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Sürdürülebilir Kalkınma Amaçları

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• MakaleYalnız künye2027/r/gumushane/13661
  Serial 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.

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• MakaleAçık Erişim2026/r/gumushane/19398
  Olgu Temelli Yapay Zekâ Eğitim Uygulamasına Yönelik Hemşirelik Son Sınıf Öğrencilerinin Görüşleri: Tanımlayıcı Nitel Çalışma

  Tuncer, Metin; Tuncer, Gülsüm Zekiye; Yalcinkaya, Turgay

  Amaç: Olgu temelli yapay zekâ uygulamalarının hemşirelik eğitimine etkili ve güvenli bir şekilde entegrasyonu, hemşirelik öğren cilerinin çağdaş eğitim ihtiyaçlarını karşılamak açısından önemli bir gerekliliktir. Bu nedenle araştırmanın amacı, hemşirelik son sınıf öğ rencilerinin yapay zekâ destekli olgu temelli eğitim uygulamasına iliş kin deneyimlerini ve görüşlerini derinlemesine incelemektir. Gereç ve Yöntemler: Tanımlayıcı nitel araştırma deseninde yürütülen bu ça lışma, bir devlet üniversitesinde öğrenim gören 15 gönüllü son sınıf hemşirelik öğrencisiyle gerçekleştirilmiştir. ChatGPT-4o tabanlı olgu temelli bir eğitim uygulaması yapan gönüllü katılımcılar ile yarı yapı landırılmış görüşmeler yoluyla veriler yüz yüze bireysel yöntemle top lanmıştır. Görüşmeler, içerik analizi yöntemiyle değerlendirilmiştir. Bulgular: Analiz sonucunda, (1) Öğrenme sürecine katkısı, (2) Kulla nım kolaylığı ve erişilebilirlik, (3) Geleneksel eğitimle kıyaslama ve (4) Güvenilirlik ve sınırlılıklar olarak 4 ana tema ortaya çıkmıştır. Ka tılımcılar, ChatGPT’nin klinik akıl yürütme becerilerini desteklediğini, bilgiye hızlı erişim sağladığını ve yargılamayan bir öğrenme ortamı sunduğunu ifade etmiştir. Ancak bilgi tutarsızlıkları, kaynak belirtme mesi ve komutlara duyarlılık gibi sınırlılıklar da vurgulanmıştır. Sonuç: Çalışma, ChatGPT destekli olgu temelli eğitimin hemşirelik öğrenci lerinin öğrenme sürecine katkı sunduğunu ve geleneksel eğitimi ta mamlayıcı bir potansiyel taşıdığını göstermektedir. Bu tür uygulamaların hemşirelik eğitimine etkili biçimde entegre edilebilmesi için öğretim elemanı rehberliğinde yapılandırılmış senaryolarla yürü tülmesi, öğrencilerin komut oluşturma ve eleştirel düşünme becerileri nin desteklenmesi önerilmektedir.

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• MakaleAçık Erişim2026/r/gumushane/13915
  The effect of eHealth-based guided self help interventions for binge eating disorder : a meta-analysis of randomized controlled trials

  Tuncer, Gülsüm Zekiye; Tuncer, Metin

  With rapid technological advancements, eHealth-based guided self-help interventions have become accessible, flexible, cost-effective, and stigma-reducing treatment options for binge eating disorder (BED). This meta-analysis evaluated the effectiveness of these interventions in individuals diagnosed with BED or showing BED symptoms, based on eight randomized controlled trials with 1,575 participants. Intervention length varied between a single session to four months. Six studies focused solely on web-based guided self-help interventions, one study implemented a hybrid approach combining face-to-face and online components, and another study employed two distinct online guided self-help methods. The interventions included psychoeducational modules, therapist feedback, online behavior monitoring, and self-assessments. eHealth-based guided self-help significantly reduced binge eating psychopathology (SMD: 0.53; 95% CI: 0.20–0.86) and objective binge eating (OBE) days (SMD: 0.49; 95% CI: 0.12–0.85) compared to controls. These interventions offer effective solutions for individuals facing barriers to traditional treatment access.

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• MakaleYalnız künye2026/r/gumushane/13829
  Exposure to Violence and Therapeutic Communication in Nursing Students

  Erol, Ahmet; Tuncer, Metin

  Background: – Workplace violence negatively affects the professional development of nursing students. Objectives: – To investigate nursing students’ exposure to violence, violence-management competence, and therapeutic communication during clinical practice. Methods: – A descriptive, cross-sectional, correlational study involves 530 nursing students. Data were collected between September 2024 and February 2025 using a Sociodemographic Form, the Workplace Violence Competence Scale, and the Therapeutic Communication Skills Scale. Results: – Violence was reported by 32.8% of students, mainly verbal (60.9%) and psychological (47.1%), often by patients or relatives. Communication skills correlated positively with violence management competence, explaining 18.1% of the variance. Higher self-confidence, problem-solving, voluntary choice of profession, and prior education were associated with better outcomes. Conclusions: – Nursing students are at substantial risk of violence during clinical practice, and their ability to manage it is enhanced by therapeutic communication and supportive factors, underscoring the need to strengthen curricula and faculty preparation.

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• MakaleYalnız künye2026/r/gumushane/13752
  Integrating Artificial Intelligence Into Nursing Care Planning: A Comparative Evaluation of Psychosocial Care for Patients With a Stoma

  Kulakaç, Nurşen; Tuncer, Metin

  This methodological study evaluated and compared the content quality and appropriateness of nursing care plans developed by nurses and artificial intelligence (AI) for addressing the psychosocial problems of patients with stomas. Two nursing care plans addressing the psychosocial needs of a patient with a stoma were developed: 1 generated by nurses and 1 generated by an AI system. The content quality and appropriateness of the care plans were independently evaluated by 12 experts, including nursing academics and clinical nurses, using the DISCERN measurement tool. Inter-rater reliability was assessed using the intraclass correlation coefficient (ICC). The mean DISCERN score of the nurse-generated care plan was significantly higher than that of the AI-generated care plan (P=.008). Inter-rater agreement demonstrated good agreement. The findings indicate that nurse-generated care plans demonstrate superior content quality and overall integrity compared to AI-generated plans. AI-generated care plans exhibit potential as supportive tools in nursing care planning.

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• MakaleAçık Erişim2026/r/gumushane/13618
  The Effect of a Psychiatric Nurse–Led AI-Based Online Group Guided Self-Help Program on Eating Behaviours and Body Image among Overweight and Obese Women Nurses: A Randomized Controlled Trial

  Tuncer, Gülsüm Zekiye; Duman, Zekiye Çetinkaya; Tuncer, Metin

  Aim: This study aimed to evaluate the effectiveness of a psychiatric nurse–led, AI-supported online group guided self-help programme on eating behaviours, body image, and body mass index (BMI) among overweight and obese women nurses. Method: A randomised controlled experimental design with pre-test, post-test, and three-month follow-up assessments was employed. Forty-four overweight and obese women nurses were randomly assigned to intervention (n = 22) and control (n = 22) groups. The intervention consisted of an 8-week online group guided self-help programme supported by a large language model (LLM), under the leadership of a psychiatric nurse. Participants did not interact directly with the LLM; all AI-generated feedback was clinically reviewed and delivered by the researcher. Results: The intervention group demonstrated significant reductions in emotional eating and external eating, along with significant improvements in body image scores and adaptive coping strategies. A significant decrease in BMI was also observed from baseline to three-month follow-up. Between-group comparisons at post-test and follow-up indicated statistically significant differences favouring the intervention for eating behaviours and selected body image–related outcomes, whereas between-group differences in BMI were not statistically significant. Conclusion: A multi-component online group guided self-help intervention incorporating structured AI-assisted feedback under psychiatric nurse leadership may represent a promising approach to improving eating behaviours, body image, and weight-related outcomes among overweight and obese women nurses.

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• Derleme MakaleYalnız künye2026/r/gumushane/13413
  Immunosuppressant 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.

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• MakaleAçık Erişim2026/r/gumushane/12198
  Protecting 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.

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• MakaleAçık Erişim2026/r/gumushane/12186
  Turkish 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.

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• MakaleAçık Erişim2025/r/gumushane/15837
  As if I don't belong here. First-Year Experiences of International Nursing Students at University - A Qualitative Study

  Tuncer, Gulsum Zekiye; Tuncer, Metin

  Background: The rapid adaptation of international nursing students to university life enables them to actively continue their education without disruption in the following years. Identifying the challenges faced by these students, who are future nursing professionals, is essential fortheir adaptation and professional development. Aim: This study aimed to explore the perspectives of international nursing students regarding their first-year experiences at university. Methods: This study employed a descriptive qualitative research design. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was used for reporting. The sample consisted of 13 international nursing students enrolled in the Faculty of Nursing at a university. Data were collected through face-to-face, individual, in-depth interviews using semi-structured interview questions. Content analysis was used to analyze the data. Results: The mean age of the nursing students was 23.3 years. Among the participants, seven were women, 11 had been residing in Turkiye for approximately one year, 12 were from Iran, and one was from Iraq. Three key themes emerged in this study: Facilitators of Adaptation, Challenges, and Coping. The students identified several facilitators of adaptation, including similarities between the Turkish economy and culture and their home countries' economies and cultures, proficiency in the Turkish language, studying at a nursing school aligned with their career goals, and receiving social support from their relatives. However, they also faced challenges such as language barriers, cultural differences, discrimination, social isolation, homesickness, and academic and clinical difficulties. Conclusion: International nursing students may encounter language barriers, cultural differences, and education-specific challenges during their first year of nursing school. In this context, developing support mechanisms to guide these students in their academic and social lives will facilitate their ability to cope with these difficulties.

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