Nursing care complexity as a predictor of adverse events in patients transferred from ICU to hospital ward after general surgery.

OBJECTIVES: Predicting the likelihood of adverse events following discharge from the intensive care unit (ICU) can contribute to improving the quality of surgical care. This study aimed to evaluate the impact of nursing care complexity as a predictor of adverse event development in general surgery patients transferred from the ICU to the hospital ward. METHODS: A prospective observational study was conducted with 100 patients in the ICU and general surgical inpatient unit of a training and research hospital in Istanbul, Turkey. The Nursing Care Complexity tool was used by ICU and hospital ward nurses to measure nursing complexity. RESULTS: A total of 65 adverse events developed in 51 patients during hospital ward hospitalization after discharge from the ICU. Nursing care complexity evaluations by the ICU nurses predicted overall and some specific adverse events, while hospital ward nurses' evaluations predicted ICU readmission and some follow-up abnormalities such as patients' blood pressure, pulse rate, and laboratory results. CONCLUSION: The results of the current study validate that nursing care complexity can serve as a valuable tool for predicting the risk of adverse events and ICU readmission following discharge from the ICU. IMPLICATIONS FOR CLINICAL PRACTICE: The use of the Nursing Care complexity tool by the ICU and even hospital ward nurses after ICU discharge may have a significant impact on patient outcomes and contribute to the recognition of nursing efforts.

Interobserver Reliability of Glasgow Coma Scale Scores for Intensive Care Unit Patients.

BACKGROUND: Intensive care units frequently use the Glasgow Coma Scale to objectively assess patients' levels of consciousness. Interobserver reliability of Glasgow Coma Scale scores is critical in determining the degree of impairment. OBJECTIVE: To evaluate interobserver reliability of intensive care unit patients' Glasgow Coma Scale scores. Methods This prospective observational study evaluated Glasgow Coma Scale scoring agreement among 21 intensive care unit nurses and 2 independent researchers who assessed 202 patients with neurosurgical or neurological diseases. Each assessment was completed independently and within 1 minute. Participants had no knowledge of the others' assessments. RESULTS: Agreement between Glasgow Coma Scale component and sum scores recorded by the 2 researchers ranged from 89.5% to 95.9% (P = .001). Significant agreement among nurses and the 2 researchers was found for eye response (73.8%), motor response (75.0%), verbal response (68.1%), and sum scores (62.4%) (all P = .001). Significant agreement among nurses and the 2 researchers (55.2%) was also found for sum scores of patients with sum scores of 10 or less (P = .03). CONCLUSIONS: Although the study showed near-perfect agreement between the 2 researchers' Glasgow Coma Scale scores, agreement among nurses and the 2 researchers was moderate (not near perfect) for subcomponent and sum scores. Accurate Glasgow Coma Scale evaluation requires that intensive care unit nurses have adequate knowledge and skills. Educational strategies such as simulations or orientation practice with a preceptor nurse can help develop such skills.

Interrater reliability in pupillary assessment among intensive care nurses.

BACKGROUND: Pupillary abnormalities are a common and reliable finding of brain herniation, ischaemia, and acute brain injury in critically ill patients. Reliable pupil assessment is a vital evaluation in diagnostic and therapeutic procedures for neurocritical patients. AIM: To evaluate inter-rater reliability of pupillary assessment among intensive care. METHODS: In this prospective, blind observational study, intensive care nurses and two researchers evaluated the pupil size, reactivity and symmetry of 200 patients with neurosurgery or neurological diseases. A total of 200 pupillary measurement sets were completed independently and blindly. RESULTS: Three observers -two researchers and the nurse- found fair-to-good and excellent agreements in initial pupil size evaluations of right and left pupils, respectively (ICC = 0.70, 95%; ICC = 0.75, 95%). In patients with pupil size ≥4 mm, the observers found fair-to-good agreements in both right and left pupil initial size measurements (ICC = 0.52; ICC = 0.65). Agreement in pupil symmetry was moderated (K = 0.58), and reactivity was near perfect (K = 0.89) between the three observers. CONCLUSION: Although the two researchers found near perfect agreement in pupil size, symmetry and reactivity assessment, two researchers and the nurse found moderate agreement in pupil symmetry and fair-to-good agreement in pre- and post-light stimulation pupil size.

Piezoelectric Surgery Versus Conventional Osteotomy in Impacted Lower Third Molar Extraction: Evaluation of Perioperative Anxiety, Pain, and Paresthesia.

PURPOSE: Piezoelectric surgery is a safe and effective osteotomy technique that can decrease the perioperative complications and morbidity in oral-maxillofacial surgery. In this study, we compared piezoelectric surgery and a conventional rotatory technique in the removal of impacted lower third molars. Our primary endpoints were perioperative anxiety, pain, and postoperative discomfort while avoiding the drilling sound of the conventional instrument. MATERIALS AND METHODS: Our study included 21 patients (14 female and 7 male patients) with bilateral, symmetrical impacted lower third molars. The 2 osteotomy techniques were randomly allocated to be performed on the right or left impacted lower third molars. The parameters evaluated were perioperative anxiety (State Trait Anxiety Inventory), postoperative pain (visual analog scale), operation time, and paresthesia. RESULTS: No significant difference was seen between piezoelectric surgery and conventional rotatory techniques in terms of pain, anxiety, and nerve damage. Preoperative anxiety was significantly higher in the female group than in the male group. No correlation was found between preoperative anxiety and postoperative pain. The operation time was significantly longer in the piezoelectric surgery group. CONCLUSIONS: Piezoelectric surgery provides a precise, less aggressive osteotomy compared with conventional rotatory techniques. However, it has not been found to significantly reduce perioperative pain and anxiety.

Translation and validation study for the stroke self-efficacy questionnaire in stroke survivors.

BACKGROUND: Self-efficacy has been shown to play an important role in rehabilitation outcomes of stroke patients. AIM: This study aimed to determine the validity and reliability of a Turkish translation of the Stroke Self-Efficacy Questionnaire. METHODS: This methodological study was conducted in a private acute stroke unit in Istanbul, Turkey. After obtaining the Institutional Review Board's approval and site consent, a translated version of the 13-item Likert-type scaled questions was tested for language and content validity. A pilot study with 10 patients was followed by recruitment of 130 stroke patient participants, with 50 patients retested after 3 weeks. RESULTS: The Stroke Self-Efficacy Questionnaire-Turkish had excellent content validity index and face validity index scores. Confirmatory factor analysis findings revealed a single factor structure that offered good model suitability. Cronbach alpha was 0.93 for the scale and its subgroups. There was no statistically significant difference between the items according to test-retest scores (P > 0.05), and a reliability index was over 0.80. CONCLUSION: The Turkish version of the Stroke Self-Efficacy Questionnaire is a valid and reliable tool, recommended for use in clinical rehabilitation and stroke self-management/self-efficacy interventions.

Effects of different suture materials on tissue healing.

PURPOSE: The purpose of this study was to investigate the healing differences in between four different widely used suture materials in the oral surgery practice, including silk (Perma- Hand; Ethicon, INC., Somerville, NJ, USA), polypropylene (Prolene; Ethicon, INC., Somerville, NJ, USA), coated polyglactin 910 (Ethicon, INC., Somerville, NJ, USA). and polyglecaprone 25 (Ethicon, INC., Somerville, NJ, USA ). MATERIALS AND METHODS: 20 male rats were randomly allocated into two groups depending on their sacrification days (post-operative 1st and the 7th days). Four longitudinal incision wounds, each 1cm in size, were created on the dorsum of each animal which were then primarily closed with four different types of sutures. RESULTS: The effects of these suture materials on soft tissue healing were compared histopathologically, by means of density of the cells, necrosis, fibrosis, foreign body reaction, the presence of cells of acute and chronic infection. No statistically significant difference was observed between the groups regarding the density of the cells, necrosis, fibrosis, foreign body reaction, and the presence of the cells of acute and chronic infections. Of note, propylene showed slightly less tissue reaction among the other materials. CONCLUSION: The results of our study showed that there is no only one ideal suture material for surgical practice. The factors related to the patient, the type of the surgery and the quality of the tissue are important to decide an appropriate suture material.

Using high-fidelity simulation as a learning strategy in an undergraduate intensive care course.

Using high-fidelity simulations to facilitate student learning is an uncommon practice in Turkish nursing programs. The aim of the present study was to understand students' perceptions of the use of simulation in nursing courses. Subjects included 36 senior nursing students taking an intensive care course. This study revealed that high-fidelity simulation is an ideal method of promoting learning by helping students transfer theory into practice, build confidence and teamwork, and raise professional awareness.

Knowledge of cardiovascular disease in Turkish undergraduate nursing students.

BACKGROUND: Cardiovascular disease is the number one cause of death worldwide. However, there is not enough data exploring student nurses' understanding, knowledge, and awareness of cardiovascular disease. AIMS: To investigate knowledge of cardiovascular disease and its risk factors among undergraduate nursing students, with an emphasis on understanding of cardiovascular disease as the primary cause of mortality and morbidity, both in Turkey and worldwide. METHODS: This cross-sectional survey assessed 1138 nursing students enrolled in nursing schools in Istanbul, Turkey. Data were collected using the Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) scale and questions from the Individual Characteristics Form about students' gender, age, level of education, and family cardiovascular health history, as well as smoking and exercise habits. RESULTS: Respondents demonstrated a high level of knowledge about cardiovascular disease, with years of education (p < 0.001), gender (p < 0.001), and high school type (p < 0.05) all significantly associated with CARRF-KL scores. However, more than half of the students were not aware that cardiovascular disease is the primary cause of mortality and morbidity in Turkey and worldwide. The majority of the respondents' body mass index (87%) and waist circumference values (females: 90.3%, males: 94.7%) were in the normal range and most were non-smokers (83.7%). However, more than half of the students did not exercise regularly and had inadequate dietary habits. CONCLUSIONS: Although students were knowledgeable about cardiovascular disease and associated risk factors, there were significant gaps in their knowledge; these should be addressed through improved nursing curricula. While students were generally healthy, they could improve their practice of health-promoting behaviors.