"His heart is hardening, but his BRAIN is softening": Life experiences of adolescents using psychoactive substances: A qualitative study

PURPOSE

The aim of the research was to portray the life experiences of adolescents using psychoactive substances with regard to their substance use.

DESIGN AND METHODS

This study was carried out in a descriptive phenomenological design, which is a qualitative research method. A purposeful sampling method, was used. The sample consisted of 15 adolescents who were treated for a history of substance use. The data were collected by the face-to-face individual interview method. A personal information form and a semi-structured interview form were used to collect data. The content analysis approach proposed by Graneheim and Lundman was used in the analysis of the data. Data were analyzed using the N-VIVO-10 Pro-package program.

RESULTS

Four main themes and thirteen sub-themes were determined: experiences before substance use (sub-themes: life before substance use, predisposing factors for substance use), experiences during substance use (sub-themes: symptoms of addiction, problems caused by substance use, family attitude to substance use, the meaning attached to substances) and experiences of the treatment process (sub-themes: motivation, difficulties experienced during treatment, the need for support, treatment results), prevention recommendations (sub-themes: for peers, for families, for society).

CONCLUSIONS

Many individual, family and social risk factors had an effect on the adolescents starting to use the substances. They were exposed to negative physical, mental, economic, social and life experiences.

PRACTICE IMPLICATIONS

Nurses working with adolescents who use substances can implement nursing interventions such as prevention activities, counselling, health education, coping and strengthening self-esteem in individual and school based interventions.

The association of mental health literacy with mental well-being and help-seeking in young people: A systematic review and meta-analysis

PROBLEM

It is important to determine the relationship between mental health literacy (MHL), mental well-being and help seeking in young people in terms of guiding research and practices related to MHL.

ELIGIBILITY CRITERIA

A literature scan of the databases of Web of Science, PubMed, Science Direct, EBSCOhost CINAHL Complete, Cochrane Library, Springer Link, Scopus, Wiley Online Library, Ovid, Taylor & Francis and ProQuest Dissertations & Theses Global was conducted in May 2022 and April 2023 without any year limitations.

SAMPLE

A total of 12 studies with 4659 young people were included. Data synthesis was performed using Comprehensive Meta-Analysis (CMA) software. Pearson correlation coefficient (r) was used to calculate the effect size.

RESULTS

It was concluded that there was no correlation between MHL and mental well-being in young people (p > 0.05, r = 0.06, 95% CI = -0.05 to 0.16). A positive correlation was found between MHL with help seeking attitude (p < 0.01, r = 0.48, 95% CI = 0.30 to 0.63) and help-seeking intention (p < 0.01, r = 0.23, 95% CI = 0.12 to 0.34).

CONCLUSION

While there was a medium effect size between MHL and help seeking attitude in young people, there was a weak effect size between MHL and help seeking intention. No studies were found examining the relationship between MHL and help-seeking behavior in young people.

IMPLICATIONS

Nurses may provide support for young people in help seeking by giving education and counselling on MHL in schools and health institutions, and by creating reliable and easily accessible sources of information.

Problematic internet use in adolescents: A phenomenological study

WHAT IS KNOWN ON THE SUBJECT?: Problematic internet use (PIU) negatively affects adolescents' lives biopsychosocially. There is limited qualitative research examining the problem of PIU in adolescents. These studies focused more on the non-clinical population. Adolescents' perceptions of the internet, their thoughts, feelings and behaviours in situations where they can and cannot access the internet have rarely been examined. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: This research provides an in-depth look at the experiences of adolescents with PIU in a clinical population. Unlike previous studies, adolescents mentioned that they turned to the internet for reasons such as lack of activity, their need to spend time with their friends and better getting along with people they met on the internet. They also described a world without internet as apocalypse, desert and grave. In this study, a holistic emphasis was placed on the thoughts, feelings and behaviours of adolescents in situations where they could and could not access the internet. This may contribute especially to mental health nurses working in clinics in terms of understanding the thought-emotion and behaviour patterns of adolescents with PIU. Adolescents also stated that their lives were affected positively and negatively as a result of PIU. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses can use activity therapy, behaviour modification: social skills, coping enhancement, parent education: adolescent, self-awareness enhancement, cognitive restructuring, emotion and behaviour management interventions to reduce the risk of PIU and the problems it causes for adolescents. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses can use activity therapy, behaviour modification: social skills, coping enhancement, parent education: adolescent, self-awareness enhancement, cognitive restructuring, emotion and behaviour management interventions to reduce the risk of PIU and the problems it causes for adolescents.

ABSTRACT

INTRODUCTION: Studies on problematic internet use (PIU) are mostly on the non-clinical population. Understanding the experiences of adolescents with PIU is critical in shaping nursing interventions and improving the quality of care.

AIMS

A comprehensive description of the experiences of adolescents with PIU.

METHODS

In the study, descriptive phenomenology design, one of the qualitative research methods, was used. Data were collected using a personal information form and a semi-structured interview form and analysed using Giorgi's phenomenological method (n = 11).

RESULTS

As a result of the content analysis, five main themes were identified: reasons of PIU, internet-related perceptions, experiences in accessing the internet, experiences in not being able to access the internet and consequences of internet use.

DISCUSSION

Different from previous studies, adolescents stated that they use the internet because of their lack of activity and their need to spend time with their friends. They stated that when they could not access the internet, they thought they could never live without the internet and started quarrel.

Suicide literacy in nurses: A cross-sectional study

AIMS AND OBJECTIVES

This study is a cross-sectional study aiming to determine the suicide literacy level of nurses and to examine the relationship between nurses' suicide literacy and certain variables.

BACKGROUND

Suicide literacy in nurses is a factor which affects knowledge levels. The level of suicide literacy in nurses may affect the care given to patients and the behaviour of obtaining help in relation to themselves.

METHODS

The study was conducted with 348 nurses between January and March 2020 at a hospital in the city of Antalya in Turkey. A personal information form and the Literacy of Suicide Scale (LOSS) were used to collect data. Descriptive statistical methods were used in data analysis. Stepwise multiple linear regression analysis was performed to determine the predictors of suicide literacy. The STROBE checklist was followed for this cross-sectional study.

RESULTS

The nurses' mean score on LOSS was 11.08 ± 3.92. Significant predictors of suicide literacy in nurses were being single, working in the emergency department, having previous experience in the psychiatry clinic, not having a mental illness, having suicide attempts in the family, having previously obtained information on intervention on individuals at risk of suicide and stating that their sources of information on this topic were nursing education and the Internet. These variables explained 19.8% of the variance in suicide literacy.

CONCLUSIONS

The nurses' suicide literacy was at a low level. It is recommended that education programs on the care of patients at risk of suicide be set up for all nurses working in general clinics.

RELEVANCE TO CLINICAL PRACTICE

It is important to raise the levels of suicide literacy in nurses in order to provide better quality care to patients who are at risk of suicide. Also, raising levels of suicide literacy may strengthen nurses' behaviours in seeking help for themselves.

Association of Premenstrual Dysphoric Disorder and Eating Behaviors Among Nursing Students: A Cross-Sectional Study

STUDY OBJECTIVE

Premenstrual dysphoric disorder (PMDD) is the most severe form for premenstrual distress. This study's objective was to understand the association among PMDD, premenstrual syndrome (PMS), and eating behaviors.

DESIGN

Cross-sectional design. The survey was composed of validated measures.

SETTING AND PARTICIPANTS

Female students at a nursing school.

MAIN OUTCOME MEASURES

PMDD and PMS diagnoses were made using the Premenstrual Symptoms Screening Tool (PSST). Eating behaviors were assessed using the Eating Attitudes Test (EAT-26) and the Three-Factor Eating Questionnaire-Revised 18 (TFEQ-R18).

RESULTS

Of the 504 participants, according to the PSST, 80 (15.9%) met the criteria for PMDD, 222 (44%) had moderate-to-severe PMS, and the remaining 202 (40%) participants showed mild or no premenstrual symptoms. The total EAT-26 scores were significantly higher in the PMDD group than in the other groups (P < .001). According to the cut-off value (20 points) of EAT-26, the total prevalence of disordered eating behaviors was also significantly higher in the PMDD group (45.5%) compared with the moderate-to-severe PMS group (16.5%) and the no/mild PMS group (13.6%) (P < .001). According to the TFEQ-R18 scores, significantly higher scores for emotional eating and uncontrolled eating were found in the PMDD group than in the other groups (P < .001 for each).

CONCLUSIONS

Given that PMDD is defined as a more severe form of PMS with more strict criteria, the findings in this study reflect that as the severity of premenstrual symptoms increase, disordered eating behaviors also increase. To the best of our knowledge, this is the first study to compare eating behaviors among PMDD, moderate-to-severe PMS, and no/mild PMS groups.

Clinical assessment of primary and secondary hypertension in children and adolescents

The aim of this study was to compare the clinical features of patients with elevated blood pressure and to detect variables associated with the diagnosis of primary hypertension. We identified 383 (69%) hypertensive children (197 [51.5%] with primary hypertension, and 186 [48.5%] with secondary hypertension) out of 553 children referred to our clinic with a history of elevated blood pressure. The primary hypertension group was significantly older and had higher BMI, positive family history of hypertension, and lower prevalence of preterm birth compared with those with secondary hypertension. No difference was found between the two groups in terms of the frequency of target organ damage. Multiple regression analysis showed that a family history of hypertension, obesity, age over 10 years, elevated uric acid, and presence of higher systolic blood pressure values at admission were independent predictors of primary hypertension; therefore, these parameters can be considered important clues for diagnosing primary hypertension.

Effect of a Solution-Focused Approach on Self-Efficacy and Self-Esteem in Turkish Adolescents With Attention-Deficit/Hyperactivity Disorder

The aim of the current research was to evaluate the effect of a solution-focused approach on levels of self-efficacy and self-esteem in adolescents with attention-deficit/hyperactivity disorder (ADHD). A mixed design was used, where the quantitative aspect was a randomized controlled study and the qualitative aspect was a case study design. Adolescents with ADHD (N = 41) were randomized into intervention or control groups. Control groups received existing treatment in outpatient clinics, whereas interviews based on a solution-focused approach were conducted with the intervention groups. After the interventions, differences were noted between groups with time, self-efficacy, and self-esteem, with increases in self-efficacy and self-esteem. Significant differences were found between postintervention and follow-up scores. Six themes were determined in the qualitative findings. Nurses in the adolescent mental health field can use the principles and techniques of the solution-focused approach when providing care. [Journal of Psychosocial Nursing and Mental Health Services, 57(11), 45-55.].

An analysis of patients in palliative care with pressure injuries

Aim

The aim of this study was to evaluate the factors that are effective for the treatment, recovery of pressure injury (PI) and costs in palliative care (PC) patients.

Materials and Methods

From a retrospective review of patient records, the PI localization, the presence of infection, PI stage on admission, discharge and treatment costs were recorded. Patients were grouped according to diagnoses, and PI localizations (sacrum, trochanter, ischium, and heel). The comparison was made of changes in wound stage in the groups.

Results

PI was present in all 154 patients during hospitalization and in 94 (61%) on discharge. Full recovery was determined in 52/129 (40.3%) patients with PI in the sacrum, in 23/46 (50%) in the trochanter, in 22/40 (55.0%) in the heel, and in 10/12 (83.3%) in the ischium. Worsening PI stage was observed in 5 (3.9%) in the sacrum, in 1 in the trochanter and in 4 in the heel. Improvement in PI stage was seen in 96 (74.4%) in the sacrum, in 35 (3.9%) in the trochanter, in 27 (50.5%) in the heel, and in 10 (83.3%) in the ischium. Regardless of wound localization, the improvement was observed in 168 (74%) of 227 PI and worsening in 10 (4.4%). The group with no change in the PI stage had prolonged hospital stay and higher costs. The Karnovsky Performance Score and Glasgow Coma Score of fully recovered patients were determined to be higher, and no statistically significant difference was seen in respect of age.

Conclusions

PC patients are prone to PI due to many chronic diseases. The localization of PI and infection are effective factors in the healing of ulcers. The treatment costs for PC patients is higher if they have a pressure ulcer. More comprehensive studies will be useful to clarify the economic and social dimensions of this issue.

The effect of dexketoprofen on ischemia reperfusion injury

OBJECTIVE

The purpose of this study was to demonstrate the effects of dexketoprofen on experimental ischemia/reperfusion injury induced in rat testicles.

METHODS

Twenty-four male Wistar albino-type rats were randomly separated into three groups. To develop testicular torsion, the right testicle was rotated 720° clockwise. After five hours of rotation, reperfusion was applied for 24 hours. The control group rats (Group C) had no procedures or treatments; basal numbers were used. Intraperitoneal 25 mg/kg dexketoprofen (1 cc) (Group D) or the same volume of serum physiologic (Group SP) were given to the Group D and Group SP rats 40 minutes before and 12 hours after detorsion. Twenty-four hours after detorsion, histopathological evaluation was performed by bilateral orchiectomy. Malondialdehyde (MDA) levels were detected in testicular tissue and in serum.

RESULTS

Histopathologic changes in the spermatic cells of torsioned testicles in Group D were significantly less than those of Group SP (p < 0.05). MDA levels in both testicles in Group D were similar to those of the control group. Although they were lower than Group SP, the difference was not statistically significant. Serum MDA levels were lower in Group D compared to the other groups (p < 0.05).

CONCLUSION

We detected that dexketoprofen decreases I/R injury in both the torsion-formed testicle and the contralateral testicle. Thus, in patients who have urgent surgery for testicular detorsion, dexketoprofen can be preferred as an analgesic to reduce I/R injury. Further study is warranted to demonstrate this effect of dexketoprofen (Tab. 3, Fig. 1, Ref. 30).

The effects of granisetron with droperidol or dexamethasone on prevention of postoperative nausea and vomiting after general anesthesia for cesarean section

This prospective, placebo-controlled, double-blinded, and randomized study was undertaken to compare the efficacy of granisetron, droperidol, and combinations of granisetron with droperidol or dexamethasone on postoperative nausea and vomiting in patients undergoing general anesthesia for cesarean section. Patients (n = 150) who were scheduled for cesarean section under general anesthesia were randomly assigned to one of the five groups: physiological saline 5 ml in Group A, granisetron 40 microg/kg + dexamethasone 8 mg in Group B, granisetron 40 microg/kg + droperidol 1.25 mg in Group C, droperidol 1.25 mg in Group D, and granisetron 40 microg/kg in Group E were administered intravenously after clamping of the fetal umbilical cord. Postoperative nausea and vomiting was observed for 024 h after the anesthesia. Cesarean sections were all performed under general anesthesia. Postoperative nausea and vomiting was more common in placebo group (56.7%) than the others during the 0-24 h after the anesthesia (p < 0.05). All granisetron groups were more effective than placebo and droperidol groups during the postoperative 3-24 h (p < 0.01). Although this trial lacks statistical power, granisetron alone and combinations with droperidol or dexamethasone were effective similarly. All treatment groups, except droperidol during the postoperative 3-24 h, were effective for prevention of postoperative nausea and vomiting during the postoperative 0-24 h.

Addition of fentanyl to bupivacaine prolongs anesthesia and analgesia in axillary brachial plexus block

BACKGROUND AND OBJECTIVES

To evaluate the analgesic and anesthetic effects of 40 mL bupivacaine 0.25%, 40 mL bupivacaine 0.25% plus fentanyl 2.5 microg/mL, and 40 mL bupivacaine 0.125% plus fentanyl 2.5 microg/mL for axillary brachial plexus block.

METHODS

Sixty patients were randomly allocated to 3 groups and received axillary brachial plexus block with 40 mL bupivacaine 0.25% (group B), 40 mL bupivacaine 0.25% with fentanyl 2.5 microg/mL (group BF), or 40 mL bupivacaine 0.125% with fentanyl 2.5 microg/mL (group DBF). The onset times and the duration of sensory and motor blocks, duration of analgesia, hemodynamic parameters, and adverse events were noted.

RESULTS

The mean duration of sensory block and analgesia were longer in group BF (10.1 hours and 20.9 hours) than group B (6.9 hours and 11.6 hours) and DBF (5.9 hours and 12.0 hours) (P < .01, P < .001, respectively). The mean duration of motor block was also longer in group BF (10.7 hours) than group B (4.9 hours) (P < .01). Only 2 patients experienced motor block in group DBF. The frequency of successful block was 35% in group DBF (P < .01). Hemodynamic parameters were similar in all groups. In group B, only 1 patient experienced dizziness. Nausea was observed in 1 patient in each fentanyl group.

CONCLUSION

The addition of 100 microg/mL fentanyl to 0.25% bupivacaine almost doubles the duration of analgesia following axillary brachial plexus block when compared with 0.25% bupivacaine alone.

Complicated airway management in a child with prune-belly syndrome

We describe a 15-month-old boy with prune-belly syndrome (PBS) in whom airway management was complicated. Following an inhalation induction using sevoflurane, tracheal intubation by direct laryngoscopy proved impossible after repeated attempts. A laryngeal mask airway (LMAtrade mark) was inserted and the child had an uneventful anaesthetic course.

Comparison of midazolam with or without fentanyl for conscious sedation and hemodynamics in coronary angiography

OBJECTIVE

To compare the hemodynamic and sedative effects of midazolam - with or without fentanyl combination - with placebo in coronary angiography.

DESIGN

Prospective, double-blind, randomized study.

SETTING

University medical centre.

PATIENTS

All patients undergoing coronary angiography.

INTERVENTIONS

Demographic data, hemodynamic variables, sedation and anxiety scores, amnesia, patient and cardiologist satisfaction, and adverse effects were evaluated and compared among coronary angiography patients taking midazolam, midazolam and fentanyl, or placebo before the procedure.

MAIN RESULTS

Ninety patients scheduled for coronary angiography were randomly assigned into three groups: a midazolam-placebo group (group MP), a midazolam-fentanyl group (group MF) and a placebo group (group P). Hemodynamic stability was better in each sedation group (groups MP and MF) than in group P. Sedation scores, anxiolysis, and patient and cardiologist satisfaction were not different between the sedation groups.

CONCLUSIONS

Both techniques of conscious sedation - midazolam and midazolam with fentanyl - are satisfactory for coronary angiography where hemodynamic stability and patient cooperation are required. In such procedures, local anesthesia without sedation may lead to hypertension and increase overall morbidity.

Brachial plexus injury during subclavian vein catheterization for hemodialysis

Although the subclavian vein is often used for placement of double-lumen hemodialysis catheters, the risk factors for complications for the patients with chronic renal failure are underestimated. We report a case of a patient with chronic renal failure in whom brachial plexus injury was caused by both a compressive hematoma and direct insertion of a needle resulting from a subclavian vein catheterization attempt for hemodialysis. This case emphasizes the need for determining the coagulation status of the patient especially with chronic renal failure before performing invasive procedures.

Acute normovolemic hemodilution and nitroglycerin-induced hypotension: comparative effects on tissue oxygenation and allogeneic blood transfusion requirement in total hip arthroplasty

STUDY OBJECTIVES

To study the comparative effects of acute normovolemic hemodilution and nitroglycerin-induced hypotension on tissue oxygenation and blood transfusion requirement.

DESIGN

Prospective, randomized study.

PATIENTS

30 ASA physical status I and II patients scheduled for primary total hip arthroplasty.

INTERVENTIONS

Patients were randomized to one of three groups of 10 patients each, to receive acute normovolemic hemodilutin (Group 1) or nitroglycerin-based hypotension (Group 2); Group 3 served as the control group. In Group 1, 2 U of blood was collected and replaced with an equal volume of hydroxyethyl starch (200/0.56%) immediately after anesthesia induction. In Group 2, nitroglycerin was infused at a rate sufficient to reduce mean arterial pressures to 60 to 65 mmHg before initiation of surgery. When hematocrit was reduced to 25%, at first autologous blood and then, if necessary, allogeneic blood was transfused to Group 1, and allogeneic blood was transfused to the other two groups, until hematocrit reached 30% for 5 days postoperatively.

MEASUREMENTS AND MAIN RESULTS

Total transfused allogeneic units of blood were determined by the fifth postoperative day. Arterial oxygen content (CaO2), venous oxygen content (CvO2), and oxygen extraction ratios (EO2) were calculated by standard formulas. The mean allogeneic transfusion requirement was significantly lower in Group 1 (1.3 +/- 0.8 U) than in Group 2 (2.3 +/- 0.8 U) or Group 3 (2.7 +/- 1.1 U) (p < 0.05). In Group 1, CaO2 and CvO2 were decreased at all times, but EO2 was significantly increased from 15 +/- 3.9% to 33.3 +/- 5.3% (p < 0.001). As for the other two groups, although CaO2 and CvO2 were decreased, EO2 was not significantly increased.

CONCLUSIONS

Acute normovolemic hemodilution is more effective than nitroglycerin-induced hypotension in reducing allogeneic blood transfusion requirement in total hip replacement surgery, without significant metabolic changes.