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Aim. This study was carried out to determine the effect of injection duration on bruising and pain following the administration of the subcutaneous injection of heparin. Background. Although different methods to prevent bruising and pain following the subcutaneous injection of heparin have been widely studied and described, the effect of injection duration on the occurrence of bruising and pain is little documented. Design. This study was designed as within-subject, quasi-experimental research. Method. The sample for the study consisted of 50 patients to whom subcutaneous heparin was administered. Heparin was injected over 10 seconds on the right abdominal site and 30 seconds on the left abdominal site. Injections areas were assessed for the presence of bruising at 48 and 72 hours after each injection. Dimensions of the bruising on the heparin applied areas were measured using transparent millimetric measuring paper. The visual analog scale (VAS) was used to measure pain intensity and a stop-watch was used to time the pain period. Data were analysed using chi-square test, Mann-Whitney U, Wilcoxon signed ranks tests and correlation. Results. The percentage of bruising occurrence was 64% with the injection of 10 seconds duration and 42% in the 30-second injection. It was determined that the size of the bruising was smaller in the 30-second injection. Pain intensity and pain period were statistically significantly lower for the 30-second injection than for the 10-second injection. Conclusions. It was determined that injection duration had an effect on bruising and pain following the subcutaneous administration of heparin. This study should be repeated on a larger sample. Relevance to clinical practice. When administering subcutaneous heparin injections, it is important to extend the duration of the injection. [ABSTRACT FROM AUTHOR]

The aim of this descriptive study was to examine the sleep quality of older adult nursing home residents and the factors that affect it. The research population included all of the older adult residents of three nursing homes (n = 992) in Izmir, Turkey. The sample comprised those who met the inclusion criteria for the research and agreed to participate (n = 540). Research data were collected using the Elderly Individual's Introduction Form and the Pittsburgh Sleep Quality Index (PSQI). The mean age of the residents was 75.49 (SD = 6.56 years), and 54.1% were women. The sleep quality for the majority of the residents (60.9%) was determined to be poor. Nurses can enhance older adults' quality of sleep and therefore improve their quality of life. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to measure subcutaneous tissue thickness at the dorsogluteal and ventrogluteal sites and to determine optimal needle length for dorsogluteal and ventrogluteal intramuscular injections in adults with a body mass index of more than 24.9 kg/m2. Background. Problems can arise if drugs designed to be absorbed from muscle are only delivered into subcutaneous tissue. Increasing obesity in all developed and many developing countries makes this an increasing concern. Method. Ultrasound measurements were made of the subcutaneous tissue of overweight, obese and extremely obese people at the dorsogluteal and ventrogluteal sites with the probe held at a 90 angle to the plane of the injection site. Subcutaneous tissue thickness was measured in 119 adults whose body mass index was >/=25 kg/m2. The data were collected in 2005-2006. Results. Mean subcutaneous tissue thickness at the dorsogluteal site was 34.5 mm for overweight adults, 40.2 mm for obese adults and 51.4 mm for extremely obese adults, and at the ventrogluteal site was 38.2 mm for overweight adults, 43.1 mm for obese adults and 53.8 mm for extremely obese adults. Conclusion. Intramuscular injections administered at the dorsogluteal site in 98% of women and 37% of men, and at the ventrogluteal site in 97% of women and 57% of men, would not reach the muscles of the buttock. A needle longer that 1.5 inches should be used in women whose body mass index is more than 24.9 kg/m2, the dorsogluteal site may be used in all overweight and obese men, and the ventrogluteal site may be used in overweight men only. [ABSTRACT FROM AUTHOR]

Aim. The aim of the present study was to test the effects of different body on BP readings in a Turkish healthy young adults. Background. It is known that many factors influence an individual's blood pressure measurement. However, guideliness for accurately measuring blood pressure inconsistently specify that patient's position and they should keep feet flat on the floor. Although there are more information on arm position in blood pressure measurement, surprisingly little information can be found in the literature with respect to the influence of body position on the blood pressure readings in healthy young people. Methods. A total of 157 healthy young students who had accepted to participate in the study were randomly selected. In all subjects the blood pressure was measured subsequently in four positions: Sitting blood pressure was taken from the left arm, which was flexed at the elbow and supported at the heart level on the chair. After at least one minute of standing, the blood pressure was then taken standing, with the arm supported at the elbow and the cuff at the heart level. After one minute of rest, the blood pressure was subsequently taken supine position. Finally, after one minute the blood pressure was again taken in this last position with supine position with crossed legs. Results. The blood pressure tended to drop in the standing position compared with the sitting, supine and supine with crossed legs. Systolic and diastolic blood pressure was the highest in supine position when compared the other positions. There was a difference between systolic blood pressures and this was statistically significant (P < 0.001) but the difference between diastolic blood pressure was not statistically significant (P > 0.05). All changes in systolic blood pressure were statistically significant except those from supine to supine position with crossed legs. Relevance to clinical practice. When assessing blood pressure it is important to take the position of the patient into consideration. Also, blood pressure measurement must be taken in sitting position with the arms supported at the right a trial level. [ABSTRACT FROM AUTHOR]

AIM AND OBJECTIVES: The aim of this study was to determine whether a disposable thermometer was at least as accurate as a tympanic thermometer when compared with a mercury-in-glass thermometer and to investigate the waiting periods of mercury-in-glass thermometers. BACKGROUND: Although different methods of temperature measurement have been widely studied and described during the last decade, comparison between readings obtained when measuring body temperature using disposable, mercury-in-glass and tympanic thermometers is little documented and there is confusion about the waiting periods of mercury-in-glass thermometers. METHODS: This research was descriptive and comparative. Temperature measurements included three sequential readings using first a tympanic thermometer in the left ear, then a disposable thermometer in the left axillary area and finally a mercury-in-glass thermometer in the right axillary area. All the temperatures were measured on the Celsius (degrees C) scale. To identify the stabilization periods of the mercury-in-glass thermometers, the temperature measurement was repeated until the reading stabilized. F-tests were used to compare readings of the mean temperatures. RESULTS: It was found that body temperature readings measured by tympanic thermometer were higher than axillary mercury-in-glass thermometer by 0.12 degrees C, body temperature readings measured by tympanic thermometer were higher than axillary disposable thermometer readings by 0.65 degrees C and body temperature readings measured by axillary mercury-in-glass thermometer were higher by 0.53 degrees C than readings measured by axillary disposable thermometer. It was found that readings measured by mercury-in-glass thermometer stabilized in the eighth minute. RELEVANCE TO CLINICAL PRACTICE: When assessing body temperature it is important to take the type of thermometer into consideration. In addition, axillary mercury-in-glass thermometers must be kept in place a minimum of eight minutes. [ABSTRACT FROM AUTHOR]

Prevention and treatment of hypothermia by active warming in perioperative period care is recommended but scientific evidence of its effectiveness in a clinical setting is scarce. The purpose of this study was to determine the effects of warmed intravenous fluids (WIVF) on the core body temperature and the patients' thermal comfort. Baseline data of 105 male patients undergoing TUR-P surgery and bladder irrigation were analyzed. The experimental group was warmed using active WIVF, and the control group's routine care was conducted using a cotton blanket. Body temperature was higher in patients in the experimental group than those in the control group. Repeated measures Manova revealed significantly different core temperature changes between groups ( F  = 34.446, p  = .001). The thermal comfort scores were also higher in the experimental group than in the control group ( x 2  = 203.552, p  = .001). The findings indicated that WIVF can enhance body temperature and improve the thermal comfort of patients.

Background: AIMS: The aim of this study was to examine the effects of the Valsalva maneuver during peripheral intravenous catheter (PIVC) insertion on procedure-related pain., Design: This work was a prospective randomized controlled study., Settings: Study was conducted in the orthopedics clinic of a university hospital., Participants/subjects: METHODS: The sample of patients (N = 110) was allocated to the Valsalva maneuver group (n = 55) and control group (n = 55) by using blocked randomization to reduce bias and achieve balance according to age and gender. Pain was evaluated by using Numerical Rating Scale. Systolic/diastolic blood pressure and heart rate before and after the PIVC placement was recorded., Results: The patients in the intervention group had less severe pain during the PIVC insertion than the patients in the control group (p ˂ .001). After PIVC placement, systolic blood pressure was significantly reduced in both groups (p = .008), no other variables changed significantly. No clinical complication related to the Valsalva maneuver occurred in the intervention group., Conclusion: Valsalva maneuver can be used as a non-pharmacologic method to reduce pain during PIVC placement., Competing Interests: Declaration of Competing Interest None, (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: PIVC is one of the essential procedures of modern medicine, and is one of the most widely used and important treatments in the clinical setting. Nevertheless, it is one of the most difficult skills to teach in nursing education, and it is the skill which causes the most anxiety in nursing students., Objectives: The aim of the study was to examine the effect of the teaching method using infrared technology on PIVC success, duration, and the level of psychomotor skills and knowledge in the acquisition of PIVC skills in nursing students., Methods: This was a pre-test post-test randomized experimental study with a control group. The research was conducted in the Skills and Simulation Laboratory of a Nursing Faculty of a university between December 2019 and February 2020 to examine the effects of teaching PIVC measurement via infrared light on students' success rate. A theory lesson on PIVC followed 15 days later by laboratory practical was carried out with all of the students included in the study. The PIVC Knowledge Evaluation Form as a pre-test. The researchers completed the PIVC Skills Performance Test from observation during the application of the checklist. Immediately after the procedure, the PIVC Knowledge Evaluation Form was applied as a post-test., Results: The procedure success rate of the experimental group was 90%, and that of the control group was 46%. Comparing PIVC skill scores between the groups, the difference was found to be statistically significant (Z = -2.741; p < 0.05). The groups' PIVC knowledge levels increased in a similar way., Conclusion: Teaching with infrared technology contributes more to students' success in PIVC skills than does standard teaching. Both methods were effective in developing knowledge of PIVC., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Patient positioning is an independent nursing intervention and may increase peripheral oxygenation for patients with lung disease. Few studies have been conducted on the effect of body positions on oxygenation in patients with lung disease., Aims and Objectives: To investigate the effects of five different positions on peripheral oxygen saturation (SpO 2 ) and vital signs in patients with lung disease., Design: A semi-experimental study was conducted., Methods: Consecutive samples were recorded from critical care patients followed in the chest clinic of a university hospital. A total of 109 patients with lung disease were recruited. Patients who were able to lie in all positions, and who had unilateral or bilateral lung disease documented by a medical diagnosis by a physician were included in this study. The SpO 2 and vital signs were measured at each position three times., Results: For patients with right, left, and bilateral lung disease, lying on the right side of the body at 45 in bed, the SpO 2 was higher, but this difference was not statistically significant. There was a significant difference at 40 minutes between the pulse rate in patients with left and bilateral lung disease, but not in patients with right lung disease. No significant differences were found between respiratory rates and body temperature in patients in any of the three groups at 10, 25, and 40 minutes., Conclusions: Although this difference was not statistically significant, lying on the right side of the body at 45 in bed can be an effective position for improving oxygenation in all patients with lung disease., Relevance to Clinical Practice: As there is insufficient evidence to suggest a specific position, further studies are needed. This study provides evidence that the best oxygenation in patients with unilateral and bilateral lung disease can be obtained by determining the appropriate position for critical care nurses., (© 2019 British Association of Critical Care Nurses.)

Purpose: This study aimed to determine the effect of cold vapor and ice cube absorption in the early postoperative period on sore throat and hoarseness induced by intubation., Design: This is a randomized controlled experimental study., Methods: Four groups (n = 30) were involved in the study: cold vapor application (group 1), ice cube absorption (group 2), ice cube absorption along with cold vapor application (group 3), and a control group (group 4). The sample consisted of 120 participants. The data were collected using the visual analog scale (VAS) and Stout's hoarseness scale postextubation (zeroth hour) and at the second, sixth, and 24th hours., Findings: After the interventions, the mean VAS scores for sore throat at the sixth postoperative hour were found to be 1.50 ± 1.71, 1.16 ± 1.08, and 1.30 ± 1.62 in group 1, group 2, and group 3, respectively. The mean VAS score for sore throat of group 4 was found to be 3.70 ± 1.89. The decrease in the VAS score for the sixth postoperative hour was ranked from highest to lowest as follows: ice cube absorption group, ice cube absorption along with cold vapor application group, and cold vapor application group. There was no significant difference between application groups in terms of mean VAS scores; however, it was found that mean VAS scores of all application groups were lower than that of control group, and there was a significant difference between them (P < .05). We found that at the sixth postoperative hour after intervention, 33.3% of group 1, 36.7% of group 2, 30% of group 3, and 46.7% of group 4 had hoarseness. No significant difference was found between groups, in terms of hoarseness scores of patients in the sixth postoperative hour after intervention (P > .05)., Conclusions: Cold vapor application, ice cube absorption, and ice cube absorption along with cold vapor application were effective in reducing sore throat but were ineffective as treatment for hoarseness., (Copyright © 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

Research related to the design and development of new incontinence containment products for women is scarce., Purpose: The purpose of this 2-part study was to 1) develop a new incontinence containment product for fecal incontinence and 2) examine the effect of this new product on the occurrence of incontinence-associated dermatitis (IAD)., Methods: In part 1, a new incontinence containment product was designed, developed, and trialed among 10 healthy female volunteers. The product was comprised of a double layer of polypropylene nonwoven fabric and 100% cotton interlock fabric with a 3-ply 100% cotton interlock fabric added into the perianal section. Participants wore the product for 8 hours and were asked to defecate into the product and evaluate its comfort, ability to contain liquids and protect privacy, any personal allergic reaction, and air permeability. In part 2, after any product modifications, 12 bedridden women treated in the neurology unit of a hospital in western Turkey who had an indwelling urinary catheter and fecal incontinence and who did not have diabetes mellitus, a darkly pigmented area in the perianal area, pressure injury, or erythema were randomized to 2 groups (study product and control, a premium adult diaper) and monitored for 8 days for the development and severity of perineal dermatitis (scored from 0 [no erythema] to 4 [broken, abraded skin]) using a skin assessment tool. Any type of erythema was considered IAD. Skin care (cleansing with a washcloth and water) was provided daily and after each defecation to all study participants. Data were collected via paper-and-pencil completion of the perineal skin integrity assessment and patient observation forms and entered into and analyzed by a computerized statistical program. Fisher's exact test and the chi-squared test were used to analyze the difference in IAD incidence and severity between the 2 groups, and the Mann Whitney U test was used to detect differences in the number and consistency of defecations., Results: No statistically significant differences were noted among the characteristics of the 12 participants (6 in each group) except for age; patients in the study product group were significantly older (70.66 ± 10.36 vs 52.20 ± 16.78 years; P <.05. Four (4) patients in the study group exhibited 13 areas of perineal dermatitis (degree 1 = 6 areas; degree 2 = 6 areas; degree 3 = 1 area; and degree 4 = 0); 1 patient in the control group had 4 areas with degree 1., Conclusion: This prototype product is not sufficient to be used in clinical practice in patients with fecal incontinence, but further study in a larger population is warranted..

Objectives: Nurse's self-concept is significant for professionalism. We aimed to determine the reliability and validity of the Turkish version of a Nurses' Self Concept Questionnaire., Methods: A methodological study was conducted with the participation of a group of nursing students and nurses. For the statistical analysis, structural equation models, convergent validity analyses, discriminate validity analyses, internal consistency analysis, and test-retest reliability analyses were used., Results: Correlation-coefficient for the test-retest reliability of the Turkish version of Nurses' Self-Concept Questionnaire was 0.87. The internal consistency of this questionnaire was calculated with Cronbach's α coefficient and it was found high across the six subscales from 0.83 to 0.91. The goodness of fit indices was determined as acceptable., Conclusions: According to results, this Nurses' Self-Concept Questionnaire is a valid and reliable instrument for assessing nurses' and nursing students' self-concept in Turkey.

Biofeedback has been shown to have some level of efficacy for the treatment of a number of chronic medical conditions; however, individualized biofeedback treatment is not always feasible. While group- based interventions are growing in practice due to numerous advantages, the dearth of research examining the efficacy of Group Biofeedback (GBF) suggests that this treatment modality may not be commonly utilized. Thus, the current paper highlights some advantages and constructively addresses potential challenges of utilizing GBF. Obstacles specific to GBF include equipment for participants, need for support staffing, and billing. However, the potential benefits are numerous, and pertain to cost-effectiveness, improved patient access, and additive benefits specific to group-based treatment. We offer a six-session GBF protocol to be used to guide future clinical work in this area. We hope that through the ideas and protocol presented in this paper, biofeedback practitioners will be more inclined to implement GBF.

The aim of this study was to investigate the effect of reflexology on pain intensity in patients with fibromyalgia, using an experimental repeated-measures design, and a convenience sample of 30 fibromyalgia inpatients. Thirty patients aged 18 to 70 years with fibromyalgia and hospitalized in the algology clinic were taken as a convenience sample. Patients received a total of 12 60-minute sessions of reflexology over a period of 6 consecutive weeks. Reflexology was carried out bilaterally on the hands and feet of patients at the reflex points relating to their pain at a suitable intensity and angle. Subjects had pain scores taken immediately before the intervention (0 minute), and at the 60th minute of the intervention. Data were collected over a 10-month period in 2012. The patients' mean pain intensity scores were reduced by reflexology, and this decrease improved progressively in the first and sixth weeks of the intervention, indicating a cumulative dose effect. The results of this study implied that the inclusion of reflexology in the routine care of patients with fibromyalgia could provide nurses with an effective practice for reducing pain intensity in these patients.

Purpose/aims: The aim of this study was to investigate the effects of the Z-track technique in the administration of intramuscular diclofenac, a nonsteroidal anti-inflammatory drug, on pain and drug leakage., Design: This is a semiexperimental and randomized controlled study., Methods: It was felt necessary to conduct this study to compare the effects on pain and drug leakage of the standard intramuscular injection method and the "Z-track technique," which is claimed to be helpful in this regard. The study was conducted in a government hospital in the Marmara region of Turkey. The research sample consisted of 60 patients, 26 female and 34 male, whose ages varied from 18 to 65 years. Sixty patients were randomly divided into 2 equal groups-the experimental group and the control group. The Z-track technique was used for intramuscular injection with the experimental group, whereas, with the control group, the standard technique of intramuscular injection was used. The patients of both groups were injected with 3-mL diclofenac sodium as prescribed by their doctor. Immediately after the procedure was finished and the needle was withdrawn, a different researcher used a 7 × 7-cm pre-prepared and sterilized standard drying paper to press on the needle entry point. The diameter of leakage was measured with a millimetric ruler and recorded on a data collection form. During this procedure, another nurse who was blind to the injection technique assessed the pain felt during the injection by means of the Visual Analog Scale., Results: In the experimental group, mean pain severity was found to be 28.30 ± 23.0, and mean drug leakage was 6.93 ± 4.62 mm, whereas, in the control group, these values were 36.40 ± 28.40 and 10.03 ± 3.69 mm, respectively., Conclusions: Drug leakage was reduced when administering intramuscular diclofenac sodium by the Z technique, but pain severity was not significantly reduced.

Aims and Objectives: The research was conducted to evaluate oxygen saturation values measured in healthy individuals in different body positions., Background: Changes in position affect ventilation-perfusion rates, oxygen transport and lung volume in normal lungs. There have been few studies and not enough information about which positioning of a healthy individual can increase oxygenation., Design: A descriptive study., Methods: A sample of 103 healthy individuals with no chronic disease, anaemia or pain was included in the research. Individuals were positioned in five different positions: sitting upright, supine position, prone position, lying on the left side and lying on the right side. Oxygen saturation and pulse rates were then measured and recorded after the individuals held each position for ten minutes., Results: It was found that the average oxygen saturation value when measured while sitting in an upright position in a chair was significantly higher than that measured when the individual was lying on the right or left side of the body. Oxygen saturation values measured in the five different body positions were significantly higher in women, in individuals below the age of 35, in those with Body Mass Indexes of below 25 kg/m(2), and in nonsmokers., Conclusion: All of the oxygen saturation values measured in the five different body positions were in the normal range. Although oxygen saturation values were within the normal range in the five different body positions, post hoc analysis showed that the best oxygenation was in the 'sitting upright' position while the lowest oxygenation was in the supine position., Relevance to Clinical Practice: Based on the results of this research, it can be concluded that the differences among oxygen saturation values according to the different body positions were statistically significant., (© 2016 John Wiley & Sons Ltd.)

There are few studies evaluating the effect of ShotBlocker on pain acquired from intramuscular injection, and these are mostly in children. We hypothesized that the use of ShotBlocker, while administering an intramuscular injection, would reduce the pain and anxiety due to intramuscular injection in adults. A randomized, placebo controlled trial was carried out for more than 20 months in 2010-2011 on 180 adults aged 18 to 80 years who received intramuscular injections of diclofenac sodium (75 mg/3 mL) at the outpatient clinic of a hospital. The patients were grouped into 3 groups: control, placebo control, and experimental. The experimental group was given an intramuscular injection of diclofenac sodium with ShotBlocker. Pain intensity was measured through a visual analog scale after the injection and anxiety was measured using Spielberger's State-Trait Anxiety Inventory. Pulse rate was counted and state and trait anxiety was measured before and after the injection. The Mann-Whitney U test and Wilcoxon and Kruskall-Wallis tests were used to evaluate the data. Patients in the ShotBlocker group had significantly lower pain intensity than those in the placebo and control groups. State anxiety level increased after the injection in the experimental group but did not change in the other 2 groups. ShotBlocker did not affect the pulse rate. Our results suggest that using ShotBlocker during intramuscular injection reduced patients' pain intensity because of injection but did not reduce anxiety levels. Thus, ShotBlocker is recommended as a pain-relieving tool during intramuscular injection in adults.

To investigate whether reflexology has an effect on the physiological signs of anxiety and level of sedation in patients receiving mechanically ventilated support, a single blinded, randomized controlled design with repeated measures was used in the intensive care unit of a university hospital in Turkey. Patients (n = 60) aged between 18 and 70 years and were hospitalized in the intensive care unit and receiving mechanically ventilated support. Participants were randomized to a control group or an intervention group. The latter received 30 minutes of reflexology therapy on their feet, hands, and ears for 5 days. Subjects had vital signs taken immediately before the intervention and at the 10th, 20th, and 30th minutes of the intervention. In the collection of the data, "American Association of Critical-Care Nurses Sedation Assessment Scale" was used. The reflexology therapy group had a significantly lower heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate than the control group. A statistically significant difference was found between the averages of the scores that the patients included in the experimental and control groups received from the agitation, anxiety, sleep, and patient-ventilator synchrony subscales of the American Association of Critical-Care Nurses Sedation Assessment Scale. Reflexology can serve as an effective method of decreasing the physiological signs of anxiety and the required level of sedation in patients receiving mechanically ventilated support. Nurses who have appropriate training and certification may include reflexology in routine care to reduce the physiological signs of anxiety of patients receiving mechanical ventilation.

Objectives: To determine the factors affecting a patient's intensive care experience., Methods: The descriptive study was conducted at an intensive care unit in the Aegean Region of Turkey, and comprised 158 patients who spent at least 48 hours at the unit between June and November 2009. A questionnaire form and the Intensive Care Experience Scale were used as data collection tools. SPSS 11.5 was used for statistical analysis of the data., Results: Of the total, 86 (54.4%) patients related to the surgical unit, while 72 (45.5%) spent time at the intensive care unit. Most of the subjects (n=113; 71.5%) reported that they constantly experienced pain during hospitalisation. Patients receiving mechanical ventilation support and patients reporting no pain had significantly higher scores on the intensive care experience scale. Patients who reported pain remembered their experiences less than those having no pain., Conclusions: Interventions are needed to make the experiences of patients in intensive care more positive.

Purpose: It is well known that intuition ability directly affects patient care quality and outcomes in nursing practice and is therefore an important aspect of nursing education. This study tests the validity and reliability of the Turkish version of the Scale of Use of Intuition by Nursing Students., Design: The sample for this methodological study was composed of 250 nursing students. Each item of the scale was translated into Turkish by the researchers and validated for Turkish use., Results: The item-total correlation was between .30 and .56 and its Cronbach α coefficient was .86. There was a statistically significant positive relationship between the level of clinical experience and the total points scored on the physical awareness, emotional awareness, and physical sensations subscales and from the total scale., Conclusions: Based on these results, the Turkish version of the Scale of Use of Intuition by Nursing Students is valid and reliable.

The aim of this study was to investigate intensive care unit (ICU) nurses' views and practices on oral care and to define the factors related to oral care measures. A study was carried out in eight ICUs of a teaching hospital in 2008. One hundred one nurses constituted the study sample. The data were collected using 'Oral Care Practices Survey' which included demographic characteristics (5 items) and current oral care practices (13 items). Oral care was given the highest priority by nearly 60% of the nurses. The most commonly used solution was sodium bicarbonate (79.2%), and the most frequently used equipment was foam swab (82.2%). Oral care was carried out less than every 4 h per day by 44.5% of the nurses. The oral care products and solutions were reported to be different in almost every unit. The relationship between the use of toothpaste and the place of employment was statistically significant (x(2) = 24.566, d.f. = 6, P = 0.000). There was a statistical significance between the clinics and frequency of oral care (x(2) = 81.486, d.f. = 42, P = 0.000). This study suggests that there is a wide variety of type and frequency of oral care measures among ICU nurses. Optimal oral care supported by evidence is an effective prevention method for eliminating oral complications., (© 2012 Blackwell Publishing Asia Pty Ltd.)

Aim: To test the reliability and validity of the Turkish version of the Stroke-Specific Quality of Life Scale (SS-QOL)., Background: Stroke is a leading cause of activity limitation and participation restriction that negatively affect health-related quality of life. The assessment of SS-QOL in stroke patients has not been validated in Turkey., Methods: Cross-sectional and methodological research design was used. Five hundred stroke survivors who had been diagnosed with stroke at least 6 months previously were included in this cross-sectional study. The reliability of the SS-QOL was based on internal consistency, item correlation. Construct validity was evaluated by Exploratory Factor Analysis. Cronbach's alpha coefficient was calculated for the total score of the SS-QOL to establish the internal consistency of the instrument. Construct validity was assessed by comparing patients' scores on the SS-QOL with those obtained by other test methods: SF-36 Health Survey and Katz Index of Activities of Daily Living., Findings: In the process of adaptation to the Turkish population, the scale was converted to 48 items. The correlation coefficient for the test-retest scores of the SS-QOL was calculated as 0.81. Internal consistency for the scale showed Cronbach's alpha = 0.97. As a result of applying factor analysis to the scale, eight factors were obtained, which accounted for 77.47% of the scale's total variance., Conclusion: SS-QOL is a reliable and valid instrument for measuring self-reported health-related quality of life at group level among people with stroke who are diagnosed with stroke at least 6 months previously in the Turkish population., (© 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.)

Aim and Objectives: To investigate the effect of a special gynaecological garment and music plus the special gynaecological garment on reducing the state anxiety related to gynaecological examination., Background: Gynaecological examination is one of the most common anxiety-producing medical procedures and causes embarrassment and discomfort. Few studies have focused on the effect of a gynaecological garment on anxiety associated with gynaecological examinations., Design: The patients were allocated to one of three groups, one control and two experimental. While the patients in the control group were subjected to the normal outpatient procedure, the patients in the first experimental group were dressed in a special gynaecological garment. In the control group, gynaecological examinations were performed with a traditional one-piece drape. In addition to wearing the special gynaecological garment, the women in the garment + music group listened to music during the gynaecological examination. The State Anxiety Inventory Form was applied to the patients in all three groups before and after gynaecological examination., Results: The state anxiety level after gynaecological examination in patients in the control group was found to be higher, but it was found to be lower in patients in both the first experimental group (garment) and the second experimental group (garment + music). The state anxiety level was found to be more reduced in the experimental groups than in the control group. The state anxiety level after gynaecological examination was found to be higher in single patients in the second experimental group., Conclusion: The special gynaecological garments are effective in reducing the state anxiety associated with gynaecological examination., Relevance to Clinical Practice: It should be taken into consideration that women perceived state anxiety during the gynaecological examinations. To allay anxiety associated with gynaecological examination in women, a special garment may be considered., (© 2011 Blackwell Publishing Ltd.)

There are limited studies on nursing diagnoses of the elderly living in nursing homes worldwide. This study aimed to define the most frequent nursing diagnoses in the elderly residents of a nursing home elder care and rehabilitation center. Seventy-four elderly individuals were included in the study. Data were collected using the "Elderly Individual's Introduction Form" between April 2007 to August 2007. The content of the form was based on a guide to gerontologic assessment, and Gordon's Functional Health Patterns. The nursing diagnoses (NANDA-I Taxonomy II) were identified by the 2 researchers separately according to the defining characteristics and the risk factors. The consistency between the nursing diagnoses defined by the 2 researchers was evaluated using Cohen's kappa (κ). There was an 84.7% agreement about nursing diagnoses defined by the 2 researchers separately. The weighted kappa consistency analyses showed there was an adequate level of consistency (κ = 0.710), and the findings were significant (p < 0.0001). The most frequent diagnoses were ineffective role performance (86.5%), ineffective health maintenance (81.2%), risk for falls (77%), and impaired physical mobility (73%). The diagnosis of ineffective role performance was more frequent in patients with dementia (x(2) =10.993, df = 1, p = 0.001). There was a very significant relationship between dementia and the diagnosis of impaired verbal communication (x(2) = 32.718, df = 1, p = 0.0001). The relationship between mobility disorder and self-care deficit was also significant (x(2) = 19.411, df = 1, p = 0.0001). To improve quality in patient care, nurses should use nursing diagnoses with a systematic assessment and should help the elderly in health promotion or use of the maximum current potential., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The aim of this study, which included 40 patients, was to compare the values pulse oximetry and the measurement times in various regions of the body. Data were analyzed using intraclass correlation coefficient test and paired-sample test. The confidence power value was found to be .81 for the comparison of oxygen saturation values by arterial blood gas analysis and measurement by the forehead probe. It was found that the time for oxygen saturation measurement using the forehead probe was shorter than those using the finger and toe probes., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the impact of lying on the ear on the measurement of body temperature by a tympanic thermometer., Methods: Participants in the study were healthy young people of the Nursing Department of the College of Health, Izmir, Turkey. Sixty-eight participants who agreed to participate, and who had no discharge or infection of the ear and no upper respiratory tract infection, were included in the study. Immediately after the first temperature reading, measurement had been performed five times. Non-probability sampling method was used and the study was conducted in January 2007., Results: Tympanic thermometer body temperature results were significantly higher (p < 0.05) when measurements were taken following lying on the ear compared to those when the subject did not lie on the ear prior to temperature measurement., Conclusions: There are significant differences in tympanic temperature caused by the subject lying on his or her ear. This is important to keep in mind during health workers' assessments.

This research was carried out to find out the nursing diagnoses in patients who have mechanical ventilation support in a respiratory intensive care unit. The study was conducted with 51 evaluations of critically ill adult patients who underwent invasive and non-invasive mechanical ventilation therapy in 2008. Data collection was based on Gordon's 11 Functional Health Patterns, and nursing diagnoses were determined according to North American Nursing Diagnosis Association-International (NANDA-I) Taxonomy II. The nursing diagnoses were determined by two researchers separately. The consistency between the nursing diagnoses defined by the two researchers was evaluated by using Cohen's kappa (κ). Forty men (78.4%) and 11 women (21.6%) whose mean ages were 70.19 (SD = 8.96) years were included in the study. Nineteen subgroups of nursing diagnoses about safety/protection domain, and 15 subgroups about activity/rest domain were seen at different rates in the patients. There was a statistically significant difference between mechanical ventilation via tracheostomy or endotracheal tube and decreased cardiac output (d.f. = 1, χ(2) = 4.760, P = 0.029). The relationship between the length of time under mechanical ventilation and impaired physical mobility was considerably significant (d.f. = 3, χ(2) = 24.459, P = 0.000). It was found out that there was a high degree of agreement (96.8%) between the nursing diagnoses defined by the two researchers separately (κ = 0.936, SE = 0.08)., (© 2011 Blackwell Publishing Asia Pty Ltd.)

Aims: The aim of this study was to investigate if relaxing music is an effective method of reducing the physiological signs of anxiety in patients receiving mechanical ventilatory support., Background: Few studies have focused on the effect of music on physiological signs of anxiety in patients receiving mechanical ventilatory support., Design: A study-case-control, experimental repeated measures design was used., Method: Sixty patients aged 18-70 years, receiving mechanical ventilatory support and hospitalised in the intensive care unit, were taken as a convenience sample. Participants were randomised to a control group or intervention group, who received 60 minutes of music therapy. Classical music was played to patients using media player (MP3) and headphones. Subjects had physiological signs taken immediately before the intervention and at the 30th, 60th and 90th minutes of the intervention. Physiological signs of anxiety assessed in this study were mean systolic and diastolic blood pressure, pulse rate, respiratory rate and oxygen saturation in blood measured by pulse oxymetry. Data were collected over eight months in 2006-2007., Results: The music group had significantly lower respiratory rates, and systolic and diastolic blood pressure, than the control group. This decrease improved progressively in the 30th, 60th and 90th minutes of the intervention, indicating a cumulative dose effect., Conclusion: Music can provide an effective method of reducing potentially harmful physiological responses arising from anxiety., Relevance to Clinical Practice: As indicated by the results of this study, music therapy can be supplied to allay anxiety in patients receiving mechanical ventilation. Nurses may include music therapy in the routine care of patients receiving mechanical ventilation., (© 2011 Blackwell Publishing Ltd.)

Objective: The aim of this study was to compare semiexperimentally the pulse oximetry values obtained from a finger on restrained or unrestrained sides of the body., Background: The pulse oximeter provides a noninvasive measurement of the oxygen saturation of hemoglobin in arterial blood. One of the procedures most frequently applied to patients in intensive care units is the application of physical restraint. Circulation problems are the most important complication in patients who are physically restrained. Evaluation of oxygen saturation from body parts in which circulation is impeded or has deteriorated can cause false results., Methods: The research sample consisted of 30 hospitalized patients who participated in the study voluntarily and who were concordant with the inclusion criteria of the study. Patient information and patient follow-up forms were used for data collection. Pulse oximetry values were measured simultaneously using OxiMax Nellcor finger sensors from fingers on the restrained and unrestrained sides of the body. Numeric and percentile distributions were used in evaluating the sociodemographic properties of patients., Results: A significant difference was found between the oxygen saturation values obtained from a finger of an arm that had been physically restrained and a finger of an arm that had not been physically restrained. The mean oxygen saturation value measured from a finger of an arm that had been physically restrained was found to be 93.40 (SD, 2.97), and the mean oxygen saturation value measured from a finger of an arm that had not been physically restrained was found to be 95.53 (SD, 2.38)., Conclusions: The results of this study indicate that nurses should use a finger of an arm that is not physically restrained when evaluating oxygen saturation values to evaluate them correctly.

Purpose: We compared the effects of 2 devices used to contain fecal incontinence--a perianal pouch and adult containment brief--on the incidence of incontinence-associated dermatitis (IAD)., Design: Randomized controlled trial., Subjects and Setting: The sample was drawn from patients hospitalized in the neurology and neurosurgery wards of a large university hospital in Turkey. Thirty bedridden subjects with fecal incontinence and indwelling urinary catheters participated in the study. Subjects were randomly allocated to treatment with a perianal pouch (n = 15) or adult containment brief (n = 15)., Methods: Routine hygiene was completed once daily and repeated whenever the perineal area was found to be soiled.Perineal skin integrity was evaluated daily during skin care. Data were collected using a Patient Identification Form, a Patient Observation Form, and a Perineal Skin Integrity Assessment Form., Results: The mean number of products used on a daily basis by patients with a perianal pouch was 5.80, as compared to 5.46 by patients with adult incontinence briefs. IAD occurred in 66.7%of patients in the perianal pouch group and in 100% of subjects managed by containment briefs, a statistically significant difference (χ² = 6.0, P = 0.04). The onset of IAD occurred later in subjects allocated to management with a perianal pouch than inpatients using adult containment briefs (U = 30.500, P = 0.011). IAD involved an average of 1.8 areas among patients managed with a perianal pouch, as compared to 2.3 areas in patients managed with adult containment briefs (P = NS)., Conclusion: Management of bedridden patients with fecal incontinence with a perianal pouch reduced the incidence of IAD and delayed to time to onset when compared to management with adult containment briefs. We recommend use of perianal pouches for prevention of IAD in bedridden patients with fecal incontinence.

The aim of this study was to investigate the effect of cold application on pain and anxiety during chest tube removal (CTR) in patients who had undergone cardiac surgery. A single-blinded randomized design was used in this study. Ninety patients aged 18-74 years, hospitalized in the intensive care unit (ICU), who had a chest tube for a duration of at least 24 hours were used for this convenience sample. The application of cold, placebo, or control therapies was randomized into three different groups. Sixty minutes before CTR was scheduled, an ICU nurse administered 10mg/kg paracetamol intravenously to all study subjects. Cold and warm packs covered with gauze dressing were applied to the area surrounding the chest tubes for 20 minutes. Pain intensity, pain quality and situational anxiety for CTR were measured. Variance analysis and the latent growth model were used in the analysis of the data. Patients in the cold group had significantly lower pain intensity than the placebo group. The perception of pain intensity measured by visual analog scores of patients in the cold group showed the least variation. There was no statistically significant difference in McGill Melzack Pain Questionnaire scores or in change of anxiety level between the three groups. The application of cold prolonged the length of time until analgesics were needed after CTR. Results showed that cold application reduced patients' intensity of pain due to CTR but did not affect anxiety levels or the type of pain. Cold application is recommended as a pain-relieving technique during CTR.

Biofeedback is a mind-body technique in which individuals learn how to modify their physiology for the purpose of improving physical, mental, emotional and spiritual health. Much like physical therapy, biofeedback training requires active participation on the part of patients and often regular practice between training sessions. Clinical biofeedback may be used to manage disease symptoms as well as to improve overall health and wellness through stress management training. Research has shown that biofeedback interventions are efficacious in treating a variety of medical conditions, and many Americans are turning to biofeedback and other less traditional therapies for their routine healthcare.Clinical biofeedback training is growing increasingly popular in the USA, as many people are seeking out relatively new approaches to healthcare. This article provides an overview of clinical biofeedback training, outlines two models of training, details research which has established how effective biofeedback is in patients with a given disease, and describes who should be referred for biofeedback training.

Aims and Objectives: This study was designed to determine the effectiveness of the auscultatory and pH methods in predicting feeding tube location in critically ill patients., Background: There is confusion about how nurses should asses feeding tubes location at the bedside. The most common method for determining tube location is the auscultatory method. It is known that auscultation is an unreliable method and additional data relating to bedside methods are needed to assist nurses in making a decision regarding tube location., Design: A methodological study., Methods: The sample consisted of 44 new insertions of feeding tubes. Data from a total of 44 auscultations relating to tube position and gastrointestinal aspirates for pH were obtained from 32 critically ill adult patients ranging in age from 38-87 years. Results from the auscultatory and pH tests were compared with the location of the tube as determined by radiography. A total of 44 feeding tube applications were investigated using the auscultatory and pH methods and concurrently with X-rays to determine the feeding tube position. Nurses used the auscultatory method to predict tube position, a concurrent researcher aspirated fluid from the feeding tube, and samples were tested for pH within five minutes of radiographs taken to determine tube location. pH was measured with a test strip., Results: Mean pH level in the gastrointestinal aspirates was 4.23 (SD 1.20). Approximately 89% of the pH strip readings from gastrointestinal fluid were between 0-5. A pH of <5 successfully identified 90.4% of the 44 feeding tube cases., Conclusion: The pH method is effective in determining the feeding tube position, but the auscultatory method is not effective in determining the feeding tube position., Relevance to Clinical Practice: Simple bedside assessment of gastrointestinal aspirate pH is useful for predicting feeding tube position.

Purpose: This study was planned as a descriptive study for the purpose of determining what nursing diagnoses are used by nursing students and their opinions about nursing diagnoses., Methods: The response rate was 70% (n= 346). Research data about the nursing diagnoses students used and their opinions about them were collected on a semi-structured questionnaire developed by the researchers after reviewing related information in the literature., Findings: Of the students, 76.9% knew what nursing diagnosis was, but 31.5% had difficulty stating patient care needs as nursing diagnoses., Conclusions: The majority of students in this study agreed that nursing diagnoses are a priority subject in the nursing profession, that nursing diagnoses needed to be used on the wards, and that nursing diagnoses needed to be documented in medical records on the wards., Implications for Nursing Practice: It is recommended that nursing diagnoses be given more concentration in the nursing curriculum and that courses about nursing diagnoses be prepared for the purpose of giving students more detailed information.

Objective: To evaluate the effects of pelvic floor muscle (PFM) training on urinary incontinence (UI) and quality of life in women diagnosed with stress or mixed UI., Design: We completed a parallel group, randomized clinical trial evaluating the effectiveness of PFM training in women with stress or mixed UI., Settings and Participants: We recruited consecutive cases of women with stress or mixed UI from outpatient urology clinics attached to a county hospital and a university hospital in Izmir, Turkey., Methods: After baseline evaluation, 41 women were randomly assigned to either the PFM training group or the control group. Muscle training included 3 sets of daily fast and slow contractions in lying, sitting, and standing positions. Participants were also taught the knack. The intervention period was 8 weeks, and the women in the exercise group telephoned once a week to provide motivation. The untreated control group had no contact during the intervention period. Outcome measures were Incontinence Quality of Life (I-QOL) Questionnaire, episodes of leakage in 3-day bladder diary, 1-hour pad test, and PFM strength., Results: Thirty-four women completed the trial. The mean age of women was 41.82 +/- 8.65 years in the exercise group and 44.64 +/- 6.90 years in the control group. The 2 groups were statistically similar regarding key demographic and clinical characteristics. After 8 weeks, significant differences in the 1-hour pad test, episodes of leakage in 3-day bladder diary, PFM strength, and I-QOL scores (P = .01) were noted when participants in the PFM training group were compared to control group participants., Conclusion: An 8-week trial of PFM training significantly increased PFM strength, improved quality of life, and reduced the frequency of UI episodes.