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Gülşah Gürol Arslan,1 Dilek Özden2 1Nursing Faculty, Dokuz Eylül University, Balçovaİzmir, Turkey; 2Nursing Faculty, Dokuz Eylül University, Balçovaİzmir, Turkey Purpose: This study was conducted to determine the impact of education on the knowledge, opinions and anxiety level of the nurses regarding the use of the ventrogluteal site for intramuscular injection. Subjects and methods: The research was conducted with a single group using a semi-empirical pre-test, post-test design. The sample consisted of 50 nurses who worked in clinics where intramuscular injection was frequently applied and who participated in training on the use of ventrogluteal site for intramuscular injection. The data were collected by the researchers with the questionnaire form for evaluation of data, in addition to using descriptive statistical methods, paired sample t-test, Kruskal–Wallis and 2-related samples tests. Results: It was found that 34.0% of the nurses frequently used the dorsogluteal site for intramuscular injection. It was determined that the difference between pre-training (12.40±6.89) and post-training (21.80±1.95) mean scores of the nurses regarding the ventrogluteal site injection was statistically significant (P0.05) was found between the pre-training (39.22±10.16) and post-training (37.52±8.54) anxiety levels. Conclusion: It can be stated that the majority of the nurses did not prefer the ventrogluteal site for intramuscular injection; the reasons for not preferring this method were a lack of knowledge on determining the site and concern about harming the patients. Keywords: ventrogluteal site, dorsogluteal site, intramuscular injection, nursing

Abstract Background We aimed to investigate whether the HALP score was a predictor of survival in patients with Glioblastoma (GBM). Methods A total of 84 Glioblastoma (GBM) patients followed in our clinic were included in the study. HALP scores were calculated using the preoperative hemoglobin, albumin, lymphocyte and platelet results of the patients. For the HALP score, a cut-off value was found by examining the area below the receiver operating characteristic (ROC) curve. Patients were divided into two groups as low and high according to this cut-off value. The relationships among the clinical, dermographic and laboratory parameters of the patients were examined using these two groups. Results Median OS, PFS, HALP score, NLR, PLR were 15 months (1.0–78.0), 8 months (1.0–66.0), 37.39 ± 23.84 (min 6.00-max 132.31), 4.14, 145.07 respectively. A statistically significant correlation was found between HALP score and OS, PFS, NLR, PLR, ECOG-PS status using Spearman’s rho test (p = 0.001, p 37.39 was associated with prolonged survival in high-grade brain tumors.

ABSTRACT BACKGROUND: Healthcare professionals’ knowledge, attitudes, and beliefs regarding skin cancer are important for reducing the future impact of the disease. OBJECTIVE: This study evaluated university students’ knowledge, attitudes, and beliefs about skin cancer and examined the variables influencing their attitudes and beliefs about the disease. DESIGN AND SETTING: This descriptive cross-sectional study was conducted at the Faculty of Health Sciences at Manisa Celal Bayar University, Manisa, Turkey. METHOD: A total of 960 students participated in this study. Data were collected using the Student Introduction Form, Fitzpatrick Skin Type Scale, Skin Cancer and Sun Knowledge Scale (SCSKS), and Health Belief Model Scale for Skin Cancer (HBMSSC). RESULTS: The mean SCSKS score of the participants was 14.91 ± 4.23. The mean HBSSC scores of the participants were 23.58 ± 7.79 for perceived susceptibility, 14.79 ± 4.59 for perceived severity, 20.64 ± 6.60 for perceived benefits, 15.93 ± 4.09 for perceived barriers, and 21.78 ± 7.14 for self-efficacy. The mean SCSKS total scores of the university students were significantly and positively correlated with the HBMSSC subdimensions. Gender explained 1.58 of the variance in perceived benefits and 1.65 of the variance in self-efficacy, whereas the SCSKS score explained most other variables. CONCLUSION: The students’ knowledge of skin cancer and sun protection was moderate. Their attitudes and beliefs regarding skin cancer were unexpected. This study identified students’ knowledge of skin cancer and sun protection as the most important variables for improving their attitudes and beliefs about skin cancer.

Abstract Background Of all the genitourinary cancers, renal cell carcinoma (RCC) is still the most common malignancy with high mortality rates. There are still insufficient biomarkers to predict disease prognosis. Systemic inflammation markers play an important role in tumor development and growth. There are studies which show the relationship of fibrinogen and albumin individually with cancer prognosis in many cancers. Fibrinogen/albumin ratio(FAR), on the other hand, has prognostic importance like other inflammation indicators in cancer. Therefore, we investigated whether FAR had a potential value in evaluating the prognosis of patients with nonmetastatic kidney cancer or not. Methods A total of 72 patients who had nephrectomy operation at 19 Mayıs University, Faculty of Medicine between January 2019 and January 2021 and who did not have distant metastasis were included in the study. FAR was calculated from the blood taken from the patients before the nephrectomy operation. The cut-off value was found for this FAR by receiver operating characteristic(ROC) curve analysis. The patients were divided into 2 groups as high- and low-FAR according to this cut-off value. Kaplan Meier test was used to evaluate the predictive value of clinicopathological parameters for overall survival (OS). The Log-rank test was used to determine whether there was a relationship between the preoperative FAR and the clinico-pathological data of the patients. Results The best cutoff value for the FAR was 0.114. A FAR > 0.114 was associated with higher Fuhrman Grade (FG) (P 0.114) had worse OS [Std. Error 2.932, 95% confidence interval (CI): 73.659–85.154, P 0.114 was significantly related to decreased survival in renal cancer patients. In addition, the platelet-lymphocyte ratio seems to be related to OS, as well as FAR. Further studies are required on this subject.

With globalization, countries’ demographic structures have evolved into multicultural societies and this has laid the groundwork for ethnic, religious and cultural conflicts. The conflict process was also the beginning of ongoing integration problems between the majority in a society and minorities with different origins. Third generation Turkish immigrants are nested with a serious identity problem in Germany today. In this a specific example of multiculturalism, Turkish immigrants have adopted spatial segregation as a security method. This is caused by identity security anxiety and reveals another dimension of alienation and exclusion in modern societies with their criminalization by the police. The police are expected to stop conflict by considering the principle of equality and to reduce discrimination to the minimum level. Criminalizing Turkish immigrants and negative experiences in judicial processes, also shape the confidence people have in the police. Finally, immigrants attempt to seek proper security of their own, in the community, where the sense of trust is also alienated. This article discusses the presence of crime and violence as a part of the everyday life of Turkish immigrants, by what means does subjective security become the cause of objective insecurity, and how two different cultures confront each other due to feelings of insecurity towards the police, in the search for security.

Background/purpose – The main purpose of this study is to examine the effects of the mobile pre-learning system developed according to the surface learning approach on academic achievement and mobile learning attitudes. Materials/methods – The research was conducted with 135 university students and a 12-week pretest–posttest unequaled control group quasi-experimental research method. Prepared in line with the content of an Instructional Technologies course, 12 educational videos varying from 3 to 6 minutes, and designed according to the surface learning approach, were issued to the experimental group’s students via the mobile pre-learning system 1 day prior to the relevant lesson, and the data obtained were then analyzed. Results – As a result of the research, it was determined that the mobile pre-learning system developed according to the surface learning approach had a significant effect on the participant students’ academic achievement and mobile learning attitudes. Conclusion – It was observed that the mobile pre-learning system developed according to the surface learning approach had a close to medium-level effect on the satisfaction and motivation factors of the participant students’ mobile learning attitudes. However, it was determined that it had no significant effect on the impact and usefulness factors of learning. In addition, it was concluded that the mobile pre-learning system based on the surface learning approach had a significant effect on the participant students’ academic achievement.

Forest area of Turkey is 22.6 million hectares, which constitutes 28.8% of the overall land area. 47% of the forests is coniferous, 32% is broad-leaved tree species and 21% mixed species. The Scale insects (Hemiptera: Coccomorpha) are cryptic and mostly invisible insects which are mostly small less than 5 mm long. Many scale insects are economically important pests of agriculture, horticulture, and forestry. Around 400 scale insect species are known in Turkey, totally 119 Coccoidea species are fed on forest trees and shrubs; among 45 species of them on conifers and 74 species on broad-leaves trees and shrubs. Marchalina hellenica Gennadius (Marchalinidae) is a famous and economically important species that resourced honeydew honey called “pine honey”. This study examines scale insects, their distribution, host plants, natural enemies, damages, and role of forest biodiversity in Turkey.

Bu çalışmada, 2003-2017 yılları arası Türkiye’de anlaşmaların uygulanma maliyeti ile girişimcilik arasında eş bütünleşme ilişkisi araştırılmıştır. ARDL modelinin kullanıldığı çalışmada kısa ve uzun dönemde sözleşmelerin uygulanma maliyeti ile girişimcilik arasında bir eş bütünleşme ilişkisi saptanmıştır. Girişim faaliyetlerinde yapılan sözleşmelerin uygulanma maliyeti arttıkça girişimcilik azalmaktadır.

Background: Elderly patients with diabetes receiving social support are likely to have better compliance with their disease self-care. However, no previous study from Turkey has assessed the effect of social support on diabetes burden among elderly patients. Objective: The objective of this study was to assess the association between social support and disease burden among elderly patients with diabetes in Turkey. Materials and Methods: This cross-sectional study included 271 randomly selected elderly patients with diabetes who presented to the internal medicine and diabetes polyclinics of three state hospitals (Sindirgi State Hospital, Balikesir Ataturk State Hospital and Balikesir State Hospital) in Balikesir, Turkey, between April and November 2017. A single interviewer collected all data using a sociodemographic form, the Elderly Diabetes Burden Scale (EDBS) and the Multidimensional Scale of Perceived Social Support (MSPSS). Data were analyzed using arithmetic averages, percentages and Pearson's correlation. Results: The mean age of the participants was 72 ± 5.2 (65–88) years, and most (53.6%) were females and lived with their family: spouse (58.3%), children (18.5%) or both (17.7%). The mean EDBS score was 35.21 ± 6.94 (25–69), and the mean MSPSS score was 67.81 ± 17.33 (12–112). A significant negative correlation was found between the mean total of both assessment tools (P < 0.05), indicating diabetes burden was higher among those with lower social support. A similar significant correlation was observed between symptom burden, social burden, burden of dietary restrictions, burden by tablets or insulin and the total EDBS score. Conclusion: This study found that in Balikesir, Turkey, social support for elderly patients with diabetes was mostly provided by their families and that their diabetes burden decreased with increased social support levels.

Feminist drama, as a suitable genre for the discussion of debates over different views within the feminist movement itself, developed in parallel with women’s movement. It is possible to find the examples of first-wave drama in England in the plays on women written for the groups of suffragette theatre such as the Actress’s Franchise League supported by the suffragette movement that was mainly an effort of women to gain the right to vote. These plays were written and performed to raise awareness. After the development of suffragette drama, the abolition of censorship in Britain by the Act of Parliament in 1968 may be regarded as a landmark and as the second step in terms of the development of feminist drama in England because it gave the feminist playwrights of the time the opportunity to deal with subjects that were formerly regarded as taboo. Hence, as opposed to the first-wave; that is, suffragette drama, the second-wave post-war feminist drama was characterised by representing women’s issues in a larger scale. Almost all woman playwrights with different attitudes were able to reflect their concerns over women’s problems on stage and most of them received consistent support from smaller, alternative theatres, and women’s companies. The purpose of this study is therefore to explore and exemplify the multiplicity or diversity of voices in post-war British feminist drama through a detailed analysis of Pam Gems’s Dusa, Fish, Stas and Vi (1976).

Copyright of Turkish Journal of Research & Development in Nursing / Hemşirelikte Araştırma Geliştirme Dergisi is the property of Association for Research & Development in Nursing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Krukenberg tumor is a rare variety of metastatic cancer to the ovary. The stomach is the most common site for the primary tumor, followed by the breast, gall bladder, colon and pancreas. It is not always possible to distinguish ovarian metastasis from primary ovarian masses in patients in whom the malignancy center is unidentified. This case report firstly aims to present a patient who presented with common nodular skin lesions, migrating arthritis and severe clinical characteristics, and diagnosed with Krukenberg tumor with further examinations.

Bu makalede, Gazi Üniversitesi Merkez Kütüphanesi’nin kuruluşu, gelişimi, verdiği hizmetler, derme yapısı, kullanıcı eğitimi ve gelecekteki hedefleri anlatılmaktadır.

Bu makalede Bilkent Üniversitesi kütüphanesi Müzik Odası ve Görsel- İşitsel Koleksiyon’un gelişimi, görevleri, verdiği hizmetler ve geleceğe yönelik hedefleri anlatılmaktadır.

Pain relief is a management problem for many patients, their families, and the medical professionals caring for them. Although everyone experiences pain to some degree, responses to it vary from one person to another. Recognizing and specifying someone else’s pain is clinically a well know challenge. Research on the biology and neurobiology of pain has given us a relationship between spirituality and pain. There is growing recognition that persistent pain is a complex and multidimensional experience stemming from the interrelations among biological, psychological, social, and spiritual factors. Patients with pain use a number of cognitive and behavioral strategies to cope with their pain, including religious/spiritual factors, such as prayers, and seeking spiritual support to manage their pain. This article provides an overview of the complex phenomenon of pain, with a focus on spiritual and religious issues in pain management.

Background: Living with an ostomy is a chronic condition, and self-care in such cases improves patient outcomes., Purpose: To adapt and test the psychometric properties of the Turkish version of the Ostomy Self-Care Index (T-OSCI) and the Turkish version of the Caregiver Contribution to Self-Care in Ostomy Patient Index (T-CC-OSCI)., Methods: A psychometric study was conducted on a convenience sample of 202 adult patients with an ostomy and their 165 caregivers. Translation and back translation, face and content validity, construct validation, and reliability assessment of the T-OSCI and the T-CC-OSCI were performed. Exploratory factor analysis was used to evaluate the construct validity. Reliability was established using Cronbach α coefficients, ceiling and floor effects, and the Hotelling T2 test, Wilcoxon signed rank test, and intraclass correlation coefficient., Results: Content validity values were in the range of 0.85 to 1 for both the T-OSCI and the T-CC-OSCI. Exploratory factor analysis demonstrated generally acceptable factor loadings. The overall index revealed a high level of internal consistency (T-OSCI = 0.968, T-CC-OSCI = 0.862). No statistically significant difference was found between test-retest measurements. There was no indication of either ceiling or floor effects, or response bias., Conclusion: The T-OSCI and the T-CC-OSCI are valid and reliable indexes to measure the self-care of patients with an ostomy and their caregivers. These indexes may allow health care professionals to evaluate self-care in research and clinical settings, identify educational needs, and collaborate in developing and supporting appropriate self-care initiatives for patients with an ostomy and their caregivers.

Background: Although research on postoperative pain has increased, postoperative pain management is still a problem today. Most patients experience moderate to severe pain after cardiac surgery. As a result of pain, patients show inefficient adaptation behaviour in physiologic, role function, self-concept, and interdependence modes., Aim: This study was conducted to examine the pain perceptions of intensive care patients after cardiac surgery according to Roy's Adaptation Model (RAM)., Study Design: A qualitative design with a phenomenological approach was used in the study. The research data were collected by using a "descriptive information form", a "semi-structured interview form", and the "numerical rating scale" through the "in-depth interview method". The study sample consisted of 16 patients who were aged 18 years or older, had undergone cardiac surgery, experienced pain post-operatively in the intensive care unit at least once, and had intensive care experience. Patients with neuropathic or chronic pain or neurological or psychiatric disorders were not included in the study. Data were classified into physiologic, self-concept, and interdependence modes according to RAM., Results: The themes and sub-themes that emerged included physiologic modes (pain responses), self-concept modes (pain self-management), role-function modes (effects of pain), and interdependence modes (support systems in pain)., Conclusions: The results of our study can enable patients and nurses to communicate effectively about pain. In future studies, the effect of model-based pain management programs on cardiac surgery patients can be investigated., Relevance to Clinical Practice: Examining the pain perceptions of intensive care patients after cardiac surgery according to RAM will guide the improvement and development of pain management. It is thought that the model addresses intensive care patients experiencing pain holistically., (© 2023 The Authors. Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Background and Aims: The clinical significance of early ostomy complications has been emphasized worldwide, and the current evidence concerning the impact of emergency or elective surgery on ostomy complications is limited. This study aimed to investigate the effect of elective and emergency colorectal surgery on early ostomy complications and the risk factors associated with specific complications., Methods: A mandatory colorectal recording system for consecutive ostomy patients between 2012 and 2020 was reviewed retrospectively. Patient socio-demographics, ostomy-related variables, and early period ostomy complications were retrieved from the patient records. The chi-square test, t -test, analysis of variance (ANOVA), and logistic regression were used to analyze the data., Results: The study cohort included 872 patients. At least one or more complications developed in 573 (65.7%) patients, 356 (63.6%) in the emergency group, and 217 (69.6%) in the elective group. When comparing emergency surgery to elective surgery, necrosis (7.4% versus 3.4%, p = 0.009), mucocutaneous separation (37.2% versus 27.1%, p = 0.002), and bleeding (6.1% versus 2.1%, p = 0.003) were more prevalent. Peristomal irritant contact dermatitis (PICD) (37.3% versus 26%, p < 0.001) was more common in elective surgery. Risk factors for PICD were comorbidity (p = 0.003), malignant disease (p = 0.047), and loop ostomy (p < 0.001) in elective surgery; female sex (p = 0.025), neo-adjuvant therapy (p = 0.024), and ileostomy (p = 0.006) in emergency surgery. The height of the ostomy (less than 10 mm) was a modifiable risk factor for mucocutaneous separation in both elective surgery (p < 0.001) and emergency surgery (p = 0.045)., Conclusion: Early ostomy complications were more likely to occur after emergency colorectal surgery than in an elective setting. Patient- and ostomy-related risk factors for complications differed between elective and emergency surgeries., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: In this study, we aimed to investigate pressure injury (PI) and its associated factors in COVID-19 patients receiving invasive mechanical ventilation (IMV)., Methods: This was designed as a retrospective, descriptive and correlational study. In this study, there was no sample selection, and the data were collected by reviewing the files of 438 patients who had been followed up on IMV in the intensive care unit (ICU) with a diagnosis of COVID-19 between April 30, 2020, and April 30, 2022. The collected data were analyzed using descriptive statistics in the Statistical Package for the Social Sciences (SPSS) program., Results: A total of 305 pressure injuries occurred in 36.3% of 438 patients receiving IMV. It was found that the length of IMV stay of the patients accelerated the occurrence of PI and that the length of stay in the intensive care unit, albumin and hemoglobin levels, Braden Pressure Sore Risk Assessment Score, APACHE-II value, nutritional status, glutamine supplementation, and vasopressor use were found to be significantly correlated with the incidence of PI (p < 0.05)., Conclusions: Patients with COVID-19 who were followed up on IMV had a high incidence of PI, and prolonged ICU stays and intubations duration as well as low albumin and hemoglobin levels increased the occurrence of PI. Hence, it is recommended that the PI risk levels of COVID-19 patients followed up on IMV should be evaluated frequently and nursing interventions should be implemented according to the evaluations., (Copyright © 2023 Tissue Viability Society / Society of Tissue Viability. Published by Elsevier Ltd. All rights reserved.)

Background: Several studies have revealed that clinicians cannot suction all available secretion in the trachea and perform more frequent suctioning with a closed suctioning system (CSS) than with an open suctioning system (OSS). There are also studies claiming that the CSS is as effective as the OSS, based on either the amount of secretion, the frequency of suctioning, or haemodynamic parameters alone. However, there is no study examining all at once., Objectives: This study aims to determine whether the CSS is as effective for secretion removal, suctioning frequency, tidal volume (V T ), and peripheral oxygen saturation (SpO 2 ) as the OSS., Methods: The study used a single-blind, randomised, 2 × 2 crossover (2-method, 2-arm, 2-period) design. One hundred intubated patients were randomly assigned to two study arms. Thirty-four were randomised to the CSS on the first day and the OSS on the second day (AB arm), and 35 were randomised to the OSS on the first day and the CSS on the second day (BA arm). A 12-h washout period was set between them. Haemodynamic parameters were measured just before suctioning and in the 5th minute after suctioning. The secretions obtained after suctioning were weighed, and the frequency of suctioning was recorded., Results: There were no effects of method, period, or carryover on suctioning frequency and amount of secretion in the 2 × 2 crossover design t-test (p > 0.05). In the OSS, there was a weak, linear, and negative correlation between the amount of secretion and SpO 2, and between V T and SpO 2 measured before and after suctioning (p < 0.05 for all)., Conclusions: Open and closed suctioning systems were similar in terms of haemodynamic alterations, amounts of secretion, and frequency of suctioning. The CSS was as effective as the OSS., Registration Number: NCT04053751., (Copyright © 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

The purpose of this study was to explore the experiences and needs of family caregivers of stroke patients who require physical restraints. The themes and sub-themes that emerged included "the reason for the use of PR" (disruptive behaviors of the patient and personal reasons of caregivers), "the turmoil of having to use PR" (inevitableness, comparing benefits and harms, the emotional effect of PR, and physical effects), and "unmet needs and suggestions" (unmeet needs and suggestions). Nurses should take the experiences of patient relatives into account in the process of PR application, organize training programs, and determine application standards for PR.

Background: Recently, moral sensitivity and professional values have become increasingly important in nursing education and have been tried to be improved., Objectives: To investigate the effects of an ethics laboratory program integrated with the fundamentals of nursing course on the moral sensitivity and professional values of nursing students., Design: The present study was designed as a randomized controlled study. The 8-week ethics laboratory program was applied to the students in the intervention group. In the ethics laboratory program, interactive education methods, such as ethical scenarios, case studies, roleplay, group discussions, project papers and watching movies, were applied. Control group received the standard fundamentals of nursing curriculum., Participants: The sample size was determined using stratified block randomization method, and 100 nursing students were assigned to intervention (n = 50) and control group (n = 50)., Results: There was no baseline difference between the groups. The moral sensitivity average of the students in the intervention (82.66 ± 12.57) was lower than the average of the control group (85.64 ± 16.83) after the ethics laboratory program; however, the difference was not statistically significant (p > .05). Similarly, there were no significant differences between the intervention (132.32 ± 16.83) and the control group (131.81 ± 20.55) regarding the average score of professional values. In the responsibility sub-dimension of professional values, there was a statistically significant increase in the intervention group (p < .05)., Conclusion: The findings suggest that the ethics laboratory program for nursing students is effective in promoting responsibility sub-dimension of professional values. However, there was no significant effect on students' moral sensitivity and other dimensions of professional values. Further refinements of interventional research in ethics education and measurement of learning outcomes should be developed., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Determination of the factors affecting missed nursing care and the impact of ethical leadership is important in improving the quality of care., Aim: This study aims to determine the missed nursing care and its relationship with perceived ethical leadership., Research Design: A cross-sectional study., Participants and Research Context: The sample consisted of 233 nurses, of whom 92.7% were staff nurses and 7.3% were charge nurses, who work in three different hospitals in Turkey. The study data were collected using a personal and professional characteristics data form, the Missed Nursing Care Survey, and the Ethical Leadership Scale., Ethical Considerations: The study was approved by the non-interventional ethics committee of Dokuz Eylül University Ethics Committee for Noninvasive Clinical Studies. All participants' written and verbal consents were obtained., Findings: The most missed nursing care practices were ambulation, attending interdisciplinary care conferences, and discharge planning. According to the logistic regression analysis, sex, the number of patients that the nurse is in charge of giving care, the number of patients discharged in the last shift, and satisfaction with the team were determined as factors affecting missed care. No significant relationship was found between ethical leadership and missed nursing care (p > 0.05), and a weak but significant relationship was found between the clarification of duties/roles subscale and missed nursing care (r = -0.136, p < 0.05)., Discussion: Ethical leaders should collaborate with policy-makers at an institutional level to particularly achieve teamwork that is effective in the provision of care, to control missed basic nursing care, and to organize working hours and at the country level to determine roles and to increase the workforce., Conclusion: The results of this study contribute to the international literature on the most common type of missed nursing care, its reasons, and the relationship between the missed care and ethical leadership in a different cultural context.

Aim: This study evaluated the evidence-based knowledge and emotional experiences of undergraduate nursing students regarding endotracheal suctioning., Research Methodology/design: A cross-sectional, descriptive, survey design was used. Nursing students' knowledge level was measured using the Suctioning Knowledge Questionnaire, and emotions were assessed using the Clinical Stress Questionnaire., Setting: University undergraduate nursing programme., Results: The study included 445 undergraduate nurses. Students' mean knowledge score was 36.86 ± 14.45, and 85.8% of the total knowledge scores were 50 or less indicating a low level of knowledge. The mean score of the students who had experienced the suctioning procedure (44.5%, n = 198) was statistically higher than that of the students without experience (38.78 ± 12.62 and 35.32 ± 15.62, respectively) (p < 0.05). Students who performed the suctioning procedure expressed their emotions relating to suctioning as follows: I felt nervous (79.3%), worried (77.8%), frightened (70.2%), daunted (53.0%) and disgusted (51.0%)., Conclusion: The majority of nursing students' knowledge levels were insufficient. That they felt frightened or disgusted performing the procedure was noteworthy. Students should be given the opportunity to perform endotracheal suctioning and express their feelings about the procedure., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Physical restraint is still widely used despite studies supporting a reduction in its use. The development of guidelines to reduce the use of PR first requires the identification of factors related to the use of alternative methods., Aim: This study aimed to determine factors associated with the use of alternatives to physical restraint (PR) in intensive care units., Design: This was a cross-sectional descriptive study., Methods: Data were collected from adult intensive care units of three hospitals in Turkey using the Physical Restraint Knowledge, Attitude and Practice Scale and a questionnaire including open-ended questions., Results: Overall, 202 nurses (80% response rate) completed the questionnaire. Nurses' knowledge, attitude, and practice scores regarding PR were 6.89 ± 1.79, 29.85 ± 4.93, and 36.76 ± 3.36, respectively. PR was reported to be necessary for patients at risk of self-harm, with dangerous behaviours, and who were trying to remove their catheters. Most nurses (64.9%) stated that they needed a written doctor's order. Analysis of free-text responses showed that patient disorientation (because of delirium, sedation, or agitation), nurses' workload, and lack of training regarding restraint were the primary reasons why nurses could not use alternatives. The main alternatives suggested by nurses were categorized as sedation, communication, and environmental regulation. Logistic regression analysis identified training (P = .009), working unit (P = .001), and nurses' practice score to use PR (P = .004) as independent risk factors for not using alternative methods of PR., Conclusions: The results of this study revealed a moderate level of knowledge, attitude, and practice among nurses regarding the use of PR. Thus, education of nurses about the prevention of delirium and alternatives to PR according to the characteristics of their units is required., Relevance to Clinical Practice: Clinical guidelines and in-service training need to be developed to increase the use of alternatives to PR and delirium management., (© 2020 British Association of Critical Care Nurses.)

Aims and Objectives: To investigate the spiritual care needs and associated factors in patients with ostomy., Background: The significance of the spiritual care needs of the patients has been emphasised across countries and cultures in the literature., Design: A descriptive, cross-sectional study., Methods: Outpatients with an ostomy (n = 127) were recruited from proctology, wound and stoma therapy unit and general surgery clinics between January and 28 March 2020. The data were collected using the Socio-demographic Characteristics Form and Spiritual Care Needs Inventory (SCNI). SCNI has two components, namely 'meaning and hope' and 'caring and respect'. Descriptive statistics, correlation, Student's t test, ANOVA and multiple linear regression analyses were used to analyse the data. The STROBE checklist was used to report the study., Results: The mean scores of the spiritual care needs (65.31 ± 12.83), meaning and hope (37.35 ± 9.37), and caring and respect (27.96 ± 5.63) of the patients with ostomy were found to be moderate. The most significant factors affecting the meaning and hope component were the age, being female and decreases in the level of income. Scores of the patients who perceived the severity of the disease seriously and who practiced religious ritual regularly had more spiritual care needs for the component of caring and respect. Patients with ostomy needed interaction, respect for their privacy and dignity, to be shown concern and to be respected for their religious and cultural beliefs, which were the most salient needs., Conclusions: There is an unambiguous requirement for nurses to ensure spiritual care for patients with ostomy. Showing interest and spending time for the interaction with patients with ostomy, need-based spiritual practices and life review are key elements of spiritual care., Relevance to Clinical Practice: Evaluating patients with ostomy spiritually requires information about how spiritual needs may arise and how to talk about spiritual needs. The result of the present study may help nurses to begin the process of maintaining spiritual care for patients with ostomy., (© 2021 John Wiley & Sons Ltd.)

Purpose: This study aimed to describe the frequency of colostomy and ileostomy complications and types of nursing interventions as well as to examine patient and ostomy variables associated with early and late complications., Methods: The records of 572 patients who received ostomy care from a wound ostomy care (WOC) nurse between 2013 and 2017 were abstracted. Patient demographic and ostomy variables, early period (< 30 days after surgery) and late period (> 30 days after surgery) complications, as well as documented nursing interventions were retrieved. Percentages and rates, chi-square statistics, and logistic regression were used to analyze the data., Results: The mean patient age was 59.1 years (standard deviation [SD], 13.86), and the majority of patients were male (302 patients; 52.8%), married (454; 79.4%), and had a temporary (438; 76.6%) end colostomy (253; 44.2%). One (1) or more complications developed in 323 patients (56.5%) in the early period and in 207 patients (36.2%) in the late period. The most common complications in the early period were peristomal irritant contact dermatitis (PICD) (181; 31.6%) and mucocutaneous separation (135; 23.6%). PICD was also the most common complication in the late period (149; 26%). The risk of PICD was significantly higher in patients with a body mass index > 24.9 kg/m2 (odds ratio [OR] = 1.547), who had an ileostomy (OR = 1.654), or a temporary ostomy (OR = 1.728). Variables associated with an increased risk of mucocutaneous separation included obstacles to ostomy care (OR = 2.222), having an end ostomy (OR = 2.171), and ostomy height < 10 mm (OR = 1.964). Complications were treated by the WOC nurse in 67.5% of patients, and the most common intervention was application of skin barrier powder and wipe layers., Conclusions: The rate of ostomy complications, especially PICD and mucocutaneous separation, in this study was high. Results confirm that patient and ostomy characteristics might significantly affect the risk of complications. The findings support the importance of outpatient follow-up by a WOC nurse. Explorative or randomized controlled studies are needed to identify optimal nursing strategies to decrease complication rates.

The aim of this descriptive and correlational study was to determine the relationship between nursing students' moral sensitivity and attitudes towards medical errors. The study sample consisted of 309 fourth graders of the school of nursing of a university. Data were collected using a Descriptive characteristics form, the Moral Sensitivity Questionnaire (MSQ) and the Medical Errors Attitude Scale (MEAS). Participants had a mean MSQ and MEAS score of 91.31 ± 21.29 and 3.77 ± 0.44, respectively. There was a negative correlation between MEAS and MSQ scores, indicating that the higher the moral sensitivity, the higher the participants' awareness of medical errors and error reporting. It is, therefore, recommended that students be offered moral education based on different teaching methods to help them develop positive attitudes towards medical errors., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Aim: To determine the compliance with nursing drug administration procedure steps associated with access to the central venous catheter for bolus infusion in intensive care units., Methods: This observational study was conducted with 30 nurses working in an intensive care unit of a university hospital. The drug administrations practiced by nurses via central venous catheter were monitored simultaneously at 12:00 a.m., 02:00 p.m., and 06:00 p.m. by two observers. The data were collected using a data collection form and central venous catheter drug administration procedure steps., Results: A total of 90 different drug administrations were observed in three different treatment hours from 30 nurses. The interobserver conformity was found to be moderate in two steps (kappa = 0.520-0.627, P = 0.01) and perfect in all other steps (kappa = 0.821-1.000, P = 0.000). According to the drug administration procedure steps via a central venous catheter, all nurses applied the following steps correctly during all treatment hours: drug card control, preparation of treatment materials, checking the patient's identity, and steps of drug treatment administration. The following tasks were frequently performed incorrectly or not at all: hand hygiene (before treatment 87.8%; after treatment 82.2%), scrubbing the three-way stopcock entrance with an alcohol swab (55.6%), waiting for the alcohol to dry (81.1%), and flushing the lumen with a compatible fluid (before treatment 84.4%: after treatment 75.6%)., Conclusion: Observation of drug administration procedure steps via central venous catheter according to the treatment hours showed that the nurses performed many incomplete or inaccurate drug administration procedure steps and the mistakes increased toward the evening hours.

Background: To reduce the neurovascular complications caused by physical restraint in intensive care patients, there is a need to examine the occurrence of neurovascular complications and their rate., Objectives: The objective of this research was to investigate the effect of physical restraint on the occurrence of neurovascular complications and their rate., Methods: A prospective observational cohort study was carried out. A total of 90 patients from anaesthesia and internal intensive care units participated in this study. Patients were assessed at intervals of 24 h for 4 days using the following instruments: Individual Characteristics Form, Richmond Agitation-Sedation Scale (RASS), Behavioral Pain Scale, and Complication Diagnostic Diary., Results: Redness (p < 0.001), limb movement (p < 0.001), oedema (p < 0.001), and colour complication (p < 0.001) increased, whereas pulse strength (p < 0.001) decreased in physically restrained sites on the arm from day 1 to day 4. Redness was increased in patients physically restrained with all types of materials (p < 0.001; p < 0.001; p = 0.020). Although there was a statistically significant difference in terms of movement (p = 0.006; p = 0.003) and oedema (p < 0.001; p < 0.001), both with a roll of gauze and tough cuff, these complications were not significantly different in patients restrained with green foam tie (p > 0.05). According to logistic regression analysis, material type, position of the limb, space between the physical restraint and limb, age, RASS, and pain were independent risk factors for neurovascular complications. RASS and pain were independent protective factors against movement complications., Conclusions: The duration of physical restraint increases neurovascular complications. This study revealed that nurses did not regularly check the restrained wrist and did not focus on the peripheral circulation. It is necessary to develop training programs, standards, and appropriate follow-up strategies in intensive care units in Turkey., (Copyright © 2019 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

The study is designed as quasi experimental including pre-test and post-test. The sample of the study is consisted of 98 students who are taking the Forensic Nursing course in the second year of the School of Nursing at a university. The mean score obtained from the test on the knowledge of forensic evidence before the training was 23.63 ± 5.24 while the mean score after the training was 33.32 ± 4.54. A statistically significant difference was found when the average scores of the students were compared before and after the course of forensic nursing. It was revealed that the course of forensic nursing taken by the students has a positive effect on the knowledge of forensic evidence of students and increases their knowledge level. The results suggest to add a course of forensic nursing as an elective or mandatory course to the curriculum of nursing programs and disseminate the postgraduate education on forensic nursing., (Copyright © 2019 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Background: The development of ethical leadership approaches plays an important role in achieving better patient care. Although studies that analyze the impact of ethical leadership on ethical climate and job satisfaction have gained importance in recent years, there is no study on ethical leadership and its relation to ethical climate and job satisfaction in our country., Objectives: This descriptive and cross-sectional study aimed to determine the effect of nurses' ethical leadership and ethical climate perceptions on their job satisfaction., Methods: The study sample is composed of 285 nurses who agreed to participate in this research and who work at the internal, surgical, and intensive care units of a university hospital and a training and research hospital in İzmir, Turkey. Data were collected using Ethical Leadership Scale, Hospital Ethical Climate Scale, and Minnesota Satisfaction Scale. While the independent sample t-test, analysis of variance, Mann-Whitney U test, and Kruskal-Wallis test were used to analyze the data, the correlation analysis was used to determine the relationship between the scales., Ethical Considerations: The study proposal was approved by the ethics committee of the Faculty of Medicine, Dokuz Eylül University., Findings: The nurses' mean scores were 59.05 ± 14.78 for the ethical leadership, 92.62 ± 17 for the ethical climate, and 62.15 ± 13.46 for the job satisfaction. The correlation between the nurses' ethical leadership and ethical climate mean scores was moderately positive and statistically significant (r = +0.625, p = 0.000), was weak but statistically significant between their ethical leadership and job satisfaction mean scores (r = +0.461, p = 0.000), and was moderately positive and statistically significant between their ethical climate and job satisfaction mean scores (r = +0.603, p = 0.000)., Conclusion: The nurses' ethical leadership, ethical climate, and job satisfaction levels are moderate, and there is a positive relationship between them. The nurses' perceptions of ethical leadership are influenced by their educational status, workplace, and length of service.

Aims: To examine the effects of aromatherapy massage on anxiety and sleep quality in patients undergoing colorectal surgery in the preoperative period., Background: In recent years, there has been an increase in the number of studies conducted on aromatherapy massage. It is stated that studies conducted on aromatherapy massage for anxiety and sleep quality reveal contradictory results and that more research is required on the issue., Design: A randomized controlled trial., Methods: Eighty patients undergoing colorectal surgery were randomly assigned to experimental and control group. To the experimental group (n = 40), aromatherapy massage was applied in accordance with the "Back Massage Guide" using 5% lavender oil (Lavandula Hybrida) for ten minutes before surgery and the morning of surgery. The control group received standard nursing care in compliance with the hospital procedure. Data were obtained by the State Anxiety Inventory (SAI) and Richard-Campbell Sleep Questionnaire (RCSQ). Results were analyzed using the t-test, Chi-square test or Fisher's exact test., Results: There was no baseline difference between the groups. A statistically significant difference was found between the experimental and control group in terms of the SAI and RCSQ mean scores recorded on the morning of surgery. It was determined that the SAI and RCSQ mean score of the experimental group after aromatherapy massage on the morning of surgery decreased when compared to that of the evening before surgery., Conclusions: It was found that aromatherapy massage with lavender oil increased the sleep quality and reduced the level of anxiety in patients with colorectal surgery in the preoperative period., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Purpose: This study was conducted to determine the attitudes and practices of nurses working in intensive care units of four different hospitals regarding oral care., Methods: One hundred eighty-five nurses who worked in adult intensive care units comprised the sample of this cross-sectional descriptive study., Conclusion: It can be said that intensive care nurses perform oral care without an oral care protocol and assessment guideline, and that the methods and frequency of oral care and solutions and tools used for oral care differ from one institution to another., Implications for Nursing Practice: The results emphasized the need for continuing training in this area., (© 2014 NANDA International, Inc.)

Aims: This study was carried out to determine the effects of open and closed suction systems on haemodynamic parameters of the patients who underwent open heart surgery., Background: Nurses should work meticulously and carefully as many complications may develop if the method used to perform suctioning is not appropriate., Design: The quasi-experimental study design was used., Method: The study sample comprised 120 patients who underwent open heart surgery in the cardiovascular surgery intensive care unit of a state hospital in Turkey. Haemodynamic parameters were determined just before, right after, at the 5th and 15th minute after suctioning. The data were evaluated with the One-Way Analysis of Variance (ANOVA) for Repeated Measures, independent t-test and Bonferroni's test for further analysis (post hoc)., Results: The difference between heart rate (HR) and mean blood pressure, mean PaO2 and PaCO2 , SaO2 and pH values measured before, right after and at the 5th and 15th minute after suctioning was found to be significant in patients who underwent the open suctioning procedure. It was determined that the difference between mean PaO2 values was not significant and that SaO2 versus SpO2 values increased in patients who underwent the closed suctioning procedure. When the open and closed suction systems were compared, statistically significant difference was determined in terms of MAP, SpO2 ., Conclusion: It was determined that HR, arterial blood pressure and arterial blood gases of the patients who underwent open heart surgery were negatively affected by the open suction system but did not increase significantly as soon as suctioning was over during the closed suctioning procedure. The data obtained indicate that closed system suctioning, compared with open system suctioning, can be used safely on this patient group., Relevance to Clinical Practice: The closed suction system is recommended since it contributes to the enhancement of patient safety and the quality of nursing care., (© 2014 The Authors. Nursing in Critical Care published by John Wiley & Sons, Ltd on behalf of British Association of Critical Care Nurses.)

Aim: This research was conducted with the aim of determining the influence of three different oral care solutions on oral mucous membrane integrity in critically ill patients., Background: Oral care is a basic part of nursing care in intensive care units., Design: A randomized controlled trial was conducted., Method: A total of 60 patients (20 patients in each group) comprised the study sample of the research. Patients were randomly allocated to three groups. Patients in groups 1, 2 and 3 were administered mouth care three times a day using 5% sodium bicarbonate, 0·2% chlorhexidine and saline solution, respectively. Data were collected by means of a 'Descriptive characteristics form' and an 'oral assessment tool'., Results: Mean scores of oral assessment tool increased according to days in all groups, however, this increase was found to be statistically insignificant (p > 0·05). Mean scores of the patients in saline solution group were seen to be lower than those of the other groups. When inter-group comparison of days was done, the difference between oral assessment scores was found to be statistically significant (p = 0·000)., Conclusion: It was found that there was no difference between patient groups receiving saline solution, sodium bicarbonate and 0·2% chlorhexidine for mouth care in terms of oral mucous membrane integrity; oral mucosa of all patients was found to be mildly dysfunctioning., Relevance to Clinical Practice: It is thought that standardized protocols for oral hygiene developed in the light of the findings of randomized controlled trials may improve the oral health in critically ill patients., (© 2013 British Association of Critical Care Nurses.)

Suffering repeated experiences of moral distress in intensive care units due to applications of futility reflects on nurses' patient care negatively, increases their burnout, and reduces their job satisfaction. This study was carried out to investigate the levels of job satisfaction and exhaustion suffered by intensive care nurses and the relationship between them through the futility dimension of the issue. The study included 138 intensive care nurses. The data were obtained with the futility questionnaire developed by the researchers, Maslach Burnout Inventory and Minnesota Satisfaction Questionnaire. It was determined that nurses who agreed to the proposition that the application of futility demoralizes health-care professionals had low levels of job satisfaction but high levels of depersonalization. It was determined that nurses had moderate levels of job satisfaction, emotional exhaustion, and personal achievements but high levels of sensitivity. Nurses' job satisfaction and sensitivities are positively affected when they consider that futility does not contradict the purposes of medicine.

Aim: The aim of this study was to determine the knowledge levels of Turkish nurses regarding implantable port catheter care., Methods: A descriptive method was used inside a university hospital that was located in a Turkish metropolis. The data were collected via a questionnaire that was given to a total of 45 nurses who were employed in the internal medicine clinics where the oncology patients were treated., Results: In this study, 42.2% of the nurses received in-service training about the implantable port catheter. It was determined that the mean knowledge point was 15.13 ± 4.78. The difference between the knowledge points of the nurses regarding implantable port catheter care, based on whether or not the nurses had received in-service training, was statistically significant. Moreover, it was determined that the majority of the nurses did not know where the implantable port catheter is placed, its period of use following implantation, the amount of normal saline to be used for washing the catheter, the special port (Huber) needle, the number of the needle, and the exchange time of these needles., Conclusion: In this study, there existed significant differences between the scores of the nurses who received in-service training about the implantable port catheter and the scores of those who did not receive in-service training. The majority of the nurses who participated in the study were willing to receive in-service training regarding this subject. Thus, the organization of in-service training programs and the implementation of care, according to the developed standards and guidelines, are considered as significant for reducing the occurrence of the complications that are related to the use of the implantable port catheter., (© 2011 The Authors. Japan Journal of Nursing Science © 2011 Japan Academy of Nursing Science.)

Aims: This study was carried out to determine the knowledge and practice of nurses before and after training and the development of standard practice guidelines for open and closed system suctioning methods in patients with endotracheal tubes., Background: Many life-threatening complications can occur when a suctioning procedure is not performed with the correct technique. It has been reported that standard practice guidelines for suctioning are insufficient in clinical practice., Design: Non-participant structured observational study., Methods: We assessed a total of 48 nurses who were employed in the cardiovascular surgery intensive care unit of a state hospital in Turkey. We used a questionnaire and nurse observation forms to assess the use of the open and closed system suctioning., Results: There was a significant difference between the mean scores of the answers ('true', 'wrong' and 'I do not know') for the use of open and closed system suctioning before and after training. In addition, all steps of both suctioning procedures were carried out correctly during the third observation., Conclusions: The compliance of the nurses to the standard practice guidelines for open and closed suctioning and their knowledge levels on the subject were increased after training, while the implementation of standards was satisfactory., Relevance to Clinical Practice: The development of open and closed system suctioning standard practice guidelines directly contributed to the enhancement of patient safety and the quality of nursing care. It is suggested that, as in other nursing care practices, suctioning should be carried out in accordance with standard practice guidelines, and health institutions should develop their standard practice guidelines and work in accordance with them., (© 2012 Blackwell Publishing Ltd.)

RNA nucleosides are often naturally modified into complex non-canonical structures with key biological functions. Here we report LC-MS quantification of the Ar(p) and Gr(p) 2'-ribosylated nucleosides in tRNA using deuterium labelled standards, and the first detection of Gr(p) in complex fungi., (© The Royal Society of Chemistry 2011)