Patient perspectives about multiple sclerosis: A metaphor study

AIM

Determining patients' perceptions of multiple sclerosis, a disease with varying symptoms and prognosis for each individual, can significantly contribute to directing care and treatment. Metaphors may be an opportunity to determine perceptions of this unique illness experience. The aim of this study was to reveal the perceptions of patients with multiple sclerosis about "multiple sclerosis" through metaphors.

METHODS

This study was conducted with metaphor analysis technique based on phenomenological method. The sample included 184 patients with multiple sclerosis. Data was collected face-to-face between July 2022 and January 2023. Each participant was interviewed individually and was asked to fill in the blanks in the sentence, "multiple sclerosis is like… because…". Content analysis was performed for metaphors.

RESULTS

The study revealed five main themes and twelve subthemes that provided insight into the participants' multiple sclerosis perceptions. The themes address (i) Manipulator multiple sclerosis; ambiguous multiple sclerosis, attritive multiple sclerosis, controller multiple sclerosis, demander multiple sclerosis, and conditional multiple sclerosis (ii) Temporal multiple sclerosis; cyclical multiple sclerosis and perpetual multiple sclerosis (iii) Follower multiple sclerosis; unaccepted multiple sclerosis, partner multiple sclerosis and ambusher multiple sclerosis (iv) Different multiple sclerosis; bittersweet multiple sclerosis and unique multiple sclerosis (v) Restorative multiple sclerosis.

CONCLUSION

This study demonstrated that patients with multiple sclerosis mostly had negative perceptions regarding their relationship with multiple sclerosis. The results place a responsibility on healthcare professionals to improve how patients adapt to multiple sclerosis. This study's results can bridge theoretical knowledge and practice.

Nursing students' exposure to violence in clinical practice and violence management competence levels

INTRODUCTION

The violence nursing students experience in the clinic may affect their attitudes towards the profession.

AIM

This study was conducted to determine nursing students' exposure to violence during their clinical practice and their violence management competence levels.

DESIGN

This was a two-centred, descriptive, and correlational study.

PARTICIPANTS

A total of 512 nursing students from two universities in Türkiye participated in this study.

METHODS

The study data was collected between March and April 2023 with the Student Information Form, Violence Exposure Form, and Management of Workplace Violence Competence Scale for Nursing Students. Institutional permission and ethics committee approval were obtained before starting the study (Date: 05/01/2023, No: 50). Descriptive statistics, Mann-Whitney U test, Kruskal Wallis test and linear regression analysis were used to evaluate the data. Statistical significance was accepted as p < 0.05.

RESULTS

It was determined that 17.4 % (n = 89) of the participant students felt competent in managing violence, and 94.3 % (n= 483) were concerned about being exposed to violence at various levels. In these results, 20.5 % (n = 105) of them were exposed to violence during clinical practice, 60.9 % (n = 64) of whom experienced verbal violence and 52.3 % (n = 55) psychological violence. The total mean score from the violence management competence scale was 103.29 ± 16.64. No statistically significant difference was found between the scale total and subscale scores according to gender (p > 0.05). The scale total scores of fourth-grade students with a good perceived academic success and who received training on coping with violence were statistically significantly higher (p˂0.05). The regression model created between the scale score and students' perceived academic success and receiving white code training (Training on the use of the alarm system that will enable security guards to reach the scene as soon as possible in cases where healthcare workers are exposed to all kinds of violence.) was statistically significant (F = 23.108, p < 0.001).

CONCLUSION

Some of the students participating in the study experienced violence in clinical practices. Their violence management competence levels were good. It can be said that academic success, coping with violence, and white code training are useful in increasing competence levels.

Verbal violence and missed nursing care: A phenomenological study

AIM

To define the missed care experiences of nurses exposed to verbal violence from patients.

BACKGROUND

Verbal violence takes the first place among the types of violence that nurses face in healthcare settings. This can cause negative emotional and physical responses in nurses and issues in patient and nurse interaction. As a result, it may lead to missed nursing care, defined as skipped, postponed or incomplete care during the patient's care.

METHODS

This is a phenomenological study. The study sample included 16 nurses working in inpatient clinics who reported experiencing verbal violence at least once in Turkey. The study was conducted between January and February 2022 with institutional permission and ethics committee approval (09/12/2021-2021/357). A semi-structured interview method was used to collect data. The information gathered from the interviews underwent thematic analysis using an inductive approach. The 'Consolidated Criteria for Reporting Qualitative Research (COREQ)' was used to report this qualitative study based on a comprehensive protocol.

RESULTS

The types of verbal violence most frequently faced by nurses were determined as swearing, insulting, shouting and threats. Study findings were classified into three main themes: (i) response to verbal violence, (ii) missed nursing care experiences and (iii) suggestions to cope with verbal violence. The most felt emotions in the face of verbal violence were feeling sad, unsafe and worthless. Nurses common behaviours, in response to verbal abuse were ignoring, getting used to, and wishing to get away. The examples of missed care included using non-therapeutic communication, postponing care or withdrawing from care.

CONCLUSION

Verbal violence caused negative emotional and behavioural responses in nurses, which, in turn, negatively affected the nurse-patient interaction. These findings mean that verbal violence may pave the way for missed nursing care.

IMPLICATIONS FOR NURSING POLICY

According to these findings, an uninterrupted nursing care process needs to focus on preventive measures against verbal violence and increase the administrative and legal support offered to nurses.

Investigation of pain associated with endotracheal aspiration and affecting factors in an intensive care setting: A prospective observational study

BACKGROUND

Endotracheal aspiration is a painful nociceptive procedure. There is still a gap in the literature on studies to determine the pain level and nursing interventions for aspiration.

OBJECTIVES

This study evaluated pain during endotracheal aspiration and examined the factors affecting pain.

METHODS

This prospective observational study was conducted with 105 inpatients meeting the inclusion criteria in the internal intensive care unit of a public hospital. Two hundred ten aspiration procedures were monitored for pain and other variables. ASPMN 2019 Position Statement recommendations were followed in designing the study and determining the procedure. The pain score range obtained from The Critical Care Pain Observation Tool was 0-8. A score of 2 or more is considered to indicate the presence of pain. The primary outcome measures were pain associated with endotracheal aspiration and affecting factors in this study. The generalised linear mixed model established for aspiration procedure-associated pain and affecting factors was analysed.

RESULTS

Patients' mean pain score was 1.24 ± 2.05 before, 3.07 ± 2.17 during, and 2.35 ± 1.94 after aspiration and 0.89 ± 1.40 at 15 min after aspiration. The pain rate was 26.1% before, 71% during, and 60.9% after the aspiration procedure and 18.8% after 15 min. There was a statistically significant difference between all pain scores evaluated. The difference in aspiration-related pain scores by age, respiratory diseases, sedation status, aspiration pressure, and tube diameter was statistically significant.

CONCLUSIONS

The pain score due to aspiration procedure increased significantly in intensive care unit inpatients and is an important risk factor for patient safety. More focus is needed on the causes and measures of aspiration-related pain.

A content validity, reliability and quality analysis of peripheral intravenous catheterization videos on YouTube™

BACKGROUND

YouTube™ has become a potential way to integrate technology into nursing curriculum and acquire skills. However, it is important to review the accuracy of the information contained in YouTube™. This study was conducted to evaluate the content validity, reliability and quality of YouTube™ videos on peripheral intravenous catheterization.

METHODS

In this descriptive study, videos were searched using the keyword 'Peripheral Venous Catheter'. The content validity, reliability and quality of the videos were evaluated using the 'Peripheral Intravenous Catheterization Insertion Skill Form', 'DISCERN Questionnaire', 'Global Quality Scale', respectively. These videos were categorized by their theme, upload source, technical features and analysed statistically.

RESULTS

Of the 48 videos, 38 (79.2%) classified as an useful video, 24 (50%) were uploaded by medical educational platforms and 28 (58.3%) had an average technical feature. There was a statistically significant difference between the reliability, quality, content validity scores by the video theme (p < 0.05). The content validity, reliability and quality score of useful videos were higher than misleading videos. In addition, pairwise comparisons indicated that there was a statistically significant difference between the content validity, reliability and quality scores of Peripheral Intravenous Catheterization demonstrated on a person or a mannequin were higher than those applied with ultrasonography (p < 0.05).

CONCLUSIONS

As a result of the reviewing of the videos, it was determined that these videos provided useful content. Despite this positive result, some videos provide risky information for patient safety due to issues such as ignoring the asepsis principles and not including proper Peripheral Intravenous Catheterization steps. It may be recommended to consider the Peripheral Intravenous Catheterization steps and patient safety principles in international guidelines in the preparation of videos showing the Peripheral Intravenous Catheterization insertion.

Turkish version of the 5-item Compassion Measurement Tool: A validity and reliability study

The aim of this methodological study with a cross-sectional design study was to examine the validity and reliability of the Turkish form of the 5-item Compassion Measurement Tool. The sample was 402 patients in a university hospital. The Content Validity Index was 0.96. Total item correlation values were between 0.559 and 0.685. Cronbach's alpha coefficient was 0.83. The scale could be used as five items, under a single factor as in the original version. A high correlation was found between patients' compassion perception and nursing care satisfaction scores. Turkish version of the 5-item Compassion Measurement Tool is a valid and reliable tool.

Nurse manager intentional rounding and outcomes: Findings of a systematic review

AIM

To summarize the evidence available on Nurse Manager Intentional Rounding (NMIR) describing the main characteristics and methodological quality of studies available, the features of rounding and the outcomes as measured to date.

DESIGN

A systematic review.

DATA SOURCES

Electronic databases, including MEDLINE-EBSCHOST, PubMed, CINAHL, Scopus, Cochrane, Clinicalkey, ScienceDirect, OVID, Sage Journals and Web of Science, were searched up to June 2021.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guideline was used to summarize methods and report findings. The Joanna Briggs Institute Critical Appraisal tools were used to evaluate the methodology quality of the studies included.

RESULTS

Seven studies were included with pre-post-test (n = 3), longitudinal, two-group post-tests, quasi-experimental, and retrospective study designs (n = 1, respectively). In five studies, the nurse managers were trained to conduct the rounding, which was shaped according to three main features: a structured (n = 4), a semi-structured (n = 1) and an unstructured rounding (n = 2) delivered from high (twice a day 7/7) to low intensity (once a day, 5/7). Two main outcomes have been measured to date, the patient satisfaction and some aspects related to the care quality. Five studies reported that the satisfaction scores of patients who received rounding were significantly higher than that perceived by patients not receiving rounding. About the other aspects of the quality of care, two studies documented significant improvements as a consequence of the NMIR (e.g. information accessibility, discharge instructions, coordination of care after discharge).

CONCLUSION

Studies available report in general a low methodological quality, mainly due to their pragmatic nature as quality improvement projects. Therefore, transforming this field of research by establishing a methodological rigour and a theoretical foundation in both interventions and outcomes and by designing experimental approaches, might expand the evidence available on the effects of nurse managers intentional rounding.

A systematic review: Unfinished nursing care and the impact on the nurse outcomes of job satisfaction, burnout, intention-to-leave and turnover

AIM

To investigate the association of unfinished nursing care on nurse outcomes.

DESIGN

Systematic review in line with National Institute for Health and Care Excellence guideline.

DATA SOURCES

CINAHL, the Cochrane Library, Embase, Medline, ProQuest and Scopus databases were searched up until April 2020.

REVIEW METHODS

Two independent reviewers conducted each stage of the review process: screening eligibility, quality appraisal using Mixed Methods Appraisal Tool; and data extraction. Narrative synthesis compared measurements and outcomes.

RESULTS

Nine hospital studies were included, and all but one were cross-sectional multicentre studies with a variety of sampling sizes (136-4169 nurses). Studies had low internal validity implying a high risk of bias. There was also a high potential for bias due to non-response. Only one study explicitly sought to examine nurse outcomes as a primary dependent variable, as most included nurse outcomes as mediating variables. Of the available data, unfinished nursing care was associated with: reduced job satisfaction (5/7 studies); burnout (1/3); and intention-to-leave (2/2). No association was found with turnover (2/2).

CONCLUSION

Unfinished nursing care remains a plausible mediator of negative nurse outcomes, but research is limited to single-country studies and self-reported outcome measures. Given challenges in the sector for nurse satisfaction, recruitment and retention, future research needs to focus on nurse outcomes as a specific aim of inquiry in relation to unfinished nursing care.

IMPACT

Unfinished nursing care has previously been demonstrated to be associated with staffing, education and work environments, with negative associations with patient outcomes (patient satisfaction, medication errors, infections, incidents and readmissions). This study offers new evidence that the impact of unfinished nursing care on nurses is under investigated. Policymakers can prioritize the funding of robust observational studies and quasi-experimental studies with a primary aim to understand the impact of unfinished nursing care on nurse outcomes to better inform health workforce sustainability.

Nursing students' perceptions of nursing diagnoses, critical thinking motivations, and problem-solving skills during distance learning: A multicentral study

PURPOSE

To determine the relationship between attitude towards nursing diagnosis, critical thinking motivation, and problem-solving skills of nursing students during distance learning.

METHOD

The descriptive and correlational study was conducted with 450 first-year nursing students from four universities. The "Positions on Nursing Diagnosis Scale," "Critical Thinking Motivational Scale," and "Problem Solving Inventory" were used for data collection in June-July 2021.

FINDINGS

The students' mean score of nursing diagnosis perception was 114.90 ± 18.47, the score for expectancy main subdimension of critical thinking motivation was 4.17 ± 1.16 and the score for value main subdimension was 4.81 ± 1.12, and score for problem-solving skills was 90.65 ± 19.03. A statistically significant positive correlation was found between nursing diagnosis perception and subdimension of critical thinking motivation scores (p < 0.001) and problem-solving skills score (p < 0.001). The linear regression model established to examine the effect of other scales on nursing diagnosis perception was found to be statistically significant (F = 17.516, p < 0.001). As the expectancy score increases by one unit, the perception of nursing diagnosis score increases 3.452 times (p = 0.001), the cost score increases by one unit, the perception of nursing diagnosis score increases by 3.894 (p = 0.001), and the problemsolving skills score increases by one unit, the perception of nursing diagnosis score decreases by 0.246 (p < 0.001).

CONCLUSIONS

To conclude that nursing diagnosis perception, critical thinking motivation, and problem-solving skills of nursing students were high and have a relationship with each other during distance education. As nursing diagnosis perception scores of students increase, their critical thinking motivation and problem-solving skills also increase.

IMPLICATIONS FOR NURSING PRACTICE

The high skills of critical thinking and problem solving have an important place effectively to identify the nursing diagnosis more quickly and easily in the nursing care process.

Youtube videos as an educational resource for ventrogluteal injection: A content, reliability and quality analysis

BACKGROUND

YouTube has become an important social media platform for teaching nursing skills. However, the content, reliability and quality levels of the videos on this platform are not adequately known.

OBJECTIVES

This study aims to evaluate the content, reliability and quality of YouTube videos on ventrogluteal injection application.

DESIGN

Descriptive.

SETTINGS

Online.

PARTICIPANTS

26 videos about ventrogluteal injection.

METHODS

Videos were searched using the keyword "ventrogluteal injection". The content of the 26 videos meeting the inclusion criteria were evaluated using the "Ventrogluteal Intramuscular Injection Skill Form", the reliability with the "DISCERN Questionnaire", and the quality levels using the "Global Quality Scale". The videos were categorized by their theme, type and upload source, and analysed statistically.

RESULTS

Of the 26 videos meeting the inclusion criteria, 21 (80.8%) were classified as useful information, 5 (19.2%) as misleading information by theme, 22 (84.6%) as educational, 4 (15.4%) as hormone therapy by type, 5 (19.2%) as official institutions, 13 (50%) as individual by source of uploads. The content, reliability, quality score of useful videos were higher than misleading videos. There was a significant difference (p < 0.05) between reliability score and the source of video uploads. Pairwise comparisons indicated that there was no statistically significant difference (p > 0.05) between the source of uploads of video and characteristics.

CONCLUSIONS

The use of the examined YouTube videos in the training of injection into the ventrogluteal site appears to have various risks in terms of ethics and patient safety. It may be suggested that the injection videos should be prepared by competent institutions/individuals, using best practice guides to increase the content, reliability and quality levels. It should particularly be borne in mind that videos on hormone therapy can be a public health threat.

Social Jetlag in adolescents: From a nursing perspective

PROBLEM

Social Jetlag (SJL) is a condition leading to many important physical, mental, behavioral, and cognitive problems in adolescents.

METHODS

The sample of this study, which used a descriptive and correlational design, consisted of 247 high school students. The SJL parameters were informed by the literature, while chronotype was identified using the Morningness-Eveningness Scale for Children. The factors associated with SJL were determined using a structured questionnaire.

FINDINGS

Students' SJL value was 2 h 10 min ± 01:11. As students' tendency to be an evening chronotype increased, the SJL value increased, as well (r = -0.472; p < 0.001). In terms of SJL, student's grade level (β = -0.167; p = 0.004) and chronotype (β = -0.438; p < 0.001) were a negative risk factor, while spending time in bed with TV/computer/smartphone before sleeping (β = 0.127; p = 0.031) was a positive risk factor.

CONCLUSIONS

The students had a high SJL value. The results might be useful for nurses to develop intervention strategies to improve adolescents sleep habits.

Reliability and validity of the Turkish version of the Barriers to Nurses' Use of Physical Assessment scale

AIM

This study aimed to translate the Barriers to Nurses' Use of Physical Assessment Scale into Turkish and assess the new version's validity and reliability.

METHODS

This was a methodological study to verify the linguistic equivalence of the scale through the translation/back-translation method. Twelve experts in health assessment confirmed the scale's content validity. Along with the Barriers to Nurses' Use of Physical Assessment Scale, an information form, including socio-demographic features, was distributed to 380 nurses, who consented to participate in the research. Data were collected between July 2017 and April 2018. Internal consistency, factor analysis and test-retest reliability were used to determine consistency over time and intraclass correlations.

RESULTS

The content validity index of the scale (0.963) was calculated following confirmation of its language equivalence. With the confirmatory factor analysis, it was determined that the fit index values were at an acceptable level and the model was suitable. The factor analysis clustered factors in seven domains. The overall internal consistency coefficient was 0.822. All subscales and the overall scale showed high intraclass correlations.

CONCLUSION

The Turkish version of the Barriers to Nurses' Use of Physical Assessment Scale is a valid and reliable instrument.

SUMMARY STATEMENT

What is already known about this topic? Nursing assessment is a critical step in the nursing process. A holistic and systematic approach is key to improving the quality of nursing care, which may be hindered by barriers to the performance of physical assessment. Several international studies have examined the barriers encountered by nurses; however, there is a lack of both instruments and research on this subject in Turkish literature. What this paper adds? The findings confirmed that the Turkish version of the Barriers to Nurses' Use of Physical Assessment Scale is a valid and reliable instrument and can be used to determine the barriers to nurses' ability to perform physical assessments. Nurses and clinic managers will be able to use the scale to identify the factors preventing assessment and develop strategies to overcome them. The questionnaire can help eliminate assessment barriers to create an effective and systematic assessment environment. The implications of this paper: Nurses and clinical managers should work together to identify and eliminate assessment barriers. Barriers to nurses' use of physical assessments can be objectively identified through a valid and reliable tool, providing opportunities for the elimination of such barriers and the development of nursing assessment activities.

The Effect of Active Warming on Postoperative Hypothermia on Body Temperature and Thermal Comfort: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to determine the effect of active warming method in temperature control and thermal comfort in hypothermia after surgery.

DESIGN

A randomized controlled trial.

METHODS

The study sample consisted of 64 male and female postanesthesia care unit and intensive care unit neurosurgery postoperative inpatients. The experimental group was warmed using the active warming method, and the control group's routine care was continued via a cotton blanket. Patients were warmed until their tympanic body temperature reached 37°C.

FINDINGS

The time needed to adequately warm patients was approximately twice as short in those who received active warming as compared with the control group. The perception of thermal comfort was significantly higher in the first hour in patients who received the active warming method (P < .05).

CONCLUSIONS

The active warming method resulted in a shorter time to warming in hypothermia after surgery and an increase in the perception of thermal comfort and body temperature.

[Investigation of the Relationship between Empathy and Burnout Levels of Nursing Students]

Amaç

Bu araştırma, hemşirelik öğrencilerinin empati ve tükenmişlik düzeyleri arasındaki ilişkiyi belirlemek amacı ile planlandı.

Yöntem

Tanımlayıcı ve kesitsel türde gerçekleştirilen araştırmanın evrenini bir Hemşirelik Fakültesi’nde 2016–2017 eğitim-öğretim yılında öğrenim gören 1294 öğrenci; örneklemini ise; tabakalı rastgele örnekleme yöntemi ile belirlenen 290 hemşirelik öğrencisi oluşturdu. Veriler, “Yapılandırılmış Soru Formu”, “Empatik Beceri Ölçeği B-Formu” ve “Maslach Tükenmişlik Envanteri-Öğrenci Formu” kullanılarak toplandı. Araştırmanın yürütüleceği fakülteden yazılı izin ve Etik Kurul’dan etik onay sağlandı. Veri analizi, SPSS 21.00 programında, tanımlayıcı ve önemlilik analizi kullanılarak yapıldı.

Bulgular

Öğrencilerin %84.1’i kız, yaş ortalaması 20.28±1.47 yıldır. Empatik Beceri Ölçeği B-Formu puan ortalaması 143.86±23.93; Maslach Tükenmişlik Envanteri-Öğrenci Formu alt boyutları puan ortalamaları ise tükenmede 15.11±4,69, duyarsızlaşmada 9.34±3.62, yetkinlikte ise 12.78±2.67 olduğu saptandı. Öğrencilerin Empatik Beceri Ölçeği puanı ile Maslach Tükenmişlik Envanteri Duyarsızlaşma alt boyutu puanları arasında istatistiksel olarak anlamlı düzeyde negatif bir ilişki bulunmaktadır (p<0.05).

Sonuç

Hemşirelik öğrencilerinin tükenmişlik ve empati becerilerinin orta düzeyde olduğu ve bazı sosyo-demografik özelliklerin empati ve tükenmişlik düzeylerini etkilediği belirlendi.

Delirium assessment in intensive care units: practices and perceptions of Turkish nurses

BACKGROUND

As delirium in intensive care unit (ICU) patients is a serious problem that can result in increased mortality and morbidity, routine delirium assessment of all ICU patients is recommended. The severity, duration and outcome of the syndrome are directly related to nurses' continuous assessment of patients for signs and symptoms of delirium. However, studies indicate that very few nurses monitor for delirium as a part of their daily practices.

AIM

The aim of this study was to identify current practices and perceptions of intensive care nurses regarding delirium assessment and to examine the factors that affect these practices and perceptions.

DESIGN

A descriptive, correlational study design was used.

METHODS

Data were collected from five Turkish public hospitals using a structured survey questionnaire. The study sample comprised 301 nurses who agreed to participate. Data were analysed using descriptive statistics.

RESULTS

More than half of the nurses performed delirium assessments. However, the proportion of nurses who use delirium assessment tools was quite low. Almost all of the nurses perceived delirium as a problem and serious problem for ICU patients. The patient group least monitored for delirium was that of unconscious patients. Statistically significant differences were found in the proportion of nurses who assessed delirium symptoms and whose care delivery system was patient-centred and perceived delirium as a serious problem.

CONCLUSION

While a majority of ICU nurses perceived delirium as a problem and serious problem, the proportion of those who perform routine delirium assessments was less. It was found that delirium assessment practices of nurses were affected from their perceptions of delirium and the implementation of patient-centred care delivery.

RELEVANCE TO CLINICAL PRACTICE

It is essential to develop strategies to encourage ICU nurses to perform delirium assessments through the use of delirium assessment tools.