Determination of Nursing Care Times Based on the Perroca Patient Classification Instrument in the Inpatient Oncology Unit: A Mixed Method Study.

OBJECTIVES: The aim of this study was to determine the daily nursing care times of hospitalized inpatient oncology unit patients according to degree of acuity using the Perroca Patient Classification tool. DATA SOURCES: This study used a mixed method sequential explanatory design. The "Nursing Activity Record Form" and "Perroca Patient Classification Instrument" were used for quantitative data collection, and direct observation was performed for 175 hours via time-motion study. Descriptive statistics, between-group comparison, and correlation analysis were used for data analysis. Using a semistructured questionnaire, qualitative data were collected from individual in-depth interviews with seven nurses who participated in the quantitative part of the study. Qualitative data were analyzed by thematic analysis. The reporting of this study followed GRAMMS checklist. CONCLUSIONS: As a result of the integration of quantitative and qualitative data, daily nursing care duration was determined as 2 to 2.5 hours for Type 1 patients, 2.6 to 3.5 hours for Type 2 patients, 3.6 to 4.75 hours for Type 3 patients, and 4.76 to 5.5 hours for Type 4 patients. The findings showed that in an inpatient oncology unit, nursing care hours increased as patients' Perroca Patient Classification Instrument acuity grade increased; thus, the instrument was discriminative in determining patients' degree of acuity. IMPLICATIONS FOR NURSING PRACTICE: Nurse managers can utilize this study's results to plan daily assignments that are sensitive to patient care needs. The results can also help nurse managers to identify relationships between nurse staffing and patient outcomes at the unit level, as well as to develop ways to analyze such relationships.

Replacing Monitoring Electrodes on Infant Skin Every 12 Versus 24 Hours.

OBJECTIVE: To examine the effect of varying the frequency of monitoring electrode replacement on skin moisture and condition of infants hospitalized in the pediatric ICU. METHODS: The population of the study consisted of 1- to 12-month-old infants receiving treatment in the pediatric ICU. The control group of the study (n = 33) included infants whose monitoring electrodes were replaced every 24 hours during monitoring, and the experimental group (n = 33) included infants whose monitoring electrodes were replaced every 12 and 24 hours during monitoring. Before assessment, the skin moisture of the monitoring areas was measured and evaluated with the Skin Condition Assessment Scale. RESULTS: When the difference in skin moisture was compared for all measurement areas of the infants before monitoring and at the 24-hour mark, an increase in moisture was seen in both groups, and the difference in the experimental group was greater than that in the control group. Increased moisture is a risk factor for medical device-related pressure injuries. When comparing between-group differences in skin condition, the researchers noted a greater increase in skin condition score in the experimental group. An increased score indicates that the infant's skin condition is worsening. CONCLUSIONS: Replacing the monitoring electrodes every 24 hours positively affected skin moisture and condition, whereas replacing them every 12 hours negatively affected skin moisture and condition.

Within- and between-subject biological variation data for serum zinc, copper and selenium obtained from 68 apparently healthy Turkish subjects.

OBJECTIVES: Trace elements (TrEL) are nutritionally essential components in maintaining health and preventing diseases. There is a lack of reliable biological variation (BV) data for TrELs, required for the diagnosis and monitoring of TrEL disturbances. In this study, we aimed to provide updated within- and between-subject BV estimates for zinc (Zn), copper (Cu) and selenium (Se). METHODS: Weekly serum samples were drawn from 68 healthy subjects (36 females and 32 males) for 10 weeks and stored at -80 °C prior to analysis. Serum Zn, Cu and Se levels were measured using inductively-coupled plasma mass spectrometry (ICP-MS). Outlier and variance homogeneity analyses were performed followed by CV-ANOVA (Røraas method) to determine BV and analytical variation estimates with 95% CI and the associated reference change values (RCV) for all subjects, males and females. RESULTS: Significant differences in mean concentrations between males and females were observed, with absolute and relative (%) differences for Zn at 0.5 µmol/L (3.5%), Cu 2.0 µmol/L (14.1%) and Se 0.06 µmol/L (6.0%). The within-subject BV (CVI [95% CI]) estimates were 8.8% (8.2-9.3), 7.8% (7.3-8.3) and 7.7% (7.2-8.2) for Zn, Cu and Se, respectively. Within-subject biological variation (CVI) estimates derived for male and female subgroups were similar for all three TrELs. Marked individuality was observed for Cu and Se. CONCLUSIONS: The data of this study provides updated BV estimates for serum Zn, Cu and Se derived from a stringent protocol and state of the art methodologies. Furthermore, Cu and Se display marked individuality, highlighting that population based reference limits should not be used in the monitoring of patients.

The Turkish version of the Patient Safety Competency Self-Evaluation Tool: A validity and reliability study.

AIM: To test the validity and reliability of the Patient Safety Competency Self-Evaluation Tool in Turkish, which was developed to evaluate the patient safety competencies of nursing students. BACKGROUND: In nursing education, it is crucial to provide students with the necessary professional knowledge and skills as well as appropriate attitudes in certain subjects. It is essential to address frequently encountered problems, to train nurses who can be aware of patient safety and improve the quality of nursing education. A valid and reliable measurement tool is needed to evaluate nursing students' current patient safety knowledge, skills and attitudes and review the curriculum and learning objectives in this context. DESIGN: This is a validation study with a cross-sectional design. METHODS: The study sample consisted of 417 third and fourth-grade nursing students studying at two universities in Istanbul and volunteered to participate in the research. The study used the Turkish version of the Patient Safety Competency Self-Evaluation Tool was used for data collection. Content validity, construct validity, stability and reliability tests were performed. Data were analyzed using SPSS and AMOS programs. Ethics committee approval and permission from the institutions were obtained. RESULTS: Nursing students' mean age was 21.98 (SD = 1.17). The Scope Validity Index of the scale was calculated as 0.97. As a result of the confirmatory factor analysis performed in the original structure consisting of three dimensions, 12 factors and 41 items, it was found that all items were in the sub-dimensions of the original scale and factor loads were between 0.168 and 0.918. Four models were tested in confirmatory factor analysis and Model 4 had the best-fit indices. They were calculated as: χ2/df = 2.38, RMSEA = 0.06 and CFI = 0.91 for Model 4. Cronbach's alpha value of the total scale was 0.941 and ranged between 0.642 and 0.932 in its sub-dimensions. CONCLUSION: The Turkish version of the Patient Safety Competency Self-Evaluation Tool is valid and reliable to measure nursing students' patient safety competencies.

Effect of simulation-based learning on first clinical day stress and anxiety levels of nursing students in Turkey.

OBJECTIVES: To determine the effect of simulation-oriented skills training on first clinical day stress and anxiety levels in nursing students. METHODS: The quasi-experimental study was conducted from April to June, 2016, in Istanbul, Turkey, and comprised first year nursing students who were divided into two groups. In Group 1, students measured vital signs on simulated patients before their first clinical practice. In Group 2, the students performed this application on each other. Then, on the first day of their clinical practice, the students evaluated the vital signs and then filled out Clinical Stress Questionnaire and the State-Trait Anxiety Inventory. Data was analysed using Number Cruncher Statistical System version 2007. RESULTS: Of the 41 subjects, 16(39%) were in Group 1 with a mean age of 19.31±3.2 years, and 25(61%) were in Group 2 with a mean age of 18.92±0.86 years (p>0.05). There was no significant differences in state-trait anxiety inventory and clinical stress questionnaire scores between the groups (p>0.05). There was a significant difference with respect to benefit subscale of the clinical stress questioaanire (p=0.049). CONCLUSIONS: The use of simulation in nursing education provided relief and confidence during clinical practice.

Examining the effect of simulation based learning on self-efficacy and performance of first-year nursing students.

BACKGROUND: Self-efficacy is an individual's belief in oneself and in one's own judgment and ability to be successful in a task. Strong self-efficacy allows for the achievement of success, well-being, personal development and the diversification of skills. An individual's perception of his/her self-efficacy plays a key role in adopting behaviors and initiating and sustaining change. AIMS: The first aim of this study is to evaluate the effects of simulation-based learning on the self-efficacy and performance of first-year nursing students. The second aim is to examine students' pre- and post-scenario proficiency in their self-assessment of competence in regard to scenario objectives to compare the students' self-assessment and their instructor's assessment in terms of performance evaluations. METHODS: This semi-experimental study was conducted with sixty-five first-year nursing students. A standardized patient method was used as a simulation technique. Students' self-efficacy and their perceptions of their own competence in completing skills were measured using the General Self-Efficacy Scale and the Proficiency Assessment Form, respectively. Students' actual performance was evaluated via an Objective Structured Clinical Assessment and performance evaluation checklists. RESULTS: The mean self-efficacy score of students was 52.68 (±10.19) before the scenario and 49.59 (±12.90) post-scenario (p = .001). With regard to their scenario objectives, a decrease was observed in students' proficiency in their post-scenario self-assessment of competence. This decrease was only statistically significant in the "Establishing a safe patient unit" objective (t = 2.27; p = .03). CONCLUSIONS: We observed that self-efficacy scores declined in the post-simulation scenario. Using standardized patients in simulation training allows novice nursing students to meet a real patient and to recognize their own true self-efficacy.

Use of simulation from high fidelity to low fidelity in teaching of safe-medication practices.

OBJECTIVE: To evaluate the effects of simulation techniques on learning outcomes in the teaching of safe drug applications to first year nursing students. METHODS: The semi-experimental study was conducted from February to April 2017, and comprised nursing students of Acibadem Mehmet Ali Aydinlar University. This student satisfaction and selfconfidence in learning scale, medication practice via oral route checklist, and pre- and post-test for safe drug application knowledge Assessment were used for data collection. Following the theoretical lectures, case studies, task trainer practices and scenario with standardised patient were carried out. Baseline knowledge, during-the-scenario performanceand post-scenario level of student's satisfaction and self-confidence were evaluated. Data was analysed using SPSS 18. RESULTS: Of the 58 subjects, 51(87.9%) were female. The overall mean age of the sample was 20.69±1.02 years. There was a statistically significant difference between students' knowledge levels before and after the scenario (p<0.05). Mean performance scoreon safe medication practice was 65.70±5.83. A significant weak positive correlation was found between the students' scores on satisfaction with the simulation and knowledge levels as well as the performance and self-confidence scores (p<0.05 each). Also, there was a strong correlation between the scores on self-confidence scale and the knowledge levels (p<0.01). CONCLUSIONS: Simulation had a positive effect on learning outcomes..

Within-subject and between-subject biological variation estimates of 21 hematological parameters in 30 healthy subjects.

BACKGROUND: The complete blood count (CBC) is used to evaluate health status in the contexts of various clinical situations such as anemia, infection, inflammation, trauma, malignancies, etc. To ensure safe clinical application of the CBC, reliable biological variation (BV) data are required. The study aim was to define the BVs of CBC parameters employing a strict protocol. METHODS: Blood samples, drawn from 30 healthy subjects (17 females, 13 males) once weekly for 10 weeks, were analyzed using a Sysmex XN 3000 instrument. The data were assessed for normality, trends, outliers and variance homogeneity prior to coefficient of variation (CV)-analysis of variance (ANOVA). Sex-stratified within-subject (CVI) and between-subjects (CVG) BV estimates were determined for 21 CBC parameters. RESULTS: For leukocyte parameters, with the exception of lymphocytes and basophils, significant differences were found between female/male CVI estimates. The mean values of all erythrocyte-, reticulocyte- and platelet parameters differed significantly between the sexes, except for mean corpuscular hemoglobin concentration, mean corpuscular volume and platelet numbers. Most CVI and CVG estimates appear to be lower than those previously published. CONCLUSIONS: Our study, based on a rigorous protocol, provides updated and more stringent BV estimates for CBC parameters. Sex stratification of data is necessary when exploring the significance of changes in consecutive results and when setting analytical performance specifications.

Staff Nurse Decisional Involvement in the United States and Turkey.

The purpose of this descriptive comparative study is to compare the levels of decisional involvement of staff nurses between one Midwestern health care system in the United States with a nongovernmental University hospital in Turkey. The Decisional Involvement Scale was used for data collection. U.S. ( n = 163) and Turkey ( n = 50) staff nurses were included in the study. Both samples preferred more decisional involvement than they currently experienced. However, Turkish nurses experienced and preferred lower levels of decisional involvement than the U.S. SAMPLE: Shared governance structures may be a strategy used to enhance staff nurse decisional involvement.

Medical errors and patient safety in the operating room.

OBJECTIVE: To investigate medical errors in the operating room, attitudes of healthcare professionals in case of errors and educational needs of professionals. METHODS: The descriptive study was conducted at a university hospital in Turkey from January 25 to February 14, 2011, and comprised operating room staff, including physicians, nurses, anaesthesia technicians and perfusion technicians. Data was obtained using a questionnaire. RESULTS: Of the 69 respondents, 45(65.2%) had experienced medical errors and 29(42%) had verbally warned the person who caused the error. The main cause of the medical errors was a lack of healthcare professionals and their inadequate qualifications, 51(73.9%); and insufficient communication, 41(59.4%). Coping with stress and communication 45(65.2%) and radiation safety 28(40.6%) were the most common educational needs. CONCLUSIONS: Patient safety applications in the operating room can be improved by offering educational programmes, designing an easy reporting system, encouraging reporting of medical errors and active participation of healthcare professionals in decisions that might affect patient safety.

Postgraduate education needs of Nurses' who are caregivers for patients with diabetes.

OBJECTIVE: Diabetic management process requires nurses with expert knowledge and patient care skills. This study was carried out to identify nurses' diabetic care approaches and their post graduate education needs in order to develop a "Basic Diabetes Patient Care Education Program" in a university hospital in Turkey. METHODS: The descriptive study, using the survey technique, was carried out in a university hospital with 87 bedside nurses who were caring for diabetic patients. Investigators developed data collection tool consisting of closed ended questions and opportunities for open-ended responses. RESULTS: Among the 87 nurses, 88.5% were staff nurses, and 11.5% were nurse managers. The mean age was 27.41 ± 4.82 and years of professional experience was 6.86 ± 4.23. The 41.4% of nurses stated that they were caring for 1-2 patients with diabetes per week and 72.4% of nurses stated that they had attended an educational session about diabetes after graduation. The 95.4% of nurses reported a need for a continuous education program for diabetes patient care. Medication regimen (69.0%) and special care applications such as wound care (54.0%) were the most needed educational requirements. There were no difference in educational needs based on basic education or years of professional experience (p>0.05). CONCLUSIONS: Nurses caring for patients with diabetes should be supported by orientation, in-service education and continuing education programs. Additionally, the placement of patient care courses for chronic diseases, like diabetes, into the core curriculum of nursing schools would be useful in responding to actual patient care and family needs.

Decisional involvement among staff nurses based on educational level and certification status.

Mechanisms to enhance the work environment are nurse decisional involvement (DI), obtainment of a baccalaureate or higher degree, and specialty certification. The purpose of this descriptive comparative study was to determine the difference between actual and preferred DI of staff nurses on the overall Decisional Involvement Scale (DIS), the differences based on its subscales, and those based on education level and certification. The sample included 163 staff nurses from a Midwestern health care organization. A statistically significant difference was found between actual and preferred DI, but no difference was found based on educational level and certification. There is a need to focus on nurses with a BSN/master's degree or specialty certification and to conduct comprehensive studies to address the effects of education and certification on DI. An additional strategy that can be useful for organizations is to provide nurses with the empowerment structures, expectations, and mentoring/coaching to become involved in the process of decision making.