Pain Behavior Experienced During Nursing Interventions by Patients on Mechanical Ventilation: A Cross-Sectional Study.

AIM: The study aimed to examine pain behavior during nursing interventions in patients who were on mechanical ventilation. METHOD: The study was carried out in patients who were under treatment at a university hospital during the 2017-2018 period and who were connected to a mechanical ventilator and were unable to communicate verbally. In two intensive cares (n = 165), 568 pain assessments were made before and during nursing interventions (aspirating the respiratory tract, wound care, injection applications, bed bath, perineal care, mouth care, etc.). Patients' sedation levels were determined according to the "Ramsay Sedation Scale" and their pain and physiological parameter were determined according to the "Behavioral Pain Scale." The Wilcoxon-signed rank test was used to evaluate the difference between the pain scores and physiological parameters before and during the procedure. A p-value of < .05 was accepted as statistically significant. RESULTS: Totally 45.4% of the patients are over age 65, 59.4% were males and 66.1% had chronic diseases. The interventions causing pain score difference was nasogastric intubation, tracheal expiration, nasotracheal expiratory, oropharyngeal expiration, dressing change, perineum care, position change, bed bath, oral care, intravenous catheter application, tracheostomy cannula care, urethral catheter application, and eye care while a significant increase was seen in all physiological parameters during bed bath, perineal care, and nasogastric intubation. CONCLUSION: It is concluded that nurses should take some precautions before painful procedures.

Effects of Different Methods Used to Take Blood Samples on Blood Glucose Measurements.

The purpose of this study is to compare whether or not there is a difference between venous and capillary blood samples in blood glucose measurements and investigate the effects of different aseptic methods used in skin cleaning before collecting blood samples on measurement results. This quasi-experimental study was conducted with 109 patients. The capillary first and second blood drop values taken from the patients after fasting and at 2 hours following 75 g oral glucose tolerance test (OGTT) and capillary and venous blood glucose values were compared. There was no significant difference between the median venous blood glucose value and the capillary second blood drop value taken after wiping the finger with alcohol. There was no significant difference between the first and second blood drop values of capillary blood glucose 2 hours after OGTT.

Comparing Intra-Arterial, Auscultatory, and Oscillometric Measurement Methods for Arterial Blood Pressure.

AIM: This study aimed to compare the measurement results of arterial blood pressure obtained through intra-arterial, auscultatory, and oscillometric methods. METHOD: This prospective and descriptive study was conducted with 180 patients hospitalized in the intensive care units of cardiovascular surgery and anesthesia. Arterial blood pressures of the patients in the study were measured with 3 methods, and the mean arterial pressure values obtained by each method were analyzed to find out whether they were different or consistent. RESULTS: The average systolic blood pressure value using the intra-arterial method was found to be 125.47 ± 21.39 mm Hg, and the average of diastolic blood pressure measurement obtained using the oscillometric method was the highest (73.91 ± 10.62 mm Hg). The highest correlation was seen between the arterial BP measurements of the intra-arterial and auscultatory methods (systolic [0.96] and diastolic [0.90]). According to the British and Irish Hypertension Society protocol, a very good agreement between the diastolic blood pressure values and a good agreement between the systolic blood pressure values were obtained. CONCLUSION: The measurement results obtained through the auscultatory method more consistent with the results obtained through the intra-arterial method compared with those obtained using the oscillometric method.

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.

Comparison of the Effectiveness of a Virtual Simulator With a Plastic Arm Model in Teaching Intravenous Catheter Insertion Skills.

The objective of this study was to compare the effectiveness of a virtual intravenous simulator with a plastic arm model in teaching intravenous catheter insertion skills to nursing students. We used a randomized controlled quasi-experimental trial design and recruited 65 students who were assigned to the experimental (n = 33) and control (n = 32) groups using the simple random sampling method. The experimental group received intravenous catheterization skills training on the virtual intravenous simulator, and the control group received the same training on a plastic model of a human arm. Data were collected using the personal information form, intravenous catheterization knowledge assessment form, Intravenous Catheterization Skill Test, Self-Confidence and Satisfaction Scale, and Fear Symptoms Scale. In the study, the mean scores in the control group were 20.44 for psychomotor skills, 15.62 for clinical psychomotor skills, 31.78 for self-confidence, and 21.77 for satisfaction. The mean scores in the experimental group were 45.18 for psychomotor skills, 16.28 for clinical psychomotor skills, 34.18 for self-confidence, and 43.89 for satisfaction. The results indicated that psychomotor skills and satisfaction scores were higher in the experimental group, while the clinical psychomotor skills and self-confidence scores were similar in both groups. More students in the control group reported experiencing symptoms such as cold and sweaty hands, significant restlessness, and tense muscles than those in the experimental group.

An Exploration of Nursing Students' Clinical Decision-Making Process.

PURPOSE: This study was carried out descriptively and retrospectively with the purpose of determining nursing diagnoses used by intern students in their clinical practice. METHODS: The study data were obtained by checking the care plans of the internship files of 248 students studying at a nursing faculty. FINDINGS: The students determined 77 different nursing diagnoses in 13 domains of North American Nursing Diagnosis Association (NANDA)-I taxonomy II. The total number of nursing diagnosis used in the care plans was 1,469. CONCLUSION: Most of the diagnoses determined by the students were in the "safety/ protection" domain; however, they determined no diagnoses in the "life principles" domain.

Investigation of the efficacy of colorimetric capnometry method used to verify the correct placement of the nasogastric tube.

OBJECTIVES: This present study was designed to determine the efficacy of the colorimetric capnometry method used to verify the correct placement of the nasogastric tube. METHODS: The present study comprised forty patients who had a nasogastric tube inserted and were being monitored in the adult intensive care unit. After the insertion of the nasogastric tube, 40 colorimetric capnometry and 40 auscultation measurements were performed. Auscultation and colorimetric capnometry results were compared with tube placement results confirmed radiologically. RESULTS: In the confirmation of the placement of the nasogastric tube, the consistency was 97.5% (p<0.05) between the colorimetric capnometry method and the radiological method, and 82.5% (p>0.05) between the auscultatory method and the radiological method. The oesophageal placement of the nasogastric tube was detected with the colorimetric capnometry method, but the gastric and duodenal insertions were not determined. While the sensitivity and specificity of the colorimetric capnometry method in determining the correct placement of the nasogastric tube were 1.00 and 0.667 respectively, those of the auscultatory method were 0.89 and 0.0 respectively. CONCLUSION: As a result, for the confirmation of the NGT placement, the colorimetric capnometry method is considered more reliable than the auscultatory method and is compatible with the radiological method. However, the colorimetric capnometry method is inadequate to distinguish between the gastric or duodenal insertion.

Evaluation of oxygen saturation values in different body positions in healthy individuals.

AIMS AND OBJECTIVES: The research was conducted to evaluate oxygen saturation values measured in healthy individuals in different body positions. BACKGROUND: Changes in position affect ventilation-perfusion rates, oxygen transport and lung volume in normal lungs. There have been few studies and not enough information about which positioning of a healthy individual can increase oxygenation. DESIGN: A descriptive study. METHODS: A sample of 103 healthy individuals with no chronic disease, anaemia or pain was included in the research. Individuals were positioned in five different positions: sitting upright, supine position, prone position, lying on the left side and lying on the right side. Oxygen saturation and pulse rates were then measured and recorded after the individuals held each position for ten minutes. RESULTS: It was found that the average oxygen saturation value when measured while sitting in an upright position in a chair was significantly higher than that measured when the individual was lying on the right or left side of the body. Oxygen saturation values measured in the five different body positions were significantly higher in women, in individuals below the age of 35, in those with Body Mass Indexes of below 25 kg/m(2), and in nonsmokers. CONCLUSION: All of the oxygen saturation values measured in the five different body positions were in the normal range. Although oxygen saturation values were within the normal range in the five different body positions, post hoc analysis showed that the best oxygenation was in the 'sitting upright' position while the lowest oxygenation was in the supine position. RELEVANCE TO CLINICAL PRACTICE: Based on the results of this research, it can be concluded that the differences among oxygen saturation values according to the different body positions were statistically significant.

Examination of Subcutaneous Tissue Thickness in the Thigh Site for Intramuscular Injection in Obese Individuals.

OBJECTIVES: The aim of the study was to investigate the thickness of subcutaneous (SC) tissue in the dorsogluteal and thigh sites in obese adults and its suitability for intramuscular injection using a standard-length needle. METHODS: The sample for this prospective study consisted of 54 obese adults who presented to the ultrasound unit of the radiology clinic of a university hospital in the province of Izmir, Turkey, between June 2012 and August 2013. The study received Institutional Review Board approval, and informed written consent was obtained from all participants. The thickness of the SC tissue in the dorsogluteal and thigh sites was measured by sonography. The sonographic measurements were performed by a radiology specialist. RESULTS: The mean thicknesses of the SC tissue were 61.70 ± 15.73 mm in the dorsogluteal site, 27.05 ± 8.52 mm in the rectus femoris site, and 23.23 ± 8.44 mm in vastus lateralis site. The SC tissue was thicker in the dorsogluteal than the thigh site (P < .001). CONCLUSIONS: A standard needle used in intramuscular injections to the thigh site would be effective in reaching the muscle in the rectus femoris and vastus lateralis sites in all men and in 77.8% of women, although it is not usually adequate for gluteal injection.

Caregiver Burden and Perceived Social Support among Caregivers of Patients with Cancer.

The purpose of this study is to describe the relationship between caregiver burden and perceived social support among caregivers of patients with cancer. The research was conducted in a university hospital in Izmir, Turkey. Eighty patient relatives who provided care service to patients with cancer who were admitted at hematology and oncology clinics participated in the study. The findings indicated that the care burden score was mild level. The mean of the perceived social support score was 58.4±21.0 supporting the conclusion that there is a weak and negative-direct relation between caregiver and perceived social support and that as the perceived social support increased, conversely, care burden decreased.

The effect of the use of ultrasound in the success of peripheral venous catheterisation.

The aim of this study was to investigate the effect of ultrasound-guided peripheral venous catheterisation in patients where difficulty was experienced in peripheral venous catheterisation. The study was conducted in the emergency department at a university hospital in Izmir Turkey. After obtaining institutional review board approval and written informed consent, 60 patients with a history or suspicion of difficult cannulation were enrolled with 30 patients in traditional and 30 in ultrasound group. In the ultrasound group, peripheral intravenous catheterisation was performed using a portable ultrasound device with 13.5 MHz ultrasound probe and 20 gauge intravenous catheter. The success rate of peripheral venous catheterisation was 30% in the control group and 70% in the treatment group. The success rate was significantly higher among the treatment group. The mean intensity of felt pain was 6.00 ± 1.98 in the control group and 4.77 ± 1.74 in the treatment group. The mean intensity of felt pain was significantly lower in the treatment group. The state of chronic disease affected the success rate in patients in the treatment group.

A study of Turkish critical care nurses' perspectives regarding family-witnessed resuscitation.

AIM: . This paper reports a study to determine the experiences and attitudes of Turkish critical care nurses concerning family presence during cardiopulmonary resuscitation. BACKGROUND: The debate surrounding family-member presence in resuscitation areas has been evolving since the 1980s. The practice of performing resuscitation of adults in the presence of family members is controversial and has stimulated discussion and debate worldwide. DESIGN: A descriptive survey. METHOD: The survey was carried out in 2007 with 135 critical care nurses from two university hospitals in Izmir. A structured questionnaire was used, which incorporated a series of attitude statements that were rated using a three-point Likert scale. The attitudes of the nurses were explored in three areas: decision making, processes and outcomes of resuscitation. RESULTS: Of the nurses, only 22.2% experienced a situation where family members were present during cardiopulmonary resuscitation. Most of these nurses (n = 20) had one or more negative experiences. The majority disagreed that family members should always be offered the opportunity to be with the patient during cardiopulmonary resuscitation. The most common concerns for not favouring family-witnessed resuscitation were reported as performance anxiety, fear of causing psychological trauma to family members and increased risk of litigation. CONCLUSIONS: Many Turkish critical care nurses have no knowledge of family-witnessed resuscitation and do not support the practice. We suggest that Turkish critical care nurses should be informed by the international literature on the concept of family-witnessed resuscitation and the culturally appropriate policies concerning this subject should be changed in Turkish hospitals. RELEVANCE TO CLINICAL PRACTICE: Most critical care nurses in Turkey are not supportive of family-witnessed resuscitation. All critical care nurses should be informed by the international literature on the concept of family-witnessed resuscitation.

Does the body temperature change in older people?

AIM: The aim of this study was to determine the mean body temperatures in older people using mercury-in-glass thermometer. BACKGROUND: Older people are unable to regulate their body temperatures to the same degree as young adults because their responses to changes in body temperature are altered. Several published reports suggest that body temperature decreases with advancing age and has a greater variability in older populations. The aim of this study was to determine the mean body temperatures in older people. DESIGN: Non-experimental. METHODS: Axillary body temperatures were taken in 133 older subjects in a nursing home for older people using mercury-in-glass thermometer. Temperatures were measured at 8 a.m., 2 p.m., and 6 p.m., over three consecutive days. Each subject had all three measurements taken on the same day. RESULTS: The mean age of the subjects was 77.2, SD 7.3. In the 133 older subjects, the mean axillary temperatures ranged from 35.1 to 36.4 degrees C (95.3-97.6 degrees F). The mean temperatures for those aged 65-74 was higher than in those aged 75-84 (p < 0.001) and those aged 85 and older (p < 0.001) at 6 p.m. but not at 8 a.m. or 2 p.m. We concluded that older people have mean axillary body temperatures lower than the reference point of 36.5 degrees C (97.7 degrees F). RELEVANCE TO CLINICAL PRACTICE: When assessing body temperature, it is important to take the age of the patient into consideration. Also, the reference point of 36.5 degrees C is inappropriate in older people, especially when diagnosing a febrile illness.

A study on the effect of the duration of subcutaneous heparin injection on bruising and pain.

AIM: This study was carried out to determine the effect of injection duration on bruising and pain following the administration of the subcutaneous injection of heparin. BACKGROUND: Although different methods to prevent bruising and pain following the subcutaneous injection of heparin have been widely studied and described, the effect of injection duration on the occurrence of bruising and pain is little documented. DESIGN: This study was designed as within-subject, quasi-experimental research. METHOD: The sample for the study consisted of 50 patients to whom subcutaneous heparin was administered. Heparin was injected over 10 seconds on the right abdominal site and 30 seconds on the left abdominal site. Injections areas were assessed for the presence of bruising at 48 and 72 hours after each injection. Dimensions of the bruising on the heparin applied areas were measured using transparent millimetric measuring paper. The visual analog scale (VAS) was used to measure pain intensity and a stop-watch was used to time the pain period. Data were analysed using chi-square test, Mann-Whitney U, Wilcoxon signed ranks tests and correlation. RESULTS: The percentage of bruising occurrence was 64% with the injection of 10 seconds duration and 42% in the 30-second injection. It was determined that the size of the bruising was smaller in the 30-second injection. Pain intensity and pain period were statistically significantly lower for the 30-second injection than for the 10-second injection. CONCLUSIONS: It was determined that injection duration had an effect on bruising and pain following the subcutaneous administration of heparin. This study should be repeated on a larger sample. RELEVANCE TO CLINICAL PRACTICE: When administering subcutaneous heparin injections, it is important to extend the duration of the injection.

Does obesity prevent the needle from reaching muscle in intramuscular injections?

AIM: This paper is a report of a study to measure subcutaneous tissue thickness at the dorsogluteal and ventrogluteal sites and to determine optimal needle length for dorsogluteal and ventrogluteal intramuscular injections in adults with a body mass index of more than 24.9 kg/m2. BACKGROUND: Problems can arise if drugs designed to be absorbed from muscle are only delivered into subcutaneous tissue. Increasing obesity in all developed and many developing countries makes this an increasing concern. METHOD: Ultrasound measurements were made of the subcutaneous tissue of overweight, obese and extremely obese people at the dorsogluteal and ventrogluteal sites with the probe held at a 90 degrees angle to the plane of the injection site. Subcutaneous tissue thickness was measured in 119 adults whose body mass index was >or=25 kg/m2. The data were collected in 2005-2006. RESULTS: Mean subcutaneous tissue thickness at the dorsogluteal site was 34.5 mm for overweight adults, 40.2 mm for obese adults and 51.4 mm for extremely obese adults, and at the ventrogluteal site was 38.2 mm for overweight adults, 43.1 mm for obese adults and 53.8 mm for extremely obese adults. CONCLUSION: Intramuscular injections administered at the dorsogluteal site in 98% of women and 37% of men, and at the ventrogluteal site in 97% of women and 57% of men, would not reach the muscles of the buttock. A needle longer that 1.5 inches should be used in women whose body mass index is more than 24.9 kg/m2, the dorsogluteal site may be used in all overweight and obese men, and the ventrogluteal site may be used in overweight men only.

Comparing mercury-in-glass, tympanic and disposable thermometers in measuring body temperature in healthy young people.

AIM AND OBJECTIVES: The aim of this study was to determine whether a disposable thermometer was at least as accurate as a tympanic thermometer when compared with a mercury-in-glass thermometer and to investigate the waiting periods of mercury-in-glass thermometers. BACKGROUND: Although different methods of temperature measurement have been widely studied and described during the last decade, comparison between readings obtained when measuring body temperature using disposable, mercury-in-glass and tympanic thermometers is little documented and there is confusion about the waiting periods of mercury-in-glass thermometers. METHODS: This research was descriptive and comparative. Temperature measurements included three sequential readings using first a tympanic thermometer in the left ear, then a disposable thermometer in the left axillary area and finally a mercury-in-glass thermometer in the right axillary area. All the temperatures were measured on the Celsius (degrees C) scale. To identify the stabilization periods of the mercury-in-glass thermometers, the temperature measurement was repeated until the reading stabilized. F-tests were used to compare readings of the mean temperatures. RESULTS: It was found that body temperature readings measured by tympanic thermometer were higher than axillary mercury-in-glass thermometer by 0.12 degrees C, body temperature readings measured by tympanic thermometer were higher than axillary disposable thermometer readings by 0.65 degrees C and body temperature readings measured by axillary mercury-in-glass thermometer were higher by 0.53 degrees C than readings measured by axillary disposable thermometer. It was found that readings measured by mercury-in-glass thermometer stabilized in the eighth minute. RELEVANCE TO CLINICAL PRACTICE: When assessing body temperature it is important to take the type of thermometer into consideration. In addition, axillary mercury-in-glass thermometers must be kept in place a minimum of eight minutes.