Ebubekir Kaplan

Background: Patients hospitalised in coronary intensive care units often experience heightened existential distress, including increased spiritual care needs and death anxiety. Spiritual well‐being has been suggested as a key protective factor that may alleviate death‐related anxiety in critically ill populations; however, the mechanisms underlying these relationships remain insufficiently explored. Aims: This study examined the relationships among spiritual care needs, spiritual well‐being and death anxiety in patients hospitalised in a coronary intensive care unit and tested whether spiritual well‐being mediates the relationship between spiritual care needs and death anxiety. Design: A cross‐sectional design was employed. Methods: The study included a convenience sample of patients hospitalised in a coronary intensive care unit in Eastern Turkey, between September and December 2024. Data were collected using a Sociodemographic and Clinical Variables Form, the Patients' Spiritual Needs Assessment Scale, the Functional Assessment of Chronic Illness Therapy–Spiritual Well‐Being Scale and the Templer Death Anxiety Scale. Data analysis involved descriptive statistics, Pearson correlation analysis and mediation analysis using Hayes's PROCESS macro (Model 4), with age and gender included as control variables. Results: Patients reported moderate levels of spiritual care needs (3.04 ± 0.47), spiritual well‐being (30.53 ± 6.87) and death anxiety (8.04 ± 3.00). Spiritual care needs were positively associated with spiritual well‐being ( r = 0.56, p < 0.001) and its subdimensions (meaning, peace and faith). Death anxiety was negatively correlated with spiritual well‐being ( r = −0.32, p < 0.001), with the strongest association observed for the peace subdimension ( r = −0.39, p < 0.001). Mediation analysis demonstrated a significant indirect effect of spiritual care needs on death anxiety through spiritual well‐being ( b = −1.46, 95% CI [−2.28, −0.67]). Although higher spiritual care needs were directly associated with greater death anxiety, they were also associated with higher spiritual well‐being, which in turn was related to lower death anxiety, suggesting that spiritual well‐being may buffer the association between spiritual care needs and death anxiety. Conclusions: Higher spiritual care needs among coronary intensive care patients are associated with greater spiritual well‐being, which in turn relates to lower levels of death anxiety. The significant indirect effect suggests that spiritual well‐being plays a buffering role in the relationship between spiritual care needs and death anxiety. Given the cross‐sectional design, these findings should be interpreted as associative rather than causal. Relevance to Clinical Practice: Assessing spiritual care needs and supporting spiritual well‐being in coronary intensive care settings may be critical for reducing death‐related anxiety. Integrating spiritual care interventions—particularly those fostering inner peace and meaning—into routine nursing care may enhance holistic patient support and psychological resilience in critically ill patients.

Background: In intensive care units, where complex patient needs require evidence‐based clinical decision‐making, individualised care is regarded as one of the cornerstones of high‐quality nursing practice. Aim: This study aimed to examine the relationships between professional values, attitudes towards evidence‐based nursing, clinical decision‐making and perceptions of individualised care among intensive care nurses. Study Design: A cross‐sectional descriptive study design was employed. Methods: Data were collected from intensive care nurses using validated instruments assessing professional values, attitudes towards evidence‐based nursing, clinical decision‐making, and perceptions of individualised care. Results: Significant positive correlations were found among all study variables ( p < 0.001). Evidence‐based nursing emerged as the strongest predictor of individualised care (β = 0.444, p < 0.001), followed by professional values (β = 0.165, p < 0.001) and clinical decision‐making (β = 0.112, p = 0.020). The final model explained 35.9% of the variance. Nurses with postgraduate education and longer ICU experience demonstrated higher scores across all variables. Conclusions: Attitudes towards evidence‐based nursing were strongly associated with perceptions of individualised care among intensive care nurses. Professional values and clinical decision‐making also contributed significantly to this relationship. Relevance to Clinical Practice: Strengthening nurses' participation in evidence‐based practice can support the delivery of better individualised care in intensive care settings.

This descriptive and correlational study was conducted with 131 patients undergoing hemodialysis in Eastern Turkey to examine levels of spiritual needs, psychological distress, and death anxiety, as well as the relationships among these variables and predictors of death anxiety. The participants reported mild levels of depression and stress and moderate levels of anxiety. The mean score on the Templer Death Anxiety Scale indicated a high level of death anxiety (M = 8.80, SD = 1.88). Spiritual needs, assessed via a contamination-adjusted measure, were positively associated with death anxiety but were not significantly related to depression, anxiety, or stress. Hierarchical regression analysis revealed that spiritual needs significantly predict death anxiety even after controlling for psychological distress. These findings suggest that spiritual needs represent a distinct existential dimension in hemodialysis patients and play a unique role in shaping fear of death. Integrating spiritually sensitive and existentially informed care into hemodialysis services may help reduce death-related distress and support psychological well-being in this population.

Background: End-of-life care is administered to individuals in the terminal stages of their life, typically when their health is steadily declining. This form of care is integral to palliative care, encompassing the alleviation of physical symptoms; the delivery of emotional, social, and spiritual assistance; and the honoring of the preferences of both patients and their families. Aim: This research aimed to explore the attitudes and behaviors of intensive care nurses regarding end-of-life care and the experience of death. Design: This study employed a descriptive and correlational research design. The participant pool comprised 306 nurses actively engaged in the intensive care units of a hospital during the period from June to December 2022. Methods: Data were gathered through the utilization of 3 instruments: “Individual Characteristics Form,” “The Scale of the Attitudes and Behaviors of Intensive Care Unit Nurses Intended for End-of-Life Care,” and the “Death Attitude Profile-Revised.” Results: The results indicated that the attitudes and behaviors of nurses concerning end-of-life care and death were, on average, at a moderate level. Married nurses, those with postgraduate education, individuals working in the intensive care unit, those with 11 or more years of experience, and those who perceived their knowledge about end-of-life issues as adequate demonstrated more favorable attitudes and behaviors towards end-of-life care compared to other groups. Conclusions: The study revealed that nurses with postgraduate education and those employed in the intensive care unit exhibited more favorable attitudes towards death. To enhance these attitudes and provide necessary support, it is advisable to implement supportive interventions and organize in-service training programs.

Background: Intensive care nurses experience moral distress due to moral conflicts, which negatively impact their attitudes and behaviours towards end‐of‐life care. Moral resilience is considered a potential factor in mitigating these negative effects. Aim: This study aims to examine the mediating role of moral resilience in the relationship between moral distress and intensive care nurses' attitudes and behaviours towards end‐of‐life care. Study Design: A descriptive and cross‐sectional study was conducted in accordance with the guidelines for observational studies (STROBE). The study was conducted with 228 intensive care nurses between December 2024 and February 2025. Data were collected using the ‘Personal Information Form’, ‘Moral Distress Scale’, ‘Moral Resilience Scale’ and ‘Scale of Attitudes and Behaviours of Intensive Care Nurses Towards End‐of‐Life Care’. Statistical analyses were performed using SPSS 26.0 and AMOS V 24.0. Results: The moral distress levels of female nurses were higher and significantly higher than male nurses (OR 0.245; 95% CI 0.074–0.598; p = 0.011). Nurses with 11 years or more of work experience had a higher and significant level of moral distress compared to other nurses (OR 0.053; 95% CI 0.080–0.115; p = 0.012). The moral resilience level of nurses with 3–6 years of work experience was higher and significantly higher than other nurses (OR 0.067; 95% CI 0.048–0.107; p = 0.023). Moral distress negatively affects nurses' attitudes and behaviours towards end‐of‐life care. Moral resilience has a significant and positive effect on attitudes and behaviours. Moreover, moral resilience mediated the relationship between moral distress and attitudes and behaviours towards end‐of‐life care (β;‐0.266, CI 95% −0.301–0.197). Conclusions: Moral distress negatively influences intensive care nurses' attitudes and behaviours in end‐of‐life care. Enhancing moral resilience can help mitigate these effects. The findings highlight the need for nursing education programmes and workplace interventions to strengthen nurses' moral resilience and improve their ability to manage moral distress. Relevance to Clinical Practice: While moral distress damages intensive care nurses' attitudes towards end‐of‐life care, moral resilience may help to reduce its negative effects. Supporting nurses is thought to improve the quality of adverse end‐of‐life care.

Nurses are routinely exposed to traumatic events as part of their professional duties, placing them at risk of developing secondary traumatic stress (STS). This condition can negatively impact both their psychological well-being and job performance. Although religious coping strategies and prosocial behaviors are thought to play a protective role against STS, these effects remain understudied in the literature. This descriptive and cross-sectional study was conducted with the participation of 516 nurses. Data were collected between April and August 2024 using the ‘Sociodemographic Data Form’, Religious Coping Scale’, “Prosocial Behavior Scale” and “Secondary Traumatic Stress Scale”. In the study, hierarchical regression analysis was applied to examine the effect of independent variables on the dependent variable. 58.6% of the nurses were between the ages of 18–31, 58.4% were undergraduate graduates, and 82.6% had experienced a traumatic event. The mean score of prosocial behavior was 3.04 ± 0.63 and the mean score of secondary traumatic stress was 48.98 ± 13.52. Positive religious coping (mean = 20.02 ± 4.31) showed a moderate negative correlation with secondary traumatic stress (r=-0.563, p = 0.001). Hierarchical regression revealed that religious coping strategies (positive and negative religious coping) alone explained 31.8% of the variance in secondary traumatic stress (R²=0.318), and when prosocial behavior was added, this percentage increased to 33.9%. This study highlights the critical role of positive religious coping and prosocial behavior in reducing secondary traumatic stress among nurses frequently exposed to traumatic events. Positive religious coping emerged as the strongest protective factor, while prosocial behavior also contributed significantly to the reduction of stress levels. Strengthening positive coping mechanisms and promoting prosocial behaviors may be effective strategies to support nurses’ mental health and resilience in trauma intensive care settings. Positive religious coping and prosocial behaviors were found to be effective in reducing nurses’ secondary traumatic stress. It is recommended that training and support programmes that support nurses’ positive coping skills should be expanded in clinical practice.

Background: It has been reported that factors such as immobility, pain, invasive interventions, separation from family, presence of unfamiliar people, constant noise and frequent sleep interruptions in intensive care units cause deterioration in comfort and sleep problems associated with deterioration in comfort, high levels of anxiety and restlessness. Aim: The aim of this randomized controlled trial was to investigate the effect of nursing care based on Kolcaba's Comfort Theory on the comfort, satisfaction and sleep quality of intensive care unit patients. Study Design: The sample of the study consisted of 40 experimental and 40 control group patients who agreed to participate in the study between April 2023 and July 2023. The data were collected by the Patient Information Form, General Comfort Questionnaire (GCQ), Newcastle Satisfaction with Nursing Scale (NSNS), Richard‐Campbell Sleep Questionnaire (RCSQ) and Comfort Behaviour Checklist (CBC). Patients in the control group received conventional care by intensive care nurses. Patients in the experimental group received individualized nursing care based on the Comfort Theory of Kolcaba during their stay in the intensive care unit. The SPSS 26 program was used for statistical analyses of the data. Results: The experimental and control groups were homogeneous in terms of demographic and disease characteristics, and no significant difference was found between the groups in terms of pre‐test GCQ, NSNS, RCSQ, CBC and pain level mean scores. Compared with the pre‐test evaluation of the experimental group, the post‐test GCQ, NSNS, RCSQ and CBC total scores increased ( p < 0.001). There was a significant difference in GCQ, NSNS, RCSQ and CBC levels between the experimental and control groups ( p < 0.001). There was a significant decrease in pain scores between the experimental and control groups ( p < 0.001). Conclusions: As a result of this study, it was found that nursing care based on Comfort Theory of Kolcaba had a positive effect on the comfort, satisfaction and sleep quality of intensive care patients. Relevance to Clinical Practice: Nursing care based on the Comfort Theory can be considered an appropriate method in clinical practice, especially in improving the quality of care of patients in the coronary intensive care unit.

Yoğun bakım ünitelerinde ölüm anksiyetesi, özellikle ileri yaş, ciddi hastalık tanıları, sosyal destek eksikliği ve uzun süreli yoğun bakım tedavisi gibi faktörlerle ilişkilidir. Bu süreçte kişilerin ölüm anksiyetesini gidermek için psikososyal destek sürdürülmesi, hasta ve yakınlarına rehberlik sağlanması ve iletişim odaklı bakım uygulamalarının benimsenmesi önemlidir. Sağlık çalışanlarının, ailelerinin kaygı düzeylerinin farklı olup olmadığı uygun müdahalelerde bulunup, sorunların çözümüne olumlu katkı sağlanabilmektedir.