Relationship Between Intensive Care Nurses' Attitudes and Behaviors Toward End-of-Life Care and Ethical Attitudes.

BACKGROUND: Nurses are in a central position to improve care for dying patients and their families by challenging current end-of-life practices in their settings. Nurses who care for such patients experience the associated ethical dilemmas. However, the relation between their attitude and behavior regarding end-of-life care and their ethical attitudes is not known. OBJECTIVES: The aim of this study was to examine the relation between the attitudes and behaviors of intensive care unit nurses to end-of-life care and their ethical attitudes in the care process. METHODS: The research was conducted in Antalya, one of the most populous provinces in Turkey, with 287 intensive care nurses working in 4 different hospitals. The research data were collected between June 30 and August 30, 2021. Self-report data were collected using a Nurses' Description Form, the Attitudes and Behaviors of ICU Nurses to End-of-Life Care Scale, and the Ethical Attitude Scale for Nursing Care. RESULTS: The mean score of the intensive care nurses for attitude and behaviors to end-of-life care was 62.36 ± 13.22, and their mean score for ethical attitude for nursing care was 149.76 ± 24.98. CONCLUSION: It was found that intensive care nurses' attitudes and behaviors to end-of-life care had a positive correlation on their ethical attitudes in the care process (P < .001). DISCUSSION: It would be of interest to understand how these attitudes impact clinical decision-making for the ultimate understanding of whether nurses' attitudes can be a barrier to the delivery of quality end-of-life care.

Arteriovenous fistula self-care behaviors in patients receiving hemodialysis treatment: Association with health literacy and self-care agency.

BACKGROUND: Arteriovenous fistula-related self-care behaviors, self-care agency and health literacy are important for vascular access patency, which is vital in the continuation of hemodialysis treatment. The purpose of this study was to determine the arteriovenous fistula-related self-care behaviors of patients receiving chronic hemodialysis treatment and the relationship between these behaviors and their health literacy and self-care agency levels. METHODS: In this descriptive correlational study, the data were collected from 216 chronic hemodialysis patients. RESULTS: The rate of the patients who had good self-care behaviors levels was 83.96%. The sociodemographic variables that were significantly related to AVF-related self-care behaviors were education, employment status and age. It was found that the patients who had had AVF for a longer time had better self-care behaviors regarding their management of symptoms and findings (p < 0.05). As the self-care agency of the patients (r = 0.612, p < 0.001) and their health literacy (r = 0.421, p < 0.001) increased, their AVF-related self-care behaviors also increased. CONCLUSION: Age, education status, health literacy and self-care agency were identified to affect AVF-related self-care behaviors.

Determination of Factors Affecting Time in Therapeutic Range in Patients on Warfarin Therapy.

BACKGROUND: The effectiveness and safety of warfarin depend on maintaining an international normalized ratio (INR) within the therapeutic range. Time in Therapeutic Range (TTR) is defined as the percentage of time a patient's INR is within the therapeutic range. OBJECTIVE: We sought to determine the factors affecting good TTR in patients on warfarin therapy. METHODS: This was a descriptive cross-sectional study conducted in a single tertiary care center. Good anticoagulation control was defined as TTR ≥65%. RESULTS: The study population consisted of 518 patients. The mean age was 57.6 ± 12.3 (19-87) and 54.4% of the patients were female. 47.5% patients achieved good anticoagulation control (TTR ≥65%). The mean Medication Adherence Report Scale (MARS) score was significantly higher in patients with good TTR (23.5 ± 1.9 vs. 22.8 ± 2.1, p = .002). Only 40.2% of the patients received education on warfarin. In multivariable analyses, the duration of warfarin therapy >10 years (OR: 2.27, 95% CI: 1.34-3.84, p = .002) and MARS score (OR: 1.22, 95% CI: 1.09-1.35, p < .001) were found to be the independent predictors of the good anticoagulation control. CONCLUSION: Duration of warfarin therapy >10 years and MARS score were the independent predictors of good anticoagulation control.

Burnout levels and care behaviours in intensive care nurses: A cross-sectional, multicentre study.

OBJECTIVE: To examine the relation between burnout levels and caring behaviours in intensive care nurses in Turkey, and the affecting factors. RESEARCH METHODOLOGY/DESIGN: The research was conducted as a descriptive, cross-sectional and multi-centred study. SETTING: In this study, an online questionnaire was applied in April and May 2021, using Google Form. A total of 460 intensive vare nurses responded to the questionnaire. MAIN OUTCOME MEASURES: Burnout was assessed with the Maslach Burnout Inventory, and care behaviours with the Caring Behaviours Inventory-24. RESULTS: The nurses reported a high level of emotional exhaustion (73.9%) and depersonalization (52.2%), and a medium level of personal accomplishment (40%). The nurses' levels of perception of care quality were high (5.4 ± 0.6). It was found that their highest score on the subdimensions was on knowledge and skills (5.6 ± 0.5), and the lowest was on connectedness (5.2 ± 0.7). There was a very weak, respectively weak correlation, between nurses' emotional exhaustion (r = -0.1), respectively depersonalization (r = -0.2), and poor care behaviours. There was a strong correlation between low personal accomplishment scores and poor care behaviours (r = 0.8). It was found that the mean scores of the nurses' exhaustion and care behaviours varied according to many descriptive characteristics, such as education, age, professional experience, the unit where they worked, communication difficulties, living conditions and whether they had chosen nursing willingly. CONCLUSIONS: It appears that the level of personal accomplishment, is the only subscale reflecting risk of burnout, that strongly correlates with care behaviour.

Effect of the head of bed elevation on back pain after elective coronary angiography: A randomized controlled trial.

BACKGROUND: Patients are restricted to bed and required to lie flat after coronary angiography (CAG) due to potential risk of vascular complications. This often causes back pain. AIM: We aimed to investigate the effect of the head of bed (HOB) elevation on back pain and vascular complications after elective CAG. METHODS: Three hundred and seven consecutive patients who underwent elective CAG were randomized into three groups. One control (HOB: 0 degree-flat position) and two experimental (HOB: 15 and 30 degrees) groups were compared. Back pain level was assessed using a visual analog scale. RESULTS: Mean age was 58.1±10.7, and 59.9% (n=184) of the patients were males. Pain level at the 3rd hour and at the 6th hour was significantly higher in the control group than in the experimental groups. In the post-hoc analysis, pain level was significantly higher in HOB 15 degrees compared to that in HOB 30 degrees. In the multivariate analysis, HOB elevation to 30 degree was the only independent predictor of the pain level at the 3rd hour and the 6th hour. Only one patient in the HOB 0 degree group had a minor bleeding at the access site CONCLUSIONS: Elevation of the HOB to 30 degrees was associated with decreased back pain level without increased risk of vascular complications.

A comparison of Gordon's functional health patterns model and standard nursing care in symptomatic heart failure patients: A randomized controlled trial.

BACKGROUND: Heart failure (HF) is associated with poor quality of life and increased morbidity and mortality. AIM: This study aimed to investigate effect of application of Gordon's functional health pattern (FHP) model in nursing care of symptomatic HF patients on quality of life, morbidity and mortality in the post-discharge 30-day. METHODS: This is a prospective randomized controlled study conducted in a single center. Experimental group received nursing care planned in accordance with Gordon's FHP model. 60 control and 60 experimental HF patients were included in the study. In the control group nursing care was given according to the standard protocol of the hospital whereas in the experimental group nursing care was given in accordance with Gordon's FHP model. Patients in both groups were followed up after discharge at 30th day. RESULTS: Mean Minnesota Living with Heart Failure Questionnaire score improved significantly in the experimental group compared to the control group at 30th day (40.2 ±â€¯23.5 vs 62.3 ±â€¯22.9 respectively, p = 0.001). Seven patients (11.7%) in the experimental group and 17 patients (28.3%) in the control group were readmitted in the post discharge 30-day (p = 0.02). Kaplan-Meier survival curve analysis revealed significant difference in 30-day event free survival rates between groups (log-rank p = 0.31). CONCLUSION: Application of Gordon's FHP model in the nursing care of HF patients was associated with significantly improved quality of life, and reduced hospital readmission rates at 30th day. This was the only independent predictor of 30-day event free survival.

The tumor microenvironment of pancreatic adenocarcinoma and immune checkpoint inhibitor resistance: a perplex relationship.

Pancreatic cancer is one of the most aggressive cancers with a high mortality rate even among patients with early-stage disease. Although recent studies with novel therapeutic approaches have led to modest improvement in survival outcomes, limited progress is achieved for the use of immunotherapeutics in this challenging cancer. Immune checkpoint inhibitors, thus far, single-agent or in combination, have not yielded significant improvement in survival outcomes except in mismatch repair-deficient pancreatic cancer. The tumor microenvironment of pancreatic cancer has been considered as an attractive target for over a decade based on preclinical studies that suggested it may adversely affect drug delivery and antitumor immunity. In this review article, we elaborate on the biology of pancreatic cancer microenvironment, its highly complicated interaction with cancer cells, and the immune system. We also discuss plausible explanations that led to the failure of immune checkpoint inhibitors as therapeutic agents and the potential impacts of pancreatic cancer stroma on these negative studies.