Standardizing Handoff Communication: Content Analysis of 27 Handoff Mnemonics.

This study synthesizes information contained in 27 mnemonics to identify what information should be communicated during a handoff. Clustering and content analysis resulted in 12 primary information clusters that should be communicated. Given the large amount of information identified, it would be beneficial to use a structured handoff communication tool developed using a participatory approach. In addition, we recommend local standardization of information communicated during handoffs with variation across settings.

Turkish critical care nurses' views on end-of-life decision making and practices.

BACKGROUND: Life-sustaining treatments are increasingly used in intensive care units (ICUs) for EOL care, but the decision to use these may cause ethical issues. AIMS AND OBJECTIVES: The aim of this study was to investigate the views and practices of critical care nurses in Turkey on the end-of-life (EOL) care. DESIGN: This was a cross-sectional study. METHODS: The research was conducted in 32 second- and third-level ICUs of 19 Ministry of Health research hospitals in Turkey. The Views of European Nurses in Intensive Care on EOL Care tool was used for data collection. RESULTS: The total sample size was 602. While half of the nurses stated that the withholding and withdrawal of life support were ethically different decisions, 40% felt both decisions were unethical. The expected quality of life as viewed by the patient, the medical team, the family and the nursing team (90·4%, 85·4%, and 83·4%, respectively) was an important factor in EOL decision making. The majority of the nurses (75·7%) were not directly involved in the EOL decision making and 78·4% of nurses were committed to family involvement in EOL decisions. When withdrawing treatment, 87·2% of ICU nurses agreed that the patient and family members should perform their final religious and spiritual duties. Further results showed that after withdrawing treatment, a majority of nurses (86%) agreed to continue pressure sore prevention, effective pain relief (85·5%), nutritional support (77·6%) and hydration (64·8%). Almost half (48·2%) indicated that keeping the patients in the ICU was unnecessary. CONCLUSION: ICU nurses expressed a range of experiences and practices regarding EOL care. ICU nurses should be more involved in the decision-making process about EOL care. RELEVANCE TO CLINICAL PRACTICE: Due to their unique relationship with patients, nurses should be involved in EOL care decision making; however, patients, families or nurses are not often involved in the decision-making process in Turkey.

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

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

Knowledge of cardiovascular disease in Turkish undergraduate nursing students.

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

The development of patient safety in Turkey: constraints and limitations.

Patient safety is a complex multifaceted issue linked with quality management. Evidence reveals that nurses are pivotal to the success of quality management and patient safety initiatives. There are many studies about patient safety in developed countries, but less is known about nursing care and patient safety in developing or mid-level economies such as Turkey. The aim of this paper is to discuss the quality management and patient safety developments in the Turkish healthcare sector.

Patients' experience of pain after cardiac surgery.

Pain after Cardiac Surgery (CS) is the most common patient complaint. However the first 48 h after surgery, when patients' pain is the most severe, is generally spent in the Intensive Care Unit (ICU). It is almost impossible for patients to report their pain because of their inadequate level of consciousness in the ICU. Many factors alter verbal communication with patients, such as administration of sedative medications, mechanical ventilation, and patients' changed level of consciousness. This descriptive study was conducted for the purpose of describing the experience of pain in CS patients in the ICU and determining situations that affect their pain. This research was conducted with 300 adult patients at a Ministry of Health Hospital who stayed in a cardiac surgery ICU post-operatively for a minimum of 48 h, had a sternal incision, chest tube, and required mechanical ventilation. The data were collected from the patients in face-to-face interviews by the researchers following transfer from the ICU to the surgical ward within 48 h of transfer. Most patients described their pain as aching (n = 177) and throbbing (n = 154). The presence of chest tubes (n = 95), endotracheal tube suctioning (n = 47), change of dressings (n = 27) and the use of air mattresses (n = 20) were also identified as painful experiences for patients. Based on these results it can be said that CS patients experience pain in the ICU, however they verbalized it with different words and identified different situations that decreased or increased their pain, which shows the subjective and complex nature of pain.

Critical care nurses' perceptions of patient safety in Turkey.

This study explored 150 critical care nurses' perceptions of patient safety standards in a selection of private, public, and university hospitals in Turkey. Quality management and patient safety programs were more prevalent in private hospitals. Private hospitals were also more likely to encourage reporting, have error/adverse event reporting systems, and less likely to have a punitive response to reported errors. However, respondents who work in private hospitals work both more hours per week and more hours per day.

Gender equality or patriarchal dividend: Structural change in Turkish nursing.

Turkey is attempting to join the European Union and is facing pressure to eliminate many forms of discrimination, including discrimination based on gender. In keeping with these aims, in early 2007 the Turkish government changed the law to permit Turkish men to become nurses. Given that Turkey is a highly patriarchal society and that occupational segregation by sex is a persistent feature, it is important to examine the potential outcome of the legislative changes. The aim of this paper is to explore the paradoxical potential for Turkish female nurses to experience increased discrimination in a system that is restructured by legislation to be non-discriminatory.

Exploring nursing education in the People's Republic of China, Japan and Turkey.

The global nursing shortage has caused competition and cooperation between countries desperate for registered nurses (RNs), and has led to an increase in migration and international recruitment of nurses. Some nursing diplomas or degrees earned in one country may not be transferable to another. As a result, there is growing interest in common standards and competencies of entry-level nurses to guide future registered nurse agreements between countries or multi-country licensure programs. An exploratory study was conducted to investigate how entry-level nurses are educated throughout the world. The researchers sent a nursing education questionnaire to nurse educators in eleven countries inviting them to participate in the study. Nurse educators from The People's Republic of China, Japan and Turkey were the first to agree to participate in the study. They responded to questions about their country's nursing history, types of nursing programs, use of national nursing licensing examination, and social and political influences on nursing education. The nurse researchers did an analysis and comparison of the nursing education in each country.

[Reality about pain control: the knowledge and beliefs of nurses on the nature, assessment and management of pain]. / Agri kontrol gerçegi: Hemsirelerin agrinin dogasi, degerlendirilmesi ve geçirilmesine iliskin bilgi ve inançlari.

The present research was conducted descriptively to define the approaches of nurses to the nature of pain, its assessment, and management. The research was carried out in October 2001 in Antalya with a scope of 227 nurses attending to the Second National Clinician Nurses' Congress. Initial aim was to include all 286 nurses attending the congress, however, because 59 nurses refused to participate, the number of the participants finalized as 227. A data gathering form of 20 questions was used. Results were presented in percentages. At the end of the research, though the knowledge the nurses had on the nature of pain was satisfactory, their attitudes related with pain assessment and management were noted to be below expectations. These results point out a void in the nurses' knowledge pertaining to pain management. As a result, we consider imperative that the nurses should acknowledge the significance of pain and should improve their professional attitudes and knowledge in order to gain control over pain through a multidisciplinary approach and to prove the crucial and inevitable role of nurses in such a team.

How do intensive care nurses assess patients' pain?

Identification and evaluation of pain in critical care patients may be difficult because of communication problems. Moreover, at present there are very few nursing studies that examine the attitudes of critical care nurses towards the assessment of patients' pain. This study was designed to determine the approach of critical care nurses towards assessing patients' pain levels, and to evaluate the problems in nursing diagnosis of those having difficulty in articulating their pain symptoms. We used a questionnaire to assess nurses attitudes to patients' pain. The study sample consisted of 91 critical care nurses who were recruited between January and February 2002. The results suggest that patient pain was considered undesirable by 44% of nurses. About 70-3% of the nurses reported resorting to administering analgesics to relieve their patients' pain. Some 57.1 % of nurses stated that they would have investigated whether the patients had really been experiencing pain, prior to administering the prescribed analgesics to patients. Some 85.7% of the sample indicated that the patients themselves would make the most accurate evaluation of their pain. The data suggested that 39.6% of nurses did not know how to evaluate pain symptoms in critical care patients suffering from complicated problems, and that 37.4% evaluated pain by monitoring the patients' behaviours. The study demonstrated that most of the critical care nurses did not know how to evaluate pain in patients having communication problems. The paper concludes by suggesting that there is a clear need to address nursing education and training with regard to evaluation and management of patients' pain whilst in critical care environment.