The effect of simulation on auscultation skills, self-confidence and anxiety levels in nursing students: A randomized controlled trial.

AIM: This study evaluated the effect of simulation on auscultation skills, self-confidence and anxiety levels. BACKGROUND: Auscultation is an essential topic in nursing education and patient care. Simulation is efficacious in improving auscultation skills and self-confidence and reducing anxiety levels. It is a valuable educational approach whose effects should be evaluated and disseminated in the context of auscultation. DESIGN: This study had a randomised controlled trial design. METHODS: The study was conducted with second-year nursing students enrolled at a university in Turkey. One group of students studied auscultation of heart, lung and bowel sounds with a simulated patient (n = 28), the second group with a high fidelity simulator (n = 30) and the third group with traditional education (n = 28). Data were collected using a demographic information form, auscultation control list and Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale. The students' psychomotor auscultation skills, self-confidence and anxiety levels were evaluated. Data on auscultation skills were assessed after the intervention, while data on self-confidence and anxiety levels were collected at baseline, after the intervention and after clinical practices throughout the academic year. RESULTS: Anxiety and self-confidence levels showed statistically significant differences in intragroup evaluation. The self-confidence levels of the groups working with simulation did not change much in the follow-up test conducted after the end of clinical practices. The mean skill scores in the auscultation control list showed a statistically significant difference between the groups. CONCLUSIONS: Simulation and traditional approaches are effective in learning auscultation skills. However, the positive effects of simulation, particularly in enhancing students' self-confidence and reducing anxiety levels, appear to be more permanent and impactful than traditional education. Therefore, it is recommended that simulation be prioritized for teaching auscultation skills.

The Effect of Pelvic Floor Muscle Exercises on Bowel Evacuation and Quality of Life in Following Intestinal Ostomy Closure: Randomized Controlled Trial.

PURPOSE: This purpose of this study was to evaluate the effect of pelvic floor muscle exercises (PFMEs) on bowel evacuation problems and health-related quality of life (HRQOL) following ostomy closure. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: Forty individuals following ostomy closure consented to participate in the study; 6 participants (15%) did not complete the trial (2 died and 2 required a second ostomy) yielding a study sample of 34. Participants were randomly allocated to an Exercise Group (EG, n = 17) and Control Group (CG, n = 17). The mean age of the EG was 55.7 (SD 12.6) years, whereas the mean age of the CG was 62.0 (SD 12.1) years. The study setting was the surgery clinic of 4 hospitals in Ankara, Turkey. Data were collected between December 2018 and May 2020. METHODS: The study intervention, PFME training by a clinician, was administered to participants in the EG; CG participants received no information regarding PFME. Data were collected during face-to-face interviews on the day before discharge and by phone at the first, second, third, and sixth months after surgery. A questionnaire was used for data collection that queried a demographic and pertinent clinical questions, along with the Assessment Form for Bowel Evacuation Habits and Psychosocial Problems, Wexner Scale, and the Short Form (SF-36) Health-related Quality of Life Scale. Descriptive statistics and Mann-Whitney U test, t-test, Pearson-χ2 test, Fisher's Exact test, Friedman test, and Cochran-Q test statistical analysis according to normal distribution were used in data evaluation. RESULTS: The number of defecations in the EG was statistically significantly lower than the CG at the second, third, and sixth months (P = .002, P = .002, P = .001, respectively). In addition, the number of individuals experiencing night defecation was statistically significantly less in the EG compared to the CG at the second-, third-, and sixth-month follow-ups (P = .001, P = .001, P = .028, respectively). HRQOL scores were also significantly higher in the EG. CONCLUSION: Pelvic floor exercises applied after ostomy closure are effective in reducing bowel evacuation and increasing quality of life. Given these findings, PFMEs are recommended for patients after ostomy closure.

The Effect of Stoma Site Marking on Stomal Complications: A Long-term Retrospective Study.

OBJECTIVE: To identify the effect of stoma site marking on stoma-related complications. METHODS: The study sample included 639 individuals with stomas who were followed up in a stomatherapy unit in Turkey between January 1, 2017, and June 20, 2021. Researchers collected patient data from nursing records. Data were evaluated using number, percentage, χ2, and logistic regression tests. RESULTS: Of the individuals with stomas, 60.6% (n = 387) were men, and 72.6% (n = 464) had a cancer diagnosis. Their mean age was 60.16 (SD, 14.81) years. The stoma site was marked preoperatively in of 67.1% of patients (n = 429), and 17.1% (n = 109) developed stoma-related complications. The complication rate was higher in individuals with unmarked stoma sites (25.7%; P = .000), emergency surgeries (25.0%; P = .006), colostomies (23.9%; P = .042), and permanent stomas (28.3%; P = .002). The three most common complications were peristomal skin problems (56.9%), mucocutaneous separation (13.8%), and edema (9.2%). CONCLUSIONS: The incidence of stoma-related complications in the postoperative period was higher in individuals with unmarked stoma sites. The authors recommend that stoma and wound care nurses mark the stoma site in individuals for whom stoma creation is planned.

The effect of flipped learning approach on nursing students' learning of patient safety: A randomized controlled trial.

AIM: This study was conducted to evaluate the effect of the flipped learning approach on nursing students' learning of patient safety BACKGROUND: Nursing students play an important role in ensuring patient safety. Flipped learning is an effective approach in nursing education related to patient safety. It is a valuable educational approach whose effects should be evaluated and disseminated in the context of patient safety. METHOD: This study had a parallel-group randomised controlled trial design. The study was conducted with first-year nursing students enrolled at a university in Turkey. The traditional educational approach was used to teach patient safety in the control group (n = 44) and flipped learning approach was used in the intervention group (n = 45). Data were collected using a demographic information form, achievement test and Patient Safety Competency Self-Evaluation Scale. Data were collected at baseline, after intervention and 6 weeks after intervention. RESULTS: The intervention group obtained significantly higher mean total scores in the achievement test (post-test and follow-up test, p < 0.001) and the Patient Safety Competence Self-Evaluation Scale than the control group (first measurement and second measurement, p < 0.001). CONCLUSION: Flipped learning positively affected students' knowledge of patient safety and their self-assessment of knowledge-skill-attitudes. It is recommended that the flipped learning approach be used to teach patient safety.

Pressure Injury Prevalence and Risk Factors: A National Multicenter Analytical Study.

PURPOSE: The purpose of this study was to determine the point prevalence (PP) of general pressure injuries (PIs), hospital-acquired PIs, PI-related risk factors, and PI preventive interventions performed by nurses. DESIGN: Descriptive, multicenter, prospective, analytical study. SUBJECTS AND SETTING: The sample comprised 5088 patients cared for in 13 hospitals in 12 geographic regions of Turkey. Data were collected between November 5, 2018, and July 17, 2019. METHODS: The study was carried out in 2 stages. First, nurses who collected data were trained in the diagnosis of PI, risk assessment, staging, and prevalence studies, and informed about the purpose and methods of the study, including data collection. Second, nurses and researchers who had received training related to data collection for this study conducted a PP study for PIs in their inpatient clinics using the ASSIST II method. The PI Prevalence Study Tool and the Braden Scale for Predicting Pressure Sore Risk were also used during data collection. RESULTS: The PP of general PIs was 9.5%; the prevalence of PIs with hospitalization in intensive care units was 43.2%; medical device-related pressure injuries prevalence was 10.7%. We found that 65.1% of the PIs were acquired after hospital admission. CONCLUSIONS: Similarities exist between PI prevalence in Turkey and reported PI prevalence rates worldwide. However, the prevalence of nosocomial PIs related to intensive care units and the prevalence of all nosocomial injuries were higher than rates previously reported. Based on results, there is a need to develop strategies to reduce the prevalence of nosocomial PIs.

Ethical Discourse of Medical Students on the Phenomenon of Death: A Qualitative Study.

The aim of this study is to discover medical students' ideas on the phenomenon of death; produce information on how these students interpret the value-related problems regarding death that they come across in different units of hospitals; and assess this data in ethical terms. This study included a qualitative research in which 12 focus group interviews were conducted with 92 fifth- and sixth-year medical students. Data obtained from interviews were assessed using a thematic content secondary analysis. The main themes were specified according to the medical students' statements and were reviewed under the contexts of the "dying process"; "effects of death"; "attitude and behavior of health professionals"; "seeing a dead body/looking at a dead body"; "accepting death"; and "forms of expressions of death." Medical students' encounters with death in different units of hospitals leads them to question their values and familiarize themselves with the borders of their areas of profession.

Nurses' attitudes toward, perceptions of, and experiences with conscientious objection.

BACKGROUND: Conscientious objection is a person's refusal to fulfill a legal duty due to their ethical values, religious beliefs, or ideological affiliations. In nursing, it refers to a nurse's refusal to perform an action or participate in a particular situation based on their conscience. Conscientious objection has become a highly contested topic in recent years. RESEARCH OBJECTIVES: This study had four objectives: (1) eliciting information on how Turkish nurses perceive conscientious objection, (2) revealing whether their moral beliefs affect the care they provide, (3) determining their experiences with conscientious objection, and (4) identifying existing or potential issues of conscientious objection. RESEARCH DESIGN: This qualitative study collected data through semi-structured interviews. The data were analyzed using thematic content analysis. PARTICIPANTS: The sample consisted of 21 nurses. ETHICAL CONSIDERATIONS: The study was approved by an ethics committee. Confidentiality and anonymity were guaranteed. Participation was voluntary. FINDINGS: The analysis revealed four themes: (1) universal values of nursing (professional values), (2) experiences with conscientious objection (refusing to provide care/not providing care), (3) possible effects of conscientious objection (positive and negative), and (4) scope of conscientious objection (grounded and groundless). CONCLUSION: Participants did not want to provide care due to (1) patient characteristics or (2) their own religious and moral beliefs. Participants stated that conscientious objection should be limited in the case of moral dilemmas and accepted only if the healthcare team agreed on it. Further research is warranted to define conscientious objection and determine its possible effects, feasibility, and scope in Turkey.

Changes in the Lives of Individuals with a Stoma and Their Spouses: A Qualitative Study.

OBJECTIVE: Individuals with a stoma and their spouses experience various changes with regard to their new life situation. The authors aimed to determine the changes caused by stoma creation in the lives of individuals with a stoma and their spouses. METHODS: This study was carried out with individuals with a stoma (n = 15) and their spouses (n = 15) in a stoma therapy unit. Semistructured interviews were digitally audio recorded and transcribed. Inductive reasoning was used in the analysis of the qualitative data. RESULTS: As a result of the data obtained from in-depth interviews, the authors identified three contexts, nine themes, and many subthemes (49 subthemes for individuals with a stoma and 30 subthemes for spouses). Most subthemes were expressed by both the individual with a stoma and his/her partner, showing that the feelings, thoughts, and difficulties experienced were often shared between spouses. CONCLUSIONS: Ostomies change the lives of individuals and their spouses. These changes have mostly negative biopsychosocial effects. However, after stoma surgery, spouses strengthen their commitment to each other and better understand the value of being healthy.

Determination of Quality of Life and Self-Care Agency in Patients Who Underwent Colorectal Cancer Surgery: A Prospective Descriptive Study.

BACKGROUND: Knowledge about the relationship between quality of life and self-care among patients with colorectal cancer in Turkey is limited. PURPOSE: This prospective, descriptive study evaluated the quality of life and self-care agency of patients who underwent surgery for colorectal cancer. METHODS: Patients were recruited to participate preoperatively from the general surgery clinics in 2 hospitals in Turkey. Sociodemographic variables were collected preoperatively, and the Quality of Life Scale for Cancer Patients (EORTC QLQ-C30) Turkish Version 3.0, the Quality of Life Scale for Colorectal Cancer Patients (EORTC QLQ-CR29), and the Self-Care Agency Scale were completed preoperatively and at 1, 3, and 6 months postoperatively. RESULTS: Thirty-seven (37) patients (average age 59.49 years [±10.84]) who met the inclusion criteria participated in the study. The majority were male (22 patients; 60%), and 25 (67%) did not have a stoma postoperatively. Compared with preoperative scores, QLQ-C30 general well-being, functional status, physical functions, and role performance scores decreased in the first month after surgery and increased in the third and sixth months (58.3 [preoperative] vs 75.0 [month 3] vs 83.3 [month 6]; P = .000). The preoperative QLQ-CR29 excretory system pleasure scores were higher than the postoperative third- and sixth-month scores (1.7 [preoperative] vs 1.0 [month 3] vs 1.0 [month 6]; P = .001). The Self-Care Agency scores at 6 months were higher than the postoperative first month (109.62 ± 11.62 vs 115.19 ± 14.22; P = .006). A positive correlation was found between Self-Care Agency scores and functional status scores of the QLQ-C30 scale at 3 and 6 months postoperatively (P = .000). CONCLUSION: Quality of life and Self-Care Agency scores decreased immediately after surgery but increased in the following 6 months. A positive correlation was found between quality of life and self-care agency.

Family Functioning, Perceived Social Support, and Adaptation to a Stoma: A Descriptive, Cross-sectional Survey.

The creation of a stoma is a life-saving surgical procedure that requires major adjustments. PURPOSE: The aim of this study was to examine the relationships among family functioning, perceived social support, and adaptation to living with a stoma. METHOD: A descriptive, cross-sectional survey was conducted between October 2013 and June 2015 among consecutive patients who visited the stomatherapy unit of a university hospital in Ankara, Turkey, for regular follow-up visits. Eligibility criteria stipulated participants must be at least 18 years of age, literate, live with family, have their stoma for at least 2 months, and be willing to participate. Instruments included a demographic and stoma-related information form, the Multidimensional Scale of Perceived Social Support (MSPSS; subscale range 4-28, total score range 12-84; higher scores indicate better perceived support), the McMaster Family Assessment Scale (FAS; range 1.32-3.15; higher scores indicate deteriorating family function), and the Ostomy Adjustment Inventory Scale-23 (OAI-23; range 19-85; higher scores indicate increasing adaptation). Data were entered into statistical software for analysis that included descriptive statistics and Mann-Whitney U and Spearman correlation tests. RESULTS: Among the 75 participants (mean age 55.4 ± 12.96 years; average stoma duration 3.77 ± 4.97 years), 41 (54.7%) were male, 59 (78.7%) were married, and mean duration of living with a stoma was 3.77 ± 4.97 years. The average MSPSS score was 61.0 5 ± 15.00, the average FAS score was 1.98 ± 0.38, and the average OAI-23 score was 49.39 ± 14.62, all within the "moderate" range for their measures. Stoma complications, time since surgery, stoma self-care, marital status, whether the surgery was planned or an emergency, and employment status significantly affected MSPSS, FAS, and OAI-23 scores. As the FAS scores increased, the MSPSS (r = -.399; P = .001), and OAI-23 (r = -.300; P = .009) scores decreased. CONCLUSION: The results suggest wound, ostomy, continence nurses should assess and encourage familial and social support. Prospective studies examining the effect of familial and social support on stoma adjustment are warranted.

Nurses' Knowledge and Practices Related to Pressure Injury: A Cross-sectional Study.

PURPOSE: The purpose of this study was to determine nurses' knowledge and practices regarding pressure injury and identify relationships between these factors and professional nurse characteristics. DESIGN: Cross-sectional, descriptive study. SETTING AND SUBJECTS: The sample comprised 347 nurses attending the 2013 and 2015 Wound Management Congresses. The meetings were organized by the Wound Management Association located in Antalya, Turkey. METHODS: A 35-item data collection form was designed for purposes of this study. It divided into 2 parts: 8 items queried demographic and professional characteristics of nurse respondents. The second part comprised 9 cases describing patients with pressure injury; these cases were associated with 27 items querying pressure injury-related knowledge and practices. Demographic and professional characteristics of nurse respondents were summarized via descriptive statistics. The Kruskal-Wallis H and Mann-Whitney U tests were used to identify relationships between nurse characteristics and pressure injury knowledge and practices. RESULTS: The mean score for the 27 items related to pressure injury knowledge and practices was 57.37 ± 14.26 out of 100 points. Pressure injury knowledge and practices were positively associated with nurses having a bachelor's and/or postgraduate degree (P = .012), nurses caring for a higher number of patients with pressure injuries per week (P = .042), nurses practicing in intensive care units and wound care clinics (P = .011), nurses with specific education in pressure injury (P = .000), and those indicating adequate skills and knowledge in pressure injury (P = .005). CONCLUSIONS: Nurses' knowledge and practices regarding pressure injuries were lower than anticipated in this sample. We recommend additional education and training activities to increase nurses' knowledge and practices related to pressure injury.

Effect of simulation on the ability of first year nursing students to learn vital signs.

BACKGROUND: The acquisition of cognitive, affective and psychomotor knowledge and skills are required in nursing, made possible via an interactive teaching method, such as simulation. OBJECTIVE AND DESIGN: This study conducted to identify the impact of simulation on first-year nursing students' ability to learn vital signs. SETTING AND PARTICIPANTS: A convenience sample of 90 first-year nursing students enrolled at a University, Ankara, in 2014-2015. METHOD: Ninety students enrolled for lessons on the "Fundamentals of Nursing" were identified using a simple random sampling method. The students were taught vital signs theory via traditional methods. They were grouped into experimental 1, experimental 2 and control group, of 30 students each. Students in the experimental 1 group attended sessions on simulation and those in the experimental 2 group sessions on laboratory work, followed by simulation. The control group were taught via traditional methods and only attended the laboratory work sessions. The students' cognitive knowledge acquisition was evaluated using a knowledge test before and after the lessons. The ability to measure vital signs in adults (healthy ones and patients) was evaluated using a skill control list. RESULTS: A statistically significant difference was not observed between the groups in terms of the average pre-test scores on knowledge (p>0.050). Groups exposed to simulation obtained statistically significantly higher scores than the control group in post-test knowledge (p<0.050). The ability of the groups exposed to simulation to measure vital signs in healthy adults and patients was more successful than that the control group (p<0.050). This was statistically significant. CONCLUSION: Simulation had a positive effect on the ability of nursing students to measure vital signs. Thus, simulation should be included in the mainstream curriculum in order to effectively impart nursing knowledge and skills.

The effect of the application of manual pressure before the administration of intramuscular injections on students' perceptions of postinjection pain: a semi-experimental study.

AIMS AND OBJECTIVES: To evaluate the efficacy of applying manual pressure before intramuscular injection and compare it with the standard injection technique in terms of reducing the young adult student's postinjection pain. BACKGROUND: The administration of intramuscular injections is a procedure performed by nurses and one that causes anxiety and pain for the patient. Nurses have ethical and legal obligations to mitigate injection-related pain and the nurses' use of effective pain management not only provides physical comfort to the patients, but also improves the patients' experience. DESIGN: Comparative experimental study. METHODS: This study was conducted with first-year university students (n = 123) who were scheduled for hepatitis A and hepatitis B vaccination via deltoid muscle injection. Students were randomly assigned to the groups. Comparison group students (n = 60) were given an injection using the conventional method, that is without manual pressure being applied prior to the injection. The experimental group students (n = 63) received manual pressure at the vaccination site immediately before injection for a period of 10 seconds. The two techniques were used randomly. The subjects were given pressure to the injection site, and perceived pain intensity was measured using Numerical Rating Scale. RESULTS: Findings demonstrate that students experienced significantly less pain when they received injections with manual pressure compared with the standard injection technique. The postinjection average pain score in the comparison group was higher than that in the experimental group (p < 0·05). CONCLUSIONS: This study's results show that the application of manual pressure to the injection site before intramuscular injections reduces postinjection pain intensity in young adult students (p < 0·05). Based on these results before the injection, applying manual pressure to the adult's intramuscular injection site is recommended. RELEVANCE TO CLINICAL PRACTICE: Applying pressure to the injection area is a simple and cost-effective method to reduce the pain associated with injection.

Determining the effect of periodic training on the basic psychomotor skills of nursing students.

BACKGROUND: Basic psychomotor skill training starts in the first year in nursing education. The psychomotor skills taught in the first year of nursing training constitute a foundation for all professional practices. Conducting periodic training for skills with which students are deficient can support mastery learning. OBJECTIVES: The study was conducted as an interventional study for determining the effect of periodic training on the basic psychomotor skills learned in the Fundamentals of Nursing course. DESIGN: The sample consisted of 70 students attending the Fundamentals of Nursing course at nursing students in a university in Ankara, over 4 years between 2010 and 2013. METHODS: The study was conducted as an interventional study for a period of 4 years. The data were collected through a questionnaire that was applied 4 times at the end of each academic year. According to the results of the forms evaluated at the end of each year, 4 additional laboratory activities were conducted addressing the deficient psychomotor skills of students at the beginning of the new academic semester in the 2nd and 3rd years. In the 4th-year clinic practice, courses were arranged to practice still deficient psychomotor skills. RESULTS: It was determined that students practiced nearly all of the basic psychomotor skills during clinical practice and that the practices with which they felt themselves to be inadequate gradually decreased following periodic training; this decrease was significant (p<0.05). While the number of students who could practice was low at the first measurement, following 3 years of periodic training, these skills increased significantly (p<0.05). CONCLUSION: This study determined that periodic training addressing the deficient psychomotor skills of nursing students was effective. We recommend that students' psychomotor skills be evaluated periodically and repetitive training based on the results of this evaluation be provided throughout the undergraduate nursing education process.

The effect of ethics training on students recognizing ethical violations and developing moral sensitivity.

BACKGROUND: Moral sensitivity is a life-long cognitive ability. It is expected that nurses who work in a professional purpose at "curing human beings" should have a highly developed moral sensitivity. The general opinion is that ethics education plays a significant role in this sense to enhance the moral sensitivity in terms of nurses' professional behaviors and distinguish ethical violations. AIM: This study was conducted as intervention research for the purpose of determining the effect of the ethics training on fourth-year students of the nursing department recognizing ethical violations experienced in the hospital and developing ethical sensitivity. METHODS: The study was conducted with 50 students, with 25 students each in the experiment and control groups. Students in the experiment group were provided ethics training and consultancy services. The data were collected through the data collection form, which consists of questions on the socio-demographic characteristics and ethical sensitivity of the students, Moral Sensitivity Questionnaire, and the observation form on ethical principle violations/protection in the clinic environment. The data were digitized on the computer with the SPSS for Windows 13.0 program. The data were evaluated utilizing number, percentile calculation, paired samples t-test, Wilcoxon test, and the McNemar test. RESULTS: The total Moral Sensitivity Questionnaire pre-test score averages of students in the experiment group were determined to be 93.88 ± 13.57, and their total post-test score averages were determined to be 89.24 ± 15.90. The total pre-test score averages of students in the control group were determined to be 91.48 ± 17.59, and their total post-test score averages were determined to be 97.72 ± 19.91. In the study, it was determined that the post-training ethical sensitivity of students in the experiment group increased; however, this was statistically not significant. Furthermore, it was determined that the number of ethical principle protection/violation observations and correct examples provided by students in the experiment group were higher than the control group and the difference was statistically significant. ETHICAL CONSIDERATIONS: Written permission and ethical approval were obtained from the university where the study was conducted. Written consent was received from students accepting to participate in the study. CONCLUSION: As a result, ethics education given to students enables them to distinguish ethical violations in a hospital and make a proper observation in this issue.

A multicenter, retrospective study to evaluate the effect of preoperative stoma site marking on stomal and peristomal complications.

Even though preoperative marking of the stoma area is considered important for the prevention of postoperative complications, not all healthcare institutions have universally adopted this practice. A multicenter, retrospective, descriptive study was conducted to determine the effect of stoma site marking on stomal and peristomal complications. The 1-year study included 748 patients (408 [54.5%] male, mean age 56.60 ± 16.73 years) from eight stomatherapy units in Turkey. Patient data, including age, gender, diagnosis, type of surgery, history of preoperative stoma site marking, person performing the marking, and postoperative complications, were obtained from patient records, abstracted, and analyzed. Cancer was the reason for the operation in 545 (72.9%) of the cases. In 287 patients (38.4%), the stoma and wound care nurse and/or surgeon marked the stoma area; this occurred 1 day before or on the day of surgery according to Wound Ostomy Continence Nurses Society and American Society of Colon and Rectal Surgeons recommendations. Stomal/ peristomal complications developed in 248 (33.2%) persons; the most frequently observed complications in patients were parastomal skin problems (136, 48.7%), mucocutaneous separation (52, 18.6%), and retraction (31, 11.1%). The rate of complications was higher among patients whose stoma site was not marked than among those whose stoma site was marked (22.9% and 46%, respectively; P <0.001). The results of this study confirm the stoma area should be marked preoperatively in all planned surgical interventions in order to reduce the risk of postoperative complications. Additional prospective and experimental studies on effectiveness of preoperative stoma site marking should be conducted with larger sample groups.

An evaluation of nurses' professional autonomy in Turkey.

BACKGROUND: The development of a profession's autonomy closely relates to that profession's level of autonomy in performing its specific role. For the nursing profession, this key role is nursing care. OBJECTIVES: This study was undertaken to evaluate the professional autonomy of nurses in care provision, from an ethical perspective. RESEARCH DESIGN: A mixed methods approach is employed in this research, which makes use of both quantitative and qualitative methods. The quantitative dimension of this research covers sociodemographic aspects and makes use of the Sociotropy-Autonomy Scale. The qualitative dimension of the research relates to the factors that affect professional autonomy in nursing care. PARTICIPANTS AND RESEARCH CONTEXT: The sample consisted of 30 nurses working in the orthopedics, neurology, or intensive care units of three hospitals. ETHICAL CONSIDERATIONS: Before conducting this research, we received permission from the ethical committee, as well as written permits from all the institutions in which the research was carried out. Informed consent was obtained from all participants. FINDINGS: According to the findings of this study, only 6.7% of the nurses surveyed stated that nurses had professional autonomy; they also stated that professional autonomy in nursing was mostly restricted by the need to be "dependent upon the physician in nursing implementations" and that autonomy in nursing care was mostly limited by a "high number of patients per nurse." DISCUSSION: This study determined that delays in resolving problems with regard to professional autonomy in nursing care in Turkey could be creating many of the professional and ethical problems that nurses face there. CONCLUSION: It is recommended that: individuals choose the nursing profession conscientiously; nurses need to be given professional awareness; their professional organizations need to be strengthened; and plans need to be made to increase research and to accumulate both knowledge and expertise.

Colostomy irrigation: an important issue for Muslim individuals.

Colostomy irrigation (CI) is a bowel management method in individuals with permanent colostomy, as an alternative to pouch use, which may provide continence. CI helps the individuals with an artificial stoma to adjust to the stoma and may increase their quality of life (QOL). An uncontrolled intestinal gas discharge invalidates ablution, and noisy gas discharge and smell prevents congregational prayers, which cause problems to Muslims with stomas. Therefore, CI may be an appropriate solution for this patient group. Using the example of one affected individual we discuss how the praying problem can be resolved with teaching to self-perform CI and emphasize the beneficial effects on QOL.