients experience. There are many factors that affect oral health negatively and nurses have important responsibilities in this regard. AIM: The aim of this study was assessment of the intensive care unit patients' oral health and risk factors. METHODS: This study was planned as a descriptive study and conducted between December 2015 and June 2016, with 202 patients in 20 intensive care units of 6 hospitals in Turkey. Data were collected via Data Collection Form and Bedside Oral Exam guide. Oral health assessment of patients was made using a source of light and a tongue depressor. RESULTS: We observed a significant difference in score of the Bedside Oral Exam guide by age, consciousness, type of respiration and feeding, the frequency of oral health, the total number of drugs, and technique of oral care (P < 0.05). None of the intensive care units were using the oral assessment guide. CONCLUSION: The result of this study shows that there are various risk factors that adversely affect the oral health of intensive care unit patients. Nurses should undertake assessments on the basis of oral care protocols for patients at risk and carry out evidence-based individualized oral care applications.

Effects of Cold Therapy on Pain and Breathing Exercises Among Median Sternotomy Patients.

The most painful activities during the days following cardiac surgery are coughing and deep breathing exercises. Cold therapy is an effective nonpharmacological method that decreases the pain during coughing and mobilization. In this study, the effects of cold therapy on pain and breathing exercises among patients with median sternotomy following cardiac surgery were investigated in a randomized crossover clinical trial. Data were collected from patients with median sternotomy (N = 34) in the first two postoperative days. Because of the crossover design of the study, each patient was taken as a simultaneous control. Gel pack application was used as the cold therapy. Patients underwent four episodes of deep breathing and coughing exercises using an incentive spirometer (volumetric). Patients were evaluated according to the visual analogue scale for pain intensity before and after deep breathing and coughing exercise sessions. The pain score was 3.44 ± 2.45 at baseline for deep breathing and coughing exercises on the first day. The reported postoperative pain in the gel-pack group was not significantly different before and after the deep breathing and coughing exercises, but it significantly increased in the no-gel-pack group (p < .001). Although the interaction between the treatment and time was significant (partial eta-squared: .09), the gel-pack group had a lower change in average pain levels. This interaction was not significant in terms of spirometric values. In conclusion, cold therapy had a positive effect on pain management in the early period of post-cardiac surgery but was not effective for the pain associated with breathing exercises.

Assessment of individualized nursing care in hospitalized patients in a university hospital in Turkey.

AIM: This study was planned to evaluate the perceptions of individualised nursing care of hospitalised patients in an orthopaedics and traumatology clinic. BACKGROUND: Nurses who have adopted the individualised care approach are aware that their patients are unique individuals in their own right and plan their programme of care together with the patient, taking into consideration the patient's own experiences, behaviour, thoughts and perceptions. METHOD: The sample in this cross-sectional study consisted of 151 patients. Patients' awareness and perception about individualised nursing care was evaluated using an Individualised Care Scale. RESULT: The mean score of the study population in the Individualised Care Scale-A section was 3.41 ± 1.23; the mean score in the Individualised Care Scale-B section was 3.72 ± 1.15. No significant association was found between Individualised Care Scale and the subscales in terms of the patients' gender, age, education, employment, the presence of a history of hospitalisation, the existence of a chronic illness and self-sufficiency. CONCLUSION: Patients had lower levels of awareness and perception about nursing actions designed to support patients' individuality in their personal life situations. IMPLICATIONS FOR NURSING MANAGEMENT: In order for nursing care to be wholly individualised, nurses should not overlook patients' individuality in their personal life situations.

Interruption of the medication preparation process and an examination of factors causing interruptions.

AIM: This study was conducted in an attempt to examine the number and duration of interruptions during the medication preparation process and to identify the factors causing these interruptions. BACKGROUND: Interruptions during the medication preparation process can cause medication errors owing to nurses' lack of attention. METHOD: A descriptive study was conducted at the Internal Diseases and General Surgery services of a university hospital between 15 June 2012 and 30 July 2012. The data were collected using the 'Observation Form of Preparing Medication.' RESULT: A total of 122 observations were made in the study. It was found that there was an interruption during the process of preparing medication in 95.9% of observations. The average number (±SD) of interruptions was 5.8 ± 4. The individuals causing the interruption during medication preparation were primarily nurses working in the same service. Receiving from or giving materials to the treatment room were the main reasons for the interruptions. CONCLUSION: This study found a very high interruption rate during the process of preparing medications. IMPLICATIONS FOR NURSING MANAGEMENT: As interruptions during medication preparation can cause medical errors, in-service teaching should be provided to raise awareness for this important issue. The findings of the study can be useful for enhancing the conditions of the physical environment, separating the treatment rooms and using the treatment rooms only for preparing medication.

Effects of Reiki on Post-cesarean Delivery Pain, Anxiety, and Hemodynamic Parameters: A Randomized, Controlled Clinical Trial.

The aim of this study was to investigate the effect of Reiki on pain, anxiety, and hemodynamic parameters on postoperative days 1 and 2 in patients who had undergone cesarean delivery. The design of this study was a randomized, controlled clinical trial. The study took place between February and July 2011 in the Obstetrical Unit at Odemis Public Hospital in Izmir, Turkey. Ninety patients equalized by age and number of births were randomly assigned to either a Reiki group or a control group (a rest without treatment). Treatment applied to both groups in the first 24 and 48 hours after delivery for a total of 30 minutes to 10 identified regions of the body for 3 minutes each. Reiki was applied for 2 days once a day (in the first 24 and 48 hours) within 4-8 hours of the administration of standard analgesic, which was administered intravenously by a nurse. A visual analog scale and the State Anxiety Inventory were used to measure pain and anxiety. Hemodynamic parameters, including blood pressure (systolic and diastolic), pulse and breathing rates, and analgesic requirements also were recorded. Statistically significant differences in pain intensity (p = .000), anxiety value (p = .000), and breathing rate (p = .000) measured over time were found between the two groups. There was a statistically significant difference between the two groups in the time (p = .000) and number (p = .000) of analgesics needed after Reiki application and a rest without treatment. Results showed that Reiki application reduced the intensity of pain, the value of anxiety, and the breathing rate, as well as the need for and number of analgesics. However, it did not affect blood pressure or pulse rate. Reiki application as a nursing intervention is recommended as a pain and anxiety-relieving method in women after cesarean delivery.

Assessment of the Oral Health Status of Patients Admitted to Pediatric Intensive Care Units: A Cross-Sectional Study.

BACKGROUND: It is important to detect oral health problems early among patients admitted to pediatric intensive care units to establish the diagnosis and consequently allow nurses to plan appropriate oral care practices. OBJECTIVES: The study aimed to assess the oral health status of patients admitted to pediatric intensive care units. METHODS: This descriptive cross-sectional study was conducted from June to September 2021 in the pediatric intensive care units of 3 hospitals. A total of 88 children were included in the study. An intraoral assessment was performed using a tongue depressor and a flashlight, and data were collected using a patient information form and the Oral Assessment Guide (OAG). RESULTS: The mean OAG score was 8.45 ± 2.876 points. A significant difference was found in the OAG score between the patients 60 months or younger and those 61 months or older (P < .05). The OAG score was significantly associated with the use of diuretics (P < .05) and the frequency of oral care (P < .05). A negative relationship was found between the OAG score and the Glasgow Coma Scale score (P < .05). CONCLUSIONS: The oral health status of the patients worsened as their age increased, and their state of consciousness decreased. Oral care was more frequently applied to the patients who received artificial respiration. The study provides evidence-based data regarding the early detection of the factors threatening oral health and the necessary precautions.

Factors affecting experiences of intensive care patients in Turkey: patient outcomes in critical care setting.

OBJECTIVES: To determine the factors affecting a patient's intensive care experience. METHODS: The descriptive study was conducted at an intensive care unit in the Aegean Region of Turkey, and comprised 158 patients who spent at least 48 hours at the unit between June and November 2009. A questionnaire form and the Intensive Care Experience Scale were used as data collection tools. SPSS 11.5 was used for statistical analysis of the data. RESULTS: Of the total, 86 (54.4%) patients related to the surgical unit, while 72 (45.5%) spent time at the intensive care unit. Most of the subjects (n=113; 71.5%) reported that they constantly experienced pain during hospitalisation. Patients receiving mechanical ventilation support and patients reporting no pain had significantly higher scores on the intensive care experience scale. Patients who reported pain remembered their experiences less than those having no pain. CONCLUSIONS: Interventions are needed to make the experiences of patients in intensive care more positive.

Oral care practices of intensive care nurses: a descriptive study.

The aim of this study was to investigate intensive care unit (ICU) nurses' views and practices on oral care and to define the factors related to oral care measures. A study was carried out in eight ICUs of a teaching hospital in 2008. One hundred one nurses constituted the study sample. The data were collected using 'Oral Care Practices Survey' which included demographic characteristics (5 items) and current oral care practices (13 items). Oral care was given the highest priority by nearly 60% of the nurses. The most commonly used solution was sodium bicarbonate (79.2%), and the most frequently used equipment was foam swab (82.2%). Oral care was carried out less than every 4 h per day by 44.5% of the nurses. The oral care products and solutions were reported to be different in almost every unit. The relationship between the use of toothpaste and the place of employment was statistically significant (x(2) = 24.566, d.f. = 6, P = 0.000). There was a statistical significance between the clinics and frequency of oral care (x(2) = 81.486, d.f. = 42, P = 0.000). This study suggests that there is a wide variety of type and frequency of oral care measures among ICU nurses. Optimal oral care supported by evidence is an effective prevention method for eliminating oral complications.

Nursing diagnoses in elderly residents of a nursing home: a case in Turkey.

There are limited studies on nursing diagnoses of the elderly living in nursing homes worldwide. This study aimed to define the most frequent nursing diagnoses in the elderly residents of a nursing home elder care and rehabilitation center. Seventy-four elderly individuals were included in the study. Data were collected using the "Elderly Individual's Introduction Form" between April 2007 to August 2007. The content of the form was based on a guide to gerontologic assessment, and Gordon's Functional Health Patterns. The nursing diagnoses (NANDA-I Taxonomy II) were identified by the 2 researchers separately according to the defining characteristics and the risk factors. The consistency between the nursing diagnoses defined by the 2 researchers was evaluated using Cohen's kappa (κ). There was an 84.7% agreement about nursing diagnoses defined by the 2 researchers separately. The weighted kappa consistency analyses showed there was an adequate level of consistency (κ = 0.710), and the findings were significant (p < 0.0001). The most frequent diagnoses were ineffective role performance (86.5%), ineffective health maintenance (81.2%), risk for falls (77%), and impaired physical mobility (73%). The diagnosis of ineffective role performance was more frequent in patients with dementia (x(2) =10.993, df = 1, p = 0.001). There was a very significant relationship between dementia and the diagnosis of impaired verbal communication (x(2) = 32.718, df = 1, p = 0.0001). The relationship between mobility disorder and self-care deficit was also significant (x(2) = 19.411, df = 1, p = 0.0001). To improve quality in patient care, nurses should use nursing diagnoses with a systematic assessment and should help the elderly in health promotion or use of the maximum current potential.

The effect of abdominal massage on gastric residual volume: a randomized controlled trial.

This study is a randomized controlled trial aimed at determining the effects of abdominal massage on high gastric residual volume seen in patients intermittently fed with enteral nutrition through a nasogastric tube. The study also investigated consequent abdominal distension and vomiting complications. The study was carried out in a university hospital between January and December 2009. The sample included 40 intervention (abdominal massage) and 40 control subjects. Findings demonstrated that 2.5% of the subjects in the massage group and 30.0% of the subjects in the control group developed high gastric residual volume from enteral nutrition through a nasogastric tube. Abdominal circumference measurements of subjects on the first and last days demonstrated that 20% of the subjects in the control group and only 2.5% of the subjects in the massage group developed abdominal distension (p = .044). Vomiting was observed in 10% of the control subjects; no vomiting was observed in the intervention group. Findings suggest that nurses should apply abdominal massage to subjects receiving enteral feedings intermittently to prevent high gastric residual volume and abdominal distension.

Effectiveness of polyethylene covers versus carbomer drops (Viscotears) to prevent dry eye syndrome in the critically ill.

AIM: The purpose of this study was to compare the effectiveness of the polyethylene covers versus carbomer eye drops to prevent dry eye syndrome in intensive care unit patients. BACKGROUND: Concerns about eye care for critically ill patients remain an issue. Few studies have focused on the effect of polyethylene covers and eye drops. In addition, there are no studies comparing polyethylene covers and carbomer eye drops for critically ill patients. DESIGN: A prospective, randomised and contralateral eye study was conducted. METHODS: The study took place in an intensive care unit in 2007. Thirty-six eyes of 18 patients, who were under mechanical ventilation or unconscious for more than 24 hours in the intensive care unit, were studied. After examining the eyes of the patients with the Schirmer 1 test and fluorescein dye test, suitable patients were included in the study. One eye of the patient was randomly covered with a polyethylene cover every 12 hours, and carbomer drops were instilled on the other eye every six hours. All eyes were checked for an ocular surface abnormality by the same ophthalmologist everyday. The study interventions were continued until a defect was detected or for five days. Patients with a defect detected completed the study and were recorded as positive for the primary endpoint. Results. Carbomer drop was effective in prophylaxis of dry eye syndrome in only three of 18 patients, whereas polyethylene cover showed greater effect in 18 of 18 eyes at the end of the study (SD 0·3835, Z = -3·873, p < 0·001). A negative effect of greater rima palpebra in the resting position was observed in the efficacy of carbomer drop (r = -0·476, p < 0·05). CONCLUSION: This study suggests that a polyethylene cover is significantly effective in prevention of dry eye syndrome in intensive care patients. As an eye care intervention, the effectiveness of polyethylene cover should be supported by further studies. RELEVANCE TO CLINICAL PRACTICE: This study, which is an initial step in preventing dry eye syndrome in critically ill patients, also offers a new and effective eye care method in these patients.

Nursing diagnoses in patients having mechanical ventilation support in a respiratory intensive care unit in Turkey.

This research was carried out to find out the nursing diagnoses in patients who have mechanical ventilation support in a respiratory intensive care unit. The study was conducted with 51 evaluations of critically ill adult patients who underwent invasive and non-invasive mechanical ventilation therapy in 2008. Data collection was based on Gordon's 11 Functional Health Patterns, and nursing diagnoses were determined according to North American Nursing Diagnosis Association-International (NANDA-I) Taxonomy II. The nursing diagnoses were determined by two researchers separately. The consistency between the nursing diagnoses defined by the two researchers was evaluated by using Cohen's kappa (κ). Forty men (78.4%) and 11 women (21.6%) whose mean ages were 70.19 (SD = 8.96) years were included in the study. Nineteen subgroups of nursing diagnoses about safety/protection domain, and 15 subgroups about activity/rest domain were seen at different rates in the patients. There was a statistically significant difference between mechanical ventilation via tracheostomy or endotracheal tube and decreased cardiac output (d.f. = 1, χ(2) = 4.760, P = 0.029). The relationship between the length of time under mechanical ventilation and impaired physical mobility was considerably significant (d.f. = 3, χ(2) = 24.459, P = 0.000). It was found out that there was a high degree of agreement (96.8%) between the nursing diagnoses defined by the two researchers separately (κ = 0.936, SE = 0.08).

Analysis of the effect of lying on the ear on body temperature measurement using a tympanic thermometer.

OBJECTIVES: To evaluate the impact of lying on the ear on the measurement of body temperature by a tympanic thermometer. METHODS: Participants in the study were healthy young people of the Nursing Department of the College of Health, Izmir, Turkey. Sixty-eight participants who agreed to participate, and who had no discharge or infection of the ear and no upper respiratory tract infection, were included in the study. Immediately after the first temperature reading, measurement had been performed five times. Non-probability sampling method was used and the study was conducted in January 2007. RESULTS: Tympanic thermometer body temperature results were significantly higher (p < 0.05) when measurements were taken following lying on the ear compared to those when the subject did not lie on the ear prior to temperature measurement. CONCLUSIONS: There are significant differences in tympanic temperature caused by the subject lying on his or her ear. This is important to keep in mind during health workers' assessments.

Effectiveness of Biofeedback Therapy on Quality of Life in Patients with Dyssynergic Defecation Disorder.

BACKGROUND: The first option to be considered in the treatment of functional defecation disorder is to correct the dyssynergia. However, limited studies exist to show the effectiveness of biofeedback. OBJECTIVE: We evaluated the effect of biofeedback on the severity of constipation, quality of life, and anorectal manometry in patients with dyssynergic defecation in which the biofeedback method was applied. METHODS: Effectiveness of biofeedback method on the quality of life of 24 dyssynergic defecation patients according to Rome III criteria after clinical and balloon expulsion tests (BETs) and colonic transit time was measured. Data were collected with patient identification form, Bristol Stool Chart, Constipation Quality of Life Scale forms, Visual Analogue Scale, diaphragmatic breathing exercises form, constipation diary, and constipation biofeedback monitoring form. Dyssnergic defecation cases received 6-week biofeedback training. For the same timeframe, the control group had a catheter into the rectum without any intervention. RESULTS: Constipation severity was reduced in both groups before biofeedback to post-biofeedback (P < .05). Anal canal pressure, BET, colonic transit time, and quality of life significantly improved in biofeedback patients compared with controls. CONCLUSIONS: Biofeedback has a favorable effect on therapy and quality of life in dyssynergic defecation cases.

Comparison of the effectiveness of the virtual simulator and video-assisted teaching on intravenous catheter insertion skills and self-confidence: A quasi-experimental study.

BACKGROUND: With the advancement of technology, methods such as clinical scenarios, role playing, video demonstration and simulation are now used to develop psychomotor skills in nursing education. Virtual reality and video-assisted teaching are useful technologies for the development of skills and self-confidence. In the literature, there is a lack of studies comparing the effects of the two methods. OBJECTIVES: The aim of study is to compare the effect of the virtual simulator and video assisted teaching on the level of intravenous catheterization skills and self-confidence of nursing students. Thus, students are enabled to develop skills and work efficiently without the need for an instructor. METHODS: This study was a randomized controlled quasi-experimental study. A total of 60 students was included in the study (30 in the virtual simulator group and 30 in the video group). In the virtual simulator group, each student performed an intravenous catheter insertion in the virtual intravenous simulator. In the video group, each student watched a training video on the peripheral intravenous catheterization skill in a classroom setting. Each of the students' level of intravenous catheterization knowledge, psychomotor skill and self-confidence score was evaluated. RESULTS: Post-test knowledge scores was higher than pretest knowledge scores for both groups. There were no significant difference between the groups in terms of post-test scores. Students' scores of psychomotor skills were found to be higher in the virtual simulator group and self-confidence scores were similar in both groups. CONCLUSION: Teaching with the virtual simulator contributed to the students' skills more than the method used in the video training. Both methods are effective in the development of knowledge and self-confidence related to intravenous catheterization.