Physical Restraint Experiences of Family Caregivers of Patients With Stroke in Turkey: A Qualitative Study.

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.

The effects of an ethics laboratory program on moral sensitivity and professional values in nursing students: A randomized controlled study.

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.

Missed nursing care and its relationship with perceived ethical leadership.

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.

Nurses' knowledge and attitudes regarding physical restraint in Turkish intensive care units.

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.

The effect of physical restraint on neurovascular complications in intensive care units.

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.

The effect of nurses' ethical leadership and ethical climate perceptions on job satisfaction.

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 Izmir, 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.