Sevil Güler

Breast-conserving surgery (BCS) is a commonly used treatment method for early-stage breast cancer that offers cosmetic benefits while ensuring oncological safety. However, postoperative complications and the current trend toward shorter hospital stays necessitate the systematic and standardized planning of perioperative care. The aim of this review is to comprehensively address the perioperative care process in patients undergoing BCS based on the literature and to present an evidence-based care protocol that can be used in clinical practice. In this context, a structured care protocol was developed by reviewing the current literature, national and international guidelines, and evidence-based nursing practices. The developed protocol consists of four main phases: pre-admission to the clinic, the day of surgery, the first postoperative day, and the 7th, 15th, and 30th postoperative days. Each phase includes key care components such as education and counseling, patient optimization, prevention of complications, and pain management and assessment. Additional components include ensuring adequate sleep and rest, managing nutrition and fluid intake, maintaining normothermia, supporting arm and shoulder movements, promoting activities of daily living and self-care, and monitoring wounds and complications. The protocol also focuses on promoting effective coping and a positive body image, as well as supporting adherence to treatment. Wound and complication monitoring, promotion of effective coping and a positive body image, and support for adherence to treatment are also incorporated into the protocol. Consequently, it is believed that this evidence-based perioperative care protocol, by increasing standardization in nursing care, can reduce complication rates, accelerate the recovery process, and improve patient outcomes.

Complex revision arthroplasties are indicated particularly in cases of severe bone loss, aseptic loosening, periprosthetic infection, and recurrent instability. Revision total hip arthroplasty is associated with higher complication rates and greater functional limitations than primary surgery. This study aimed to evaluate the effects of a multidisciplinary approach on pain, mobilization, and pressure injury following revision hip arthroplasty in a high-risk patient. The case involved a 75-year-old patient with a history of multiple partial hip arthroplasties and revision procedures. Preoperative assessment revealed acetabular protrusion and femoral and pelvic bone defects. Pelvic reconstruction was performed using an ilioischial cage, a distally fixed femoral stem, and a constrained liner to address instability. Postoperative care was provided by a multidisciplinary team consisting of orthopedic surgeons, an orthopedic nurse, and a physiotherapist. Management included hemodynamic stabilization, pain control, thromboembolism prophylaxis, pressure injury monitoring, and early mobilization. The patient's Visual Analog Scale (VAS) pain score decreased from 7–9 during the first week to 1–3 by the fifth week. Mobilization progressed from complete bed dependence to short-distance ambulation. A pre-existing Stage 2 pressure injury progressed to Stage 3 postoperatively but improved to Stage 2 after appropriate wound care. Although complete independent ambulation was limited by neurological deficits and advanced age, functional improvement was achieved. This case highlights the importance of a multidisciplinary approach, close follow-up, and patient education in improving outcomes and facilitating early rehabilitation after complex revision hip arthroplasty.

This research was conducted to determine the effects of preoperative fasting durations on blood glucose levels, dehydration, and anxiety in patients. This cross-sectional study was conducted in the General Surgery Clinic of a university hospital. The study included 92 patients undergoing elective laparoscopic cholecystectomy. Data collection forms such as the Sociodemographic Characteristics Questionnaire and the State Anxiety Inventory were administered in the preoperative period, while the Dehydration and Blood Glucose Monitoring Form and Visual Analog Scale were applied a total of three times: in the preoperative period, at the second hour postoperatively, and at the 8th hour postoperatively. Necessary permissions were obtained for the study. The patients’ mean solid and liquid fasting time was 16.65 (2.80) and 15.85 (2.95) hr. The prolongation of the preoperative mean solid fasting time showed a negative correlation with blood glucose levels and a positive correlation with some dehydration symptoms, skin turgor return time, and the nausea score. The prolongation of the preoperative mean liquid fasting time showed a positive correlation with prominence of lingual fissures, nausea scores, thirst scores, heart rate, skin turgor return time and heart rate. In addition, prolonged solid fasting time was associated with higher anxiety levels. Prolonged fasting before surgery negatively affected patients’ anxiety and blood glucose levels and led to dehydration symptoms. Prolonged fasting and fluid restriction before surgery had negative effects on patients’ anxiety and blood glucose levels, while also leading to the emergence of some dehydration symptoms.

To develop an extracorporeal membrane oxygenation (ECMO) training program for intensive care unit (ICU) nurses and assessing the impact of the training on the knowledge and self-efficacy outcomes of the ICU nurses. The number of patients receiving ECMO support is increasing in Turkiye. However, ICU nurses providing care to ECMO patients lack of structured ECMO training programs. A quasi-experimental study including a single group pretest and posttest. The study was conducted with 50 ICU nurses working in a public hospital in Ankara, Türkiye. ECMO training program was developed based on the ADDIE (A = Analyze, D = Design, D = Develop, I = Implement, E = Evaluation) model. Data were collected through with a “Knowledge Test’, ‘Self-Efficacy Perception Scale Regarding the Effectiveness of ICU Nurses in the Care of Patients with ECMO (ECMO- SEPS), ‘Simulation checklist’ and ‘Evaluation form for the effectiveness of the training programme’. In the pretest measurement of the nurses, the mean total score of the knowledge test was 12.0 ± 3.60, while it increased to 21.4 ± 3.57 after the training. In a retest one month after the training, the mean was found to be 20.2 ± 4.92 (p < 0.05). The effect size in the knowledge test (d = 2.62) confirms that the educational content was successful in transferring knowledge. It was found that the posttest and retest sub-dimension scores of the ECMO- SEPS increased in all three sub-dimensions compared to the pretest scores, and this increase was statistically significant (p < 0.05). The training significantly increased nurses’ self-efficacy (η²=0.702) at a statistically significant and practically important level. The strongest effect was in the cognitive domain (η²=0.736). In the psychomotor domain (η²=0.592), it significantly improved application skills. Affective (η²=0.576): Education had a significant impact on motivation and self-confidence. After the training, an average of 15.0 ± 4.04 of the 22 items in the simulation checklist were fully implemented by the nurses. In this study η² values and statistical significance (p < 0.001) prove that ECMO training program is clinically effective and sustainable for ICU nurses knowledge and self-efficacy. The lack of a control group in the study and the fact that all participants were from a single hospital limits the generalisability of the findings. Therefore, it is recommended that future studies implement the ECMO training programme nationwide and be randomised controlled trials. Not applicable.

BACKGROUND: Pupil examination, a fundamental part of the neurologic examination, is essential to detect problems after intracranial surgery. However, this examination may be worrying to patients because it requires close physical proximity and a light source directed at the patient's eyes. This study aimed to describe patient perspectives on pupil examination after intracranial surgery. METHODS: This is a qualitative descriptive study. Semistructured face-to-face, individual interviews were conducted with 12 patients after intracranial surgery. RESULTS: Three main themes, namely, “what I know about pupil examination,” “what I felt during the pupillary examination,” and “my expectations,” were identified through thematic analysis. CONCLUSION: Pupil examination, a routine practice for nurses, may result in worry and uncertainty for patients. This study revealed the importance of nurses using practical communication skills during pupil examinations.

Objective: This study investigated orthopedic and trauma nurses' experiences of caring for patients undergoing extremity surgery due to trauma. Methods: This study adopted a descriptive and qualitative research design. The sample consisted of 11 nurses working in the Orthopedic and Traumatology Clinic of a public hospital in Ankara, where trauma patients are primarily admitted. The determination of the sample size was based on data saturation. Data were collected online (Zoom) using a semi-structured interview guide. Thematic content analysis was used for data analysis. Results: The data were grouped under four themes. The themes were Differences in Care, Competencies in Care, Areas of Improvement in Care, and Challenges Faced by Patients in the Eyes of Nurses. Conclusion: The results showed that our participants were aware of the care needs of patients after trauma surgery. Especially, nurses emphasized that nursing care of orthopedic trauma patients is more complex than that of other orthopedic patients. These results suggest that nurses need training specifically for the care of trauma patients and that different studies should be conducted to evaluate patient outcomes and nurse experiences after training.