Missed nursing care: A cross-sectional and multi-centric study from Turkey.

AIM: The aim of this study is to explore the extent of missed nursing care in Turkey and identify its predictors. DESIGN: This was a descriptive, cross-sectional, multicentre study. METHODS: A total of 477 nurses working in seven public hospitals participated in this study from March to July 2019. The survey included two components: a personal and professional characteristics data form and the MISSCARE survey. RESULTS: The study revealed that emotional support, patient bathing and ambulation were the most frequently missed nursing care activities. An inadequate number of assistive personnel and staff, along with an unexpected increase in patient volume, were identified as the primary reasons for missed nursing care. Of the 21 missed nursing care activities, nine predictive models showed statistical significance (p < 0.05). Factors such as the type of unit, years of work experience, working hours, number of patients cared for in a shift and intention to leave the unit were found to be significant predictors of seven missed nursing care activities (p < 0.05). CONCLUSION: This study found that numerous variables influence each care activity, which suggests the need to devise more targeted and specific strategies to minimize missed nursing care. Thorough investigation into the impact of these strategies on each care activity is essential.

The Effectiveness of Active External Warming of Patient Concurrently With Ice Application on the Incision Site on Post-Thoracotomy Pain and Analgesic Consumption.

The aim of study is to investigate the effects of active external warming of patient concurrently with application of ice to incision site on thoracotomy pain and analgesic consumption. The research is a quasi-experimental design with control and study groups. The study was conducted in 2018 and 2019. A total of 70 patients were included in the study: 35 in the control group and 35 in the study group. The mean verbal pain scale values were significantly lower in the intervention group (2.85 point) than in the control group (4.57 point; p < .001). Opioid consumption rate was high in control group patients (77.1% tramadol 30 mg; 45.7% morphine sulfate 5 mg) In contrast, the rate of opioid consumption was lower in patients in the intervention group (40% tramadol 30 mg; 17% morphine sulfate 5 mg). Active external warming and ice application on the incision area, could reduce the intensity of thoracotomy pain.

Understanding the essence of care in nurses' lived stories: A phenomenological study.

BACKGROUND: Caring contains understanding and connecting with the individual and the process of providing the healing effect. Nurses' awareness of the science of care can be improved by analyzing and sharing their care experiences, including their healing power, with members of the profession. AIM: The aim of this study was to understand the meaning of care from nurses' experiences and the real-life stories told by nurses. METHOD: A descriptive phenomenological design was used. A total of 124 stories told by 23 nurses participating in the training of Human Caring Theory constituted the sample of the study. The content analysis of the stories was carried out in four stages with Giorgi's phenomenological method analysis. RESULTS: Three themes and six subthemes were derived from the 124 stories. Three main themes: (1) care holds mysteries, (2) care as praxis and (3) obstacles to caring relationship. The first main theme consisted of three subthemes; "Hearing the call for help", "Metaphysical presence" and "Discovery of the healing effect". The second main theme consisted of three subthemes; "Criticism of the objective approach", "Unforgettable experiences of carecaring experiences" and "Awareness of expertise". CONCLUSION: The use of stories in the training of Human Caring Theory that centers care, besides facilitating learning, has created awareness among nurses about the 'Concept of Care' and has been an important step towards developing awareness of care among nurses.

Determination of patients' family members' needs and related factors in the intensive care unit with visiting restrictions during the COVID-19 pandemic.

OBJECTIVES: To determine the needs of family members of patients and related factors in the intensive care unit during the COVID-19 pandemic. RESEARCH METHODOLOGY: This descriptive, cross-sectional, and correlational type study was conducted with a total of 301 family members. Data were collected by using two validated inquiry forms, the "Introductory Information Form" and the "Critical Care Family Needs Inventory" through an online survey. Descriptive statistical methods, as well as the Mann-Whitney U test, Kruskal-Wallis test, Dunn-Bonferroni test, and Backward Linear Regression Analysis, were used for the analysis of data. RESULTS: The average scores of information, assurance, proximity, support, and comfort needs of family members were 3.54 ± 0.61 (Min = 1.11-Max = 4), 3.72 ± 0.60 (Min = 1-Max = 4), 3.50 ± 0.62 (Min = 1-Max = 4), 3.27 ± 0.77 (Min = 1.07-Max = 4), and 3.32 ± 0.73 (Min = 1-Max = 4), respectively. A very weak positive correlation was found between the ages of family members and information, assurance, and proximity needs (p < 0.05). Some variables such as sex, income level, and degree of affinity had significant effects on the needs of family members (p < 0.05). CONCLUSION: Family members of critically ill patients had needs at most in the assurance sub-dimension during the COVID-19 pandemic. As the length of time of family members spent in the hospital increased, their support and comfort sub-dimension needs also increased. Institutional policies should be developed to assure family members in intensive care units.

The empathy level and caring behaviors perceptions of nursing students: A cross-sectional and correlational study.

PURPOSE: The aim of the study was to investigate the empathy level and caring behaviors perceptions of nursing students. METHOD: This cross-sectional and correlational study was conducted with 276 nursing students. RESULTS: The mean Empathic Tendency Scale score was 62.71 ± 5.10 (min. 20 to max. 100), indicating a low level of empathy. The mean of the Caring Assessment Questionnaire was 5.42 ± 0.80 (min. 1 to max. 7), showing a good perception of caring behaviors. There was a positive, low, and significant relationship between empathy and caring behaviors (r = 0.286, p < 0.001). CONCLUSION: This study revealed that nursing students have low-level empathy and high-level caring behaviors. PRACTICE IMPLICATIONS: Throughout the educational process, the students' caring competencies, which include empathy and caring behaviors, developed. It is suggested that humanistic and value-oriented pedagogical approaches be incorporated into nursing curricula.

Effectiveness of Music Intervention on Postoperative Nausea and Vomiting: A Systematic Review and Meta-analysis.

PURPOSE: To evaluate the evidence for the effectiveness of music intervention on postoperative nausea and vomiting in the first 24 hours after surgery. DESIGN: A systematic review and meta-analysis of randomized controlled trials. METHODS: The study was conducted according to recommendations from Cochrane Handbook. The studies were selected based on PICOS inclusion and exclusion criteria. The revised Cochrane risk-of-bias tool for randomized trials was used for bias assessment and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for reporting the study. Data was analyzed using the Comprehensive Meta-analysis version 3 software. A meta-analysis of randomized controlled trials was conducted using both fixed and random-effect models. FINDINGS: There were 576 patients in the seven studies who met the inclusion criteria. The number of participants ranged from 58 to 163. Music was implemented in postoperative, intraoperative, and perioperative periods. Meta-analyses revealed that music interventions significantly reduced postoperative vomiting (95% CI: 0.01 to 0.63, Z = 2.07, P < 0.05, Hedge's g = 0.32), and had no statistical significant effect on postoperative nausea (95% CI: -0.13 to 0.70, Z = 1.34, P > 0.05, Hedge's g = 0.28). CONCLUSION: Music intervention is effective in decreasing postoperative vomiting. Music intervention can be applied by healthcare professionals and the patients. However, more studies are still necessary to estimate the effects of postoperative nausea and vomiting and to increase the amount of available evidence. STUDY REGISTRATION NUMBER: CRD42020209691.

Nursing students' expectations, satisfaction, and perceptions regarding clinical learning environment: A cross-sectional, profile study from Turkey.

AIM: The study aimed to examine the nursing students' expectation, satisfaction and perception regarding the clinical learning environment. BACKGROUND: The clinical learning environment is the place where the students socialize professionally and gain professional competence. DESIGN: This was a cross-sectional descriptive study. PARTICIPANTS: A total of 1484 nursing students enrolled in undergraduate programs for the 2019-2020 academic year. METHODS: A self-designed questionnaire and The Clinical Learning Environment Scale was used to collect the data. Data were collected between May and July 2019. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology checklist. RESULTS: Nursing students primarily expected supportive attitudes and active participation in nursing practices. A total of 53.8% of the students were satisfied with the clinical learning environment. The two components they were most satisfied with were technical skills and interpersonal caring experiences. The mean scale score for the clinical learning environment perceived by the students was 70.12 (SD = 9.25) (min: 22, max: 110). The students' professional perspective, ability to transfer theory to practice and satisfaction with clinical practice affected their perception of the clinical learning environment. CONCLUSIONS: This research revealed that nursing students expect support and supervision from both the instructor and the clinical staff. The importance of educational and clinical support, which are the most basic needs of students during the learning process, is also clearly seen in the research results. Considering the unbalanced distribution in the instructor-to-student ratio, the importance of clinical mentoring becomes more evident.

The effect of using standardized patients in the Simulated Hospital Environment on first-year nursing students psychomotor skills learning.

BACKGROUND: The aim of this study was to determine the effect of using standardized patients in the Simulated Hospital Environment on first-year nursing students' psychomotor skills. METHODS: This semi-experimental study was carried out in the one-group pretest-posttest design. Students performed the psychomotor skills in the Non-Simulated Clinical Skill Laboratory and Simulated Hospital Environment. The skill performances of the students were evaluated with the Objective Structured Clinical Assessment form. At the same time, students' views on both environments were received. RESULTS: Students' mean Objective Structured Clinical Assessment score in the Simulated Hospital Environment (69.42 ± 10.94) was significantly higher than their mean score in the Non-Simulated Clinical Skill Laboratory (57.07 ± 10.05) (p < 0.05). The differences in scores were particularly significant in the stages of meeting the patient, performing the procedure in accordance with the steps and ending the procedure. The majority of the students stated that they could not do some applications in the Non-Simulated Clinical Skill Laboratory in a similar way to the hospital clinic (85.9%), and they felt like they were in a real hospital clinic in the Simulated Hospital Environment (100%). CONCLUSIONS: The results showed that students developed psychomotor skills more fully in a learning environment designed in a similar way to a real hospital clinic setting.

Examination of the professional values of the nurses and the associated factors.

PURPOSE: This study is conducted to examine the professional values of nurses and their personal and professional characteristics affecting these values. DESIGN AND METHODS: A total of 369 nurses completed a questionnaire on personal information and nursing professional values scale (NPVS-R). FINDINGS: The total scores of the nurses on the NPVS-R were found to be 100.87 ± 21.07, and the item mean scores were found to be 3.87 ± 0.81. When the scores for individual scale factors were examined, the highest scores were observed for the "caring" (4.02 ± 0.87) and "activism" (3.90 ± 0.89) factors. PRACTICE IMPLICATIONS: The fact that nurses are aware of their individual values and how these values affect their behavior can be a guide in human-focused value nursing planning.

Being an international nursing student in Turkey: A qualitative study.

PURPOSE: The purpose of this study is to explore the perspectives of international nursing students in Turkey on their learning experience. DESIGN AND METHODS: Qualitative semi-structured individual interviews and focus group interviews were used to explore nursing students' perspectives on their learning experiences in Turkey. The research population comprised 10 international students. RESULTS: The students expressed fear of being rejected by patients in a clinical setting, as well as feelings of isolation and discrimination. They feel foreign and experience the typical prejudice against their color and language. PRACTICE IMPLICATIONS: Educators should take language and cultural differences into consideration and should listen to international students regarding education methods. Teachers of international students, both academic and clinical, need to be cognizant of the "otherness" of international students.

Nurses' responses to monitor alarms in an intensive care unit: An observational study.

OBJECTIVE: The present study aimed to determine the types of monitor alarms and nurses' responses to them in an adult intensive care unit. DESIGN AND METHODS: This was an observational descriptive research study conducted in the adult intensive care unit of a university hospital in the Mediterranean region of Turkey. The nonparticipant observation method was used. Data were collected by two observers using a semi-structured observation form developed according to literature. RESULTS: Between August 2016 and January 2017, 13 registered nurses were observed for 328 hours. There were 1781 alarms, which included alarms for blood pressure (37.6%), respiration and oxygen saturation (35.3%) and heart rate and arrhythmia (27.1%). Nurses responded to approximately half (46.9%) of the alarms that required a response. Responses to alarms included silencing them, responding to the patient's clinical condition and solving contact and transmission problems. CONCLUSION: In the present study, according to response requirement, the division of the alarms was different. The number of alarms that do not reflect the clinical status of the patient was high. It was found that as the false alarm rate increased, the response rate of nurses to these alarms decreased.

Determining the opinions of the first-year nursing students about clinical practice and clinical educators.

The clinical experience prepares nursing students to become competent and professional practitioners. The evaluation of the clinical learning environment is important to determine if the clinical experience and clinical instructor provide essential learning opportunities as well as a supportive environment. This study aimed to determine the opinions of first-year nursing students about their instructors and clinical practice in the clinical education setting. The sample of the study consists of 227 students from Akdeniz University Nursing Faculty enrolled in the 'Nursing Basics' course. The mean age of the students was 19.30 ±â€¯0.83, and 74% of the students stated that they were satisfied with clinical practice. During clinical applications, 70.8% of the students were guided by one nurse and one educator while 20.4% and 8.8% were accompanied with only an educator and only a nurse, respectively. A review of the opinions of the students about their educators revealed that they held positive opinions about the educators in terms of adequate theoretical knowledge (74.1%), openness to dialogue (67.9%), encouraging students to do research (62.7%), giving support to students during clinical practice (61.6%), and appreciating the positive behaviours of students (61.7%). In conclusion, it was determined that, although the students regarded the educators as competent in terms of theoretical knowledge and skill and successful in motivating, orienting, and encouraging the students, they viewed inaccessibility of educators as the leading problem.

The effectiveness of strategies similar to the Magnet model to create positive work environments on nurse satisfaction.

AIM: The objective of this study was to identify the satisfaction levels of nurses with positive environment initiatives and positive management strategies. METHOD: In total, 235 and 259 nurses participated in the study before and after the application of the initiatives and strategies, respectively. Strategies adopted from the magnet model to create positive work environments and management styles were executed according to the forces of magnetism. Data related to satisfaction were collected twice, once before and once after the strategies to create positive working environments were implemented. RESULTS: The rates of working environment satisfaction in the nurses' department were 57.07% in 2011 and 69.01% in 2013. The rate of satisfaction with governance differed significantly between 2011 and 2013, especially in terms of the merit system, equity and equality, information flow between the administration and the employees, and the influence of the nursing managers on institutional decision making. CONCLUSION: This study showed that 24 months after the implementation of these strategies, nurse satisfaction with their work environment and management style increased significantly.

Training needs of clinical nurses at an university hospital in Turkey.

The learning needs of clinical nurses should be determined and evaluated at regular intervals for evaluate the continuity and the efficiency of education. The descriptive study was conducted to determine the training needs of nurses working in an educational hospital between February 1st 2012 and May 1st 2012. It was determined that, among the training topics related to patient care, those demanded the most were cardio-pulmonary resuscitation, fluid-electrolyte balance, safe drug administration and wound Care. As for the topics related to management skills, the nurses stated that they needed training especially on stress and crisis management. The results of the present study suggest that in-service training is necessary in the clinical field and training programs, which should be aimed to ensure the participation of; nurses in in-service training sessions to the maximum extent possible, are needed.

The Effectiveness of Measures Aimed at Noise Reduction in an Intensive Care Unit.

Noise is a significant problem for both hospitalized patients and health care workers. This study aimed to determine the effectiveness of noise reduction strategies in an intensive care unit. Noise was measured in two phases. In the first phase, the unit's present level of noise was established over 3 weeks between January 1, 2012, and February 1, 2012. During the month following initial measurements, noise reduction interventions, including staff education and physical space arrangement, were initiated, and device alarms were checked. The second phase of measurement was conducted during another 3-week period (between June 1, 2012, and July 1, 2012). The noise levels before and after noise reduction interventions were calculated as 67.6 dB-A and 56 dB-A; the difference between the two levels was statistically significant (p<.05). The interventions were effective in reducing noise in intensive care units; the interventions are relatively easy and low cost.

The effectiveness of environmental strategies on noise reduction in a pediatric intensive care unit: creation of single-patient bedrooms and reducing noise sources.

PURPOSE: Noise is a substantial problem for both patients and healthcare workers in hospitals. This study aimed to determine the effectiveness of environmental strategies (creating single-patient rooms and reducing noise sources) in noise reduction in a pediatric intensive care unit. DESIGN AND METHODS: Noise measurement in the unit was conducted in two phases. In the first phase, measurements aimed at determining the unit's present level of noise were performed over 4 weeks in December 2013. During the month following the first measurement phase, the intensive care unit (ICU) was moved to a new location and noise-reducing strategies were implemented. The second phase, in May 2014, measured noise levels in the newly constructed environment. RESULTS: The noise levels before and after environmental changes were statistically significant at 72.6 dB-A and 56 dB-A, respectively (p < .05). PRACTICE IMPLICATIONS: Single-patient rooms and noise-reducing strategies can be effective in controlling environmental noise in the ICU.

Preoperative education and use of analgesic before onset of pain routinely for post-thoracotomy pain control can reduce pain effect and total amount of analgesics administered postoperatively.

The purpose of this study was to investigate the efficiency of preoperative pain management education and the role of analgesics administration before the onset of pain postoperatively. The study was a prospective, randomized, and single-blind clinical trial, which was conducted January 1, 2008 through October 1, 2008 in the Thoracic Surgery Unit of Akdeniz University Hospital. A total of 70 patients who underwent thoracotomy (35 in the control group and 35 in the study group) were included in the study. Of the patients, 70% (n = 49) were male and 30% (n = 21) were female. Mean age was 51 ± 10 years (range = 25-65). The same analgesia method was used for all patients; the same surgical team performed each operation. Methods, including preemptive analgesia and placement of pleural or thoracic catheter for using analgesics, that were likely to affect pain level, were not used. The same analgesia medication was used for both patient groups. But the study group, additionally, was educated on how to deal with pain preoperatively and on the pharmacological methods to be used after surgery. An intramuscular diclofenac Na 75 mg was administered to the study group regardless of whether or not they reported pain in the first two postoperative hours. The control group did not receive preoperative education, and analgesics were not administered to them unless they reported pain in the postoperative period. The routine analgesics protocol was as follows: diclofenac Na 75 mg (once a day) intramuscular administered upon the complaint of pain following extubation in the postoperative period and 20 mg mepederin intravenously (maximum dose, 100 mg/day), in addition, when the patient expressed pain. Pain severity was assessed during the second, fourth, eighth, 16th, 24th, and 48th hours, and marked using the Verbal Category Scale and the Behavioral Pain Assessment Scale. Additionally, the total dose of daily analgesics was calculated. The demographic characteristics showed a homogeneous distribution in both patient groups. The rate of pain, which was defined as sharp, stabbing, and exhausting, was higher in the control group than in the study group, and the difference between the two groups was statistically significant (p < .05). As the doses of analgesics used for pain management in both groups were compared, it was determined that analgesic consumption was lower in the study group than in the control group, and the difference was statistically significant (p < .05). As a result, it was determined that preoperative thoracic pain management education and analgesics administered postoperatively, before the onset of pain, reduced the amount of analgesics used in the first postoperative 48 hours.

Evaluation of the outcomes of ice application for the control of pain associated with chest tube irritation.

The aim of this study was to evaluate the effectiveness of the use of ice for the control of pain associated with chest tube irritation. The randomized and single-blinded study consisted of 40 patients (20 in the control and 20 in the study group) who underwent thoracotomy with chest tube placement. The same general anesthesia protocol was used for all patients, and the procedure was performed by the same surgery team. Procedures such as decortication and thoracic wall resection were not included in the study. Standard postoperative analgesic methods were applied to all patients. Additionally, ice (in flexible and bendable cold gel packs wrapped in fine cloth sheaths) was applied to the chest tube insertion site at the 24th, 28th, 36th, and 40th postoperative hours for 20 minutes. To assess the effectiveness of ice application, Verbal Category Scale and Behavioral Pain Scale methods were used to measure the severity of pain. Average pain severity scores during the mobilization activities, including coughing and walking, were compared and found to be significantly lower in the study group patients who received cold therapy than in the control group patients (p < .05). Additionally, analgesic consumption was lower in the study group than in the control group patients (p < .05). As a result, the application of ice to the chest tube insertion site reduced pain associated with irritation along with the need for analgesics.

Nature and intensity of the pain following thoracotomy.

The aim of this study is to clearly define and describe the pain characteristics that disturb the patients having thoracotomy in postoperative period. It can be possible to manage to get pains under control according to pain characteristics. The study included 70 patients who underwent thoracotomy (lobectomy or segmentectomy and mean duration of surgery was 90 min) and were hospitalized in the intensive care unit of the Thoracic Surgery Department of Akdeniz University Hospital between November 2007 and November 2008. In this study, 68.6% of the patients were male and mean age was 49.90. The study was achieved. Consider that the patients have pain in the first 24 h postoperatively and the effect of sedation, the Behavioural Pain Scale, which is filled out by a researcher, and the Verbal Category Scale, which allows the patient to define his/her pain with short responses, were used for pain assessment. Pain was assessed at the postoperative 4th, 8th, 16th, 24th and 48th hours, following extubation. The patients mostly reported throbbing (65.7%), stabbing (65.7%) and stinging (62.9%) pain in the incision site, while 40% of them (n = 28) reported a 'sharp', 'exhausting' and 'splitting' pain. The investigation of the factors increasing pain during the postoperative period revealed that most of the patients (85.7%) reported that their pain increased due to movement in bed and/or walking, while 74.3%, 68.6%, 54.3% and 37.1% of them stated that their pain increased due to breathing, coughing, chest tube movement and noisy environment, respectively. Each pain characteristics, throbbing, stabbing and stinging, can be specifically relief using one or more methods such as touching on the incision site, little press on the thoracotomy region, talking to the patient about pain, etc. We determined that the patients experienced a sharp, stabbing and unbearable pain in the first 48 postoperative hours. Therefore, our study suggests that some interventions such as pressure exertion and touching to the painful area were stated to provide pain relief to the patients.