Inadvertent Hypothermia in the Perspective of Operating Room Nurses: A Phenomenological Qualitative Study.

PURPOSE: The aim of the study was to reveal the awareness and perceptions of operating room nurses concerning inadvertent hypothermia, as well as their experiences and recommendations for its prevention. DESIGN: The study employed a phenomenological qualitative approach. METHODS: This study was conducted with 17 nurses working in the operating room of a university hospital in Konya, Turkey. Data were collected face to face between 15 August and 30 September 2022 using the in-depth individual interview method. The data were subjected to inductive content analysis. Written permission was obtained from the hospital, the ethics committee, and the participants to conduct the study. FINDINGS: The mean age of the nurses was 28.4 years and the majority were female. The nurses were graduates of a four-year health vocational high school, a two-year nursing associate degree program, or a four-year nursing bachelors' degree program. Their operating room experience ranged from 1 to 22 years. All the nurses were aware of inadvertent hypothermia, and all but one encountered hypothermia and applied preventive measures. The data analysis revealed 263 codes, 12 categories, and 4 themes on the awareness and perceptions of operating room nurses about inadvertent hypothermia and their experiences and recommendations for its prevention. CONCLUSIONS: The findings showed that the majority of the participants were aware of inadvertent hypothermia and its risk factors, and frequently encountered inadvertent hypothermia despite implementing preventive measures.

Health Problems and Reasons for Stress of Intensive Care Nurses During COVID-19.

AIM: This study aimed to examine health problems and related reasons for stress including physiological, psychological, and patientcare-related stressors among intensive care unit (ICU) nurses during COVID-19 in Turkey. METHOD: This study was designed as a cross-sectional study. Data were collected between June and July 2020 and from 1140 ICU nurses who were actively working in the pandemic process from 65 provinces in Turkey. An online questionnaire was used consisting of questions regarding nurses' health problems, reasons for psychological, physiological, and patient care-related stress during the pandemic. Descriptive data were presented in mean, median, or number and percentage. RESULTS: Only 15.6% of ICU nurses experienced health problems. Nurses had psychological symptoms such as anxiety, insomnia, and physiological symptoms such as respiratory, musculoskeletal symptoms. The majority of nurses experienced the following psychological stressors: fear of being a COVID-19 carrier and infecting loved ones, and getting sick with COVID-19. Reasons for physiological stress were mostly due to working with personal protective equipment (PPE), skipping toilet breaks, and inadequate hydration. Reasons for patient care-related stress included excessive sweating in PPE, fogging of goggles, and inability to select a venipuncture site with double gloves. CONCLUSION: The findings of this study indicate that almost one-fifth of ICU nurses experience various health problems although most of them experience intense psychological, physiological, and patient care-related stress.

Effect of abdominal massage on bowel evacuation in neurosurgical intensive care patients.

BACKGROUND: There are many factors, which affect the bowel evacuation of neurosurgical intensive care unit (NICU) patients, resulting in constipation. AIM AND OBJECTIVES: The aim of this study was to investigate effect of abdominal massage on bowel evacuation and the risk of constipation in NICU patients. DESIGN: A prospective, randomized-controlled clinical trial. METHODS: The sample of this study included 80 NICU patients. The patients were randomly assigned to abdominal massage and control groups. The constipation risk of all the patients was assessed with Constipation Risk Assessment Scale (CRAS). The patients in the abdominal massage group received a total of 30 minutes of massage, 15 minutes every morning and evening, until the first defecation. The bowel sounds of all patients in the abdominal massage and control groups were assessed on a daily basis. The days when bowel sounds were heard and the first defecation took place were recorded in a Bowel Evacuation Form. RESULTS: The risk of constipation was higher in the patients in the abdominal massage (CRAS score 19.02 ± 1.81) and control groups (CRAS score 20.45 ± 2.61). The time of return of bowel sounds and the time of the first defecation were earlier in the abdominal massage group, compared to the control group (P < .05). In the control group, there was a weak correlation (P = .004) between the CRAS score and the time of return of bowel sounds, while there was a moderate correlation between the CRAS score and the time of the first defecation (P < .001). CONCLUSION: Our study results show that the risk of constipation is high in NICU patients, and abdominal massage is an effective nursing intervention to shorten the time of return of bowel sounds and the time of the first defecation. RELEVANCE TO CLINICAL PRACTICE: Nurses can safely apply abdominal massage to improve bowel evacuation in NICU patients.

The Effect of Cuff Size on Blood Pressure Measurement in Obese Surgical Patients: A Prospective Crossover Clinical Trial.

AIM: This study aimed to determine the effect of a cuff properly sized for mid-upper arm circumference on blood pressure measurement in obese surgical patients. METHOD: This prospective crossover clinical trial was conducted with 100 patients who had body mass index ≥30 kg/m2 and mid-upper arm circumference ≥27 cm and were admitted to the general surgery unit of a medical faculty hospital in Istanbul, Turkey between January 1, 2015, and December 31, 2015. Blood pressure of the patients was measured using a small-sized adult cuff and a cuff properly sized for mid-upper arm circumference. RESULTS: Among the patients, 39% were morbidly obese and 67% had mid-upper arm circumference between 35 and 44 cm. Systolic blood pressure of the patients with a small adult cuff was 20.78 mmHg higher than that obtained with a cuff properly sized for mid-upper arm circumference, and their diastolic blood pressure was 10.15 mmHg higher on average (p<0.001). Only 6% of those with systolic hypertension according to the small adult cuff readings were found to have hypertension according to the cuff properly sized for mid-upper arm circumference (p<0.001). CONCLUSION: The results showed that, in obese surgical patients, blood pressure is measured inaccurately and found to be falsely high when measurements are not performed using a cuff properly sized for mid-upper arm circumference.

The effects of different degrees of head-of-bed elevation on the respiratory pattern and drainage following thyroidectomy: a randomized controlled trial.

BACKGROUND: The patient's position is important for ensuring patient comfort and preventing complications after thyroidectomy. OBJECTIVES: This study was carried out to determine the effects of different degrees of head-of-bed elevation (HOBE) on the respiratory pattern and drainage following thyroidectomy and to provide suggestions for evidence-based clinical practice. METHODS: The sample of this prospective, parallel arm, randomized controlled trial included 114 patients undergoing thyroidectomy in a university hospital in Turkey. The patients were randomly assigned (1:1:1) to supine 0° (baseline), 30° and 45° HOBE groups. Respiratory pattern including respiratory rate (RR), peripheral oxygen saturation (SpO2) and dyspnea, and drainage including amount of drainage and hematoma formation were evaluated at the 1rd, 2rd, 3rd and 4th hours following thyroidectomy. RESULTS: The majority of the patients (83.3%) were female and 84.2% had undergone total thyroidectomy. The mean RR (18.47, 95% CI=17.85-19.09) of the patients in the supine 30° HOBE group at the 1rd hour was significantly higher than that of the patients in the supine 0° group (17.32, 95% CI=16.88-17.76; p<0.05). There was no significant difference between the SpO2 values of the patients in the groups (p>0.05). The amount of drainage was significantly higher in the supine 0° group at the 2nd hour than that of the patients in the supine 45° HOBE group (5.92±5.18; 3.34±5.56 respectively; p<0.05). None of the patients in the groups had hematoma formation. While no patient in the supine 30° HOBE group had dyspnea, dyspnea occurred in 9 patients in the supine 0° group and in 3 patients in the supine 45° HOBE group. CONCLUSION: This study showed that different HOBE positions resulted in clinically insignificant changes on the RR and amount of drainage during the first 4 hours following thyroidectomy but did not affect SpO2 value.

Effects of Different Head-of-Bed Elevations and Body Positions on Intracranial Pressure and Cerebral Perfusion Pressure in Neurosurgical Patients.

PURPOSE: The aim of this study was to evaluate the effects of different head of bed (HOB) elevations and body positions on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) and to identify safe positions for neurosurgical patients with different Glasgow Coma Scale (GCS) scores. METHODS: This study with a quasi-experimental, prospective repeated measures is designed with control over the intervention consisted of 30 patients hospitalized in the neurocritical care units (NCU). Patients' HOB was elevated (degree of 15,30,45) and the patients were at supine, left lateral and right lateral positions. ICP and CPP were recorded for each patient. RESULTS: It was found that ICP increased and CPP decreased at supine, left and right lateral positions with different HOB elevations, which, however, did not reach statistical significance. When patients with a GCS score of 3-8 were at degree of 15 right and left lateral positions and 45 right lateral position; and when patients with a GCS score of 13-15 were positioned at degree of 15 left lateral, ICP and CPP changed significantly. CONCLUSION: The results of this study showed that different positions the patients' HOB (degree of 15,30,45) led to slight insignificant changes in ICP and CPP; and these values were maintained within the ranges established by recent guidelines.

The effect of different types of music on patients' preoperative anxiety: A randomized controlled trial.

OBJECTIVE: The purpose of this study was to determine effect of three different types of music on patients' preoperative anxiety. METHOD: This randomized controlled trial included 180 patients who were randomly divided into four groups. While the control group didn't listen to music, the experimental groups respectively listened to natural sounds, Classical Turkish or Western Music for 30 min. The State Anxiety Inventory (STAI-S), systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and cortisol levels were checked. FINDINGS: The post-music STAI-S, SBP, DBP, HR and cortisol levels of the patients in music groups were significantly lower than pre-music time. All types of music decreased STAI-S, SBP, and cortisol levels; additionally natural sounds reduced DBP; Classical Turkish Music also decreased DBP, and HR. CONCLUSIONS: All types of music had an effect on reducing patients' preoperative anxiety, and listening to Classical Turkish Music was particularly the most effective one.

A Risk Assessment Comparison of Breast Cancer and Factors Affected to Risk Perception of Women in Turkey: A Cross-sectional Study.

BACKGROUND: The increase in breast cancer incidence has enhanced attention towards breast cancer risk. The aim of this study was to determine the risk of breast cancer and risk perception of women, factors that affect risk perception, and to determine differences between absolute risk and the perception of risk. METHODS: This cross-sectional study was carried out among 346 women whose score in the Gail Risk Model (GRM) was ≥ 1.67% and/or had a 1st degree relative with breast cancer in Bahçesehir town in Istanbul, Turkey between Jul 2012 and Dec 2012. Data were collected through face-to-face interviews. The level of risk for breast cancer has been calculated using GRM and the Breast Cancer Risk Assessment Form (BCRAF). Breast cancer risk perception (BCRP), has been evaluated by visual analogue 100-cm-long scale. RESULTS: Even though 39.6% of the women considered themselves as high-risk carriers, according to the GRM and the BCRAF, only 11.6% and 9.8% of women were in the "high risk" category, respectively. There was a positive significant correlation between the GRM and the BCRAF scores (P<0.001), and the BCRAF and BCRP scores (P<0.001). Factors related to high-risk perception were age (40-59 yr), post-menopausal phase, high-very high economic income level, existence of breast cancer in the family, having regular breast self-examination and clinical breast examination (P<0.05). CONCLUSION: In women with high risk of breast, cancer there is a significant difference between the women's risk perception and their absolute risk level.

Undergraduate nursing students' perceptions about disaster preparedness and response in Istanbul, Turkey, and Miyazaki, Japan: a cross-sectional study.

AIM: Although the awareness of disasters has increased among nurses, the concept of disaster preparedness and response has not been sufficiently explored with undergraduate nursing students. The aim of this study was to assess and compare the perceptions of students regarding disaster preparedness and response that live in different earthquake-prone cities; Istanbul, Turkey and Miyazaki, Japan. METHODS: A cross-sectional study employing seven questions was conducted in a final group of 1053 nursing students from Istanbul, Turkey, and Miyazaki, Japan. RESULTS: Most study respondents were female, aged 18-22 years, with a high proportion of second year students in both cities. Istanbul's students had more knowledge about disaster preparedness and response in relation to age and year of university, showing statistically significant differences. Istanbul's highest rated responses to disaster characteristics were on structural elements and injuries/deaths, while Miyazaki's was "unpredictable/sudden/disorganized". Respondents in Istanbul identified earthquakes as the disaster most likely to occur, while respondents in Miyazaki identified typhoon/hurricane. Study participants responded that they could provide caregiver roles during a disaster event rather than triage or managerial roles as disaster responders. CONCLUSION: Disaster characteristics were not described by one third of the students. Of the two-thirds that were described, most were of events that were highly predictable because of their frequencies in the given areas. Universities need to target and then focus on high-risk factors in their areas and have disaster plans for students who can provide triage and managerial nursing roles as disaster responders.

Nursing educators' perceptions about disaster preparedness and response in Istanbul and Miyazaki.

AIM: As healthcare professionals, nursing educators need to be prepared to manage and deliver care in what are often dangerous conditions. This research aims to determine and compare nursing educators' perceptions of disaster preparedness and response (DP&R) in Istanbul and Miyazaki. METHODS: An 18 question descriptive questionnaire was used. RESULTS: One hundred and forty-four nursing educators representing two state university nursing schools in Istanbul, Turkey, and one state and two private universities in Miyazaki, Japan were enrolled. Educators had an average age of 40 years and had been educators for 1-15 years. Just over half of the participants had basic knowledge regarding DP&R with most of them considering taking special courses in the future. The majority considered "caregiver" as a role they could undertake in a disaster situation. The existence of major concerns and conflicts in disaster responses were low. The top ranked item was in the area of conflict between family and job responsibilities. Age and academic levels showed significant differences in basic knowledge on DP&R. Regardless of knowledge in this subject area, no statistical significance on personal preparedness or being a volunteer to disaster events was found. CONCLUSION: Nursing educators were not thinking about what kinds of disasters occur in the areas where they currently teach and were underprepared to deal with disaster situations. To improve the perceptions of the nursing educators on DP&R, mass casualty care and disaster management skills need to be incorporated into formal education and training on disaster preparedness and workplace preparedness.

Educational needs concerning disaster preparedness and response: a comparison of undergraduate nursing students from Istanbul, Turkey, and Miyazaki, Japan.

AIM: To compare 4 year undergraduate nursing students' educational needs concerning disaster preparedness and response in Istanbul and Miyazaki. METHODS: This was a 13 question descriptive/comparative survey. RESULTS: Females, aged 18-22 years, and in their second year of their nursing programs, rarely participate in disaster preparedness and response courses at their universities (75.2%) or outside (89.8%). Educational needs of Miyazaki's students who had already participated in these courses (85%) were higher than in Istanbul's (67.2%). Of those whose educational needs had not been met, 55.9% were considering taking another lecture/course in one of the following years (Istanbul, 47.4%; Miyazaki, 71.4%). The majority of students from Istanbul reported some knowledge about disaster preparedness and response from courses at their universities while Miyazaki's students showed less. Effective teaching methods/resources were mock drills. Nursing interventions in disaster situations in "response competencies" were preferred issues to be included in course content (Istanbul, 90.4%; Miyazaki, 93.1%). Most student nurses had no expectations on skills that could be gained from a disaster preparedness and response course/culture of disaster lecture (Istanbul, 48.7%; Miyazaki, 34.5%). CONCLUSION: Nursing students in both cities seem more likely to participate in disaster preparedness and response courses/lectures. The present study also addresses the need to incorporate mass casualty care and disaster management skills into undergraduate curricula. Core contents for nursing curricula in both cities need to be continued. Outcome competencies must be identified and validated through further research.