Aysel Badir

Background: Life‐sustaining treatments are increasingly used in intensive care units (ICUs) for EOL care, but the decision to use these may cause ethical issues.Aims and objectives: The aim of this study was to investigate the views and practices of critical care nurses in Turkey on the end‐of‐life (EOL) care.Design: This was a cross‐sectional study.Methods: The research was conducted in 32 second‐ and third‐level ICUs of 19 Ministry of Health research hospitals in Turkey. The Views of European Nurses in Intensive Care on EOL Care tool was used for data collection.Results: The total sample size was 602. While half of the nurses stated that the withholding and withdrawal of life support were ethically different decisions, 40% felt both decisions were unethical. The expected quality of life as viewed by the patient, the medical team, the family and the nursing team (90·4%, 85·4%, and 83·4%, respectively) was an important factor in EOL decision making. The majority of the nurses (75·7%) were not directly involved in the EOL decision making and 78·4% of nurses were committed to family involvement in EOL decisions. When withdrawing treatment, 87·2% of ICU nurses agreed that the patient and family members should perform their final religious and spiritual duties. Further results showed that after withdrawing treatment, a majority of nurses (86%) agreed to continue pressure sore prevention, effective pain relief (85·5%), nutritional support (77·6%) and hydration (64·8%). Almost half (48·2%) indicated that keeping the patients in the ICU was unnecessary.Conclusion: ICU nurses expressed a range of experiences and practices regarding EOL care. ICU nurses should be more involved in the decision‐making process about EOL care.Relevance to clinical practice: Due to their unique relationship with patients, nurses should be involved in EOL care decision making; however, patients, families or nurses are not often involved in the decision‐making process in Turkey.

Using high-fidelity simulations to facilitate student learning is an uncommon practice in Turkish nursing programs. The aim of the present study was to understand students' perceptions of the use of simulation in nursing courses. Subjects included 36 senior nursing students taking an intensive care course. This study revealed that high-fidelity simulation is an ideal method of promoting learning by helping students transfer theory into practice, build confidence and teamwork, and raise professional awareness.

Cardiovascular disease is the number one cause of death worldwide. However, there is not enough data exploring student nurses’ understanding, knowledge, and awareness of cardiovascular disease. To investigate knowledge of cardiovascular disease and its risk factors among undergraduate nursing students, with an emphasis on understanding of cardiovascular disease as the primary cause of mortality and morbidity, both in Turkey and worldwide. This cross-sectional survey assessed 1138 nursing students enrolled in nursing schools in Istanbul, Turkey. Data were collected using the Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) scale and questions from the Individual Characteristics Form about students’ gender, age, level of education, and family cardiovascular health history, as well as smoking and exercise habits. Respondents demonstrated a high level of knowledge about cardiovascular disease, with years of education (p < 0.001), gender (p < 0.001), and high school type (p < 0.05) all significantly associated with CARRF-KL scores. However, more than half of the students were not aware that cardiovascular disease is the primary cause of mortality and morbidity in Turkey and worldwide. The majority of the respondents’ body mass index (87%) and waist circumference values (females: 90.3%, males: 94.7%) were in the normal range and most were non-smokers (83.7%). However, more than half of the students did not exercise regularly and had inadequate dietary habits. Although students were knowledgeable about cardiovascular disease and associated risk factors, there were significant gaps in their knowledge; these should be addressed through improved nursing curricula. While students were generally healthy, they could improve their practice of health-promoting behaviors.

Patient safety is a complex multifaceted issue linked with quality management. Evidence reveals that nurses are pivotal to the success of quality management and patient safety initiatives. There are many studies about patient safety in developed countries, but less is known about nursing care and patient safety in developing or mid-level economies such as Turkey. The aim of this paper is to discuss the quality management and patient safety developments in the Turkish healthcare sector.

This study explored 150 critical care nurses' perceptions of patient safety standards in a selection of private, public, and university hospitals in Turkey. Quality management and patient safety programs were more prevalent in private hospitals. Private hospitals were also more likely to encourage reporting, have error/adverse event reporting systems, and less likely to have a punitive response to reported errors. However, respondents who work in private hospitals work both more hours per week and more hours per day.

Summary: Identification and evaluation of pain in critical care patients may be difficult because of communication problems. Moreover, at present there are very few nursing studies that examine the attitudes of critical care nurses towards the assessment of patients’ pain This study was designed to determine the approach of critical care nurses towards assessing patients’ pain levels, and to evaluate the problems in nursing diagnosis of those having difficulty in articulating their pain symptoms We used a questionnaire to assess nurses attitudes to patients’ pain. The study sample consisted of 91 critical care nurses who were recruited between January and February 2002. The results suggest that patient pain was considered undesirable by 44% of nurses. About 70·3% of the nurses reported resorting to administering analgesics to relieve their patients’ pain Some 57·1% of nurses stated that they would have investigated whether the patients had really been experiencing pain, prior to administering the prescribed analgesics to patients Some 85·7% of the sample indicated that the patients themselves would make the most accurate evaluation of their pain. The data suggested that 39·6% of nurses did not know how to evaluate pain symptoms in critical care patients suffering from complicated problems, and that 37·4% evaluated pain by monitoring the patients’ behaviours The study demonstrated that most of the critical care nurses did not know how to evaluate pain in patients having communication problems. The paper concludes by suggesting that there is a clear need to address nursing education and training with regard to evaluation and management of patients’ pain whilst in critical care environment