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Effectiveness of a honey dressing for healing pressure ulcers.

Objective To compare the effect of a honey dressing vs an ethoxy-diaminoacridine plus nitrofurazone dressing in patients with pressure ulcers. Design This 5-week randomized clinical trial evaluated the effect of a honey dressing on pressure ulcer healing. Setting and subjects Thirty-six patients with a total of 68 stage II or III pressure ulcers referred from a university hospital in İzmir were enrolled in the study. Twenty-six subjects completed the trial. Instruments Ulcers were measured with acetate tracings and Pressure Ulcer Scale for Healing (PUSH) evaluations. Methods Fifteen patients with 25 pressure ulcers were treated with honey dressings, and 11 patients with 25 pressure ulcers were treated with ethoxy-diaminoacridine plus nitrofurazone dressings. Wound healing was assessed weekly using the PUSH tool, version 3.0. The primary outcome measure was the change in PUSH tool scores in each group at 5 weeks. Results The two groups were statistically similar with regard to baseline and wound characteristics. After 5 weeks of treatment, patients who were treated by honey dressing had significantly better PUSH tool scores than subjects treated with the ethoxy-diaminoacridine plus nitrofurazone dressing (6.55 ± 2.14 vs 12.62 ± 2.15, P < .001). Conclusion By week 5, PUSH tool scores showed that healing among subjects using a honey dressing was approximately 4 times the rate of healing in the comparison group. The use of a honey dressing is effective and practical.

A study of Turkish critical care nurses’ perspectives regarding family-witnessed resuscitation

AIM . This paper reports a study to determine the experiences and attitudes of Turkish critical care nurses concerning family presence during cardiopulmonary resuscitation. BACKGROUND The debate surrounding family-member presence in resuscitation areas has been evolving since the 1980s. The practice of performing resuscitation of adults in the presence of family members is controversial and has stimulated discussion and debate worldwide. DESIGN A descriptive survey. METHOD The survey was carried out in 2007 with 135 critical care nurses from two university hospitals in Izmir. A structured questionnaire was used, which incorporated a series of attitude statements that were rated using a three-point Likert scale. The attitudes of the nurses were explored in three areas: decision making, processes and outcomes of resuscitation. RESULTS Of the nurses, only 22.2% experienced a situation where family members were present during cardiopulmonary resuscitation. Most of these nurses (n = 20) had one or more negative experiences. The majority disagreed that family members should always be offered the opportunity to be with the patient during cardiopulmonary resuscitation. The most common concerns for not favouring family-witnessed resuscitation were reported as performance anxiety, fear of causing psychological trauma to family members and increased risk of litigation. CONCLUSIONS Many Turkish critical care nurses have no knowledge of family-witnessed resuscitation and do not support the practice. We suggest that Turkish critical care nurses should be informed by the international literature on the concept of family-witnessed resuscitation and the culturally appropriate policies concerning this subject should be changed in Turkish hospitals. RELEVANCE TO CLINICAL PRACTICE Most critical care nurses in Turkey are not supportive of family-witnessed resuscitation. All critical care nurses should be informed by the international literature on the concept of family-witnessed resuscitation.

Effect on pain of changing the needle prior to administering medicine intramuscularly: a randomized controlled trial

AIM This paper is the report of a study to determine whether changing the needle before administering an intramuscular injection could reduce pain, and to investigate gender differences in pain perception. BACKGROUND A skilled injection technique can make the patients experience less painful and avoid unnecessary complications, and the use of separate needles to draw up and administer medication ensures that the tip of the needle is sharp and free from medication residue. METHOD A randomized controlled trial was carried out between January 2009 and May 2009 with 100 patients receiving diclofenac sodium intramuscularly in an emergency and traffic hospital in İzmir, Turkey. The primary outcome was pain intensity measured on a numerical rating scale. Each patient received two injections by the same investigator using two different techniques. The two techniques were randomly allocated and the patients were blinded to the injection technique being administered. After each injection, another investigator who had no prior knowledge of which injection technique was used immediately assessed pain intensity using a numerical rating scale. Descriptive statistics, paired t-test and t-test were used to evaluate the data. RESULTS Findings demonstrated that changing the needle prior to intramuscular medication administration significantly reduced pain intensity. A statistical difference in pain intensity was observed between the two injection techniques. CONCLUSION The results supported the hypothesis that changing the needle prior to administering the medicine significantly reduced pain intensity.

A comparison of 3 wound measurement techniques: effects of pressure ulcer size and shape.

PURPOSE: The aim of this study was to examine the levels of agreement among 3 techniques used in wound measurement comparing more spherical versus irregularly shaped wounds. DESIGN: The design of this study is evaluative research. SUBJECTS AND SETTING: Sixty-five consecutive patients with 80 pressure ulcers of various sizes referred from a university hospital in Izmir, Turkey, were evaluated. METHODS: The 80 pressure ulcers identified on the 65 participants were divided into 2 groups based on pressure ulcer shape and wound surface area. Twenty-four of the 80 ulcers (30%) were characterized as irregularly shaped and greater than 10 cm2. Fifty-six were regularly shaped (approximating a circle) and less than 10 cm2. Pressure ulcer areas were measured using 3 techniques: measurement with a ruler (wound area was calculated by measuring and multiplying the greatest length by the greatest width perpendicular to the greatest length), wound tracing using graduated acetate paper, and digital planimetry. The level of agreement among the techniques was explored using the intraclass correlation coefficient (ICC). RESULTS: Strong agreement was observed among the techniques when assessing small, more regularly shaped wounds (ICC = 0.95). Modest agreement was achieved when measuring larger, irregularly shaped wounds (ICC = 0.70). CONCLUSION: Each of these techniques is adequate for measuring surface areas of smaller wounds with an approximately circular shape. Measurement of pressure ulcer area via the ruler method tended to overestimate surface area in larger and more irregularly shaped wounds when compared to acetate and digital planimetry. We recommend digital planimetry or acetate tracing for measurement of larger and more irregularly shaped pressure ulcers in the clinical setting.

Does the body temperature change in older people

AIM The aim of this study was to determine the mean body temperatures in older people using mercury-in-glass thermometer. BACKGROUND Older people are unable to regulate their body temperatures to the same degree as young adults because their responses to changes in body temperature are altered. Several published reports suggest that body temperature decreases with advancing age and has a greater variability in older populations. The aim of this study was to determine the mean body temperatures in older people. DESIGN Non-experimental. METHODS Axillary body temperatures were taken in 133 older subjects in a nursing home for older people using mercury-in-glass thermometer. Temperatures were measured at 8 a.m., 2 p.m., and 6 p.m., over three consecutive days. Each subject had all three measurements taken on the same day. RESULTS The mean age of the subjects was 77.2, SD 7.3. In the 133 older subjects, the mean axillary temperatures ranged from 35.1 to 36.4 degrees C (95.3-97.6 degrees F). The mean temperatures for those aged 65-74 was higher than in those aged 75-84 (p < 0.001) and those aged 85 and older (p < 0.001) at 6 p.m. but not at 8 a.m. or 2 p.m. We concluded that older people have mean axillary body temperatures lower than the reference point of 36.5 degrees C (97.7 degrees F). RELEVANCE TO CLINICAL PRACTICE When assessing body temperature, it is important to take the age of the patient into consideration. Also, the reference point of 36.5 degrees C is inappropriate in older people, especially when diagnosing a febrile illness.

Oral glucose solution to alleviate pain induced by intramuscular injections in preterm infants.

PURPOSE The purpose was to assess the effectiveness of 5% oral glucose solution in reducing pain in preterm infants during intramuscular injection. DESIGN AND METHODS We conducted a prospective, randomized, controlled, unblinded trial to investigate the effect of glucose solution on the pain of intramuscular injection in preterm infants (N = 80). RESULTS Infants who received oral glucose had significantly lower pain scores (p < .001), less crying time (p < .001), higher oxygen saturation (p < .001), and lower heart rate after compared with during the procedure (p = .02). PRACTICE IMPLICATIONS Our results suggest that oral glucose, even if used in the lowest dose, may have a pain-relieving effect in preterm infants if administered pre-procedure.

The effect on pain of three different methods of intramuscular injection: A randomized controlled trial

This paper is the report of a study to determine the effect on pain of internally rotating the foot, pointing the toes down and/or using the Z-track technique during intramuscular injection and to investigate differences in pain perception related to gender and body mass index. A randomized controlled trial was carried out from September to November 2010 on 75 patients receiving diclofenac sodium intramuscularly at a university hospital in Zonguldak, Turkey. The primary outcome measure collected was pain intensity, measured on a visual analogue scale. Each subject received three injections by the same investigator using three different techniques. The three techniques were randomly allocated, and the subjects were blinded to the injection technique being used. After each injection, another investigator, who had no prior knowledge of which injection technique was used, immediately assessed pain intensity using the visual analogue scale. Research findings demonstrated that the Z-track and internally rotated foot techniques significantly reduced pain intensity during intramuscular injection. Statistically significant differences in pain intensity were observed between the three injection techniques. The results supported the hypothesis that the internally rotated foot and Z-track techniques significantly reduce pain intensity.

The validity and reliability of the Turkish version of short-form McGill Pain Questionnaire in patients with leukemia.

AIMS AND OBJECTIVES To assess reliability and validity of the Turkish version of the Short-form McGill Pain Questionnaire. BACKGROUND Pain is one of the most frequent and significant problems encountered by nurses practice across the world. The Short-form McGill Pain Questionnaire was widely translated and used to assess the pain experience of several types of patients because it combines the properties of the standard McGill Pain Questionnaire but takes substantially less time to administer. DESIGN The study used psychometric testing to establish reliability and validity of the Turkish version of Short-form McGill Pain Questionnaire. METHODS A convenience sample of 160 patients with leukaemia in Turkey was used to collect data regarding pain evaluation. The original version of the Short-form McGill Pain Questionnaire, adapted into Turkish, was tested for internal consistency, content validity, construct validity and concurrent validity. RESULTS Internal consistency was found adequate at both assessments with Cronbachs α 0.88 for test and 0.91 for retest. For reliability of the total, sensory, affective and evaluative total pain intensity, high intraclass correlations were demonstrated (0.85, 0.84, 0.82 and 0.70, respectively). Correlation of total, sensory and affective score with the numerical rating scale was tested for construct validity demonstrating r = 0.61 (p < 0.01) for test and r = 0.68 (p < 0.01) for retest. Correlation with blood pressure values for concurrent validity was found to be r = 0.78 (p < 0.001) for test and r = 0.73 (p < 0.001) for retest. CONCLUSION Turkish version of the Short-form McGill Pain Questionnaire has shown statistically acceptable levels of reliability and validity for pain evaluation in patients with leukaemia. RELEVANCE TO CLINICAL PRACTICE This study provided evidence that the Turkish version of the Short-form McGill Pain Questionnaire is a reliable and valid instrument for assessing pain. This scale can be used to assess nursing interventions aimed at decreasing pain and efficacy of the treatment.

Comparison of agreement between different measures of blood pressure in normotensive females.

The aim of this study was to determine whether there are differences between nurse-taken blood pressure (BP), physician-taken BP, and automated device. BP was measured in 163 normotensive females. In a center for family planning and mother-child health, measurements were taken by a male physician and by a nurse and by using a validated automatic device. The difference between the systolic and diastolic BP recordings at the three measurement modalities was statistically significant (p < .001). BPs taken by the physician were markedly higher than the measurements taken by the nurse and the automated device. The results from this study show that systolic and diastolic BP taken using an automated device in normotensive females are significantly lower than the readings obtained by the physician and are almost identical to those taken by the nurse. Physicians should therefore not make any decisions based on BP measured manually during a first encounter and should rely on BP reported by well-trained observers or by validated automatic devices.