Psychometric Property Examination of a Self-Assessment Fear Scale in Turkish Children Aged 4-12 Years: A Methodological Study.

Background: Given the lack of validated tools to assess fear in Turkish children, this research aims to address this gap by conducting a methodological study to examine the validity and reliability of the Fear Scale, thereby providing health care professionals and researchers with a reliable instrument to evaluate fear levels in this population. Methods: The research was conducted on 150 children aged 4-12 years and their parents who applied to the pediatric blood collection unit of Koç University Faculty of Medicine Hospital. In the study, the "Sociodemographic Characteristics Form," "Fear Scale," and "Child Fear Scale" were used for data collection. Results: A very high statistically significant positive relationship was obtained between the Fear Scale and the Child Fear Scale (r = .973; p < .001). The high correlation value between the two forms indicates that the child form is valid. The content validity index and item content validity index values of the scale were found to be 0.98. A very good level of statistically significant agreement was achieved between the Fear Scale and the Child Fear Scale (κ = .878; p < .001). Conclusion: It was found that the Turkish psychometric properties of the Fear Scale are valid and reliable for children aged 4-12 years. It is suggested that pediatric nurses use the scale in clinics to evaluate their fear about procedural operations.

The effect of watching videos using virtual reality during operating room transfer on the fear andanxiety of children aged 6-12 undergoing inguinal hernia surgery: A randomized controlled trial.

BACKGROUND: Being in a hospital and undergoing a surgical intervention are very stressful for the children and their parents. It is critical to keep the pain, fear and anxiety of children at a minimum level during this period in order to have a better process. PURPOSE: The aim of this study was to evaluate the effect of watching videos using virtual reality on fear and anxiety of children aged 6-12 years old during operating room transfer for inguinal hernia surgery. METHODS: This prospective and randomized controlled study used parallel trial design guided by the CONSORT checklist. The study was conducted with two groups: the group that watch videos using virtual reality group and the control group. Data were collected using follow-up forms; the Children's State Anxiety Scale and the Children's Fear Scale. RESULTS: Children in the virtual realty group had lower anxiety and fear scores than the children in the control group (p < 0.05). Evaluation of the in-group measurements demonstrated that the fear and anxiety scores of the children in the virtual reality group decreased after the transfer compared to that of the pre-transfer, while the children in the control group experienced higher fear and anxiety scores (p < 0.05). CONCLUSION: Virtual reality is an effective method to reduce fear and anxiety in children aged 6-12 years old during their transfer to the operating room. IMPLICATIONS FOR PRACTICE: Evidence-based protocol and guidelines should be developed for nonpharmacological methods such as virtual reality for procedural fear and anxiety in children.

The Effect of Buzzy Application on Pain Level During Vaccine Injection in Infants.

BACKGROUND: Nonpharmacological interventions are needed to reduce pain during vaccine administration in infants. PURPOSE: To determine the effect of the Buzzy device, which is a combination of cold and vibration, on pain during measles-mumps-rubella (MMR) vaccine administration in 12-month-old infants. METHODS: A prospective randomized controlled experimental research design was used. RESULTS: A total of 60 infants were included in the study. During and after vaccine injection, pain scores of infants who had the Buzzy device were significantly lower than those of infants in the control group ( P = .001). CONCLUSIONS: Buzzy application may be an effective method in reducing pain during MMR vaccine administration. Use of the device is recommended for infants receiving vaccinations.

Effect of Two Bathing Methods on Physiologic Parameters in Pediatric Intensive Care.

To determine the effect of traditional and disposable bed baths performed in the pediatric intensive care unit (PICU) on the physiologic parameters of children. This research was conducted as a randomized controlled trial with children who were monitored in the PICU. It was found that the pulse and blood pressure immediately after the bath were higher for both bath applications and was the lowest 30 minutes after the bath (p < .05). Children who used traditional baths had a lower body temperature than those who used the disposable bed bath after bathing for the second day. Oxygen saturation averages were found that within the group to be the highest 30 minutes after bathing methods (p < .05). Both bathing methods applied in the PICU had a positive effect on physiologic parameters. It may be recommended to regularly perform the most appropriate bathing for patients with stable hemodynamics in PICUs.

The Effect of Intermittent and Continuous Feeding on Growth and Discharge Time in Very Low Birth Weight Preterm Infants.

OBJECTIVES: The aim of this study was to determine the effect of intermittent bolus feeding and continuous feeding models on early growth and discharge time in very low birth weight infants. METHODS: The study was designed as a prospective, randomized, and controlled study. Infants born in our hospital with birth weight below 1500 g within a 1 year period were included in the study. The number of samples was determined by power analysis. Babies were randomized according to birth weight and fed with intermittent bolus feeding and continuous feeding models. Demographic characteristics, clinical findings, diagnosis, nutritional status, and length of hospital stay were compared. RESULTS: The study was conducted with 80 preterm infants, which consisted of continuous feeding (n=41) and intermittent bolus feeding (n=39). There was no significant difference in gender, gestational week, birth weight, height, and head circumference distribution of the babies between groups. The difference between the reach time to birth weight and maximum weight loss rates, parenteral feeding time, transition time to full enteral feeding, transition time to oral feeding, development of feeding intolerance, mechanical ventilation time, and hospitalization time in intensive care unit were not statistically significant. Necrotizing enterocolitis (NEC) Stage I and II developed in 34.1% of babies fed with continuous feeding model and 28.2% of babies fed intermittently; NEC was detected to start in 4.5±2.8 days in the continuous feeding group and in 2.8±5.2 days in the intermittent group. These differences were found to be insignificant between the two groups (p=0.634 and p=0.266, respectively). CONCLUSION: There was no difference between growth parameters and discharge time of preterm babies who were applied continuous and intermittent bolus feeding model. Although there was no statistically significant difference on the development of NEC, it was determined that NEC developed earlier in the intermittent bolus feeding model.

The Effect of Cartoon Watching and Distraction Card on Physiologic Parameters and Fear Levels During Inhalation Therapy in Children: A Randomized Controlled Study.

OBJECTIVE: The study was conducted as a randomized controlled study to investigate the effect of cartoon watching and distraction cards on physiologic parameters and fear levels in children with acute bronchitis in the emergency department. METHODS: Ninety-nine children with acute bronchitis aged 3-6 years were randomized in the emergency department. The study was conducted with three groups: cartoon group, distraction card group, and the control group. Data were collected using a follow-up form and the Children's Fear Scale. RESULTS: The difference between the mean pulse rates of the groups evaluated by an observer nurse was found to be statistically significant. The pulse rates of the cartoon and distraction card groups were lower than in the control group during inhalation therapy (p < 0.05). The difference between the mean fear scores in the cartoon and control groups as evaluated by the observer nurse and the accompanying parent was found to be statistically significant during after inhalation therapy (p < 0.01). CONCLUSION: It was observed that watching cartoons during inhalation therapy was more effective in reducing the level of fear in children that distraction card.

The Effect of a Cartoon and an Information Video About Intravenous Insertion on Pain and Fear in Children Aged 6 to 12 Years in the Pediatric Emergency Unit: A Randomized Controlled Trial.

INTRODUCTION: Intravenous insertion is the most common invasive procedure made for administering intravascular fluid and medicine. Peripheral venous catheterization may cause pain, fear, and stress in children. This study aimed to compare the effects of watching a cartoon and an information video about intravenous insertion on the pain and fear levels of children aged 6-12 years. METHODS: The study was an experimental, randomized controlled clinical trial. It was conducted with 477 children aged 6-12 years randomized into 3 groups: the informative animated video group, the cartoon group, and the control group. Fear and pain perception were evaluated on the basis of the feedback from the child, observer nurse, and parents. The Children's Fear Scale was used to evaluate the fear level and the Wong-Baker FACES Scale was used to assess pain levels. Data were analyzed using one-way analysis of variance, the chi-square test, and the intraclass correlation coefficient test. RESULTS: The children who watched the information video before the intravenous insertion procedure and those who watched a cartoon during the procedure had lower mean pain and fear scores as evaluated by the child (pain: F = 278.67, P = 0.001; fear: F = 294.88, P = 0.001), parent (pain: F = 279.53, P = 0.001; fear: F = 294.47, P = 0.001), and nurse (pain: F = 286.88, P = 0.001; fear: F = 300.81, P = 0.001) than children in the control group. DISCUSSION: This study showed that watching an animation video or a cartoon was effective in lowering children's perceived level of pain and fear during an intravenous insertion intervention.

Effect of Pressure Injury Prevention Guides Used In a Pediatric Intensive Care.

The aim of this study was to determine the effectiveness of a pressure injury prevention guide used in a pediatric intensive care unit (PICU) on the occurrence of pressure injuries. The design is a pre-post intervention with a control group and a prospective intervention group. Pressure injuries occurred on 9.4% of children in the nontreatment group, and in 3.6% of children in the treatment group. There was a statistically significant difference in the occurrence of pressure injuries between the nontreatment group and the treatment group (p = .033). The average Braden Q pressure injury score was 12.20 ± 2.280 at the beginning of the intensive care hospitalization, and 13.73 ± 3.312 at discharge in the treatment group (p < .001). The results show that the risk of pressure injuries was reduced and pressure injuries occurred later when an evidence-based pressure injury prevention guide was used.

Examination of Care Burden and Stress Coping Styles of Parents of Children with Autism Spectrum Disorder.

OBJECTIVE: The study was conducted to examine the caregiver burden and stress coping styles of parents of children with Autism Spectrum Disorder (ASD). DESIGN AND METHODS: This descriptive cross-sectional study was conducted with parents of 131 children with ASD who were enrolled in a private education practice center in Istanbul between August 2015 and August 2016. The data were collected using a questionnaire prepared by the researchers, and the "Caregiver Strain Index" and "Ways of Coping Questionnaire." RESULTS: The mean age of the children in the sample group was 4.83 ±â€¯0.99 years; 63.4% were boys. Nearly 40% (38.2%) were diagnosed as having ASD at the age of 2 years. It was determined that the parents of children with ASD had a higher burden of care (CSI mean score: 7.68 ±â€¯4.30). The caregiver burden was significantly higher (p < 0.05) for parents of one child as compared to parents with more children, and parents with daughters compared to parents with sons. In addition, the mothers were found to have higher scores of 'submissive approach' and 'seeking social support' than fathers. CONCLUSION: Parents of children with ASD had a higher caregiver burden. Scores of approach types of self-confident, helpless, optimistic, and seeking social support were significant predictors of caregiver burden. PRACTICE IMPLICATIONS: Nurses are encouraged to take a more active role to improve the health of children with autism and families should contribute to mitigating the burden care of parents by informing families about social support systems.

Evaluation of a School-Based Program for Internet Addiction of Adolescents in Turkey.

This study aimed to evaluate a school-based program for Internet addiction, the Healthy Internet Use Program, with adolescents in Turkey. Forty-one students were included in the intervention group, and the control group was composed of 43 students. All students were from two primary schools. Students in the intervention group participated in the Healthy Internet Use Program, which was developed in accordance with the literature. The intervention group was given eight training sessions over a 3-month period, and their parents were given two training and consultancy sessions. Data were collected using a data collection form and the Internet Addiction Scale. The third evaluation of the Internet Addiction Scale scores showed a significant difference between the intervention group and the control group (p < .05). The fourth evaluation of the Internet Addiction Scale points showed a highly significant difference between the two groups (p < .001). The findings suggest that use of the Healthy Internet Use Program decreases the rate of Internet addiction among adolescents.

The Effect of Oral Care Using an Oral Health Care Guide on Preventing Mucositis in Pediatric Intensive Care.

OBJECTIVES: To evaluate the effectiveness of standard-of-care oral care guides developed specifically for children in intensive care to prevent mucositis. DESIGN AND METHODS: This prospective, interventional and single-group study design was performed in the pediatric intensive care unit of a university hospital in Istanbul between January and December 2014. Daily oral care was implemented to pediatric patients in the study group in line with an oral care guide developed by the researchers. Data were collected using the data collection form and oral mucositis assessment scale published by the World Health Organization (WHO). RESULTS: Oral mucositis occurred in 16 (5.2%) patients in the pre-intervention group and 7 (2.5%) in the post-intervention group, 10 patients had grade 1, and 6 patients had grade 2 oral mucositis in the pre-intervention group, and in the post-intervention group, three patients had grade 1, and four patients had grade 2 oral mucositis. Although more patients in the pre-intervention group had mucositis than in the post-intervention group, the differences were not statistically significant (P=0.067). CONCLUSIONS: Oral mucositis can be reduced through the practice of administering oral care in accordance with oral healthcare guidelines. PRACTICE IMPLICATIONS: Oral care implemented in line with an evidence-based oral care guide and frequent observation of patients are the most important steps in preventing oral mucositis.

Umbilical Cord Care and Infection Rates in Turkey.

OBJECTIVE: To compare the efficacy of umbilical cord sponging with 70% alcohol, sponging with 10% povidone-iodine, and dry care on the time to umbilical cord separation and bacterial colonization. DESIGN: Prospective, interventional experimental study design. SETTING: Three different family health centers in Istanbul, Turkey. PARTICIPANTS: In total, 194 newborns were enrolled in one of three study groups: Group 1, 70% alcohol (n = 67); Group 2, 10% povidone-iodine (n = 62); and Group 3, dry care (n = 65). METHODS: Data were collected between January 2015 and July 2015. Umbilical separation time and umbilical cord bacterial colonization were considered as the study outcomes. RESULTS: The most commonly isolated bacteria were Staphylococcus aureus, Escherichia coli, and enterococci. There was no significant difference among the groups for umbilical cord separation times (p > .05). CONCLUSION: Dry care may be perceived as an attractive option because of cost benefits and ease of application.

Povidone-Iodine, 0.05% Chlorhexidine Gluconate, or Water for Periurethral Cleaning Before Indwelling Urinary Catheterization in a Pediatric Intensive Care: A Randomized Controlled Trial.

PURPOSE: The aim of this study was to evaluate the efficacy of periurethral cleaning with 10% povidone-iodine, 0.05% chlorhexidine gluconate, or sterile water in preventing catheter-associated urinary tract infections (CAUTIs) prior to indwelling urinary catheter insertion in a pediatric intensive care unit. A secondary aim was to identify pathogens resulting in CAUTIs in this group. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: One hundred twenty-two patients cared for in a pediatric intensive care unit of a university hospital between September 2012 and December 2013 participated in the study. METHODS: Subjects were randomly allocated to 1 of 3 groups: periurethral cleansing with 0.05% chlorhexidine; 10% povidone-iodine; or sterile water. The patients in each group were cleansed 3 times using different sterile pads and assigned cleansing solutions for as long as the patients were observed or until the urinary catheter was removed. Daily monitoring forms, which included physiologic and physical parameters and catheter-related infections, were completed for all patients. We used Centers for Disease Control and Prevention/National Health and Safety Network criteria to determine the presence of a CAUTI. RESULTS: CAUTIs occurred in 6 patients (15%) allocated to periurethral cleansing with povidone-iodine, 2 (4.8%) in the chlorhexidine gluconate group, and 3 (7.5%) in the sterile water group. Although more patients in the povidone-iodine group had CAUTI than in the other 2 groups, differences were not statistically significant (P > .05). CONCLUSION: We found no statistically significant differences in CAUTI rates in the 3 groups. Further investigation with a larger study group is needed to more definitively identify any difference in CAUTI occurrences based on periurethral cleansing solution.

Chlorhexidine-Impregnated Dressings and Prevention of Catheter-Associated Bloodstream Infections in a Pediatric Intensive Care Unit.

BACKGROUND: Bloodstream infections related to use of catheters are associated with increased morbidity and mortality rates, prolonged hospital lengths of stay, and increased medical costs. OBJECTIVES: To compare the effectiveness of chlorhexidine-impregnated dressings with that of standard dressings in preventing catheter-related bloodstream infections. METHODS: A total of 100 children were randomly divided into 2 groups of 50 each: a chlorhexidine group and a standard group. Patient care was provided in accordance with prevention bundles. Patients were followed up for development of catheter-related bloodstream infections. RESULTS: Catheter colonization occurred in 4 patients in the standard group (8%) and in 1 patient in the chlorhexidine group (2%). Catheter-related bloodstream infections occurred in 5 patients in the standard group (10%) and in 1 patient in the chlorhexidine group (2%). Although more patients in the standard group had catheter-related bloodstream infections, the difference in infection rates between the 2 groups was not significant (P = .07). CONCLUSIONS: Use of chlorhexidine-impregnated dressings reduced rates of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in a pediatric intensive care unit but was not significantly better than use of standard dressings.

The Effects of Bundles on Catheter-Associated Urinary Tract Infections in the Pediatric Intensive Care Unit.

BACKGROUND: There are few studies in the literature from developing countries regarding the rates of catheter-associated urinary tract infection (CAUTI), which is frequently encountered in pediatric intensive care units (PICUs). AIM: The aim of this study is to evaluate the 2-year rates of CAUTI in a PICU where a CAUTI Prevention Bundle was implemented. DESIGN: This was an interventional prospective study. METHODS: The study was conducted with 390 patients in the PICU of Istanbul Faculty of Medicine, Turkey, from July 2013 to July 2015. The patients were selected based on the diagnostic criteria of the Centers for Disease Control and Prevention. RESULTS: Urinary colonization occurred in 8 (2.2%) patients in the prebundle group and 3 (0.8%) patients in the postbundle group, and contamination occurred in 10 (2.8%) patients in the prebundle group and 6 (1.5%) patients in the postbundle group. The CAUTI incidence and rates were 5.8% and 6.1 per 1000 urinary catheter days and 1.5% and 1.8 per 1000 urinary catheter days prebundle and postbundle, respectively. There was a statistically significant difference between the prebundle and postbundle CAUTI rates. CONCLUSION: Our findings support that clinical nurse specialists in developing countries should consider the use of CAUTI bundles to prevent CAUTIs.

Obesity in Nursery School Children in Corum, Turkey.

BACKGROUND: Regular body mass index (BMI) screenings in schools is important to ensure that 3- to 6-year-old children are not negatively affected by obesity in terms of their current and future health. OBJECTIVES: The aim of this study was to determine the overweight and obesity results of 3- to 6-year-old children and to guide children and their family in making healthier dietary choices by informing them. METHODS: This analytical-descriptive study was conducted in Corum, Turkey, in the year 2011. The study's sample consisted of all available 3- to 6-year-old children entering nursery school (specifically, the Buharaevler, Karsiyaka, Nasrettin Hoca, Ulukavak, Mimar Sinan, and Sevgi nursery schools). Findings from the study were statistically analyzed using the SPSS 15.0 program. The Chi-square test and analysis of variance (ANOVA) program were used in the comparison of study data. A p-value of less than 0.05 was considered significant. RESULTS: It was determined that 9.5% of the participating female children and 5.2% of the male children were underweight and that the boys were more obese than the girls in general. The correlation between the child's gender and their BMI was not found to be statistically significant (P-value > 0.05). The overweight frequency of the children was 12.1%, and the obesity frequency was 14.3%. Furthermore, it was determined that the obesity rates of the children increased with their age. Accordingly, the correlation between the child's age and BMI was found to be statistically significant (P-value < 0.05). CONCLUSIONS: An approach to preventing obesity must not be enacted only in health centers. Schools should also offer information and resources for families in order to prevent obesity in children.