Şule Ecevit Alpar

The relationship among pressure ulcers, oxygenation, and perfusion in mechanically ventilated patients in an intensive care unit.

PURPOSE We examined the relationships among oxygenation, tissue perfusion, and other comorbid conditions not incorporated into the Norton Scale, and pressure ulcer (PU) development in subjects receiving mechanical ventilation. DESIGN Descriptive, observational study. SETTING AND SUBJECTS The setting was our university hospitals surgical/emergency intensive care unit in Istanbul province, Turkey. The sample comprised 30 patients who were older than 18 years, did not have a PU on admission, and had been mechanically ventilated for more than 24 hours when data collection began. METHODS Skin integrity and a PU risk, using the Norton Scale, were administered twice daily. In addition, serum blood testing, vital signs, and data regarding ventilation and oxygenation status were obtained from the patients electronic medical records. RESULTS Slightly less than half of subjects were women (n = 14, 46.7%). Their mean age was 54.36 years (SD = 20.68). Pressure ulcers developed in 5 patients (16.7%); all PUs were located on the heel. All ulcers were initially observed as stage I lesions; 1 progressed to a stage II ulcer and 1 progressed to a stage III ulcer. Patients who developed pressure ulcers have higher serum glucose levels (z = −2.198; P = .028), higher serum pH levels (z = −2.031; P = .028), and lower diastolic blood pressures (z = 0.055; P = .057) than those who remained ulcer free. CONCLUSION Our results demonstrate that mechanically ventilated patients who develop PUs were more likely to have significantly higher blood glucose levels, significantly lower diastolic blood pressure values, and significantly higher serum pH values than were patients who remained free of PUs. Nurses who care for mechanically ventilated patients should recognize these factors and initiate preventive interventions as indicated.

Preoperative Education and Use of Analgesic Before Onset of Pain Routinely for Post-thoracotomy Pain Control Can Reduce Pain Effect and Total Amount of Analgesics Administered Postoperatively

The purpose of this study was to investigate the efficiency of preoperative pain management education and the role of analgesics administration before the onset of pain postoperatively. The study was a prospective, randomized, and single-blind clinical trial, which was conducted January 1, 2008 through October 1, 2008 in the Thoracic Surgery Unit of Akdeniz University Hospital. A total of 70 patients who underwent thoracotomy (35 in the control group and 35 in the study group) were included in the study. Of the patients, 70% (n = 49) were male and 30% (n = 21) were female. Mean age was 51 ± 10 years (range = 25-65). The same analgesia method was used for all patients; the same surgical team performed each operation. Methods, including preemptive analgesia and placement of pleural or thoracic catheter for using analgesics, that were likely to affect pain level, were not used. The same analgesia medication was used for both patient groups. But the study group, additionally, was educated on how to deal with pain preoperatively and on the pharmacological methods to be used after surgery. An intramuscular diclofenac Na 75 mg was administered to the study group regardless of whether or not they reported pain in the first two postoperative hours. The control group did not receive preoperative education, and analgesics were not administered to them unless they reported pain in the postoperative period. The routine analgesics protocol was as follows: diclofenac Na 75 mg (once a day) intramuscular administered upon the complaint of pain following extubation in the postoperative period and 20 mg mepederin intravenously (maximum dose, 100 mg/day), in addition, when the patient expressed pain. Pain severity was assessed during the second, fourth, eighth, 16th, 24th, and 48th hours, and marked using the Verbal Category Scale and the Behavioral Pain Assessment Scale. Additionally, the total dose of daily analgesics was calculated. The demographic characteristics showed a homogeneous distribution in both patient groups. The rate of pain, which was defined as sharp, stabbing, and exhausting, was higher in the control group than in the study group, and the difference between the two groups was statistically significant (p < .05). As the doses of analgesics used for pain management in both groups were compared, it was determined that analgesic consumption was lower in the study group than in the control group, and the difference was statistically significant (p < .05). As a result, it was determined that preoperative thoracic pain management education and analgesics administered postoperatively, before the onset of pain, reduced the amount of analgesics used in the first postoperative 48 hours.

Image of nursing held by nursing students according to gender: a qualitative study.

This paper is a report of a study to determine the nursing images of female and male nursing students. The study used a qualitative research design to determine nursing images of male (n = 20) and female (n = 20) nursing students. To analyse the data, the method used content analysis. Statements were organized under three categories and seven themes after content analysis. The first category, nursing concept, incorporates the two themes of: (i) female or sister; (ii) job definition. The second category, choosing, incorporates the four themes of: (i) Desire of Others; (ii) Guarantee of Work; (iii) Being Helpful to Others; and (iv) Limited to Academic Achievement. The third category, Gender, incorporates the one theme of: (i) Gendered Approach. Male students have started to take part in nursing programs relatively recently; therefore, more research is needed in the fields of academic accomplishments of male students.

Yenidoğan ve Süt Çocuklarında Girişimsel Ağrı ve Non-farmakolojik Yönetimi

Agri saglik durumunu direk etkileyen kontrol edilmediginde hayatin butun alanlarinda olumsuz sonuclar doguran bir sorundur. Tum cocuklara dogumdan itibaren bir dizi girisimsel agrili islem uygulanmaktadir. Kan alma, enjeksiyon, asi gibi girisimsel islemler cocuklarin en buyuk agri kaynaklarindandir. Agrinin yarattigi travma cocuklarda basta igne fobisi olmak uzere, asi uygulamalarinda aksaklik, tedaviye uyumda yetersizlik sebebi olabilir ve bu durumlar onlenebilir bircok hastalikta salginlara neden olarak cocuklari savunmasiz birakabilir. Ozellikle beyin gelisimin hizli oldugu sut cocuklugu doneminde agrinin gelisimsel ve emosyonel etkilerini gidermek icin girisimsel islem agrilari iyi yonetilmelidir. Agri yonetiminde farmakolojik ve non-farmakolojik pek cok yaklasim vardir. Farmakolojik yontemlerin deneyimli personel tarafindan uygulanma zorunlulugu, komplikasyon riski ve maliyeti nedeniyle kullanimini nerdeyse imkansizdir. Sukroz, kivirarak tutmak, anne kucagi, kanguru bakimi, emzik vermek, taktil uyari, emzirme, kundaklama kullanilan yenidogan ve sut cocuklari icin kullanilan non-farmakolojik yontemlerdendir. Bu makale yenidogan ve sut cocugunda girisimsel islem agrilari ve bunun non-farmakolojik yonetiminin onemini vurgulamak icin yazilmistir.

Development of Parenteral Drug Preparation Skills of First Year Nursing Students

* N Şahin Orak, Yrd. Doç. Dr. Marmara Üniversitesi, Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, Hemşirelik Esasları Anabilim Dalı Yazışma Adresi / Address for Correspondence: Marmara Üniversitesi Haydarpaşa Kampüsü, Selimiye M. Tıbbiye C. No: 38 Haydarpaşa 34668 İstanbul Tel.: 0 505 570 44 99 e-posta: nurayorak@yahoo.com * B Gülseven Karabacak, Yrd. Doç. Dr.; D Emre Yavuz, Araş. Grv.; G Karahan Okuroğlu, Araş. Grv.; Ş Ecevit Alpar, Prof. Dr.; Marmara Üniversitesi, Sağlık Bilimleri Fakültesi Hemşirelik Bölümü, Hemşirelik Esasları Anabilim Dalı, İstanbul