An Investigation of Surgical Nurses' Professional Values, Ethical Sensitivity and Quality of Care: A Cross-Sectional Study From Northwest Turkey.

Nurses' professional values are closely associated with their ethical sensitivity and the quality of nursing care. The aim of this study was to determine surgical nurses' perceptions of their professional values, ethical sensitivities and quality of care, the relationship between these variables, and the factors influencing these. The sample of this cross-sectional, descriptive and relational study consisted of 231 nurses working in the surgical units of two university hospitals and a training and research hospital. The study revealed a statistically significant negative relationship between the nurses' professional values scale median score and the Moral Sensitivity Questionnaire median score, and a positive significant relationship between the Nurses' Professional Values Scale median score and the Care Behaviors Scale median score. Having ethical problems in their professional lives increased the ethical sensitivity of nurses, while having a medical-vocational high school and vocational school of health services degree and participation in training/meetings about professional values and ethics increased the perception of the quality of nursing care. Awareness of professional values is crucial in providing quality nursing care that is in line with ethical principles; therefore, it is recommended that the continuity of surgical nurses' participation in training/meetings on professional values and ethics be ensured, that they be supported to become members of professional associations, and that supportive working environments be provided to improve the quality of nursing care.

The effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms: A prospective, randomized controlled trial.

INTRODUCTION: The major salivary glands can be stimulated by chewing gum to increase saliva flow and decrease xerostomia. The aim of this study was to investigate the effect of chewing gum on dry mouth, interdialytic weight gain, and intradialytic symptoms in hemodialysis (HD) patients. METHODS: This prospective randomized controlled single-blind study was conducted with patients who had been treated for at least 6 months with sessions 3 days a week for 4 hours at two HD units. Patients were randomly allocated to chewing gum group or the control group. In the chewing gum group, gum was chewed for 10 minutes six times a day, and when the patients felt mouth dryness or were thirsty. In the nonchewing gum group, gum was not chewed. The patients were followed-up for 3 months. A total of three saliva samples were taken before starting treatment at the first, 12th, and 36th HD session. Data were collected with the "Visual Analogue Scale (VAS)," "Hemodialysis Patients Fluid Control Scale," "Dialysis Symptom Index," and "Hospital Anxiety and Depression Scale" at baseline, week 4, week 8, and week 12. FINDINGS: The study was completed with a total of 44 patients consisting of 22 patients in the each group. The second and third month VAS values (xerostomia) of the patients in the chewing gum groups were statistically significantly lower than those in the control group (P = 0.014, P < 0.001, respectively). The third month salivary flow rate in the chewing gum group was higher than the values in the control group patients (P < 0.001). DISCUSSION: It is anticipated that this study will raise nurses' awareness of dry mouth and encourage future studies on interventions to increase the salivary flow rate to prevent or treat dry mouth.

Satisfaction of Patients with Triage and Nursing Practice in Emergency Departments.

AIM: This research was carried out to evaluate the satisfaction of triage and nursing practice for emergency patients. METHOD: The sample for this descriptive study comprised 198 patients (115 women and 83 men) that visited the emergency department at an education and research hospital between December 01, 2013, and December 31, 2013, and agreed to participate in the study. The participants had been informed about the purpose, content, and methods of this study. Then, the data collection forms (patient information form, Triage Satisfaction Scale, and Newcastle Satisfaction with Nursing Scale) were administered to the patients. Data analysis involved descriptive statistical methods as well as parametric and nonparametric tests. RESULTS: It was determined that the mean age of the patients in the emergency department was 38.56 ± 17.43 years, and 51.5% (n=102) patients were in the yellow triage category. It was determined that a majority of patients did not wait for triage and indicated that they were receiving treatment in accordance with the triage category. The total Triage Satisfaction Scale mean score was 7.37±2.11 and the total Newcastle Satisfaction with Nursing Scale mean score was 73.34±17.66. It was found that there was a significant difference between the waiting status and satisfaction scores in the triage section of the patients. It was also found that there was a meaningful difference between the dimensions of satisfaction with treatment and care in terms of the triage category. CONCLUSION: It was determined that the patients who applied to the emergency unit were generally satisfied by the triage practice and nursing care. The nursing care satisfaction levels of the patient and their family regarding the health status and psychological support were found to be low. It may be advisable to periodically implement satisfaction analyses of the nursing practices in such units in order to make necessary arrangements and to eliminate deficiencies.

Role of intensive care nurses on guiding patients' families/relatives to organ donation.

OBJECTIVE: The aim was to determine the role of intensive care nurses on guiding the families/relatives of brain-death patients to organ donation. METHODS: This research is a descriptive study. While the population of the study consisted of 1710 nurses working in the intensive care units of public, private and university hospitals in the city of Istanbul, the sample consisted of 353 intensive care nurses selected with stratified random sampling method from the probability sampling methods from this population. The data were collected by using "Data Collection Form". RESULTS: It was determined that 74.5% of the intensive care nurses carefully listened the family/relatives of the patient with possible brain death or suffering from brain death and supported them to express their emotion and thoughts clearly; when the family/relatives of the patients hospitalised in the intensive care unit wanted to get information about organ donation, 20.7% of the nurses made the preliminary explanation themselves and then guided the patient to an organ transplant coordinator for detailed information and 3.1% of the nurses generally gave this information themselves. CONCLUSIONS: It was determined that the knowledge of the intensive care nurses about brain death and organ donation was partially adequate and the function of guiding the families/relatives of brain-death patients to organ donation was mostly done by the physician.

The Effect of Hand Exercise on Reducing the Symptoms in Hemodialysis Patients with Carpal Tunnel Syndrome.

CONTEXT: Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies, and there is no consensus on the preferred method of treatment. AIMS: The aim of this study is to determine the effects of hand exercise performed with a ball on symptoms and to evaluate the results in hemodialysis (HD) patients with CTS. SETTINGS AND DESIGN: This study was conducted in patients with HD who were treated in dialysis centers and state hospitals in Turkey between 2011 and 2012. SUBJECTS AND METHODS: This study included 19 patients (28 hands) that were diagnosed as CTS. For exercise treatment, a hand and finger exercise ball that consists of two parts: a foam body and flexible rubber cords was used. Patients placed their fingers through each cord, squeezed it for 1 s, and then opened their fingers against the cord for 1 s. Patients repeated this exercise for 30 s to 1 min/day. STATISTICAL ANALYSIS USED: The McNemar, Friedman ANOVA, and the Wilcoxon test with a Bonferroni correction were used on SPSS 20.0 software package program. P < 0.05 was considered statistically significant. RESULTS: Results showed that recovery was performed from physical examination results, grip strength, and Boston questionnaire scores. About 21.4% of patients' electrophysiological results were negative at the end of the 1st month and 32.1% of them at the end of the 3rd month. CONCLUSION: Due to the slowed progress of CTS and detection of slight improvement in evaluation parameters, this self-applicable and practical exercise can be used as an alternative treatment of mild CTS in patients with HD.

A Risk Assessment Comparison of Breast Cancer and Factors Affected to Risk Perception of Women in Turkey: A Cross-sectional Study.

BACKGROUND: The increase in breast cancer incidence has enhanced attention towards breast cancer risk. The aim of this study was to determine the risk of breast cancer and risk perception of women, factors that affect risk perception, and to determine differences between absolute risk and the perception of risk. METHODS: This cross-sectional study was carried out among 346 women whose score in the Gail Risk Model (GRM) was ≥ 1.67% and/or had a 1st degree relative with breast cancer in Bahçesehir town in Istanbul, Turkey between Jul 2012 and Dec 2012. Data were collected through face-to-face interviews. The level of risk for breast cancer has been calculated using GRM and the Breast Cancer Risk Assessment Form (BCRAF). Breast cancer risk perception (BCRP), has been evaluated by visual analogue 100-cm-long scale. RESULTS: Even though 39.6% of the women considered themselves as high-risk carriers, according to the GRM and the BCRAF, only 11.6% and 9.8% of women were in the "high risk" category, respectively. There was a positive significant correlation between the GRM and the BCRAF scores (P<0.001), and the BCRAF and BCRP scores (P<0.001). Factors related to high-risk perception were age (40-59 yr), post-menopausal phase, high-very high economic income level, existence of breast cancer in the family, having regular breast self-examination and clinical breast examination (P<0.05). CONCLUSION: In women with high risk of breast, cancer there is a significant difference between the women's risk perception and their absolute risk level.

The Impact of Lifestyle Interventions in Breast Cancer Women after Completion of Primary Therapy: A Randomized Study.

OBJECTIVE: Many breast cancer survivors have unmet physical and psychological needs. Therefore, current study aimed to evaluate the impact of a lifestyle interventions program on fatigue, quality of sleep, quality of life (QoL), and body mass index (BMI) in women with breast cancer. MATERIALS AND METHODS: This randomized controlled trial study (RCT) was carried between 2012 and 2015, and included 80 women with breast cancer. They were divided into two groups via a random allocation process: 40 women were allocated to the lifestyle interventions group, and 40 to the control group. Women in the lifestyle group received dietary energy-restriction training and practiced supervised aerobic exercises for 45-60 minutes three times per week throughout 24 weeks and the control group continued their routine life. RESULTS: Differences between the two groups were significantly high for those who participated in the intervention group; this group reported significantly less fatigue, less BMI, improved QoL and better quality of sleep as compared to the control group (p<0.05). CONCLUSION: Breast cancer survivors may physically and psychologically benefit from participating in a healthy lifestyle interventions program. This program can help relieve fatigue, maintain healthy BMI, improve QoL and enhance the quality of sleep in women with breast cancer. Lifestyle interventions program may provide a non-pharmacologic adjunctive therapy for symptom management in breast cancer survivors.

Assessing sexual function and dysfunction in Turkish women undergoing surgical breast cancer treatment.

AIM: The purpose of this study was to determine whether there are differences between Turkish women undergoing postmastectomy breast reconstruction and those undergoing breast-conserving surgery (BCS) or mastectomy alone. METHODS: The sample of the study, which was designed as a descriptive and regressional one, consisted of a total of 100 female patients, 33 undergoing BCS, 34 undergoing postmastectomy breast reconstruction, and 33 undergoing mastectomy for breast cancer, between 2008 and 2012. Data were collected through an individual characteristics form and Female Sexual Function Index (FSFI). RESULTS: The comparison of the type of surgical procedure and the mean FSFI scores for the subscales of desire, arousal, orgasm, satisfaction, and pain, and the mean total FSFI scores revealed a statistically significant difference in favor of postmastectomy breast reconstruction and BCS (P < 0.05). When the authors evaluated the effects of age and surgical procedure type from the risk factors associated with total FSFI score classification by the logistic regression analysis, variations of age and surgical procedure type were found significant in the authors' model (P < 0.05). Age and surgical procedure type were independent risk factors effective on the total FSFI score of less than 26.55. CONCLUSION: In this study, based on the mean total FSFI scores of women, it was concluded that postmastectomy breast reconstruction had positive effects on sexual lives of Turkish women with breast cancer, that more satisfactory outcomes were obtained in those undergoing BCS, that mastectomy had negative effects on sexual function, thus leading to sexual dysfunction, and that age was negatively associated with sexual functions.

Effect of perceived social support on psychosocial adjustment of Turkish patients with breast cancer.

AIMS: To identify the psychosocial adjustment of Turkish patients with breast cancer and the effects of perceived social support on their adjustment. MATERIALS AND METHODS: The sample comprised 100 volunteering patients diagnosed with breast cancer in the last six months reporting to the Outpatient Chemotherapy Unit at the Medical Faculty Hospital in northern Turkey. The data for the study were collected through the Descriptive Information Form, the Psychosocial Adjustment to Illness Scale-Self-reflection (PAIS-SR) and the Cancer-Specific Social Support Scale and analyzed via SPSS 16.0 for Windows. Descriptive statistics, Chi square test, ANOVA and correlation were used to evaluate data. RESULTS: There was a negative significant correlation between mean scores in the sub-scales of the social support scale and the ones in the sub-scales of the psychosocial adjustment to illness scale (p<0.05). Similarly, there was a negative significant correlation between confidence support and health care orientation as well as adjustment to social environment. Likewise, emotional support was in a negative significant correlation with health care orientation, adjustment to domestic environment, extended family relationships and adjustment to social environment. CONCLUSIONS: It was concluded that social support for patients with breast cancer had an influence on their psychosocial adjustment to illness. Holistic care should be given to breast cancer patients by oncology nurses especially in the first six months of treatment. It could be concluded that patients should be accompanied by their family/relatives in treatment and care following their diagnosis with breast cancer, that their family should be made more aware of the fact that the patient should be physically and psychologically supported, that patients with breast cancer should be provided with domiciliary care, and that they should be encouraged to participate in social support groups.

Comparison of pain scale preferences and pain intensity according to pain scales among Turkish Patients: a descriptive study.

Pain scale preferences may vary among patients. Providing a choice of which pain scale to use might be helpful for patients. The aim of this study was to determine patient pain scale preferences and compare the level of agreement among pain scales commonly used during postoperative pain assessment. A total of 621 patients during the early postoperative period were enrolled in this descriptive study. A questionnaire form, the faces pain scale (FPS), visual analog scale (VAS), numeric rating scale (NRS), verbal descriptor scale (VDS), thermometer pain scale (TPS), McGill Pain Questionnaire (MPQ), Short-form McGill Pain Questionnaire (SFMPQ), and Brief Pain Inventory (BPI) were used to collect data. Most patients reported that their pain was not measured with any of the pain scales. Patient preference for pain scales were as follows: 97.4% FPS, 88.6% NRS, 84.1% VDS, 78.1% TPS, 60.1% SFMPQ, 37.0% BPI, 11.4% VAS, and 10.5% MPQ. Education was an important factor in the preferences for all scales (p < .000). The level of pain determined by the VAS did not correlate with the level of pain identified by the NRS, TPS, FPS, and VDS (p < .05). There was no difference among the levels of pain for the NRS, TPS, FPS and VDS (p > .05), but there was for the VAS (p < .05). The pain scales chosen should be reliable, valid, and able to evaluate the effects of treatment. The results suggest that the NRS, TPS, FPS, and VDS were appropriate pain rating scales for the participants in this study, and that the VAS should be used in combination with one of these scales.

Comparison of complications and procedural activities of pulmonary artery catheter removal by critical care nurses versus medical doctors.

BACKGROUND: None of the nursing studies on PA catheter removal pointed out any differences in complications after removal and procedural activities for removal of PA catheter by CCNs vs MDs in Turkey. AIMS: This quasi-experimental study was conducted to determine the occurrence and type of complications and to indicate the differences between CCNs and medical doctors' (MDs) activities for removal of PA catheter. METHODS: Totally, 60 critical care unit patients were scheduled as a sample, and they were assigned randomly to the CCN (n = 30) or to the MD (n = 30) groups. For the comparison purposes of the different activities and complications of PA catheter removal procedure between the two groups, 'Instruction Form' was followed step by step. The differences in the prevalence of variables were tested using Student's t statistics. For categorical data, Fisher's exact test was used. Significance was declared by P value of <0.05. RESULTS: Preprocedural activities like patient positioning (P < 0.001) and instructing the patient for breathing (P = 0.001) demonstrated statistically significant differences between the two groups. The PA catheters were removed properly in both groups (P > 0.05). The majority of postprocedural activities were completed successfully. The complications of the catheter removal were documented more carefully by nurses compared with doctors (P < 0.01). Additionally, singular premature ventricular complexes were observed on electrocardiogram in both groups (P > 0.05). CONCLUSION: Instructing CCNs to remove a PA catheter has been highlighted in keeping the number of complications associated with removal procedure of PA catheter.

Determining female physicians' and nurses' practices and attitudes toward breast self-examination in Istanbul, Turkey.

PURPOSE/OBJECTIVES: To determine female physicians' and nurses' practices and attitudes toward breast self-examination (BSE). DESIGN: Descriptive, cross-sectional. SETTING: Two large, bed-capacity university hospitals and 11 smaller, bed-capacity public hospitals. SAMPLE: 201 female nurses and 149 female physicians who work day shift on medical and surgical wards. METHODS: Data were collected on a questionnaire form that was prepared based on information in the literature. The questionnaire had three sections: sociodemographic characteristics, health characteristics, and attitudes and practices related to BSE. Data were analyzed using t tests and chi-square tests. MAIN RESEARCH VARIABLES: Attitudes and practices related to BSE, clinical breast examination, and mammography. FINDINGS: Almost all of the female physicians and nurses knew how to conduct BSE but did not prioritize practicing it. CONCLUSIONS: Female physicians and nurses in Istanbul, Turkey, did not take enough care in the proper timing of BSE (i.e., day 5 to day 7 after menstruation with the first day of menstruation being day 1) despite their knowledge about it. IMPLICATIONS FOR NURSING: Female physicians and nurses need to improve their knowledge and sensitivity concerning breast cancer and BSE if they are to improve and maintain their own well-being as well as carry out their professional roles.

Sleep disturbance: the patient care activities applied at the night shift in the intensive care unit.

AIMS AND OBJECTIVES: The aim of the study was to determine the frequency and types of nursing activities on sedated and non-sedated patients in the intensive care unit at night shift. BACKGROUND: The complex intensive care unit and nursing activities has been described as an environment in which patients enter in a physiological crisis. This is even more so when the patient is unable to communicate or heavily sedated or unable to move. Nursing activities, fear and apprehension cause low morale and sleep disturbance. METHOD: The study was carried out on a descriptive basis in the Surgical Intensive Care Unit. Thirty sedated and 30 non-sedated patients to whom the nursing care was applied during 19.00-07.00 hours for three consecutive nights were chosen with simple random sampling. Data were gathered by means of retrospective examination of the standard nursing chart notes about the 60 patients for three consecutive nights. Data were analysed using percentage calculations and chi-square test. RESULTS: The results demonstrate that patient records indicated a mean of 51 interactions per patient per night. Nursing activities were more frequent between 02.00 and 05.00 hours. It was detected that nursing activities such as mouth and eye care, decubitus ulcer care, change of dressing, bed bath, catheter change for three night shifts were more frequently between 24.00 and 05.00 hours. Mechanical ventilation control and endotracheal suctioning were more frequently performed on sedated patients than on non-sedated patients (P < 0.05). CONCLUSION: These findings of this study indicate that the nursing activities in the intensive care unit were focused on the activities, which will maximize what is seen to be physiological stability. RELEVANCE TO CLINICAL PRACTICE: This study has provided further data that identify the activities of nurses working in the intensive care unit at night shift. We hope to contribute to the development of the sleep protocol in surgical intensive care units.

Nursing role on preventing secondary brain injury.

Secondary brain injury is a complicated, multifactorial process that results from hypoxemia, hypercapnia or hypocapnia, and increased ICP. Implementation of a traumatic brain injury protocol for patients with head injury including hemodynamic management, pulmonary care, maintenance of body temperature, control of the environment, positioning of patients, and seizure prophylaxis provides critical care nurses a proactive means to prevent or minimize the development of secondary brain injury in the emergency department.

Effects of normal saline on endotracheal suctioning.

This study was designed to determine the effects of saline solution administered prior to endotracheal suctioning by nurses working in intensive care on oxygenation, heart rate and long-term pulmonary hygiene. The study was carried out on an experimental basis in the Intensive Care Unit of a university hospital in Turkey. A total of 20 patients were included, who were mechanically ventilated because of pulmonary or cardiovascular problems or trauma. Data were collected using a data form. Each patient was monitored for 5 minutes following suctioning with or without saline solution and findings of heart rate, SpO2, and blood gas measurements were recorded. Data were analysed using percentage calculations, the student's t-test and the Friedman test. The study showed that most of the patients were between 60 and 69 years and were intubated because of respiratory insufficiency. Evaluation of blood gases following suctioning with or without saline solution showed partial decreases in pO2, pCO2, HCO3, and oxygen saturation (SaO2), which did not reach a significant level. No significant difference was found between pH levels recorded prior to and 5 minutes after suctioning without saline solution; however, the increase in pH following suctioning with saline solution was significant. Patients undergoing suctioning with saline solution exhibited significantly increased heart rates in the fourth and fifth minutes, whereas no increases were detected in these undergoing suctioning without saline solution. SpO2 values obtained by pulse oxymeter did not show significant differences. Saline solution administered with suctioning resulted in undesirable, although not significant, alterations in oxygen saturation and arterial blood gas levels.