Leyla Khorshid

The effect of music therapy on physiological signs of anxiety in patients receiving mechanical ventilatory support

AIMS The aim of this study was to investigate if relaxing music is an effective method of reducing the physiological signs of anxiety in patients receiving mechanical ventilatory support. BACKGROUND Few studies have focused on the effect of music on physiological signs of anxiety in patients receiving mechanical ventilatory support. DESIGN A study-case-control, experimental repeated measures design was used. METHOD Sixty patients aged 18-70 years, receiving mechanical ventilatory support and hospitalised in the intensive care unit, were taken as a convenience sample. Participants were randomised to a control group or intervention group, who received 60 minutes of music therapy. Classical music was played to patients using media player (MP3) and headphones. Subjects had physiological signs taken immediately before the intervention and at the 30th, 60th and 90th minutes of the intervention. Physiological signs of anxiety assessed in this study were mean systolic and diastolic blood pressure, pulse rate, respiratory rate and oxygen saturation in blood measured by pulse oxymetry. Data were collected over eight months in 2006-2007. RESULTS The music group had significantly lower respiratory rates, and systolic and diastolic blood pressure, than the control group. This decrease improved progressively in the 30th, 60th and 90th minutes of the intervention, indicating a cumulative dose effect. CONCLUSION Music can provide an effective method of reducing potentially harmful physiological responses arising from anxiety. RELEVANCE TO CLINICAL PRACTICE As indicated by the results of this study, music therapy can be supplied to allay anxiety in patients receiving mechanical ventilation. Nurses may include music therapy in the routine care of patients receiving mechanical ventilation.

The effects of pelvic floor muscle training on stress and mixed urinary incontinence and quality of life.

OBJECTIVE To evaluate the effects of pelvic floor muscle (PFM) training on urinary incontinence (UI) and quality of life in women diagnosed with stress or mixed UI. DESIGN We completed a parallel group, randomized clinical trial evaluating the effectiveness of PFM training in women with stress or mixed UI. SETTINGS AND PARTICIPANTS We recruited consecutive cases of women with stress or mixed UI from outpatient urology clinics attached to a county hospital and a university hospital in Izmir, Turkey. METHODS After baseline evaluation, 41 women were randomly assigned to either the PFM training group or the control group. Muscle training included 3 sets of daily fast and slow contractions in lying, sitting, and standing positions. Participants were also taught the knack. The intervention period was 8 weeks, and the women in the exercise group telephoned once a week to provide motivation. The untreated control group had no contact during the intervention period. Outcome measures were Incontinence Quality of Life (I-QOL) Questionnaire, episodes of leakage in 3-day bladder diary, 1-hour pad test, and PFM strength. RESULTS Thirty-four women completed the trial. The mean age of women was 41.82 ± 8.65 years in the exercise group and 44.64 ± 6.90 years in the control group. The 2 groups were statistically similar regarding key demographic and clinical characteristics. After 8 weeks, significant differences in the 1-hour pad test, episodes of leakage in 3-day bladder diary, PFM strength, and I-QOL scores (P = .01) were noted when participants in the PFM training group were compared to control group participants. CONCLUSION An 8-week trial of PFM training significantly increased PFM strength, improved quality of life, and reduced the frequency of UI episodes.

Effectiveness of the auscultatory and pH methods in predicting feeding tube placement

AIMS AND OBJECTIVES This study was designed to determine the effectiveness of the auscultatory and pH methods in predicting feeding tube location in critically ill patients. BACKGROUND There is confusion about how nurses should asses feeding tubes location at the bedside. The most common method for determining tube location is the auscultatory method. It is known that auscultation is an unreliable method and additional data relating to bedside methods are needed to assist nurses in making a decision regarding tube location. DESIGN A methodological study. METHODS The sample consisted of 44 new insertions of feeding tubes. Data from a total of 44 auscultations relating to tube position and gastrointestinal aspirates for pH were obtained from 32 critically ill adult patients ranging in age from 38-87 years. Results from the auscultatory and pH tests were compared with the location of the tube as determined by radiography. A total of 44 feeding tube applications were investigated using the auscultatory and pH methods and concurrently with X-rays to determine the feeding tube position. Nurses used the auscultatory method to predict tube position, a concurrent researcher aspirated fluid from the feeding tube, and samples were tested for pH within five minutes of radiographs taken to determine tube location. pH was measured with a test strip. RESULTS Mean pH level in the gastrointestinal aspirates was 4.23 (SD 1.20). Approximately 89% of the pH strip readings from gastrointestinal fluid were between 0-5. A pH of <5 successfully identified 90.4% of the 44 feeding tube cases. CONCLUSION The pH method is effective in determining the feeding tube position, but the auscultatory method is not effective in determining the feeding tube position. RELEVANCE TO CLINICAL PRACTICE Simple bedside assessment of gastrointestinal aspirate pH is useful for predicting feeding tube position.

Examination of Nursing Diagnoses Used by Nursing Students and Their Opinions About Nursing Diagnoses

PURPOSE This study was planned as a descriptive study for the purpose of determining what nursing diagnoses are used by nursing students and their opinions about nursing diagnoses. METHODS The response rate was 70% (n= 346). Research data about the nursing diagnoses students used and their opinions about them were collected on a semi-structured questionnaire developed by the researchers after reviewing related information in the literature. FINDINGS Of the students, 76.9% knew what nursing diagnosis was, but 31.5% had difficulty stating patient care needs as nursing diagnoses. CONCLUSIONS The majority of students in this study agreed that nursing diagnoses are a priority subject in the nursing profession, that nursing diagnoses needed to be used on the wards, and that nursing diagnoses needed to be documented in medical records on the wards. IMPLICATIONS FOR NURSING PRACTICE It is recommended that nursing diagnoses be given more concentration in the nursing curriculum and that courses about nursing diagnoses be prepared for the purpose of giving students more detailed information.

The effect of 2 different care products on incontinence-associated dermatitis in patients with fecal incontinence.

PURPOSE: We compared the effects of 2 devices used to contain fecal incontinence—a perianal pouch and adult containment brief—on the incidence of incontinence-associated dermatitis (IAD). DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The sample was drawn from patients hospitalized in the neurology and neurosurgery wards of a large university hospital in Turkey. Thirty bedridden subjects with fecal incontinence and indwelling urinary catheters participated in the study. Subjects were randomly allocated to treatment with a perianal pouch (n = 15) or adult containment brief (n = 15). METHODS: Routine hygiene was completed once daily and repeated whenever the perineal area was found to be soiled. Perineal skin integrity was evaluated daily during skin care. Data were collected using a Patient Identification Form, a Patient Observation Form, and a Perineal Skin Integrity Assessment Form. RESULTS: The mean number of products used on a daily basis by patients with a perianal pouch was 5.80, as compared to 5.46 by patients with adult incontinence briefs. IAD occurred in 66.7% of patients in the perianal pouch group and in 100% of subjects managed by containment briefs, a statistically significant difference (&khgr;2 = 6.0, P = 0.04). The onset of IAD occurred later in subjects allocated to management with a perianal pouch than in patients using adult containment briefs (U = 30.500, P = 0.011). IAD involved an average of 1.8 areas among patients managed with a perianal pouch, as compared to 2.3 areas in patients managed with adult containment briefs (P = NS). CONCLUSION: Management of bedridden patients with fecal incontinence with a perianal pouch reduced the incidence of IAD and delayed to time to onset when compared to management with adult containment briefs. We recommend use of perianal pouches for prevention of IAD in bedridden patients with fecal incontinence.

A comparison of the effects of a special gynaecological garment and music in reducing the anxiety related to gynaecological examination

AIM AND OBJECTIVES To investigate the effect of a special gynaecological garment and music plus the special gynaecological garment on reducing the state anxiety related to gynaecological examination. BACKGROUND Gynaecological examination is one of the most common anxiety-producing medical procedures and causes embarrassment and discomfort. Few studies have focused on the effect of a gynaecological garment on anxiety associated with gynaecological examinations. DESIGN The patients were allocated to one of three groups, one control and two experimental. While the patients in the control group were subjected to the normal outpatient procedure, the patients in the first experimental group were dressed in a special gynaecological garment. In the control group, gynaecological examinations were performed with a traditional one-piece drape. In addition to wearing the special gynaecological garment, the women in the garment + music group listened to music during the gynaecological examination. The State Anxiety Inventory Form was applied to the patients in all three groups before and after gynaecological examination. RESULTS The state anxiety level after gynaecological examination in patients in the control group was found to be higher, but it was found to be lower in patients in both the first experimental group (garment) and the second experimental group (garment + music). The state anxiety level was found to be more reduced in the experimental groups than in the control group. The state anxiety level after gynaecological examination was found to be higher in single patients in the second experimental group. CONCLUSION The special gynaecological garments are effective in reducing the state anxiety associated with gynaecological examination. RELEVANCE TO CLINICAL PRACTICE It should be taken into consideration that women perceived state anxiety during the gynaecological examinations. To allay anxiety associated with gynaecological examination in women, a special garment may be considered.

Comparison of oxygen saturation values and measurement times by pulse oximetry in various parts of the body

The aim of this study, which included 40 patients, was to compare the values pulse oximetry and the measurement times in various regions of the body. Data were analyzed using intraclass correlation coefficient test and paired-sample test. The confidence power value was found to be .81 for the comparison of oxygen saturation values by arterial blood gas analysis and measurement by the forehead probe. It was found that the time for oxygen saturation measurement using the forehead probe was shorter than those using the finger and toe probes.

Reflexology: its effects on physiological anxiety signs and sedation needs.

To investigate whether reflexology has an effect on the physiological signs of anxiety and level of sedation in patients receiving mechanically ventilated support, a single blinded, randomized controlled design with repeated measures was used in the intensive care unit of a university hospital in Turkey. Patients (n = 60) aged between 18 and 70 years and were hospitalized in the intensive care unit and receiving mechanically ventilated support. Participants were randomized to a control group or an intervention group. The latter received 30 minutes of reflexology therapy on their feet, hands, and ears for 5 days. Subjects had vital signs taken immediately before the intervention and at the 10th, 20th, and 30th minutes of the intervention. In the collection of the data, “American Association of Critical-Care Nurses Sedation Assessment Scale” was used. The reflexology therapy group had a significantly lower heart rate, systolic blood pressure, diastolic blood pressure, and respiratory rate than the control group. A statistically significant difference was found between the averages of the scores that the patients included in the experimental and control groups received from the agitation, anxiety, sleep, and patient-ventilator synchrony subscales of the American Association of Critical-Care Nurses Sedation Assessment Scale. Reflexology can serve as an effective method of decreasing the physiological signs of anxiety and the required level of sedation in patients receiving mechanically ventilated support. Nurses who have appropriate training and certification may include reflexology in routine care to reduce the physiological signs of anxiety of patients receiving mechanical ventilation.

Nursing diagnoses in patients having mechanical ventilation support in a respiratory intensive care unit in Turkey

This research was carried out to find out the nursing diagnoses in patients who have mechanical ventilation support in a respiratory intensive care unit. The study was conducted with 51 evaluations of critically ill adult patients who underwent invasive and non-invasive mechanical ventilation therapy in 2008. Data collection was based on Gordons 11 Functional Health Patterns, and nursing diagnoses were determined according to North American Nursing Diagnosis Association-International (NANDA-I) Taxonomy II. The nursing diagnoses were determined by two researchers separately. The consistency between the nursing diagnoses defined by the two researchers was evaluated by using Cohens kappa (κ). Forty men (78.4%) and 11 women (21.6%) whose mean ages were 70.19 (SD = 8.96) years were included in the study. Nineteen subgroups of nursing diagnoses about safety/protection domain, and 15 subgroups about activity/rest domain were seen at different rates in the patients. There was a statistically significant difference between mechanical ventilation via tracheostomy or endotracheal tube and decreased cardiac output (d.f. = 1, χ(2) = 4.760, P = 0.029). The relationship between the length of time under mechanical ventilation and impaired physical mobility was considerably significant (d.f. = 3, χ(2) = 24.459, P = 0.000). It was found out that there was a high degree of agreement (96.8%) between the nursing diagnoses defined by the two researchers separately (κ = 0.936, SE = 0.08).

Effect on pain intensity of injection sites and speed of injection associated with intramuscular penicillin

The aim of this one-group, quasi-experimental study was to examine the effect of choice of injection site and injection duration on the intensity of pain associated with intramuscular penicillin injection. Injections containing the same dose of drug were administered 12 hours apart for each patient over 5 s/mL and 10 s/mL durations in the dorsogluteal and ventrogluteal sites. Sixty patients who had a medical order for intramuscular penicillin at least twice in a day and for two successive days at the same dose were included in the study. No difference in pain was perceived by participants between the two injection durations at either the dorsogluteal or the ventrogluteal site. This study showed that intramuscular penicillin can be administered to either site over 5 s/mL or 10 s/mL durations. There is a need for further research with a randomized controlled design in different settings and in a larger sample on the impact of choice of injection site and injection duration on pain intensity.The aim of this one-group, quasi-experimental study was to examine the effect of choice of injection site and injection duration on the intensity of pain associated with intramuscular penicillin injection. Injections containing the same dose of drug were administered 12 hours apart for each patient over 5 s/mL and 10 s/mL durations in the dorsogluteal and ventrogluteal sites. Sixty patients who had a medical order for intramuscular penicillin at least twice in a day and for two successive days at the same dose were included in the study. No difference in pain was perceived by participants between the two injection durations at either the dorsogluteal or the ventrogluteal site. This study showed that intramuscular penicillin can be administered to either site over 5 s/mL or 10 s/mL durations. There is a need for further research with a randomized controlled design in different settings and in a larger sample on the impact of choice of injection site and injection duration on pain intensity.