Migrant and ethnic minority nurses' experience of working in European health services: a qualitative study.

OBJECTIVE: To analyze the perception of culture and experience of working in European health services of a purposive sample of qualified migrant and ethnic minority nurses currently living in Belgium, Portugal, Spain and Turkey. METHOD: A qualitative phenomenological method was chosen. Individual interviews took place with 8 qualified migrant and ethnic minority nurses currently living in four European countries. Thematic analysis was conducted using Braun and Clark's stages after qualitative data had been verbatim transcribed, translated into English, and analyzed. RESULTS: Four themes and 4 subthemes emerged from thematic analysis of the transcripts. CONCLUSION: Migrant and ethnic minority nurses working in the European Union experience and witness discrimination and prejudice from patients and colleagues due to cultural differences. European health services should closely monitor and address discrimination and prejudice towards migrant and ethnic minority staff and patients, and take initiatives to reduce and, eventually, eradicate them.

Qualified Nurses' Perceptions of Cultural Competence and Experiences of Caring for Culturally Diverse Patients: A Qualitative Study in Four European Countries.

BACKGROUND: European nurses are expected to provide appropriate care for patients from diverse cultural backgrounds. However, there is limited knowledge and understanding of this process. The aim of this study was to analyse the perceptions of culture and experiences of caring for patients from diverse cultural backgrounds of a purposive sample of qualified nurses from four European countries, namely Belgium, Portugal, Spain and Turkey. METHODS: A qualitative phenomenological approach was selected in order to understand complex phenomena through the participants' lived experiences, meanings and perspectives. Individual interviews and focus groups took place with 28 staff nurses and 11 nurse managers from four European countries. The sociodemographic and cultural characteristics of the sample were described and analysed using descriptive statistics. Qualitative data were transcribed verbatim, translated into English and analysed following Braun and Clark's phases for thematic analysis. RESULTS: Five themes and twelve subthemes emerged from thematic analysis of the transcripts. The themes included: (1) relevance of culture for nursing; (2) culture in the healthcare service; (3) qualities of the healthcare professionals; (4) challenges to culturally competent care; (5) becoming a culturally competent nurse. CONCLUSIONS: There are challenges to the delivery of culturally congruent care, namely language and communication difficulties, prejudices and stereotyping in the health service, a tendency for ethnocentrism, a lack of education and training in cultural competence and a lack of support from the health service to facilitate new ways of acting.

Migrant and ethnic minority nurses' experience of working in European health services: a qualitative study / Experiência de enfermeiros migrantes e de minorias étnicas em trabalho em serviços de saúde europeus: estudo qualitativo / Experiencia de trabajo de enfermeras inmigrantes y de minorías étnicas en los servicios de salud europeos: un estudio cualitativo

ABSTRACT Objective: To analyze the perception of culture and experience of working in European health services of a purposive sample of qualified migrant and ethnic minority nurses currently living in Belgium, Portugal, Spain and Turkey. Method: A qualitative phenomenological method was chosen. Individual interviews took place with 8 qualified migrant and ethnic minority nurses currently living in four European countries. Thematic analysis was conducted using Braun and Clark's stages after qualitative data had been verbatim transcribed, translated into English, and analyzed Results: Four themes and 4 subthemes emerged from thematic analysis of the transcripts. Conclusion: Migrant and ethnic minority nurses working in the European Union experience and witness discrimination and prejudice from patients and colleagues due to cultural differences. European health services should closely monitor and address discrimination and prejudice towards migrant and ethnic minority staff and patients, and take initiatives to reduce and, eventually, eradicate them.

RESUMO Objetivo: Analisar a percepção da cultura e experiência de trabalho em serviços de saúde europeus de uma amostra intencional de enfermeiros qualificados migrantes e de minorias étnicas que moram atualmente na Bélgica, Portugal, Espanha e Turquia. Método: Optou-se pelo método fenomenológico qualitativo. Realizaram-se entrevistas individuais com 8 enfermeiros qualificados migrantes e de minorias étnicas que moram atualmente em quatro países europeus. A análise temática foi realizada por meio das etapas de Braun e Clark após os dados qualitativos terem sido transcritos na íntegra, traduzidos para o inglês e analisados. Resultados: Quatro temas e 4 subtemas emergiram da análise temática das transcrições. Conclusão: Enfermeiros migrantes e de minorias étnicas que trabalham na União Europeia vivenciam e testemunham discriminação e preconceito de pacientes e colegas devido a diferenças culturais. Os serviços de saúde europeus devem acompanhar de perto e combater a discriminação e o preconceito contra os trabalhadores e pacientes migrantes e de minorias étnicas, e tomar iniciativas para os reduzir e, em seguida, erradicá-los.

RESUMEN Objetivo: Analizar la percepción de la cultura y la experiencia de trabajar en los servicios de salud europeos de una muestra intencional de enfermeros calificados de minorías étnicas y migrantes que actualmente viven en Bélgica, Portugal, España y Turquía. Método: Se decidió utilizar un método cualitativo fenomenológico. Se realizaron entrevistas individuales con 8 enfermeros calificados inmigrantes y de minorías étnicas que actualmente viven en cuatro países europeos. El análisis temático se realizó utilizando las etapas de Braun y Clark después de que los datos cualitativos fueran transcritos palabra por palabra, traducidos al inglés y analizados. Resultados: Del análisis temático de las transcripciones surgieron 4 temas y 4 subtemas. Conclusión: Los enfermeros de minorías étnicas y migrantes que trabajan en la Unión Europea experimentan y son testigos de la discriminación y de los prejuicios de los pacientes y colegas sobre la base de la diferencia cultural. Los servicios de salud europeos deben monitorear de cerca y abordar la discriminación y los prejuicios hacia el personal y los pacientes de minorías étnicas y migrantes, y tomar iniciativas para reducirlos y, eventualmente, erradicarlos.

Nursing students' experience of learning cultural competence.

INTRODUCTION: European societies are rapidly becoming multicultural. Cultural diversity presents new challenges and opportunities to communities that receive immigrants and migrants, and highlights the need for culturally safe healthcare. Universities share a responsibility to build a fair and equitable society by integrating cultural content in the nursing curricula. This paper aims to analyze European student nurses´ experience of learning cultural competence and of working with patients from diverse cultural backgrounds. MATERIALS AND METHODS: A phenomenological approach was selected through a qualitative research method. 7 semi-structured focus groups with 5-7 students took place at the participants' respective universities in Spain, Belgium, Turkey and Portugal. RESULTS: 5 themes and 16 subthemes emerged from thematic analysis. Theme 1, concept of culture/cultural diversity, describes the participants' concept of culture; ethnocentricity emerged as a frequent element in the students' discourse. Theme 2, personal awareness, integrates the students' self-perception of cultural competence and their learning needs. Theme 3, impact of culture, delves on the participants' perceived impact of cultural on both nursing care and patient outcomes. Theme 4, learning cultural competence, integrates the participants' learning experiences as part of their nursing curricula, as part of other academic learning opportunities and as part of extra-academic activities. Theme 5, learning cultural competence during practice placements, addresses some important issues including witnessing unequal care, racism, prejudice and conflict, communication and language barriers, tools and resources and positive attitudes and behaviors witnesses or displayed during clinical practice. CONCLUSION: The participants' perceived level of cultural competence was variable. All the participants agreed that transcultural nursing content should be integrated in the nursing curricula, and suggested different strategies to improve their knowledge, skills and attitudes. It is important to listen to the students and take their opinion into account when designing cultural teaching and learning activities.

Perception and Experience of Transcultural Care of Stakeholders and Health Service Users with a Migrant Background: A Qualitative Study.

INTRODUCTION: While European health policies do frequently take into consideration the ideas and experiences of their users, the voices of minority and marginalized communities are not often heard. European healthcare services must address this issue as the number of healthcare users with an MM background increases. AIM: To explore the perspectives of key stakeholders and healthcare users with an MM background on transcultural care in four European countries. DESIGN: Qualitative phenomenological study. METHODS: Semi-structured, individual interviews were conducted with stakeholders and MM users. Interviews were translated and transcribed verbatim and were carried out from February to May 2021. Descriptive statistics was used to describe the characteristics of the sample; qualitative data were analyzed thematically following Braun and Clarke's phases, resulting in 6 themes and 18 subthemes. RESULTS: For stakeholders and MM users with long-established residence in their respective countries, cultural differences involve different family and community norms, religious beliefs, lifestyles, and habits. These components are perceived as in tension with healthcare norms and values, and they mediate in two key and related aspects of the relationship between MM users and healthcare providers: accessibility and communication. CONCLUSIONS: Communication and access to healthcare are key to MM health service users, and they are the most frequent sources of misunderstanding and conflict between them and healthcare professionals. IMPACT: It is important to extend the investigation of cultural issues in healthcare to stakeholders and MM users. There is no doubt that healthcare professionals should be trained in cultural competence; however, cultural competence training is not the only area for improvement. There should be a change in paradigm in healthcare services across Europe: from individual to organizational integration of culture and diversity.

Nursing Lecturers' Perception and Experience of Teaching Cultural Competence: A European Qualitative Study.

Cultural competence is an essential component in providing effective and culturally responsive healthcare services, reducing health inequalities, challenging racism in health care and improving patient safety, satisfaction and health outcomes. It is thus reasonable that undergraduate nursing students can develop cultural competency through education and training. The aim of this paper was to investigate nursing lecturers' perception and experience of teaching cultural competence in four undergraduate nursing programs. A phenomenological approach was selected to illicit nursing lecturers' perception of culture and experience of teaching cultural competence. Semi-structured personal interviews were held with a sample of 24 lecturers from four European universities. The anonymized transcripts were analyzed qualitatively following Braun and Clark's phases for thematic analysis. Six themes and fifteen subthemes emerged from thematic analysis of the transcripts. Cultural competence was not explicitly integrated in the nursing curricula. Instead, the lecturers used mainly examples and case studies to illustrate the theory. The integration of cultural content in the modules was unplanned and not based on a specific model. Nursing programs should be examined to establish how cultural content is integrated in the curricula; clear guidelines and standards for a systematic integration of cultural content in the nursing curriculum should be developed.

Comparison of the effects and side effects of misoprostol and oxytocin in the postpartum period: A systematic review.

Follow-up of the side effects of uterotonics used for postpartum hemorrhage is one of the most important roles of health care providers. In this review, it is aimed to compare the side effects of misoprostol and oxytocin that are used to prevent postpartum hemorrhage. This systematic review was carried out in accordance with the guidelines for the Center for Reviews and Dissemination 2009 (CRD). Articles published in the PubMed, CINAHL, Wiley Interscience, Science Direct and Cochrane databases between 2010 and 2016 were examined. Finally, although 2277 articles were found to be related to misoprostol and oxytocin, only 12 randomized controlled (n = 6290) articles were included in the review. Results: In the misoprostol group, the rate of >500 mL blood loss was lower than that in the oxytocin group (p < 0.05). The groups were similar in terms of ≥500 mL blood loss were similar (p > 0.05). Although misoprostol was more effective than oxytocin in preventing PPH, the side effects of misoprostol were more. The incidence of drug-induced shivering, nausea and increase in body temperature were significantly higher in the misoprostol group than the oxytocin and placebo groups (p < 0.05). Shivering was most frequently seen in the 600 mg of sublingual misoprostol group (56.4%). Severe side effects of uterotonics used to prevent postpartum hemorrhage on maternal health were determined. Nurses and midwives should be aware of the side effects of uterotonic drugs and should develop care guidelines that explain the interventions to be performed in case of side effects.

Student nurse perceptions of Gypsy Roma Travellers; A European qualitative study.

BACKGROUND: Gypsy Roma Travellers are Europe's largest ethnic minority group. Yet they remain one of the most stigmatised communities who have significant health inequalities. Whilst nurses have a role in promoting health access, there have been minimal studies exploring health care professionals' attitudes towards these communities and no studies exploring nursing students' perceptions. OBJECTIVES: To explore nursing students understanding, knowledge and perceptions of working with Gypsy Roma Travellers. PARTICIPANTS: 23 nursing students from across four European countries (UK, Spain, Belgium, Turkey) participated in the study. The students ages ranged between 19 and 32 year old, there was a mix of students between year one to year three of their programme and both male (n = 3) and female students (n = 19). METHODS: This qualitative research utilised focus groups and one to one interviews based at the four different universities, all following a pre-agreed interview schedule. Focus groups and interviews were conducted by the research team in the students' first language and later translated into English for analysis using thematic analysis. The COREQ criteria were used in the reporting of the study. RESULTS: Four themes were identified which included: Exposure to Gypsy Roma Traveller Communities, Perceptions of Gypsy Roma Traveller cultures, Unhealthy lifestyles and culture and Nursing Gypsy Roma Travellers. CONCLUSIONS: Although personal and professional contact with Gypsy Roma Travellers was limited, most of the students' perceptions of these communities were negative. Nurse educational programmes need to embed transformational learning opportunities enabling student nurses to critically reflect upon values and beliefs of Gypsy Roma Travellers developed both before and during their nursing preparatory programme if they are to work effectively in a respectful, culturally sensitive way. There is also generally, a lack of research focussing upon healthcare professionals' attitudes towards these communities that needs to be explored through further research.

Relationship Between Maternal Characteristics and Postpartum Hemorrhage: A Meta-Analysis Study.

BACKGROUND: Postpartum hemorrhage (PPH) is a leading cause of maternal death in low-income countries and the primary cause of approximately one of every four maternal deaths worldwide. PURPOSE: The aim of this study was to determine the antenatal risk factors of PPH and its effects. METHODS: The literature from nine databases was reviewed, and studies published between 2000 and 2012 were analyzed using terms such as "postpartum hemorrhage," "prevention of postpartum hemorrhage," and "management of postpartum hemorrhage." The full text of 1,061 articles was reviewed, and 29 studies were selected according to the inclusion criteria. Studies that determined bias using the funnel plot test were excluded, and 20 studies were included in the meta-analysis. The data were analyzed using Microsoft Office Excel 2010 and comprehensive meta-analysis. RESULTS: The meta-analysis included five studies and 1,286,752 women for maternal age, six studies and 607,822 women for body mass index, and six studies and 1,118,490 women for parity. The results of the analysis showed that body mass index ≥ 25.00 kg/m (OR = 1.43, 95% CI [1.40, 1.47]), primiparity of mothers (OR = 1.37, 95% CI [1.35, 1.40]), and hypertensive disorder in mothers (OR = 1.52, 95% CI [1.43, 1.61]) are risk factors for the development of PPH. No rela-tionship was found between maternal age ≥ 35 years and PPH (OR = 1.02, 95% CI [0.99, 1.04]). CONCLUSIONS: Midwives, obstetric nurses, and obstetricians should carefully evaluate mothers for the risk factors of PPH during the antepartum, intrapartum, and postpartum periods. Moreover, at-risk pregnant women should give birth in a unit with emergency initiative options. Future studies should examine relevant personal characteristics of mothers, as familiarity with the risk factors facilitates the management and treatment of PPH. Finally, meta-analyses should review more studies to detect risk factors more comprehensively.

The effect of a peer education program on combating violence against women: A randomized controlled study.

BACKGROUND: Student nurses in Turkey need to be exposed to appropriate undergraduate training if they are to acquire the required knowledge, attitudes and skills that will help them to fight the issue of violence against women (VAW). OBJECTIVES: The aim of this research study was to assess the effect of a peer education program about combating VAW on the knowledge, attitudes and skills of nursing students. DESIGN: The study was designed as a randomized controlled trial. SETTINGS: The participants in the intervention group received peer education on combating VAW. PARTICIPANTS: 136 nursing students (intervention group: n=63, control group: n=73) were included in the study. RESULTS: Participants in both the intervention and control groups were assessed at pre-training and at two months post-training. Pre-training and post-training knowledge and attitudes were significantly different in the intervention group (p<0.001). Moreover, the intervention group displayed a statistically significant difference in their ability to explain the correct interventions in a case study about VAW (p<0.001). CONCLUSIONS: Our results indicate that peer education should be used as a part of undergraduate nursing education on VAW.

Effectiveness of the Sexual Health/Reproductive Health Education Given to Turkey Adolescents Who Use Alcohol or Substance.

OBJECTIVE: The research was conducted experimentally to evaluate the effectiveness of the sexual health/reproductive health (SH/RH) education given to Turkish adolescents who use alcohol or illicit substances. METHODS: The population was adolescents who use alcohol and substances and were inpatients at the Child and Adolescent Substance Addiction Research, Treatment and Education Center. The adolescents were grouped into the following three groups: Group 1 (control group), Group 2 (those who have received training once), and Group 3 (those who have received training twice). Data were collected between September 2011 and December 2012 using the forms Self-Introduction and Information on Sexual Health-Reproductive Health and Information on Sexual Health-Reproductive Health Education Modules. RESULTS: Upon studying the total SH/RH test scores of the groups individually, a statistically significant difference was observed in the scores of Groups 2 and 3 (p < .01). Upon studying the change in the posttest scores from the pretest ones for each group individually, the increase in the scores of Group 3 (34.57 ± 16.33) was observed to have a statistically highly significant difference from those of Groups 1 (2.73 ± 10.65) and 2 (20.23 ± 12.09; p < .01). CONCLUSIONS AND PRACTICE IMPLICATIONS: Adolescents who abuse alcohol or substances should be given SH/RH education in a repetitive manner for prevention of risky sexual behavior.

Antenatal Education on Pregnant Adolescents in Turkey: Prenatal Adaptation, Postpartum Adaptation, and Newborn Perceptions.

PURPOSE: This clinical trial study was planned in order to evaluate the effect of antenatal education on antenatal and postpartum adaptation and newborn perceptions among adolescent pregnant women. METHODS: A research assistant met with pregnant adolesencents in a Family Health Center and at the participants' homes. The sample included 70 pregnant adolescents (35 in experimental group, 35 in control group) chosen through simple random sampling. The experimental group received antenatal eduation, whereas the control group merely had routine surveillance. As for data collection tools, the Prenatal Self Evaluation Questionnaire (PSEQ), the Postpartum Self Evaluation Questionnaire (PPSEQ) and the Newborn Perception Scale (NPI) was used. RESULTS: It was found that the experiment group who received antenatal education had a lower mean total PSEQ score (133.94 ± 15.62) compared to the control group (159.86 ± 17.83). In the comparison of two groups, it was determined that the experiment group had lower mean total PPSEQ scores on the 1st day, 1st week and 2nd week compared to the control group, indicating higher levels of postpartum adaptation (p = .017, p = .009, p = .029). CONCLUSION: It was determined that the level of prenatal adaptation was higher in the experiment group, which received antenatal education, than in the control group and that levels of postpartum adaptation was significantly higher in the experiment group on the 1st postpartum day and the 1st and 2nd postpartum weeks but not on the 4th postpartum week. There were no significant differences between the experiment and control groups in terms of NPI results.

Effect of Turkish classical music on prenatal anxiety and satisfaction: A randomized controlled trial in pregnant women with pre-eclampsia.

OBJECTIVES: The present study aimed to evaluate the effect of music therapy on anxiety and satisfaction in pregnant women with preeclampsia. DESIGN, SETTING AND SUBJECTS: A randomized controlled trial was performed on 70 pregnant women with pre-eclampsia hospitalized in the research and application hospital of Kahramanmaras Sütcü Imam University between December 2012 and February 2014. The subjects were allocated to experimental or control groups in a random manner (n=35 each). INTERVENTIONS: Pregnant women in the experimental group were subject to a 30min Turkish classical music therapy trial each day for a period of 7days (5days before and 2days after labor) whereas those in the control group received routine care and also were assigned to 30min of bed rest a day. The Personal Information Form, State-Trait Anxiety Inventory, and Newcastle Satisfaction with Nursing Scale were administered to participants. Data were analyzed using descriptive statistics, student t-test, and Mann-Whitney U test where appropriate. MAIN OUTCOME MEASURES: Outcome measures were anxiety scale scores, satisfaction scale scores, vital signs, fetal movement and fetal heart rate. RESULTS: The differences between anxiety scores were not statistically significant (p>0.05). On the other hand, Newcastle Satisfaction with Nursing Scale scores of the experiment group were higher than the control group (p<0.01). Finally, when considering fetal movement counts, a significant increase was determined in the experiment group, whereas Music Therapy had a minimalizing effect on fetal heart rate and a lowering effect on blood pressure (p<0.05). CONCLUSION: It may be suggested that nurses and midwives can utilize music therapy in the care and follow-up of pregnant women with preeclampsia in obstetrics units.

The effects of local low-dose heat application on dysmenorrhea.

OBJECTIVES: This is a controlled, prospective study which compares the effects of a low-dose heat patch for self-medication on the reduction of pain symptoms in dysmenorrhea. METHODS: The sample group included female sophomore students studying at a university in Istanbul, Turkey, between 2007 and 2008. These female participants completed the Dysmenorrhea Identification Form to determine the sample group, and a total of 193 female students possessed the eligible criteria. The research control group consisted of 66 patients, the analgesia group consisted of 61, and the heat patch group consisted of 66. The control group did not use any treatments, while the self-medication group used analgesic medication (single dose), and the heat patch group applied a heat patch on the lower abdomen, against the skin, for an application period of 2 menstrual cycles. Using a visual analog scale (VAS), the pain severity was recorded at the baseline, after 4 hours of intervention, and after 8 hours of intervention. The data were examined using ANOVA. RESULTS: There were significant differences between the groups in terms of pain severity after 8 hours of application (P < .001). All groups had similar pain levels at baseline and during the fourth and eighth hours, with no significant differences between the groups during the first and the second menstrual cycles (P > .05). CONCLUSION: The authors conclude that the heat patch is an effective method for reducing dysmenorrhea.

Effects of SP6 Acupuncture Point Stimulation on Labor Pain and Duration of Labor.

BACKGROUND: Acupressure has been used frequently to improve labor, manage labor pain, and shorten delivery time. However, there has been little research-based evidence to support the positive effects of acupressure in the obstetric area and obstetric nursing. OBJECTIVES: The aim of this study was to evaluate the effects of SP6 acupressure on labor pain and delivery time in primigravida women in labor. PATIENTS AND METHODS: The study was conducted at the Trabzon Maternity Hospital in Turkey. Its design was a randomized controlled clinical trial study using a single-blinded method. One hundred (100) primigravida women in labor were randomly assigned to either the SP6 acupressure (n = 50) or control group (n = 50). Acupressure was practiced 35 times in total on the SP6 point of both legs in the SP6 acupressure group; 15 times (during contraction) when cervical dilation was 2-3 cm, 10 times when cervical dilation was 5-6 cm and 10 times at 9-10 cm dilation, while the women in the control group received standard care. Labor pain was measured five times using a structured questionnaire of a subjective labor pain scale (visual analogue scale-VAS) when dilation was 2-3 cm (VAS 2), 5-6 cm (VAS 3) and 8-9 cm (VAS 4) before and after acupressure was applied to the SP6 point (VAS 1), and finally at the early postpartum period (VAS 5). The duration of labor in both groups was measured with a partograph and the length of delivery time was calculated in two stages: from 3 cm cervical dilation to full cervical dilation, and from full cervical dilation to delivery. RESULTS: There were significant differences between the groups in subjective labor pain scores (except VAS 4) (P < 0.001). The duration of the Phase one (3 cm dilatation to full dilatation) and Phase two (full dilatation to birth) in the acupressure group was shorter than the control group (Phase one, 225 min and 320 min, respectively; Phase two, 15 min and 20 min, respectively; both P < 0.001). CONCLUSIONS: It was determined that SP6 acupressure was effective in decreasing pain and duration of labor.

Prevalence of dysmenorrhea in university students in Turkey: effect on daily activities and evaluation of different pain management methods.

This study was conducted to determine the following among a group of female university students: the prevalence of dysmenorrhea; pain severity ratings; methods used to manage dysmenorrhea; and the effect of dysmenorrhea on daily activities, school attendance, and ability to communicate with friends. This cross-sectional study was conducted between December 2009 and February 2010 at a public university located in Istanbul, in the northwest area of Turkey. The study group included 1515 female students. Data were collected from the female students in the study group using a self-report questionnaire; the severity of dysmenorrhea was determined with the visual analog scale. The data were examined with mean, percentages, chi-square analysis, and logistic regression. The prevalence of dysmenorrhea in the study group was 85.7%. Of this group of subjects with dysmenorrhea, 30.4% described their menstrual pain as severe, 49.8% as moderate, and 19.8% as mild. The mean severity of pain among the students was 6.33 ± 2.32 on the VAS. The majority of participants who experienced moderate or severe pain regularly used analgesics for pain management, and participants who experienced severe pain used analgesics before the beginning of menstruation. Participants who experienced moderate pain used herbal tea, massage, heat application, rest, and distraction for pain management. Participants who experienced severe pain consulted a physician and that a significant difference existed between the dysmenorrhea rating groups in this regard (p < .001). Severe pain was significantly associated with school absenteeism and limitations in social activities/functioning (p < .001). Dysmenorrhea is highly prevalent among university students and is related to school absenteeism, ability to participate in and enjoy daily activities, and limitations in social activities/functioning.

Development and area adaptation of flow charts related to gynecologic oncology nursing practices.

AIM: This one group semi-experimental study was performed to develop and adapt flow charts of nursing practices applied to gynecologic oncology patients to the field. METHODS: The research was conducted between October 2008 and March 2009 in 6 hospitals in Istanbul (3 health ministry hospitals, 2 private hospitals and 1 university hospital) with effective programs. The scope of the study included 97 midwives/nurses who had been working as caregivers of gynecologic oncology patients in this unit at least for 6 months and who participated in this study voluntarily; 87 people composed the sample because of the absence of others on vacation or sick leave when the data were collected or who did not wish to participate. The data were in descriptive information form collected via "Forms to Determine the Efficiency of Flow Charts". Before data collection, risks related to gynecologic oncology problems were identified, a literature scanning was made for existing flow charts based on actual practices and the discovered charts were reviewed. As a result of the evaluations, it was decided to create 15 flow charts intended for risks, symptoms, operation processes and discharge. Questionnaires to determine activity were applied to participants before and after practice. RESULTS: As a result of the study, it was determined that the efficiency of the flow charts increased significantly (p <0.01) after practice of the participants, nosignificant relationships (p>0.01) being apparent with age group, education level, occupational period in the job and in the gynecologic oncology field and evaluations of the practice before and after it was applied. CONCLUSION: The results of the study revealed that nursing participants in university and private hospitals and who supported the existence of a flow chart in the field evaluated the flow charts positively.

Bladder training and Kegel exercises for women with urinary complaints living in a rest home.

BACKGROUND: Urinary incontinence is an annoying, uncomfortable and unpleasant condition affecting the elderly. The problem of bedwetting and other urinary complaints are common in rest homes. OBJECTIVE: Our study aimed to determine the efficiency of bladder training and Kegel exercises for older women living in a rest home. METHODS: This is an experimental prospective research study. Through a randomization process, 25 women were included in the treatment group, and another 25 were included in the control group. Participants were living in a rest home for women aged older than 65 years with urinary complaints. The pretreatment interview form, Quality of Life Scale, Mini-Mental Test, Rankin Scale, daily urinary forms and pad tests were administered to the treatment and control groups. Bladder training and Kegel exercises were given to the treatment group for 6-8 weeks. The second evaluation was performed 8 weeks after treatment, and the last evaluation was carried out 6 months after treatment. RESULTS: The average age of the treatment group was 78.88 +/- 4.80 years, and the average age of the control group 79.44 +/- 5.32 years. Urgency, frequency and nocturia were common complaints. Pretreatment, 8-week and 6-month evaluations revealed that the amount of urinary incontinence with urgency, frequency and nocturia complaints statistically and significantly decreased in the treatment group compared to the control group. In the pad test results, a statistically significant decrease was observed in the treatment group compared to the control group. A significant increase in pelvic floor strength was observed in the treatment group compared to the control group upon all evaluations. CONCLUSION: Behavioral therapy can be used easily as an effective treatment for urinary incontinence in elderly women living at a rest home.