The validity and reliability of the Pressure Ulcer Quality of Life instrument: A methodological study.

AIM: This study aimed to adapt the Pressure Ulcer Quality of Life instrument to Turkish and to determine the validity and reliability by using the Rasch model. MATERIALS AND METHODS: This methodological study used forward translation, expert opinion, back translation, pilot testing, and finalization for the language adaptation of the instrument. Prior to back translation, the instrument was assessed by five experts certified in wound care nursing. Then, the comprehensibility of the instrument was tested in the pilot study. The study was conducted between March 2017 and September 2019 at one private, one state, and four university hospitals in Turkey. Eligible participants were patients 18 years of age or older, having pressure injury, and fully conscious. Data were collected from a total of 250 patients by using a demographic and clinical history form, the Pressure Ulcer Quality of Life instrument, and the World Health Organization Quality of Life - Brief Form Turkish scale. The instrument's internal construct validity using the Rasch model, the external construct validity, internal consistency, and test-retest reliability were assessed. RESULTS: The final Turkish version of the Pressure Ulcer Quality of Life self-report instrument differed from the original, comprising 74 items under the following ten subscales: three regarding symptoms, plus one itchiness item; four regarding physical functioning; two regarding psychological well-being, self-consciousness, and appearance; and one regarding social participation. CONCLUSION: The Turkish version of the PU-QOL is a valid, reliable, and widely available instrument for measuring quality of life for patients with pressure injury.

Pressure Injury Prevalence and Risk Factors: A National Multicenter Analytical Study.

PURPOSE: The purpose of this study was to determine the point prevalence (PP) of general pressure injuries (PIs), hospital-acquired PIs, PI-related risk factors, and PI preventive interventions performed by nurses. DESIGN: Descriptive, multicenter, prospective, analytical study. SUBJECTS AND SETTING: The sample comprised 5088 patients cared for in 13 hospitals in 12 geographic regions of Turkey. Data were collected between November 5, 2018, and July 17, 2019. METHODS: The study was carried out in 2 stages. First, nurses who collected data were trained in the diagnosis of PI, risk assessment, staging, and prevalence studies, and informed about the purpose and methods of the study, including data collection. Second, nurses and researchers who had received training related to data collection for this study conducted a PP study for PIs in their inpatient clinics using the ASSIST II method. The PI Prevalence Study Tool and the Braden Scale for Predicting Pressure Sore Risk were also used during data collection. RESULTS: The PP of general PIs was 9.5%; the prevalence of PIs with hospitalization in intensive care units was 43.2%; medical device-related pressure injuries prevalence was 10.7%. We found that 65.1% of the PIs were acquired after hospital admission. CONCLUSIONS: Similarities exist between PI prevalence in Turkey and reported PI prevalence rates worldwide. However, the prevalence of nosocomial PIs related to intensive care units and the prevalence of all nosocomial injuries were higher than rates previously reported. Based on results, there is a need to develop strategies to reduce the prevalence of nosocomial PIs.

Ethical Discourse of Medical Students on the Phenomenon of Death: A Qualitative Study.

The aim of this study is to discover medical students' ideas on the phenomenon of death; produce information on how these students interpret the value-related problems regarding death that they come across in different units of hospitals; and assess this data in ethical terms. This study included a qualitative research in which 12 focus group interviews were conducted with 92 fifth- and sixth-year medical students. Data obtained from interviews were assessed using a thematic content secondary analysis. The main themes were specified according to the medical students' statements and were reviewed under the contexts of the "dying process"; "effects of death"; "attitude and behavior of health professionals"; "seeing a dead body/looking at a dead body"; "accepting death"; and "forms of expressions of death." Medical students' encounters with death in different units of hospitals leads them to question their values and familiarize themselves with the borders of their areas of profession.

The effect of professional education on medical and nursing students' attitudes toward death.

This qualitative study aims to reveal the effect of professional education on medical and nursing students' attitudes toward death. The study was carried out with nursing and medical students (N = 197). Research data was collected through semi-structured interview questions and 23 focus group interviews. The data was assessed using thematic analysis method. The themes were evaluated within the context of perception of death, ethical dilemmas, and, death education. To achieve professional competency in attitudes toward death, it is imperative to form a common educational curriculum and practice that would help students develop a mutual language and value system about death.

Development, reliability and validity of the Nurses' Ethical Behaviours for Protecting Patient Rights Scale.

AIM: The aim of this study was to develop a self-assessment scale for nurses' ethical behaviours for protecting patients' rights and to determine its reliability and validity. METHODS: This was a methodological study. This study was conducted in public, private and university hospitals in Turkey between August 2018 and May 2019. The sample group consisted of 450 nurses. The item pool was formed with 44 items. After five experts' assessment for content validity, the draft scale was formed with 37 items with a 5-point Likert-type scale. The item-total score correlation and exploratory factor analysis were used. RESULTS: The scale included 28 items and five subscales (respect for right to information and decision making, providing fair care, providing benefit-not harming, respect for patient values and choices, attention to privacy). Cronbach's alpha was 0.84 for the whole scale. CONCLUSION: Validity and reliability have been demonstrated for a newly developed scale to measure nurses' ethical behaviours to protect patients' rights.

Nurses' attitudes toward, perceptions of, and experiences with conscientious objection.

BACKGROUND: Conscientious objection is a person's refusal to fulfill a legal duty due to their ethical values, religious beliefs, or ideological affiliations. In nursing, it refers to a nurse's refusal to perform an action or participate in a particular situation based on their conscience. Conscientious objection has become a highly contested topic in recent years. RESEARCH OBJECTIVES: This study had four objectives: (1) eliciting information on how Turkish nurses perceive conscientious objection, (2) revealing whether their moral beliefs affect the care they provide, (3) determining their experiences with conscientious objection, and (4) identifying existing or potential issues of conscientious objection. RESEARCH DESIGN: This qualitative study collected data through semi-structured interviews. The data were analyzed using thematic content analysis. PARTICIPANTS: The sample consisted of 21 nurses. ETHICAL CONSIDERATIONS: The study was approved by an ethics committee. Confidentiality and anonymity were guaranteed. Participation was voluntary. FINDINGS: The analysis revealed four themes: (1) universal values of nursing (professional values), (2) experiences with conscientious objection (refusing to provide care/not providing care), (3) possible effects of conscientious objection (positive and negative), and (4) scope of conscientious objection (grounded and groundless). CONCLUSION: Participants did not want to provide care due to (1) patient characteristics or (2) their own religious and moral beliefs. Participants stated that conscientious objection should be limited in the case of moral dilemmas and accepted only if the healthcare team agreed on it. Further research is warranted to define conscientious objection and determine its possible effects, feasibility, and scope in Turkey.

Nurses' Perspectives and Experiences Regarding Organ Transplantation in Turkey: A Qualitative Study.

As professionals, nurses are often required to provide care for patients from different cultural and religious backgrounds during an organ transplantation process. It is therefore important to understand the views and experiences of nurses regarding the organ transplantation process. The aim of this study was to explore nurses' perspectives and experiences in providing care to donors and transplant recipients. In this descriptive qualitative study, semistructured in-depth interviews were conducted with 17 nurses in Turkey. The qualitative interviews were analyzed using thematic analysis. At the end of the study, four themes were represented: nurses' characteristics, nurses' roles and responsibilities, nurses' views on organ transplantation, and nurses' experiences with providing care. The results of the study revealed that nurses have positive and negative attitudes about organ transplantation, and they need education on this topic. In addition, considering the cultural factors and religious beliefs that prevent organ donation, cooperation between health professionals and religious authorities is necessary. Furthermore, support systems should be developed to reduce the problems that nurses face. The relevant authorities should collaborate to increase the number of donors by informing the public that the religious view is favorable to organ donation.

Nurses' Opinions on Do-Not-Resuscitate Orders.

The aim of this study was to determine nurses' opinions on Do Not Resuscitate (DNR) orders. This is a descriptive study. A total of 1250 nurses participated in this study. The mean age of participants was 34.5 ± 7.7 years; 92.6% were women; 56.4% had bachelor's degrees, and 28.8% were intensive care, oncology, or palliative care nurses. Most participants (94.3%) agreed that healthcare professionals involved in DNR decision-making processes should have ethical competence, while they were mostly undecided (43%) about the statement whether or not DNR should be legal. More than half the participants (60.2%) disagreed with the idea that DNR implementation causes an ethical dilemma. Participants' opinions on DNR decisions significantly differed according to the number of years of employment and unit of duty. The results showed that most of the nurses had positive attitudes towards DNR orders despite it being illegal. Future studies are needed to better understand family members' and decision makers' perceptions of DNR orders for patients.

Nursing Students' Experiences With Death and Terminal Patients During Clinical Education.

The aim of this study is to explore nursing students' experiences with death and terminal patients during clinical education. A secondary analysis of qualitative data that were collected through 11 focus group interviews with nursing students was performed. Data obtained from the interviews were analyzed using thematic analysis. There were a total of 9 themes across 3 contexts. Data were grouped under the following themes: feelings experienced when encountering death for the first time, reactions to the first encounter with death, factors affecting the reactions to death, involvement in terminal patient care, being informed about the physical process that terminal patients are going through, students' approach toward terminal patients and their relatives, health professionals' approach toward terminal/dying patients/their relatives, changes in the ideas about death, and changes in the ideas about terminal/dying patients. The study shows a lack of guidance on the part of teachers who also avoid patients and families who are considered terminally ill.

Impact of tailored training about pressure injuries on nurses' knowledge levels and pressure injury point prevalence: The case of Turkey.

AIM: This study was conducted to determine the impact of tailored training provided to nurses for preventing pressure injuries (PIs) on nurses' knowledge levels and the PI point prevalence (PP). MATERIALS AND METHODS: This interventional study was carried out in a university hospital with a bed capacity of 1114 in an urban center in Turkey. Ethics committee approval (28.06.2018/31) and institutional permission were obtained for the study, in addition to the nurses' written, informed consent. The study was completed in three stages. In the first stage an initial PP study was conducted in the clinics with the participation of the nurses and the members of the research team (n = 422 patients). In the second stage the knowledge levels of 194 nurses were measured before training was given on following-up and preventing PIs. The nurses then participated in the tailored training and their knowledge levels were re-measured afterwards. All the nurses were given individual advice related to the prevention of PIs for 30 days after they had completed the training. In the third stage a second PP study was conducted four months after the first PP study (n = 454 patients). The data were collected using the Pressure Injury Prevalence Form, the Braden Pressure Ulcer Risk Assessment Tool and the Knowledge Level Measurement Form. Descriptive values, the paired samples t-test, Pearson's chi-squared test and Fisher's Exact test were used to evaluate the data. RESULTS: The nurses' pretest mean knowledge score was 55.36% ± 14.40 and their posttest mean score was 69.92% ± 9.73. The difference between these scores was statistically significant (p < 0.05). The study found no significant difference between the first PP ratio and the second PP ratio (p > 0.05), and the nurses were better able to evaluate skin and PIs after the training. CONCLUSION: The study determined that the tailored training given to the nurses increased their knowledge; however, it had no impact on the PP after four months. It is recommended that any training programs using this model be continued and that PP studies of institutions be conducted annually.

Determining anxiety levels and related factors in operating room nurses during the COVID-19 pandemic: A descriptive study.

BACKGROUND: Health care professionals responsible for care and treatment during outbreaks are more likely to experience anxiety, depression, insomnia and stress. AIM: This study investigated operating room nurses' anxiety levels and related factors during the COVID-19 pandemic. METHODS: The research was conducted between July and September 2020. The sample consisted of 192 operating room nurses. Data were collected using a descriptive questionnaire and the Beck Anxiety Inventory (BAI). RESULTS: Participants had moderate levels of anxiety. The risk factors associated with high levels of anxiety included having chronic diseases, working with patients causing worry, fear of contracting COVID-19 and transmitting it to loved ones, incompetence of hospitals in managing the pandemic, lack of support from hospital managers, taking few breaks and working long shifts due to preventive measures at the workplace. CONCLUSION AND IMPLICATIONS OF NURSING MANAGEMENT: The results show that operating room nurses have had moderate anxiety levels since the onset of the pandemic. Therefore, it is critical to regularly identify and meet their mental and emotional needs to implement early preventive interventions. Identifying risk factors will help recognize anxiety in operating room nurses and take measures to protect their mental health while working with high-risk patients in different clinics during the pandemic. What is more, managers should draw up action plans for extraordinary conditions, such as a pandemic.

Nurses' Knowledge and Practices Related to Pressure Injury: A Cross-sectional Study.

PURPOSE: The purpose of this study was to determine nurses' knowledge and practices regarding pressure injury and identify relationships between these factors and professional nurse characteristics. DESIGN: Cross-sectional, descriptive study. SETTING AND SUBJECTS: The sample comprised 347 nurses attending the 2013 and 2015 Wound Management Congresses. The meetings were organized by the Wound Management Association located in Antalya, Turkey. METHODS: A 35-item data collection form was designed for purposes of this study. It divided into 2 parts: 8 items queried demographic and professional characteristics of nurse respondents. The second part comprised 9 cases describing patients with pressure injury; these cases were associated with 27 items querying pressure injury-related knowledge and practices. Demographic and professional characteristics of nurse respondents were summarized via descriptive statistics. The Kruskal-Wallis H and Mann-Whitney U tests were used to identify relationships between nurse characteristics and pressure injury knowledge and practices. RESULTS: The mean score for the 27 items related to pressure injury knowledge and practices was 57.37 ± 14.26 out of 100 points. Pressure injury knowledge and practices were positively associated with nurses having a bachelor's and/or postgraduate degree (P = .012), nurses caring for a higher number of patients with pressure injuries per week (P = .042), nurses practicing in intensive care units and wound care clinics (P = .011), nurses with specific education in pressure injury (P = .000), and those indicating adequate skills and knowledge in pressure injury (P = .005). CONCLUSIONS: Nurses' knowledge and practices regarding pressure injuries were lower than anticipated in this sample. We recommend additional education and training activities to increase nurses' knowledge and practices related to pressure injury.

Cardiovascular nurses' experiences of working in the COVID-19 intensive care unit: A qualitative study.

BACKGROUND: Cardiovascular nurses' skills and experiences of cardiac critical care, management of cardiovascular emergencies, and mechanical circulatory support have been considered vital in providing nursing care for COVID-19 patients in intensive care units during the COVID-19 pandemic. To our knowledge, there are no studies have focused on the contribution and experiences of cardiovascular nurses in the critical care of COVID-19 patients. OBJECTIVES: To explore the experiences of cardiovascular nurses working in a COVID-19 intensive care unit during the pandemic. METHODS: The study was conducted as a qualitative study with phenomenological approach in June-December 2020. Study data were gathered from ten cardiovascular nurses through semi-structured interviews. RESULTS: Six themes emerged from the interview data: the duties and responsibilities in a COVID-19 intensive care unit; the differences of COVID-19 intensive care unit practices from cardiovascular practices; the transferrable skills of cardiovascular nurses in a COVID-19 intensive care unit; the difficulties encountered working in a COVID-19 intensive care unit; the difficulty of working with personal protective equipment; and the psychosocial effects of working in a COVID-19 intensive care unit. CONCLUSION: Cardiovascular nurses made an important contribution to the management of nursing services with their experiences and skills in the COVID-19 pandemic.

Psychometric Evaluation of the Caring Behaviors Inventory in Turkish Nurses and Patients.

BACKGROUND AND PURPOSE: Instruments developed specifically to measure nurse caring behaviors need to be assessed in different cultural contexts. The purpose was to translate the Caring Behaviors Inventory (CBI) into Turkish and evaluate its psychometric properties. METHODS: This was a methodological study with 356 nurses and 363 patients. Linguistic, content validity, and construct validity tested for the validity of scale. Internal consistency and test-retest were calculated for reliability of scale. RESULTS: Exploratory factor analysis identified 30 items that could be categorized under three factors. Cronbach's α for the CBI was .97 for nurses and .99 for patients. CONCLUSIONS: The Turkish version of the CBI is a valid and reliable instrument for measuring caring behaviors.

Surrogates' Perceptions of Service Quality While Making Decisions for ICU Patients.

A qualitative secondary analysis was undertaken to identify aspects of health care service quality in an intensive care unit from the perspective of surrogate decision makers (N = 19) who were making decisions for relatives at end of life. Directed content analysis was guided by the Donabedian model of health care quality. Nineteen participants averaged 59 years old and were over half female (53%) and patients' spouses (53%) and adult children (32%). Salient aspects of quality service included surrogate perceptions that clinicians conveyed honesty about the patient's condition and in an easily understandable way; staff were sensitive and responsive to emotions and practical needs; clinicians demonstrated a clear, confident understanding of the patient's condition; and support by clinicians was given for surrogates' choices. Surrogates also commented on the hospital and intensive care unit environment, including cleanliness, comfort, privacy, and noise level. Further research is needed to explore how decision-support strategies might include service quality concepts.