Sürdürülebilir Kalkınma Amaçları
Yayınlar
- MakaleYalnız künye2027Serial mediating role of belonging and state mindfulness in the relationship between clinical learning environment and caring behaviors in nursing students
Özalp, Cemal; Tuncer, Metin; Kaya, Abdulsamed; Şahin, Fatih
Aim: The study aimed to examine the relationship between clinical learning environment and caring behaviors in nursing students and to test the serial mediating roles of belonging and state mindfulness in this relationship. Background: The psychosocial mechanisms linking the clinical learning environment to caring behaviors remain unclear, particularly the combined roles of belonging and state mindfulness. Design: The study had a cross-sectional design and was conducted in line with the STROBE guidelines. Methods: The sample consisted of 452 undergraduate nursing students studying at a state university in Turkiye. The data were collected between December 2025 and January 2026 using the Personal Information Form, Clinical Learning Environment Scale, Nursing Department Belonging Scale, State Mindfulness Scale, and Caring Behaviors Inventory. Results: The clinical learning environment was found to be positively correlated with sense of belonging (B = 0.412, p < .001). Sense of belonging significantly predicted both State Mindfulness (B = 0.607, p < .001) and caring behaviors (B = 0.857, p < .001). State mindfulness is also a significant predictor of caring behaviors (B = 0.734, p < .001). Indirect effects analyses indicated that the clinical learning environment was associated with caring behaviors through sense of belonging and through the sequential pathway involving both sense of belonging and state mindfulness. However, the direct effect of the clinical learning environment on caring behaviors was not significant. Additionally, the indirect effect of the clinical learning environment on caring behaviors through state mindfulness alone was not significant. Conclusions: The results of the study showed that the clinical learning environment is associated with nursing students' caring behaviors indirectly through sense of belonging and state mindfulness, rather than directly.
- Derleme MakaleYalnız künye2026Immunosuppressant adherence levels in kidney transplant recipients measured by electronic monitoring devices: A systematic review and meta-analysis
Tuncer, Metin; Yalcinkaya, Turgay; Erol, Ahmet; Özalp, Cemal
Background: Kidney transplantation improves survival and quality of life in patients with end-stage renal disease; however, long-term graft success depends on adherence to immunosuppressive therapy. Objective: To quantify adherence levels among kidney transplant recipients using electronic monitoring devices. Methods: PubMed, Web of Science, Scopus, and the Cochrane Library were systematically searched for studies published between 2000 and 2025. A random-effects meta-analysis was conducted including studies that assessed adherence using electronic monitoring devices. Results: Seven studies with a total of 1025 kidney transplant recipients were included. The pooled mean adherence measured using electronic monitoring devices was 94.39%. In studies with monitoring durations of three months or longer, adherence decreased to 90.50%. Substantial heterogeneity was observed across studies. Conclusion: Although electronically measured adherence appears generally high, its decline over longer monitoring periods indicates that adherence is dynamic and may decrease over time. However, these estimates should be interpreted cautiously because electronic monitoring devices cannot confirm actual medication ingestion. Furthermore, intentionally non-adherent patients may be less likely to participate in or remain engaged with electronic monitoring studies and may therefore be underrepresented, potentially leading to an overestimation of true adherence. Even modest reductions in adherence may carry important clinical consequences, underscoring the need for sustained monitoring.
- MakaleAçık Erişim2026Protecting the Privacy of Patients With Impaired Consciousness in Intensive Care: A Qualitative Study
Tuncer, Metin; Özalp, Cemal; Keskin, Azra
Background: Maintaining privacy in intensive care units (ICUs) is challenging because of high workload, invasive procedures, continuous monitoring and shared care environments. Patients with impaired consciousness may be particularly vulnerable because their ability to express privacy preferences, assert personal boundaries and advocate for themselves is limited. Aim: To explore intensive care nurses' experiences of protecting privacy when caring for patients with impaired consciousness. Study Design: A descriptive qualitative study was conducted with 20 intensive care nurses in Türkiye between March and April 2026. Data were collected through semi-structured online interviews and analysed using inductive thematic analysis. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative Research guidelines. Findings: Four themes were identified: the marginalisation of privacy under clinical priorities; structural and process-related constraints on privacy in intensive care; loss of subjectivity and the mechanisation of care in patients with impaired consciousness; and ethical and psychosocial implications of privacy violations. Conclusions: Privacy in intensive care is shaped not only by individual ethical awareness but also by workload, environmental conditions, care routines and communication practices. Patients with impaired consciousness have the same rights to privacy and dignity as other patients; however, their reduced ability to express preferences, assert personal boundaries and advocate for themselves may make privacy violations less visible and increase their dependence on nurses for protection. Relevance to Clinical Practice: Protecting the privacy of patients with impaired consciousness in ICUs requires structured care routines, standardised bedside communication, minimisation of unnecessary exposure during procedures and targeted ethical awareness training to support dignity in everyday practice.
- MakaleAçık Erişim2026Turkish Adaptation, Psychometric Validity and Measurement Invariance of the Reasons for Implicit Rationing of the Nursing Care Scale
Özalp, Cemal; Gerçek, Abdullah; Tuncer, Metin
Aim: This study aimed to adapt the Reasons for Implicit Rationing of Nursing Care Scale into Turkish and evaluate its validity, reliability and measurement invariance among nurses in Türkiye. Background: Implicit rationing of nursing care may compromise care quality and patient safety and is influenced by organizational, resource-related and communication factors. A culturally valid instrument is needed to identify the factors contributing to implicit rationing of nursing care within the Turkish healthcare context. Design: A methodological, cross-sectional psychometric validation study. Method: Data were collected between July and December 2025 from nurses working in a public hospital in Türkiye. The source population comprised 900 nurses and 411 nurses were included in the final sample using convenience sampling. Data were collected using the Personal Information Form and the Reasons for Implicit Rationing of Nursing Care Scale. Construct validity was examined using exploratory and confirmatory factor analyses on randomly divided samples. Convergent and discriminant validity and gender-based measurement invariance were assessed. Reliability was evaluated using Cronbach's alpha, McDonald's omega and the intraclass correlation coefficient. Results: The Kaiser–Meyer–Olkin value was 0.936, indicating that the data were suitable for factor analysis. Exploratory factor analysis revealed a two-factor structure consistent with the original scale, explaining 74.30% of the total variance. Confirmatory factor analysis demonstrated acceptable model fit. Convergent validity was supported, whereas the heterotrait–monotrait ratio value indicated borderline discriminant validity. Measurement invariance across genders was largely supported at the configural, metric and scalar levels. The scale demonstrated high internal consistency and temporal stability, with a Cronbach's alpha value of 0.941, a McDonald's omega value of 0.932 and an intraclass correlation coefficient value of 0.873. Conclusion: The Turkish version of the Reasons for Implicit Rationing of Nursing Care Scale is a valid, reliable and gender-invariant instrument. It can be confidently used in Turkish clinical settings to assess factors contributing to implicit rationing of nursing care.