Sevil Güler Demir

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.

Yoğun bakım ünitesinde nozokomiyal enfeksiyonların önlenmesi ve hemşirelik uygulamaları

Aim: Completion thyroidectomy is required at situations such as recurrent nodular goiter and malignant findings at histopathology after primary operation for noduler goiter. The aim of this study was to investigate the indications for the completion thyroidectomy and the effect of the operation timing on morbidity. Materials and Methods: Thirty-one consecutive patients (26 females and 5 males) with a mean age of 36.5p7.7 years (range, 23-55 yrs) that underwent completion thyroidectomy were investigated. The patients, who needed re-operation for recurrence with diagnosis of histopathologically proven malignancy or re-operated for recurrence, were included. Results: Seventeen patients had the second operation performed within 10 days or more than 90 days after initial operation (group 1). Fourteen patients had re-operation between 10 and 90 days after the first procedure (group 2). Histopathological examination after the completion thyroidectomy revealed remnant tumour in 7 patients (23%), two of them in the contralateral lobe. One patient suffered from a permanent hypoparathyroidism in group 1 and a permanent vocal cord paralysis in group 2. Conclusion: Our results suggest that other treatment modalities except total thyroidectomy are insufficient, since remnant tumour was seen over 20% of the histopathological specimens of the completion thyroidectomy. Timing of completion thyroidectomy had no effect on the thyroid cancer development. Total thyroidectomy can be preferred in the surgical management of tiroid cancers or benign nodular goiter.A 10 years old boy admitted to Ophthalmology Clinic with the complaint of low vision. His ophthalmologic examination showed decreased visual acuity as counting fingers from 2 meters in both eyes. Biomicroscopic examination of his both eyes was normal. Optic atrophy was apparent in his both eyes on fundoscopic examination. He has been followed with the diagnosis of diabetes mellitus type 1 for the last two years and had nocturnal enuresis. He was diagnosed as Wolfram (DIDMOAD) syndrome based on the results of clinical and laboratory examinations. His medical management has been carried out carefully however he was no longer able to attend his school. His IQ was within normal ranges and he was referred to a school which educates visually disabled children. Wolfram syndrome can easily be diagnosed in outpatient clinics since it does not require a genetic analysis. Physicians should keep in mind this diagnosis during their daily practice and provide the best management to the patient by achieving interdisciplinary co-operation.Cerebral salt wasting syndrome (CSW) has been reported in cases with subarachnoid haemorrhage, infections, head injury, brain tumours, transsphenoidal pituitary surgery, and neurosurgery. It is characterized by extracellular fluid depletion and hyponatraemia caused by progressive natriuresis with concomitant diuresis. The relationship between tuberculous menengitis and CSW in children has been desciribed rarely. We describe a case of CSW in an eight years old child with tuberculous meningitis in Pediatric Intensive Care Unit (PICU) whose main biochemical findings were low serum sodium, excessive urine sodium loss and clinical evidence of a contracted extracellular fluid volume. It is essential that in any child with hyponatremia and meningitis in PICU, an evaluation to be undertaken to differentiate between syndrome of inappropriate antidiuretic hormone secretion (SIADH) and CSW. A wrong diagnosis might lead to inappropriate fluid restriction and worsen the hypovolemia in children with CSW. Supplements of sodium chloride and mineralocorticoids may be useful in managing children with CSW. PICU professionals must be aware of the clinical and laboratory features that distinguish CSW from SIADH.

The effect of standard pain assessment on pain and analgesic consumption amount in patients undergoing arthroscopic shoulder surgery

Pain assessment has a key role in relief of the postoperative pain. In this study, we aimed to examine the effect of the Standard Pain Assessment Protocol (SPAP), which we developed based on acute pain guidelines, on pain level, and analgesic consumption. The study population consisted of a total of 101 patients who had arthroscopic shoulder surgery. The routine pain assessment was administered to the control group, while the SPAP was administered to the study group. The routine pain therapy of the clinic was administered to the subjects from both groups based on the pain assessment. Throughout the study, pain was assessed nearly two times more in the study group (p<0.001) and the mean pain levels were lower at 8th-11th hours in the study group (p<0.001). Pain assessment was not performed after 12th hour despite the severe pain in the control group, and, therefore, analgesia was administered at irregular intervals or was not administered at all. However, the hours of analgesic administration were found to be more regular according to the pain levels of the patients in the study group. In conclusion, the SPAP reduced the pain level by providing regular analgesia when used in combination with regular pain assessment. PERSPECTIVE This article highlights the appropriate assessment for patients with surgical pain. In majority of literature on the subject, the authors emphasize the importance of Standard Pain Assessment Protocol to provide adequate pain relief.

The Effect of Cold Vapor Applied for Sore Throat in the Early Postoperative Period

PURPOSE This study was conducted for the purpose of determining the effect of cold vapor applied for sore throat in the early postoperative stage. DESIGN A quasi-experimental design was used. METHODS The study sample consisted of 60 patients who underwent lumbar disc herniation surgery in the Neurosurgery Clinic of Gazi University Health Research and Practice Center in Ankara, Turkey. The study involved two intervention groups and one control group. The study data were collected through questionnaire and observation forms. FINDINGS 65% (n = 39) of patients experienced sore throat. There were no statistical differences between the groups in terms of sore throat and hoarseness (P > .05); however, a significant difference was determined in the group to whom oxygen together with cold vapor was applied for dry throat (4th and 8th hours) and swallowing difficulties(8th and 12th hours) (P < .05). CONCLUSIONS Cold vapor did not have an effect on sore throat on its own; however, it decreased hoarseness and swallowing difficulties when applied together with oxygen.

The Problems Experienced by Parents Providing Postoperative Home Care Following Their Child's Surgery for Developmental Dysplasia of the Hip.

BACKGROUND: Families, especially mothers, experience problems providing home care after their childs surgery for developmental dysplasia of the hip (DDH). PURPOSE: To assess the problems experienced by parents providing postoperative home care to their child after DDH surgery. METHODS: This was a descriptive cross-sectional study. The sample consisted of 33 parents. Data were collected through a survey conducted at the hospital following the childs surgery and by telephone 4–6 weeks after surgery. Frequencies, means, percentages, and chi-square tests were used to analyze the data. RESULTS: The parents (93.9% women) provided postoperative care for approximately 3 months. Nearly all of the parents (97%) had physical (96.9%), psychological (65.6%), and social (75.0%) problems in addition to child care problems. CONCLUSIONS: We recommend preparing a comprehensive discharge-training package for parents after their childs DDH surgery, supplementing home care instructions with visual training materials, and providing telephone counseling to parents after discharge.