The relationship between physical child abuse resulting from excessive crying in babies and mothers' perceived social support and mental well-being: A structural equation model.

In this study the researchers tested a conceptual model of the relationship between the perceived social support and mental well-being of mothers and their physically abusive behavior (slapping or shaking) toward babies who cry excessively. A structured questionnaire was employed to conduct a cross-sectional study. Between February and June 2021, research data were collected from 418 mothers with 0- to 12-month-old babies who cried at least 2 hours a day. The survey data were analyzed with a structural equation model. Perceived family support and mental well-being were significantly associated with physically abusive behavior that occurred in the form of slapping or shaking (ß1 = 0.401; ß2 = 0.471; p < 0.001). Mental well-being mediated the relationship between perceived family support and physically abusive behavior in the form of slapping or shaking (ß = 0.108; p = 0.002).

Home experiences of parents of children undergoing hematopoietic stem cell transplantation: A qualitative study.

PURPOSE: This study aimed to describe the home experiences of parents of children undergoing hematopoietic stem cell transplantation. DESIGN AND METHODS: This study was conducted using a descriptive qualitative research design. The study sample consisted of 12 parents with a child treated with hematopoietic stem cell transplantation (HSCT) at a university hospital in Turkey. Semi-structured individual interviews and researcher observations were used for data collection. The interview transcripts of the study were analyzed using content analysis. RESULTS: Five main themes were obtained, each of which had associated sub-themes: difficulties faced in home experiences, changes in family life, feelings about home experiences, parents' ways of coping with difficulties, and parents' suggestions. CONCLUSIONS: Parents faced various difficulties in their own home experiences, and they felt fear, anxiety and stress during this period. Following the child's HSCT, there were changes in health, physical, psychological and social aspects of family life. Some parents used distraction techniques, and the support of their spouses and health professionals to cope with difficulties. PRACTICE IMPLICATIONS: For pediatric nurses to comprehensively assess and support the home care needs of the child and parents, they should understand the difficulties parents face in home experiences, as well as their feelings, changes in their lives, suggestions regarding home experiences, and ways of coping. Regular health screening and psychosocial support can be provided for parents of children after HSCT, and regular training can be given for parents' management of care-related problems and increasing their self-efficacy for this management.

The effect of using maternal voice, white noise, and holding combination interventions on the heel stick sampling.

BACKGROUND: Heel stick sampling, a common procedure in newborns, causes acute pain. AIMS: This study aims to measure the outcome of five various non-pharmacologic pain relief groups; maternal voice, white noise, holding, maternal voice+holding, and white noise+holding. METHODS: The study is an open label, randomized controlled trial. A total of 178 newborns were included in this study. Newborns were randomly allocated to each group; white noise (n = 31), maternal voice (n = 31), holding (n = 30), white noise+holding (n = 29), maternal voice+holding (n = 28), and control (n = 29) interventions. Newborns' pain responses were evaluated using the Neonatal Infant Pain Scale (NIPS), and the Premature Infant Pain Profile (PIPP). The primary measured outcomes were the newborns' pain levels, while the secondary outcomes were the heart rate and changes in oxygen saturation. The mean values of pain in neonates between groups were evaluated one minute before (Phase1), during (Phase2), and one minute after (Phase3) the procedure. RESULTS: The research results are given with comparisons in three time periods (Phase1, Phase2 and Phase3). White noise and white noise+holding were found to have the lowest mean NIPS and PIPP score (p < 0.001). The mean heart rate was found to be the lowest in the white noise+holding group (p < 0.001). There was no significant difference between the groups in terms of oxygen saturation score (p = 0.453). CONCLUSION: The white noise+holding applied to newborns during heel stick sampling were effective in pain reduction. Nurses and midwives can use white noise+holding method. IMPLICATIONS TO PRACTICE: These results contribute to the pain management of newborns.

Effects of Comfort-Oriented Nursing Care Based on the Comfort Theory on Perioperative Anxiety and Fear in Children Undergoing Surgical Circumcision: RCT.

PURPOSE: This study explored the effect of comfort-oriented nursing care based on comfort theory on reducing perioperative anxiety and fear in children undergoing surgical circumcision. DESIGN: Randomized controlled trial. METHOD: The study was completed with the participation of children circumcised in a hospital in Turkey using the same surgeon, anesthesia, and surgical technique. A total of 120 children meeting the inclusion criteria and providing consent to participate in the study were randomly divided into two equal groups. The study was conducted between June and September 2019. The intervention group received comfort-oriented nursing care based on the comfort theory. The control group received routine nursing care. Data were collected using the Children's Anxiety Meter-State and Children's Fear Scale. Outcome variables were determined at seven measurement points, including baseline, five intermediate points, and at the follow-up visit on the 10th postoperative day. RESULTS: A statistically significant difference in the fear of the group receiving comfort-oriented nursing care based on comfort theory was noted compared with the control group. CONCLUSION: Comfort-oriented nursing care based on the comfort theory was effective in reducing perioperative anxiety and fear among children undergoing surgical circumcision. This study is important given that comfort-oriented nursing care based on the comfort theory may be applied to those receiving care in pediatric surgery.

Investigation of coronavirus anxiety and caregiving burden among the parents of children with cancer during the COVID-19 outbreak: A descriptive and cross-sectional study.

OBJECTIVE: This study aimed to investigate the coronavirus anxiety and caregiving burden of parents of children with cancer during the COVID-19 outbreak. METHODS: This descriptive and cross-sectional study, including 136 parents of children with cancer, was administered through an online survey at a university hospital from 1 to 31 January 2021. Participants completed a questionnaire form, the Zarit Caregiver Burden Scale and the Coronavirus Anxiety Scale. RESULTS: This study identified a significant difference in the caregiving burden scores of parents according to whether their relatives had been diagnosed with COVID-19, whether they were exposed to coronavirus in their environment and whether their children had other illnesses. A significant difference in the coronavirus anxiety scores of parents was observed according to their child's sex and the time elapsed since their child's cancer diagnosis. No correlation was identified between the Zarit Caregiver Burden Scale scores and the Coronavirus Anxiety Scale scores. CONCLUSION: Oncology nurses and other health professionals should be aware of and consider the factors that influence the caregiving burden and coronavirus-related anxiety experienced by parents of children with cancer during the COVID-19 outbreak.

The effect of a peer-assisted video-based training programme and counselling to reduce anxiety in children newly diagnosed with cancer: Non-randomised controlled trial.

OBJECTIVE: The aim of this study is to evaluate the effect of 'peer-assisted video-based education programme' (VTPA) and counselling to reduce anxiety in children newly diagnosed with cancer. METHODS: A non-randomised controlled trial design with repeated measures was conducted. The sample of the study consisted of 50 children between the ages of 9 and 18 who were newly diagnosed with cancer in the hospital. Intervention and control groups were created. Children in the intervention group received both VTPA training and counselling practice 3 days a week for 2 months. Data were collected with the State-Trait Anxiety Inventory for Children. The basal assessment in the research was the first meeting with the child, with interval assessments 1 month after, 2 months after and 3 months after the education. RESULTS: In the study, it was determined that the state anxiety mean scores of the children in the PAVEP and control groups differed over time (p < 0.05). However, it was determined that there was no difference between the trait anxiety mean scores of the children (p > 0.05). CONCLUSION: VTPA with peer assistance and counselling application supported the reduction of state anxiety in children newly diagnosed with cancer over time.

Effect of care programme based on Comfort Theory on reducing parental anxiety in the paediatric day surgery: Randomised controlled trial.

AIMS AND OBJECTIVES: The aim of the study was to determine the effect of a care programme based on the Comfort Theory on reducing parental anxiety forming during the perioperative process of paediatric day surgery. BACKGROUND: According to the Comfort Theory, nurses provide comfort and take precautions related to comfort, and they provide care and assistance by encouraging individuals/families/society and supporting coping methods. This study is the first randomised controlled study to test the effect of a nursing care programme based on the Comfort Theory for paediatric day surgery. DESIGN: Randomised controlled trial. METHODS: The research was completed from June-September 2019 with participation of parents whose children were undergoing paediatric day surgery at a hospital in the Mediterranean region of Turkey. A total of 120 participants were randomly assigned to two equal groups. The intervention group received care programme based on Comfort Theory. The control group received nursing care routinely provided in the clinic. Data were collected using the State-Trait Anxiety Inventory. Measures were obtained at six points, at baseline, at four interval observations after the initial point and during follow-up on the 10th postoperative day. The repeated measures ANOVA test and t-test for independent samples were used to compare the anxiety levels between the intervention and control groups. RESULTS: There was a statistically significant difference in favour of the group receiving the care programme based on the Comfort Theory when the anxiety levels between the intervention and control groups were compared. CONCLUSIONS: The care programme based on the Comfort Theory was effective in reducing parental anxiety forming in the perioperative process of paediatric day surgery. RELEVANCE TO CLINICAL PRACTICE: The results of this study show the applicability of the care programme for paediatric day surgery. It is recommended that this programme be introduced to nurses in paediatric day surgery.

Effects of mother-sung lullabies on vaccination-induced infant pain and maternal anxiety: A randomized controlled trial.

PURPOSE: This study aimed to investigate the effects of mother-sung lullabies during vaccination on vaccine-induced pain in infants and anxiety in mothers. DESIGN AND METHODS: Our team conducted a randomized controlled trial with two parallel groups between March 4, 2020 and August 28, 2020, at two family health centers in Turkey. This study included 60 healthy-term infants (lullaby group: 30, control group: 30) aged two months, who received the Bacillus Calmette-Guérin (BCG) vaccine, and their mothers. We used the Information Form, the Neonatal Infant Pain Scale, the Intervention Follow-Up Form (including heart rate, oxygen saturation, and crying duration), and the State Anxiety Inventory as data collection tools. RESULTS: Infants in the lullaby group had significantly decreased pain responses than those in the control group (p < .05). Further, singing a lullaby resulted in significantly reduced maternal anxiety in the lullaby group compared to the control group (p < .05). CONCLUSIONS: The lullaby singing method was effective for reducing infants' pain response and mothers' anxiety during vaccination. PRACTICE IMPLICATIONS: The lullaby method can be used to reduce pain during potentially painful procedures performed in infants and reduce anxiety in mothers. The study is registered under the ClinicalTrials.gov identifier NCT04692584.

The effect of Web-based preterm infant care training on mothers' self-confidence.

The internet can be used as an alternative method in infant care education for mothers of preterm infants. This study was conducted to examine the effect of the Web-based infant care training program given to mothers of preterm infants on the self-confidence levels of mothers. This nonrandomized controlled study with a posttest design was conducted in Ministry of Health training and research hospital and university hospital. The study group comprised 84 mothers and their infants (intervention group: N = 42; control group: N = 42). Mothers with preterm infants in the intervention group participated in the Web-based program. The self-confidence of the mothers was evaluated before and after the training. The mothers' Pharis self-confidence scale mean scores were higher than the control group, but there was no significant difference. Web-based education program can be an alternative method that can be used in the education of mothers with preterm infants.

The effect of delaying first bathing on skin barrier function in late preterm infants: A study protocol for multi-centre, single-blind RCT.

AIMS: The study aims to examine the effect of delaying first bathing on skin barrier function, body temperature, and neonatal comfort of late preterm infants. DESIGN: This study is a multi-centre, single-blind, prospective randomized controlled trial. METHODS: We attempt to report this randomized controlled trial to comply with the SPIRIT. The study population will consist of 80 late preterm infants born at three centres (hospitals) in Turkey. The study, between September 2020-September 2021 will be held in the Neonatal Intensive Care Unit. The participants will be randomly divided into two groups, each with different bathing times. The first group (N = 40) will be bathed between 24-48 hr after birth and the second group (N = 40) will be bathed between 48-72 hr after birth. Each group's intervention will be performed by a blinded researcher. The infants' transepidermal water loss, body temperature, and comfort level will be measured before the bath and again at three times after the bath. The measurements will be taken by a blinded researcher and blinded nurse. DISCUSSION: The benefits of infant bathing are known. However, the effect of delaying first bathing of late preterm infants on skin barrier function is unknown. At the same time, the effect of delaying bathing on maintaining body temperature and neonatal comfort is unknown. IMPACT: This study is expected to provide a piece of credible evidence of the delay of first bathing and benefit of neonatal care in this population. It is thought that postponing bathing time of late preterm infants to 48-72 hr after birth will lead to a protective effect on skin barrier and temperature. It will be performed in clinical practice if it can effectively improve transepidermal water loss and heat loss. TRIAL REGISTRATION: It was registered at ClinicalTrials.gov in January 2020 (NCT04231799).

Determination of methods used by the neonatal care unit nurses for management of procedural pain in Turkey.

OBJECTIVE: To determine the pharmacological and non-pharmacological methods used by neonatal intensive care unit nurses to reduce procedural pain. METHODS: The cross-sectional study was conducted from September 2011 to June 2012 and comprised nurses employed in the paediatric departments, consisting of neonatal intensive care units and newborn units, of 15 hospitals in various cities of Turkey: 8 in Istanbul, 3 in Izmir and two each in Antalya and Edirne. Data was collected using a questionnaire and analysed using SPSS 15. RESULTS: The mean age of the 486 nurses was 28.19±5.14 years; 316(65%) had bachelor's degrees; 278(57.2%) had nursing experience greater than 6 years; and 322(72.5%) had newborn nursing experience greater than 6 years. Overall, 364(74.9%) nurses used non-pharmacological methods, and 145(29.8%) used pharmacological methods for pain relief. The most commonly used non-pharmacological methods were skin touch 364(75%) and giving a pacifier 269(55.3%). The most commonly used pharmacological methods were paracetamol and ibuprofen by 145(29.8%) nurses. A statistically significant difference was found between the level of education and use of pharmacological and non-pharmacological methods for pain relief (p< 0.05). CONCLUSIONS: Among the nurses in both groups, very little pain management was used for invasive procedures. Educational programmes for pain management in newborns should be arranged to develop an institutional culture. Guidelines for these patients' pain management should also be established.

The Relationship Between Digital Game Addiction and Levels of Anxiety and Depression in Adolescents Receiving Cancer Treatment.

BACKGROUND: Adolescents diagnosed with cancer are vulnerable to symptoms of anxiety, depression, and posttraumatic stress. OBJECTIVE: To examine the relationship between digital game addiction and levels of anxiety and depression in adolescents receiving cancer treatment. METHODS: This analytical cross-sectional study was carried out with 120 adolescents aged 12-17 years who were receiving cancer treatment. Data were collected using the Digital Game Addiction Scale (DGAS-7) and the Hospital Anxiety and Depression Scale (HADS). Data were analyzed using independent-samples t test, 1-way analysis of variance, Pearson correlation analysis, and simple linear regression. RESULTS: The mean age of the adolescents participating in the study was 15.21 ± 1.64 years. The mean DGAS-7 score was 15.19 ± 5.58, whereas the mean HADS Anxiety subscale score was 8.54 ± 4.33, and the mean HADS Depression subscale score was 7.72 ± 3.96. A positive, statistically significant relationship was found between the DGAS-7 mean score and the HADS Anxiety and Depression subscale mean scores (P < .001). CONCLUSIONS: As the addiction levels increased in adolescents diagnosed with cancer, their anxiety and depression levels also increased. IMPLICATIONS FOR PRACTICE: Health professionals should be mindful that in adolescents diagnosed and treated for cancer, digital game addiction and levels of anxiety and depression may mutually reinforce each other.

Turkish pediatric surgical nurses' knowledge and attitudes regarding pain assessment and nonpharmacological and environmental methods in newborns' pain relief.

Effective pain management requires accurate knowledge, attitudes, and assessment skills. The purpose of the present study was to describe Turkish pediatric surgical nurses' knowledge and use of pain assessment and nonpharmacologic and environmental methods in relieving newborn's pain in hospital. The sample consisted of 111 pediatric surgical nurses employed in pediatric surgical unit in 15 university hospitals located in Turkey. A questionnaire was used to measure the nurses' knowledge and use of pain assessment, nonpharmacologic, and environmental methods. Data were analyzed with the use of descriptive statistics. Of the nurses that participated in the study, 83.8% were between the ages of 20 and 35 years, 54.1% had a bachelor degree, and 75.7% had a nursing experience ≤10 years. 50.5% stated that physiologic and behavioral indicators used in the assessment of pain in infants. The most commonly used nonpharmacologic methods were giving nonnutritive sucking, skin-to-skin contact, and holding. The most commonly used environmental methods were avoiding talking loudly close to the baby, minimal holding, care when opening and closing of the incubator, avoiding making noise when using wardrobe, drawers, trash, or nearby devices, such as radio and television, avoiding sharp fragrances, such as alcohol, perfume, near the baby, and reducing light sources. Although Turkish pediatric surgical nurses used some of the nonpharmacological and environmental methods in infant's pain relief, there remains a need for more education about pain management and for more frequent use of these methods in clinical care.

Complementary and alternative medicine use in children with thalassaemia.

AIMS AND OBJECTIVES: The aims of this study were to: (1) determine the types of complementary and alternative medicine use among children with thalassaemia as reported by parents and (2) describe sociodemographic and medical factors associated with the use of such treatments in families residing in southern Turkey. BACKGROUND: Thalassaemia is one of the most common human genetic diseases. Despite the therapeutic efforts, patients will encounter a variety of physical and psychological problems. Therefore, the use of complementary and alternative medicines among children thalassaemia is becoming increasingly popular. DESIGN: This is a descriptive study of complementary and alternative medicine. METHODS: This study was conducted in the Hematology Outpatient Clinic at Akdeniz University Hospital and in the Thalassemia Centre at Ministry of Health Antalya Education and Research Hospital, Antalya, Turkey, between January 2010-December 2010. Parents of 97 paediatric patients, among 125 parents who applied to the haematology outpatient clinic and thalassaemia centre between these dates, agreed to take part in the study with whom contact could be made were included. Data were collected by using a questionnaire. RESULTS: The proportion of parents who reported using one or more of the complementary and alternative medicine methods was 82·5%. Of these parents, 61·8% were using prayer/spiritual practice, 47·4% were using nutritional supplements and 35·1% were using animal materials. CONCLUSION: It was determined that a significant portion of the parents using complementary and alternative medicine use it to treat their children's health problems, they were informed about complementary and alternative medicine by their paediatricians and family elders, and they have discussed the use of complementary and alternative medicine with healthcare professionals. RELEVANCE TO CLINICAL PRACTICE: To sustain medical treatment and prognosis of thalassaemia, it is important for nurses to consult with their patients and parents regarding the use and potential risks of some complementary and alternative medicine.

The effect of neonatal resuscitation training based on a serious game simulation method on nursing students' knowledge, skills, satisfaction and self-confidence levels: A randomized controlled trial.

BACKGROUND: Although students are well prepared theoretically, they lack real-life practical skills because they have not faced an adequate number of emergencies such as neonatal resuscitation. OBJECTIVES: This study was conducted with the objective of determining the impact of integrating serious game simulation (SGS) into neonatal resuscitation training on the neonatal resuscitation related knowledge, skills, satisfaction with training, and self confidence in learning of nursing students. DESIGN: The study is a randomized controlled, pre-test post-test design and single-blind study. SETTINGS AND PARTICIPANTS: This study was conducted on 90 undergraduate nursing students (SGS based training group = 45, control group = 45) enrolled in the fifth semester at the Faculty of Nursing. METHODS: The students were allocated with simple randomization method to intervention and control groups. The training program prepared on the basis of neonatal resuscitation algorithm used a neonatal resuscitation serious game simulation method. At the same time, the serious game simulation method was used as a pre-test and post-test skill assessment tool. Support was obtained from a statistician in evaluation of the data and the data were analyzed using the SPSS (Statistical Package for Social Sciences) for Windows 25.0 program. RESULTS: Post-test measurements indicated a statistically significant positive difference in the ventilation and chest compression performing skills of the intervention group compared to the control group (p = .011, p = .020, respectively). A considerable increase was found in the knowledge and skills level of both groups, after the neonatal resuscitation training (p < .05). The score averages of the Student Satisfaction and Self-Confidence in Learning Scale and its sub-dimensions were high for both groups. CONCLUSIONS: It was concluded that the serious game simulation application used in neonatal resuscitation training was effective in raising the students' ventilation and compression performing skills.

The effect of using a kaleidoscope during central venous catheter dressing changes on pain and anxiety in children with cancer: A randomised controlled trial.

PURPOSE: Many medical interventions, including the dressing changes of central venous catheters, a common procedure used for children with cancer, cause pain and anxiety in children. This can adversely affect their care and recovery. This study aims to evaluate the effect of using a kaleidoscope on reducing pain and anxiety in children with cancer during central venous catheter dressing changes. METHODS: This was a parallel randomised controlled trial with 60 children aged 6-12 diagnosed with cancer who were placed either in a kaleidoscope group (n = 30) or a control group (n = 30). Each child's anxiety was evaluated by the child using the Children's Fear Scale before, during, and after a central venous catheter dressing change, and each child's pain during and after the procedure was evaluated by the child using the Wong-Baker Faces Pain Rating Scale (WB-FACES). Each child's heart rate and oxygen saturation were measured with a pulse oximeter device before, during, and after central venous catheter dressing changes. RESULTS: Pain and anxiety scores were significantly lower in the kaleidoscope group than in the control group during and after central venous catheter dressing changes (both p < 0.001). During the procedure, the oxygen saturation values were higher (p <0 .05), and the heart rate was lower (p < 0.001) in the kaleidoscope group compared to the control group. CONCLUSION: Distraction with a kaleidoscope was an effective method for pain and anxiety relief during central venous catheter dressing changes in children. CLINICALTRIALS: gov NCT04924023.

A year and a half later: Clinical experiences of intern nursing students in the COVID-19 Pandemic: A constructivist grounded theory.

AIMS: The aim of this study is to develop a theory to explore the clinical experiences of interns in clinical practice during the COVID-19 pandemic. BACKGROUND: The COVID-19 pandemic is a serious public health problem influencing the healthcare systems worldwide. Nursing students were excluded from clinical practice for a long time due to the pandemic. However, the prolonged and uncertain pandemic conditions required the inclusion of fourth-year nursing students in clinical practice. DESIGN: A qualitative research design based on the Constructivist Grounded Theory approach was used in this study. METHODS: The research data were collected from fourth-year nursing students doing an internship at a university hospital in Turkey. Fourteen nursing students (12 females and 2 males) in the clinical practice during the COVID-19 pandemic with a mean age of 22.64 ± 0.225 were included in the study. In the collection of data, firstly, the purposeful sample selection method, then the theoretical sample selection method was used. On the online interview platform, the data were collected through individual interviews with those agreeing to participate in the study between July 2021 and August 2021 using a semi-structured interview form. The results were analyzed with initial, focused and theoretical coding. The research was reported based on the Consolidated Criteria for Reporting Qualitative Research guide. RESULTS: A core category and five main categories emerged in the study. The core category is a lonely bird and the main categories are emotions, challenges, coping methods, nursing experiences and solution suggestions. CONCLUSIONS: This research can help create a conceptual framework of clinical practice experiences of intern nursing students during the COVID-19 pandemic. It is thought that intern nursing students need to be supported by reliable authorities before and during the internship. Intern students stated that they experienced many emotions together and felt alone. Our study results revealed that intern nurses need more psychological support, especially during the pandemic period. A remarkable finding of the research is that interns now think of themselves as professional nurses. For interns to develop effective coping methods, intensive and regular training should be organized in cooperation with the hospital and school administration.

The effect of a shaken baby syndrome prevention program on Turkish mothers' awareness and knowledge: A randomized controlled study.

PURPOSE: This study aimed to develop an evidence-based education program to increase mothers' awareness and knowledge of shaken baby syndrome (SBS) and evaluate program effectiveness. DESIGN AND METHODS: Mothers with babies between 2 and 4 months of age were completed the study (intervention group = 43 and control group = 44). This single-blind randomized controlled study was conducted between September 2020 and February 2021. The intervention group participated in an 8-week follow-up. Outcome variables were assessed at baseline and 8 weeks after commencement of the intervention, which included measures to evaluate the administration of the shaken baby syndrome prevention program (SBSPP). The study was approved by ClinicalTrials.gov NCT04568538. RESULTS: Scores for the SBS assessment survey were significantly higher in the intervention group than in the control group. PRACTICE IMPLICATIONS: Developing effective interventions for SBS is an important public health goal. This study is the first to prove the effectiveness of an SBSPP conducted by nurses in Turkey. We believe that the implementation of this program in a larger sample will make a significant contribution to SBS reduction. Pediatric nurses identify the needs of parents with babies younger than 6 months and support them to manage this process correctly.

Student nurses' perceptions of a patient safety culture: A descriptive and cross-sectional study.

PURPOSE: The aim of this study was to evaluate nursing students' perceptions of a patient safety culture in one university in Turkey. DESIGN AND METHODS: The sample of this descriptive cross-sectional study consisted of 299 undergraduate nursing students. Data were collected by having participants complete the Patient Safety Culture Scale (PSCS) and a personal information form. FINDINGS: Participants' scores on the PSCS were found to be moderate, and no significant differences were found between participants' study levels. Female students and students who had willingly chosen the nursing profession obtained statistically significantly higher scores on the PSCS, indicating positive perceptions of a patient safety culture. PRACTICE IMPLICATIONS: The inclusion of patient safety education and training of nurses in the nursing curriculum may contribute to students' development of a patient safety culture.

The effect of expressed breast milk, swaddling and facilitated tucking methods in reducing the pain caused by orogastric tube insertion in preterm infants: A randomized controlled trial.

BACKGROUND: Orogastric tube feeding is used to support the nutrition of preterm infants. Although nonpharmacological methods are effective in reducing the pain caused by orogastric tube insertion, only limited studies have been found addressing this pain. No study has used combined nonpharmacological methods to reduce this orogastric tube insertion pain. OBJECTIVE: This randomized controlled study aims to compare the effects of expressed breast milk, swaddling, facilitated tucking, expressed breast milk+swaddling, expressed breast milk+facilitated tucking and routine care methods on preterm infant pain and the physiological parameters (i.e., heart rate, oxygen saturation) before, during and after orogastric tube insertion procedures. DESIGN: Randomised controlled trial. SETTING: Three level III neonatal intensive care units in Turkey. METHOD: Preterm infants born at 32-34 weeks gestation were randomly assigned to six groups: routine care (n = 33), swaddling (n = 30), facilitated tucking (n = 32), expressed breast milk (n = 31), swaddling+expressed breast milk group (n = 30), and facilitated tucking+expressed breast milk group (n = 31). Orogastric tube insertion included four phases: baseline (the last one minute of 30 min without stimuli), the insertion, recovery (one minute after insertion), and recovery (two minutes after insertion). The four phases were videotaped. Premature infant pain profile score, heart rate and oxygen saturation were assessed by two independent evaluators who were blinded to the purpose of the study. Data were assessed by analysis of variance for the multiple repeated measurements, bonferroni and generalised estimating equation logistic regression. RESULTS: There was a significant main effect of the intervention groups for all the pain and physiological parameters (heart rate: F = 3.99, p = 0.001; oxygen saturation: F = 5.22, p<0.001; pain profile 1 score: F = 9.55, p<0.001; pain profile 2 score: F = 9.74, p<0.001). The use of the nonpharmacological methods combined or alone was more effective in reducing infants' pain profile score and physiological variables than routine care. Infants receiving swaddling+expressed breast milk had significantly lower pain profile scores during the insertion (phase2) (5.2 ± 1.7) than those receiving routine care (9.5 ± 3.6), swaddling (8.8 ± 2.9), facilitated tucking (7.2 ± 3.2), expressed breast milk (7.9 ± 2.6), facilitated tucking+expressed breast milk (6.6 ± 2.3) (p<0.001). The breast milk group had 6.195 times more pain than the swaddling+expressed breast milk, while the facilitated tucking group had 6.301, the facilitated tucking+expressed breast milk group had 3.107, the control group had 13.015, and the swaddling group had 7.892 times more pain. CONCLUSION: The swaddling+expressed breast milk method is clinically better pain relief nonpharmalogical option and is the recommended method to nurses for the orogastric tube insertion procedures, preterm infants.