The tendency and affecting factors of nursing students' Xenophobia toward refugees from the perspective of ecological systems theory: A convergent parallel mixed method study.

AIM: This study aims to develop a comprehensive understanding of nursing students' xenophobic tendencies toward refugees and affecting factors from the perspective of Ecological Systems Theory. BACKGROUND: Nursing students' xenophobia toward refugees may negatively affect their care for patients. To effectively prevent xenophobia, it is essential to identify its underlying factors. DESIGN: A convergent parallel mixed method. METHODS: This study was conducted with third and fourth-grade nursing students at a university in Turkey. In the quantitative phase, online surveys were used, employing convenience sampling, with 227 participants. In the qualitative phase, purposive sampling was used and data were collected through in-depth interviews with 17 participants on the Zoom platform. Data were obtained using the Participant Information Form, Xenophobia Scale and Semi-Structured Interview Form. RESULTS: Nursing students who are male, in their third year, have low economic status, lack immigrant friends, lack immigrants in the family members, receive information about immigrants from social media and live in regions with a high concentration of immigrants have higher levels of xenophobia (p<0.05). In the qualitative phase, our study results showed that negative experiences with refugees, economic and social worries, perception of security threats, cultural conflicts and negative media messages toward refugees can lead to xenophobia. In addition, students stated that lessons about immigrants and caring for them in clinics can improve their ability to empathize with immigrants. CONCLUSION: Nursing curriculums should cover immigrant care and interaction to combat xenophobia, which can improve empathy skills and raise awareness.

The relationship between moral distress, individual and professional values in oncology nurses: A structural equation study.

OBJECTIVES: This study examined the relationship between moral distress, individual and professional values in oncology nurses. METHODS: Employing structural equation modeling, a descriptive-correlational study was conducted among 116 oncology nurses. Data were collected using the Moral Distress Scale-Revised Adult Nurses, the Nursing Professional Values Scale, and the Values Scale. RESULTS: The mean moral distress frequency was evaluated as low (1.6 ± 0.7) and the intensity as moderate (1.9 ± 0.8). Both the Nursing Professional Values Scale and Values Scale subdimension mean scores were at levels evaluated as high. There was no specific value that stood out from the others. Structural equation modeling analysis showed that individual values were found to have a direct and negative significant effect on moral distress intensity (ß = -0.70, p < 0.01) and frequency (ß = -0.58, p <0.01) and professional values had a direct positive and significant effect on moral distress intensity (ß = 0.37, p < 0.05) and frequency (ß = 0.25, p < 0.05). SIGNIFICANCE OF RESULTS: It is believed that more national and international studies need to be conducted to examine the relationship between the moral distress concept and values. While individual values were found to have a direct and negative significant effect on moral distress, professional values had a direct positive and significant effect on moral distress.

'It is not a mannequin disease': A lived experience narrative of living with bulimia nervosa.

WHAT IS KNOWN ON THE SUBJECT?: Bulimia nervosa is characterized by recurrent episodes of binge eating, inappropriate compensatory behaviours to prevent weight gain and excessive mental preoccupation with body weight and shape. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: In this paper, the feelings, thoughts and experiences of an individual with bulimia nervosa are explained, and the positive and negative effects of their experiences during the treatment process are emphasized. This paper offers advice to patients, relatives and healthcare professionals in recognizing and treating bulimia nervosa. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should organize training, seminars and conferences to raise awareness of society against bulimia nervosa, which is defined as a mannequin disease and therefore creates a positive perception. Mental health nurses, an essential part of the health system, should raise awareness of individuals and families about recognizing, monitoring and supporting the early symptoms of bulimia nervosa. ABSTRACT: INTRODUCTION: Bulimia nervosa is one of the areas where mental health professionals have difficulties due to its nature and course. It is important to understand the factors related to this problem in-depth to discover the dynamics unique to the individual that causes the difficulty, identify new perspectives on these dynamics and identify alternative behaviours, stop stubborn binge-eating attacks and prevent relapse. AIM: It is aimed to provide an in-depth insight into the nature, course and treatment processes of bulimia nervosa through the narrative of the lived experience of an individual living with this problem. IMPLICATION FOR PRACTICE: The perception of beauty seriously impacts the onset and later course of bulimia nervosa and draws attention to the fact that mental health professionals and media workers have important duties to change the concept of beauty equals being skinny, created in society and the media. Quality of perceived social support is very important in preventing, treating and rehabilitating bulimia nervosa. Adopting a more objective approach, which will prevent the positive or negative stigmatization of the disease in explaining bulimia nervosa to the public, should be adopted.

First death experiences of newly graduated nurses: A qualitative phenomenological study.

Newly graduated nurses typically face death for the first time during the transition to their professional careers. This encounter can cause nurses to experience compelling emotions and make it difficult for them to manage and cope with the process of adaptation to the profession and the death process of the patient. This study aims to retrospectively examine and reveal the first death experiences of newly graduated nurses (N = 15) using a retrospective phenomenological method. Analysis of the responses of the newly graduated nurses revealed three themes: first encounter with death, nothing is like before, and support need. Newly graduated nurses realized that their first death experiences change their perspectives on life and profession and that nursing touches human life.

Moral distress and moral sensitivity in clinical nurses.

Health care providers are expected to have a certain moral sensitivity (MS) to make an ethical assessment. Moral distress (MD) is a common phenomenon in nursing. It can negatively affect nurses physically, psychologically, socially, and spiritually. This study aimed to investigate the relationship between MD and MS among nurses using a cross-sectional descriptive design. The study was conducted in two stages. The first stage was a methodological study that analyzed validity and reliability of the Measure of MD-Healthcare Professionals. The second stage was a descriptive- predictive analysis that investigated the relationship between MD and MS. The MD intensity and frequency scores of the participants were high and moderately high, respectively. There was no direct effect on the total score and frequency of MS and MD. However, a direct and significant negative effect of MS was seen on the intensity of MD. Based on the results of this study, MS should be considered as a measure in studies aimed at understanding MD among clinical nurses. Empowerment programs should be established to increase the awareness of health workers about ethical and moral situations and to support them to cope with the problems they experience in these areas.

"Working in the emergency department is not a job; it's like a war" A narrative inquiry and interpretive phenomenology of the violence experienced by emergency nurses in Turkey.

AIMS: This study aims to reveal the violent experiences of nurses working in the emergency department and the meanings they attribute to them. METHODS: This research was conducted as narrative inquiry and interpretive phenomenology and recruited 15 nurses. Interviews with nurses actively working in the emergency department and who had been exposed to violence by patients or their relatives were conducted with a semi-structured interview form. The consolidated criteria for reporting qualitative research (COREQ) checklist was used. RESULTS: In the study, three themes were determined (1) Unpredictable event, (2) Interminable effects of violence, and (3) Like a bottomless pit. With seven sub-themes. CONCLUSIONS: This study underlined that violence applied to nurses by patients or relatives of patients in the emergency department is an unexpected situation that causes negative emotions. Violence affects all aspects of life and limits communication with the patient. Coping with a violent situation is challenging for nurses, and they demand support from the management.

A structural equation modeling analysis of the effects of nurses' spirituality and spiritual care on professional quality of life.

Spiritual care helps nurses establish a deeper connection with patients and meet their spiritual needs. Spiritual belief is thought to enable nurses to be more effective in their profession and positively affect their quality of life. This study aimed to investigate the effects of nurses' spirituality and spiritual care on quality of life. This study was designed as a descriptive cross-sectional study using structural equation modeling. A total of 221 nurses were included. Data were collected using the Professional Quality of Life Scale, and Spirituality and Spiritual Care Scale. The data were analyzed using descriptive statistics, correlational statistics, and structural equation modeling. Spirituality and spiritual care were negative predictors of burnout and positive predictors of compassion satisfaction. Spirituality and spiritual care decreased the level of burnout in nurses and significantly increased the level of compassion satisfaction. This study suggests raising nurse awareness of spirituality and spiritual care. Supporting nurses with professional training programs, including spiritual care, may benefit their quality of life.

Turkish Adaptation of the Moral Distress Scale-Revised for Pediatric Nurses: A Validity and Reliability Study.

Background and Purpose: Recent studies have demonstrated the adverse effects that moral distress experienced by nurses has on nurses, patients, and the healthcare system. This study aims to analyze the validity and reliability of the Turkish version of the Moral Distress Scale-Revised (MDS-R, pediatric). Methods: This study was conducted with 210 pediatric nurses. Results: Explanatory factor analysis was conducted, and a five-factor structure emerged. The Cronbach's α value of the scale was found to be 0.865, and the correlation-based item analysis showed that the values were within the acceptable range, and the discrimination of the items was adequate. Conclusions: Analyses conducted revealed that the Turkish version of the MDS-R (pediatric), consisting of 21 items and five subdimensions, is a valid and reliable measurement tool for the Turkish culture and language.

Examining the effect of moral resilience on moral distress.

AIMS: The study aims to test the Turkish validity and reliability of the Rushton Moral Resilience Scale (RMRS) and examine the effect of moral resilience on moral distress. BACKGROUND: Moral distress is a phenomenon that negatively affects health workers, health institutions, and the person receiving care. In order to eliminate or minimize the negative effects of moral distress, it is necessary to increase the moral resilience of nurses. Moral resilience involves developing systems that support a culture of ethical practice in healthcare and aim to increase an individual's capacity to cope with moral challenges. METHODS: A methodological and descriptive-predictive study design was adopted. Sociodemographic Information Form, Measure of Moral Distress - Healthcare Professionals (MMD-HP), and Rushton Moral Resilience Scale were used to collect data from the nurses. A total of 255 clinical nurses were recruited. ETHICAL CONSIDERATIONS: Hacettepe University's non-interventional ethics committee approved the study's protocol and informed consent was obtained from the participants. RESULTS: The original four-factor structure of the scale was tested with confirmatory factor analysis, and the index values were evaluated and found at an acceptable level. The Cronbach Alpha coefficient of the scale was found to be 0.826. Moral resilience predicted moral distress total, intensity, and frequency levels. A moderate and weak relationship was found in the negative between all sub-dimensions of moral distress and moral resilience. CONCLUSIONS: The Rushton Moral Resilience Scale Turkish version showed good psychometric properties. Moral resilience has a reducing effect on moral distress. Young nurses who have less experience are at risk because they have lower moral resilience levels, while nurses working in intensive care units are at risk because of their high moral distress levels. A healthy workplace can be created by developing specific approaches to improve moral resilience in reducing the impact of moral distress in the healthcare environment.

The experience of moral distress by chief nurse officers during the COVID-19 pandemic: A descriptive phenomenological study.

AIM: The aim of this study is to explore the moral distress experiences of nurse officers during the COVID-19 pandemic. BACKGROUND: Moral distress has emerged as a challenge for nurses ad nurse leaders, revealing the need for health professionals and health care managers to examine, understand and deal with moral distress un Nurse leaders. METHODS: It is a descriptive phenomenological study that used content analysis. RESULTS: Thirteen chief/assistant nurse officers were interviewed, and four themes were identified: being a manager in the pandemic, situations that cause moral distress, effects of moral distress and factors that reduce moral distress. CONCLUSION: Faced with various expectations, such as the management of unusual and uncertain processes, and the management of the psychological responses of both employees and themselves, chief nurse officers struggled significantly to maintain their moral integrity and experienced moral distress during the COVID-19 pandemic. IMPLICATIONS FOR NURSING MANAGEMENT: Extraordinary situations such as pandemics have factors that led to moral distress for a Chief Nursing Officer (CNO). Health care systems in which nurse managers are excluded from decision-making processes have a traditional hierarchical structure that ignores CNOs professional autonomy, contributing to the development of moral distress. Therefore, CNOs should engage in self-reflection to recognize their own moral distress experiences, examine the existing health system to identify the factors that cause moral distress and take actions to implement changes to eliminate these factors. To cope with moral distress, CNOs should also improve their communication skills, team collaboration skills and the use of scientific knowledge and take responsibility in their managerial role.

Culturally-sensitive moral distress experiences of intensive care nurses: A scoping review.

BACKGROUND: Moral distress is a phenomenon that all nurses experience at different levels and contexts. The level of moral distress can be affected by individual values and the local culture. The sources of the values shape the level of moral distress experienced and the nurses' decisions. AIM: The present scoping review was conducted to examine the situations that cause moral distress in ICU nurses in different countries. RESULTS: A scoping review methodology was adopted for the study, in line with the approach of Arksey, and O'Malley Literature was searched within PubMed/Medline, Scopus, Web of Science, and PsycINFO indexed keywords such as "moral distress", "Critical Care Nurse", and "Moral Distress Scale-Revised". Of the 617 identified citations, 12 articles matched the inclusion criteria. CONCLUSION: The moral distress experienced in countries and regions with similar cultures and geographies was parallel. The situations that cause the most moral distress are futile-care to prolong death, unnecessary tests and treatments, and working with incompetent healthcare personnel.

Experience and views of nurses on nursing services and personal protective equipment in Covid-19 pandemic the case of Turkey: A cross-sectional study.

BACKGROUND: During the COVID-19 pandemic, there were difficulties in planning the nursing workforce and personal protective equipment. AIM: The purpose of this study was to identify the experiences and views of nurses on personal protective equipment use and nursing workforce planning in Turkey. METHODS: This descriptive and cross-sectional study was conducted between 23 December 2020 and 3 May 2021, among 362 nurses who agreed to participate in this study voluntarily. RESULTS: The findings showed that the satisfaction scores were significantly higher for those nurses who worked in 8-h shifts, were not assigned to different clinics, were notified by an official letter and 1 week or month in advance before assignment compared with nurses in other categories. CONCLUSIONS: The problems that have arisen in the COVID-19 pandemic process have made it clear that there is a need for a nursing services management model in the event of an epidemic. IMPLICATIONS FOR NURSING MANAGEMENT: This study reveals the need for the 'Nursing Services Management Model in the Event of an Epidemic' by discussing the problems of nurse workforce planning and protective personal equipment management from the perspective of nurses who experienced these problems at first hand.

"For Years I lived in a Cage. Now the Cage Is Open and I Am Just Learning to Fly." Perspectives of Cancer Survivors on Psychological Resilience.

BACKGROUND: Transitioning from treatment to survivorship engenders several challenges that cancer survivors must learn to manage. These challenges are commonly associated with struggling to manage reentry into postcancer life. Thus, balance is restored after cancer, and postcancer experiences should be considered along with all previous life experiences. This balancing process surrounding cancer causes some cancer survivors' life to deteriorate, whereas other cancer survivors begin a psychological resilience process. OBJECTIVE: The aim of this study was to investigate the way that psychological resilience is experienced by cancer survivors. METHODS: The present descriptive qualitative design study was conducted from August 2019 through January 2020. A total of 12 cancer survivors were sampled from the follow-up clinics of a hospital. Data were collected through semistructured, pilot-tested, face-to-face interviews using an interview guide. RESULTS: Three main themes were clarified based on the descriptive analysis of the data on cancer survivors' experiences: "fight vs lose," "balancing uncertainties," and "learned to fly." The results demonstrate the importance and influence of psychological resilience in the overall cancer experience. CONCLUSION: This study provides insight into the subjective psychological resilience process of cancer survivors. Nurses may use this knowledge in fostering effective strategies enabling cancer survivors to develop psychological resilience. IMPLICATIONS FOR PRACTICE: The results offer a promising resource for nurses to assess and address the risk and protective factors of cancer survivors to identify unique needs and to provide individualized care. In this context, nurses can develop novel approaches and interventions for cancer survivors in accordance with Kumpfer's resilience framework.

'Young saplings on fire' newly graduated nurses in the COVID-19 pandemic: A qualitative study.

AIM: To explore the experiences of newly graduated nurses during the pandemic. BACKGROUND: Newly graduated nurses were employed during the pandemic by several countries to meet the increasing demand for healthcare services. METHODS: A descriptive qualitative study with thematic analysis. The study was conducted with 14 newly graduated nurses. RESULTS: Themes were systematized into four variables of the system research organization model, and a total of 12 themes were identified. Nurses, who started to work in the beginning months of the pandemic, faced several difficulties in their transition period, including the difficulties of starting employment and the effects of the pandemic on both society and health systems. CONCLUSIONS: During the pandemic, newly graduated nurses faced various difficulties in transition processes, difficulties in starting the employment process and the effects of the pandemic on both society and health systems. In order to reduce these effects, regulations are needed at all stages of the health system. IMPLICATIONS FOR NURSING MANAGEMENT: It is the responsibility of health system policymakers, hospital managers, nurse managers and senior nurses to ensure that newly graduated nurses endure these pandemic conditions, which are quite challenging even for senior nurses, without any damage, and continue in the profession.

Moral distress in oncology nurses: A qualitative study.

PURPOSE: Oncology nursing is a special field of practice containing many factors that cause moral distress. The purpose of this study was to explore the sources of moral distress in oncology nurses. METHODS: This qualitative phenomenological study was conducted with 14 oncology nurses. The mean interview duration was 30 min. Data were analyzed using qualitative inductive content analysis according to the methods of Corbin and Strauss. RESULTS: Four main themes were identified in the study. The first theme, related to the failure of quality of care, includes the failure to provide holistic care and competence problems (not feeling competent in oncology practice). The second theme includes biomedical ethical issues commonly observed in the field of oncology. The third theme includes treatment and care practices, consisting of futile treatments, lack of regulation for 'do not resuscitate' orders and decisions to limit life-prolonging treatment, limited informational authority of nurses, and problems related to educational practices on the patient. The final theme includes problems arising from the health care system and institution's management and the need for regulation to support ethical decisions. CONCLUSION: Oncology nurses face ethical problems in providing the quality and continuity of care they desire. It is difficult to manage the problems, especially in the end-of-life period. In order to reduce and eliminate these difficulties, it is recommended to make administrative, institutional, legislative, and systemic arrangements.