Comparison of the Predictive Validity of Norton and Braden Scales in Determining the Risk of Pressure Injury in Elderly Patients.

AIM: To compare the reliability and predictive validity of Norton and Braden scales in determining the risk of pressure injury in elderly patients. DESIGN: This research used a comparative design. One hundred thirty elderly patients participated in the study. METHODS: The daily pressure injury risk of participants was evaluated by a researcher using both the Norton and Braden scales in a consecutive manner. RESULTS: The mean age of patients was 75.1 ± 8.5 years, and that for those without and with pressure injury development was 75.0 ± 8.3 years and 76.1 ± 9.7 years (P < .001), respectively. The reliability coefficients of the Norton and Braden scales were .82 and .89, respectively. The sensitivity, specificity, and positive and negative predictive values of the Norton Scale were 100%, 40.7%, 20.2%, and 100%, and those of the Braden Scale were 100%, 32.7%, 18.3%, and 100%, respectively. CONCLUSIONS: The reliability of both scales for elderly patients was found to be high, and their ability to differentiate patients at risk was comparable. However, both scales had low specificity. Further research is needed to develop scales that have higher predictive validity for the elderly population, taking into account other risk factors that influence total scale scores.

Sleep Quality and Factors Affecting Sleep in Individuals With an Intestinal Ostomy: A Descriptive Cross-Sectional Study.

BACKGROUND: Multiple factors affect the sleep quality of individuals with intestinal stomas. PURPOSE: This study sought to determine sleep quality and factors affecting sleep in individuals with intestinal ostomies. METHODS: A descriptive cross-sectional design was used. This study followed 68 individuals with intestinal stomas at the stoma therapy unit of a university hospital. A form was used to gather information about patient demographic and stoma-related data (age, sex, work status, stoma duration, cause and type of stoma, stoma care provider, sleep status during the day, daily coffee consumption, and stoma-related factors affecting sleep), and the Pittsburgh Sleep Quality Index was used to score patient sleep patterns. Descriptive statistics, t-test, chi-square test, Fisher's exact test, and logistic regression analysis were used for statistical analysis. RESULTS: The patients' mean age was 53.7 ± 13.8 years; 51.5% were male, and 66.2% were married. Of the 68 patients, 41.2% had a diagnosis of rectal cancer, and 55.9% had ileostomies. Mean stoma duration was 24.1 ± 5.8 months, and 57.4% of participants performed their own stoma care. On a scale of 0 to 21, the participants' mean sleep score was 9.08 ± 5.03, and 66.2% of patients were found to have poor sleep quality. High sleep quality was significantly positively associated with colostomy (odds ratio, 1.78; 95% confidence interval [CI], 1.18-2.69; P = .006) and self-performed stoma care (odds ratio, 1.54; 95% confidence interval, 1.03-2.30; P = .036). CONCLUSION: The results of the current study can provide reference data for future studies and highlight the importance of assessing sleep quality in persons with intestinal stomas.

Assessment of the Effectiveness of Patient Education and Interviews in Improving Medication Adherence of Renal Transplant Recipients.

Background Non-compliance with immunosuppressive drugs has been reported as the most significant cause of graft loss. Since non-compliance with immunosuppressive drugs is preventable, certain approaches based on the risk factors and causes of non-compliance can help eliminate this problem. Aims The purpose of this study is to assess the effectiveness of patient education and interviews in improving medication adherence of renal-transplant recipients. Materials and methods This study was designed as a randomized controlled trial. Using the G*Power program, the sample size was calculated as 60 subjects, with 30 in both the intervention group and control group. Data collection tools included a patient information form, a pretest-posttest, a drug monitoring form for kidney transplant patients, the Immunosuppressive Therapy Adherence Scale, measurement of tacrolimus blood levels, and a training booklet.  Results The mean knowledge score in the intervention group was 12.17±3.39 at baseline, and it increased to 20.73±1.57 after the intervention. The mean scores on the Immunosuppressant Therapy Adherence Scale were 11.67±0.55 and 10.70±0.99 in the intervention group and control group, respectively. There was a statistically significant difference between the pre-test and post-test means on the Immunosuppressant Therapy Adherence Scale in the intervention group. The mean Immunosuppressant Therapy Adherence Scale score was higher in the intervention group. In the measurement of tacrolimus blood levels, medication adherence was found the be higher in the intervention group. The difference between the groups was statistically significant. There was a positive correlation between the tacrolimus blood levels and the Immunosuppressant Therapy Adherence Scale scores in both groups. Conclusions To conclude, our results have demonstrated that patient education and interviews improve immunosuppressant medication adherence in renal transplant recipients. Using direct or indirect methods proved similar outcomes, suggesting that both evaluation methods are safe.

The Effect on Pain and Anxiety of Hot Pad Applied to Patients During Transrectal Prostate Biopsy.

AIM: The aim of the study was to evaluate the effect of the application of a heating pad on the sacral region on pain and anxiety during a transrectal prostate biopsy. DESIGN: This was a quasi-experimental study. METHODS: The quasi-experimental study was conducted in the Urology Outpatient Clinic of a Training and Research Hospital in Istanbul. A total of 40 males were nonrandomly divided into two groups: experimental group (n = 20) and control group (n = 20). A heating pad (40-45°C) was applied to the sacral region of the patients in the experimental group during transrectal prostate biopsy. Data were collected using the Beck Anxiety Inventory (BAI) and visual analogue scale (VAS). RESULTS: It was detected that the mean scores of the BAI were significantly lower in the experimental group compared with the control group (p < .001). The scores of the VAS were significantly lower in the experimental group compared with the control (p = .016). CONCLUSION: Applying a heating pad to the sacral region during a transrectal prostate biopsy is an effective non-pharmacologic method to increase patient comfort and reduce pain and anxiety.

Low Back Pain in Operating Room Nurses and Its Associated Factors.

OBJECTIVE: To determine the presence of low back pain and the associated factors in operating room nurses. METHODS: The population of the descriptive study consists of 133 operating room nurses working in the operating rooms of five major hospitals located in Istanbul, and the study sample consists of 96 operating room nurses who are not on leave or sick leave between July-2016 to February 2017. Data were collected via a question form prepared by the researchers. RESULTS: It was determined that more than half of the operating room nurses forming the sample group had low back pain and that it is affected from the practices of operating room nurses during a shift, which may cause physical strain such as year of working as an operating room nurse, bending and staying in the same position for a long time, holding an instrument for a long time, rotational movement inadequate to body mechanics, lifting/carrying heavy medical items and pushing/pulling heavy medical equipment. CONCLUSION: Majority of operating room nurses had low back pain and it was associated with coercive movements during surgery.

Determining the incidence of postoperative delirium in elderly patients who undergo orthopaedic surgical interventions in Turkey.

OBJECTIVE: To determine the incidence of postoperative delirium in elderly patients having undergone orthopaedic surgical interventions. METHODS: The cross-sectional study was conducted at the traumatology clinic of GATA Haydarpasa Training and Research Hospital in Istanbul, Turkey, from April 2014 to April 2015 and comprised patients who underwent orthopaedic surgical interventions. The subjects included were aged >65 years, had no mental disorders, no acute cerebrovascular disease, no known history of delirium and/or dementia. Data was collected using a self-generated questionnaire, mini mental state examination and delirium rating scale. SPSS 18 was used for data analysis. RESULTS: Of the 60 participants, 39(65%) were female and 21(35%) were male. The overall mean age was 77.07±8.66 years. Besides, 22(36.7%) patients hadmoderate cognitive impairment preoperatively, and 51(85%) had no delirium postoperatively while 9(15%) had delirium. CONCLUSIONS: Degree of cognitive impairment,advanced age and type of surgery were determined to be risk factors for delirium.

The Effect of Pelvic Floor Muscle Training On Incontinence Problems After Radical Prostatectomy.

The aim of the current study was to determine the effect of pelvic floor muscle exercises (PFME/Kegel) training administered to patients scheduled for robot-assisted radical prostatectomy on postprocedural incontinence problems. This study was a randomized controlled trial. Pelvic floor muscle exercises were applied to the procedure group three times a day for 6 months. No exercises were applied to the control group. Incontinence and quality-of-life assessments of the 60 patients in the experimental and control groups were performed on months 0 (10 days after removal of the urinary catheter), 1, 3, and 6 through face-to-face and telephone interviews. Total Incontinence Consultation on Incontinence-Short Form scores, which provide an objective criterion for the evaluation of individuals with incontinence problems, decreased over time. This decrease was statistically highly significant in the third and sixth months. Pelvic muscle floor exercises are suitable for patients experiencing incontinence after radical prostatectomy.

Effect of Early Postoperative Feeding on the Recovery of Children Post Appendectomy.

The aim of this study was to determine the effect of early postoperative feeding on recovery after appendectomy in children. It was undertaken as a multicenter study. Patients were randomly assigned to 2 groups, each containing 46 children. Postoperatively, liquid and solid food intake and evacuation of first flatus and stool were recorded for the intervention and routine care groups. Postoperative thirst, hunger, nausea, and pain levels were evaluated at regular intervals using the Visual Analogue Scale. Data were obtained as number, mean, and percentage, and statistically analyzed using the chi-square test and the 2-sample t test. A statistically significant difference was found for both the first evacuation of flatus and stool and the length of hospital stay. Patients in the intervention group had evacuated flatus and stool earlier and had a shorter hospital stay than the control group. In addition, a significant difference was found in hunger (48th hour), thirst (36th and 48th hours), and pain (48th hour) levels between the intervention and control groups. Early postoperative feeding in children who have had an appendectomy affects the occurrence of the first evacuation of flatus and stool, the length of hospital stay, and the level of hunger, thirst, and pain.

The effect of education of nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery.

AIMS AND OBJECTIVES: The aim of the study was to investigate the effect of educating nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery. BACKGROUND: Urinary tract infections after hip fracture surgery are observed at a rate of 12% to 61%, and the most important risk factor associated with urinary tract infection is considered to be the presence of urinary catheters. Nurse education about the use and management of urinary catheters is important to decrease the risk of urinary tract infections. DESIGN: The study was semi-experimental. METHODS: The study was conducted in an orthopedics and traumatology clinic of a training hospital between January 2014-December 2015. After a power analysis was performed, a total of 60 patients fulfilled the criteria to be included in the study, with n = 30 in the pre-education group and n = 30 in the posteducation group. Nurses who worked in the orthopedics and traumatology clinic of the military hospital were the target population, and 18 nurses who consented to join the study constituted the sample. The "Patient Monitoring Form," "Nurse Information Form" and "Daily Urinary Catheter Assessment Tool" were used as data collection tools. RESULTS: The mean pre-education knowledge score of the nurses was found to be 68.05 ± 10.69, while the mean posteducation score was 95.13 ± 6.27. The mean catheter duration decreased from 11.06 ± 6.34 days-3.83 ± 0.95 days after the education. The catheter-associated urinary tract infection rate decreased by 9.37 per thousand. CONCLUSION: Educating nurses on preventing catheter-associated urinary tract infections in patients who underwent hip fracture surgery significantly decreased the rate of catheter-associated urinary tract infections and the duration of catheterisation. RELEVANCE TO CLINICAL PRACTICE: The systematic and comprehensive education of all healthcare professionals and the development and practice of catheter removal protocols could contribute to the prevention of catheter-associated urinary tract infections.

Coping and Help-Seeking Behaviors for Management of Urinary Incontinence.

OBJECTIVES: To describe the coping strategies and help-seeking behaviors of women and men with urinary incontinence (UI). METHODS: In cross-sectional study, 156 women and 106 men Turkish with UI were interviewed using a questionnaire covering 29 questions. RESULTS: It was determined that 50.6% of women and 34.0% of men seek help in first for treatment of UI. Forty eight percent of men consulted a physician in the first 6 months after the UI occurred, 44.9% of women consulted a physician 2-5 years later after the UI occurred. Coping behaviors of both groups for management of the UI were as follows: keeping feet warm, performing hot application to perineum, reducing the amount of daily drinking water, using pad, cloth pads, restricting physical activity, refraining from social life and praying etc. CONCLUSIONS: While women mostly do not prefer to seek medical advice for UI, men tend to go to doctors more often than women. Except for treatment seeking behaviors, both men and women are practicing coping methods for the management of UI such as going frequently to the toilet, keeping feet warm, hot application to perineum etc.

Approaches to Cope with Stress and Depression in Individuals with Urinary Incontinence.

AIM: The aim of study was to assess individuals with urinary incontinence (UI) with respect to depression and to determine coping mechanisms with stress. METHODS: One hundred sixty female and 110 male participants that applied to Istanbul Faculty of Medicine, Urology and Urogynecology Department with UI complaints and accepted to participate in the study were included in the study. Depressive symptoms were assessed with Center for Epidemiological Studies Depression Scale (CES-D). The mechanisms of coping with stress were evaluated using Ways of Coping with Stress Inventory (WCSI). RESULTS: Females (57.5%) scored 16 points and more from the CES-D scale, while the rate was significantly higher in males (79.1%). The scores obtained in 5 subdimensions of the WCSI showed that females utilized a desperate approach (female 1.39 ± 0.63, male 1.11 ± 0.51, p < 0.000), self-confident approach (female 1.98 ± 0.60, male 1.70 ± 0.42, p < 0.000), and social support approach (female 1.90 ± 0.57, male 1.48 ± 0.44, p < 0.000) statistically and significantly more than males in coping with stress. CONCLUSION: Males experienced more depression symptoms when compared to females. Females were significantly more self-confident and utilized social support mechanisms and desperate approaches more than males in order to cope with stress.

Sleep and quality of life in people with ileal conduit.

OBJECTIVE: The aim of this study was to determine the sleep quality and the association between sleep quality and quality of life in people with ileal conduit. MATERIALS AND METHODS: A descriptive and cross-sectional design was adopted. The study sample comprised 111 people with ileal conduit operated on in urology clinics in a state hospital between January 2011 and May 2014. Six months after the operation, they were called by telephone to participate in the study. Data for the study were collected using a questionnaire form, the Pittsburgh Sleep Quality Index (PSQI) and the Stoma Quality of Life Scale (SQLS). RESULTS: The mean ± SD total PSQI score of the people with ileal conduit was 10.20 ± 2.95, mean total score of SQLS was 43.63 ± 7.21, mean Work/Social Function domain score was 37.27 ± 5.80 and mean Stoma Function domain score was 50.0 ± 12.56. The total sleep quality had a low degree of negative correlation with total SQLS score, a medium degree of negative correlation with Work/Social Function (r = -0.327, p < .001) and no correlation with Stoma Function (r = -0.096, p > .001). People using a night drainage system had higher sleep quality. CONCLUSIONS: This study determined that quality of life and sleep deteriorate in people with ileal conduit. The quality of life decreases when the sleep quality is poor, and decreased quality of life affects quality of sleep in people with ileal conduit.

Assessment of nursing students' stress levels and coping strategies in operating room practice.

The aim of this study was to evaluate the stress levels and stress coping strategies of nursing students in their first operating room experience. This descriptive study was done with 126 nursing students who were having an experience in an operating room for the first time. Data were collected by using Personal Information Form, Clinical Stress Questionnaire, and Styles of Coping Inventory. The nursing students mostly had low clinical stress levels (M = 27.56, SD = 10.76) and adopted a self-confident approach in coping with stress (M = 14.3, SD = 3.58). The nursing students generally employed a helpless/self-accusatory approach among passive patterns as their clinical stress levels increased, used a self-confident and optimistic approach among active patterns as their average age increased, and those who had never been to an operating room previously used a submissive approach among passive patterns. The results showed that low levels of stress caused the nursing students to use active patterns in coping with stress, whereas increasing levels of stress resulted in employing passive patterns in stress coping. The nursing students should be ensured to maintain low levels of stress and use active patterns in stress coping.

Effect of perceived social support on psychosocial adjustment of Turkish patients with breast cancer.

AIMS: To identify the psychosocial adjustment of Turkish patients with breast cancer and the effects of perceived social support on their adjustment. MATERIALS AND METHODS: The sample comprised 100 volunteering patients diagnosed with breast cancer in the last six months reporting to the Outpatient Chemotherapy Unit at the Medical Faculty Hospital in northern Turkey. The data for the study were collected through the Descriptive Information Form, the Psychosocial Adjustment to Illness Scale-Self-reflection (PAIS-SR) and the Cancer-Specific Social Support Scale and analyzed via SPSS 16.0 for Windows. Descriptive statistics, Chi square test, ANOVA and correlation were used to evaluate data. RESULTS: There was a negative significant correlation between mean scores in the sub-scales of the social support scale and the ones in the sub-scales of the psychosocial adjustment to illness scale (p<0.05). Similarly, there was a negative significant correlation between confidence support and health care orientation as well as adjustment to social environment. Likewise, emotional support was in a negative significant correlation with health care orientation, adjustment to domestic environment, extended family relationships and adjustment to social environment. CONCLUSIONS: It was concluded that social support for patients with breast cancer had an influence on their psychosocial adjustment to illness. Holistic care should be given to breast cancer patients by oncology nurses especially in the first six months of treatment. It could be concluded that patients should be accompanied by their family/relatives in treatment and care following their diagnosis with breast cancer, that their family should be made more aware of the fact that the patient should be physically and psychologically supported, that patients with breast cancer should be provided with domiciliary care, and that they should be encouraged to participate in social support groups.

Comparison of intermittent pneumatic compression with manual lymphatic drainage for treatment of breast cancer-related lymphedema.

BACKGROUND: The aim of this prospective controlled study was to assess the efficacy of two different combination treatment modalities of lymphedema (LE). Manual lymphatic drainage (MLD) and compression bandage combination (complex decongestive therapy) have been compared with intermittent pneumatic compression (IPC) plus self-lymphatic drainage (SLD). METHODS AND RESULTS: Both MLD with compression bandage (complex decongestive therapy) group (Group I, n=15) and IPC with SLD group (Group II, n=15) received treatment for LE 3 days in a week and every other day for 6 weeks. Arm circumferences were measured before and the 1st, 3rd, and 6th weeks of the treatment. EORTC-QLQ and ASES-tests were performed to assess the quality of life before and after 6 week-treatment. Patients in both groups had similar demographic and clinical characteristics. Even though both treatment modalities resulted in significant decrease in the total arm volume (12.2% decrease in Group II and 14.9% decrease in Group I) (p<0.001), no significant difference (p=0.582) was found between those two groups. Similarly, ASES scores were significantly (p=0.001) improved in both Group I and II without any significant difference between the groups. While emotional functioning, fatigue, and pain scores were significantly improved in both groups, global health status, functional and cognitive functioning scores appeared to be improved only in patients of group I. CONCLUSIONS: Different treatment modalities consisting of MLD and compression bandage(complex decongestive therapy) or IPC and SLD appear to be effective in the treatment of LE with similar therapeutic efficacy in patients with breast cancer. However, combination modalities including IPC and SLD may be the preferred choices for their applicability at home.

Effects of the contact isolation application on anxiety and depression levels of the patients.

This study was aimed to assess the effects of contact isolation application on anxiety and depression levels of the patients, the effects of certain sociodemographics and patient characteristics on anxiety and depression levels, and the thoughts of the isolated patients about contact isolation. This non-randomized quasi-experimental study was carried out with 60 isolated and 57 non-isolated patients with hospital infection. The data were acquired from Hospital Anxiety and Depression Scale (HADS-A (anxiety) and HADS-D (depression)) and patient information form. There was no statistically significant difference between the anxiety and depression levels of the isolated and non-isolated patients. In the isolated patients, the depression points were higher in patients who were, women, received primary education and had lower income levels. Of the patients, 86.4% of them told that they were happy to be in the isolation room. Contact isolation application did not affect anxiety and depression levels of the patients. However, personal attributes increased the development of depression. In contact isolated patients, personal attributes should be taken into consideration in nursing care planning to prevent development of depression.

Inadequate knowledge levels of Turkish male university students about testicular self-examination.

INTRODUCTION: Testicular cancer occurs in men aged between 15-35, accounting for 1% of all male cancers. The most common symptom is a painless swelling in the early period, so it is important for individuals to be conscious about and perform testicular self-examination. The aim of this study was to determine the knowledge and performance of testicular self-examination (TSE) in male university students. METHODS: The target population of the study consisted of 275 male university students aged between 20-25. Data were collected using a 27 item-questionnaire developed by the investigators consisting of 3 sections: 1) socio-demographic characteristics; 2) risk factors for testicular cancer; 3) practices related to TSE. The data obtained were analyzed using frequency distribution and percentages. RESULTS: 88% of the students (n=242) reported having no knowledge of TSE, whereas 36% (n=12) of the remaining 12% (n=33) reported having performed TSE. With regard to the reasons for non-performance, 88% (n=242) of the participants said they did not know about TSE, 6% (n=17) said they did not attach importance to TSE and 4% (n=11) were afraid. CONCLUSION: The results of our study demonstrated that adolescent males should be educated by nurses about testicular tumors and their symptoms as well as TSE performance.

Overview of the social impact of urinary incontinence with a focus on Turkish women.

Although urinary incontinence is a common problem among women and can seriously affect their quality of life, more than half of women report no discomfort with the disorder, and most do not seek medical help. In Turkey, women traditionally prefer not to seek medical advice for a urinary incontinence problem. Except for treatment-seeking behaviors, women practice coping methods for the management of urinary incontinence. The problem of urinary incontinence has been gaining more importance in recent years, and nurses' roles and responsibilities have been increased in this area. Consequently, there have been developments in Turkey related to the education of nurses.

Determining female physicians' and nurses' practices and attitudes toward breast self-examination in Istanbul, Turkey.

PURPOSE/OBJECTIVES: To determine female physicians' and nurses' practices and attitudes toward breast self-examination (BSE). DESIGN: Descriptive, cross-sectional. SETTING: Two large, bed-capacity university hospitals and 11 smaller, bed-capacity public hospitals. SAMPLE: 201 female nurses and 149 female physicians who work day shift on medical and surgical wards. METHODS: Data were collected on a questionnaire form that was prepared based on information in the literature. The questionnaire had three sections: sociodemographic characteristics, health characteristics, and attitudes and practices related to BSE. Data were analyzed using t tests and chi-square tests. MAIN RESEARCH VARIABLES: Attitudes and practices related to BSE, clinical breast examination, and mammography. FINDINGS: Almost all of the female physicians and nurses knew how to conduct BSE but did not prioritize practicing it. CONCLUSIONS: Female physicians and nurses in Istanbul, Turkey, did not take enough care in the proper timing of BSE (i.e., day 5 to day 7 after menstruation with the first day of menstruation being day 1) despite their knowledge about it. IMPLICATIONS FOR NURSING: Female physicians and nurses need to improve their knowledge and sensitivity concerning breast cancer and BSE if they are to improve and maintain their own well-being as well as carry out their professional roles.

Safety of personnel working in endoscopy units.

All personnel performing or assisting with endoscopic procedures and those responsible for reprocessing the equipment should be trained in how to handle the infectious and chemical hazards associated with the endoscopic environment. Endoscopy personnel should follow a comprehensive safety program that outlines the steps individuals should take to prevent injuries from the potential hazards they may encounter in endoscopy units. Safety measures include ensuring that there is adequate lighting and ventilation in the endoscopy unit, cleaning endoscopy instruments thoroughly, and operating equipment safely.