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BackgroundIntensive care units are stressful places where patients experience physical and psychological discomfort. Understanding the experience of these patients regarding nursing care is very important.Aims and objectivesTo determine the intensive care experiences of thoracic and cardiovascular surgery patients and the factors that affect them.DesignThe research consists of two phases: quantitative and qualitative.MethodsThis was a descriptive and cross‐sectional study. Its research sample comprised 100 patients who spent at least one night in an intensive care unit after thoracic or cardiovascular surgery. The Intensive Care Experiences Scale (ICES) and the Numeric Rating Scale were used. Two open‐ended questions were asked to the patients to understand what they felt when they were attached to mechanical ventilation and to describe their intensive care experiences.ResultsThe ICES mean score was 66.35 ± 6.88. Significant negative relationships were found between length of stay and severity of pain and ICES total scores. A significant difference was found between scale scores and being understood by health care professionals when attached to mechanical ventilation. The patients stated that, when they were attached to mechanical ventilation and during their stay in the intensive care unit, they experienced feelings of helplessness, uncertainty, and fear. They also experienced physical discomfort and reported no longer fearing death.ConclusionIt was determined that patients partially positively perceived their experiences. It was found that they focused on coming out of surgery alive. The physical discomfort and negative emotions reported can be reduced or relieved by competent care.Relevance to clinical practiceThe intensive care experiences and emotions of intensive care patients are important. Physical discomfort and negative emotions can be mitigated or alleviated by competent nursing care.

Objective: This study aimed to determine the relationship between preoperative anxiety and postoperative pain and perioperative sleep quality in open-heart surgery patients. Methods: It was a cross-sectional study. The research sample included 126 patients who underwent open-heart surgery for the first time and remained in intensive care for a maximum period of 48 hours. All patients' procedures were performed with cardiopulmonary bypass and sternotomy. Data were collected using a Patient Identification Form, developed by the researcher and used to determine patients' characteristics; the Anxiety Specific to Surgery Questionnaire (ASSQ), used to determine patients' anxiety level; the Pittsburgh Sleep Quality Index (PSQI), used to measure perioperative sleep quality, and the Numeric Pain Scale (NPS), used to determine postoperative pain levels. Results: Open-heart surgery patients experienced moderate levels of anxiety (27.28±8.48), moderate postoperative pain (4.30±2.29) and poor sleep quality (10.27±4.23) perioperative period. In this paper, a significant, weak, and positive correlation between ASSQ score and postoperative NPS score (r=0.318, p<0.05) was found; no correlation between the ASSQ score and perioperative PSQI score was found. It was determined that 90.48% (n = 114) of patients who underwent open heart surgery had poor sleep quality and there was no relation between preoperative anxiety and postoperative sleep quality. Conclusion: The authors concluded that preoperative anxiety impacts postoperative pain but has no effect on sleep quality for open-heart surgery patients in Turkish people.

Kalp kapak ameliyatları sonrası dönemde hemşirelik bakımı oldukça karmaşıktır. Bu ameliyatlar açık kalp cerrahisi tekniğiyle yapıldığından; ameliyatta hipotermi uygulanması, median sternotomi, mekanik protez kapak implantasyonu, göğüs tüpleri, akut dönemde yoğun bakımda mekanik ventilasyona bağlı kalınması odaklanılması gereken ve çeşitli güçlükler yaratan konulardan sadece bir kaçıdır. Bu alandaki rehberler genellikle tedavi ilkeleri üzerine yoğunlaşmakta olup, kalp kapak ameliyatı olan hasta grubunun bakımını tümüyle içeren bir rehbere ulaşılamamıştır. Açık kalp ameliyatı yöntemiyle kalp kapak ameliyatı uygulanan hastanın bakımına yönelik ülkemizdeki yayın sayısının yetersiz olması, bu derlemenin yazılış amacını oluşturmuştur. Kalp kapak hastalıkları dünyada ve ülkemizde oldukça sık görülmektedir. Bu ameliyatlar hastaların yaşam sürelerini uzatmak ve yaşam kalitelerini artırmak için yapılsa da, çeşitli komplikasyonlara ve istenmeyen durumlara neden olabildikleri için ameliyat sonrası dönemde yakın izlem ve yoğun hemşirelik bakımı gerektirmektedir. Kalp kapak ameliyatları hastaların tüm sistemlerini etkilediğinden, ameliyat öncesi hazırlıktan ameliyat sonrası bakıma kadar olan tüm süreçte hastanın yakından izlenmesi, komplikasyonların erken saptanması ve yönetilmesi açısından önemlidir. Kalp damar cerrahisi hemşireleri, bu özel hasta grubunun bakımında klinik bilgi ve becerilerinin yanı sıra eğitici rollerini aktif bir şekilde kullanabilirler.

Kalp kapak hastalıkları oldukça yaygın görülen sağlık sorunlarından biridir. İleri derece kapak hastalıklarında cerrahi tedavi ön plana çıkmaktadır. Kalp kapak ameliyatları sonrasında hasta hem ameliyat hem de antikoagülan ilaç nedeniyle uyum sağlamak durumundadır. Cerrahi yara, sternotomi, kardiyak rehabilitasyonun yanında antikoagülan tedavinin başlanması, sürdürülmesi ve komplikasyonların önlenmesinde uyum oldukça önemlidir. Beklenen yaşam süresinin artması ve mekanik protez takılma sınırının 60 yaşa kadar uzatılması, ömür boyu antikoagülan kullanan hasta sayısının artacağını düşündürmektedir. Bu nedenle hemşireler giderek daha yaşlı bir hasta grubunda antikoagülan tedaviye uyumu arttırma sorumluluğu taşımaktadır. Ülkemizde kalp kapak protezleri ameliyatları sonrasında antikoagülasyonu sağlamak için K vitamini antagonisti olarak varfarin kullanılmaktadır. Varfarin kullanımına yönelik bir eğitim programı ve terapotik doza ulaşmada hastalar için uygulanan belirli bir protokol bulunmamaktadır. Bu durum hasta uyumunu zorlaştıran bir unsurdur. İlacın kullanımı, beslenme, ilaç etkileşimleri, yan etkiler ve izlemler antikoagülan tedaviye uyumda anahtar noktalardır. Hastanın antikoagülan tedaviye uyum sağlaması için hemşire bu konularda hastayı desteklemelidir. Ameliyat sürecinin getirdiği komplikasyonlar yanında ilaç uyumsuzluğu yaşayan hastalar tromboemboli ya da kanama gibi hayatı tehdit eden komplikasyonlarla karşı karşıya kalmaktadır. Kişiye özgü alışkanlıkların değerlendirildiği, ilaç dozu ile sınırlı kalmayıp kişinin uyumsuzluğuna neden olan etmenlerin incelendiği danışmanlık sisteminin sağlanması ve sürdürülmesi öncelikli konulardan biridir.

Background: Patients with mechanical heart valve replacement surgery (MHVRS) should be followed up in terms of prosthetic valve-related and open heart surgery complications. This study aimed to determine the anticoagulant complications in long term in patients with MHVRS. Methods: This retrospective and descriptive study was conducted in a university hospital, İzmir, Turkey. The data were collected from July to December 2019. In total, 73 patients referring for regular check-ups to the hospital with intervals not exceeded more than 90 days, and those who had international normalized ratio (INR) measurements for January-April-July-October 2018 were included in this study. Results: The mean age of the patients was obtained at 58.98±12.89 years, and 53.4% (n=39) of the cases were male. Moreover, the mean follow-up period was estimated at 65.98±28.47 months. According to the results, complications developed in 60 patients (82.2%). The first hospitalized unit was the emergency department. The factors affecting the development of complications after MHVRS were evaluated, and a difference was found regarding gender (X2=6.18, P=0.013), comorbidities (X2=25.58, P=0.018), and monthly referral for regular check-ups to the hospital (X2=5.20, P=0.023). There was no relationship between the INR levels and the development of complications. Furthermore, the results of evaluating the factors affecting the number of hospitalizations after MHVRS revealed that monthly referral to hospital for check-ups (t=3.18, P=0.002) and history of previous valve surgery (Z=201.00, P=0.03) affected the number of hospitalizations. Conclusions: It was observed that patients frequently refer to the emergency department and struggled with various complications. Moreover, it was found that the patients had frequent bleeding and refer to the emergency service repeatedly. Accordingly, there is a need for interventional studies to reduce postoperative complications and provide the therapeutic INR level.

Purpose: Anticoagulants are an important group of drugs used by many patients with different diseases. There are general adherence scales that measure adherence to treatment in the literature. However, the correct use of the drug alone is not sufficient for adherence with warfarin therapy. To develop Anticoagulant Therapy Adherence Scale for use in patients on warfarin and to examine psycholinguistic and psychometric properties. Methods: The research was of a methodological and consisted of 170 patients. The validity of the scale was tested by using content validity, explanatory and confirmatory factor analysis. The reliability of the scale was examined by utilizing item-total scale correlations and Cronbach’s alpha. Results: After the scale items were created, opinions were received from twenty experts and content validity indexes were found to be above 0.80. In the explanatory factor analysis, a 3-factor structure with factor loads between 0.30 and 0.81 was obtained. Fit indices obtained in the confirmatory factor analysis were as follows: χ2 = 181.116, df = 116 χ2/df value 1.561, Root Mean Square Error of Approximation (RMSEA) = 0.058, Comparative Fit Index (CFI): 0.88 and Goodness Fit Index (GFI): 0.88. Item-total scale correlation coefficients were found to range between 0.57 and 0.25. The Cronbach's alpha reliability coefficient was 0.74 for the overall scale and 0.63, 0.77 and 0.65 for its subscales. Conclusions: ATAS was found to be a valid and reliable measurement tool in Turkish population. The scale can be used by healthcare professionals to evaluate patients' use of warfarin in a standard way.

Koronavirüs hastalığı-2019 [coronavirus disease-2019 (COVID-19)] pandemisi, tüm dünyada insanların yaşamını büyük ölçüde etkilemiştir. Bir-çok insan özellikle kronik hastalığı bulunanlar ve yaşlılar hastalık sürecini ağır yaşamış ve çoğunlukla da mortaliteyle sonuçlanmıştır. Bu durum insanlarda