Sevgi Hatipoglu

An analysis of the factors affecting the transition period to professional roles for newly graduated nurses in Turkey

Background For the majority of newly graduated nurses, the transition to professional roles in their lives may be stressful. Common reasons for this include feelings of insufficiency with regard to clinical skills, fears of making mistakes, increased responsibilities and insufficient guidance. Aim To identify the factors affecting the transition period of newly graduated nurses. Methods This study was designed and carried out as a descriptive and a cross-sectional study of three cohorts of newly graduated students. The study was implemented at a military education and research hospital in Ankara, Turkey. The population consisted of 234 (89%) of newly graduated nurses. For evaluating data, the SPSS 15.0 program was used. The paired samples t-test and the Mann–Whitney U-test were employed to compare the participants’ perceptions about the transition period based on certain variables. Results It is found that 54.7% of nurses surveyed have the intent to quit the profession. More than half of the participants stated that their expectations were met through working with a preceptor nurse (58.73%). Furthermore, almost half of the newly graduated nurses experienced and expressed disappointment in the first year of their professional lives. Conclusions The findings indicate that newly graduated nurses experience some difficulty during this period of transition, but assistance from experienced nurses facilitates the transition period. Implications for Nursing Practice and Research In order to increase work quality and satisfaction levels of new graduates, support programs must be initialized and their effectiveness must be evaluated regularly by clinical administrators and educators.

Implementation of a clinical pathway in breast cancer patients undergoing breast surgery

PURPOSE The present study was conducted to develop a clinical pathway for breast cancer patients undergoing breast surgery. We also aimed to determine the effects of this model on the (1) reduction of patient anxiety, (2) satisfaction of the patient, and (3) quality of life. METHODS The present study was conducted using a quasi-experimental nonequivalent study design. The study was applied to 69 patients diagnosed with breast cancer, who underwent surgical operations. We collected data using a questionnaire form, the State-Trait Anxiety Inventory, Questionnaire for the Evaluation of Patient Satisfaction, and SF-36 Quality of Life Scale. The data were analysed using percentages, the Students t-tests, Mann-Whitney U-Test, and chi-square tests. RESULTS This study showed that a comprehensive breast surgery clinical pathway significantly improved the quality of life and patient treatment satisfaction and reduced anxiety, even though it did not affect the hospitalization time. According to the level of state anxiety, there was not a meaningful statistical difference between groups but the anxiety level of the study group was lower than the control group and there was not a statistically meaningful difference between them in the period of pre-discharge. For quality of life, the physical, general health, vitality, social functioning, and emotional subscale averages were higher for the study group. CONCLUSION The results of the study indicate that the implementation of a clinical pathway on patients with breast surgery has a positive effect on increasing patient satisfaction, decreasing patient anxiety levels, and improving their quality of life.

The effect of low back pain on the daily activities of patients with lumbar disc herniation: a Turkish military hospital experience.

ABSTRACT This study was performed to assess disability on daily living activities, which developed secondary to low back pain, in patients with lumbar disc herniation and treated either conservatively or surgically. The study was performed between November 2008 and June 2009. Visual analogue scale (VAS) was used to measure the intensity of pain, and the Oswestry Disability Index (ODI) was used to assess the disability of the patients on daily living activities. Of the 112 patients, 55 were women and 57 were men. The mean age was 39.68 years for the conservative treatment group and 46.46 years the for surgical treatment group. In the pretreatment period, the patients who were selected for surgical treatment had higher VAS score and ODI than did the patients who were selected for conservative treatment. The disability areas that were reported in the pretreatment period were walking, sleeping, standing, and traveling for the surgical treatment group and self-care, sitting, and social life areas for the conservative treatment group. When the ODI and VAS score of the patients were statistically compared at the third month of posttreatment period, the scores were significantly low in the surgical treatment group. The disability areas that were reported at the third month of posttreatment period were weight lifting, self-care, and walking for the surgical treatment group and social life, sleeping, sitting, and standing for the conservative treatment group. This study found that patients with low back pain experience physical disabilities due to pain. Their daily living activities are affected by these disabilities and the intensity of pain affects the level of disability. Knowledge of the disability areas caused by low back pain plays an important role in the determination of nursing care and content of the education which will be offered to the patients. The use of scale on the patient’s care is important to form a common language in nursing and to obtain evidence-based data related to the patients.

Effect of head and body positioning on cerebral blood flow velocity in patients who underwent cranial surgery

AIM AND OBJECTIVES The aim of this study was to investigate the effects of head and neck positions on the cerebral blood flow velocity by transcranial Doppler ultrasound in patients who underwent cranial surgery. BACKGROUND Inappropriate head elevation and body positioning in patients who undergo cranial surgery may affect cerebral blood flow and cerebral perfusion pressure. DESIGNED: Experimental clinical study. METHOD Our sample consisted of 38 patients who underwent cranial surgery between October 2009 and May 2010. The measurments of mean cerebral blood flow velocity were taken by the transcranial Doppler ultrasound through the temporal window. The mean cerebral blood flow velocity of the patients was measured in supine position with 0° and 30° head elevations, right and left lateral positions, right and left lateral positions with head flexion and extension. The measurements were taken before surgery and within 72 hours after surgery. RESULTS The mean cerebral blood flow velocity of the middle cerebral arteries was increased in head elevations from 0° to 30°, in right and lateral positions with 30° head elevations, but the velocity was decreased in head flexion and extension positions in preoperative and postoperative periods. DISCUSSION Head and body positioning, which is one of the nursing care activities, may affect intracranial pressure and cerebral perfusion pressure. Our results are similar with those of previous studies, which showed that head elevation did not affect the cerebral blood flow velocity. RELEVANCE TO CLINICAL PRACTICE By the results of this study, the head elevation of the patients, who underwent cranial surgery, should be 30° during the nursing care to provide optimum cerebral blood flow. Right and left lateral positioning is safe and recommended for these patients if there is no medical contraindication.

Living with a malignant musculoskeletal tumor: experiences of family caregivers.

PURPOSE To describe the experiences of the family caregivers of patients with malignant musculoskeletal tumors. DESIGN AND METHODS Descriptive qualitative approach using a semi-structured interview guide. SETTING Orthopaedics Department of the Gulhane Military Medical Academy in Ankara, Turkey. A total of 11 family caregivers aged 25–62 years were recruited. RESULTS The analysis revealed 5 themes: religious attributions in terms of the cause and treatment of the tumor, the effect of malignant tumor on daily life, the tendency to think positively and constructively and find meaning through caregiving, the anxiety about the prognosis of the malignant tumor, and the support received from significant others. CONCLUSION It is important to develop effective nursing care to family caregivers of patients with malignant musculoskeletal tumor to understand the physical, emotional, and spiritual experiences in their lives.

A comparison between the effectiveness of full outline of unresponsiveness and glasgow coma score at neurosurgical intensive care unit patients

AIM To evaluate the effectiveness and the use of Glasgow Coma Score (GCS) and Full Outline of Unresponsiveness (FOUR) score by nurses in the follow-up and evaluation of patients admitted to the neurosurgical intensive care unit for cranial surgery or head trauma. MATERIAL and METHODS The study was performed at a neurosurgical intensive care unit. Sample size was determined as 47 patients (a= 0.05, power= 0.95). The correlation coefficient less than 0.5 was accepted as weak. In the first 24 hours, Karnofsky Performance Scale was applied and the Acute Physiology and Chronic Health Evaluation II (APACHE II) Score calculated for patients who were admitted to the intensive care unit for cranial surgery or head trauma. Also FOUR and GCS were applied by two different nurses twice a day. Intraclass Correlation Coefficient, Pearson Correlation and Cronbach?s Alpha Security Index analyses were used to evaluate the data. RESULTS Concordance was above 0.810 and correlation was above 0.837 between GCS and FOUR score evaluation results of nurses. Correlation of two different evaluation at every shift for GCS was 0.887, and for FOUR was 0.827 and above. Karnofsky Performance Scale correlation with FOUR and GCS scores of patients at admission and discharge from the intensive care unit was 0.709 and above. The correlation between APACHE II and FOUR was 0.851; between APACHE II and GCS 0.853. There was no difference between the evaluations of two scores and two nurses statistically. CONCLUSION Concordance between nurses was found high both for GCS and FOUR. The FOUR score is as effective as GCS on the follow-up of patients who are managed in the neurosurgical intensive care units.