Inter-rater reliability in the assessment of consciousness in patients receiving palliative care in intensive care: A prospective cross sectional observational study.

BACKGROUND: The Glasgow Coma Scale (GCS) is one of the methods that has validity for evaluating the consciousness levels of patients in the literature and is accepted by health authorities. AIM: The purpose of this study was to evaluate the inter-rater reliability of GCS in intensive care patients receiving palliative care. STUDY DESIGN: A prospective cross sectional observational study. The study was conducted in a general intensive care unit with 20 beds with patients receiving palliative care. In the unit, 18 nurses worked in two shifts, day and night. Each patient's primary palliative care nurse and two additional researchers were given one minute to independently record the patient's GCS total and subscale scores. All observations were completed within 5 min as there could be significant changes in the patient's GCS score during observations. RESULTS: A total of 258 assessments were completed. For the GCS total scoring, a moderate agreement was found between palliative care nurses and the first researcher-observer (49.0%) and also between palliative care nurses and the second researcher-observer (47.7%). In addition, there was a substantial agreement between the first and second researchers (78.9%) and also between all observers (61.5%) (all p = .001). CONCLUSIONS: Although there was a near-perfect agreement between the two researcher-observers, we found only moderate agreement among all observers (palliative care nurses and two researcher-observers) in the evaluation of GCS total and subscale scores. RELEVANCE TO CLINICAL PRACTICE: We found that lack of knowledge and training on the standardized use of GCS is still a problem for palliative and intensive care units. Because of the diversity of patients requiring GCS assessment in palliative care units, refresher training programs and hands-on workshops on consciousness assessment should be organized regularly for more experienced nurses.

The effect of occupational therapy on anxiety, depression, and psychological well-being in older adults: a single-blind randomized-controlled study.

PURPOSE: To evaluate the effect of occupational therapy on anxiety, depression, and psychological well-being in older adults. METHODS: This study is a single-blind, randomized-controlled prospective experimental study conducted with 84 older adult individuals, 41 in the intervention group and 43 in the control group, in a nursing home. Occupational therapy was applied to the patients in the intervention group, and all patients were followed for a week. In the study, data were collected using the Participant Information Form, Geriatric Anxiety Scale, Psychological Well-Being Scale, and Geriatric Depression Scale. RESULTS: The mean age of the participants was 68 years in the intervention group and 70 years in the control group. While 65.9% of the participants in the experimental group were male, 65.1% of the control group was male. The post-test anxiety scores of the participants were lower in the intervention group than in the control group (7.0 ± 4.2 vs. 16.7 ± 10.9) (p < 0.001). The post-test psychological well-being scores of the participants were higher in the intervention group than in the control group (47.9 ± 6.8 vs. 38.4 ± 6.5) (p < 0.001). There was no statistically significant difference between the depression scores of the intervention group and the control group (6.9 ± 3.7 vs. 6.2 ± 5.4) (p = 0.468). CONCLUSIONS: In this study, it was determined that after occupational therapy was applied to older adults, their anxiety decreased and their psychological well-being increased, while there was no statistically significant difference in their depression levels. Occupational therapy, with a focus on decreasing anxiety, is a potential approach that can improve older adults' health, psychological well-being, and coping skills. GOV ID: NCT05576558.

The Relationship Between Work Environment and Missed Nursing Care in Nurses: The Moderator Role of Profession Self-Efficacy.

AIMS: This study aimed to examine the relationship between work environment and missed nursing care (MNC) in nurses and determine whether profession self-efficacy has a moderator role in this relationship. DESIGN: A quantitative, cross-sectional, correlational study design was used to test the study model. METHODS: The study was conducted with 433 nurses in 2 city hospitals in Istanbul, Turkey. Data were collected between November 2022 and February 2023 using the "MISSCARE Survey-Turkish," the "Work Environment Scale," and the "Nursing Profession Self-Efficacy Scale." RESULTS: The participants had a mean Nursing Profession Self-Efficacy Scale score of 66.67 ± 14.37, a mean Work Environment Scale score of 84.96 ± 13.62, a mean elements of MNC score of 1.30 ± 0.73, and a mean reason for MNC score of 3.18 ± 0.78. Nursing profession self-efficacy was determined to be positively related to the work environment of the participants and their reasons for MNC (respectively, r = 0.276 and r = 0.114) and negatively related to elements of MNC ( r = -0.216) ( P < 0.05). There was also a negative relationship between the work environment and elements of MNC ( r = -0.249; P < 0.05). Profession self-efficacy had a significant moderator role in the relationship between the work environment and elements of MNC. Having low or moderate levels of profession self-efficacy moderated the negative effects of the work environment on elements of MNC. CONCLUSIONS: There is a need for interventions to reduce elements of missed nursing care in nurses. Especially nurses and/or nurse managers may have difficulties in improving their work environment, considering its multifaceted structure. In such cases, administrators can reduce missed nursing care by increasing the profession self-efficacy of nurses. Therefore, profession self-efficacy should be considered in addition to interventions for the work environment to improve care.

Emotional labour behavior of nursing students: A qualitative study.

AIM: This study aimed to determine the opinions of nursing students on emotional labor behavior. BACKGROUND: It is of importance to teach emotional labor behavior to nursing students, the nurses of the future. DESIGN: The research has a phenomenological qualitative design. METHOD: Participants consisted of 20 nursing students who were in face-to-face communication with patients in clinical practice. The Standards for Reporting Qualitative Research (COREQ) was used to report this research. RESULTS: Considering the theoretical structure of the subject, emotional labor behavior was examined under three main themes: surface acting, deep acting, and genuine acting. CONCLUSIONS: Emotional labor behavior affects students' approach to patients and performance in clinical practice. Education has a supportive effect on the management of emotions and the guidance of the clinical environment and clinical services.

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.