ABSTRACT BOOK INTERNATIONAL CONGRESS ON ETHICS IN NURSING APPLICATIONS SEPTEMBER 2017, IZMIR, TURKEY

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2 Değerli Katılımcılar, Sizleri Ege Bölgesinde hemşirelik ve etik alanlarını birbiri ile buluşturacak olan ULUSLARARASI HEMŞİRELİK UYGULAMALARINDA ETİK KONGRESİ ne davet etmekten onur duyuyoruz. Son yıllarda tüm dünyada sosyal ve mesleki alanların yükselen değerleri arasında yer alan etik kavramların pekiştirilmesi, bunun sınırlarının belirginleştirilmesi ve bu konunun akademik boyutlarının ortaya konması gerekmektedir. Tıbbi ekibin önemli bir unsuru olan hemşirelik alanının tıbbi uygulamaları esnasında karşılaşılan etik sorunlarının ele alınacağı ve bunlara ilişkin bilimsel çalışmaların paylaşılacağı bu kongrenin faydalı ve örnek olacağı kanısındayız. Bilimsel program içeriğinde; ülkemizden ve yurtdışından katılım sağlayacak bilim insanlarının katkıları ile gerçekleşecek konferanslar, paneller, forumlar ve serbest bildiriler yer alacaktır. Hemşirelik etiği açısından bir farkındalık oluşturmak için bir arada olmaktan mutluluk duyacağız. Sevgiyle ve Saygıyla. Kongre Eş Başkanı Doç. Dr. Esra AKIN KORHAN Kongre Eş Başkanı Prof. Dr. Çağatay ÜSTÜN

3 KONGRE BAŞKANLARI Doç. Dr. Esra AKIN KORHAN Prof. Dr. Çağatay ÜSTÜN ONURSAL KURUL İzmir Katip Çelebi Üniversitesi Rektörü, Prof. Dr. Galip AKHAN İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dekan V. Prof. Dr. Bumin Nuri DÜNDAR DÜZENLEME KURULU BAŞKANLARI Doç. Dr. Esra AKIN KORHAN Prof. Dr. Çağatay ÜSTÜN ÜYELER Prof. Dr. Selahattin Fehmi AKÇİÇEK Prof. Dr. Fisun Şenuzun AYKAR Prof. Dr. Leyla DİNÇ Prof. Dr. Sibel ERKAL Prof. Dr. Nermin ERSOY Prof. Dr. İsmet EŞER Prof. Dr. R. Selma GÖRGÜLÜ Prof. Dr. Ayişe KARADAĞ Prof. Dr. Mağfiret KARA KAŞIKÇI Prof. Dr. Leyla KHORSHID Prof. Dr. Fatma Arın NAMAL Prof. Dr. Candan ÖZTÜRK Prof. Dr. Hülya UÇAR Yrd. Doç. Dr. Burcu CEYLAN Yrd. Doç. Dr. Nuray DEMİRCİ GÜNGÖRDÜ Öğr. Gör. Dr. Derya UZELLİ YILMAZ Arş. Gör. Ayşe AKBIYIK

4 SEKRETERYA Yrd. Doç. Dr. Burcu CEYLAN Öğr. Gör. Dr. Derya UZELLİ YILMAZ

5 BİLİMSEL KURUL Prof. Dr. Asiye DURMAZ AKYOL Prof. Dr. Şule ECEVİT ALPAR Prof. Dr. İnsaf ALTUN Prof. Dr. Türkinaz ATABEK AŞTI Prof. Dr. Fisun ŞENUZUN AYKAR Prof. Dr. Ate DIJKSTRA Prof. Dr. Leyla DİNÇ Prof. Dr. Hanzade DOĞAN Prof. Dr. Juliane EICHHORN Prof. Dr. Mustafa Ruhan ERDEM Prof. Dr. Sibel ERKAL Prof. Dr. Nermin ERSOY Prof. Dr. İsmet EŞER Prof. Dr. R. Selma GÖRGÜLÜ Prof. Dr. Ülkü GÜNEŞ Prof. Dr. Ayşe HAVUTÇU Prof. Dr. Ayişe KARADAĞ Prof. Dr. Ayfer KARADAKOVAN Prof. Dr. Mağfiret KARA KAŞIKÇI Prof. Dr. Leyla KHORSHİD Prof. Dr. Kornelia KEDZIORA KORNATOWSKA Prof. Dr. Fatma Arın NAMAL Prof. Dr. Gürsel ÖZTUNÇ Prof. Dr. Candan ÖZTÜRK Prof. Dr. Tülün ÖZTÜRK Prof. Dr. Oğuz SANCAKDAR Prof. Dr. Maria MULLER STAUB Prof. Dr. Aynur UYSAL TORAMAN Prof. Dr. Hülya UÇAR Prof. Dr. Meltem UYAR Prof. Dr. Mehmet UYAR Prof. Dr. Çağatay ÜSTÜN Prof. Dr. Kate WHEELER Prof. Dr. Yasemin KUZEYLİ YILDIRIM Prof. Dr. Ayten ZAYBAK Doç. Dr. Rahşan ÇEVİK AKYIL Doç. Dr. Leyla BAYSAN ARABACI Doç. Dr. Elif ÜNSAL AVDAL Doç. Dr. Zehra GÖÇMEN BAYKARA Doç. Dr. Nurcan ÇALIŞKAN Doç. Dr. Yurdanur DİKMEN Doç. Dr. Gülendam KARADAĞ Doç. Dr. Serap PARLAR KILIÇ Doç. Dr. Esra AKIN KORHAN Doç. Dr. Elif VATANOĞLU LUTZ Doç. Dr. Fatma ORGUN Doç. Dr. Türkan ÖZBAYIR Doç. Dr. Müesser ÖZCAN Doç. Dr. Dilek ÖZDEN Doç. Dr. Yasemin TOKEM Doç. Dr. Gülengün TÜRK Doç. Dr. Şebnem ÇINAR YÜCEL Yrd. Doç. Dr. Gülşah GÜROL ASLAN Yrd. Doç. Dr. Elif ALTINOK ÇALIŞKAN Yrd. Doç. Dr. Gülay OYUR ÇELİK Yrd. Doç. Dr. Neşe ÇELİK Yrd. Doç. Dr. Kıvan ÇEVİK Yrd. Doç. Dr. Yıldız DENAT Yrd. Doç. Dr. Ayşe DEMİRAY Yrd. Doç. Dr. Emine GERÇEK Yrd. Doç. Dr. Nazmiye ÇIRAY GÜNDÜZOĞLU Yrd. Doç. Dr. Fatoş KORKMAZ Yrd. Doç. Dr. Tülay SAĞKAL MİDİLLİ Yrd. Doç. Dr. Sevgi Nehir TÜRKMEN Dr. Marta MUSZALIK Dr. Anne H. OUTWATHER

6 2017 ULUSLARARASI HEMŞİRELİK UYGULAMALARINDA ETİK KONGRESİ KONFERANS, WORKSHOP VE FORUM KONUŞMACI LİSTESİ Prof. Şahin FİLİZ Akdeniz University, Faculty of Letters, Department of Philosophy, Prof. Esin Emin ÜSTÜN Ege University, Faculty of Medicine, Department of Radiology (Retired Faculty Member) Prof. Örsan K. ÖYMEN Işık University, Faculty of Arts and Sciences, Department of Humanities and Social Sciences Prof. Çağatay ÜSTÜN Ege University, Faculty of Medicine Department of Medical History and Ethics Prof. Leyla DİNÇ Hacettepe University, Faculty of Nursing, Department of Fundamentals of Nursing Prof. Nermin ERSOY Kocaeli University, Faculty of Medicine, Department of Medical History and Ethics Prof. Hanzade Doğan İstanbul Üniversitesi Cerrahpaşa, Faculty of Medicine, Department of Medical History and Ethics Prof. Selma GÖRGÜLÜ Doğu Akdeniz University, Faculty of Health Sciences, Department of Fundamentals of Nursing Prof. Mağfiret KARA KAŞIKÇI Atatürk University, Faculty of Health Sciences, Department of Fundamentals of Nursing Prof. Hülya UÇAR Nuh Naci Yazgan University, Faculty of Health Sciences, Department of Fundamentals of Nursing Prof. Leyla KHORSHID Ege University, Faculty of Nursing, Department of Fundamentals of Nursing Prof. İsmet EŞER Ege University, Faculty of Nursing, Department of Fundamentals of Nursing Prof. İnsaf ALTUN İstinye University, Faculty of Health Sciences, Department of Fundamentals of Nursing Prof. Sibel ERKAL İLHAN Ankara University, Faculty of Health Sciences, Department of Fundamentals of Nursing Prof. M. Olcay ÇAM Ege University, Faculty of Nursing, Department Of Psychiatric Nursing Prof. Besti ÜSTÜN Üsküdar University, Faculty of Health Sciences, Department of Fundamentals of Nursing Prof. Fisun ŞENUZUN AYKAR Ege University, Faculty of Nursing, Department of Internal Medicine Nursing Prof. Ülkü GÜNEŞ Ege University, Faculty of Nursing, Department of Fundamentals of Nursing

7 Prof. Oğuz SANCAKDAR Dokuz Eylül University, Faculty of Law Department of Administrative Law Assoc. Prof. Türkan ÖZBAYIR Ege University, Faculty of Nursing, Department Of Surgical Nursing Assoc. Prof. Selmin ŞENOL Ege University, Faculty of Nursing, Department Of Child Health And Illness Nursing Assoc. Prof. Esra AKIN KORHAN İzmir Kâtip Çelebi University, Faculty of Health Sciences, Department of Fundamentals of Nursing Assoc. Prof. Zehra Göçmen BAYKARA Gazi University, Faculty of Health Sciences, Department of Fundamentals of Nursing Assist. Prof. Behire SANÇAR Toros University, School of Health Sciences Department of Nursing & Health Care Assist. Prof. Lale Burcu ÖNÜT Dokuz Eylül University, Faculty of Law Department of Administrative Law Phd. Nurse Gülbin KONAKÇI Ege University Medical Faculty Hospital Emergency Service Unit Specialist Nurse Gönül DÜZGÜN Izmir Tepecik Training and Research Hospital, Palliative Care Clinic Nurse Nadide EMBEL Johns Hopkins Anadolu Health Center, Medical Oncology Clinic Nurse Asu GÜREL Ege University, Faculty of Medicine, Anesthesiology and Reanimation Intensive Care Unit

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19 11 Eylül 2017, Pazartesi SÖZEL BİLDİRİ OTURUMLARI I-II-III 17:00-18:00 ANA SALON SALON A SALON B Saat Oturum Başkanları: Prof. Dr. Sibel ERKAL İLHAN, Doç. Dr. Müesser ÖZCAN Oturum Başkanları: Doç. Dr.Serap PARLAK KILIÇ, Doç.Dr.Gülendam KARADAĞ 17:00-17:05 THE DEVELOPMENT AND DEFINING OF PROFESSIONAL VALUES MODEL IN NURSING - Ayla Kaya, İlkay Boz LOCATION IN AN EVIDENCE-BASED ETHICAL ROLE IN CHILDHOOD DISORDERS -Ramazan İnci, Ahmet Erol Oturum Başkanları: Doç.Dr.Murat BEKTAŞ, Yrd. Doç.Dr.Sevgi TÜRKMEN THE PERSPECTIVE OF NURSES TOWARDS OBESE PATIENTS AND THEIR CARE - Ezgi Yıldız - Şerife Karagözoğlu 17:05-17:10 CORE CONCEPT IN NURSING :CARE - Nadiye Barış Eren,Remziye Cici NURSES' KNOWLEDGE, ATTITUDE AND PRACTICES TOWARDS PHYSICAL RESTRAINTS - Ahmet Göktaş - Kadriye Buldukoğlu THE ETHICAL PROBLEMS IN END-OF-LIFE FAMILY-CENTERED HOME-BASED AND CASE REPORT- Fatma Birgili 17:10-17:15 RELATIONSHIP BETWEEN FOOT CARE BEHAVIORS AND SOME METABOLIC PARAMETERS IN GERIATRIC INDIVIDUALS DIAGNOSED WITH DIABETES MELLITUS- Özlem Ovayolu - Nimet Ovayolu - Sümeyra Mihrap İlter DETERMINATION OF THE MORAL SENSITIVITY OF HEALTH CARE PROVIDERS IN EMERGENCY DEPARTMENTS - Aslı Aydoğan - Özlem Ceyhan RELATIONSHIP BETWEEN NURSES PERCEPTIONS OF CONSCIENCE AND PERCEPTIONS OF INDIVIDUALIZED NURSING CARE - Gülay Yıldırım - Nurdan Kaya - Nermin Altunbaş 17:15-17:20 PATIENT ADVOCACY ROLE OF NURSES: AGANIST PHYSICIAN S FAULTY DECISION- Yakup Gökhan Doğramacı EXAMINING THE ATTITUDES OF THE PATIENTS AT A UNIVERSITY HOSPITAL TOWARDS USING PATIENT RIGHTS - Ayşe Aslı Oktay - Filiz Taş - Merve Gülpak - Fadime Yel AN ETHİCAL PROBLEM: MİSSED NURSİNG CARE - Gülbanu Zencir 17:20-17:25 THE NURSE'S ROLE ON ETHICS COMMITTEES- Nadiye Barış Eren,Handan Eren NURSING AND ETHICAL SENSITIVITY IN APPROACH TO THE PATIENT IN TURKEY: LITERATURE REVIEW-Berna Kurt, Sevgisun Kapucu INVESTIGATION OF THE VALIDITY AND RELIABILITY OF THE TURKISH VERSION OF THE SPIRITUAL CARE NEEDS INVENTORY - Ayten Zaybak - Elif Günay İsmailoğlu - Handan Özdemir - Ahmet Erol 17:25-17:30 NURSING AND ETHICS: TWEET OR NOT TWEET? - Nedime Gül Dogan - Cansu Karadeniz - Ayşe Metin - Özen Kulakaç PRACTICES IN HUMAN DIGNITY IN PALLIATIVE CARE: A QUALITATIVE STUDY - Esra Akın Korhan - Çağatay Üstün - Derya Uzelli Yılmaz NECESSITY OF HOSPICE IN TURKEY IN TERMS OF ROUTINE NURSING PRACTİCE - Nadide Embel - Nuray Demirci Güngördü - Cagatay Ustun 17:30-17:35 DETERMINATION THE OPINIONS OF PHARMACEUTICAL TECHNICIANS ON PATIENT RIGHTS AND ETHICAL PRINCIPLES ETHICAL APPROACH TO THE VULNERABLE - Ece Kurt - Ayten Zaybak PSYCHOMETRIC EVALUATION OF THE CARING BEHAVIOURS INVENTORY IN A SAMPLE OF TURKISH NURSES AND PATIENTS - Şenay Gül - Leyla Dinç 17:35-17:40 AN ETHICAL EVALUATİON OVER THE THİN LİNE BETWEEN LİFE AND DEATH- Nuray Demirci Güngördü -Çağatay Üstün ETHICAL RESPONSIBILITIES OF NURSES- Gülay Çelik - Aliye Demirok - Emel Top INVESTIGATION OF NURSES AND PATIENTS PERCEPTIONS REGARDING NURSING CARE - Şenay Gül - Leyla Dinç 17:40-17:45 TELE NURSING IN HEALTH SERVICES: LEGAL AND ETHICAL DIRECTIONS USING OF NEW TECHNOLOGY-Öznur Erbay, Öznur Usta Yeşilbalkan THE RELATIONSHIP BETWEEN CARE DEPENDENCY LEVEL AND SATISFACTION WITH NURSING CARE OF NEUROLOGICAL PATIENTS IN TURKEY - Esin Kavuran - Nihan Türkoğlu LEVELS OF TENDENCY IN MALPRACTICE AMONG NURSES WORKING IN MARMARIS PRIVATE AHU HOSPITAL - Fatma Birgili, Meral Ekinci, Aysu Ak Tuncel 17:45-17:50 GENE TECHNOLOGY AND ITS ETHICAL DIMENSION - Gamze Göke Arslan - Şebnem Çınar Yücel PROFESSIONAL VALUES OF NURSING STUDENTS AND PERCEPTIONS OF CARE ATTITUDES- Gülengün Türk - Filiz Adana - Rahşan Çevik Akyıl - Nihal Taşkıran - Emel Top

20 11 Eylül 2017, Pazartesi 18:05-18:10 EVALUATION OF THE STATUS OF ETHICAL VALUES OF NURSES IN A STATE HOSPITAL IN IZMIR- Begüm Es, Nurgül Güngör SÖZEL BİLDİRİ OTURUMLARI IV-V-VI 18:00-19:00 ANA SALON SALON A SALON B Saat Oturum Başkanları: Prof.Dr. Ayten ZAYBAK, Doç. Dr. Dilek SARI Oturum Başkanları: Doç. Dr.Leyla BAYSAN ARABACI, Yrd.Doç.Dr. Nuray DEMİRCİ GÜNGÖRDÜ DETERMINATION OF OPINIONS ON ETHICAL ISSUES OF TRANSPLANTATION UNIT NURSES COMPARISON OF ETHICAL DECISION MAKING LEVELS OF NURSES WITH THEIR PROFESSIONAL 18:00-18:05 DURING PROCESS ARISING TRANSPLANTATION: PILOT STUDY- Hicran Yıldız - İlknur Yalçın BEHAVIORS - Mağfiret Kaşıkçı - Bahar Çiftçi - Emrah Ay,Gülcan Canberk, Özlem Şahin, Alparslan Ersoy ARE NURSES BIASED AGAINST OBESE PATIENTS? - Meryem Türkan Erer - Gülay Altun Uğraş - Zübeyde Usanmaz Oturum Başkanları: Yrd. Doç.Dr. Ayşe DEMİRAY, Yrd. Doç. Dr. Kıvan Çevik PEER LEARNİNG AND ETHİCS İN NURSİNG EDUCATİON - Buket Şimşek Arslan - Ahmet Göktaş - Kadriye Buldukoğlu PREVENTING DEFENSIVE MEDICINE OF FIRST RESPONDERS IN DISASTER SETTINGS- Iskra Alexandra Nola - Ana Borovecki - Ignaas Devisch - M. Murat Civaner 18:10-18:15 18:15-18:20 18:20-18:25 18:25-18:30 A STUDY OF THE ETHICAL SENSITIVITY OF NURSES - Bilgi Gulseven Karabacak - Ünzile Taşkin - Fatma Öz EXAMNATION OF ETHICAL SENSITIVITY OF NURSES IN INTERNAL CLINICS: AN EXAMPLE OF UNIVERSITY HOSPITAL- Dilek Yılmaz - Fatma Düzgün - Derya Uzelli Yılmaz - Esra Akın Korhan - Yurdanur Dikmen - THE VALIDITY AND RELIABILITY STUDY OF MORAL DISTRESS QUESTIONNAIRE FOR NURSES - Şebnem Çınar Yücel - Fatma Orgun - Eda Ergin - İsmet Eşer - Mücahide Gökçen- Yasemin Üstün THE EFFECT OF NURSES OCCUPATIONAL SATISFACTION ON ETHICAL SENSITIVITY- Seyhan Çıtlık Sarıtaş - Zeliha Büyükbayram - Esra Anuş Topdemir NURSES' APPROACH TO ETHICAL DILEMMAS: AN EXAMPLE OF A PUBLIC HOSPITAL-Nilüfer Demirsoy, Aysun Türe Yılmaz, Ömür Şaylıgil PROFESSIONAL VALUES AND AFFECTING FACTORS OF NURSES IN A PUBLIC HOSPITAL-Aysun Türe Yılmaz, Nilüfer Demirsoy, Ömür Şaylıgil THE RELATIONSHIP BETWEEN CRITICAL THINKING LEVELS AND ETHICAL SENSITIVITY OF NURSERIES -Özlem Albayrak - Elanur Uludağ - Mağfiret Kaşıkçı MORAL DEVELOPMENT LEVEL OF THE PROFESSIONALS AND THE AFFECTING FACTORS: NURSE SAMPLE Ayla Ünsal - Aybike Bahçeli - Sevinç Köse Tuncer - Serap Sökmen - Papatya Karakurt ETHICAL EDUCATION IN NURSING - Büşra Aleyna Önver, Rabia Mina Abbak ETHICS EDUCATION IN NURSING UNDERGRADUATE PROGRAMS: A TURKISH PROFILE - Semra Açıksöz - Cevriye Özdemir - Merdiye Şendir ETHICS EDUCATION IN NURSING: LITERATURE REVIEW - Cevriye Özdemir - Semra Açıksöz - Merdiye Şendir ANALYSIS OF TURKISH VALIDITY AND RELIABILITY OF NURSING EFFECTIVENESS OF ETHICS EDUCATION SCALE Çağatay Üstün - Esra Akın Korhan - Derya Uzelli Yılmaz 18:30-18:35 NURSES PERCEPTION OF PROFESSIONAL VALUES IN TURKEY - Gülhan Erkuş - Leyla Dinç RELATIONSHIP BETWEEN BURNOUT LEVELS OF NURSES AND THEIR TENDENCY TO MAKE MEDICAL ERRORS Papatya Karakurt - Rabia Hacıhasanoğlu Aşılar - Arzu Yıldırım IN NURSING LICENSE EDUCATION PROGRAMS LOCATION OF ETHICS EDUCATION IN NURSING- Ebru Dığrak - Pelin Calpbinici 18:35-18:40 18:40-18:45 18:45-18:50 DOES CLINICAL NURSING EFFECT THE LEVEL OF LIFE SATISFACTION? - Ayşe Demiray - Cansu Kanca - Hatice Turan - Hilal Yıldız INVESTIGATION OF THE RELATIONSHIP BETWEEN ETHICAL SENSITIVITY AND PROFESSIONAL VALUES IN DIALYSIS NURSES- Hicran Yıldız - İlknur Yalçın,Gülcan Canberk, Özlem Şahin, Kadriye Çiçek, Fatma Düzgün, Aparslan Ersoy ROLE AND RESPONSIBILITY DILEMMAS OF FORENSIC PSYCHIATRIC NURSES: SYSTEMATIC REVIEW- Gül Dikeç, Leyla Baysan Arabacı, Gülsenay Taş EXAMINATION OF PROFESSIONAL VALUES OF OPERATING ROOM NURSES-Sinem Geçit, Türkan Özbayır THE RELATIONSHIP BETWEEN NURSE S JOB SATISFACTION AND ORGANIZATIONAL ETHICAL CLIMATE Ceren Sonakın - Yasemin Ergün EFFECTS ON ETHICAL PREDISPOSITION WITH PROBLEM SOLVING SKILLS OF ETHICAL COURSE AND RELATIONSHIP BETWEEN: HEALTH STUDENTS SAMPLE- Ebru Kılınç - Özgür Alparslan AN ANALYSIS OF POSTGRADUATE NURSING THESES ON ETHIC IN TURKEY - Kamile Kırca - Esra Doğan Yılmaz - Hüsna Özveren INVESTIGATION OF NURSES' ETHICAL SENSITIVITY LEVELS AND RELATED FACTORS - Fatma Orgun, TIENT ATTITUDE AND INTEREST LEVELS AMONG NURSES WORKING IN MARMARIS PRIVATE AHU HOSPITAL Fatma Birgili, Meral Leyla Khorshid, Esra Akın Korhan, Nermin Ersoy

21 12 Eylül 2017, Salı Saat Oturum Başkanları: Prof.Dr. Meltem Uyar, Prof.Dr. Yasemin K. Yıldırım Oturum Başkanları: Doç. Dr. Yurdanur DİKMEN, Yrd.Doç.Dr. Yıldız DENAT 15:00-15:05 SÖZEL BİLDİRİ OTURUMLARI VII-VIII-IX 15:00-16:00 ANA SALON SALON A SALON B ETHICAL DECISION-MAKING PROCESSES AND BURNOUT LEVELS OF NURSES STUDIED POSTGRADUATE EDUCATION - Eylem Paslı Gürdoğan - Ezgi Kınıcı - Berna Aksoy GESTASYONEL DIABETES MELLITUS (GDM): ETHICS IN COUNSELING AND SCIENTIFIC RESEARCHES- Nuran Nur Aypar - Merlinda Aluş Tokat Oturum Başkanları: Yrd. Doç.Dr. Nazmiye ÇIRAY GÜNDÜZOĞLU, Yrd. Doç. Dr. Tülay SAĞKAL MİDİLLİ THE RELATION BETWEEN ETHICAL SENSITIVITY AND CRITICAL THINKING DISPOSITION OF NURSING STUDENTS- Aynur Kızılırmak - Pelin Calpbinici 15:05-15:10 DEALING WITH DIFFICULT NURSING STUDENTS -Handan Eren - Fatma Ayhan 15:10-15:15 VIEWS OF NURSING STUDENTS ON REFLECTION OF ETHICS COURSE DURING THEIR UNDERGRADUATE STUDY ON THE CLINICAL PRACTICES- Fatma Tanrikulu - Handenur Gündoğdu - Nasibe Yağmur Filiz - Yurdanur Dikmen 15:15-15:20 ETHICS IN NURSING EDUCATION: AN EVALUATION - Rana Can - Funda Can - Hatice Tambağ COMMUNICATION PROBLEMS AND ETHICAL DIMENSIONS IN CONTEXTABLISHED IN THE BIRTH OF CONTINUOUS WOMEN REFUGEES- Ruşen Öztürk - Özlem Güner INVESTIGATION OF FACTORS AFFECTING ETHICAL SENSITIVITY OF MIDWIVES- Şükran Çakır - Emine Öztürk - Selda İldan Çalım COMMUNICATION IN INFERTILITY CLINIC: WHAT DO WOMEN AND NURSES THINK?- Sevcan Fata - Merlinda Aluş Tokat A STUDY RELATED TO MORAL SUSCEPTIBILITY OF NURSING STUDENTS: KOCAELİ SAMPLE- Pervin Şahiner - Belgin Babadağlı - Nermin Ersoy NEEDLESTICK /SHARPS INJURIES CASES AND RELATED FACTORS OF NURSING STUDENTS DURING CLINICAL PRACTICES- Seher Satılmış - Aynur Uysal Toraman 15:20-15:25 EXAMINATION OF POSTGRADUATE DISSERTATIONS ON NURSING ETHICS IN TURKEY - Nevin Doğan - Zehra Göçmen Baykara ADVANCED AGE PREGNANCIES AND ETHICAL AWARENESS- Sümeyye Bakır - Aylin Taner - Özlem ANALYZING THE MORAL SENSITIVITY AND CRITICAL THINKING TENDENCY OF NURSING AND MEDICAL STUDENTS- Demirel Bozkurt Serap Parlar Kılıç - Gülendam Karadağ - Cihat Demirel - Nermin Kılıç 15:25-15:30 EXPECTATIONS AND PERSEPTIONS OF NURSING STUDENTS ABOUT ETHICS COURSE - Nevin Utkualp - Aylin Palloş - Hicran Yıldız - Aysel Özdemir - Neriman Akansel INVESTIGATIONS OF MISSED CARE IN NEONATAL INTENSIVE CARE UNITS; A HOSPITAL EXAMPLE- Ayşe Kahraman - Figen Yardımcı NURSING AND MIDWIFERY STUDENTS OPINIONS ON ABORTION WHO HAVE TAKEN COURSES RELATED TO ETHICS- Gönül Akgün - Zülfiye Bıkmaz - Özlem Özdemir 15:30-15:35 15:35-15:40 15:40-15:45 15:45-15:50 NECESSITY OF CLINICAL ETHICS COURSE IN NURSING UNDERGRADUATE EDUCATION: AN EVALUATION FROM STUDENT NURSES- Nuray Demirci Güngördü - Cagatay Ustun INVESTIGATION OF MORAL DILEMMAS AND FAIRNESS OF TAKING ETHICAL COURSE IN NURSING AND MIDWIFERY STUDENTS- evgi Nehir Türkmen - Nurgül Güngör Tavşanlı - Hatice Irmak - Dilek Çeçen EVALUATION OF NURSES ATTITUDES IN MEDICAL ERRORS- Nigar Ünlüsoy Dinçer - Serpil İnce - Rana Can EXAMİNATİON THESİS İN THE FİELD OF NURSİNG ETHİCALLY IN TURKEY- Nihal Gördes Aydoğdu - Zuhal Bahar - Kübra Pınar Gürkan - Ayşe Çal - Dilay Açıl - Burcu Cengiz THE RELATIONSHIP BETWEEN LEVELS OF BURNOUT NURSES TO ETHICAL SENSITIVITY IN PEDIATRICS DEPARTMENT - Emral Gülçek - Filiz Polat - Rukuye Aylaz INVESTIGATION OF OPINIONS ABOUT DEATH, TERMINAL PERIOD AND PALLIATIVE CARE IN INTERN NURSES TO PEDIATRIC CLINICS:FOCUS GROUP DISCUSSION- Nurdan Akçay Didişen - Hatice Uzşen - Dilek Zengin - Hamide Nur Çevik Özdemir - Satı Bozkurt PEDIATRIC HEMATOLOGY-ONCOLOGY NURSES OPINIONS ABOUT TELLING CANCER DIAGNOSIS TO CHILDREN- Selmin Şenol - Seda Ardahan-Sevgili - Hamide Nur Çevik-Özdemir PERCEPTIONS OF NURSING STUDENTS TOWARDS ETHICAL BEHAVIORS OF FACULTY MEMBERS - - Ülkü Güneş - Elçin Ülker Efteli - Gül Şahbudak ATTITUDES OF ACADEMICIAN NURSES TO ACADEMIC ETHICAL VALUES AND RELATED FACTORS- Duygu Yıldırım - Merve Kırşan - Servet Kıray - Esra Akın Korhan - Fisun Şenuzun Aykar - Çağatay Üstün INVESTIGATION OF ACADEMICIANS ATTITUDES AND BEHAVIORS WITH REGARDS TO ACADEMIC ETHICAL VALUES - Sevgi Pakiş Çetin - Kıvan Çevik ACADEMIC ETHICS VALUES OF NURSE ACADEMICIANS- Yildiz Denat - Yurdanur Dikmen - Gülşah Gürol Arslan

22 12 Eylül 2017, Salı SÖZEL BİLDİRİ OTURUMLARI X-XI-XII 16:00-17:00 ANA SALON SALON A SALON B Saat Oturum Başkanları: Prof.Dr. İnsaf ALTUN, Prof.Dr. Ayşegül BİLGE Oturum Başkanları: Doç. Dr. Dilek ÖZDEN, Yrd.Doç.Dr. Gülşah GÜROL ARSLAN 16:00-16:05 AN ETHICAL DILEMMA IN PSYCHIATRIC CLINICS: PHYSICAL RESTRAINT- Mehtap Çöplü - Fatma Ayhan ETHICAL SENSITIVITY OF NURSING STUDENTS IN PATIENT CARE PRACTICES- Nimet Ovayolu - Özlem Ovayolu - Merve Gülpak - Ayşe Aslı Oktay - Sema Aytaç Oturum Başkanları: Yrd. Doç.Dr. Gülay OYUR ÇELİK, Yrd. Doç. Dr. Neşe ÇELİK THE CORRELATION BETWEEN THE ATTITUDES OF NURSING STUDENTS TOWARD GENDER ROLES AND THEIR PERCEPTIONS OF CARE BEHAVIORS -- Emine Pınar Martlı - Nigar Ünlüsoy Dinçer 16:05-16:10 16:10-16:15 16:15-16:20 ETHICAL PROBLEMS IN MENTAL HEALTH SERVICES IN THE LIGHT OF FINANCIAL OPPORTUNUTIES- Leyla Baysan Arabacı - Gülsenay Taş - Dilek Ayakdaş Dağlı ATTITUDES TOWARDS THE PERCEPTION OF OCCUPATIONAL ETHICS OF WORKING NURSES IN MANISA MENTAL HEALTH AND DISEASES HOSPITAL- Sevgi Nehir Türkmen - Çağatay Üstün - Hatice Irmak THE IMPORTANCE OF ETHICAL EDUCATION IN PSYCHIATRIC NURSES- Nihal Güngör, Şeyda DÜLGERLER EXAMINING THE RELATION BETWEEN THE PREDISPOSITION TO ETHICAL VALUES AND DEVOTION NURSING STUDENTS' WILLINGNESS TO PROVIDE CARE TO PEOPLE LIVING WITH HIV/AIDS- Erdal Ceylan - Ayşegül TO NURSING PROFESSION IN STUDENT NURSES -- Özlem Ovayolu - Nimet Ovayolu - Sema Aytaç - Koç THE PROBLEMS OF FINAL YEAR STUDENTS IN NURSING DEPARTMENT IN INTERNSHIP PRACTICE, THEIR ATTITUDES AND ETHICAL CONSIDERATIONS -Ayşe Gümüşler Başaran A STUDY ON THE MORAL SENTITIVITY OF MIDWIFERY STUDENTS: KOCAELİ EXAMPLE- Pervin Şahiner - Belgin Babadağlı - Nermin Ersoy ETHICAL PROBLEMS EXPERIENCED BY TURKISH PEOPLE LIVING WITH HIV/AIDS- Erdal Ceylan - Ayşegül Koç DETERMINING THE RELATIONSHIP BETWEEN NURSING STUDENTS PROFESSIONAL VALUES AND THEIR MORAL SENSITIVITY- Eylem Paslı Gürdoğan - Berna Aksoy - Ezgi Kınıcı 16:20-16:25 STIGMA AND ETHICS- Gamze Göke Arslan - Şebnem Çınar Yücel DETERMINING THE IMPACT OF NURSING STUDENTS MORAL SENSITIVITY ON THEIR LEVELS OF PROFESSIONAL ATTITUDE - Zehra Göçmen Baykara - Ceyda Su Gündüz - Gülcan Eyüboğlu ETHICAL VALUES OF THE INCLINATION IN UNIVERSITY STUDENTS AND RELATED FACTORS - Filiz Taş 16:25-16:30 COMMUNICATION AND COMMUNICATION PROBLEMS WITHIN HEALTH TEAM- Remziye Cici - Nadiye Barış Eren DETERMINATION OF AWARENESS LEVELS OF NURSING STUDENTS TOWARDS ENVIRONMENTAL ETHICS- Derya Uzelli Yılmaz - Ismet Eşer INVESTIGATION OF ETHICAL SENSITIVITY AND EMPATHY LEVELS OF FINAL YEAR NURSING STUDENTS-Gülay Taşdemir Yiğitoğlu - Gülbanu Zencir - Fadime Gök 16:30-16:35 NURSE AND PHYSICIAN COOPERATION: EXAMINATION OF SUPREME COURT OF APPEALS DECISIONS- Yakup Gökhan Doğramacı ATTITUDES TOWARDS GOOD DEATH PERCEPTION OF NURSING S STUDENTS- Duygu Bayraktar - Ülkü Güneş - Burcu Bayraktar - Leyla Khorshtd THE RELATIONSHIP BETWEEN NURSING STUDENTS BURNOUT LEVELS AND THEIR PROFESSIONAL VALUES- Gülcihan Arkan - Yaprak Sarıgol Ordın - Meryem Ozturk Haney 16:35-16:40 DETERMINATION OF RELATIONSHIP BETWEEN CULTURAL INTELLIGENCE AND COMPASSION IN NURSING FACULTY STUDENTS OF ATATURK UNIVERSITY -Esin Kavuran - Afife Yurttaş - Mağfiret Kaşıkcı - Özlem Şahin Altun STUDYING THE ETHICAL DECISION MAKING LEVELS OF MIDWIFERY STUDENTS -Ebru Kılınç - Özgür Alparslan THE EXPERIENCE OF THE PARTICIPATION OF A STUDENT NURSE IN THE CARE OF A CLOSE RELATIVE: A QUALITATIVE STUDY- Handan Eren 16:40-16:45 ETHICAL ISSUES IN INFECTIOUS DISEASES REQUIRING CONTACT ISOLATION- Ayşe Akbıyık - Esra Akın Korhan THE IMPACT OF MORAL SENSITIVITIES AND PROFESSIONAL VALUES OF NURSING STUDENTS ON CARE PERCEPTION - Diğdem Lafcı - Ebru Yıldız - Kübra Akkaya - Gamze Çolak DETERMINATION OF ALTRUISM LEVELS OF NURSING STUDENTS- Handan Eren - Ayşe Sonay Türkmen 16:45-16:50 MORAL DISTRESS IN NURSES- Pelin Calpbinici - Ebru Dığrak EVALUATION OF MORAL APPROACHES SAME AS TWO SEPARATE GROUPS FROM NURSING STUDENTS-Elanur Uludağ - Dicle Tuba Musa - Yasemin Aygün DETERMINATION OF ETHICAL PROBLEMS ENCOUNTERED BY NURSING STUDENTS DURING CLINICAL PRACTICES- Nilay Orkun - İsmet Eşer

23 12 Eylül 2017, Salı SÖZEL BİLDİRİ OTURUMLARI XIII-XIV-XV 17:00-18:00 ANA SALON SALON A SALON B Saat Oturum Başkanları: Prof.Dr. Asiye AKYOL, Doç.Dr. Şebnem ÇINAR YÜCEL Oturum Başkanları: Doç. Dr. Fatma ORGUN, Doç.Dr. Gülengün TÜRK ETHICAL PROBLEMS EXPERIENCED BY NURSES WORKING IN INTENSIVE CARE UNITS- Duygu INVESTIGATION OF ETHICAL DECISIONS OF CLINICAL CASE OF FINAL YEAR NURSING STUDENTS- 17:00-17:05 Soydaş Yeşilyurt - Filiz Tuncel Sağlam - Eylem Paslı Gürdoğan - Ümmü Yıldız Fındık - Ayşe Çağatay Üstün - Sevgi Nehir Türkmen - Hatice Irmak Gökçe Işıklı 17:05-17:10 17:10-17:15 THE EFFECT OF INTENSIVE CARE UNIT NURSES ANXIETY LEVELS ON ETHICAL SENSITIVITY- Serdar Sarıtaş - Esra Anuş Topdemir - Zeliha Büyükbayram THE IMPACT OF NURSE S ETHICAL SENSITIVITY LEVELS ON THEIR APPROACHES TO ISSUES SPECIFIC TO INTENSIVE CARE UNIT- Gökçe Arslan - Esra Uğur ANALYSIS OF METHAPHORS FOR BASIC CONCEPTS OF NURSING IN ULUDAG UNIVERSITY NURSING STUDENTS- Hava Gökdere Çinar - Dilek Kara Yılmaz - Beyzanur İşbay - Mustafa Eryılmaz DETERMINATION OF PROFESSIONAL VALUES AND MORAL SENSITIVITY OF NURSING STUDENTS- Dilek Özden - İlkin Yılmaz Oturum Başkanları: Yrd. Doç.Dr. Burcu CEYLAN, Öğr.Gör. Dr. Derya UZELLİ YILMAZ LIFE PERCEPTIONS OF PEOPLE WITH STOMA: A QUALITATIVE RESEARCH - Sema Kocan - Nuray Demirci Güngördü - Cagatay Ustun - Ayla Gursoy - Aysel Kahraman THE PRACTICE DIMENSION OF PRISON NURSING: AN EXAMPLE FROM CENTRAL ANATOLIA- Nuray Demirci Güngördü - Fatma Ayhan - Cagatay Ustun CHALLENGES OF INTERNATIONAL STUDENTS IN A FACULTY OF HEALTH SCIENCES- Sevgin Samancioglu - Ayla Aydın 17:15-17:20 THE RELATIONSHIP BETWEEN ETHIC SENSITIVITY AND BUSINESS SATISFACTION OF INTENSIVE CARE NURSES - Emral Gülçek - Fatma Karasu - Rukuye Aylaz EXAMINATION OF NURSING STUDENTS MORAL SENSITIVITIES- Ulku Gunes - Leyla Baran - Huri Ozturk DETERMINING THE STATUS OF NEWLY GRADUATED NURSES BEING SUBJECTED TO VERBAL AND PHYSICAL VIOLENCE IN THE FIELDS OF APPLICATION- Sevgul Donmez - Eylem Karakuş 17:20-17:25 17:25-17:30 EXAMINATION OF ATTITUDES AND BEHAVIORS OF INTENSIVE CARE NURSES FOR END-OF-LIFE CARE- Sultan Özel Yalçınkaya - Fatma Tanrıkulu - Nasibe Yağmur Filiz - Handenur Gündoğdu - Yurdanur Dikmen AN EVALUATION OF THE APPROACH OF INTENSIVE CARE NURSES TOWARDS TERMINAL PATIENTS AND THEIR ETHICAL BEHAVIOR -Gülbanu Zencir - Fadime Gök - Gülay Taşdemir Yiğitoğlu - Züleyha Öztürk A GROUP OF NURSING STUDENTS VIEWS RELATED TO THE PATIENT S WELL-BEING IN THE INTRAOPERATIVE PERIOD- Nuray Demirci Güngördü - Sema Kocan - Cagatay Ustun INVESTIGATION OF BEING FAIRLY AND MORAL DILEMMA SITUATIONS OF NURSING AND MIDWIFERY STUDENTS WHO TOOK ETHICS COURSE.- Sevgi Nehir Turkmen - Nurgül Güngör Tavşanlı - Hatice Irmak - Dilek Çeçen PROFESSIONAL VALUES AND INFLUENCING FACTORS IN NURSING -- Tuğba Dündar, Belma Toptaş, Sevgi Özsoy, Hilmiye Aksu EVALUATION OF ETHICAL SENSITIVITY OF THE STUDENTS IN DIFFERENT EDUCATION PROGRAMS IN THE FIELD OF HEALTH: A COMPARATIVE STUDY- Seval Ağaçdiken Alkan - Yasemin Özyer - Cansev Bal Kaplan - Zeliha Koç 17:30-17:35 OPINION OF THE INTENSIVE CARE NURSES FOR THE IMPLEMENTATION OF USELESS TREATMENT OF ELDERLY PATIENTS -İsmet Eşer - Nilay Orkun - Perihan Çetin INVESTIGATION ON PROBLEM-SOLVING PERCEPTIONS AND MORAL SENSITIVITY OF INTERN NURSES- Nurhan Çingöl - Mehmet Karakaş - Ebru Çelebi - Seher Zengin HOW DOES VIOLENCE TOWARDS HEALTHCARE WORKERS AFFECT STUDENTS' OPINIONS ON THEIR PROFESSION and PATIENTS? Setenay Yalınbaş - Filiz Bulut - M. Murat Civaner 17:35-17:40 CRITICAL CARE NURSES APPROACHES TO ETHICAL PROBLEMS : ETHICAL DILEMMA QUESTIONNAIRE FOR PATIENT CARE - CRITICAL CARE VERSION (ECNQ-CCV) TURKISH VERSION -Nilüfer Demirsoy - Aysun Türe Yılmaz A COMPARISON OF NURSING STUDENTS ' ATTITUDES REGARDING HIV/AIDS- Nurten Alan - İsmet Eşer THE DEATH UNDER GOOD CARE - Esra Akın Korhan, Çağatay Üstün, Merve Kırşan 17:40-17:45 ETHICAL PROBLEMS ENCOUNTERED BY THE INTENSIVE CARE NURSES AND EFFECTS OF THESE PROBLEMS ON THEIR STRESS LEVELS- Didem Öndaş Aybar - Serap Parlar Kılıç EVALUATING THE EFFECTIVENESS OF ETHICS EDUCATION FOR NURSING STUDENTS Esra Akın Korhan - Burcu Ceylan - Ayşe Akbıyık - Derya Uzelli Yılmaz ETHICAL PROBLEMS IN INTENSIVE CARE: A SYSTEMATIC REVIEW - Merve Kırşan, Duygu Yıldırım, Burcu Ceylan, Esra Akın Korhan 17:45-17:50 DETERMINATION OF MIDWIFERY AND NURSING STUDENTS OPINIONS ON INFORMED CONSENT- Özlem Özdemir - Zülfiye Bıkmaz - Gönül Akgün IF YOU WERE WHAT WOULD YOU DO? Gülay OYUR ÇELİK, Kemal Erdinç KAMER, Sinem ESKİDEMİR, Sümeyye ZEHİR

24 KONUŞMACI METİNLERİ

25 TREATMENT OF HUMAN WITH HUMANITY Ethics as a Paradigm of Philosophical Treatment in Modern Age Prof. Dr. Şahin FİLİZ 1 1 /Akdeniz University, Faculty of Literature Summary: The practice of philosophical treatment of man as a therapy of mankind is definitely different from the forms of all other psychological and psycho-therapeutic consultative practices that operate outside of an abstract theoretical framework. Abstract-minded philosophy provides a framework for applied philosophy (moral, social, political). Theoretical philosophy forms the epistemological basis of counseling by objectively applying them to specific problems and issues of practical areas. The most important of these areas is the field of education. Philosophical counseling, then, suggests that the human being should join the world and the life with all its existence in order to obtain cognitive and practical virtues. Cognitive virtue is to be open to the broader means of understanding ourselves and our world. However, practical virtue is the ability to see sincerity, patience, compassion and justice in a broader sense. Key Words: Philosophical treatment, humanity, ethics Özet İnsanın insanlıkla terapisi olarak Felsefi sağaltım uygulaması, soyut kuramsal bir çerçeve dışında işleyen diğer bütün psikolojik ve psiko-teröpatik danışmanlık uygulamalarının formlarından kesin olarak farklıdır. Soyut düşüntülü felsefe, uygulamalı felsefe (ahlaksal, toplumsal, siyasal)ye çerçeve sağlar. Kuramsal felsefe, pratik alanların belirli sorunlarına ve konularına nesnel olarak uygulanarak danışmanlığın epistemolojik temelini oluşturur. Bu alanların en önemlisi, eğitim alanıdır. O halde felsefi danışmanlık bilişsel ve pratik erdemleri edinmek için insanın tüm varoluşuyla dünyaya ve hayata katılmasını ön görür. Bilişsel erdem kendimizi ve dünyamızı anlamanın geniş yollarına açık olmaktır. Pratik erdem ise, samimiyet, sabır, merhamet ve adaleti daha geniş açıdan görebilmektir. Anahtar Kelimeler: Felsefeyle Sağaltım, İnsanlık, Etik İnsan, iki katmanlı bir varlıktır. Biyolojik varlığı ile doğar, büyür, beslenir, ürer, dışkılar ve ölür. Öteki tüm canlılar aynı şeyleri yapar. Biyolojik yaşamı diğer canlılar gibi tek düze ve yalındır. Oysa asıl varlığı ve varoluşunun anlamı, simgeler yaratma yeteneğine sahip olmasıdır. Ancak bu

26 yeteneğe salt sahip olmak, hem ontolojik hem de etik olarak insanlaşması için yeterli değildir. Potansiyel olarak böyle bir yeteneğe bağlı bir insan varoluşu tanımı, Ernest Cassirer in deyimiyle tözsel bir tanımdır (Cassirer, 1997, s.135). Oysa kültürel simgeler yaratan bu ikinci tür varoluş, tözsel tanımlarla anlaşılamaz. Mutlak, genel geçer ve sonsuz karakteristikler taşıyan tözsel tanım, tanrısal ve metafiziksel bir tanım olup kültür yaratan insanın anlaşılmasına yardım etmez. Tam aksine insanın tanımı veya anlaşılması onu işlevleri açısından tanımlamaya bağlıdır. İnsan olarak insan değil, işlevsel olup olmaması bakımından bir insandan söz edebiliriz. Cassirer, bunu insanlık insan aracılığıyla değil, insan insanlık aracılığıyla açıklanmalıdır (Cassirer, 1997, s.135 vd.) diyerek özetler. İşlevsel varoluş olarak insan, tözsel varlık olarak insana nazaran daha karmaşıktır. Tözsel varlık olan insan, sonsuz, sınırsız ve mutlak olarak betimlendiği için, gizemlidir; gizemli olduğu kadar tek yanlıdır; anlaşılmaz, bilinmezdir ama buna rağmen karmaşık değildir. Daha doğrusu karmaşık varoluş yapısı görünmez hale gelmiştir. Çünkü düşünce, eylem ve etkinlikleri ile var olma olanakları yerine, tözsel sonsuzluğun tek yanlı bilinmezliğine terkedilmiştir. Burada insana dair eylemlere, işlevselliğe rastlanamaz. İnsanın ayırıcı göstergesi, metafizik doğası olmayıp yaptığı iştir. İnsanlık halkasını tamamlayıp belirleyen bu iş, insan etkinliklerinin bir dizgesidir. Dil, söylence, din, sanat, bilim, tarih bu halkanın öğeleri ve çeşitli dilimleridir. Bu kültür öğeleri hiç de soyutlanmamış, rastgele yaratılar değildir. Onlar ortak bir bağla bir arada tutulmaktadır. Ama bu bağ, skolastik düşüncede düşünüldüğü ve betimlendiği gibi bir vinculum substantiale (tözsel bir bağ) olmayıp daha çok bir vinculum functionale (işevsel bir bağ) dır. (Cassirer, 1997, s.135 vd.) Hayat geriye dönük olarak yaşanmaz, ancak anlaşılır.(ferguson, 2015, s.11). Yaşanması ise, ancak ileriye dönük olabilir. İleriye dönük yaşamak, insanın işlevsel olarak betimlenip tanımlanmasıyla doğrudan ilgilidir. Eğitim de geriye dönük, geride kalan bir hayatı değil, yaşanacak hayatı anlamlandırmak içindir. Felsefi danışmanlık ve sağaltım, Sokrates ten bu güne, öznenin özellikle zihinsel ve ruhsal terapisini, bu terapiden sonra da eğitilmesini amaçlamaktadır. Felsefi danışmanlık uygulaması, soyut kuramsal bir çerçeve dışında işleyen diğer bütün psikolojik ve psiko-teröpatik danışmanlık uygulamalarının formlarından kesin olarak farklıdır. (Walsh, 2005, s ). Soyut düşüntülü felsefe, uygulamalı felsefe (ahlaksal, toplumsal, siyasal)ye çerçeve sağlar. Kuramsal felsefe, pratik alanların belirli sorunlarına ve konularına nesnel olarak

27 uygulanarak danışmanlığın epistemolojik temelini oluşturur. Bu alanların en önemlisi, eğitim alanıdır. Akıl, ruh ve zihin, sağaltım yoluyla doğru düşünme ve doğru eylemeye hazır hale gelir. Genelleştirme ve sistemleştirme yapabilme yetisi kazanan özne, mantıklı düşünmeyi ve davranmayı öğrenir. Psikoloji ile insan yetilerini analiz etmeyi; iradenin iyiye kullanılmasını öğreten ahlakla varoluşunu ahlaksal nitelikle anlamlandırmayı, evrenin gösterisini keşfetmeyi kolaylaştıran doğal felsefeyle yakınlaşmayı öğrenme ve kendini bu yollarla eğitmenin yöntemlerini tecrübe eder. Metafizik terapi ile, varlığı varlık olarak bilmeyi, varoluşunun ve insanlığın ortak ruhunu kavramayı öğrenir. Bütün bunlardan yoksun olmak, felsefi hasta ve dolayısıyla eğitimsiz, bilgisiz, bilinçsiz olarak kalmak demektir. Sonuç ise, anlamsızlıktır. İnsanın İnsanlıkla Eğitimi Felsefi danışmanlık, insanın insanlıkla eğitimini amaçlar. Yönlendirme, bilişsel-rasyonel davranış geliştirme, rasyonel-duygusal çözümleme ve fenomenolojik-varoluşsal anlamlandırma bu eğitimin benimsediği yöntemler arasındadır. Felsefi sağaltım, kişilerarası ya da özneler arası ilişkilerin çözümlenmesini insanlık düzeyine taşır. Felsefi danışmanlık ya da sağaltım, bir var olma yolu olarak felsefenin hikmet, doğruluk ve anlam araştırmasıdır. Bütüncül değer, kapsamlı bir farkındalık, felsefi bütünlük ve psikolojik uyumu kurar. Sağaltım yalnız erdemli bir hayatın ilke ve pratiklerini değil, kuramsal düzlemde özellikle Kant, Fichte ve Hegel için, sezgi ve düşünceye aracılık yapan imgelem yaratma (Fichte, 1982, s.i/472, 45; Hegel, 1978, s.i/ ; Kant, 1965, s.a ; B 132) sanatıdır. İmgelem, cüz ileri evrenselle birleştirip böylece rasyonel yargıyı mümkün kılarak zihnin daha yüksek sentetik etkinliklerinden sorumlu olur. Bilişsel erdemler ve pratik erdemler (Tukiainen, 2010, s.48-57), felsefi sağaltımın kuram-eylem bütünlüğü içinde anlam kazanır. Ataraxia (sükûnet) ve Autarkia (kendine güven, kendine yeterlik) bu bağlamda bütünleşebilir. Sırasıyla kabz ve bast hallerine karşılık geldiğini hatırlayalım. Ancak bu bütünleşmeyi tehdit eden bazı sorunlar da yok değildir. Fenomenolojik yöntem, -o zamanlar adı konulmamış olsa da-sokrates ve Marcus Aurelius un dediği gibi, insanın doğasını, ona dışarıdan eklemlenen tüm dış ve rastlantısal özelliklerden uzak tutarak tanımamızı önerir. Fenomenoloji bunu epokhé yani paranteze alma yoluyla başarmaya çalışır. Varsayımları paranteze alma ve betimlemeye odaklanma, fenomenolojiyi pozitivist, post-pozitivist, yapısalcı, eleştirel ve göreceli yöntem ve yaklaşımlardan farklılaştırır. (Wertz, 2005, s ) Fenomenoloji sistemik bir felsefe olmadığı için kuramlar formüle etmez, dedüksiyon yapmaz, varsayımları denemez. Yalnız öznenin bilinci ve nesneyi bilincinde yeniden algılama süreçlerini dikkate alır.

28 İnsanın insanlıkla eğitiminde, Herakleitos ta gerçekliği bilmek, onun anlamını anlayabilmek için insanın kendini düşünmesi, bilmesi koşul olarak öne sürülür. Kendini bilmek, başka bir deyişle kendini araştırmak Sokrates in insan felsefesine kadar uzanan süreci özetler. Sokrates in araştırdığı evren, insan evrenidir. Kendini araştıran ve bilen insan, hem kendini hem de başkalarını eğitmeye hazır duruma gelmiş özne demektir. Sokrates öncesi felsefede insanı deneysel gözlem ve mantıksal çözümleme ile tanımak etkisiz ve yetersizdir. Çünkü onu tanımanın yolu, onunla gerçekten karşılaşmak, özyapısının iç yüzünü bu şekilde tanımakla mümkündür. Sokrates, nesnel içerikten çok, düşüncenin yeni bir etkinliği ve işlevi üzerinde durur. İnsan doğasının bilgisine ancak diyalog yolu ya da diyalektik düşünce aracılığıyla erişebiliriz. (Cassirer, 1997, s.19 vd.) Bu yüzden Antikçağ ın felsefi danışmanlık ve sağaltımda günümüzde bile model olmaya devam ettiğini düşünenler az değildir. Eugenio Borgna (Borgna, 2015), Judith A. Rubin (Rubin, 2010), Rollo May (May, 2013) Pierre Hadot, Lou Marinoff, Lahav, Aleksandar Fatic bu isimlerden sadece bir kaçıdır. Örneğin Fatic e göre (Fatic, 2013, s ) Epiküros felsefesinin modern çağın felsefesinden farkı, kişisel ya da tüzel bir danışmanın, insanların tecrübelerini anlamlı kılması ve onların genel değerleri ve tercihleri bağlamında en ideal çözümler bulmasıdır. Felsefi danışmanlık ya da sağaltım, Platonculuktan dil ya da mantık felsefesine kadar uzanan hemen her felsefe okuluna dayanabilir. Sağaltımın bakış açısı ve danışmanın tecrübesi ne kadar geniş olursa etki edebilme potansiyeli o denli geniş ve ileri olur. Epiküros etiği, bu gün de felsefi danışmanlığa uygun felsefi bir hayatın ilk örneği olarak kabul edilmektedir. O, Modern danışmanlığın ilkelerinin pratik ve kapsamlı yalın bir sistemidir. Kuramsal olarak felsefi danışmanlık, insanı, onun evrendeki yerini ve varoluşsal sürecini anlamlandırma çabasıdır. Eylem olarak ise, bu anlamlandırma temelinde özneyi erdemli, iyi ve bilgece hayata karşı donatmasıdır. Anlamlandırma ve donatma, insanın eğitimi için sağaltımın vazgeçilmez aşamalarıdır. Felsefe tarihinde bence bütün felsefe sistemleri ve filozoflar, odaklandıkları felsefi sorunları hep bu iki aşamanın farklı bakış açılarına göre oluşturdukları yaklaşım yöntemleri doğrultusunda çözümlemeyi amaçlamışlardır. Eğitim için tek bir model ya da vazgeçilemez biricik yöntemden söz etmek, karmaşık varlık olan insanı anlamak için yeterli değildir. Her filozofun kendi bakış açısına göre çözümledikleri insan ve ona ilişkin her şey, beraberinde birbirinden farklı yöntemlerin gelişmesine yol açmıştır. Karmaşık varlık, karmaşık anlama ve donatma yaklaşımlarıyla ancak anlaşılabilir. Eylemi ve pratiği kışkırtmayan herhangi bir felsefe kuramının yaşama şansı azdır. Salt mantık kuralları, zihnin düşünme yönteminin onarılmasına, iyileştirilmesine; siyaset felsefesi doğru ve sağlıklı siyaset ilkelerinin geliştirilmesine; bilimsel araştırmalar, bilimin teknolojiye dönüştürülüp insanlığın yaşam kalitesinin artmasına; din

29 felsefeleri, tarafsız ve karşılaştırmalı dini düşüncenin geliştirilip toplumsal barışa katkı sunmasına; doğa felsefesi, insanın doğayla uyum içinde yaşamanın koşullarını araştırmasına; modern çağdaki felsefi arayışların Antikçağ ın insan ve eylemlerinin değeri sorununa yeniden eğilinmesine neden olmuştur. Bunlar felsefe tarihinde verilebilecek örneklerden yalnız bir kısmıdır. Karl Jaspers e göre insan için, hiçbir zaman ve hiçbir yerde olmuş-bitmiş, tamamlanmış bir şey yoktur. İnsan düşüncesi sürekli bir oluş içindedir. Bu nedenle, her düşünce yapısı daima yarımdır. Hiçbir bilgi de mutlak ve sonsuz olamaz. Bu nedenle, hem dünyadaki objeleri hem de öznel insan varoluşunu açıklayacak genel bir gerçeklik kuramı oluşturmak için felsefenin yöntem ve ilkelerine dönmek gerekir. (Büyükdüvenci, 2001, s.69). XIX. yüzyılda felsefe-bilim ayrışması, kuram-eylem bütünlüğünün yeniden tesis edilmesi görüşünün kuvvetlenmesine neden olmuştur. Bu görüş, düşünce ve eylemde insanlık ekseninin yitirilmesinden doğan varoluşsal sorunları gün yüzüne çıkarmıştır. Bu sorunlar, felsefe ve bilimin yeniden bir araya gelerek kuram-eylem bağlamında insanın modern çağda yitirdiği varoluşsal sıhhatini geri kazanması ve iyileştirilmesini amaçlayan felsefi danışmanlık veya sağaltımın eğitim sorununu çok yönlü, çok yöntemli bir şekilde ele almasını zorunlu kılmaktadır. Felsefe Tarihinde Felsefi Sağaltım ve Terapi Felsefi Danışmanlık, Felsefi Terapi ya da Felsefi Sağaltım, felsefenin kuram-eylem bağlamı içinde doğrudan normal insanların zihinsel, ruhsal ve hatta bedensel tedavisini dile getiren farklı ama anlamca birbirine yakın kavramlardır. Tam olarak birbirinin yerine kullanılmasa da, hepsini birden içine alacak şekilde sağaltım kavramının kullanılmasını şimdilik önermekten başka alternatif bir adlandırma bulunmamaktadır. Şöyle ki, felsefe ve tedavinin yan yana kullanılması, akla hiç olmazsa ilk bakışta klinik bir müdahaleyi getirir. Modern literatürde counseling yani danışmanlık, felsefi terapi ya da tedavi anlamında yaygın olarak kullanılmaktadır. Ancak bence danışmanlık, felsefi yaklaşım ve yöntemin derinliğini karşılayacak özgün bir kavram sayılmaz. Çünkü danışan, genel olarak müşteri yani client olarak adlandırılır. Oysa tıbben hasta olanlar dışındaki büyük çoğunluğu oluşturan insanlar, felsefe karşısında potansiyel ya da fiili bir müşteri değil, sağaltıma muhatap bireylerden oluşur. Şu halde normal koşullar altında bedensel veya zihinsel-ruhsal anlamda hasta teşhisi konulmamış bütün insanların muhtemel ve potansiyel hasta olabilecekleri postulatından hareketle, hastalığın kuvveden fiile geçmesine önceden müdahale etmek anlamında felsefi sağaltım kavramının istihdamı daha elverişli görünmektedir. Zaman zaman yine de galat-ı meşhur olduğu için tedavi, terapi, danışmanlık kavramları çalışmamda yer alacaktır.

30 Şimdi felsefi sağaltım neyi amaçlar? İlk olarak, varoluşsal sorunlarda istisnasız ortak olan tüm insanların terapisini amaç edinir. Potansiyel olarak zihinsel-ruhsal veya bedensel hasta olmalarını önceden önlemek için, felsefe tarihi boyunca biriken, birikmekte olan bilim, kültür, sanat, din, siyaset gibi kültürel öğeleri yeniden üreterek insanın/insanlığın sağlıklı düşünen ve davranan bireylerden oluşmasına yardım etmektir. Felsefi tedavi ya da sağaltımın bu ilk amacı esastır ama daha esaslı olan diğer amacı ise, bu yolla insanları eğitmektir. Bu eğitim, felsefe tarihinde kuram-eylem bütünlüğü sayesinde gerçekleştirilir. Felsefe yaygın kanaate göre daha çok kuramsal sayılsa da hemen her filozofun düşünce sisteminde ya doğrudan ya da dolaylı olarak bu kuram-eylem birliği söz konusudur. Antik çağda Sokrates, Platon, Aristoteles, Epiküros, Epiktetos, Seneca, Marcus Aurelius örneklerden bazılarıdır. Yine Ortaçağ Hıristiyan felsefesinde Aziz Augustinus, Aquinalı Thomas, Aziz Anselmus, Ortaçağ İslam felsefesinde Muhasibi (er-riaye, 2000), el-kindi, Farabi, İbn Sina, İbn Tufeyl, Ahmet Yesevi, Mevlana gibi filozof-mistikler de İslam Felsefesinden verebileceğim örneklerdendir. Nihayet XVII. Yüzyıldan itibaren Modern Çağ felsefesinde Rene Descartes tan Max Scheler a, Edmund Husserl e, Nietzsche ye, Lacan a, Foucaoult ya kadar uzanan zincirde bir çok filozof, işte felsefi sağaltımın tarihsel sürecinde yer almaktadırlar. Felsefi sağaltımdaki nihai amaç bütün bu filozoflarca insanın ruhsal ve zihinsel eğitilmesi olarak belirlenmiştir. Felsefi Sağaltımın Kapsamı ve Sınırları Felsefe Tarihi, Antik çağlardan modern zamanlara kadar uzanan bir tarih bilimi olduğu kadar, aynı zamanda zihinsel, ruhsal ve bedensel olmak üzere insan varoluşunu tümüyle kuşatan bir danışmanlık ve terapi sürecidir. Felsefenin danışmanlık ve terapi kavramlarıyla bitiştirilmesi literal anlamda modern bir icat olsa da, felsefe tarih boyunca salt insan eseri bir düşünme ve davranma yöntemi (aksiyoloji) olarak, yine insanın varoluşunu dolaylı ya da dolaysız konu almış; düşünen ve düşünülen olarak, sonuçta insanda vücut bulmuştur. Sokrates, Aristoteles ve Platon dan, Hegel ve Freud a, hatta Otto Rank a uzanan Batı tarihinde felsefe varlık, bilgi, ahlak ve sanata dair hemen her analizinde danışmanlık ve terapinin zengin birikimlerini bu güne kadar taşımıştır. İslam dünyasında felsefi danışmanlık ve terapiye kaynak temin edecek benzer zenginlik, Farabi, İbn Sina, Gazali gibi filozoflardan; Ahmet Yesevi, Yunus Emre, Mevlana gibi mutasavvıflara kadar devam eden silsile ile günümüze ulaşmış durumdadır. Ne var ki Ortaçağlar, İslam düşüncesi için

31 bir Rönesans olsa da, felsefeyi günümüze taşıyabilme başarısını sağlayan Avrupa düşüncesi için henüz Rönesans değildi. Buna rağmen, genel olarak Ortaçağ da din, tarih ve felsefenin neredeyse tek ve ortak pradigması olarak her iki dünyanın danışılan ve sayesinde ruhsal, zihinsel ve bedensel iyileştirmenin gerçekleştirildiği birinci yol idi. Ortaçağda bilme, düşünme, etkileme ve eylemenin tek yöntemi, din faktörüydü. Yazılı geleneğe ait felsefenin tarihindeki ilk danışmanlık ve terapi yolu, din idi. Ancak insan varoluşunun holistik doğası ve buna bağlı olarak karmaşıklığının, bu birinci yolla çözümlenmesine dair beklenti, XVIII. Yüzyılda tıkanınca, dinin yerini, bilim ve sonra da bilimsel yöntem almayı denedi. Aynı yüzyıllarda salt bilimsel araştırmalarda geçerli olabilecek klasik ve yeni olgucu yöntemin, insan bilimlerinde işlevsiz kaldığına ilişkin güçlü itirazlarla karşılaşması, bilimin de birinci yol olan din gibi kendini modern din olarak takdim ettiği savları dillendirilmeye başladı. Bilim, modern çağda, insanın varoluşsal süreç ve koşullarına müdahalede Ortaçağlarda dinin yerine geçen ikinci yol olmuştu. İnsan kendisi, evren ve Tanrı ya ilişkin problemleri din ile çözemediği gerekçesiyle, bilim ve bilimsel yönteme tutunmuştur. Ancak bilim de dinleştiği için, hakikat ve mutluluğa, bu yolla da ulaşılamamıştır. Üçüncü yol din, bilim ve felsefeyi, yine felsefenin kavrayıcı ve kapsayıcı yöntem ya da yöntemleriyle birleştirdiğini düşündüğüm yoldur. Yalnız insana özgü ve insanın kendi öz güçleriyle meydana getirilen üçüncü yol, felsefi danışmanlık ve terapide, modern çağımızda ilk iki yola ait felsefe tarihi boyunca süre gelen her türlü bilimsel, dinsel, kültürel ve medeni insanlık birikimlerini insanın mutluluğu için seferber etmeyi önermektedir. Varoluşsal olarak hakikat ve mutluluktan yoksun kalan bu bunalım çağındaki insan zihinsel, ruhsal ve bedensel olarak parçalanmış durumdadır. Bu parçaları, ait oldukları kendinde varlık olarak insan bütününe iade etmek için, üçüncü yol olarak felsefi danışmanlık ve terapi, din, bilim ve kültürü bir araya getirerek bunların esasen hep insan merkezli olduğunu vurgular. Üçüncü yolla felsefe, dünden bugüne felsefe tarihinde kendinden kopan bu parçaların, aslında insanın varlık yapısının parçaları olduğu düşüncesini öne sürmektedir. Felsefi danışmanlık ve terapi, insan ya da insanları değil, insanlığa dair temel sorunları hastalık olarak görmektedir. Tinselliği ile dine, olgusallığı ile bilime ve sorunsallığı ile de felsefeye dayanır. İçerik zenginliğini yöntemsel zenginliğe taşır ve buradan da pratik hayata geçer. Kapsamlı Bir Danışmanlık Olarak Felsefi Sağaltım Kuramsal Çerçeve

32 Epikür felsefesi, modern çağın akademik felsefesinden farklı olarak kişsel ya da tüzel bir danışmanın, insanların tecrübelerini anlamlı kılması ve onların genel değerleri ve tercihleri bağlamında en ideal çözümler aramasıyla öne çıkar. Felsefi danışmanlık Platonculuktan dil ya da mantık felsefesine kadar uzanan hemen her felsefe okuluna dayanabilir. Danışmanlığın bakış açısı ve danışmanın tecrübesi ne kadar geniş olursa etki potansiyeli o denli geniş ve ileri olur. Epikür etiği, bu gün felsefi danışmanlığa uygun felsefi bir hayatın ilk örneğidir. Modern danışmanlığın ilkelerinin pratik ve kapsamlı yalın bir sistemidir (Fatic, 2013: ). Felsefe ile psikolojinin genel-özel ilişkisinden/eskilerin deyimiyle umum-husus ilişkisi) doğan farklılık, her biri ile yürütülen danışmanlık türleri için de geçerlidir. Her psikolojik danışmanlık, aynı zamanda felsefi bir danışmanlıktır ama her felsefi danışmanlık yalnız psikolojik danışmanlık değildir, bundan daha fazlasıdır. Felsefi danışmanlık ve terapi çağımızın rakipsiz danışmanlık paradigması olma yolundadır. Felsefi danışmanlık psiko-terapik bir yöntem olarak işlese de bütünüyle psikolojik bir sağaltım değildir. Çünkü felsefe psikoloji dahil bütün pozitif ve insani bilimlerin esasıdır. Felsefeden doğma bir bilim olarak psikoloji, tanımlanmış, eğitim ve tedavi ölçütleri ve sınırları olan, sonuçlar verebilen ve en önemlisi, kesin ya da kesine yakın yargılarla ruhsal ve zihinsel çözümlemelerde bulunan bir bilimdir. İnsanı ve varoluş yapısını felsefe gibi holistik bir varlık tarzı olarak değil, bir parçasıyla; ruhsal ve zihinsel işleyiş sürecine eşlik eden koşullarla ele alır. Oysa felsefe, insanı yalnız ruhsal ve zihinsel koşullar altında tepki ve davranışları açısından değil, onu başlı başına biyolojik bir canlı ve kültür yaratan tinsel bir varlık olarak görür. Psikoloji tedavi etme iddiasındadır; psikoloji tedavi edilmesi gereken ruhsal yönelimleri ve zihinsel işleyişlerini konu edinir; insanı hasta olarak görür. Ne ki felsefe için insan, biyolojik ve kültürel olmak üzere iki katmanlı bölünmez bir varlık bütünü olarak göz önüne alınır. O hem canlıdır, hem de ahlaksal bir kültür varlığıdır. Felsefi danışmanlığa göre insan ve insanlar hasta ya da hasta adayları değildir. İlki doğum, ikincisi ölüm olmak üzere başlangıç ve sonunu belirleyen iki büyük travmayla birlikte yaşamı boyunca irili-ufaklı travmalarda ortak olan transandantal bir süjedir. Bu travmalar onun biyolojik varlık katmanı ile tinsel-kültürel varlık katmanı için eşit olarak geçerlidir. Felsefi danışmanlığa göre travmalar ve yarattığı sonuçlar, varoluşun kaçınılmaz ve evrensel doğasında içkindir. Başka bir deyişle, hiçbir insan teki, bunlar karşısında şanslı ya da şanssız, hasta ya da sağlıklı kategorileri ile nitelendirilmez. Kaldı ki sorun, şu da bu bireyi değil, tüm insanlığı ilgilendirir. Travmalar, psikolojideki gibi, belli bir birey ya da bireylere özgü bir hastalık; ruhsal ya da zihinsel bir aksaklığın psikolojik kökenleri değil, insan varlığının varoluşsal karakteristiği; üstelik yaşamın vazgeçilmez fırsatlarını içinde barındırır.

33 Bu noktayı açıklığa kavuşturmada fenomenolojik yaklaşıma başvurmak yararlı olabilir: Husserl in temel yöntem ve kavramları varoluşsal fenomenolojinin psikologlar arasında benimsenmesini kolaylaştırmıştır. Husserl psikolojiye yoğun bir şekilde odaklanmıştır. XX. Yüzyıl boyunca fenomenolojik hareket Karl Jaspers, Max Scheler, M. Heidegger, J. Paul Sartre, Maurice Merleau-Ponty, Alfred Schutz, Gaston Bacholard, Gabriel Marcel, Emmanuel Levinas ve Paul Ricoeur un çalışmalarında psikolojiye çok önemli katkılarda bulunmaya devam etmiştir. Fenomenoloji algı, tasavvur, duygular, davranış, dil ve sosyal süreçler gibi psikolojinin temel alanlarında çığır açan bilgi sağlamış olmasına rağmen psikoloji üzerinde en büyük etkisi, zihin sağlığı alanında meydana gelmiştir (Wertz, 2005: ). Felsefi Sağaltımda Fenomenolojik Yöntem Fenomenoloji apriori-betimleyici bir bilimdir. Fenomenolojide ilkin bir öz betimlemesinin, yani öze (mahiyete) ait bulunan bir algı nın (görüşün) varlığı kastedilmektedir; çünkü ancak görülen, algılanan ve verilen bir şey betimlenebilir. Husserl in bu konudaki iddiası şudur: zaman ve mekan kaydına tabi olmayan, genel, ideal objeler (mahiyetler) vardır; biz bunları fenomen olarak verili hale, yani görünebilir, algılanabilir bir hale getirebiliriz; oysa öteden beri sanılıyordu ki, verilen yalnız ferdi (individual), real olan şeylerdir. Genel, ideal olan şeyler, verili hale getirilemez. Özellikle nominalist felsefe, genel objelerin değil, ancak genel bir anlamı olan sözcüklerin, işaretlerin, sembollerin var olduğunu öne sürer. Bu bakımdan burada nominalist felsefeye aykırı, esaslı bir bakış açısı karşısındayız: biz yalnız ferdi, real olguları değil, aynı zamanda genel olan objeleri (mahiyetleri) de asli şekilde bize verildikleri gibi algılayabilir, görülebilir bir hale getirebiliriz (Mengüşoğlu, 1945: 47-74). Fenomenoloji felsefesinin bu yaklaşımı çerçevesinde, psikoloji ile felsefe arasındaki fark açık-seçik hale gelir. Psikoloji, verili olandan, yalnız ferdi, real olan şeyleri kasteder; genel ve ideal olan şeylerle ilgilenmez. Genel objeler değil, ferdi, algılanabilir, görülebilir tek tek objelerin tasviri sınırları içinde hareket eder. Oysa felsefeye göre, genel, ideal ve zaman-mekan kaydıyla sınırlı olmayan mahiyetler vardır; biz bunları ferdi objelerde görünür ve algılanabilir hale dönüştürürüz. Felsefe, ferdi objeleri bu fenomenolojik yaklaşımla yadsımadığı gibi, mahiyet objelerinin yani genel özlerin varlığının her zaman ferdi objelere bağlı olduğunu öne sürmez. Şöyle ki, kurgu fenomenoloji için bir yaşam unsurudur. Bununla mahiyetlerin var olan bir şeye bağlı olmalarına ihtiyaç duymadıkları ve mahiyet alanının çok geniş olduğu kastedilmektedir.

34 Çünkü bütün realitenin, bütün olguların, hatta hayal ve masal aleminin, özetle her şeyin bir mahiyeti vardır; fakat fenomenolojik bilgi için var olan bir şeyin mahiyetleri ile hayali olan, hatta anlamı olmayan bir şeyin ( mesela dairesel bir dikdörtgen) mahiyetleri arasında bir fark yoktur, yani hepsi hakkında aynı mahiyet yasaları geçerlidir (Mengüşoğlu, 1945: 47-74). Psikoloji, ferdi objelere bağlı olan mahiyetler dışındaki tüm mahiyetleri gerçek dışı olarak nitelediğinden bunları hastalıkla ilişkilendirir; felsefe ise fenomenolojik olarak değerlendirir. Felsefi danışmanlık teşhis ve tedavi döngüsü içinde hareket etmez; analitik ve sentetik yöntem uygular. Zaman-mekanla kayıtlı olup olmadığına bakmaksızın, realite ile bağının bulunup bulunmasını şart koşmaksızın mahiyetlerin varlığını kabulle yola çıkar. Çünkü insan ve onun varlık tarzına ilişkin her fenomen, insanı tedavi bekleyen hasta kategorisinin dışında ve ötesinde anlatabilmek için bir fırsattır. Hasta olan insan değil, hastalığın kendisidir. Çözümlenmesi gereken sorun insan değil, insanlığın kendisidir. Felsefi danışmanlık sorunları konu edinir; hasta ları tedavi etmez. İnsana hasta teşhisi koymaz ve onu tedavi etmeye kalkmaz. Teşhis koymak ve tedavi yapmak felsefi danışmanlığın işi değildir. Tam tersine, onun hedefi, hastalıklar ve sorunlar dır. Bir sorunun hastalık düzeyinde olup olmadığı teşhis ve yargısını, pozitif bilimlere bırakır. Onun odaklandığı nokta, hastalıklara kaynak gösterilen sorunları incelemek ve tahlil etmektir. Çok yönlüdür, tek yöntem ve tek yaklaşım tarzı dogması yoktur. Felsefe tüm bilimlere ev sahipliği yaptığı için psikolojik danışmanlığa ve terapiye de ev sahipliği yapar. Felsefi danışmanlık ile psikoterapi arasındaki ilişki, felsefi danışmanlık hareketinin kısa tarihinde çok tartışılmaktadır. Felsefi danışmanlık sadece tıbbi veya psikoterapik müdahalelerden sonar değil, oncesinde de yardımcı olabilir. Felsefi danışmanlık tüm insanlık için ortak, evrensel olan, insanlığın ve evrenin özü olan şeyleri arayan soruları kullanır. Sorgulanmış bir hayat, bir varolma tarzı olarak hikmetin araştırılması ve bazı psikolojik problemlerden sakınmak felsefenin hedefidir. Psikoterapi ise insan huyları, arzu, nefret, sevmek, sevmemek gibi duyguların iyileştirilmesine yardım eder. Felsefi danışmanlık ise, bunları insanın bütün bir varolma özelliklerinin parçası olarak görür. Daha önemlisi, günlük yaşamı anlamlı kılar. Sanat terapisi yoluyla, sıradan olanı, sıra dışı hale dönüştürerek insan ruhu ve zihninin dinginleşmesine zemin hazırlar (Lizeng, 2013: ). O halde felsefi danışmanlık bilişsel ve pratik erdemleri edinmek için insanın tüm varoluşuyla dünyaya ve hayata katılmasını ön görür. Bilişsel erdem kendimizi ve dünyamızı anlamanın geniş yollarına açık olmaktır. Pratik erdem ise, samimiyet, sabır, merhamet ve adaleti daha geniş açıdan

35 görebilmektir (Tukiainen, 2010: 48-57). İslam tasavvuf literatürü bu tinsel erdemlerin felsefesi olarak benzer bir zihinsel ve ruhsal danışmanlık potansiyeli taşır. Türk ermişi Ahmet Yesevi den, yine Türk bilgesi Yunus Emre ye, Mevlana, Hacı Bektaş ve burada adı geçmeyen bütün sufilere kadar tasavvuf geleneğinde İslam ve Türk dünyasının modern insanı iyileştirme yolunda henüz keşfedilmemiş felsefi-dini bir birikimi vardır. Modern zamanlar, gittikçe artan ölçüde insan varoluşunu zihinsel, ruhsal ve bedensel olarak derinden sarsan farklı yaşam biçimlerini dayatmaktadır. Psikolojinin ve Psikiyatrinin hasta ya da hafif deyimle, danışan adını verdiği, hatta ABD gibi ülkelerde müşteri denilen tek tek bireyler dışında, adı konmamış ama tıbben sağlıklı olduğu halde acı çeken bir insanlık söz konusudur. Benim felsefi sağaltım dediğim felsefi danışmanlık, tıp biliminin içinde yer alan daha çok olgucu bu iki bilim dalının ilgi alanına girmeyen çoğunluğun terapisi ve iyileştirilmesini amaçlamaktadır. Felsefi danışmanlık psikoloji ve psikiyatri gibi teşhis ve tedaviyi değil, doğrudan tüm insanlık için ortak olan acı nın varoluşsal boyutlarına odaklanır. Psikoloji ve psikiyatrinin geçmişi en çok 18. Yüzyıla kadar giderken Felsefi sağaltımın tarihi en az Antikçağ a uzanır. Antikçağ dan bugüne düşünce tarihinde önemini hep korumaktadır. Varoluşçu filozoflardan ve aynı zamanda yetkin bir psikiyatristlerden biri olan Karl Jaspers ın dediği gibi, Felsefi sağaltımın amacı, psikoloji ve psikiyatri gibi tıbben hastalar; yani tıbbi olarak müdahaleden başka hiçbir tedavi şeklinin yarar sağlamadığı hastalar dışında kalan sağlıklı acı çekenler in oluşturduğu insan topluluğunun zihinsel ve ruhsal acılarını dindirmek için benimsediği ilke ve yöntemleri belirlemektir. Tek tek hastalar dışında kalan insanlık ya da acılı sağlıklı insanlar, felsefi sağaltıma göre hasta değil, ortak varoluşsal sorunları olan normal insanlar dır. Felsefi terapi, danışmanlık ya da felsefi sağaltım, genel olarak doğum travmasından ölüm travmasına ve bu ikisi arasında yaşanan irili-ufaklı ömür boyu var olan travmaları hastalık olarak değil, varoluşsal sorunlar olarak görür. Söz konusu iki bilim alanının sınırlarına kadar dayanmamış tüm insanlar, felsefi sağaltımın konusudur, muhatabıdır. Hasta ya da danışan olmaktan çok, kozmik varoluşun her travmasını diğer sağlıklı acı çeken türdeşleri ile aşağı yukarı eşit ölçülerde paylaşan insandır. Felsefi sağaltım, ruhsal tedavinin sınırına daha varmadan, genel olarak insanın ruhsal ve zihinsel travmalarını bilimlerin bütün imkânlarını seferber ederek anlamlandırmaya çalışmakla işe başlar. İnsan varoluşu başlı başına bir travmadır; ruh hekimleri duygu ve düşünce dünyasında olup biten bu varoluşsal gel-gitleri, ancak gözlemlenen davranışlardaki bozukluklar olarak tespit ettiklerinde, müdahil olurlar. Bu noktaya kadar akıl ve ruh hastalıkları hekimleri, ortak varoluşsal sorunlara ve travmalara, genel olarak hastalık tanısı ile yaklaşamazlar. Çünkü psikoloji ve psikiyatrinin bu

36 durumda hem yapabilecekleri, hem de yapabileceklerini uygulayacakları insan sayısı sınırlıdır ve böyle olmak zorundadır. Çünkü felsefi sağaltım insanlara hasta, ya da psikolojik sorunları olan kişi gözüyle bakmaz. Bu iki bilimsel alandan yararlanmakla birlikte felsefi sağaltım, hasta tedavi etmez; teşhis koymaz ve ilaç vermez. Ancak hasta, tanı ve ilaç, tıbbi kavramlar olup, bu noktada felsefi danışmanlık sorunu, bu bilim alanlarına havale eder. Felsefi sağaltımın amacı, insan varoluşunu ruhsal, zihinsel ve kozmik düzeyde anlamlandırmak olup çağın bütün bilgilerini bu uğurda kullanmaktır. Felsefi sağaltım, tıbben hasta olanı sağlığına kavuşturmak, hastalığı iyileştirmek, son sınırına gelmiş acının hastalığa dönüşmüş halini geriye çevirmek ya da ilaç tedavisi uygulama yoluna gitmez. Tam tersine, bütün insanların bu sınırlara dayanma ihtimaline karşı, varolmanın anlamını çözümleyerek daha az insan türünün ruhsal ve zihinsel olarak ruh biliminin hastası na dönüşmesini sağlıklı acı ya odaklanarak engellemeye çalışır. Bu kapsamda Felsefi sağaltım, bu gün psikoloji ve psikiyatriden daha yaygın hale gelme eğilimindedir. Psikoloji, Psikiyatri ve Felsefi Sağaltım İnsanın bedensel, ruhsal ve zihinsel sorunları, modern zamanlarda karmaşıklaştığı gibi, daha da görünür hale gelmiştir. Bu sorunlar görünürleştikçe modern deneysel bilim yaklaşımı tanı, tanım ve çözüm yöntemlerini olgusal veriler üzerinde yoğunlaştırmaktadır. Başka bir deyişle, bilimsel yöntemin insana ve insanın bu üç boyutlu sorunlarına yaklaşım biçimi de olgucudur. Örneğin psikoloji, insan davranışları ve zihinsel süreçleri, bunların altında yatan nedenleri ile birlikte inceleyen bir bilim olarak kısa bir geçmişe sahiptir. Psikoloji insan zihninin yapısını inceler; insan zihni doğrudan gözlemlenemediği için gözlenebilen davranışların bilimsel incelenmesi olarak Modern Psikolojinin tanım ve sınırlarını belirlenir. İnsan, bu tanıma göre, bir organizma olup zihinsel süreçlerinden kaynaklanan gözlenebilir davranışları incelenen akıllı bir varlıktır. Psikolojik bulgular aracılığıyla bu zihinsel durumların varlığı belirlenir. Bu bulgular, ancak gözlenebilir davranışlar gibi somut verilere dayandığı için, insan, varoluşsal bir varlık olarak değil, bir organizma olarak görülür. Psikoloji, bu tutumuyla insanı, salt somut verilerle gözlemlenen bir araçsallığa indirger. İnsan buna gore ancak gözlemlenebilir davranışları ve bunlara ilişkin somut bulguları ile tanımlanan bir canlıya dönüşür. Modern psikoloji, modern zamanların betimsel, ölçülebilir ve hesaplanabilir algısının doğurduğu sorunlara, yine aynı biçimde yaklaşarak deneysel bilimlerle işbirliği yapar. Modern çağın sorunlu insanı, psikolojide üstü kapalı olarak hasta adını alır. İnsan varlığının araçsallaştırılması, bilimsel yöntemdeki deneycilik ve olguculuk keskinleştikçe, daha belirgin duruma gelir. Tıp bilimi olarak psikiyatri, psikolojiye

37 gore daha deneysel ve olgucudur. Psikoloji gibi psikiyatrinin geçmişi de yenidir. Nitekim Johann Christian Reil, bir psikiyatrist olarak bu adı ilk kullanan bilim insanıdır. Psikiyatri, insanın duygu, düşünce ve davranışlarınki sapmaları tanımlayıp modern tekniklerle tedaviyi etmeyi amaçlayan bir tıp disiplinidir. Psikiyatri, elde ettiği bu sapmalarla ilgili verileri tıp diline özgü çeşitli hastalık kavramlarıyla tanımlar ve bu hastalıklar dan herhangi birinin bulgularını taşıyan kişi de tıbben hastadır ve yine psikiyatrinin benimsediği tıbbi yollarla tedavi edilmelidir. Felsefe bilimi ve bilimsel yöntemi yadsımaz. Bilimi reddetmek felsefenin doğasında yoktur. Ancak felsefi sağaltım, doğrudan psikoloji ve psikiyatrinin alanına girmez. Bu bilimlere özgü tanı, tedavi gibi kavramlara yer vermez. Zihinsel ve ruhsal süreçlerdeki sapmaları, bu sapmaların davranışa yansıyan yönlerini belirmek, tanımlamak ve tedavi etmek yine felsefi sağaltımın konusu değildir. Çünkü felsefi sağaltım ne psikoloji ne de psikiyatrinin yöntemini kullanır. Bununla birlikte, felsefe tinsel ya da deneysel olsun, bütün bilimlerden yararlanmak zorundadır. Kaldı ki Antikçağ dan modern zamanlara kadar bütün bilimler felsefenin içinde idi. Ancak felsefi yöntem, bu bilimlerin kendilerine özgü yöntemlerini değil, elde ettikleri bulguları alır. Felsefi sağaltım da aynı şekilde, psikoloji ve psikiyatrinin yöntemini değil, modern bulgularını izlemek zorundadır. Peki, felsefi sağaltım bilimsel yöntem yani deneyci-olgucu yöntemi izlemediğine gore, modern psikoloji ve psikiyatride nasıl bir eksiklik görmektedir? Ya da farklı olan yanı nedir? Çağımızın psikiyatristlerinden Eugenio Borgna, uzmanı olduğu psiiyatrinin neyi eksik bıraktığını kendi diliyle açıklar: Ruh acısı hayata dair bir deneyimdir ve sadece bir patolojinin uzantısı olarak görülemez. Ruh acısı, olaylar üzerine düşünmenin ve onları içselleştirmenin de kaynağıdır ve her durumda bizdenbaşka-olanın acısını tanımak, psikiyatriyi insani kılmak ve bununla ilintili olarak da, kişiler arası ilişkileri insani kılmak anlamına gelmektedir: psikiyatride ve insani ilişkilerde yatan köklü varoluşsal anlamlar sıklıkla kesin bir biçimde reddedilmekte, bunların nedenleri görmezden gelinmektedir. (Borgna, 2015: 59). Çağımızın insani sorunlarını psikiyatrinin tanılama ve çözümlemede yetersiz kaldığını yine bu bilim disiplinin uzmanından öğreniyoruz. O halde psikiyatri felsefi yaklaşımın insani boyutuyla buluşması artık kaçınılmaz hale gelmektedir. Felsefenin yalnız insan psikolojisi ve insan olmanın ne anlama geldiği ile ilgilenmez, aynı zamanda derinlere kadar giden felsefi soruyla da ilgilenmek zorundadır. Felsefi sağaltım, insana salt hasta olarak bakmaz. Büyük boyutlarda bilinçli ve

38 bilinçsiz zihinsel güçler, algılamalar, kaygılar, duygusal ve davranışsal sapmalar, umutlar ya da umutsuzluklar gibi ruhsal ve zihinsel süreçlere maruz iki ya daha fazla insan arasında gerçekleşen filo-psikolojik süreç olarak kendini gösterir. Felsefenin temel teropötik işlevi olasılıkla açık biçimde Epikürcü etikle ortaya konmaktadır. Modern çağ psikolojisi ve psikologları, terapik konuşmaya en yetkin uzmanlar olarak kendileri için yasal bir alan ayırmış iseler de, felsefi sağaltım, psikolojinin felsefi sağaltım yöntemini basite indirgemeye çalıştığını ifade eder. Kuşkusuz, tıbii müdahaleyi gerektiren apaçık zihinsel hastalıklar olsa da kaygıya, depresyona, kişiliğe ve ilişki sorunlarına neden olan çok daha fazla anlam sorunları söz konusudur. Bugün bunlar genel olarak tıpla tedavi edilir, bununla birlikte pek çoğu düzenli olarak felsefenin alanı içindedir. Felsefi sağaltıcı için terapi kavramının kullanılmasına yönelik kanuni yasak, sağaltıcının insandışılaştırılmasında (de-humanization) ve psikoloğun münhasırlık iddiasının ateşli savunucularınca dayatılan keyfi sınırlamaya işaret etmektedir. (Fatic, 2013: ) Psikoloji ve psikiyatri, yalnız kendilerine özgü bilimsel yöntem e sahip oldukları için değil, yasalarla güvence altına alınan bilimler oldukları için de insanı ve sorunlarını, kendi sınırları içinde belirlemektedirler. Felsefi sağaltımdaki insan insana ilişkisi, bu bilimlerde doktor hastaya ilişkisine indirgenmektedir. Çağımızda psikologlar ve psikiyatristler arasında, insan zihni ve ruhuna dair derinlikli durumlarının yalnız bu iki bilimle anlaşılamayacağını, felsefenin işe müdahale etmesine gereksinim olduğunu yüksek sesle dile getirenler yok değildir. Oysa felsefe tarihinde psikolojik hiç bir zaman insan varoluşunun anlaşılmasında atlanmış değildir. Örneğin Edmund Husserl (Wertz, 2005: ) psikolojiye yoğun bir biçimde odaklanan bir çok filozoflardan yalnız birisidir. XX. Yüzyıl boyunca fenomenolojik hareket Karl Jaspers, Max Scheler, Martin Heidegger, J. Paul Sartre, Maurice Merleau-Ponty, Alfred Schutz, Gaston Bacholard, Gabriel Marcel, Emmanuel Levinas ve Paul Ricoeur un çalışmalarında psikolojiye çok önemli katkılarda bulunmaya devam etmiştir. Algı, tasavvur, duygular, davranış, dil ve sosyal süreçler gibi psikolojinin temel alanlarında çığır açan bilgiler ortaya koymuş olmasına rağmen, psikoloji üzerinde en büyük etki, zihin sağlığı alanında meydana gelmiştir. Felsefi sağaltımda erdemin pratik yaşam bilgeliği olarak öne çıktığnı görürüz. Erdemler esaslı bir biçimde psikolojik kuramlar ve psikoteropatik tekniklerin hazinesine birebir ait görünmese de bu durum, felsefi sağaltımın bir sağaltım ya da iyileştirme yöntemi olmadığını göstermez. Erdem öğretileri ve bilgece yaşam teknikleri teröpatik aktivitelere belirgin olarak katkı sağlamaktadır.

39 Felsefi sağaltım, psikoloji ve psikiyatriden farklı olarak şu soruları sorar: Bütün insanlık ve evren için ortak olan şey nedir? İnsanlığın temeli ve gerçekliği nedir? Psikoterapi insanlıkla ilgili olarak yalnız kişisel ve somut şeyler bakımından ilgilenebilir. Bu bakımdan onun özünün içine açılan bilinçliliği kavrayamaz, hayatın sorunlarına ve değerlerin görünümlerine yanıt veremez. Felsefi sağaltım yalnız ben le ilgilenmez, aynı zamanda zihni, ben in gelişmiş bir algısına açar. Felsefi sağaltımın muhatabı kendini aşmayı öğrendikçe, felsefi sağaltım ona geçicilik ve ölümle baş etmeyi öğretir. Felsefi sağaltım, Antik dünyanın karakteristiği olan bütüncül ve disiplinler arası görüşü ortaya koyar. Psikoterapi, sosyal bilimler arasında özel bir alandır. Toplumun hayatını sürdürmesi ve bireylerin üremesini sağlamaya odaklanır. Sağlıklı acı kavramı, tıbbi olarak hasta tanısı konmuş kişiler dışında kalan bütün normal ve sağlıklı insanlar için kullanılır. (Lizeng, 2013: ). Hasta için, felsefi sağaltımın yapabileceği pek fazla bir şey yoktur. Tıbbi tedavi, psikoloji ve özellikle psikiyatrinin özel alanını ilgilendirir. Felsefeyle hasta tedavisi mümkün değildir. Ancak tıp doktorlarının müdahalesi noktasına kadar uzanan sağlıklı acılı durum, kalan diğer tüm normal insanları felsefi sağaltımın muhatabı kılar. Tüm insanlık için ortak, evrensel olan, insanlığın ve evrenin özü olan gerçekleri arayan soruları kullanır. En son amaç ve varılması gereken nokta, hayatın anlamlı hale getirilmesidir. Hayatın anlamı ya da anlamsızlığı sorunu ise, bu iki bilim dalının, başka bir ifadeyle tıbbi alanın dışında kalır. Felsefi Sağaltımla İlgili Modern Literatür Felsefi sağaltımın tarihi çağımızda ancak 40 yıl öncesine kadar götürülebilir. Pratik yaşam bilgeliği ya da felsefi yaşam sanatı olarak sağaltımın geçmişi, bir uygulama olarak en az Antik çağa uzanır. Modern bilim ve teknolojinin yarattığı ruhsal, zihinsel ve bedensel sorunlar arttıkça, çağımızda yeniden felsefenin bir yaşam bilgeliği olarak öne çıktığını görmekteyiz. Başta Almanya olmak üzere Avrupa da ve ABD de felsefi sağaltım için klinikler kurulmakta; psikoloji ve psikiyatri felsefeyle yeniden bütünleştirilmektedir. Son yüzyıllarda felsefe yalnız bilimsel ve akademik bir çalışma alanı biçiminde etkin olmakla birlikte, Avrupa nın politik yapılanmasında da önemli bir rol oynadı. Ancak son birkaç on yıldır felsefi yaşam pratiğinin psikanaliz ve başka klinik yaklaşımlara alternatif olarak, felsefi sağaltım adı altında Antik çağdaki rolüne geri döndüğünü gözlemekteyiz. Schuster, danışman ile hastası ya da karşısındaki gurup arasında oluşan diyalogun kuramsal yaklaşımlarını psikanalitik yöntemle

40 karşılaştırma yaparak incelemektedir. (Schuster, 1999:80) Felsefi sağaltım psikanalitik yönteme nasıl katkıda bulunabilir sorusu bunun gibi son dönem psikanaliz konusundaki çalışmalarda sıklıkla dillendirilmektedir. Öte yandan, felsefenin psikoterapi ve sağaltım alanlarından nasıl yararlanacağı da meselenin başka bir boyutunu oluşturur. Lebon, hastaların felsefi sağaltım sayesinde daha doğru kararlar alabileceklerini ve duygusal olarak olgunlaşabileceklerini öne sürmektedir. (Lebon, 2009: 95) Duyguların olgunlaştırılması, özgür irade eğitimi, hayatın anlamının kavranması ve etik ilkelerin pratik yaşama uygulanması felsefi sağaltımın psikoterapiden yararlanarak başarı şansını artıracaktır. Duyguların akılla denetimi, özgürlük sorunlarının çözümü felsefi sağaltımın ana konularındandır. (Curnow, 2001: 65). Kuram-eylem bütünlüğü, felsefi sağaltımla psikoterapinin işbirliği sayesinde gerçekleştirilebilecektir. (Macaro, 2006:75). Duygularımızın çelişkili, karmaşık ve çözülemez yoğunluğundan ve ortaya çıkardıkları mutsuzluktan, yıpranmaksızın nasıl kurtulabileceğimizi bize gösteren, düşüncelerimizin altında yatan ve birden bire beliriveren duygusal karışıklıkları tespit etmemizi, duygusal, düşünsel çözümsüzlüklerin üstesinden gelebilmemizi sağlayan bir yol gösterici olarak felsefi sağaltım (Cohen, 2003: 89), çağımızın alternatif bir iyileştirme yöntemi olarak kendinden söz ettirmektedir. Cohen, felsefi sağaltımı mantığı temel alarak kurmaya çalışan çağımız düşünürlerindendir. Ona göre kaygı, suçluluk duygusu, sinir ve üzüntü gibi günlük hislerimiz mantıksal temel üzerinde analiz edilmelidir. Mantık-temelli terapinin altı basamağının felsefi sağaltıma nasıl uyarlanabileceğini, günlük duygularımızdan doğan sorunların üstesinden cesaret, empati ve sabırla nasıl gelebileceğimizi anlatır. (Cohen, 2016: 125). Bu çabasıyla, çağımızın felsefe-psikoloji ve psikiyatri bütünlüğü söylemleri doğrultusunda psikoloji ile felsefeyi birleştirmeyi ön görmüş olmaktadır. Cohen çağımız sorunlarının karmaşıklaşması, psikolojinin çözüm üretmesini güçleştirdiği kanaatindedir. Gerçekten de yüzyıllar boyunca Platon, Aristoteles, Epikuros, Thomas Aquinas, Rene Descartes, Spinoza, I. Kant ve Nietzsche gibi büyük düşünürler günlük yaşamımızda karşılaştığımız sorunlarla baş edebilmenin ve mutluluğu elde etmenin çeşitli yollarından söz etmişlerdir. Ona göre çağımız psikolojisi bu birikimden yeterince yararlanmamaktadır. Benlik inşasında psikoloji felsefi birikim olmadan başarısız kalacaktır. ((Cohen, 2007: 154). Psikoloji ve psikiyatrinin tek yönlü ve kendi sınırları içinde kalan terapi yöntemleri eleştirilirken, günümüzde felsefe için de benzer bir eleştiri yapılmalıdır. Neredeyse modern çağımıza kadar felsefe, yukarıda anılan ve anılmayan filozoflarda kuram-eylem bütünlüğü içinde bütüncül bir sağaltım yolu olarak kendini göstermişse de, bu gün akademik düzeyden sapma kaygısından dolayı, kuramları tekrarlayan bir döngü içindedir. Cohen e göre felsefe, sıradan insanların kişisel

41 ve kişilerarası sorunlarına çözüm getirebilir. Ona göre günümüzde pek çok kişi gündelik ya da varoluşsal sorunları için çözümün yalnız psikoloji veya psikoterapide aranamayacağına, felsefenin mutlaka devreye girmesi gerektiğine inanmaktadır. Bu durumda felsefe, akademik ortamdan kopup acaba sıradan, gündelik bir uğraşa dönüşebilir mi sorunu ortaya çıkar. Bu sorunu Cohen eserinde ayrıntılı olarak tartışmaktadır. (Cohen&Zinaich, 2013: 190). Felsefi düşünce ve yaşam bilgeliği felsefe tarihinde bir takım yöntemlerle uygulama alanı bulmuştur. Bu yöntemleri değerlendiren Raabe, sağaltım için psikoloji ve psikiyatriden yararlanarak yeni yöntemler üzerinde durur. (Raabe, 2001:156). Felsefi danışmanlık ve terapinin çağdaş yöntemleri üzerinde Raabe den başka yeni öneriler getiren Lahav ı da anmak gerekir. (Lahav, 2016: 57). Weiss bu noktada Sokratik metodu önerir. Modern çağın zihinsel ve ruhsal sorunlarıyla baş etmek için Antik çağdan bu yana Sokratik metodun kullanıldığını ve bu gün de işlevsel olabileceğini belirtir. (Weiss, 2015: 109). Raabe, zihinsel hastalıkların iyileştirilmesinde felsefenin etkili bir yöntem olabileceğini öne sürer. (Raabe, 2013:45). Bilinçaltı kavramına felsefe, klinik psikoloji ve kişisel zihinsel sağlık açılarından yaklaşarak bilinçaltının felsefi sağaltımcılar tarafından göz ardı edilmemesi, psikoloji ile olan köklü geçmişinden yararlanmaları gerektiğini vurgular. (Raabe, 2006: 129). Felsefi sağaltımda en kafa karıştırıcı sorular, muhatabın varoluşsal sorunlarını anlamak açısından gereklidir. (Raabe, 2002: 77). Felsefe bütün alanları içine aldığına göre felsefi psikoloji ve psikiyatrinin geçmişin ve geleceğinden habersiz olması düşünülemez. Tıbben hasta olan veya hastalık olarak tanılanan kişi ve durumlar dışındaki normal bütün insanların ortak oldukları varoluşsal yaşam sürecini sağlıklı acı diye kavramlaştıran Zhang Lizeng (Lizeng, 2013:1122),bu acıyı varoluşsal bir düş kırıklığı olarak açıklar. Anlam yitimi, varoluşsal bir boşluğa neden olur. Bu ise uyuşukluk, can sıkıntısı ve ilgisizliğin resmidir. Bu durum kalıcı olursa, evrensel bir insan tecrübesinde varoluşsal düş kırıklığını çoğaltabilir. Varoluşsal düş kırıklığı yine de anlam verme iradesinin çöküşünü resmeden başka bir ifadedir. Böyle bir varoluşsal boşluğu, varoluşsal düş kırıklığını veya bunların altında yatan anlamsızlık hissinin ayırtına varmadıkça saldırganlık, bağımlılık, depresyon ve intihar eğilimi tam olarak anlaşılmaz. XX. yüzyılda psikoloji, metodolojisindeki ciddi çelişkilere karşın insanlığın sorunlarını çözmede ayrıcalıklı bir yere sahip olmuştur. Lahav ve Tillmans a göre psikolojik terapiler felsefi sağaltımdan oldukça farklıdır. Ancak bunları birbirinden ayırmak zor bir iş olmaktadır. Bu ayırım henüz bütünüyle başarılmış değildir. Lydia Amir e göre felsefi uygulama mutlaka psikoloji veya psikologlara karşı değildir. Felsefi uygulayıcılar genellikle psikoterapiye öykünmektedirler. Felsefi sağaltım disiplinler arası bir bakış açısı gerektirmektedir. (Lizeng, 2013: ).

42 Öyleyse felsefi sağaltım psikoloji ve psikiyatri ile sürekli işbirliği içinde olmalıdır. Bu da, her iki bilimsel alanın felsefi yaşam kuramları ve eylemlerinden yararlanmasına bağlıdır. Yaşamın ve Davranışın Öznesi Olarak İnsan Felsefe insanı türdeş doğası olan, özüyle tanımlanan ve iyi ya da kötü diye nitelendirilemeyen bir varlık olarak görür. Önceden tanımlanamaz, öz ya da varoluşu kesin yargılarla belirlenemez karmaşık bir varlıktır. Her bilim insanı kendi açısından tanımlar. Bu bir bilimsel zorunluluktur. Ancak bu zorunluluk felsefenin insan görüşü için geçerli değildir. İnsanı bilebilmek için, onun yaşam ve davranışını anlatmaktan başka yol yoktur. İnsanın bir doğası, yalın ve türdeş bir doğası yoktur. O var olanla var olmayanın garip bir karşımıdır. İnsanın yeri, bu iki karşıt kutup arasındadır. İnsanın göze çarpan karakteri, ayırıcı göstergesi, metafizik doğası olmayıp yaptığı iştir. İnsanlık halkasını tanımlayıp belirleyen bu iş, insan etkinliklerinin bir dizgesidir. Dil, söylence, din, sanat, bilim, tarih bu halkanın öğeleri ve çeşitli dilimleridirler. Bu nedenle bir insan felsefesi, bu insansal etkinliklerin temel yapısını kavramamıza ve aynı zamanda onları bir bütün olarak anlamamıza yardımcı olan bir felsefedir. ( Cassirer, 1980:170 vd.). Kant insanı doğal varlık ve akıl varlığı olarak ikiye ayırır. Bu ikili sınıflamayı Max Scheler gidermeye çalıştıysa da tam olarak başarılı değildir. Ne ki her ikisi için de insan bütüncül bir varlıktır. İkili ayrım, onun varlık bütünlüğüne parçalayıcı ontik bir tutumun eseri değildir. İnsanın doğal varlığını (aposteriori), otonom varlığını (apriori) bilgi, aynı biçimde insanın görünüşü olan doğal yanını eğilimler, otonom varlığını da özgürlük, kişilik ve ahlak yasası karşılar. Doğal varlıkla akıl varlığının birleşmesi olan insan, hayvan gibi, her şeyi doğuştan getirmeyen bir varlıktır; o yalnız bir imkânlar dünyasıdır. Bu imkânların gerçekleşmesi ya da gerçekleşmemesi, insanın kendisine düşen bir iştir. Doğa insana akıl ve akla dayanan isteme özgürlüğünü verdiği için, onun donatışındaki niyeti açığa vuruyor. Artık insan, içgüdünün iradesine bırakılmayan, doğal ve doğuştan bir bilgi ile donatılmayan, aksine her şeyi kendisi yapan bir varlıktır. Kant ın şu sözü de bu görüşü onaylamaktadır: insan birçok yoksunlukları kendinde toplayan bir varlıktır. (Mengüşoğlu, 2014: 113). İnsan, bir varlık tarzı olarak bilgeliği aramaya koyulmak için, ilkin kuramı eyleme dönüştürmek zorundadır. Çünkü insan bir eylem ve davranış varlığıdır. Felsefe ve buna bağlı olan sağaltım da bilgece bir yaşam için, günlük pratiklerden yola çıkar. İnsan, her gün yaşayan bir varlık olabilmek için, sürekli bir eylem öznesi olmakla yüz yüzedir. Bunun için de, her gününü-ister istemezanlamlı kılarak yaşamını sürdürmeye yazgılıdır.

43 Rollo May in kaydettiği gibi (May, 2013: 158) endişe dönemindeyiz. İçimizde bir dayanak noktası bulmak zorundayız. Beğenilmemek, dışlanmak ve onaylanmamak modern çağın korkunç yüzlerini anlatır. Günümüz insanı başkalarının onayına bağımlı hale gelmiştir. Boşluk duygusu hayatta etkili bir şey yapmaktan aciz olmamıza yol açmaktadır. Oysa felsefi sağaltım yoluyla öz farkındalığa ulaşarak kaygıyı yok edebiliriz. Bununla birlikte endişe, doğanın bize, görmemiz gereken bir sorun olduğunu gösterme yöntemidir. Her olumsuz şeyden aynı güçte olumlu bir şey çıkarmak mümkündür. Modern çağımızla Ortaçağ arasında şöyle bir fark vardır: Ortaçağda ve Rönesans ta toplum bireyleşirken modern çağda birey toplumlaşmaktadır. Modern dönemde akıl ile duygular birbirinden koparıldı. Rönesans taki birey, kendinden birey, Modern birey, başkası nedeniyle bireydir. Modern dönemde insanın felsefi yolla sağaltılıp hayatını anlamlanlandırmak, iki türlü mümkündür: İlki, bilişsel erdemdir. Bilişsel erdem kendimizi ve dünyamızı anlamanın yeni yollarına açık olmak demektir. İkincisi ise, pratik erdemdir. İçtenlik, sabır, acıma ve adaleti daha geniş açıdan görebilmektir. Sokratik felsefi sağaltma tarzı bu yöntemin ilk örneği sayılabilir. Sokrates in diyalektik metodu, sistematik soru sorma, indüktif us yürütme ve evrensel tanımlamalar yapmak şeklinde, üç yönlüdür. Diyalektik metot, felsefi sağaltım için başlıca yönlendirme aracı olarak kullanılabilir. Yanlış kullanılırsa muhatabın inanç dünyasını çökertebilir. Felsefi sağaltımda sürekli bir kendini hesaba çekme ve bu dünyadaki varlığını yeniden yorumlama esaslarına dayanır.(walsh, 2005: ). Stoacılık, Epikürcülük ve Sinizm tarihte sükûneti ve kendinden memnun zihinsel durumu daha derinlemesine anlamamızı sağlamıştır. Autarkeia (kendine yeterlik, kendine güven), duyguları rahatsız etmeden zihni sakinliğe iletmektir. (Tukiainen, 2010: 48-57). Özellikle Epikür etiği bu gün felsefi sağaltıma uygun felsefi bir hayatın ilk örneğidir. Modern sağaltımın ilkelerinin pratik ve kapsamlı yalın bir sistemidir (Fatic, 2013: ). Antikçağ daki Sokratik felsefi sağaltım geleneği bu gün yeniden canlanmaktadır. Felsefi Sağaltım ve Sağlıklı Acı Felsefe tarihi boyunca her kültür ve dinden bütün filozoflar, ister sistemsiz isterse sistematik görüşler ortaya koysunlar, hemen hepsinin görüşleri insan varoluşunun bu dünyadaki anlamı üzerine sağaltıcı niteliktedir. Felsefeyle sağaltımın tarihi Antikçağ dan başlatılabilir ve hatta bu çağ, sağaltım için bu gün en geçerli örnek olarak kabul edilmektedir. Felsefe, bilgece ve erdemli bir yaşam biçimi olarak tıpkı antikçağda olduğu gibi bu gün yeniden sağaltıcı gücüyle dikkatleri üzerine çekmiştir.

44 Felsefi sağaltım, psikoloji ve psikiyatrinin bir alternatifi değil, onlarla işbirliği yapmasına gittikçe daha çok gereksinim duyulan bir iyileştirme yöntemidir. Psikoloji ve psikiyatrinin hasta ve hastalığı, felsefi sağaltımın konusu ve etkili olacağı şeyler değildir. Ancak, sağlıklı acı her insan için geçerlidir. Hasta veya hastalık ortaya çıkmadan önce felsefe etkili olmalıdır. Felsefi sağaltım hasta tedavi etmez ama insan varoluşunu tıbbi hastalıklara sürükleyen zihinsel, ruhsal ve hatta bedensel sağaltımı, hayat boyu uygulama alanına taşır. Başka bir ifadeyle, felsefi sağaltım, hasta olmayanların sağaltılması ve hastalığa düşmelerinin engellenmesi için bütün felsefi birikimi seferber eder. Felsefeye göre, örneğin mantık ilkelerini bilmeyen zihin, mantıksal açıdan hastadır. Usun ilkelere göre düşünmesi, mantıksal acıyı ortadan kaldırır. Başka bir örnek: herhangi bir alanla ilgili bilmesi gerekeni bilmeyen bir insan, bilgisizlik hastasıdır. Araba kullanmayı bilmeyenin sürücü koltuğunda oturması, belki tıbben hasta olduğunu göstermez ama tıbbın çok ötesinde beklenmeyen pek çok acıyı hem de sağlıklı iken muhtemel acıyı beraberinde getirebilir. Çaresi, sürücünün gerekli kuralları öğrenmesidir. Örnekleri çoğaltabiliriz. Felsefi sağaltım, tıbben hasta olmayan çoğunluk için zihinsel ve ruhsal acıları dindirmenin yöntem ve ilkelerini belirmek ve uygulamanın yollarını aramaktır. Felsefi sağaltımın hasta sı, normal çoğunluktur ve ortalama insan ömrünün pek büyük bir kısmı, tabiplerle değil, filozoflarla geçecek bir sağlıklı acıyı içerir. Başka bir deyişle, insan ömründe tıbba pek doğaldır ki mecbur ve muhtaçtır. Ancak bu zorunluluk, insan ömrünün az bir kısmını işgal eder. Oysa hayatın geri kalan azami kısmı, aklın, bedenin, ruhun ve zihnin sağlıklı acılarının her alanda sağaltılmasına muhtaçtır. Bilgi, varlık, ahlak, sanat, siyaset, din, kültür ve genel olarak her türlü beşeri olgu ve olaylar, işte bu sağlıklı acının felsefi sağaltımı yoluyla terbiye edilir; düzene sokulur. Örneğin ölüm korkusu, başka denildiğinde, ölüm travması, bütün insanlar için geçerlidir. Ölüm kaygısını insani varoluşun normal düzleminde hisseden herkesi tıbben hasta saymak mümkün olmadığına göre, ölüm korkusunu normal olarak hisseden herhangi biri için tıbbın yapabileceği bir şey yoktur. Buna karşılık felsefi sağaltım, hasta tedavi etmez, tanı koymaz, ilaç vermez. Ama hasta olmayan insanları, bilimin hastaları na dönüşmemeleri için önceden ve ölünceye dek, varoluşsal sağaltıma tabi tutar. Hastalık sınırına daha az insanın sürüklenmesini sağlamak felsefenin görevidir. Sağlıklı acı ya da acılar, psikoloji ve psikiyatrinin sınırlarına kadar dayanıp zorlamadığı sürece, felsefi sağaltımın alanı içindedir. Varoluşun her travmasına diğer sağlıklı acı çeken türdeşleri ile maruz kalan insanlığın büyük çoğunluğu, belki tıbbın değil ama felsefi sağaltımın adayıdır. Felsefi sağaltım ile anılan iki ve daha fazla bilimlerin ilişkisi bu gün yeniden tartışılmalıdır. Hatta felsefenin din, kültür ve modern mitlerle ilişkisi bile yeniden kurulmak zorundadır. Çünkü Modern çağın yarattığı sorunlar, hiçbir bilimin tek başına çözebileceği yalınlıkta değildir.

45 Karmaşık, dolambaçlı, çok nedenli, çok uyaranlı ve kronikleşmiştir. Tam da Modern yaşam biçiminin dayattığı bu karmaşık-sağlıklı acıyı, yine felsefenin bütün bilimlerle yeniden kuracağı karmaşık ve çok disiplinli yöntemle sağaltması lazımdır. Felsefi sağaltım, psikiyatri ve psikoterapiyi çağımızda tahtından indirmeye değil, tarihsel süreç içinde bunlarla kopan bağını yeniden kurmak için bu gün sıklıkla gündeme gelmektedir. Hakkında yapılan çalışmalar, araştırmalar ve tartışmalar yoğunlaştıkça ve yaratacağı olumlu etkiler yaygınlaştıkça felsefi sağaltım, tıbbi hastalığı azaltacak, daha çok sağlıklı acı yı yaratacaktır. Bedenin hastalığı, tıbbın müdahalaesiyle iyileştirilirken, ruhun ve zihnin hastalığı, felsefeyle sağaltım yoluyla iyileştirilebilir. Her iki yolla elde edilen tedavi, insanın mutluluğa ulaşmasını sağlamaktır. Mutluluk iyi-kötü ayırımı yapabilme ve özgürlük gibi temel iki etik kavramın pratikte gerçekleşmesiyle elde edilebildiğine göre, insanın insanlıkla tedavisi, etiğin modern zamanlar için vazgeçilemez bir pradigma olmasına bağlıdır. Felsefi sağaltım, kuram-eylem bütünlüğü olarak uygulamalı etik adını böyle bir paradigma olmasından dolayı almaktadır. Kaynakça A.Rubin, J. (2010). Introduction to Art Theraphy. NY: Routledge. Aristoteles (2015). Politika (Çev. F. Akderin). İstanbul: Say. Becker, E. (2013). Ölümü İnkar (Çev. A. Tüfekçi). İstanbul: İz. Borgna, E. (2015). Ruhun Yalnızlığı (Çev. M.M. Çilingiroğlu). İstanbul: YKY Borgna, E. (2015). Ruhun Yalnızlığı, İstanbul: YKY. Büyükdüvenci, S. (2001). Varoluşçuluk ve Eğitim. İstanbul: Siyasal. Cassirer, E. (1980). İnsan Üstüne Bir Deneme, İstanbul: Remzi Kitabevi. Cassirer, E. (1980). İnsan üstüne bir deneme. Çev. Necla Arat. İstanbul: Remzi Kitabevi Cassirer, E. (1997) İnsan Üstüne Bir Deneme (Çev. N. Arat). İstanbul:YKY. Cohen, E.D.&Zinaich, S. (Philosophy, Counseling and Psychotherapy, UK: Cambridge Scholars Publishing. Cohen, E.D. (2003). What Would Aristotle Do? Self-Control Through the Power of Reason, New York: Prometheus Books.

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49 HEMŞİRELİK ETİĞİNİN TARİHSEL GELİŞİMİ Prof. Dr. Mağfiret KARA KAŞIKÇI 1 1 Atatürk University, Faculty of Nursing Hemşirelik kendini bir sanat, uygulamalı bir disiplin ve profesyon olarak tanımlamaktadır. Aynı zamanda bir gelenek olan hemşireliğin tarihi orijini, fikirleri ve inançlarından kaynaklanan geleneğinden oluşur. Sağlık bakımında üstlendiği rollerle toplumun optimal sağlık bakımının sağlanmasını hedefleyen hemşirelik hastalık nedeniyle adapte olma çabasındaki bireye baş etme yetenekleri ve stratejileri, bireyselleşmiş bakım, konfor, yaşam şekli değişimi, fiziksel, psikolojik ve sosyal iyiliğe yönelik davranışların yeniden sağlanması, hastalığın önlenmesi ve iyileşmesi için gerekli çevrenin oluşturulmasını sağlar. Literatürde hemşireliğin ahlaki bileşenlerinin tanımlanması konusunda üstlenilmesi gereken görevin ihmal edildiği izlenmektedir. Hemşireliğin ahlaki tanımlarına ilişkin çalışmaların azlığının yanı sıra; kürtaj, ötenazi, yaşam sonu bakım, hasta hakları, hastanın tedaviyi reddi, insan üzerinde yapılan tıbbi araştırmalar gibi biyoetik alanına giren konulara ilginin arttığının tespiti dikkat çekicidir. Oysa biyoetik konuları medikal perspektiflidir ve çoğu durumda hemşirelik ve hemşirelik uygulamalarıyla ilgisinin olmadığı görülmektedir. Literatürde hemşirelik etiğinin biyoetik içerikli değil sosyal içerikli olması gereği savunulmaktadır. Hemşirelik grubunun tarihi ve geleneğine dayanan hemşirelik tarihinin desteklenen bir profesyon, kadın hakimiyeti, evlenmemiş kadınlar, şiddetli sosyal savunuculuk, kadın ve hemşirelik eğitimine başkaldırı, hemşireliğin gelişimine hekim engeli ve kadınların yasal yoksunlukları gibi özellikler gösterdiği izlenmektedir. Bugün hemşirelik etiğinin medikal perspektifli olan bioyetik yerine hemşireliğin tarihiyle, literatür ve teorisiyle elemlendirilmesi; hemşireliğin hizmet ideali, sosyal etik ve sosyal adalet konuları kapsamında irdelenmesi gereği vardır.

50 ROLE OF NURSING ETHICS IN PATIENTS CARE Prof. Dr. Leyla Dinç 1 1 /Hacettepe University, Faculty of Nursing Caring is a basic and universal need for every living beings. For human beings, Daniel Engster (2005) defines caring as everything we do to help individuals to meet their vital biological needs, develop or maintain their basic capabilities, and avoid or alleviate unnecessary or unwanted pain and suffering, so that they can survive, develop, and function in society. As it is explicit in this definition, caring is both an essential aspect of human existence and a moral responsibility of everyone towards each other. Patient care is providing help to meet the caring needs of individuals who have any health disorder, disease or illness by health care professionals such as physicians, dentists, nurses, midwives, physical therapists, dietetics, technicians etc. within their own scope of practice. Although patient care is among the responsibilities of all health care professionals, caring is unique to nursing and it is the primer responsibility of nurses. In order to discuss the role of nursing ethics in patient care, it is important to overview main factors that influence the current health care and ethical problems. Major factors that influence health care are demographic changes and free market economy politics in line with the globalisation. The ageing of populations due to the increase in average life expectancy has led to an increase of chronic diseases and more complicated health problems, which in turn increased the demand for health care. In addition, the epidemics of infectious diseases such as AIDS, SARS and Bird flu, social isolation and loneliness within plurality of social networks on internet, traffic accidents, and natural disasters that are getting worse due to global warming have also increased the demand for care. In contrast, the number of nurses who are primary responsible for providing care has sharply declined while their average age has increased. According to the International Council of Nurses, the average age of employed nurses in developed countries is years (ICN, 2002). In the United Kingdom, one in five nurses is aged 50 or older and nearly half are over 40 (Dubois, McKee, Nolte, 2006; UKCC, 1998; Finlayson ve ark. 2002). Another demographic change that has impact on the health care is the gender factor. Most of the care providers depends on labour force participation by woman and they are more likely to take career breaks due the traditional role of the mother as the dominant carer in the family, which also includes pregnancy and childbirth. This in turn, results in critical shortage of qualified nurses, who are already scarce in number around the world. Developed countries prefer to match supply with nurse s assistants or young migrant nurses from poor

51 countries, while developing countries try to replace the nursing workforce with less educated, unskilled and cheaper labour. However, in line with the globalisation, which refers to free transfer and diffusion of capital, goods, and services across national frontiers, the international agreements designed to reduce barriers to trade liberalization have provided new legal frameworks for international movements of health professionals (Dubois, McKee, Nolte, 2006). In Europe, for example, the development of common educational standards, harmonization of mutual recognition of qualifications between countries are prerequisites for establishing effective regional markets. This resulted with the Bologna process, which aims to introduce a more comparable, compatible and coherent system for European higher education and member countries established their qualifications frameworks (YÖK, Bologna Süreci). From the point of patient care, this means that care providers, majority of which are nurses have to complete higher education to meet the professional qualification. For nursing, The Directive 2005/36/EC of the European Parliament and of the European Council of 7 September, 2005 on the recognition of professional qualifications requires nurses training to comprise at least three years of study or hours of theoretical and clinical training. It seems that on one hand, international agreements require qualified workforce for patient care, but on the other hand, market-driven conditions place pressure on supplying the demand for care with unqualified and cheaper workforce. This contradictory situation related to nurses professional qualifications will have impact on the quality of patient care and has the potential to increase medical errors, which can be serious for patient safety. However, patient care is provided within complex health care systems composed by financing and rendering of services, relevant regulations and health policies. Todays health care systems are increasingly with sophisticated scientific and biotechnological development in areas such as surgery, imaging, transplantation, oncology and genetics; information and managing systems to coordinate financing, human resources and services with a special focus on competitiveness, cost-containment and efficiency (Dubois, McKee, Nolte, 2006; T.C. Sağlık Bakanlığı, 2011; Institute of Medicine and National Academy of Engineering, 2011). The increase and diversity of occupations, specialization and expertise in the field of health care enhance the accurate and affective diagnosis, treatment and care process, while expanding the roles of nurses e.g. diabetic nursing, dialysis nursing. Literature indicate that nurses are quite successful in performing their expanded roles. For instance, a review on nurses partial substitution for physicians in the management of diabetes concluded that nurses control the level of blood glucose better than physicians (Renders ve ark., 2001). Other studies suggest that nurse practitioners in British emergency departments are as much skilled as junior doctors in interpreting radiographs (Meek et al., 1998) or better document treatment and achieve higher

52 level of patient satisfaction (Cooper, et al. 2002). However, the specializations and increase of various occupations in health care also contribute to the complexity of the system by hindering the continuity, timing and holistic health care service. Patients might feel lost within the system while running from one department or expert to another in different times and settings within the same health care institution. In such complex systems and organizations critical decision making over life and death and ethical challenges are inevitable. Some of ethical problems encountered at health care organizations arise from unethical attitudes of health care professionals. These may include delay in patients treatment due to late decisions regarding admissions to hospital or intensive care units, informed consent issues about procedural interventions, disclosing information about the patient's case to others without permission, not respecting a patient s dignity and privacy, insisting on treatment despite a competent patient s refusal, and performing unnecessary painful procedures on a patient. Compounding these issues are communication problems and conflicts between health care staff arising from uncertainty and confusion on tasks, duties, and responsibilities, autocratic leadership and management, providing greater access and attention or allocating resources to very important persons (VIP), conflicts of interest due to promotions from pharmaceutical, medical device and equipment manufacturers (Megan, 2010; Fowler & Davis, 2013). The importance of ethical problems for patient care is that they can violate patients rights, autonomy or may induce direct or indirectly harm. However, the aim of health care is the prevention, diagnosis and treatment of disease, or the promotion, maintenance and restoration of health. What is the role of nursing ethics in patient care? It is almost impossible to control the demographic, global, social, economic and political factors that have impact on health care. However, it is vital to be cognisant how these factors affect the profession of nursing, education level of nurses and the quality of patient care because nursing is not isolated in a vacuum and ethical care is not limited to nurse-patient relationship. Yet, the nurse-patient relationship is essential to the delivery of care. The caring relationship is an asymmetric relationship because of the powerful position of caregiver that stems from the professional knowledge, skills and authority, whereas the care receiver (patient) lacks the necessary power to care himself or herself and is vulnerable to the goodwill of the caregiver. Despite of the power imbalances between caregivers and those who need care, caring relationship is also a trusting relationship because patients entrust their health to care providers with the expectation that will receive good care without any harm. Therefore, not betraying trust of

53 patients and avoiding from harm are cornerstones of caring relationship. In other words, to rely upon the principle of non-maleficence, nurses should achieve higher levels of education and continuously update their knowledge and skills, maintain competence in practice and provide evidence-based nursing care, and be able to use biomedical, information and genetic technology without disregarding the humanistic aspects and on behalf of the benefit of patients. Moreover, to ensure patient safety, they have to assess and identify risks, avoid medication errors and prevent harm by considering the safety indicators such as falls, nosocomial infections, pressure ulcers etc. (Ballard, 2003; Montalvo, 2007; Huston, 2013). In addition, good care requires effective communication and empathy to understand patients who may have different personalities and cultural background, values and expectations. The preamble of the ICN Code of Ethics for Nurses states that respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect is inherent in nursing. Nursing is unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status (ICN, 2012). Thus, nurses must respect to human dignity and patients rights without any discrimination, should obtain patients informed consent for nursing interventions, and advocate for their patients, particularly for those who are vulnerable and have limited capacity for decision-making or unable to protect themselves e.g. infants, children, disabled, unconscious and debilitated patients (Cook, 2014; Tomaschewski-Barlem et.al, 2015). Taken together, good nursing care is an essential component and outcome of professional and ethical nursing. From this point of view, the question whether nursing ethics, -a sub-discipline of bioethics- contribute to patient care or not, should be discussed within the context of macrodynamic factors and conditions that influence health care. However, as the largest part of health care professionals and those who have the closer and longer interactions with patients, nurses should embrace professional values and ethics that provide the philosophical framework for nursing ethics by considering not only how they are providing care within the complex health care systems, but also what they ought to do for ethical practice. REFERENCES Ballard, K. "Patient Safety: A Shared Responsibility". OJIN: The Online Journal of Issues in Nursing, 2003; 8 (3): Manuscript 4. Retrieved from:

54 fcontents/volume82003/no3sept2003/patientsafety.aspx. Accessed: Cook, W.E. Sign here:" Nursing value and the process of informed consent. Plastic Surgical Nursing, 2014; 34(1), Cooper, M.A. et al. Evaluating emergency nurse practitioner services: a randomized controlled trial. Journal of Advanced Nursing, 2002; 40: Dubois, C.A.; McKee, M., Nolte, E. (Ed.). Human Resources for Health in Europe. The European Observatory on Health Systems and Policies Series. World Health Organization, Engster D. Rethinking Care Theory: The Practice of Caring and the Obligation to Care. Hypatia, 2005; 20(3): Finlayson, B. et.al. Mind the gap: the extent of the NHS nursing shortage. British Medical Journal 2002; 325: Fowler MD, Davis AJ. Ethical issues occurring within nursing education. Nursing Ethics, 2013;20(2): Huston, C. The Impact of Emerging Technology on Nursing Care: Warp Speed Ahead. OJIN: The Online Journal of Issues in Nursing 2013; 18 (2), Manuscript 1. Institute of Medicine (US) and National Academy of Engineering (US) Roundtable on Value & Science-Driven Health Care. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary. Washington (DC): National Academies Press (US); , Healthcare System Complexities, Impediments, and Failures. Retrieved from: Accessed: International Council of Nurses (ICN). (2012). The ICN code of ethics for nurses. Retrieved from Accessed: International Council of Nurses. Overview paper. ICN Workforce Forum, 2002; Reykjavik. Megan J.J. Registered and enrolled nurses experiences of ethical issues in nursing practice, Australian Journal Of Advanced Nursing, 2010; 22(1), Meek, S. et al. Can accident and emergency nurse practitioners interpret radiographs? A multicentre study. Emergency Medical Journal, 1998; 15:105-7.

55 Montalvo, I. The National Database of Nursing Quality IndicatorsTM (NDNQI ). OJIN: The Online Journal of Issues in Nursing, 2007; 12 (3): Manuscript 2. Renders, CM. et al. Interventions to improve the management of diabetes in primary care, outpatient, and community settings: a systematic review. Diabetes Care 2001;24: Tomaschewski-Barlem, J.G., Lunardi, V.L., Barlem, E.L.D., Ramos, A.M., Figueira, A.B., & Fornari, N.C. Nursing beliefs and actions in exercising patient advocacy in a hospital context. Rev Esc Enferm USP, 2015; 49(5), Türkiye Cumhuriyeti Sağlık Bakanlığı Refik Saydam Hıfzıssıhha Merkezi Başkanlığı Hıfzıssıhha Mektebi Müdürlüğü. Avrupa da Sağlıkta İnsan Kaynakları. Çeviri Baş editörü: Prof. Dr. Recep Akdağ; Çeviri Editörleri: Salih Mollahaliloğlu, Hasan Gökhun Öncül, Elif İşlek. Başak Matbaacılık Tanıtım Hizmetleri İthalat İhracat Tic. Ltd. Şti. Ankara, United Kingdom Central Council for Nursing Midwifery and Health Visiting. Annual Report. 1998; London, UKMCC. Yükseköğretim Kurulu. Uluslararası İlişkiler Birimi. Bologna Süreci. Retrieved from: Accessed:

56 RESPONSIBILITIES AND ETHICAL APPROACHES OF THE NURSES IN MEDICINE MANAGEMENT Prof. Dr. Ülkü GÜNEŞ 1 1 /Ege University, Faculty of Nursing Medicines management involves the safe and cost-effective use of medicines in clinical practice, with maximum patient benefits while minimizing potential harm. Medication administration is one of the most time consuming nursing duties, accounting for 40% of a nurse's workload. The management of medicines is one of the essential roles of nurses, which requires attention to detail and safety. Although this is a multidisciplinary task, last control responsibility belongs to the nurse before the medication reaches to the patient. Medication administration and management is one of the most risky applications. Because medication errors in hospitals is one of the most common causes of preventable death and diseases. A medication error is 'a failure in the treatment process that leads to, or has the potential to lead to, harm to the patient'. 38% of medication errors are serious or fatal, and 42% of those are preventable. Medicine management involves more than the administration of drugs to the patient. According to the National Patient Safety Foundation, nurses act as patient advocacy during this process, provide relevant information and support to the patient. Therefore, nurses are responsible for informing to the patient about effect and side effects of the drugs. While providing this information needed for the patient, the nurses use professional knowledge and skills. In this process, all information should be shared in a language that the patient can understand. Collaborative study is of great importance for good practice in medicine management. In recent years, along with developments in clinical risk management in health care, drug management has become more important. First, the nurses must have knowledge and understand about the medication that use for their patient. The most important responsibility of the nurses during this process is to update their drug knowledge. Nursing care must be based on the best evidence. While administering medicine, nursing decisions and drug administration techniques should be based on valid and reliable evidence. Legal responsibilities of the nurses for require that nurses must adhere to 10 rights of medication administration. Ethical principles that should be adhered to by every nurses during medication management is of great importance, such as not to harm to the patient due to the inexperience and carelessness, provide patient safety, know side effects of the drugs and take precautions, respect to dignity of the patients, respect to the right to refuse medication, take informed consent before drug

57 administration, education to patient and family about drugs and join to activities to maintain of their professional competence. İLAÇ YÖNETİMİNDE HEMŞİRENİN SORUMLULUKLARI VE ETİK YAKLAŞIMLARI İlaç yönetimi hastanın ihtiyacı olan maksimum etkinin sağlanabilmesi için ilaçların güvenli ve maliyet etkin olarak kullanılması olarak tanımlanmaktadır. İlaç uygulamaları hemşirenin iş yükünün yaklaşık %40 ını oluşturan ve en çok zaman alan uygulamalardan biridir. İlaç uygulamalarında ve yönetiminde güvenli uygulama hemşirenin en temel rollerinden biridir. İlaç uygulamaları multidisipliner bir görev olmasına karşın, ilacın hastaya ulaşmasından önce son kontrol sorumluluğu hemşireye aittir. İlacın uygulanması ve yönetimi en çok risk içeren uygulamalardan biridir. Çünkü ilaç hataları hastanelerde hastalıkların ve önlenebilir ölümlerin en sık nedenlerinden biridir. İlaç hatası hastaya zarar veren veya zarar verme potansiyeli olan ilaç tedavi sürecindeki başarısızlık olarak tanımlanmaktadır. İlaç hatalarının %38 inin ciddi sonuçları olan veya ölümcül, %42 sinin ise önlenebilir hatalar olduğu saptanmıştır. İlaç yönetimi hastaya ilaç uygulamaktan daha fazlasını içerir. Ulusal hasta güvenliği Kurumuna göre bu süreçte hemşirenin görevi bakım verdiği hastasının savunuculuğu yapması, ilgili bilgiyi sağlaması ve desteklemesidir. Bu yüzden hemşire hastasının kullandığı ilacın etkileri ve yan etkileri hakkında hastasını bilgilendirmekle sorumludur. Hemşire bu ihtiyaç duyulan bilgiyi sağlarken profesyonel bilgi ve becerisini kullanır. Bu süreç içerisinde her bilgi hastanın anlayabileceği bir dilde paylaşılmalıdır. İlaç yönetiminde iyi uygulama için kolloboratif çalışma büyük önem taşımakta ve son yıllarda sağlık bakımında klinik risk yönetimindeki gelişmelerle birlikte daha önemli hale gelmiştir. Öncelikle hemşire hastasının kullandığı ilaçları anlamalı ve bilgi sahibi olmalıdır. İlaç uygulama sürecinde hemşirenin en önemli sorumluluğu ilaç bilgisini güncellemektir. Bakımı uygularken mevcut en iyi kanıt üzerine temellendirmesi gerekir. İlacı uygularken hemşire kararlarını ve ilaç uygulama tekniğini geçerli ve güvenilir bir kanıta dayandırmalıdır. İlaç uygulamasında hemşirenin yasal sorumluluğu ilaçların güvenli bir şekilde uygulanmasını ve 10 doğru ilkeye dikkat edilmesini gerektirir. İlaç yönetimi sürecinde hemşirenin etik olarak hastaya deneyimsizlik ve dikkatsizlik nedeniyle zarar vermemesi, hasta güvenliğini koruması, ilaçların yan etkilerini bilmesi ve önlem alması, insan onuru ve özerkliğine saygı duyması, hastanın ilacı reddetme hakkına saygı duyması, ilaç

58 uygulamasından önce bilgilendirilmiş onam alması, hasta ve hasta yakınlarını ilaç hakkında eğitmesi ve mesleki yeterliliğini sürdürebilmesi için aktivitelere katılması büyük önem taşımaktadır.

59 ETHICAL PROBLEMS IN SURGICAL NURSING PRACTICES Doç. Dr. Türkan ÖZBAYIR 1 1/Ege University, Faculty of Nursing Nursing care is intertwined with the level of scientific knowledge and constantly renewed developments in technology. However, the benefits of technology in health care often involve serious dilemmas, both in terms of professionals and patients. Changing technologies, sharing of resources, patient rights and the changing role of the nurse can lead to ethical problems that nurses may encounter in the working environment. Today, it is expected that nurses will be able to quickly and accurately identify ethical issues in the perioperative practice areas and act to protect patient rights. Universal ethical principles guide nurses in solving ethical problems. These universal ethical principles are; autonomy, benefit, do not harm, justice, honesty, loyalty and trustworthiness. Perioperative nurses provide patient care within the framework of the nursing process. They use tools of the patient assesments, care planning, intervention, and evaluation of patients outcomes. Perioperative nurses use similar models when they make ethical decisions. These are: Identification of the problem, data collection, investigation of strategies, implementation of the strategy and evaluation of results. As a result; since there is no clear-cut ethical response, the perioperative nurse will continue to face ethical dilemmas and debate many issues. The important thing is the value and respect for autonomy and integrity in human life. In this talk, ethical problems in surgical nursing practice will be discussed in the light of ethical principles. Key Words: Ethics, Surgical (Perioperative) Nursing, Ethical problems REFERENCES 1. Churchill L R, The American Association for Thoracic Surgery 2016 ethics forum: Working virtues in surgical practice, J Thorac Cardiovasc Surg 2017;153:

60 2. Adedeji S, Sokol D K, Palser D, McKneally M, Ethics of Surgical Complications, World J Surg, 01 February Lachman V D Applying the Ethics of Care to Your Nursing Practice, MedSurg Nursing March-April 2012, Vol. 21/No Burkhardt M A, Nathaniel A K, (Ed), Çağdaş Hemşirelikte Etik, Ecevit Alpar Ş, Bahçecik Ş, Karabacak Ü (Çeviri Ed.) 1. Baskı, İstanbul Tıp Kitabevi, İstanbul, Erdemir Demirhan A, Oğuz Y, Elçioğlu Ö, Doğan H, (Ed) Klinik Etik, Klinik Uygulamalarda Etik Sorunlar, Nobel Tıp Kitabevleri, İstanbul, Karaöz S, Cerrahi Hemşireliği ve Etik, C.Ü. Hemşirelik Yüksekokulu Dergisi,2000,4 (1).

61 ÇOCUK SAĞLIĞI HEMŞİRELİK BAKIMINDA ETİK SORUNLAR Doç. Dr. Selmin ŞENOL 1 1/Ege University, Faculty of Nursing Ülkemizde çocuk sağlığı hemşireliği nin resmi anlamda tanımı, 8/3/2010 tarihli hemşirelik yönetmeliğinde yapılmıştır. Bu kapsamda çocuk sağlığı hemşiresi; evrensel çocuk hakları ve profesyonel hemşirelik 61oller doğrultusunda 0-18 yaş aralığındaki çocukların 61oller61 toplum içinde fiziksel, bilişsel, duyusal ve sosyal yönden sağlıklı büyüme ve gelişmesi, hastalıklardan korunması ve sağlığının yükseltilmesi, hastalandığında tedavisi, bakımı ve rehabilitasyonundan sorumlu hemşiredir ifadesi ile son derece geniş bir sorumluluk 61oller61 dikkat çekmektedir. Söz konusu yönetmelikte çocuk sağlığı hemşiresinin doğumdan başlayarak çocuğun 18 yaşına dek olan sürecinde gerek sağlıklı dönemlerinde gerekse hastalık halinde üstlenmiş olduğu görev, yetki ve sorumluluklar kuramsal boyutuyla maddelenmeye çalışılmıştır. Her bir madde çocuk sağlığının daha nitelikli bakım almasını hedefler. Bu nedenle çocuk sağlığı hemşiresinin 61oller arasında savunucu kimliği nin olması son derece önemlidir. Çünkü çocukluk; yaşamın ilk yıllarında tümüyle bağımlı, ilerleyen yıllarda bağımsızlaşma adımları ile büyüme gelişme süreci (fizyolojik, duygusal, bişsel, sosyal ve entelektüel-fidubisoen) devam eden bir dönemdir. Çocuk sağlığı hemşireliğin FiDuBiSoEn alanlarındaki yaklaşımlar, uygulamalar yetişkinden çok daha farklı bir bilgi, donanım, duyarlılık ve farkındalık gereksinimi yaratır. Tam da bu noktada, çocuk sağlığı hemşirelik bakımında ikilemlerin yaşanması, yaşamın içinden gerçek olgularda etik kuramların keskin/net çözümler sunmakta yetersiz kalması etik sorunlarla yüz yüze geldiğimiz zamanlardır. FiDuBiSoEn alanları olgunlaşma sürecinde (0-18 yaş) çocuk sağlığı hemşiresinin etik sorunlarda sağlıklı, etkin, çocuğun üstün yararına görüş ve uygulamalarında temel yol göstericilerin ilki etik ilkelerdir; yararlı ol, zarar verme, otonomi-özerkliğe duyarlı ol, adaletli ol, gizliliğe saygılı ol, gerçeği söyle-dürüst ol. Bir diğeri ise, Amerikan Hemşireler Birliği(ANA) nin 1976 yılında sunduğu profesyonel etik kodlardır. ANA etik kodları 1983 te çocuk sağlığı hemşireliğine uyarlanarak on bir madde üzerinden çocuk sağlığı hemşireliği yaklaşımları ve uygulamalarında çocukların üstün yararına hizmet etmesi hedeflenmiştir. Bu sunumda çocuk sağlığı hemşirelik bakımındaki etik sorunların, etik ilkeler, kodlar, çocuk hakları, bildirgeler ve son yasal gelişmeler ışığında ele alınarak, tartışılması ve farkındalık sürecine katkıda bulunması amaçlanmıştır. Anahtar sözcükler: Çocuk, Hemşirelik Bakımı, Etik

62 ETİK DUYARLILIKTAN ETİK EYLEME Prof. Dr. Nermin Ersoy 1 1 /Kocaeli University, Faculty of Medicine Kuzey İsveç te yapılan bir çalışmada hekim ve hemşirelere etik açıdan zor bir durumda kaldıklarında ne yaptıkları sorulmuş, cevap vicdanımıza bakıyoruz olmuş. Vicdan ın bazı eylemleri yasakladığını, bazı eylemleri emrettiğini kendimizden biliyoruz. Bir diğer çalışmada da etik açıdan zor bir durumda hemşirelerin kendilerini yetersiz ve suçlu hissettikleri öğrenilmiş. Suçluluk duygusu ya da yeterince iyi bir şey yapmadım hissi, bir durumun ahlaki yapısı hakkında farkındalığı göstermekle birlikte, durumun ahlaki ya da etik yapısı hakkında farkındalığı sağlayan etik / ahlak duyarlılığıdır. Başkalarının esenliğini, bütünlüğünü gözetmek anlamına da gelen duyarlılık, sorumluluğu da beraberinde getirmektedir. Toplum tarafından görevlendirilmiş olan profesyoneller, mesleki kuruluşları aracılığıyla kendilerinden hizmet ya da bakım alan kişilerin ihtiyaçlarının, ricalarının dikkate alınması, hatta haklarını onların yerine gözetmesi gerektiği inancıyla meslek etik kodlarını oluşturmuşlardır. Bu standartların ortak amacı profesyonelin mesleki uygulamalarına etik/ahlaki duyarlılıklarını yansıtabilmesi ve/veya bunun için etik/ahlaki duyarlılıklarının geliştirilmesidir. Etik duyarlılık kavramı birçok çalışmada ahlaki duyarlılık olarak da isimlendirilmiştir. Bu nedenle terimlerin eş anlamlı olduğunu savunanlarla birlikte, aralarında fark bulunduğunu ileri sürenler de bulunmaktadır. Örneğin Lutzen, etik duyarlılığı, verilen kararların iyiliğini ya da doğruluğunu tarifler ve mesleki kuruluşlar tarafından mesleğin değerleri ve/veya kodları ile davranış standartları haline gelir, diyerek etik duyarlılığı mesleki hüküm ve eylem kapsamında ele almaktadır. Ahlaki duyarlılık ise günlük yaşamdaki iyilikler ve doğruluklar ile ilgilenir, denmektedir. Oysa 1982 yılında Rest, etik ikilemleri yorumlama kapasitesi olarak ahlaki duyarlılık kavramını bilim dünyasıyla tanıştırmış, ancak mesleğin etik kodları ve davranışlarının mesleki uygulamalara yansıtılması esası üzerinde durulunca kavram etik duyarlılık olarak değiştirilmiştir. Etik Duyarlılık: Kendisi gerçeklikten ziyade gerçeklik için hesaba katılan sembol bir sözcüktür. Eylemlerin, sezgilerin, duyguların ve algıların davranışsal bir yönü olmakla birlikte etik duyarlılığa davranışsal bir kavram demek de güçtür. Literatürde davranışsal bir kavram olarak bakımın etik yönünü tanımlama becerisi, başkalarının rahatlığını ve esenliğini sağlama sezgisi gibi öğeleri bildirilmektedir. Kavramın profesyonellerin bakımları altındaki kişilerin acı çekmesini ve incinmesini önleme sorumluluğunu da kapsadığı ısrarla ileri sürülmektedir.

63 Etik duyarlılığı anlamak için kişiye kavram yüklemek yerine bilimsel bir kavram olarak işlevini ve rolünü düşünmesini sağlamanın daha yararlı olacağı da iddia edilmektedir. Örneğin hemşirelikte bakımın etik konularını belirlemek, tanımak ve çözüm üretmek gibi bir anlam taşımaktayken, eğitim de karar vermeden önce uygun etik konuyu tanımak etik duyarlılığın ölçütü kabul edilmektedir. Bilimsel bir kavram olarak etik duyarlılık; hekimliği, hemşireliği, diş hekimliğini, felsefeyi, işletmeyi, eğitimi, psikolojiyi, biyoetiği, hukuku, gazeteciliği, sosyal ve politik bilimleri kapsayan bir disiplindir. Lützen, duyarlılığı sezgiyle elde edilebilen, doğruluk ve fark edebilme yeteneğine rehberlik eden düşüncelilik diye de açıklarken, Rest, bir şey yapma ya da yapmama algısının başkalarının esenliğini dolaylı ya da dolaysız olarak etkileyebildiğinin farkına varılması olarak savunmaktadır. Bu bağlamda Rest, bazı mesleklere (diş hekimliği, hemşirelik, tıp, gazetecilik, muhasebe) özgü uygulamalar için etik duyarlılığın pozitif bir yönü ve zorunlu olduğunu ileri sürmektedir. Weaver, profesyoneller halkın ihtiyaçlarını fark etmeli, karar için gerçekleri bilmeli ve bakımı altındaki kişilere akıllıca ve şefkatle hizmet etmelidir, diyerek etik duyarlılık kapsamına şefkati dahil etmektedir. Fakat şefkat, sorumluluk sorununu ele almamakta veya etik yükümlülüklerimizi biçimlendirmemektedir. Buna karşın, hem ahlaki alanda olduğumuzu görmemize, hem de bizim harekete geçmemize yardımcı olabilir. Buna göre, empati ve şefkatin geliştirilmesi ahlâki ve etik duyarlılığı geliştirebildiği gibi, etik duyarsızlıktan kurtulma veya en aza indirgeme, kendimizin ve toplumumuzun uygulamalarını eleştirel bir şekilde değerlendirme yeteneğini de geliştirir. Etik duyarlılığın üç ana öğesi olan; 1. Bir durumun etik konular/sorunlar içerip içermediği belirleme becerisi, 2. Bir etik konunun altında yatan ahlaki erdemleri veya etik değerleri belirleme becerisi, 3. Etik konunun ahlaki yoğunluğunun farkında olunması, şeklinde etik duyarlılık ele alınabildiği gibi, James Rest in Dört Bileşenli Modeli de etiğe uygun bakım vermek isteyen profesyoneli etik eyleme yönlendirebilmektedir. Dört Bileşenli Model; etik duyarlılık, etik hüküm (karar), etik güdülenme (motivasyon) ve etik eylemden oluşmaktadır. Modelin ilk bileşeni olan etik duyarlılık; başkalarının tepkilerini, duygularını yorumlama becerisi veya yeteneğini kapsamaktadır. Başkaları için duygulanma kapasitesi olarak da tariflenen etik duyarlılık, hizmet ya da bakım alan kişilerin sıkıntılarını tanımlayabilme, eyleminin ya da eylemsizliğinin onu ne kadar etkilediğini fark edebilme, sorumluluk ve yükümlülük üstlenebilme kapasitesidir.

64 Etik hüküm, bir hemşirenin etik bir durumun varlığını keşfettikten ve etik eylem gerektirdiğini tespit ettikten sonra, hangi yolun en doğru olduğuna karar verebilmesidir. Mesleki ya da toplumsal yargı ve ön yargının etik hükmü engelleyebildiği unutulmamalı, etik bilgisi ile meslek etik kodları karara yansıtılmalıdır. Etik güdülenme (motivasyon), etik yargı (hüküm) ile etik eylem arasındaki bağı sağlayan etik güdülenme, etik olma, kişinin ahlaki değerleriyle tutarlı bir şekilde hareket etme ve böyle yaşama arzusudur. Ahlaklılık bir hemşirenin kendini tanıma duygusunun merkezinde olduğundan hemşirenin etik açıdan uygun davranma sorumluluk ve yükümlülüğünü etik güdülenmeyi artırabilmekte ve ahlaki açıdan savunulabilir eylem tercihi yaptırabilmektedir. Etik duyarlılığın etik açıdan doğru eylemin esas öğesi olarak tariflenen etik eylem, seçilen kararın uygulanması için en iyi yolun belirlenmesi ve etik eylemin tamamlanması için cesaret ve yeteneğe sahip olunmasını gerektirmektedir. Etik eylemin ortamının ve zamanının belirlenmesi de eyleme ilişkin çatışmanın çözülmesi karar önemlidir. Hemşirenin eylem için cesaretli olması, bilgi ve becerili olması, aksi eyleme ilişkin direncini, kendine olan güven ve yeteneği artırabilmektedir. Hemşirelik için özel bir anlamı olan etik duyarlılığın geliştirilmesi için de meslek eğitiminde problem çözmeye yönelik eğitim planlarının yapılması, senaryo ya da olgu tartışmaları ile eğitimin anlaşılırlığının sınanması önerilmektedir. Eğitimden başka hemşirelik etik kurullarının oluşturulması, etik tartışma gruplarının kurulması, disiplinler arası etik tartışmaların yapılması etik duyarlılığın gelişimine katkı sağlayacağı aşikardır. FROM ETHICAL SENSITIVITY TO ETHICAL ACTION In a study in Northern Sweden, physicians and nurses were asked what they were doing when they were in a difficult situation ethically, and the answer was "we are looking at our conscience". We know from ourselves that conscience forbids certain actions and orders certain actions. In another study, it was learned that nurses felt themselves to be inadequate and guilty in a difficult ethical situation. The sense of guilt or the feeling of not doing something good enough is an ethical / moral sense that provides awareness of the ethical nature of a situation, while providing awareness of the moral or ethical nature of the situation. It also brings with it the responsiveness and responsibility that comes to mean the care of others, the integrity of others. The professions appointed by the community have formed occupational ethics codes with the belief that the needs of the persons receiving services or care of them through their professional

65 organizations should be taken into account and even their rights should be respected. These standards are intended to reflect ethical / moral sensitivities to the professional practice of the common purpose professional and / or to develop ethical / moral sensitivities for it. The concept of ethical sensitivity is also called moral sensitivity in many studies. For this reason, there are those who argue that the terms are synonymous, and that there are differences between them. For example, Lutzen describes ethical sensitivity, goodness or justice of the decisions given, and professional standards and values and / or codes of conduct and standards of conduct by professional organizations, thus addressing ethical sensitivity within the scope of professional judgment and action. Moral sensitivity is concerned with goodness and righteousness in daily life. However, in 1982, Rest introduced the concept of ethical sensitivity as the capacity of interpreting ethical dilemmas, but the concept was changed to ethical sensitivity, focusing on the ethical codes and behavior of the profession as reflected in professional practice. Ethical Sensitivity: It is a symbolic word that participates in the account for reality rather than reality. It is also difficult to say a behavioral concept to ethical sensitivity, along with a behavioral aspect of actions, intuitions, emotions and perceptions. In the literature, as a behavioral concept, things like "the skill of defining the ethical direction of care, the intuition of providing comfort and well-being of others" are reported. It is argued that the concept's professionals also include the responsibility to prevent the suffering and suffering of the people under the care. It is also claimed that in order to understand ethical sensitivity, it would be more useful to provide a function and role as a scientific concept, rather than a concept of personality. For example, in nursing, while recognizing ethical issues, recognizing and producing solutions, recognizing proper ethics before deciding education is accepted as the criterion of ethical sensitivity. Ethical sensitivity as a scientific concept; Is a discipline that covers medicine, nursing, dentistry, philosophy, administration, education, psychology, bioethics, law, journalism, social and political sciences. Rest argues that Lutzen is aware of the fact that the perception of doing or not doing something can indirectly or directly affect the well-being of others, while Lutzen explains that thoughtfulness can be achieved with intuition intuitively, guiding accuracy and ability to notice. In this context, Rest suggests that ethical sensitivity is a positive aspect and necessary for some occupations (dentistry, nursing, medicine, journalism, accounting). Weaver, includes affection for ethical sensitivity, saying that professionals should recognize the needs of the people, know the truths for the decision, and serve wisely and caringly to the people

66 under their care. But compassion does not address the issue of responsibility or shape our ethical obligations. However, it can help us not only to see that we are the moral field, but also to help us move on. Accordingly, the development of empathy and chastity can enhance moral and ethical sensitivity, as well as the ability to escape ethical insensitivity or reduce the most, to develop a critical appraisal of the practices of ourselves and our society. The three main elements of ethical sensitivity are; 1. The ability to determine whether a situation involves ethical issues / problems, 2. Ability to identify moral virtues or ethical values underlying an ethical concern, 3. Ethical sensitivity to the awareness of the moral intensity of ethics, as well as James Rest's Four Component Models can also lead professional ethics to give appropriate care to ethics. The Four Component Model includes ethical sensitivity, ethical decision (decision), ethical motivation (motivation) and ethical action. Ethical sensitivity, the first component of the model; the ability or ability to interpret others' reactions, feelings. The ethical susceptibility, also referred to as the affective capacity for others, is the capacity to identify the difficulties of those who receive service or care, the ability to recognize how much action or inaction affects them, and to assume responsibility and liability. The ethical judgment is that a nurse can decide what is the most correct, after discovering the existence of an ethical condition and determining that it requires ethical action. It should be remembered that professional or social judgment and prejudice can prevent ethical judgment, ethical information and professional codes of ethics. Ethical motivation is the desire to live and to behave in a way consistent with ethical motivation, ethics, moral values of one, which provides the link between ethical judgment and judgment. Because morality is at the center of a nurse's sense of self-awareness, the nurse's ethical responsibility and obligation to act appropriately can increase ethical motivation and favor morally defensible action. Ethical action, defined as the essential element of ethical correct action, requires that the best way to implement the chosen decision is to have the courage and ability to complete ethical action. It is important to determine the context and timing of the ethical action, as well as the resolution of the action-related conflict. The fact that the nurse is brave for action, knowledge and skill, resistance to action, and self-confidence and ability can be improved.

67 In order to develop ethical sensitivity, which is a special meaning for nursing, it is suggested to make training plans for problem solving in vocational education, test scenario or case discussions and understandability of education. Establishment of nursing ethics committees other than education, establishment of ethical discussion groups, and discussions among ethical disciplines will contribute to the development of ethical sensitivity.

68 ETHICAL APPROACHES IN THE PROCESS OF SCIENTIFIC RESEARCH AND PUBLICATION Prof. Dr. Çağatay ÜSTÜN 1 1/Ege University, Faculty of Medicine Nowadays, we frequently encounter ethical problems during a scientific research and scientific publication. The rationale for the existence of science is to engage in an activity for innovation and advancement. While minimizing the damage to humans and other living beings should be the fundamental goal when doing this, unfortunately we face difficulties in behaving in line with this valuable principle. When designing a scientific study, we should not overlook the possibility that it will turn into an article. The outcome of a scientific study is innovation or sharing of the advancement with the world of science. The easiest way of doing this is to create a scientific publication out of this study. We know that scientific publications pass through a variety of stages in the course of their preparation and those who prepare the publication should show the same ethical care as in the scientific study. The responsibility of the authors does not end when they send the article to the journal. The editors and reviewers of the journal as well as the readers and all those who will be influenced by the information contained in this article have the right to know the presence of such responsibility. A scientific article prepared in a careless way or changed and distorted to produce results different from those of the scientific study cannot render any contribution to the world of science. The matter should be examined in a reasonable way to understand how the concepts of scientist, laboratory, scientific article writer, journal, article, editor, reviewer, publication process, and publication are linked to ethics. The reason for preparing this conference in this framework is to enable the participants to review their knowledge again, to reveal the conflicting aspects of what are known to be correct and to share some beneficial tips for converting an ethical scientific study into an ethical article. BİLİMSEL ARAŞTIRMA VE YAYIN SÜRECİNDE ETİK YAKLAŞIMLAR Günümüzde bilimsel çalışmalar ve bilimsel yayın aşamasındaki etik sorunlar sıklıkla karşımıza çıkmaktadır. Bilimin var oluş gerekçesi yenilik ve ilerleme sağlamaya yönelik bir faaliyet içinde olmaktır. Ancak bunu gerçekleştirirken insana ve canlılara yönelik zararın en az indirgenmesi temel amaç olması gerekirken, ne yazık ki bu değerli ilkeye uygun davranılmasında zorluklarla

69 karşılaşılmaktadır. Bilimsel çalışmanın kurgulanması sırasında bunun bir makale haline dönüşme olasılığı gözden uzak tutulmamalıdır. Bilimsel bir çalışmanın sonucu yenilik ya da ilerlemenin bilim dünyası ile paylaşılmasıdır. Bunu sağlamanın en kolay yolu çalışmanın bilimsel bir yayın haline getirilmesidir. Bilimsel yayınların oluşma sürecinde çok farklı aşamalardan geçildiğini, yayını hazırlayanların bilimsel çalışmadaki kadar etik bir özen göstermeleri gerektiğini biliyoruz. Yazarların yayın üzerindeki sorumluluğu makalenin ilgili dergiye gönderilmesiyle sona ermez. Derginin editör ve hakemleri, okurları ile bu makalenin içeriğindeki bilgiden etkilenecek herkesin böyle bir sorumluluğun var olduğunu bilme hakkı vardır. Özensiz, bilimsel çalışmanın sonuçlarından farklı, değiştirilmiş, çarpıtılmış bir şekilde hazırlanmış bilimsel makalelerin bilim dünyasına vereceği bir katkı olamaz. Bilim insanı, laboratuvar, bilimsel makale yazarı, dergi, makale, editör, hakem, yayın süreci ve yayın kavramlarının etik ile olan bağlantılarını anlamak için konunun mantıklı bir şekilde incelenmesi lazımdır. Bu konferansın bu çerçevede hazırlanmasının sebebi, katılımcıların bilgilerini yeniden gözden geçirmelerine olanak tanımak, doğru bilinenlerin ikilem oluşturan yönlerini ortaya çıkarmak ve etiğe uygun bir bilimsel çalışmanın etiğe uygun bir makale haline dönüşmesindeki yararlı ipuçlarını paylaşmaya yöneliktir.

70 ETİK BOYUTLARI İLE HEMŞİRELİK ÖYKÜLERİ Prof. Dr. S. Erkal İlhan 1, Yrd. Doç. Dr. Behire Sançar 2 1/Ankara University, Faculty of Health Sciences 2/ Toros University, Health of High School Öykü, insan eyleminin ve eğiliminin deneyimsel özelliğini en iyi ortaya koyan düşünce ve iletişim biçimidir. Bir öykünün yapısı içerisinde, yaşanan bir olay, bir deneyim bulunmaktadır. Öyküler, deneyimleri organize eden bir yapı, deneyimlerin yansıtıcısı ya da tam olarak deneyimlerin kendisidir. Öykü araştırması, en kısa ifadeyle bir bireyin deneyiminin, o deneyimle ilgili yaşam öykülerine dayalı olarak incelendiği ve deneyimlerde var olan anlamların ayrıntılı biçimde betimlendiği nitel bir araştırma sürecidir. Bu sunumda hemşirelik öyküleri, etik boyutları ele alınmıştır. Hemşirelerin Mesleki Deneyimlerini Yazma ve Yayınlama Becerilerinin Geliştirilmesi adlı iki projeden biri Koç Üniversitesi SANERC, diğeri Toros Üniversitesi BAP tarafından desteklenmiştir. Proje bitiminde öyküler kitap haline getirilmiş ve yayınlanmıştır. Öykülerde hastane ismi belirtilmemiş ve şahıs isimleri değiştirilmiştir. Bu sunumda hemşirelik öykülerinde yer alan etik ilkeler (özerklik, yararlılık, zarar vermeme, dürüstlük, adalet, sadakat, gizlilik, gerçeği söyleme), hemşireliğin sınırlarına giren boyutları ile ortaya konmaya çalışılacaktır. Bu çalışma, hemşirelik öykülerine yansıyan etik ilkeler, uygulama alanında bu ilkelerin nasıl kullanıldığı, bakıma yansıyıp yansımadığı hakkında fikir verecektir. Öykülerde yer alan konular tartışmaya açıktır. Farklı bakış açıları ile ele alınıp tartışılabilir. Özerklik bireyin yaşamına yön veren durumlarla ilgili tercihler yapabilme özgürlüğüdür. Özerklik bireyin kendi kendini yönetmesidir. Özerklik kavramı içinde bireyin kararlarına saygı yer almaktadır. Özerklik kavramı içinde yer alan unsurlar insana saygı, bireyin kişisel hedeflerini belirleyebilmesi, bireyin bir eylem planı ile ilgili karar verme yeteneğinin olması, bireyin tercihleri doğrultusunda eylemde bulunmasıdır. Özerklik sağlanabilmesi için, bu dört unsuru içermesi gerekir. Hemşirelerin bu dört unsuru göz önüne almaları gerekir. Bu unsurlardan ilki olan insana saygılı olunmasını ve önemini vurgulayan, saygı göstermenin ihlal edildiği Acemiliğin Kurbanı Oldum adlı öyküde, yoğun çalışma temposunda olan bir hemşirenin, hastanın servise kabulü sırasında diğer hemşire ile hasta hakkında konuşmaları dikkat çekicidir.

71 Hemşire arkadaşım bir hasta ile servise geldi. Hemşire arkadaşıma Hastayı neden buraya getirdin!. Başka servise götürseydin dedim. Konu hoş olmayan bir şekilde uzadı. Hasta tüm bu konuşmalara tanık oluyordu. Hastanın Hemşire Hanım! Ben tedavi olmayayım da öleyim! Yeter ki siz tartışmayın! diyerek araya girmesi bizi ve özellikle de beni kendime getirdi. Bu kadar ciddi bir hata yapmam hoş görülecek gibi değildi. Belgen Varsa Aklanırsın adlı öyküde ise hastanın kendisi ile ilgili verdiği karara saygı gösteren hemşire oluşacabilecek zararlardan haberi yokmuş gibi görünmekte ve kedisinin haklı olduğunu düşünmektedir. O gece genel cerrahi servisinde nöbetteydim. Burun ameliyatı olan hastamızın yanındaydım. Sabah taburcu olacağını söyledikten sonra Benim tansiyonumu ölçmenize ve bulgularımı almanıza gerek yok! dedi ve ardından Lütfen odama girmeyin. Rahatsız etmeyin! diyerek gece boyunca uyumak istediğini dile getirdi. Bu durumda hastanın bu talebini, kendi isteği olarak hemşire gözlem formuna kaydettim. Sabah erken saatlerde, hastanın odasından hasta yakınının yardım isteyen sesi koridoru inletiyordu.koşarak hasta odasına gittiğimde, hastanın lavaboda bayıldığını gördüm. Hemen hastaya gerekli müdahaleleri yaparak yatağa alınmasını sağladım. Hastamızın gece boyunca hiç kimsenin kendisiyle ilgilenmediği için tansiyonun düştüğünü ifade etmesi beni çok üzdü. Oysa ben görevimi eksiksiz yapmıştım. Hemşire Gözlem Formuna not aldığım hasta isteğini, hasta yakınlarına gösterdim. Hasta ve yakınlarının sorumlu hemşiremizden özür dilediklerini, şikâyetçi olmaktan vazgeçtiklerini öğrendim. Hemşirelik eğitimlerimiz süresinde önemle üzerinde durulan konu, hemşire gözlem forumlarının ne kadar önemli olduğunu bir kere daha anlamış oldum. Hasta özerkliği bilgilendirilmiş onam, paternalizm, itaat ve özgür irade gibi kavramlarla da tartışılabilir. Onam alma, bilgilendirme sonrası hastanın özgür bir şekilde yapılacak uygulamalara izin verme sürecidir. İstemeden Ameliyata Getirildim adlı öyküde onam almanın önemi, alınan onamın hemşire tarafından kontrol edilmesi gerektiği, hemşirenin bu konuya yaklaşımı, çarpıcı bir şekilde işlenmiştir. Bir üniversite hastanesinin kulak burun boğaz servisinin ameliyathanesinde çalışıyordum. Burun estetiği ameliyatı için genç bir kız, ağlayarak ve çok mutsuz bir şekilde ameliyathaneye geldi. Estetik ameliyatlarına girecek hastalar, genellikle çok mutlu ve heyecanlı olurlar. Ama bu hastamız öyle değildi. Ameliyat öncesi anestezi ekibi geldi ve anestezi için hazırlık yapmaya başladı. Biz de kendi aramızda Bu hasta sanki zorla ameliyat oluyor diyorduk. Ameliyat masasında olan hasta

72 bir anda oturur pozisyona gelip Evet zorla İstemeden ameliyata getirildim! dedi Hepimiz şaşkındık! Hasta özerkliğine saygı, bireyin bir eylem planı doğrultusunda karar vermesidir. Bu ilke ile ilgili ne en iyi örnek Herşey Efe İçindi adlı öyküdür. Bu öyküde adalet ilkesini de yer almaktadır. Adalet ilkesi, bireylere adil, eşit ve uygun sağlık hizmetinin sağlanması anlamına gelen bir ilkedir. Sağlık bakımında bu ilkenin en uygun şekilde uygulanması mal ve hizmetlerin dağılımında göze çarpmaktadır yılında, özel bir hastanenin doğum servisi yenidoğan ünitesinde çalışıyordum. O gün erken doğum eylemi ile gelen bir anne, ikiz doğum yapacaktı. O yıllarda yeni doğan bakım üniteleri çok donanımlı değildi. Bu nedenle sorunlu doğan bebeklerin, devlet hastanelerine ya da tıp fakültesi hastanelerine sevk edilmesi gerekiyordu. Annenin doğumu başlamıştı ve ekibimiz hazırdı. Doğum gerçekleşti. Bebekleri küvöze aldık. Erkek bebek gram, kız bebek ise 1750 gram doğmuştu. Daha donanımlı bir hastaneye sevkleri için telefon ederek onlara yer bulmaya çalışıyorduk. Devlet hastanesinden beklediğimiz haber geldi. Ancak bebeklerin sadece birisi kabul edilecekti. İkizlerden kız olanının gitmesine karar verildi. Bir hafta sonra maalesef kız bebek yaşamını yitirdi. Ancak erkek bebek yaşam mücadelesine devam ediyordu. Bir yandan bebeğe solunum desteği veriyor, bir yandan beslenmesi için yöntemler geliştiriyorduk. Annenin; Çabalarınıza, içtenlikli müdahalelerinize ve bütün uğraşılarınıza saygı duyuyorum sözleri, bize biraz daha umut ve cesaret veriyordu. Ekipteki diğer arkadaşlarımıza Bize destek olun yeter! mesajını verdik. O gün ve daha sonraki birkaç gün, hastaneden hiç ayrılmadık. Bebeğin adını Efe koyduk. Başka hastaneye sevki için çok uğraştık, ancak hastane bulamadık. Efe nin durumu çok iyi değildi, ancak kötü de değildi. Günler sonra devlet hastanesinden Efe yi getirebilirsiniz! haberi geldi. Durumu ailesine ilettik Ailesi şiddetle karşı çıktı. Bebeğin bizim hastanede kalmasını istediklerini, bizim ilgilenmemizi isteyerek Efe burada tedavi görecek dediler. Çocuk doktorumuzla birlikte başta ben olmak üzere, çok zor koşullarda Efe için hastanemiz seferber oldu. Yaklaşık 45 gün sonra Efe taburcu oldu. Yararlılık ilkesi hemşirelerin hastalara yarar sağlayacak şekilde davranmasıdır. Profesyonel hemşirelik rolü yararlı olan eylemleri içermektedir. Yararlılık ilkesinin üç temel özelliği iyilik yapmak/iyiliği desteklemek, zararı engellemek, kötülüğü/zararı ortadan kaldırmakdır. Hemşireler etik olmayan davranışlardan, yetersiz ve güvenli olmayan bakımdan şüphelenmeli, bakım sürecinde karşılaşılabilecek olası zararları ve bireyin iyilik halini göz önünde bulundurmalıdır. Annem Yaşlıydı, Hastaydı ve İhmal Edilmişti adlı öyküde yararlılık ilkesinin göz ardı edildiği açık bir şekilde anlatılmaktadır.

73 Annem 80 yaşındaydı. İshal ve beslenme bozukluğu tanısıyla hastaneye yatırılmıştı. Beş gün sonra durumunun kötüye gittiği haberinin gelmesi üzerine izin alarak hastaneye gittim. Yattığı odanın kapısından girdiğimde annem yatağında yarı dik pozisyonundaydı. Beni tanıyamadı. İlk gördüğüm görüntü gerçekten çok kötüydü. Normalde çok zayıf olan annemin yüzü ve dudakları şişti. Ağzı açıktı ve güçlükle, kesik-kesik nefes alıp veriyordu. Yaygın ödem geliştiği ilk bakışta belli oluyordu.. Dili paslanmış kalınca bir kabuk bağlamıştı. Aynı şekilde ağzındaki diş protezleri kir içinde, kurumuş ve paslanmıştı. Kendi kendine hareket etmesi şöyle dursun, kolunu bile kıpırdatamıyordu. Örtüsünü açıp, baktığımda meslek hayatım boyunca görmediğim, iç acıtıcı bir manzara ile karşılaştım. Ne yazık ki hemşireliği sadece hekimin yazdığı tedaviyi uygulamak, hasta yatış dosyalarını doldurmak (tıbbi sekreterlik yapmak), doktorun yazması gereken reçeteleri yazmak olarak gören, yaptığı işlemlerle ilgili hasta ve yakınlarına hiçbir açıklama yapma gereği duymayan, mahremiyete saygı göstermeyen hastayı, tıbbi tedaviyi bile refakatçilere bırakan, tedavinin etkisini ve yan etkilerini takip etmeyen, hastanın tedavisi dışında başka hiçbir ihtiyacını karşılama sorumluluğu hissetmeyen, hastaların herhangi bir şey istemekten korktuğu hemşireler yetiştirmişiz biz. Zarar vermeme ilkesi yararlılık ile ilişkilidir. Bu ilke hemşirelerin hastaya zarar vermeyecek şekilde hareket etmelerini gerektirir. Bu ilkeyi diğer ilkelerden üstün tutan etik bilimciler vardır. Hipoktarik bu ilke kasıtlı zarara yol açacak eylemlere izin vermez. Bu ilke aynı zamanda doğacak zarardan kaçınmayı da içermektedir. Bir Tetanoz Vakası adlı öyküde ise hastanın zarar görmemesi için hemşirenin ortaya koyduğu çaba çok dikkat çekicidir. Yıl 1986 Bir devlet hastanesinin intaniye servisinde ilk haftalarım Meslekte çok yeni ve deneyimsiz olmamıza rağmen, daha çok hemşire yetersizliği nedeniyle gece nöbetleri tutardık. Servisi teslim aldığım nöbetlerden birinde, hastalarımdan biri, tetanoz teşhisi ile yatıyordu. Hastalığı ileri derecedeydi. Şiddetli kasılmaları olduğu için nefes almakta çok zorlanıyordu. Benim gözlemlerime göre hasta terminal dönemdeydi. Nöbette tek hemşireydim. Bir taraftan diğer hastalarımın takiplerini yapıyor, diğer taraftan da tetanozlu hastamla ilgileniyordum. Oldukça yoğun bir nöbet geçiriyordum. Hasta çok kötü durumdaydı. Ağızdan nefes alamıyordu. Önce acil doktorunu aradım, o da beni servis doktoruna yönlendirdi. Doktor evindeydi, telefonla görüştüm. O da ameliyathaneyle görüşmemi ve trakeostomi açılması gerekebileceğini söyledi. Bunun üzerine ameliyathaneyle görüştüm. Acilen trakeostomi açılması gerektiğini ilettim. Ameliyathane yetkilileri Buraya tetanoz hastası alamayız! diyorlardı. Ben işin önemini ve hemen olması gerektiğini ısrarla anlatmaya çalışıyordum. Tekrar acil servisi arıyordum, onlar da beni yine

74 servis doktoru ve ameliyathaneye yönlendiriyorlardı. Bu görüşme trafiği üç ya da dört kez devam etti. Israrlarım sonucunda, nihayet hastayı ameliyathaneye gönderebildim. Trakeostomi açılan hastamın ameliyathanedeki müdahalesi bitmiş servise gelmişti. Uyaranlardan etkilenmemesi için sessiz ve loş bir odaya yatırdık. Kasılmaların tetiklenmemesi için ve acil bir durum gerektiğinde tekrar ameliyathaneye gitmesi gerekebilir düşüncesi ile hastayı yatağına alamadık. Başını yükselterek sedyede yatırmaya ve orada izlemeye devam ettik. Hasta çok hırıltılı bir şekilde nefes alıp veriyor, her nefes alıp verişinde trakeotomiden kan sızıyordu. İyileşmeyeceğini düşünmeme rağmen tedavisine devam ediyordum. Yapılabilecek her şey yapılmıştı. Aslında bu hasta için ölmek değil de ölememek daha zordu. Hastayı gündüz vardiyasına gelen hemşire arkadaşlarıma teslim ettim. Eve gittim. Ertesi gün çalışmaya başladığımda, o hastanın nöbetimi teslim ettikten bir saat sonra vefat ettiğini öğrendim. Sadece bir kere daha nefes alabilmek için, nasıl savaştığına, nasıl direndiğine ve nasıl mücadele ettiğine şahit olmuştum. Bu öyküde hemşirenin ve hekimin hastaya yaklaşımı, nafile tedavi açısından da tartışmaya açıktır. Dürüstlük ilkesi uygulama yaparken doğruyu söylemekle ilişkilidir. Hemşirelik literatüründe dürüstlük, bir erdem olarak görülmekte ve doğruyu söylemenin de hemşirelerin görevi olduğu kabul edilmektedir. Ancak biyoetik açıdan bakıldığında her durumda doğrunun söylenmesi konusunda tam bir fikir birliği bulunmamaktadır. Hemşirelerin doğruyu söylemesi saygıya, açık iletişime, güvene ve sorumluluğun paylaşılmasına yol açar. Doğruyu söylememek ve bilgi vermekten kaçınmak bireyin kararlara katılımını engelleyen unsurlardır. Doğruyu söylemek güven ilişkisini geliştirir. Bu güven hasta-hemşire ilişkisi açısından önemlidir. Bu ilişki sayesinde hastalar özerkliklerinden bir süre için vazgeçebilir ve bakım gereksinimlerinin karşılanmasını hemşireden bekleyebilirler. Gerçeği Söylemeliydim adlı öyküde gerçeği söyleme konusunda hekim ve hemşire açısından farklı yaklaşımlar ortaya konmaktadır. Yoğun bakımda gece nöbetim sırasında, 23 yaşında trafik kazası geçirmiş, kafa travması olan bir hastaya bakım için görevlendirilmiştim. Hasta beyin kanaması geçirmiş, ama bilinci yerindeydi. Ancak ne söylediğini ya da ne söylemek istediğini tam olarak anlayamıyordum. Gece yarısını geçmişti ama hasta bir türlü uyumuyordu. Bana seslendi, ben de hastanın yanına gidip, neden uyuyamadığını ve istediği olup olmadığını sordum. Buradaki seslerden rahatsız oluyorum dedikten sonra, Uyuyamıyorum, biraz sohbet edelim diye devam etti. Ben de hastanın kendisini daha iyi hissetmesi için, belki yararı olabilir düşüncesiyle onunla konuşmaya başladım. Kız arkadaşıyla nasıl tanıştıklarını, birlikte nasıl vakit geçirdiklerini, onu çok sevdiğini uzun uzun anlattı. Ancak hastanın bilmediği önemli bir ayrıntı vardı. Trafik kazası sırasında yanında olan kız arkadaşı hayatını kaybetmişti. O kız arkadaşı sanki yanındaymış gibi ya da her an kendisini

75 görmeye gelecekmiş gibi konuşmalarına devam ediyordu. Ben gerçeği biliyordum. Birkaç defa araya girip, söylemeye çalıştıysam da başaramamıştım. Ama hastanın bunu bilmesinin gerektiğini düşünmekteydim. Ayrıca bu durumu hastaya söylemek de işin etik yönüydü. Bir süre sonra hastama gerçeği anlattım. Hasta çok sinirlendi. Kendi kendine tokat atmaya başladı. Nabzı hızlı atmaya başlamıştı. Sinir krizi geçirmekteydi. Hemen doktoru arayıp, durumu anlattım. Doktor gereken müdahaleyi yaptıktan sonra, bana dönerek, Hemşire hanım bir daha hasta iyileşene kadar bu konuda konuşmayınız! diye uyardıktan sonra, Bu durumdaki hastalara böyle haberler verilirse beyinde kalıcı hasarlar yapabilir dedi. Sadakat ilkesi, sadık olmak ve verilen sözü tutmak anlamındadır. Hemşireler kendilerine uygulama hakkı veren topluma karşı sadık olmalı, mesleğin etik kurallarını üstlenmeli, belirlenen uygulamalar ve tanımlar doğrultusunda uygulamalarını yapmalı, uygulamalarda yetkin olmalı, çalıştıkları kurumların politikalarına uymalı ve hastalara verdikleri sözleri tutmalıdırlar. Sadakat ilkesi hastahemşire ilişkisi içindeki bağlılığı kapsar. Sözleri tutmak ve sözleşmelere uymak bağımsız bir sorumluluğa yol açar. Yoğun Bakımda Umuda Giden Yol adlı öyküde hemşirenin hastaya verdiği söz dikkati çekmektedir. Yedi hafta geçmişti, Kâzım bey yoğun bakıma geleli. Herkes, giderek umudunu yitiriyordu ve o solunum cihazında, hiç ayrılamayıp yoğun bakımdan hiç çıkamayacağına iyice alışıyordu. Ben her nöbet bitiminde, gelecek sefer ne yapacağımı planlıyordum Kâzım beyle ve onunla paylaşıyordum Bir sonraki gün, onu sandalyeye oturtacaktım, söz vermiştim. Sabah sekizde hastanedeydim. Saat dokuza geliyordu, ekibi organize etmiştim Kâzım beyi sandalyeye oturttuk. Günlerdir yatıyordu ve oturduğundaki mutluluğu tarif edilecek gibi değildi. Solunum cihazına bağlı olmasa, kalkıp gidecekti sanki. Elini tuttum ve her şeyin yolunda olduğunu, çok az kaldığını, kısa zaman içinde köyüne gideceğini bir kez daha yineledim. Tam arkamı dönüp yandaki hastaya geçeceğim sırada, solunum cihazından gelen ve Kâzım beyin sesiyle karışan o ânı hiç unutmayacağım. Kâzım bey solunum cihazından kendini ayırmış bağırıyordu. Serpil hemşire köyüme gitmek istiyorum, bak iyileştim, bu makineye da ihtiyacım kalmadı artık diyordu. Sonuçta, iki proje sonucu ortaya çıkarılan öyküler, etik karar verme, profesyonel alanda ilkeli davranış, malpraktis ve önleme, profesyonel ilişkiler, yaşam ve ölüm sürecinde etik konular açısından da incelenebilir ve tartışılabilir. Öykülere dayalı olarak kavram analizi yapılması bir sonraki aşamasıdır.

76 İki proje çalışmasında da bizi en çok etkileyen öykü Yaşama Direnci adlı öykü olmuştur. Bu öyküde hemşire ahlaksal hesaplaşma süreci geçirmiş ve örtük bilgisi sayesinde hasta haklarını sonuna kadar korumuştur. Yaşama Direnci İstanbul un büyük devlet hastanelerinden birinin acil servisinde görevliydim. O gün acil servisin Resüsitasyon odası nöbetindeydim. Diğer nöbetçi arkadaşımla birlikte çalışacağımız odayı düzenledikten sonra, diğer arkadaşlarla birlikte hemşire odasına geçtik. Kısa bir süre sonra görevli personelin, Resüsitasyon Hemşiresi!! diye seslendiğini duydum. Görev yerime koşarak giderken, ambulansla görevlilerin bir hastayı resüsitasyon odasına götürdüklerini gördüm. Sedyeyi taşıyan personel Acele etmenize gerek yok. Hasta zaten ex. (yaşamıyor) dediklerini duydum. Arkadaşım, yaşamını yitirmiş olarak getirilen hastanın kayıt işlemlerini yapmaktaydı. Ben de hastanın üzerindeki örtüyü açtım. Hastayı getiren görevliden bilgiler almaya başladım. Boğulma vakası Hemşire Hanım! Sudan çıkartılması, müdahale edilmesi ve buraya getirilmesi toplam dakika sürdü. Yolda müdahale edildi, ama yanıt vermedi, yani hiç kalp atımı olmadı dedi. Tamam. Diyerek hastayı teslim aldım. Arkadaşım diğer işlemler için işine devam ederken, ben de EKG den düz çizgi kaydı yapmak üzere hastanın yayına doğru yöneldim. Ex (yaşamıyor) dedikleri hastamın örtüsünü kaldırdığımda, 17 yaşlarında, güzel yüzlü bir genç karşımdaydı. Pembe beyaz bir yüzü vardı, sanki ex olmuş gibi değildi, adeta uyuyor gibiydi. O anda duygu yüklüydüm, düz çizgi işlemine bir türlü başlayamıyordum. Arkadaşımın Hadi ama! Daha çekmedin mi düz çizgisini? şeklindeki uyarısını duymuyor gibiydim Hareketlerim istem dışı yavaşlamıştı. Bu sırada, dahiliye doktorumuz geldi. Sözlü olarak olmasa da hareketlerimle Nerede kaldınız? Ne kadar uzun sürdü işiniz! dercesine baktım doktora. Doktor benim çaresiz, üzgün bakışımı ve duruşumu gördükten sonra Neler oluyor burada? Hasta yakının mı, tanıdığın biri mi yoksa? sorularına, O kadar genç ki, o kadar küçük ki, bir türlü düz çizgi çekmeye elim varmıyor diyebildim. Beni tanıyan, anlamsız istekleri olan biri olmadığımı bilen doktor Hemen hastayı monütöre bağlayın! dedi. Ardından da Damar yolu açın! talimatını verdi. Biz diğer hemşire arkadaşımla damar yolu açarken, kendisi de hastaya entübe ediyor (solunum yollarına tüp yerleştirilmesi), son hayati müdahaleyi yapıyordu. Bir yandan da; Hemşire Hanım! Meslekte çok yenisin. İlerde yapsaydım keşke dememen için, bir de seni hiç böyle görmediğim için bu son müdahaleleri yapıyorum. Ne var ki fazla umutlanma. Çünkü şu anda ex kabul edilen bir hasta var karşımızda dedi. Bu hastanenin, bu servisinde, bu servisin, bu odasında onlarca hastayla karşılaşmıştım. Ama hiç bu kadar etkilen- memiştim. 17 yaşında bir genç olması mıydı? Güzel

77 yüzlü bu çocuğun önünde daha nice yıllar olması gerektiğini düşünmem miydi? Umutları vardı Bütün bunlar beni çok mu etkilemişti? Bir yanda doktora yardım ederken, bir yandan da bunları düşünüyordum ki, diğer hemşire arkadaşımın Kalp atım varrr! sesiyle adeta irkildim Gerçekten de kalp atıyordu. Doktorun, Hemen anesteziyi çağırın! diye bağırarak koridorlarda yankılanan sesi atım göstergesi hastanın yoğun bakıma götürülmesi Olduğum yere adeta yığıldım. Nerdeyse dakikadır, ex diye kabul edilen hastamız yaşama dönmüş, yoğun bakıma götürülmüştü. İki yıllık hemşire ve 20 yaşındaydım. Nasıl oldu da ex olarak getirilen bu hastanın, yaşama dönüş savaşını kazanmasında katkım oldu? Bunu nasıl hissettiğimi bilmiyorum. İşte böyle karmaşık duygular içindeyken, doktor ve çocuğun babası odaya girdiler, mutluluğunu gizlemeyen doktor Teşekkür edecekseniz bu Hemşire Hanıma teşekkür edin Öldü diye getirilen oğlunuzun yaşama dönmesindeki en büyük emek bu değerli hemşiremizindir! dedi. Ambulansı takip ederek ex oğluyla hastaneye gelen babaya, Oğlun kurtuldu! müjdesi verdiklerinde sevinci görülmeye değerdi gerçekten O koca adam, o babam yaşında adam, oğluyla birlikte yeniden dünyaya gelmişti sanki Karşımda durdu, ellerini uzattı Kızım yatayım da üstümden geç, senin yollarına öleyim ben! Sana hakkını nasıl öderim ben! derken bir yandan da sevincinden ağlıyordu. Ben de, Oğlunuz daha çok gençti. Gençliğinin baharındaydı. Elimizden geleni yapmaya çalıştık gibisinden bir şeyler söylemeye çalıştığımı anımsıyorum. O gece adının Faruk olduğunu sonradan öğrendiğim hastamızın son durumunu takip etmek için kaç defa yoğun bakıma gittiğimi ben bilirim. Faruk yirmiyedinci günde taburcu edildi. Yaşamıyor yani ex oldu diye sedyeyle getirilen Faruk, Anne ve Babasıyla beraber yürüyerek evine gidiyordu. Bundan büyük mutluluk olur muydu? Bundan büyük sevinç yaşanır mıydı? İyi ki hemşire olmuşum İyi ki insanlara somut olarak, dokunarak, şifa ve sağlık sunma olanaklarımız var KAYNAKLAR 1. Burkhardt MA, Nathanie AK. Çağdaş Hemşirelikte Etik. Editörler: Ecevit Alper Ş, Bahçecik N, Karabacak Ü. İstanbul Tıp Kitabevi. İstanbul Dinç L. Hemşirelik Hizmetlerinde Etik Yükümlülükler. Hacettepe Tıp Dergisi. 40, Ersoy N. Hemşirelik ve Etik. Hemşirelik Bülteni. Cilt VII, sayı 33, Karadağlı F. Profesyonel Hemşirelikte Etik. Düzce Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 6(3), 2016.

78 5. Şahin Gezer D. Yoğun Bakım Hemşirelerinin Yaşadıkları Etik Sorunlar Konusunda Adana Ölçeğinde Bir Araştırma. Çukurova Üniversitesi Sağlık Bilimleri Enstitüsü Tıp Tarihi ve Etik Anabilim Dalı, Yayınlanmamış Yüksek Lisans Tezi. Adana Utlu N. Hastane Ortamında Hemşirelerin Etik Yaklaşımı ve Etik İkilemler. İstanbul Aydın Üniversitesi Dergisi 29, (2016) (17-35) 7. Yaşamını Duyuyorum, Hemşireler İçin Etik İlkeler ve Sorumluluklar. Türk Hemşireler Derneği, Aralık, 2009 ETHICS EDUCATION WITH INTERNATIONAL CURRICULA EXAMPLES IN HEALTH CARE Hanzade Doğan 1 1 /Cerrahpasa Medical School At the conference of ethics education from a global perspective in the international congress of ethics education in health care in İzmir, I will try to focus on the ethics curriculum and applications through a comparative global viewpoint in relation to our curriculum in Turkey. The first issue I must emphasize is that health care ethics and medical ethics is a comparatively new topic increasing with a logarithmic acceleration within the last 50 years. Ethics is the essence of medical thought. There is a very delicate border between research and treatment on human subjects. Dilemmas, rational questions and risk assessment need to be analyzed carefully at this border. All health care personnel have a deep and critical responsibility for human subjects. I will try to focus on nurses and physicians in this panel where we will, I believe, discuss the curriculum for an effective education together. I believe we will deliberately bring out the most critical problems in ethics education via clinical research and conservative treatment modalities and care principles, and reach not only rational but also humanistic answers together with this wonderful group of academicians, clinicians and ethicists. Up until my 30th year of professional life in medicine as a physician and my 36thyear including the medical education years, I have witnessed many problems in education and also organized many curricula. My experience in various centers in the world also contributed to my synthesis of the optimum curricula.

79 Health Care Ethics is a matter of specialty nowadays. In addition to the very specific characteristics according to the professions, it differs a lot according to the topic. Still ethics has common denominators like Education, Policy Making and Consultationcase-noncase or mixt in any case. Education has four main headings. These have to be planned according to the process or timing of the education. WHO, WMA and UNESCO has defined standards and references. Education naturally has to differ on the basis of achievement requirements of various education levels and types such as license, masters, PhD, post doc, residency etc. Support of administrations in institutions, societal factors, accreditation criteria are also among what affect the curricula a lot. Besides, methods in education are another issue to be discussed. Through teaching methods; an example for a training case at a specific topic: A couple who have a 2 year old kid, learn that they are having another baby. The lady is pregnant and she is having twins. They think about it and admit to perinatologist and request an elective abortion for one of the embryos. The perinatologist offers various options: They might really go under an elctive abortion for one of the embryos, they might end the pregnancy, they might give one for adoption after birth or they might go outland and solve the problem there. The family insists on the first option. The perinatologist admits to clinical ethics committee: The clinical ethics committee does not have a written document or policy about the relevant issue. They advice a negative approval of the request of the family with the reasoning that the other embryo might be damaged during the surgical intervention in terms of being twins and the location of the twins. The perinatologist evaluates the advice of the committee and the offer of the family and suggests that: From the legislative viewpoint, there is no problem for the voluntary abortion of one embryo at that stage, so there is no problem for the voluntary eradication of twins to single. From the viewpoint of medical indications, risk evaluation and approach from the surgical techniques, he takes the written informed consent of the family explaining all the possible risks of the intervention and after documenting them. Then he performs the intervention without any complications and malfunctioning. This is an important topic to be taught at different levels of education.

80 Reproduction and its consequences bear a special importance for women, as women s social status is largely determined by these matters. It can also be argued that health problems specific to women that appear as a result of female physiology and pathophysiology and which seriously affect the female reproductive system, must be handled separately and with special attention. Different risk groups, that show variation according to age, must also be considered differently in the light of relevant diseases and health conditions. Among the birth preventive approaches, abortion is one of the most problematic ones composing psychological, sociological, economic, moral, religious and cultural questions within one body. Elective voluntary abortion is more problematic than others in terms of justification of the decision when compared with fetuses with malformations, fetuses threatening mother s health, eugenic abortions, multiple pregnancies, genetic purposed pregnancies etc. Decisions that are allowed from legislative viewpoint might be questionable from moral viewpoint and vice versa is correct. Elective voluntary abortion is generally regulated by laws and in Turkey this proposal is valid, as well as in many other countries. The boundaries are defined in Turkey however politically activated negotiations have started among public as well. Basically borders are drawn for elective abortion to protect mother s well being and fetuses rights. Still, every case would have its special conditions, realities and values. So, the basic ethical question should be: What kind of pathway should I follow if I want to end this pregnancy? Health care personel are free to take part in abortion and they are not obliged to fullfil this intervention but they are supposed to direct the woman to an eligible other obstetrician. It is different than other mandatory intervention in those terms. Are clinical ethics committees eligible to give advisory decisions for elective voluntary abortions? How will health care professionals and ethics committee members be educated at those topics? In Turkey the legal status is that voluntary abortions are permitted until ten weeks of pregnancy and protected by law.another point to consider is the real freedom of women about that type of decision. It is reported that there is some kind of difference between urban and rural areas since cultural differences are one of the factors affecting women s decisions. My personal experience belonging to my mandatory physician service in rural areas showed me the same thing. Main topic is the freedom of women s decisions about critical subjects such as reproductive health.

81 Health care personel s decision is also affected by the circumstantial factors belonging to the women. Under those conditions education of health care personel about cultural differences and developing appropriate attitude becomes crucially important. In principle everybody is against abortion but in practice people are sometimes face to face with such obstacles. A crucially important subject is, when access to reproductive health care is considered, how free a woman is when she decides really about her body or to whom she has to leave her decision socially starting with her husband. Also the other accompanying subject is how educated helath care personel are abour circumstanding issues. Applications in medicine and professional responsibilities of physicians and nurses require a network of education via ethics. Different regions in the world such as the West (U.S.A, Canada, England, Germany, etc.), China, South American countries, Taiwan, eastern Mediterranean countries have some consensus for education of ethics although different cultures dominate these societies. Literature and common web sites discuss Basic ethical concepts and ethics in Clinical Settings. Besides, How new concepts should be discussed with older professionals is another issue to be resolved in the course of education. There is an ongoing debate about health care problems as ethical issues in today s globalizing world as well as in Turkey. Since culture dependent factors are critically important, health care personnel need to be well educated about the topic. My obligatory service experiences support this. Otherwise new technologies and strategies might be applied without being efficient and without convincing results. National perspective, collaborations with international institutions, what we have done in Cerrahpaşa Medical School until now, postgraduate education will be discussed thoroughly and consensus will be sought with our valuable professionals, the physicians and nurses. Could ethics really be taught? and Could common rationales between health care personnel and patients be really reached? are the questions to be raised and investigated. REFERENCES 1. Jonsen AR. Siegler M. Winslade WJ. Clinical Ethics. A Practical Approach to Ethical Decisions in Clinical Medicine. 5th edition. Colombus. OH. McGraw-Hill Medical:2002.

82 2. Harris J. Value of Life. Istanbul, Koptagel G. Psikiyatride Haklar ve Etik Kurallar. Medikal Etik. Cilt.5. Hatemi H. Doğan H. (eds). 2003, İstanbul. s: Doğan H. Tıp Etiğinde Kliniğe Geçiş. Sağlıklı Kararlar için Pratik Bir Rehber. İstanbul Fletcher J. Introduction to Clinical Ethics. 2nd Ed.University Publishing Group. USA.1997.

83 ETHICAL WORKING ENVIRONMENT IN NURSING Leyla KHORSHID 1 1 /Ege University, Faculty of Nursing The two most common descriptors for organizational environment are culture and climate. Each organisation has an organisational climate that clearly distinguishes it from other organisations. Organisational climate is the perception of the working environment directly and indirectly and which occurs in time, and which affected behaviors of employees' in an organisation. Ethical climate is perceived as an organizational variable that can be manipulated in order to improve the health care environment, and provide the context for ethical decision making. The ethical climate influences both decision making and subsequent behavior responses to ethical dilemmas. McDaniel described an ethical environment as one in which ethical values guide behavior, including setting priorities that provide for the ethical treatment of patients. An health care organization that supports professional nursing practice provides an ethical work environment. An ethical environment address ethical problems involving patients, also is reflected in how the organization treats the staff, sets institutional goals and manages conflict. Nursing centres around the obligation to care and being sensitive to the physical and emotional needs of patients. One of the most important issues in moral decision making is an ethically sensitive environment. Ethical sensitivity and responsibility is important to nurses who provide care according to their own moral values. A poor ethical climate coupled with increased ethical sensitivity may result in moral distress. For example, conflict arises when the organization requires that costs be reduced however, the needs of patients require adequate nurse time despite the cost. An organization that supports professional nursing practice provides an ethical work environment. Today, providing nursing care is a physically demanding and intellectually challenging process delivered in contexts that are increasingly complex and fraught with ethical questions and dilemmas. Increased technological and pharmacological interventions in patient care when patient outcomes are uncertain have been linked to the escalation in moral and ethical dilemmas experienced by health care providers in care settings. Ethical conflict with hospital policy, do not advocate for patients because they fear reprisals from the institution s administration are sources of moral distress for nurses. If the organization has not developed strategies for managing conflict that arises between patients and family members, or among nurses over treatment decisions, nurses who do not advocate effectively for patients experience moral distress. In this

84 article was described the ethical working environment in nursing that enhance ethical practice and contribute to improved patient care and outcomes. Key Words: Ethical climate, nursing, organisational climate

85 ETHICAL PROBLEMS IN COMMUNICATION OF HEALTH WORKERS Prof. Dr. Olcay Çam 1 1 /Ege University, Faculty of Nursing All life is a communication and interaction event. Communication is examined in two groups as verbal and non-verbal communication. They can also be considered as parts of a whole that complement each other. The whole is a reflection of one's sense of self, individuality and existence in life. If the person carries belief as a worthwhile being in life, the one will reflect the inner integrity to the around. In fact, the behaviors and expressions of the person reflect the selfperception and the self-respect the respect of the individual,briefly the individual's self-concept. For this reason, when the person is at peace with himself, what they do and say is peaceful. Indeed, the provision of external peace is the outward reflection of the inner peace of the individual. Trusting and feeling safe are the basic components of healthy communication. It will not always be possible for every individual to feel this. This is a hard part of the situation and the job of mental health and disease specialists is to provide this to the individual. If the person is too busy with himself / herself, the person becomes to more misunderstood what happens in the environment. This determines the communication with the people who live and work together. In this context, culture is a crucial element of giving directions communication with others. Culture influences the individual's beliefs, attitudes, thinking, perception, perspective, selfevaluation to a significant degree. It is necessary to see each person evaluating it in this originality, characteristic, authenticity and uniqueness, acknowledging that the cultural background may also differ as far as the individual past of each individual. This includes that accepting other people as they are, valuing and respecting. Every behavior creates tomorrow, bearing yesterday's sign, today's influence. SAĞLIK ÇALIŞANLARININ İLETİŞİMİNDE ETİK SORUNLAR Tüm yaşam bir iletişim, etkileşim olayıdır. İletişim genel olarak sözlü ve sözsüz iletişim olarak iki grupta incelenir. Bunlar birbirini tamamlayan bir bütünün parçaları olarak da değerlendirilebilir. Bütün dediğimiz de kişinin kendisini, benliğini, yaşamda varoluşunu anlamlandırışının yansımalarıdır. Kişi yaşamda kendisinin değerli bir varlık olarak bulunduğu inancını taşıyorsa, çevresindekilere de içsel bütünlüğünü yansıtacaktır. Aslında kişinin davranışları, yapıp ettikleri, söyledikleri içsel benlik bütünlüğününki bu benlik algısını, saygısını kısaca bireyin benlik

86 kavramını yansıtır. Bu nedenle kişi kendi kendisiyle barışık ise yapıp, ettikleri söyledikleri huzur vericidir. Aslında dışsal barışın sağlanması da toplumdaki bireylerin içsel barışlarının dışa yansıyan bütünlüğüdür. Güvenmek ve kendini güvende hissetmek sağlıklı iletişimin temel bileşenidir. Bunu her zaman, her bireyin hissedebilmesi mümkün olmaz. İşin biraz da zor kısmı burasıdır ve ruh sağlığı ve hastalıkları uzmanlarının yaptıkları tüm işler bireylerde bunun sağlanması çalışmasından öte bir şey değildir. Kişi kendisi ile çok fazla meşgul ise ortamda olup bitenleri çarpık, yanlış anlamaya daha müsait hale gelir. Birlikte yaşadığı, çalıştığı insanlarla ilişkisini iletişimini bu belirler. Bu kapsamda kültür diğerleri ile iletişime yön veren önemli bir öge olmaktadır. Bireylerin inançları, tutumları, düşünceleri, algıları, bakış açısını, kendisini değerlendirişini kültür önemli düzeyde etkiler. Her bir bireyin bireysel geçmişi kadar, kültürel geçmişinin de farklılık gösterebileceğini kabul ederek, her bir insanı bu özgünlük, özellik, otantiklik ve biriciklik içinde değerlendirerek görmek gerekir. Bu diğer insanları oldukları gibi daha fazla kabul edebilmeyi, değer verebilmeyi, saygı duyabilmeyi içerir. Her davranış dünün izini, bu günün etkisini taşıyarak, yarını oluşturur.

87 THE NURSES LEGAL AND ETHICAL LIABILITIES IN TERMS OF MEDICAL APPLICATIONS Doç. Dr. Esra Akın Korhan 1 1 /İzmir Katip Çelebi University, Faculty of Health Sciences The medical application are the medical rules and applications commonly used and continue to be relevant because they were medically adopted as useful as a result of experiments. The nurses, with the healthcare professionals, carry out various medical applications in the processes of carrying on the individual s health, supporting the healing process, and making the individual gain his/her independence. The nurses legal liabilities in terms of medical applications has been determined by the rules and regulations from past to present. The Nursing Law that has been changed in 2007 is the basic resource that should be resorted to determine the nurses duties and authorities. The 4th article of the Nursing Law is the article that has been regulated in order to determine the nurses duties and authorities. In addition, the Nursing Regulations that have become valid in 2010 and 2011 are pretty important for determining the roles and authorities of nursing and have important components on behalf of our profession. Despite these important changes occurred in Nursing Law inacceptable job definitions for professional autonomy were determined and changes were experienced by difference rules and regulations that have been valid in the field of health. Thus, the place of nursing profession in medical intervention has been matter of opinion in the light of some laws, although it was bounded clearly by the members of profession. The nurses also have the ethical liabilities based upon the idea of keeping the human dignity in addition to their legal responsibilities in medical applications. The nurses ethical liabilities were determined by Nursing Code of Ethics", Ethical Principles and Ethical Values that were designed by the professional organizations at an international level. A Text entitled The Nurses Ethical Principles and Liabilities were prepared by Turkish Nurses Association on the purpose of providing guidance for the nurses ethical liabilities also in our country. Despite all, it will be meaningful to review the code of ethics the way that they will provide power of sanction at an international level and that they will guide the problems encountered in the field of clinic. In addition, it is pretty important to develop the code of ethics by considering the essential points in question also at the national level in our country.

88 AN EVALUATION RELATED TO THE HEALTH PUBLIC SERVICES IN THE CONTEXT OF RECENT COUNCIL OF STATE S DECISIONS Yrd. Doç Dr. Lale Burcu ÖNÜT 1 1 /Dokuz Eylül University, Faculty of Law Health services are closely related to many fundamental rights and freedoms, in particular to the right to life and the protection of body integrity. Personal data must be protected, equality principle must be applied, and understanding of the state of law and social state should be taken as basis in the delivery of health services. Administrative acts established to carry out health public services effectively, are reviewed through the action for annulment. A full remedy action can also be filed in cases of failed operation, late operation or no operation (service fault) of the health public service. According to the Council of State's established case-law, the existence of a severe service fault is necessary for the compensation of damages when the service is risky. However the existence of a service fault is sufficient if the care, surveillance and side interventions are not done at all or if they are not done properly. Giriş Kamu hizmeti, devlet ve diğer kamu tüzel kişilerinin toplumun genel ve ortak ihtiyaçlarını gidermek amacıyla doğrudan doğruya ifa ettiği ya da gözetim ve denetimi altında özel kişilere yaptırdığı hizmetleri olup 1, sağlık kamu hizmeti idari kamu hizmetlerinin bir alt türü arasında yer almaktadır 2. Anayasamızın sosyal ve ekonomik haklar ve ödevler başlıklı üçüncü bölümünde yer alan sağlık hizmetleri ve çevrenin korunması başlıklı 56. maddesinde, Devlet, herkesin hayatını, beden ve ruh sağlığı içinde sürdürmesini sağlamak; insan ve madde gücünde tasarruf ve verimi artırarak, işbirliğini gerçekleştirmek amacıyla sağlık kuruluşlarını tek elden planlayıp hizmet vermesini düzenler. Devlet, bu görevini kamu ve özel kesimlerdeki sağlık ve sosyal kurumlarından yararlanarak, onları denetleyerek yerine getirir. hükmü yer almaktadır. Söz konusu düzenleme ile sağlık hizmetine ilişkin olarak Devlete pozitif edim yükümlülüğü çerçevesinde görev yüklenmiştir 3. Bu görev çerçevesinde sağlık kamu 1 Anayasa Mahkemesi, T , E. 1994/43, K. 1994/42-2, RG. T , S , s. 21; SANCAKDAR Oğuz/ US Eser/ KASAPOĞLU TURHAN Mine/ ÖNÜT Lale Burcu, İdare Hukuku Teorik Çalışma Kitabı, Seçkin Yayıncılık, Ankara 2015, s.511; Kamu hizmeti kavramına ilişkin olarak ayrıca bkz. ÖZAY İl Han, Günışığında Yönetim, Filiz Kitabevi, İstanbul 2004, s ; GÜNDAY Metin, İdare Hukuku, İmaj yayınevi, Ankara 2011, s ; TAN Turgut, İdare Hukuku, Turhan Kitabevi, Ankara 2013, s ; AKYILMAZ Bahtiyar/ SEZGİNER Murat/ KAYA Cemil, Türk İdare Hukuku, Seçkin Yayıncılık, Ankara 2016, s ; GÖZLER Kemal/ KAPLAN Gürsel, İdare Hukuku Dersleri, Ekin Kitabevi Yayınları, Bursa 2016, s GÜNDAY, s. 338; TAN, s.353; SANCAKDAR/ US/ KASAPOĞLU TURHAN/ ÖNÜT, s Danıştay 8. Dairesi de bir kararında, sağlık hizmetlerinden yararlanma hakkının, ekonomik ve sosyal bir hak olduğunu, bu yönüyle kamuya ya da Anayasada geçen biçimiyle devlete belli yükümlülükler öngördüğünü,

89 hizmetinin etkili şekilde yürütülmesi amacıyla sağlık kamu kurumlarınca idari işlemler tesis edilmekte, bu işlemler yetki, şekil, sebep, konu ve amaç unsurları yönünden hukuka aykırı oldukları gerekçesiyle menfaatleri ihlal edilenler tarafından iptal davası ve tazminat bakımından da tam yargı davası yoluyla denetlenmektedir (İYUK m. 2/1 a, 2/1 b). Belirtelim ki Anayasa Mahkemesi; kamu hizmetini Devlet veya diğer kamu tüzel kişileri tarafından veya onların gözetim ve denetimleri altında, ortak gereksinimleri karşılamak ve kamu yararını sağlamak için topluma sunulmuş bulunan sürekli ve düzenli etkinlikler olarak tanımlamakta ve toplumsal yaşamın zorunlu gereksinimlerinden olan düzenlilik ve süreklilik isteyen sağlık hizmetinin de nitelikleri gereği kamu hizmeti olduğunu belirtmektedir 4. Anayasa Mahkemesi ne göre, doktorlar için getirilen mecburi hizmet yükümlülüğü, bu kişilerin almış oldukları eğitim sonucunda elde ettikleri bilgi birikimlerini ülke ihtiyaçları doğrultusunda Devlet hizmetine sunmalarını ifade etmektedir. Söz konusu mecburi hizmet yükümlülüğü, ülke ihtiyaçlarının zorunlu kıldığı alanlarda öngörülen vatandaşlık ödevi niteliğindedir ve Anayasa m. 18 de öngörüldüğü üzere zorla çalıştırma sayılamaz 5. Sağlık kamu hizmetinin kötü işlemesi, geç işlemesi veya hiç işlememesi hizmet kusuru oluşturur 6. Hizmet kusuru nedeniyle idarenin sorumluluğuna karar verilebilmesi; kusur, zarar ve kusur ile zarar arasındaki illiyet bağının varlığını gerektirmektedir 7. Anayasamızda 8 ve Devlet Memurları Kanununda 9, kamu görevlilerinin görevlerini yerine getirirken yetkilerini kullanmaları esnasında gerçekleştirdikleri kusurlu davranışlar nedeniyle zarara uğrayan kişilerin ancak idareye karşı dava Devletin bu ödevleri imzaladığı Ekonomik, Sosyal, Kültürel Haklar Sözleşmesinin de bir gereği olarak yerine getirmek ve herkesin sağlık hizmetlerinden yararlanması için gerekli tedbirleri almak, kişilerin sağlık hizmetlerinden gecikmeksizin yararlanmasını sağlamak durumunda olduğunu belirtmiştir. Danıştay 8. D., T , E. 2011/5155, K. 2011/6094 ( 4 Anayasa Mahkemesi, T , E. 2004/114, K. 2007/85, RG., T , S Anayasa Mahkemesi, T , E.2006/21, K. 2006/38, RG., T , S Hizmet kusuruna ilişkin olarak bkz. ÖZGÜLDÜR Serdar, İdarenin Hukuki Sorumluluğu ve Tam Yargı Davaları, içinde ÖZAY İl Han, Günışığında Yönetim, Filiz Kitabevi, İstanbul 2004, s ; GÜNDAY, s ; TAN, s ; SANCAKDAR/ US/ KASAPOĞLU TURHAN/ ÖNÜT, s SANCAKDAR/ US/ KASAPOĞLU TURHAN/ ÖNÜT, s Anayasamızın 40/3. maddesinde, Kişinin, Resmî görevliler tarafından vaki haksız işlemler sonucu uğradığı zarar da, kanuna göre, Devletçe tazmin edilir. Devletin sorumlu olan ilgili görevliye rücu hakkı saklıdır., 129/5. maddesinde, Memurlar ve diğer kamu görevlilerinin yetkilerini kullanırken işledikleri kusurlardan doğan tazminat davaları, kendilerine rücu edilmek kaydıyla ve kanunun gösterdiği şekil ve şartlara uygun olarak, ancak idare aleyhine açılabilir. hükmü yer almaktadır. 9 Devlet Memurları Kanununun 13/1. maddesinde, Kişiler kamu hukukuna tabi görevlerle ilgili olarak uğradıkları zararlardan dolayı bu görevleri yerine getiren personel aleyhine değil, ilgili kurum aleyhine dava açarlar Kurumun, genel hükümlere göre sorumlu personele rücu hakkı saklıdır. hükmü yer almaktadır.

90 açabileceği kabul edilmiştir 10. İdareye karşı açılan tam yargı davalarında sağlık kamu hizmeti bakımından özellik arz eden hususlar Danıştay içtihatlarında belirtilmektedir. Çalışmamızda sağlık kamu hizmetinin önemi ve temel hak ve özgürlüklerle ilişkisi dikkate alınarak öncelikle sağlık kamu hizmeti ile ilgili idari işlemler ve daha sonra sağlık kamu hizmetinde idarenin sorumluluğu ile ilgili bazı Danıştay kararları örnek olarak incelenmektedir. I. Sağlık Kamu Hizmetinde İdari İşlemler İle İlgili Danıştay Kararlarından Örnekler A. Kişisel Verilerin Korunması Özel bir hastanede muayene olmak isteyen kişinin biyometrik kimlik doğrulaması 11 yaptırmak istememesi nedeniyle hasta giriş kaydının yapılmamasına ilişkin işlem ile bu işlemin dayanağını oluşturan Sağlık Uygulama Tebliğinin biyometrik yöntemlerle kimlik doğrulaması yapılma zorunluluğunu içeren ilgili kısımlarının iptali ve yürütmesinin durdurulması istemiyle açılan davaya ilişkin olarak Danıştay, kişisel veriler ile ilgili usul ve esasların kanunla belirlenmesinin Anayasal bir zorunluluk olduğunu, dava konusu işlemlerde hukuka uyarlık bulunmadığını belirtmiş ve yürütmelerinin durdurulmasına karar vermiştir 12. Anayasada açıkça kanunla düzenlemesi öngörülen konularda idarenin doğrudan düzenleyici işlem yapması yasama yetkisinin devredilmezliği ilkesine aykırılık oluşturmaktadır. Esasen Danıştay kararına konu olan Tebliğin yasal dayanağı 5510 sayılı Sosyal Sigortalar ve Genel Sağlık Sigortası Kanununun 67/3. maddesidir 13. Ancak söz konusu düzenlemede kişisel verilerin korunmasına ilişkin usul ve esaslar düzenlenmemektedir. Söz konusu yasal düzenlemede yer alan... Biyometrik yöntemlerle kimlik doğrulaması yapılması ve/veya... ibaresinin Anayasaya aykırılığı iddiasıyla somut norm denetimi için Anayasa Mahkemesine de başvuruda bulunulmuştur. Sağlık Bakanlığı ve Bağlı Kuruluşları Tarafından Evde Sağlık Hizmetlerinin Sunulmasına Dair Yönetmelik in kayıtların tutulması başlıklı 22. maddesinde de, Hastalara ait veriler Halk Sağlığı Bilgi Sistemi çalışmaları kapsamında oluşturulan Evde Sağlık Hizmetleri Modülü kullanılarak kayıt altına 10 Ayrıntılı bilgi için bkz. GÜNDAY, s. 377; GÖZLER/ KAPLAN, s ; Hizmet kusuru, kişisel kusur ayrımı için bkz. TAN, s ; SANCAKDAR/ US/ KASAPOĞLU TURHAN/ ÖNÜT, s ; AKYILMAZ/ SEZGİNER/ KAYA, s ; GÖZLER/ KAPLAN, s Biyometrik yöntemler, ölçülebilir fizyolojik ve bireysel özellikler aracılığıyla gerçekleştirilen ve otomatik şekilde doğrulanabilen parmak izi tanıma, avuç içi tarama, el geometrisi tanıma, iris tanıma, yüz tanıma, retina tanıma, DNA tanıma gibi kimlik denetleme tekniklerini ifade etmektedir. 12 Danıştay 15. D, T , E.2014/4562 ( sayılı Sosyal Sigortalar ve Genel Sağlık Sigortası Kanununun 67/3. maddesinde, Ayrıca genel sağlık sigortalısı ve bakmakla yükümlü olduğu kişilerin sağlık hizmetlerinden ve diğer haklardan yararlanabilmeleri için sağlık hizmet sunucularına başvurduklarında acil haller hariç olmak üzere (acil hallerde ise acil halin sona ermesinden sonra); biyometrik yöntemlerle kimlik doğrulamasının yapılması ve/veya nüfus cüzdanı, sürücü belgesi, evlenme cüzdanı, pasaport veya Kurum tarafından verilen resimli sağlık kartı belgelerinden birinin gösterilmesi zorunludur hükmü yer almaktadır.

91 alınır. Evde sağlık hizmetlerini müştereken yürütmekle mükellef olan Türkiye Halk Sağlığı Kurumu ve Türkiye Kamu Hastaneleri Kurumu, kendilerine bağlı sağlık kuruluşlarının mezkûr modülü kullanmalarını sağlamak, bunun için gerekli olan düzenlemeleri ve eğitimleri yaptırmakla yükümlüdürler. hükmü yer almaktadır. Söz konusu düzenlemenin de aralarında bulunduğu hükümlerin iptali ve yürütmesinin durdurulması istemiyle açılan davaya ilişkin olarak Danıştay, kayıtların korunması bakımından idarenin bilgi güvenliği ve mahremiyeti hakkındaki mevzuat hükümlerine uyması gerektiğini belirtmekle birlikte yürütmenin durdurulması isteminin reddine karar vermiştir 14. Esasen Yönetmeliğin 26. maddesi de kişisel veriler ile ilgilidir. Söz konusu düzenlemede Evde sağlık, bakım, sosyal destek ve benzeri diğer kamu hizmetlerinin bütüncül bir anlayışla ve işbirliği içerisinde vatandaşlara sunumunun sağlanması, hizmetlerin etkinliğinin artırılması ve tekrarların önlenmesi amacıyla ilgili kamu kurum ve kuruluşları arasında, bilgi güvenliği ve mahremiyeti hakkındaki mevzuat hükümlerine riayet edilerek ve ilgili ulusal mevzuat hükümleri dikkate alınarak veri güvenliği ile korunmasına ilişkin gerekli tedbirlerin alınması koşulu ile elektronik ortamda veri paylaşımını sağlayacak entegre yazılımlar oluşturulabilir. Birinci fıkra kapsamında yapılacak işbirliğine ilişkin usul ve esaslar, ilgili bakanlıklar ve/veya belediyeler ile diğer kamu kurum ve kuruluşlarıyla yapılacak protokoller ile belirlenir. Bu protokollerde, evde bakım ve sosyal destek hizmetleri amacıyla kurulan dernek, vakıf ve benzeri kuruluşlara, talep etmeleri halinde görev verilebilir. hükmü yer almaktadır. Kararın karşı oyunda da belirtildiği üzere, yönetmeliğin dayanağını oluşturan düzenlemeler kişisel verilerin korunmasına ilişkin usul ve esasların kanunla düzenlenmesine ilişkin Anayasal güvenceyi karşılamamaktadır. Ayrıca kararın azlık oyunda, Yönetmeliğin dayanağını oluşturan düzenlemelerde kişisel verilerin paylaşılmasına imkân veren bir hükmün yer almadığı ve bu nedenle Yönetmeliğin 26/1. maddesinin yürütmesinin durdurulması gerektiği vurgulanmıştır. Kişisel verilerin korunması hem Anayasal bir zorunluluk 15, hem de uluslararası bir yükümlülüktür 16. Nitekim Danıştay İdari Dava Daireleri Genel Kurulu da 2015 tarihli kararında Devlet hastanesinde parmak izi alınmak suretiyle mesai takibi uygulamasının sonlandırılması istemiyle yapılan başvurunun reddi işleminin iptali için açılan davaya ilişkin olarak, ilgililerden kişisel veri alınması niteliğinde olan parmak izi taramasının, özel hayatın gizliliği ilkesi kapsamında olduğunu belirtmiş ve uygulamanın sınırlarını, usul ve esaslarını gösteren bir yasal dayanağın bulunmamasını 14 Danıştay 15. D., T , E. 2015/3602 ( 15 Anayasanın özel hayatın gizliği başlıklı 20. maddesinin 3. fıkrasında, Herkes, kendisiyle ilgili kişisel verilerin korunmasını isteme hakkına sahiptir. Bu hak; kişinin kendisiyle ilgili kişisel veriler hakkında bilgilendirilme, bu verilere erişme, bunların düzeltilmesini veya silinmesini talep etme ve amaçları doğrultusunda kullanılıp kullanılmadığını öğrenmeyi de kapsar. Kişisel veriler, ancak kanunda öngörülen hallerde veya kişinin açık rızasıyla işlenebilir. Kişisel verilerin korunmasına ilişkin esas ve usuller kanunla düzenlenir. hükmü yer almaktadır. 16 Kişisel veriler, Avrupa İnsan Hakları Sözleşmesinin özel ve aile hayatına saygı hakkı başlıklı 8. maddesi kapsamında yer almaktadır.

92 ve toplanan verilerin ileride başka şekilde kullanılmayacağına ilişkin bir güvencenin mevcut olmamasını dikkate alarak dava konusu işlemde hukuka uyarlık bulunmadığı sonucuna varmıştır 17. Yukarıda belirtilen kararlardan sonra, 6698 sayılı Kişisel Verilerin Korunması Kanunu 2016 da yürürlüğe girmiş 18 ve konu yasal güvenceye bağlanmıştır. B. Kazanılmış Hak Kazanılmış hak, hukuka uygun şekilde elde edilen subjektif haktır 19. Kazanılmış hakkın söz konusu olabilmesi için objektif ve genel hukuki durumun kişisel bir işlemle özel hukuki duruma dönüşmesi gerekir 20. Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğünün "Botoks-Dermal Dolgu" konulu genelgesinin iptali ve yürütmenin durdurulması istemiyle açılan davaya ilişkin olarak Danıştay İdari Dava Daireleri Genel Kurulu, sertifika sahibi hekimlerin Güzellik ve Estetik Amaçlı Sağlık Kuruluşları Hakkında Yönetmelik yürürlükte iken kazandıkları sertifikaya bağlı tıbbi işlemleri hakları çerçevesinde yapabileceklerine dair işlemde hukuka aykırılık bulunmadığını ve Danıştay 15. Dairesince verilen yürütmenin durdurulması kararının kaldırılmasına karar vermiştir 21. Güzellik ve Estetik Amaçlı Sağlık Kuruluşları Hakkında Yönetmelik, Ayakta Teşhis ve Tedavi Yapılan Özel Sağlık Kuruluşları Hakkında Yönetmelik ile yürürlükten kaldırılmıştır. Yürürlükteki Yönetmeliğin geçici 4/4. maddesinde, 39 uncu maddenin birinci fıkrasının (b) bendi ile yürürlükten kaldırılan Yönetmelikte sayılan tıbbî işlemlerin tamamı, sertifika veya buna benzer yetki belgesine dayanılarak unvanlarda, estetik veya bu anlama gelecek herhangi bir ibare kullanılmaksızın tıp mesleğini icra yetkisi sahasına göre tabip veya uzman tabiplerin tıbbi uygulaması şeklinde yürütülür. hükmü yer almaktadır. Diğer bir ifade ile sertifikalı hekimlerin, yürürlükten kaldırılan Yönetmelikte sayılan tıbbî işlemlerin tamamını yürütebileceği belirtilmiştir. C. Eşitlik İlkesi Tüp bebek tedavisinde kullanılan ilaç bedelinin ödenmemesine ilişkin işlem ile bu işlemin dayanağı olan 2005 Mali Yılı Bütçe Uygulaması Talimatının ödemeye engel oluşturan hükümlerinin iptali istemiyle açılan davaya ilişkin olarak Danıştay, dava konusu talimat hükümlerinin ve ilaç bedellerinin ödenmesine ilişkin istemin reddi yolunda tesis edilen birel 17 DİDDGK, T , E. 2014/ 2242, K. 2015/4991 ( 18 R.G., T , S SANCAKDAR/ US/ KASAPOĞLU TURHAN/ ÖNÜT, s İbid., s DİDDGK, T , E.2016/844 ( Karara konu olayda davacı dernekler, dolgu ve botoks gibi işlemlerin, uygulandığı alanla ilgili eğitim gerektiren tıbbi birer girişim olduğunu ve bu işlemlerin hekim tarafından yüz bölgesinde uygulanabilmesi için, plastik ve rekonstrüktif cerrahi ve dermatoloji uzmanlık dallarında eğitim görmüş olmak gerektiğini ileri sürmüştür.

93 işlemin hukuka aykırı olmadığına karar vermiştir 22. Danıştay ın kararına konu olan olayda davacının eşinin ilaç alım tarihinde 40 yaşını geçerek 41 yaşından 4 ay 9 gün aldığı belirtilerek eşinin tedavisine ilişkin ilaç bedelinin ödenmesi yolunda yaptığı başvuru reddedilmiştir. Ret işlemi ile dayanağı olan talimat hükümlerinin iptali ve yoksun kalınan ilaç bedelinin yasal faiziyle birlikte ödenmesi istemiyle dava açılmıştır. Dava konusu talimatta Tüp bebek işlemi, hastanın 40 yaşına kadar olan yaşam süresi içerisinde en fazla üç uygulama (siklus) olmak üzere yapılabilir. hükmü yer almaktadır. Danıştay kararında; uygulamanın bedelinin ancak olumlu sonuç alınma ihtimali yüksek kişiler bakımından ödenmesi, bilimsel olarak bu ihtimalin düşük olduğu belirlenen 40 yaş ve üstü kişiler bakımından kamu kaynaklarının riske edilmemesi, kişisel menfaat ile kamusal menfaat arasında gözetilmesi gereken adil dengenin bozulmaması, kamu kaynaklarının etkin ve verimli kullanılmasının sağlanması amacıyla, yaş sınırı getiren dava konusu talimat hükümlerinde ve bu hükümler doğrultusunda ilaç bedellerinin ödenmesine ilişkin istemin reddinde hukuka ve mevzuata aykırılık olmadığı sonucuna varmıştır. Danıştay tüp bebek uygulamasına ilişkin kararında aynı durumda olanlar arasında eşitliği ve kamu yararını dikkate almıştır 23. D. Sosyal Güvenlik Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliğinin ekinde Vagal Sinir Stimülatörü (VNS) cihazının bedelinin Kurum tarafından ödenmesi kriterleri arasında yer alan Hastaların zekâ düzeyi ağır derecede geri olmamalı şartının yürütmesinin durdurulması ve iptali istemini içeren davaya ilişkin olarak Danıştay, Anayasa'nın 17. maddesinde düzenlenen yaşam hakkının sadece yaşamı sürdürmeyi değil, sağlıklı yaşam hakkına sahip olmayı ifade ettiğini; sosyal güvenlik kuruluşları oluşturularak, kişilerin sosyal risklere karşı asgari yaşam düzeylerinin korunmasının amaçlandığını; cihazın ağır derece zekâ geriliği bulunan hastalarda nöbetlerin azalmasını sağladığı hususunun davalı idarece de ortaya konulduğunu belirtmiştir. Davaya konu düzenlemenin kamu yararına uygun olmadığını açıklayan Danıştay tebliğde yer alan şartın yürütmesinin durdurulmasına karar vermiştir 24. Koroner stent bedelinin yardımdan faydalanacakların üzerinde bırakılmasının kanuna aykırılık oluşturduğu yönündeki Danıştay İdari Dava Daireleri Genel Kurulunun kararı da sosyal devlet ilkesi açısından önemlidir Danıştay 2. D., T , E.2007/4397, K.2008/3749 ( 23 AYKIN Aykut Cemil/ÇINARLI Serkan, Sağlık Personelinin Hukuki Sorumluluğu, Seçkin Yayıncılık, Ankara 2016, s Danıştay 15. D., T , E. 2015/6475 ( 25 Danıştay kararda, ister ilaçsız, ister ilaç salınımı olsun koroner stentlerinin bedelinin ödenmesine olanak tanıyan bir düzenleme bulunmamaktadır. Bu durumun ise koroner stentlerin bedelinin tamamının tedavi yardımından faydalanacakların üzerinde bırakılmasına neden olduğu ve sonuçta 5434 sayılı Yasa'nın geçici 139. maddesine aykırılık oluşturduğu açıktır. Belirtilen durum karşısında davalı idarenin, Sağlık Bakanlığı'nın görüşünü alarak, ilaç salınımlı stentlerin tedavinin sağlanması için ilaçsız stentlerin yerine kullanılmasının

94 II. Sağlık Kamu Hizmetinde İdarenin Sorumluluğuna İlişkin Danıştay Kararlarından Örnekler A. Hastaya Bilgilendirme Yapılmaması Hasta Hakları Yönetmeliğinin üçüncü bölümünde hastanın sağlık durumu ile ilgili bilgi alma hakkı düzenlenmiştir. Down sendromu ile ilgili test hakkında yeterli bilgilendirme yapılmayan ailenin maddi ve manevi tazminat istemiyle açtığı davaya ilişkin olarak Danıştay, dosya kapsamında aydınlatmaya ilişkin belgeye rastlanmamasını dikkate alarak davacıların yeterince aydınlatılmamış olmaları nedeniyle gebeliği sonlandırma haklarının ihlâl edildiği sonucuna varmıştır. Karara konu olayda aile test sonuçları hakkında yeterince bilgilendirilmediklerini, amniosentez testi yapılması konusunda aydınlatılmadıklarını, aydınlatma yapılmış olsaydı riskleri de dikkate alarak bu testin yapılmasını isteyeceklerini, test sonucuna göre gebeliği sonlandırma haklarını kullanacaklarını ifade etmiştir. Danıştay kararında, bebeğin down sendromlu olarak dünyaya gelmesi ile doktorun uygulamaları arasında uygun illiyet bağı bulunmasa da, aydınlatma yükümlülüğünün ihlâli nedeniyle manevi tazminat ödenmesi gerektiğini açıklamıştır 26. B. Hasta Dosyasındaki Kayıtların Düzenli Tutulmaması Bel fıtığı ameliyatı sırasında omuriliğinde kitle oluştuğu ve çalışma gücünü kaybettiği iddiasıyla kişinin, idarenin hizmet kusurunu ileri sürerek maddi ve manevi tazminat istemiyle açmış olduğu davaya ilişkin olarak Danıştay, sağlık hizmetinin tıp kurallarına uygun olup olmadığı konusunda görüş bildirilebilmesi için sağlık personelinin eylemlerinin tıbbi kayıtlarla doğrulanması gerektiğini, ameliyat öncesi ve sonrası bütün tıbbi kayıtların özenle tutulmaması, belgelerin denetime sunulmak üzere saklanmaması nedeniyle sağlık hizmetinin kusurlu işletildiği sonucuna varmıştır. Danıştay kararında, sağlık hizmetlerinin bünyesinde risk taşıyan bölümünün tedavi hizmetleri olduğunu, teşhis ve tedavide hizmetin niteliği gereği doğal kabul edilebilecek hatalar dışında tedavinin tıbbi gereklere uygun olmadığına ilişkin açık ve belirgin kusurların idarenin tazmin sorumluluğunu gerektireceğini, tedavi hizmetleri dışında kalan hasta kayıtlarının tutulması ve zorunlu olduğu halleri bilimsel verilere dayalı olarak saptaması, başka bir ifadeyle, ilaçsız koroner stentlerin hangi hallerde ilaç salınımlı koroner stentlerin yerine ikame edilemeyeceğinin ortaya konulması durumunda ilaç salınımlı koroner stentlerin bedelinin kurumlarınca ödenecek bölümünü yukarıda açıklanan esaslar çerçevesinde belirleyeceği, dolayısıyla davacının ilaç salınımlı koroner stent bedelinin karşılanması yolundaki başvurusunun da buna bağlı olarak değerlendirilerek sonuçlandırılacağı açıktır. Ayrıca sağlık hizmetinin ertelenemezliğinin yanı sıra yaşam hakkı da dikkate alındığında, idarenin, belirtilen bu inceleme ve düzenlemeyi gecikmeksizin yerine getirmekle yükümlü olduğu kuşkusuzdur ifadelerine yer vermiştir. DİDDGK, T , E. 2008/798 ( 26 Danıştay 15. D., T , E. 2013/4351, K. 2015/2019; Karar için bkz. GÖKCAN Hasan Tahsin, Tıbbi Müdahaleden Doğan Hukuki ve Cezai Sorumluluk, Seçkin Yayıncılık, Ankara 2017, s

95 muhafazası şeklindeki sağlık hizmetinde ise, hizmetten yararlananlarla ilgili kayıtların eksikliğinin, tedavilerin kayıt altına alınmamasının, tetkik ve inceleme sonuçlarının saklanmamasının hizmetin kusurlu işletildiğinin kabulü için yeterli olacağını açıklamıştır 27. Nitekim Danıştay ın yerleşik içtihadına göre de, hizmetin riskli olduğu durumlarda, zararın tazmini idarenin ağır hizmet kusurunun varlığı halinde mümkün olabilmektedir 28. Riskli tıbbi müdahale ve operasyonlar bakımından ağır hizmet kusurunun varlığı gerekirken, tıbbi operasyon kapsamına dâhil edilemeyecek bakım, gözetim ve yan müdahalelerin hiç veya gereği gibi yapılmaması nedeniyle oluşan zararlarda hizmet kusurunun varlığı yeterli görülmektedir 29. Hasta kayıtlarının tutulması ve muhafazasına ilişkin hizmetler de sağlık hizmetlerinin bünyesinde risk taşıyan bölümü içerisinde yer almamaktadır. Ameliyat öncesi filmlerin saklanmaması nedeniyle hizmet kusuru çerçevesinde değerlendirme yapan Danıştay, hasta kayıtlarının düzgün tutulmaması ve hastaya ilişkin örneklerin saklanmaması nedeniyle oluşan manevi zararın tazminine karar verilmesi gerektiğini açıklamıştır 30. C. Teşhis Hatası Hatalı Parenoplastik Sendromu tanısı nedeniyle manevi tazminat istemiyle açılan davaya ilişkin kararında Danıştay; hakkında gerçekte bulguları ortaya konulmamış, vücutta tümör oluşumunun varlığına işaret eden bir tanının Sağlık Kurulu raporunda belirtilmesi nedeniyle yeni Sağlık Kurulu raporu alınıncaya kadar kısa bir süre de olsa kişinin öğrendiği ve doğruluğu varsayılan tanı nedeniyle sıkıntı ve üzüntü yaşadığını belirtmiş ve kişinin, uğradığı manevi zarara karşılık olarak manevi tatmin aracı olma niteliği dikkate alınarak zenginleşmeye yol açmayacak miktarda, ancak idarenin kusurunun niteliğini ve ağırlığını ifade edecek düzeyde manevi tazminata karar verilmesi gerektiğini açıklamıştır 31. Muayene ve tetkik yapılmadan rapor düzenlenmesi de hukuka aykırıdır. Nitekim, Danıştay 1. Dairesi bir kararında, hastaların hastaneye gelmeden sadece sağlık kurulu raporu almaları için hastaneye giriş kayıtlarının yapıldığının, hipertansiyon ve hiperkolesterolemi tanısı konularak 27 Danıştay 15. D., T , E.2014/10100, K.2015/7481; Karar için bkz. ibid, s Danıştay 10. D., T , E. 8407/6526; Karar için bkz. ibid, s ; Danıştay 15. D., T , E. 2013/3865, K. 2014/1691 ( İdarenin tazmin yükümlülüğü açısından ağır hizmet kusurunun bulunup bulunmadığı hususunun adalet işlerinde bilirkişilik görevi yapmak üzere kurulan Adli Tıp Kurumu aracılığıyla belirlenmesi gerekir. DİDDGK, T , E. 2004/721, K. 2007/2030 ( 29 Danıştay 15. D., T , E. 2013/3865, K. 2014/1691 ( Danıştay 15. D., T , E. 3990/3507, Karar için bkz. ibid, s Danıştay 15. D., T , E.2014/10100, K.2015/7481; Karar için bkz. ibid, s Danıştay 15. D., T , E. 2013/4336, K.2016/2244; Karar için bkz. ibid, s

96 sağlık kurulu raporunun düzenlendiğinin anlaşılması nedeniyle şüphelilerin TCK m. 257 (görevi kötüye kullanma) gereğince yargılanmaları gerektiğini belirtmiştir 32. D. Ameliyat Kusuru Sağlık Bakanlığına ait hastanede gerçekleştirilen ameliyat sonrasında, vücutta bir adet ameliyat pensi unutulduğundan bahisle uğranıldığı ileri sürülen maddi ve manevi zararın tazmini istemiyle açılan davaya ilişkin olarak Danıştay, idarenin ağır hizmet kusuru sonucu davacının ikinci kez ameliyat olmak zorunda kaldığını, iyileşme süresinin ikinci ameliyat nedeniyle yeniden hastanede yatırıldığı gün ve taburcu edilirken bu ameliyat nedeniyle verilen rapor süresi kadar uzadığını, evlerde gündelik temizlik işlerinde çalışan davacının elde edeceği gelirden mahrum kalması nedeniyle uğradığı maddi zararının tazmin edilmesi gerektiğini belirtmiştir. Ayrıca manevi tazminatın, duyulan elem ve ızdırabı kısmen de olsa hafifletmeyi amaçladığını, zenginleşmeye yol açmayacak şekilde ve idarenin kusurunun ağırlığını ortaya koyacak düzeyde olması gerektiğini vurgulamıştır 33. E. Hastaneye Kabul Edilmeme Danıştay 15. Dairesinin kararına konu olan olayda, bebeklerinin solunum güçlüğü çekmesi ve dudaklarındaki morarma üzerine aile Erciyes Üniversitesi Tıp Fakültesi Hastanesi acil servisine başvurmuş, burada ilk müdahale yapıldıktan sonra bebek konjenital kalp hastası ön tanısı ile yenidoğan ünitesinde yer olmadığı belirtilerek Kayseri Doğumevi Hastanesine sevk edilmiştir. Burada bebeğin durumu kötüleşince Erciyes Üniversitesi Tıp Fakültesi Hastanesine sevk edilmek istenmiştir. Ancak yer olmadığı için başta kabul edilmemiş, sonra bir hastanın taburcu edilmesi üzerine bebeğin getirilebileceği bildirilmiş, ancak aynı gün bebek ölmüştür. Aile bu ölüm olayında davalı idarelerin hizmet kusuru olduğunu ileri sürerek tazminat istemiyle dava açmıştır. Danıştay 15. Dairesi, Sağlık Bakanlığına bağlı tam teşekküllü hastanelerde EKO olmaması, teşhis koymaya yetecek imkânların bulunmaması yanında, üniversite hastanesinin yenidoğan servisinde yeterli yatak bulundurulmaması, acil durumdaki bir hasta için ısrarla aranmasına rağmen ek yatak konulması, başka servislerde yatak ayarlanması ya da kısa süreli hastalar arası yer değişimi gibi alternatif çözüm yolları aranmaksızın talebin geri çevrilmesi gibi hususlar göz önünde bulundurulduğunda, olayda doktor kusuru bulunmasa bile, ertelenemez mahiyette olan sağlık hizmetinin kuruluşunda ve işleyişindeki eksiklik ve aksaklıklar nedeniyle hizmetin gereği 32 Danıştay 1. D., T , E. 2006/647, K. 2006/1013 ( 33 Danıştay 10. D., T , E.2006/6098, K.2008 /7590 ; Karar için bkz. ibid, s

97 gibi yürütülmediği ve bu durumun da hizmet kusuru oluşturduğu sonucuna ulaşmıştır 34. Danıştay ın bu yaklaşımı benzer hukuki sorunla ilgili olarak Avrupa İnsan Hakları Mahkemesi nin Menekşe Şentürk 35 ve Asiye Genç 36 hakkında verilen kararlara da uygun gözükmektedir. SONUÇ Sağlık hizmetleri başta yaşam hakkı, beden bütünlüğünün korunması olmak üzere birçok temel hak ve özgürlükle yakından ilişkilidir. Sağlık hizmetleri alanında teknolojik gelişmelerin de etkisiyle değişkenlik ve uyarlanma ilkeleri temel hak ve özgürlükler korunarak uygulama alanı bulmalıdır. Sağlık personelinin haftalık çalışma süresinin 40 saat olarak uygulanması talebinin sağlık hizmetinin özelliği itibariyle kesintisiz olarak sunulması gerektiğinden bahisle reddedilmesi ise yerinde değildir 37. Kamu hizmetinin kesintisiz sunulması, bu hizmeti yürütenlerin de kesintisiz çalışmasını gerektirmez. Bu noktada batı standartlarına uygun bir yaklaşım sergilenmeli, sağlık personel sayısı artırılmalı, mutlaka insan haklarına uygun, bezdirici olmayan çalışma koşulları tüm sağlık çalışanlarına sunulmalıdır. Dinlenme hakkının temel bir sosyal hak olduğu dikkate alınmalıdır. Sağlık hizmetlerinin sunumunda kişisel verilerin korunması, eşitlik ilkesinin uygulanması, sosyal devlet ve hukuk devleti anlayışının esas alınması gerekmektedir. İdarenin mali sorumluluğu da hukuk devleti anlayışının bir gereğidir. Danıştay ın yerleşik içtihadına göre, hizmetin riskli olduğu durumlarda, zararın tazmini idarenin ağır hizmet kusurunun varlığı halinde mümkün olabilmektedir 38. Riskli tıbbi müdahale ve operasyonlar bakımından ağır hizmet kusurunun varlığı gerekirken, tıbbi operasyon kapsamına dâhil edilemeyecek bakım, gözetim ve yan müdahalelerin hiç veya gereği gibi yapılmaması nedeniyle oluşan zararlarda hizmet kusurunun varlığı yeterli görülmektedir 39. Hasta kayıtlarının tutulması ve muhafazasına ilişkin hizmetler de sağlık hizmetlerinin bünyesinde risk taşıyan bölümü içerisinde yer almamaktadır. Dolayısıyla bu çerçevede oluşan zararların tazmini bakımından da ağır hizmet kusuru aranmamaktadır 40. Belirtelim ki, yargı kararlarında sağlık kamu hizmetini koruyucu bir yaklaşımın hakim olması sosyal devlet ilkesi ve tüketici hakları yönünden bizce de yerinde ve olumludur. Öte yandan Türk 34 Danıştay 15. D., T , E. 2013/3865, K. 2014/1691 ( 35 AİHM 2. D., Başvuru No: 13423/09, T ( 36 AİHM 2. D., Başvuru No: 24109/07, T ( 37 Sağlık personelinin haftalık çalışma süresinin 40 saat olarak uygulanması için yapılan başvurunun zımnen reddine ilişkin işlemin iptali istemiyle açılan davanın reddine ilişkin karar Danıştay tarafından onanmıştır. Danıştay 12. D., T , E. 2003/611, K. 2006/2289 ( 38 Danıştay 10. D., T , 8407/6526; Karar için bkz. GÖKCAN, s Danıştay 15. D., T , 3990/3507, Karar için bkz. ibid, s Danıştay 15. D., T , E.2014/10100, K.2015/7481; Karar için bkz. ibid, s

98 Hukukuna girmiş olan arabuluculuk müessesesinin bu alana belli koşullarla ve açık yasal düzenlemelerle sirayet ettirilebilmesinin yararlı olabileceği, kanısındayız. KAYNAKÇA AKYILMAZ Bahtiyar/ SEZGİNER Murat/ KAYA Cemil, Türk İdare Hukuku, Seçkin Yayıncılık, Ankara AYKIN Aykut Cemil/ ÇINARLI Serkan, Sağlık Personelinin Hukuki Sorumluluğu, Seçkin Yayıncılık, Ankara GÖKCAN Hasan Tahsin, Tıbbi Müdahaleden Doğan Hukuki ve Cezai Sorumluluk, Seçkin Yayıncılık, Ankara GÖZLER Kemal/ KAPLAN Gürsel, İdare Hukuku Dersleri, Ekin Kitabevi Yayınları, Bursa GÜNDAY Metin, İdare Hukuku, İmaj yayınevi, Ankara ÖZAY İl Han, Günışığında Yönetim, Filiz Kitabevi, İstanbul ÖZGÜLDÜR Serdar, İdarenin Hukuki Sorumluluğu ve Tam Yargı Davaları, içinde ÖZAY İl Han, Günışığında Yönetim, Filiz Kitabevi, İstanbul SANCAKDAR Oğuz/ US Eser/ KASAPOĞLU TURHAN Mine/ ÖNÜT Lale Burcu, İdare Hukuku Teorik Çalışma Kitabı, Seçkin Yayıncılık, Ankara TAN Turgut, İdare Hukuku, Turhan Kitabevi, Ankara Anayasa Mahkemesi Kararları Anayasa Mahkemesi, T , E. 1994/43, K. 1994/42-2, RG. T , S Anayasa Mahkemesi, T , E.2006/21, K. 2006/38, RG., T , S Anayasa Mahkemesi, T , E. 2004/114, K. 2007/85, RG., T , S Avrupa İnsan Hakları Mahkemesi Kararları AİHM 2. D., Başvuru No: 13423/09, T AİHM 2. D., Başvuru No: 24109/07, T Danıştay Kararları Danıştay 12. D., T , E. 2003/611, K. 2006/2289. Danıştay 1. D., T , E. 2006/647, K. 2006/1013. DİDDGK, T , E. 2004/721, K. 2007/2030. Danıştay 10. D., T , 8407/6526. DİDDGK, T , E. 2008/798.

99 Danıştay 2. D., T , E. 2007/4397, K. 2008/3749. Danıştay 10. D., T , E.2006/6098, K.2008/7590. Danıştay 8. D., T , E. 2011/5155, K. 2011/6094. Danıştay 15. D., T , E. 2013/3865, K. 2014/1691. Danıştay 15. D., T , 3990/3507. Danıştay 15. D, T , E. 2014/4562. Danıştay 15. D., T , E.2013/4351, K.2015/2019. Danıştay 15. D., T , E.2015/3602. Danıştay 15. D., T , E.2014/10100, K.2015/7481. DİDDGK, T , E.2014/ 2242, K.2015/4991. Danıştay 15. D., T , E.2013/4336, K.2016/2244. Danıştay 15. D., T , E.2015/6475. DİDDGK, T , E.2016/844.

100 ORAL PRESENTATIONS

101 [OP-1] THE DEVELOPMENT AND DEFINING OF PROFESSIONAL VALUES MODEL IN NURSING Ayla Kaya¹, İlkay Boz¹ ¹ Akdeniz University, Faculty of Nursing Aim: One of the most important criteria for professionalism is accumulation of knowledge able to be used in practice. Creation of knowledge basis that can be put into practice is the main principle of all professional disciplines. Nursing models and theories are important elements of accumulating nursing knowledge. Using these elements in practice plays an important role in professionalization of nursing. In recent years, there has been an increase in use of models in nursing research and newly created terminology has started to be used in nursing. Use of models in nursing research and discussions about model development are exciting professional developments. In this study, a new model, Professional Values Model developed by authors was described. Concepts comprising the conceptual framework of the model and relations between the concepts were explained. It is assumed that awareness about concepts of the model will increase patients satisfaction with nursing care, nurses job satisfaction and quality of nursing care. Methods: Extant, contemporary literature has been reviewed and synthesized to develop this theoretical paper on Professional Values Model in nursing. Results: Having high values in nursing increases job satisfaction, which results in improvement of patient care and satisfaction. In addition, individual characteristics are effective in determination of individual needs, priorities and values. This relation, proved through research about Professional Values Model, has been explained. With development of these concepts, individuals satisfaction with care and nurses job satisfaction will be enhanced, which will increase the quality of nursing care. Conclusion: Testing the PVM will contribute to its improvement. The model is suitable for manager nurses. Therefore, it was thought that implementation of the model by manager nurses can increase motivation of nurses they work with. It is suggested that guidance of this model be taken in the motivation enhancement studies of the manager nurses. Key Words: Nursing values, nurses job satisfaction, patient satisfaction, professional values model

102 [OP-2] CORE CONCEPT IN NURSING: CARE Nadiye Barış Eren¹, Remziye Cici¹ ¹ Hitit University Health College Nursing Nurse is the person who participates in, deals with, makes an effort for, improves, and manages care. Care is acknowledged as a core concept in the applied discipline of nursing. In the care process, nurses should be aware of their moral responsibilities and develop an attentive and respectful attitude by empathizing patients needs. Nursing care is a reliable, high quality, holistic, ethical, cooperative, individualised and interpersonal care process which is planned and designed according to the best evidence-based knowledge. Positive outcomes of the care process are the optimization of health, management of symptoms, or facilitation of a peaceful death. Perception of care and providing care might depend on the situation. For instance, while the care priority of a person who has pain is to take the right medicine, at right time and in right doses; the care priority of a person who is in terminal period or long-term hospitalised is a reliable care provider with whom s/he can share fears, expectations and hopes and feel comfortable. When the patient with pain has a stable medical condition, s/he may have a different care need. Therefore, nurses should be sensitive about the dynamic and rapidly changing care needs. Besides, nurses and patients care perceptions could have some striking and important differences. To Hamington, care ethics deals with a contextual structure that can be understood by internalising care. Besides, it adopts an approach that involves personal and social ethicalness. Care ethics considers individuals relational, mutually dependent and vulnerable. Nurses take care of the needs of people they are responsible for and approach them with such emotions as sympathy, empathy and responsibility. An individual is assessed through a moral approach that involves social network and environment and the related factors. Key Words: Care, care ethics, patient, nurse

103 [OP-3] RELATIONSHIP BETWEEN FOOT CARE BEHAVIORS AND SOME METABOLIC PARAMETERS IN GERIATRIC INDIVIDUALS DIAGNOSED WITH DIABETES MELLITUS Özlem Ovayolu¹, Nimet Ovayolu¹, Sümeyra Mihrap İlter² ¹ Department of Nursing, Faculty of Health Sciences, Gaziantep University, Gaziantep, Turkey. ² Gaziantep Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey Aim: This study was performed to evaluate foot care behaviors of geriatric individuals diagnosed with diabetes mellitus and to examine relationship between foot care behaviors and some metabolic parameters. Methods: This study was conducted in an Educational and Research Hospital between 01/02/2017 and 04/07/2017. It was approved from the Ethics Committee of Gaziantep University. Informed consent was obtained from the patients before beginning the study. Patients who were diagnosed with diabetes mellitus, who had no mental retardation, who had no a visual or hearing impairment at advanced level, who were able to speak Turkish, who had no bilateral foot amputation, who accepted to participate in the study, and who had an MMSE score of 24 or higher were included in the study. 61 patients were enrolled in the study based on the power analysis. Some laboratory results were obtained from medical records. In order to collect the data of the study, we used a questionnaire containing information on sociodemographic characteristics, diabetes mellitus, and its complications. The Diabetes Foot Self-Care Behavior Scale was also administered to the patients. This scale consists of 15 items on a 5-point Likert scale and does not include subscale. The lowest possible score was 15 and the highest possible score was 75. The findings of the study were evaluated by the Student s t-test, one-way ANOVA and correlation analysis in computer environment. P <0.05 was considered statistically significant. Results: Of the patients participating in the study, 65.2% were between the ages of and 56.3% were female. 80.7% had any illness other than diabetes mellitus, and 30.4% of these patients were hypertensive. 57.0% received diabetes training, and 84.5% of these trainings were given by nurses and physicians. 56.3% had previously undergone a foot examination, and 63.2% of these examinations were performed by physicians. The mean HbA1c level was %8.42. The mean fasting blood glucose was mg/dl. The mean score on the Diabetes Foot Self-Care Behavior Scale was As the mean scores for HbA1c level, fasting blood glucose level, waist

104 circumference, BMI, and triglyceride level increased, the mean score on the Diabetes Foot Self- Care Behavior Scale decreased. Conclusion: This study found that there was a relationship between some metabolic parameters and the mean score on the Diabetes Foot Self-Care Behavior Scale in geriatric individuals. It was also determined that the mean score on the Diabetes Foot Self-Care Behavior Scale decreased in patients whose metabolic control was not sufficient. Therefore, it may be advisable to educate patients and their relatives in order to provide metabolic control and to prevent complications. Key Words: Geriatrics, diabetic foot, metabolic control, nursing

105 [OP-4] PATIENT ADVOCACY ROLE OF NURSES: AGANIST PHYSICIAN S FAULTY DECISION Yakup Gökhan Doğramacı¹'² ¹ Gaziemir Nevvar Salih İşgören Public Hospital ² Medipol University, Institue of Social Sciences Aim: Evaluation of the patient advocacy role of nurses by judicial case example in the United States, our national legislation and ethic codes. Methods: Koeniguer v Eckrich (422 N.W.2d 600) case will be examined in the role of patient advocacy for nurses in the Supreme Court of South Dakota in And then the relevant articles will be examined in the Nursing Law and Nursing Regulation. Results: Patient Advocacy goals: To foster partnerships between patients, families and healthcare professionals. To help patients and families cope better with the complexities of the healthcare system. To provide information about the patient s diagnosis, treatment, prognosis and choices, and to suggest alternatives. To promote acceptance of the informed choice of the patient. To safeguard the interests, values and rights of patients to make decisions that affect their lives. To develop a sense of control and positive self-concept among patients. To ensure safety, quality of care and a better quality of life for patients. To achieve social justice by confronting inappropriate rules or policies in the healthcare system Conclusion: Nurses have a responsibility to advocate for the rights, values, wellbeing and best interests of patients. The role of patient advocacy is not clearly regulated, but we understand from the ethic codes and legislations. Key Words: Patient advocacy, nurse, healthcare

106 [OP-5] THE NURSE'S ROLE ON ETHICS COMMITTEES Nadiye Barış Eren ¹, Handan Eren² ¹ Hitit University Health College Nursing ² Karamanoglu Mehmetbey University Health Sciences Faculty A number of problems are often experienced in health care facilities. In such cases, ethical committees are activated. Hospital ethics committees play a leading role in resolving ethical dilemmas in patient care. Members of the hospital ethics committee are composed of a president, a legal counsel, a representative from the nursing department, a member of the general administration of the hospital, a counselor in the name of the community, a patient advocate, a patient's doctor, a psychiatrist, a social services specialist, and a consultant. Patients' willingness to autonomy has led to the establishment of these committees. The nurse undertakes the advocacy of the patients. Besides, the nurse can contribute to the function of organizing training programs and making written sources, counseling and producing policies aiming to "sensitize patients, families, health personnel to ethical issues". The nurse, who is in constant contact with the patient and his family, faces ethical problems in practice. It is dominated by nursing and bioethics, it also respects the different moral aspects of patients and other health professionals. The nurse makes decisions about patient benefit using appropriate communication skills. The nurse puts out the official way by sharing his observations on ethics committees. Finally, it may be suggested that the nurse in the ethics committee gain some positive qualities in order to take an active role in the decision-making process. The nurse with moral integrity does not insist on a single opinion, but rather creates an atmosphere of mutual respect and logical thinking. Sensitive, compassionate, and thoughtful nurses perceive the conditions, behaviors, and emotions of others. A responsible nurse understands the issues from a humanistic point of view and acts effectively in resolving them. The nurse, patient and willing to give counseling, supports the patient, family and other health care workers by creating a safe environment. Key Words: Ethics committee, nurse, patient, nurse s role

107 [OP-6] NURSING AND ETHICS: TWEET OR NOT TWEET? Nedime Gül Dogan¹, Cansu Karadeniz¹, Ayşe Metin¹, Özen Kulakaç¹ ¹ Ondokuz Mayıs University, Faculty of Health Sciences The computer and internet usage rates of Turkish Statistical Institute in August-2016 were 54, 9% and 61% respectively in the age groups in April 2016 (TUİK, 2016). When considering the use of social media tools in the health environment, it is said to be that social media provides an environment and opportunity for health professionals to explore, listen and interact (McNab, 2009). At the Istanbul University (2008), 70.2% of the nurses stated that they use internet in professional matters (Kaya et al., 2008). On the other hand examples such as the nurse E.G, who shares a photo in the social media with the title A Tiny Picture from Those Who Nearing Dead, exemplify the abuse of social media. In many countries, professional organizations have published guidelines on the ethical use of social media. In Turkey, nurses need to create a social media guide to reduce or prevent the negative consequences of using the Internet and social media. This study examined seven social media usage guides that were searched through the databases of Web of Science, Google Scholar, CINAHL, and Science Direct, and a guidebook was prepared accordingly. The aim of this study is to give information regarding the social media usage guides for the nurses in the developed countries and to draw attention of our colleagues about working on creating a guide in Turkey. In this review, three of the scenarios located within the examined media usage guidelines were included in the study and conclusions and recommendations were made for them. The recommendations and conclusions were supported by the ethical codes used by the nursing law and regulations in Turkey and by the Turkish Nurses Association. Key Words: Nursing, social media, social media usage guideline

108 [OP-7] DETERMINATION THE OPINIONS OF PHARMACEUTICAL TECHNICIANS ON PATIENT RIGHTS AND ETHICAL PRINCIPLES Rahşan Çevik Akyıl 1, Neşe Erdem 1, Ayşegül Kahraman Aksoy 1, Gülengün Türk 1 ¹ Adnan Menderes University, Faculty of Nursing Amaç: Bu çalışma eczacı teknikerlerinin hasta hakları ve etik ilkelere ilişkin görüşlerinin belirlenmesi amacıyla tanımlayıcı olarak yapılmıştır. Methods: Araştırmanın evrenini ve örneklemini; Adnan Menderes Üniversitesi Sürekli Eğitim Merkezi (ADÜSEM) in düzenlediği Eczacı Teknikerleri Eğitimi ne katılan 63 birey oluşturmuştur. Bulgular: Katılımcıların %60.3 ü erkek, %47.6 sı mesleğinden çok memnun, %76.2 si hasta haklarıyla ilgili eğitim almış, %64.7 si eğitimi hizmet içi eğitimler ile almış, %50.8 i Türkiye de hastaların haklarını savunamadığını, %54 ü haklarını alamadığını düşünüyor. Katılımcıların %76.2 si sağlık personelinin görev/ünvanları hakkında bilgi isteyebileceğini, %96.8 i kayıtların gizli tutulması gerektiğini, %71.4 ü başkasının dosyasını inceleme hakkının olmadığını, %47.6 sı hastanın bilgilerini açıklayan sağlık personeline hapis cezası verilebileceğini, %84.1 i sağlık personelinden sır saklamasını isteyebileceğini, %82.5 i herhangi bir tıbbi müdahaleden önce izin alınması gerektiğini, %44.4 ü hayati tehlike varsa tıbbi müdahaleden vazgeçebileceğini, %87.3 ü müdahaleden önce hastaların bilgilendirilmesi gerektiğini, %63.5 i hastaların ötenazi hakkının olmadığını, %61.9 u sağlık durumları ile ilgili dosya/kayıtları inceleme haklarının olduğunu, %50.8 i tedavisi ile doğrudan ilgili olmayan personelin bulunmasının hastanın rızasına bağlı olduğunu, %69.8 i hastaların can-mal güvenliği için gerekli tedbirlerin hastane yönetimi tarafından alınması gerektiğini, %98.4 ü sağlık personelinin güler yüzlü davranmak zorunda olduğunu, %81 i refakatçi hakkı olduğunu, %81 i hasta haklarının ihlalinde sağlık personelinin bağlı olduğu kuruma tazminat davası açılabileceğini, %77.8 i hasta ve yakınlarının hasta hakları konusunda eğitim alması gerektiğini, %93.7 si hasta hakları için yönlendirileceği birim olması gerektiğini, %85.7 si hasta hakları yönetmeliğinde hastanın uyması gereken kurallar bulunduğunu, %54 ü Bakanlığın izni ve kendi rızası bulunmadan eğitim amaçlı tıbbi müdahalede bulunulamayacağını belirtmektedir. Katılımcıların %95.2 si etik kelimesinin anlamını bildiklerini, %58.7 si Etik ve Ahlakın aynı şey olmadığını, %44.4 ü hastaya nasıl yaklaşması gerektiği konusunda sıklıkla çelişki yaşamadığını, 88.9 u % hastaya karşı dürüst olmanın önemli olduğunu,

109 88.9 u bilgiyi sorgulamadan sakladığını, %82.5 i tek bir ilacı tanıdığı için saklamayacağını, %98.4 ü ilacın nasıl kullanılacağını açıklayacağını belirtmişlerdir. Sonuç: Katılımcıların çoğunluğunun hasta hakları ile ilgili eğitim aldıkları, yarısının Türkiye de hastaların haklarını savunamadığı ve alamadığını düşündükleri, çoğunluğunun hasta ve yakınlarının hasta hakları ile ilgili eğitim almaları gerektiğini düşündükleri, tamamına yakınının etik kelimesinin anlamını bildikleri ve çoğunluğunun olaylara etik açıdan baktıkları belirlenmiştir. Key Words: Parmaceutical technicians, patient rights, ethical principles

110 [OP-8] AN ETHICAL EVALUATION OVER THE THIN LINE BETWEEN LIFE AND DEATH Nuray Demirci Gungordu¹, Cagatay Ustun² ¹ Recep Tayyip Erdogan University, Health College Nursing ² Ege University, Faculty of Medicine Recent developments in the medical world related to the value and meaning of life have led to the emergence of different perspectives. Conceptions which regard life as individual s own personal right have paved the way for euthanasia which is described as taking one s own life. It is necessary to stand against the euthanasia approaches that are especially in demand in the Western culture. Giving initiative to individual himself to take his/her own life which is one of the basic personal rights may result in some problems. There are many examples of how right to life is perceived by a second person in the world and in our country. In our notice, we will examine the medical story of V.K from an ethical and moral point. Shortly, he was treated in intensive care unit of a training and research hospital after having got diagnosed Subarachnoid Hemorrhage because of an accident. After the treatment, the medical staff intended to discharge him from hospital by deciding that there was nothing more to do but his wife insisted on her husband s being followed in neurosurgery clinic during 13 months. Key Words: Ethical, euthanasia, death

111 [OP-9] TELENURSING IN HEALTH SERVICES: LEGAL AND ETHICAL DIRECTIONS USING OF NEW TECHNOLOGY Öznur Erbay¹, Öznur Usta Yeşilbalkan¹ ¹ Ege Üniversitesi Hemşirelik Fakültesi Hemşirelerin teletıp alanındaki planlama, tasarlama ve uygulamada dikkate almaları gereken hukuki ve etik sorunları incelemektir. GİRİŞ: Teletıp kullanımı teknolojinin gelişmesiyle birlikte kullanımı günden güne artmasına rağmen, onu çevreleyen etik ve yasal konular yeterince ele alınmamaktadır. Uygulamalarda karşılaşılan sorunların artışı bu konuların gündeme gelmesini zorunlu hale getirmiştir. Teletıp hizmetlerinindeki bazı belirsizlikler, hastayla olan iletişim güçlükleri ve yetersiz kaynaklar sebebiyle alanda özellikle hemşireler sorunlar yaşamaktadır. Tıpta geçerli olan etik kurallar, teletıpta birebir uygulanma açısından problem yaratmaktadır. Hemşirelerin bu alanla ilgili hukuki ve etik konuları ele alması ve konuyla ilgili bilgilendirilmesi çok önemlidir. Teletıp alanında hastanın gizliliği, onamı ve zarar vermeme gibi etik ilkeler temel ilkeleri oluşturmaktadır. Ancak teletıp alanının verimsiz ve etkisiz kullanılmasındaki artışla birlikte öngörülemeyen tıbbi ve yasal konuların ortaya çıkabileceği konusunda bazı uyarılar yapılmıştır. Brahams a göre bu sorunlar 3 başlık altında özetlenmiştir; -Sağlık profesyonellerinin sorumlulukları ve potansiyel yükümlülükleri; -Hasta bilgilerinin gizliliğini ve mahremiyetini koruma yükümlülüğü; -Sınır ötesi konsültasyonlarla ilgili yargı sorunları. Telehemşirelik uygulamalarında hasta ile hemşire arasında fiziksel temasın olmaması mesleğin doğasına aykırı düşmektedir. Telehemşirelik ile ilgili etik sorunların birçoğu, sağlık alanında gerçekleşen yüz yüze iletişimin aksini çevrelemektedir. Teletıp ve telehemşirelik uygulamalarının entegrasyonu ve geliştirilmesi, hükümetlerin ve sağlık kuruluşlarının titiz politikalar, prosedürler ve stratejiler geliştirmelerini gerektirir. Teknoloji ile ilgili ekipmanın çalıştırılması ve bakımı, açık prosedürlerin ve güvenlik kodlarının oluşturulması, hasta mahremiyetinin korunması ve kayıtların güvenliği bu alanda önemli bir yere sahiptir. Hemşirelerin, bu alanının belirli bir hasta için uygun olup olmadığını belirlerken dikkate alınması gereken faktörler vardır. Bunlar, hastanın hastalık süreci, stabilitesi, fonksiyonel kısıtlamaları, hastanın evindeki altyapı ve genel olarak konut koşulları, hastanın zihinsel durumu, sisteme karşı tutumu ve bilgilendirilmiş onam verme konusundaki istekliliği ve destek mekanizmaları gibi konulardır. Hemşireler sanal ziyaret türünü bunları göz önünde bulundurarak gerçekleştirmelidir. Her hasta, kendi sorunlarına göre değerlendirilmeli ve bu alanda tıbbı hizmet almaya uygun olup olmadığı araştırılmalıdır. Key Words: telehemşirelik, etik, teletıp

112 [OP-10] GENE TECHNOLOGY AND ITS ETHICAL DIMENSION Gamze Göke Arslan¹, Şebnem Çınar Yücel¹ ¹ Ege University, Faculty of Nursing Today, gene technology is used every field of life from diagnosis of diseases to new food sources and reproduction of endangered animals. Studies being conducted in the field of gene technology determine the susceptibility to more than 3000 genetic diseases which cannot be treated, make the diagnosis and treatment of these diseases possible by discovering the locations and structures of the related genes and make genetic corrections. The idea of reproducing better, smarter, healthier, taller people goes back to Plato. In gene technology, the discovery of the human gene map and the manipulation of genomes leading to permanent changes in human nature has brought about many ethical issues. Of these ethical issues, the leading ones are as follows: how making the diagnosis of genetic illnesses before the illness occurs would affect the person,his/her perception of the future, how right and ethical it is to tell a person in advance that he/she has a fatal disease in terms of his/her right to life, methods such as gene therapy and cloning do not contribute to improvement of the health quality of the whole society but enable only a group of people to benefit from these therapies, whether the genetically programmed person or the gene designer has the ethical responsibility for that person s life,whether having an unlimited intelligence and a retentive memory will always lead to positive results for the person who has these characteristics. That nurses who have an important place among health professionals are knowledgeable about this issue, that they provide genetic counseling services and that they specialize in this newly emerging field of science are expected to facilitate nurses making ethical decisions. It is recommended to make necessary legal arrangements considering human benefit by evaluating studies carried out on genetics from a scientific perspective and in terms of ethical values. Key Words: Gene technology, nursing, ethic

113 [OP-11] LOCATION IN AN EVIDENCE-BASED ETHICAL ROLE IN CHILDHOOD DISORDERS Ramazan İnci¹, Ahmet Erol ² ¹ Batman University, Health of High School ² Ege University, Faculty of Nursing Aim: The effort shown to be evidence-based for all nursing practices in and out of the hospital is seen as a factor to increase the quality of care and treatment in nursing practice. Scientific studies in the field of nursing in Turkey mostly come out among the nurses academicians. The purpose of these research studies is to provide a basis for evidence-based applications and to ensure that clinical practice is based on a sound foundation. Evidence-based applications are the most sophisticated solution to eliminate "ethical" problems and to avoid them. Patients with chronic illnesses are much more vulnerable to care and treatment. Chronic diseases; Periodic support and care should be given to such illnesses, which are difficult to treat with medical interventions and are included in fear-anxieties such as constant sadness, depression, family separation and fear of death. Nevertheless, care must be taken to ensure that all the applications are done in a professional manner and that they are not made in the wrong place. Methods: This study was conducted with 120 nurses who agreed to participate in the research in two university hospitals (Malatya, Elazıg) in Eastern Anatolia Region with a face-to-face interview method, which was conducted between November 2015 and January Results: It was determined that the average age of the nurses participating in the study was 30.5, 88% of them were university graduates, 82% of them were women, and nursing experiences were 7.2 years. In this study it was determined that 12% of the nurses knew what the blood-based practice was, 33% had previously received information on blood-based practice, and 20% could describe the results of the KDU. It was determined that the majority of the nurses did not follow the current information and publications, and 80% did not make an explanation for it. Conclusion: Made works; Demonstrates that they have not been used in combination with previous scientific studies and clinical expertise of these evidence-based data, and that they do not have enough knowledge about them. For this reason, it may be suggested that each of the nurses examine the studies related to their specific areas and take the necessary continuous special training courses. Key Words: Chronic disorder, ethic, evidence

114 [OP-12] NURSES' KNOWLEDGE, ATTITUDE AND PRACTICES TOWARDS PHYSICAL RESTRAINTS Ahmet Göktaş¹, Kadriye Buldukoğlu¹ ¹ Akdeniz University Faculty of Health Sciences, Department of Nursing Aim: This study was carried out to identify nurses knowledge, attitudes and practices regarding the use of physical restraint in psychiatric settings. Methods: This decriptive study was conducted in seven Psychiatric Hospitals between May and October 2015 in Turkey. In the study, it was tried to reach whole population without any sampling, and completed with 304 nurses (%62.8). Data were collected with Level of Knowledge Attitudes and Practices of Staff Regarding Physical Restraints Questionaire and Questionaire Form and assessed by SPSS program using descriptive statistics, T test, Nonparametric tests and Kolmogorov-Smirnov normality test. Results: It was determined that knowledge of the nurses about the complications of using physical restraint was lacking and majority of nurses (%65.8) did not use alternative methods to physical restraints. Nurses mean knowledge, atttitudes and practice scores regarding the use of physical restraints were determined respectively 7.75±1.27, 27.29±4.12 and 38.58±2.61. The mean knowledge score of nurses who did not use physical restraints (p=0.031) had higher scores statisticly than others. The mean attitudes score of nurses whose age was between (p=0.044), who was bachelor (p=0.026), and who did not use physical restraints (p=0.034) had higher scores statisticly than others. The mean practice score of women (p=0.005) and nurses who had over 10 years clinical experices (p=0.03) had higher scores statisticly than others. Conclusion: It was identified nurses knowledge levels regarding physical restraints were good, attitudes were negative and practices was about excellent. It was suggested to hold comprehensive and practical training programs promoting nurses knowledge, attitudes and practices towards physical restraints for nurses because of these conclusions Key Words: Psychiatric nursing, psychiatric setting, physical restraint practice

115 [OP-13] DETERMINATION OF THE MORAL SENSITIVITY OF HEALTH CARE PROVIDERS IN EMERGENCY DEPARTMENTS Aslı Aydoğan¹, Özlem Ceyhan² ¹ Amasya University, Sabuncuoğlu Şerefeddin Health Services Vocational School. ² Erciyes University, Faculty of Health Sciences Aim: This study was conducted as cross-sectional to determine moral sensitivities of health care providers who are working in emergency departments. Methods: The extent of the study is composed of 402 health care providers (doctor, nurse, health officer, midwife, emergency medical technician, paramedic, anesthesia technician) working at emergency departments of public hospitals and private hospitals in the center of Kayseri city. The study is completed with 259 health care providers reached at the hospitals for which the permission to conduct the study was granted. Data of research were collected by using questionnaire form and Moral Sensitivity Questionnaire form. In the comparison of two groups are performed by Mann-Whitney U test, more than two groups comparisons with Kruskal-Wallis analysis and multiple comparisons with Dunn test. Results: It was detected that 54.1% health care providers who are working at emergency services, live ethical dilemmas, 45.7% live ethical dilemmas in the treatment applications, 54.3% faced with the ethical dilemma in the early years of the profession, 38.6% stated that with ethical dilemma approach According to the patients doing the most beneficial things, 67.2% received training on ethics and also was observed that health care providers moral sensitivities were improved who joined the trainings as seminars and courses. Female health care providers moral sensitivity level was found high who chose voluntarily to the profession of female health care providers and profession working time 11 years and more. In addition, it was observed that the institutions affected to the their staffs moral sensitivity level (p<0.05). Conclusion: Depending on the results of the study, suggestions were made for the inclusion to plan comprehensive and continuous trainings to the health care providers working at emergency departments to develop their moral sensitivity levels and these trainings should be applied. Key Words: Emergency department, moral sensitivity, health care provider

116 [OP-14] EXAMINING THE ATTITUDES OF THE PATIENTS AT A UNIVERSITY HOSPITAL TOWARDS USING PATIENT RIGHTS Ayşe Aslı Oktay¹, Filiz Taş¹, Merve Gülpak¹, Fadime Yel² ¹ Kahramanmaras Sutcu Imam University School of Health, Department of Nursing ² Bartin University School of Health, Department of Nursing Aim: It is expected that patients have adequate knowledge on Patient Rights defined by the relevant regulations, and show sensitive attitudes and behaviors in using their rights. This study was planned to determine the attitudes of patients towards their rights mentioned in Patient Rights Regulation. Methods: The study was planned in the Descriptive Design, and was conducted between the dates April 2017-June patients, who were hospitalized in Kahramanmaraş Sütçü Imam University, Healthcare Practice and Research Hospital, and who volunteered and met the inclusion criteria, were included in the study. The data of the study were collected with the Introductory Information Form and the Patient Rights Use Attitude Scale(PRUAS).The Definitive Statistics, the t-test, and the variance analysis were used in the analyses of the data. Results: 46.3% of the participants of the study were female, and 53.7% were male. The mean age of the participants was 51.5±17.5.It was determined that the average score received by the patients from the scale was 122.0±14.8.The average scores of the patients who stated that they knew that they had information on Patient Rights, and knew that there were Patient Rights Departments in hospitals were higher, and the difference was found to be statistically significant. When the total average scores of the patients were compared with the clinic where they were treated, it was determined that the attitudes of the patients being treated in Internal Diseases Clinics towards using Patient Rights were found to be higher at a statistically significant level than those who were being treated in Surgery Clinics(p=0.03). Conclusion: It was observed in the present study that the scores received by the patients from the PRUAS were high, and therefore, it was concluded that the patients developed attitudes on using Patient Rights. It was also determined that having information on Patient Rights was extremely influential on the attitudes developed by patients. Key Words: Nursing, patient, patient rights

117 [OP-15] NURSING AND ETHICAL SENSITIVITY IN APPROACH TO PATIENTS IN TURKEY: LITERATURE REVIEW Berna Kurt 1, Sevgisun Kapucu 1 1 Hacettepe University, Faculty of Nursing Ethics, which examines the moral dimension of whether the values in the center of interpersonal relationships are good or bad and true or false, is closely related to nursing profession which provides holistichealthcare services to healthy or sick individuals and their families. Nurses, who provide holistic healthcare to patients and their families, may encounter ethical dilemmas conflicting with their own or patients values during healthcare process. Nurses should act and behave without harming both patient psychology and their own personal values, to cope effectively with these value conflict situations. The purpose of this literature review is to determine the relationship between ethical sensitivity and nursing, and also identify the relevant potential problems. This literature study, which was conducted to determine ethical sensitivity aspect of nursing profession, has made inquiries with 3 keywords using Turkish National Thesis Center. These key words are 'ethics', 'nursing' and 'ethical sensitivity'. The criteria for inclusion in the study consist of being master thesis and doctoral dissertation studies, which includes relevant subjects on nursing and ethical sensitivity and were conducted between 2006 and As a result of the keyword search, nine out 398 articles were selected in accordance with the criteria and included in the study. The data collection tools in these studies were examined in terms their methods and results, and the common points among them were revealed. Based on this, it is aimed to reveal the issues that may be a research question/problem for researches to be carried out in the future. The research data in the majority of these studies had been collected using the Personal Information Form (PIF) and the Moral Sensitivity Questionnaire (MSQ). The total sample of these studies consisted of 1421 nurses. Ithas been found in these studiesthatmore than half of the nurses had a working experience in the range of 1 to 5 years, 67% of them have received ethical training and values education, and 54% had an experience of more ethical dilemma in the first years of professional life. It has been determined that nurses mostly put religious valueson/near the top in their value preference order. It has been observed that the ethical sensitivities of female healthcareprofessionals who voluntarily choose their profession and have been in the profession for more than 10 years have a high ethical sensitivity, and also found that education status is influential on the ethical principles of autonomy and benefit

118 provision. In conclusion, these studies are similar to each other in terms of content, method and results. It is suggested to conduct studies with more samples. Key Words: Nursing, ethical sensivity, petient

119 [OP-16] PRACTICES IN HUMAN DIGNITY IN PALLIATIVE CARE: A QUALITATIVE STUDY Esra Akın Korhan¹, Çağatay Üstün², Derya Uzelli Yılmaz¹ ¹ Izmir Katip Çelebi University Faculty of Health Sciences ² Ege University Faculty of Medicine Aim: The objective of the study was to determine the views and experiences of nurses and doctors based on their human dignity approaches in the ethical area of palliative care. Methods: In-depth semi-structured interviews were conducted with nine nurses and five doctors with human dignity experiences in palliative care, and a qualitative Colaizzi method of analysis was performed. Results: Following the analysis of the data, the statements made by the nurses and doctors during the interviews were grouped under nine categories. Nine clusters of themes were identified. Consistent with the questionnaire format, nine themes and 43 subthemes of responses were determined describing the human dignity of the nurse and physicians. Conclusion: The results of the study showed that in some of the decisions and practices of the nurses and doctors relating to their patients when giving medical care to palliative care patients, while they displayed ethically sensitive behaviour, on some points they showed approaches which violated human dignity and showed lack of awareness of ethical, medical and social responsibilities. Key Words: Palliative Care, human dignity experiences, qualitative study

120 [OP-17] ETHICAL APPROACH TO THE VULNERABLE Ece Kurt¹, Ayten Zaybak¹ ¹ Ege University Faculty of Nursing Aim: Vulnerability is defined as a state of needing help to fulfill basic functions, having a condition that inhibits communication with others, inability to protect from attacks, bad behavior and abuse. Methods: The present study covers some ethical dilemmas faced by nurses offering care for individuals in the vulnerable group. Results: In our society; nurses offering care for individuals in the vulnerable groups such as women, immigrants, minorities, soldiers, the handicapped, the unemployed, disaster victims, marked individuals and terminal period patients may encounter various ethical dilemmas. Some examples of this ethical dilemma in the care of terminal period patients may include such decisions as carrying out palliative practices instead of curative treatment at the hospital or at home, finalizing life support treatments, directive of non-resuscitation, spiritual support, practices of analgesia and passive euthanasia. In psychiatric patients, problems in obtaining informed consent may cause ethical dilemmas while in individuals with contagious diseases, some unethical approaches may occur such as condemning, isolation, avoiding consultancy and unwilling caring. It is also controversial whether to inform families of some health problems experienced by the adolescent. As a fundamental part of the health care team, the nurse has such responsibilities as protecting patient rights, respecting individual values and beliefs, following ethical principles, informing patients, helping with decision making, being their voice when necessary, protecting from side effects of treatments and preserving privacy. These responsibilities are taken within the role of patient advocacy. Conclusion: Occupational codes and principles of ethics have a significant role in the solution of dilemmas in the care of vulnerable groups. In order to make the right decisions for patients when that fail to do so, these principles and codes must be known in detail, a bias-free and professional approach must be adopted. Key Words: Vulnerable, nursing, ethic

121 [OP-18] ETHICAL RESPONSIBILITIES OF NURSES Gülay Çelik¹, Aliye Demirok¹, Emel Top¹ ¹ Bingöl University Faculty of Health Sciences Aim: There has been a number of questions about value that led to the advance of ethics in the field of health with the advancement of medicine and science together with technology. These problems are also on the agenda in the field of nursing. Knowing ethical responsibilities of nurses is of great importance in terms of adhering to ethical principles while carrying out professional practices. The purpose of this compilation is to present the ethical responsibilities of the nurses. Methods: After the screening of the subject; Full-text Turkish and foreign articles, book chapters were used to prepare this review in the literature. Results: Ethics is defined as a group of ethical principles or a group of values that governs the behavior of a person or profession as a word (Kutlay ve Yılmazlar, 2001). Responsibility is that one undertakes the consequences of an event that falls within the scope of his or her behavior or authority (Potter and Perry, 2010). Nurses are responsible for the professional functions involved in their legal duties, powers and responsibilities and should bear the responsibilities they have. These responsibilities have been determined by the Turkish Nurses Association (THD) in the context of 'ethical principles and responsibilities for nurses'. The nurse has ethical responsibilities to the individual, the family and the community, the profession, the profession and the healthcare team. The primary responsibility of the nurse is to care for the individual, the family and the community. Nurses also have occupational responsibilities in maintaining occupational prestige, improving professional practice standards, sharing knowledge and experiences, maintaining and upgrading professional competence to provide quality care, preparing appropriate learning environments for students and strengthening professional organization (THD). Conclusion: It is crucial that nurses who are in the caregiver role are aware of their ethical responsibilities towards the caregiver and profession. This should also provide training on ethical responsibilities as it is important in terms of respect for the profession and maintenance and improvement of the quality of care. Key Words: Ethical responsibilities, ethic, nursing.

122 [OP-19] THE RELATIONSHIP BETWEEN CARE DEPENDENCY LEVEL AND SATISFACTION WITH NURSING CARE OF NEUROLOGICAL PATIENTS IN TURKEY Esin Kavuran¹, Nihan Türkoğlu¹ ¹ Atatürk University Nursing Faculty Aim: This study was carried out to determine the relationship between care dependency level and satisfaction with nursing care of neurology patients in Turkey.Care dependency has been described as: The Professional support to a patient whose self-care abilities have decreased and whose care demands make him/her to a certain degree dependent. The aim of the support is to restore the patient s independency in performing self care. Nursing care is one of the major health care services that contribute significantly to the patient healing process. Patient satisfaction is often determined by the nursing care in any health setup.nurses should help their patients use their self-care abilities to become independent again. Methods: This was a cross-sectional study was conducted in A descriptive survey was administered to a convenience sample of 204 neurology patients. Data were collected from June to August The study population consisted of all patients admitted to Ataturk University Hospital. Research data were collected via a questionnaire and Care Dependency Scale and Newcastle Scale of Satisfaction with Nursing. Results: It was determined that 39.7 % of patients are in the age group of years and most of the patients are male (55.4%), married (79.1%), literate-primary school graduates (83.3%), 44.1% of the patients lived with their wife/husband and children, 33.8% of them supported their wife/husband. 32.8% were obliged to look after their wife and children and 73.5% of the patients stayed in hospital between 1-7 days. No statistically significant difference was found between average scores of care dependency and patients gender and health problem (p> 0.05). Conclusion: There was a positive correlation between Care Dependency and Newcastle Scale of Satisfaction with Nursing of neurology patients. Key Words: Care dependency level, satisfaction with nursing care, neurological patients

123 [OP-20] PROFESSIONAL VALUES OF NURSING STUDENTS AND PERCEPTIONS OF CARE ATTITUDES Gülengün Türk¹, Filiz Adana 1, Rahşan Çevik Akyıl 1, Nihal Taşkıran¹, Emel Top¹ ¹ Adnan Menderes University, Faculty of Nursing Aim: This study was conducted as a descriptive study to determine the professional values and perception of caring behaviors of nursing students. Methods: The sample of the study consisted of 343 third and fourth grade nursing students who agreed to participate in the study year In the collection of data, Student Identification Form, Nursing Professional Values Scale and Caring Behaviors Inventory-24 (CBI-24) were used. Results: The mean age of the student nurses included in the study was ± 1.43 and 72.6% were female. 29.7% of the students stated that they give care to the average of two patients in clinical practice, 41.1% of them spent minutes on average, and 42% of them had the most oral care. It was determined that Caring Behaviors Inventory-24 total mean score of the student nurses is 5.10 ± It was found that mean score of the sub-dimensions of the inventory is 5.12 ± 0.78 for assurance dimension, 5.11 ± 0.82 for being respectful dimension, 5.10±0.82 for knowledge and skill dimension and 5.04 ± 0.83 for connetedness dimension, respectively. The highest score of the students in the Professional Values Scale is 130, the lowest 26, and the mean score is ± A positive moderate level correlation was found between the total score of the total score of the Professional Value Scale and total score of caring behaviors inventory- 24 and the sub-dimensions of inventory which are assurance, knowledge and skill, being respectful and connectedness. Conclusion: The concluded that student nurses' professional values and perception of caring behaviors was higher and professional values increased with the increasing the perception of caring behaviors. Key Words: Professional values, nursing, students

124 [OP-21] THE PERSPECTIVE OF NURSES TOWARDS OBESE PATIENTS AND THEIR CARE Ezgi Yıldız¹, Şerife Karagözoğlu² ¹ Cumhuriyet University Suşehri Health College Nursing ² Cumhuriyet University Faculty of Health Sciences Aim: The research was conducted in a descriptive design to assess the perspective of nurses towards obese patients and their care. Methods: The sample of the study consists of 215 volunteer nurses working in internal, surgical, pediatric, emergency and intensive care units in a university hospital between 1 June and 30 July and undertaking the care of obese patient who has spent at least one day in these clinics. Ethics Committee Decision, written permission from the hospital administration, informed consent from the participantswere obtained. The research data were collected through a Personal Information and Questionnaire Form consisting of 22 questions. The data were evaluated in the SPSS 22.0 for Windows, and the percentage calculations and the Chi-square significance test were used in data analysis. Results: 65.6% of the nurses are in age range of years, 68.8% are women, 76.3% havebachelor s degree, 74.4% love their profession and 45.1% are working in profession between 0-5 years % of the nurses regarded obese patients asgluttons, 20.46% said these patients were pretty, 54.9% wanted to give obesity care, but 68.8% said they would not give priority for these patients if they had a choice. More than half of thenurses stated that the age of obese patients (63.3%) and their consciousness (53.5%) had no effect on their desire for caregiving, and 73.3% of nurses who thought otherwisenoted that they were more willing to care for conscious patients. 91.6% of the nurses stated they have difficulty while caring obese patients, 73.5% while giving emergencyintervention for obese patients, 23.7% while positioning the patientin bed, and 20.55% while trying to prevent the formation of bedsore. When comparing the level of education of nurses, the level of knowledge of high school graduate nurses about obesity and accompanying chronic diseases was found to be statistically lower than other nurses (p<0.05), but 40.0% of all nurses in the study noted that they provided training to obese patients about their diseases and nutrition.

125 Conclusion: In accordance with the research findings, it can be said that nurses do not make discriminations between patients while giving professional care, do not have enough knowledge about obesity and its management and do not want to give care to obese patients because of the difficulties they have experienced. In this context, it is suggested that the knowledge and sensitivity of the nurses towards obesity concept and obese patients should be increased by various in-service training programs and activities. Key Words: Key Words: Nurse, obese patient, care

126 [OP-22] ETHICAL ISSUES AND CASE REPORT IN TERMINAL FAMILY- CENTERED HOME CARE Fatma Birgili¹ ¹ Muğla Sıtkı Koçman University Faculty of Health Sciences The change in the age structure of society and increasing life expectancy lead to the prolongation of the time spent with non-contagious diseases. In a study conducted in the United States, in case of Alzheimer's disease, the sixth most common cause of death, it was found that the average life expectancy can be prolonged from 3 years to 12 years after the disease is diagnosed (Mitchell, 2015). Health needs are defined as inadequacies and deficiencies related to health requiring health care at all levels from health improvement to terminal care, as not only determined by health professionals, but also perceived by the individual (WHO, 2016). Terminal care refers to health care and support services given during the period surrounding the death (National Institute on Aging, 2010). These services have become increasingly widespread over the past several decades under the heading of hospice or palliative care. Patient care in the terminal period is of great concern to the patients' relatives; so families participate in the terminal care of their patients and may have difficulty in cooperating with the health team. The main goal in family-centered home care is to minimize the anxiety by helping patients and their relatives during the terminal period. The home-care nurse; using the nursing process, enables the provision of long-term, comprehensive and family-centered care by assessing the strengths and weaknesses of the family, their coping behaviors, communication patterns, the quality of the relationship between the patient and the family, his/her place in the family and the resources they can access. With this review, family-centered palliative care at home as well as ethical issues specific to home care will be discussed with a case report. Key Words: Family-centered home care, palliative care, ethical issues, bedbound patient

127 [OP-23] RELATIONSHIP BETWEEN NURSES PERCEPTIONS OF CONSCIENCE AND PERCEPTIONS OF INDIVIDUALIZED NURSING CARE Gülay Yıldırım¹, Nurdan Kaya¹, Nermin Altunbaş¹ ¹ Cumhuriyet University, Faculty of Medicine Aim: Conscience is regarded as an important value since it improves nurses moral awareness while giving healthcare and guides them while offering high-quality care. Increasing value conflicts make personal conscientious approaches important, and thus studies to determine the place of conscience in healthcare practices are gaining importance. Objective: To determine the relationship between the perception of conscience and individualized nursing care. Methods: The sample of this descriptive, cross-sectional study included 326 nurses working in state and University Hospitals. Data were collected with the Nurse Information Form, Perceptions of Conscience Questionnaire(PCQ) and Individualized Care Scale-A-Nurse Version(ICSA-Nurse). To evaluate the data, statistical criteria such as arithmetic means, standard deviation, frequency, percentage distribution were used. Besides, if parametric test assumptions were met, the t test/variance analysis and correlation coefficient, if not, the chi square test was used. Statistical significance level was accepted as p<0.05. Before the research was conducted, approvals from the ethics committee and hospitals and informed consent from the participants were obtained. Results: The participants mean age was 31.38±6.75(Min=21, Max=58). Of them, 40.8% had 10 years of employment and 51.5% worked in internal-medicine clinics. Their mean score for the ICSA-Nurse was 3.96±0.72(Min=1, Max=5). Their mean scores for the subscales of the PCQ were as follows: Voice of Conscience: 39.11±6.27(Min=11-Max=48), Primary Characteristics of Conscience: 22.18±4.33(Min=5-Max=30), Strict of Conscience: 4.89±2.48(Min=2-Max=12) and Misleading Conscience: 3.69±1.40(Min=1, Max=6). There was a statistically significant positive correlation between their scores for the ICSA-Nurse and Voice of Conscience (r=0.174; p=0.002) and Primary Characteristics of Conscience (r=0.268;p=0.000). Conclusion: The participants were more aware of care behaviors supporting individuals' individuality but less aware of care behaviors aimed at supporting individuals' habits, beliefs and cultural characteristis of daily life. The participants considered their conscience as a reference when performing their care actions and defined conscience as an expression of social and spiritual values.

128 Key Words: Conscience, care, nursing [OP-24] AN ETHICAL PROBLEM: MISSED NURSING CARE Gülbanu Zencir¹ ¹ Pamukkale University, Faculty of Health Sciences When ethics is defined as "good or bad evaluation of human attitudes and behaviors", the attitudes and behaviors of the nurses "to do their job well and not to cause harmful consequences while they are doing their job" are the basic principle of the profession. In accordance with this principle, the care must be fully and completely maintained by the nurses as a requirement of their responsibility, the individuals should leave from the health organisation by providing benefits without being harmed. The "care giving" was the first role defined for nurses in the literature. The nurse provides benefits the patient by supplying the vital requirements that individual can not achieve during his/her illness. In a "care" work which is based on an unequal power relationship, the individual entrusts his/herself to the self-care taker. This situation, that gives an ethical responsibility to the nurses, should be combined with professional knowledge-skill and reflected to patient care. However, it is reported that nurses do not fulfill the care of individuals under their responsibilities for reasons arising from different situations and routine negligences related to care is an important problem. The term of "missed nursing care (MNC)" is defined as "partly/completely delaying or neglecting required patient care". Nine themes (ambulation, turning, feeding, patient education, hygiene etc.) and seven other themes which cause these themes (decrease in number of staff and inappropriate use, inadequate time, "this is not my business" approach, inappropriate delegation, habits, denial) were determined for MNC. Although the MNC is an awared of/accepted care problem for the nurses, they are reported to be unexplained, ignored, undesirable, and non-agenda problems unless asked to them. The healthcare service which is opened to the market with the structural reforms, increased nursing schools and student quotas together with the quality of the nursing education set the appropriate stage for MNC. Rather than a patient/individual care-based approach, the dominance of cost-effectiveness-based care suggests that the frequency of MNC will increase further.

129 It is the "indispensable" responsibility of nurses to provide qualified nursing care services to those in need. Regardless of the cause, every missed nursing care affects the prognosis of the individual and the disease negatively. It is important that to consider the ethical violations frequently attributed to physicians or the system in the nursing literature as an ethical problem via MNC in the nursing mosque and treat as professional responsibility. Key Words: Care, ethical violation, missed nursing care

130 [OP-25] INVESTIGATION OF THE VALIDITY AND RELIABILITY OF THE TURKISH VERSION OF THE SPIRITUAL CARE NEEDS INVENTORY Ayten Zaybak¹, Elif Günay İsmailoğlu¹, Handan Özdemir¹, Ahmet Erol¹ ¹ Ege Üniversity Nursing Faculty Aim: Determining the spiritual care needs of patients is thought to be effective on the patients participation in the care while they are given care, the perception of the importance of the holistic approach and the improvement of the quality of care. In this sense, this methodological study was conducted to determine the validity and reliability of the Turkish version of the Spiritual Care Needs Inventory (SCNI). Methods: The study population consisted of year-old patients who were admitted to a university hospital between February and May 2017, and agreed to participate in the study. To collect the study data, the Personal Information Form and SCNI" were used. In the validity study of the ınventory, the content validity index was used to assess the language equivalence, content validity, and expert opinion. In the reliability study of the Inventory, to determine the internal consistency of the scale, Cronbach's alpha coefficient calculations, item analysis and semi-test reliabilitymethods were used.the SCNI developed by Wu et al. in 2015 is a 5-point Likert type scale and consists of 21 items. The scale consists of two components: "meaning and hope" and "caring and respect". Results:The mean age of the patients participating in the study was 48.9 ± Of them, 55% were female, and 45% were primary school graduates. At the end of the study, the item factor loads of SCNI were found to range between 0.59 and The internal consistency coefficient was calculated separately for each subscale and the Cronbach alpha value was determined as for the "meaning and hope" subscale and 0.90 for the "respect and respect" subscale. Conclusion: It can be said that the SCNI is a measurement tool with high validity and reliability and that the inventory can be used safely to determine patients' spiritual care needs. Key Words: Spiritual care, nursing, ethical

131 [OP-26] NECESSITY OF HOSPICE IN TURKEY IN TERMS OF ROUTINE NURSING PRACTICE Nadide Embel 1, Nuray Demirci Güngördü 2, Çağatay Üstün 3 ¹ John Hopkins Anadolu Medical Centre 2 Recep Tayyip Erdogan University School of Health, Department of Nursing 3 Ege University, Faculty of Medicine The management of patients thought to be in the last period of their illness due to a chronic illness and a hopeless prognosis is carried out by hospice in many countries. Since the set-up of hospice in our country is not yet available, the care and management of such patients is carried out in hospitals, intensive care units, oncology clinics or home care services. In this context, many of the patients are hospitalized unnecessarily in hospitals or they die at home through lack of adequate medical and psychological support to the patients and their relatives. The necessity of establishing a separate care system for the more rational use of resources limited not only for all terminal period patients but also for cancer patients under the favour of the necessary infrastructure arrangements in Turkey has been emphasized in studies. In another study carried out in our country, it has been stated that the planning of patient treatment for the hospice practice or for the only terminal period patients in special care units reduces the health expenditures, increases the patient and patient relatives satisfaction, increases the medical expenses in the current intensive care conditions of the terminal patients, decreases the satisfaction of the patients and their relatives and also that the limited number of intensive care inpatient bed availability is further restricted and support for the intensive care needs of patients due to treatable diseases can not be provided. It is stated that, together with the necessary legal regulations, the setting up of palliative care units or hospice systems, and the more rational use of limited resources are important for both patient and patient relatives satisfaction. It is stated that the patients who are expected to be in the terminal period should be treated in the hospice environment and their palliative care should be provided through physicians, nurses, caregivers and health care teams; these principles are necessity, vitality and a legal obligation in our country. According to the Regulation on Home Care Services Presentation, by Ministry of Health, published in the Official Gazette dated and numbered 25751, there is not any article enabling home care services to be given in hospice which is a kind of health institution. In addition, there are currently no structures in our country that can be characterized as hospice except for a few private institutions that provide home support services and limited number of

132 palliative treatment units. The statement presented in the Lisbon Declaration (1981) Every patient has the right to die in dignity and the phrase stated by the World Medical Associaton in 1995 at Bali, Indonesia meeting The patients have the right to be cared properly and have the right to die in dignity in the last period of their lives. emphasize that the patient must get medical care and attention at a high level in the death process included in life. Death is a part of life. In this context, it is every human being s right to die in dignity. In our report, we will try to reveal the necessity of hospice in Turkey within routine nursing practices and we will try to examine this situation from ethical and moral point. Key Words: Nursing, terminal period, ethics, hospice, Turkey

133 [OP-27] PSYCHOMETRIC EVALUATION OF THE CARING BEHAVIOURS INVENTORY IN A SAMPLE OF TURKISH NURSES AND PATIENTS Şenay Gül¹, Leyla Dinç¹ ¹ Hacettepe University, Faculty of Nursing Aim: Since nursing care has a significant impact on health outcomes, there is need for instruments to measure nurses caring behaviours from the perspectives of care provider and receiver. Most instruments developed specifically to measure caring and nurse caring behaviours need to be assessed for utility in in different cultural contexts. The purpose of this study was to adapt The Caring Behaviours Inventory (CBI-42) into Turkish and evaluate its psychometric properties in a sample of 356 nurses and 363 patients. Methods: A methodological design was used. The instrument was translated into Turkish and content validity was established by a committee of experts. Construct validity was assessed using confirmatory factor analysis and exploratory factor analysis. Results: Confirmatory factor analysis indicated a poor fit. Exploratory factor analysis identified 30 items that could be categorized under three factors. The three factors of the Revised Turkish Caring Behaviour Inventory-30 included: respectful deference to other, professional knowledge and attitude, and assurance of human presence. Cronbach s α for the overall revised inventory was 0.97 for nurses and 0.99 for patients. Cronbach s α for the three factors ranged 0.91~0.99 among nurses and patients. Test-retest scores were higher than 0.90 for each item of the revised inventory. Conclusion: Results provide evidence of the original inventory s content validity and confirm the construct validity and reliability of the shortened Turkish version of the inventory with three factors and it is suitable to measure nurse caring among Turkish nurses and patients. Further studies to cross validate the Revised Caring Behaviour Inventory-30 is recommended. Key Words: Caring Behaviours Inventory, psychometric properties, nursing care, nurses, patients, instrument validation

134 [OP-28] INVESTIGATION OF NURSES AND PATIENTS PERCEPTIONS REGARDING NURSING CARE Şenay Gül¹, Leyla Dinç¹ ¹ Hacettepe University Faculty of Nursing Aim: Care is a phenomenon that has not only cognitive and technical skills, but has affective, subjective and ethical dimensions. The satisfaction of patients is used as a criterion in many hospitals to measure the nurse caring behaviors. So the patient's perception regarding nurse caring behaviors is largely associated with patients satisfaction. It is also important for nurses to develop a consciousness about their own perception regarding nurse caring behaviors that have a positive impact on their practice and increase the patients satisfaction. For this reason, it is necessary to show how nurses and patients perceive nursing care. This descriptive study was carried out order to investigate nurses and patients perceptions regarding nursing care. Methods: The participants were 140 patients and 140 nurses who provided care to those patients. The data were collected using Identification Form and Caring Behaviors Inventory-30. Participants in the study were voluntary and based on patients ability to give informed consent. Ethical clearance was secured from Hacettepe University Non-Interventional Clinical Researches Ethics Board. Results: It was determined that Caring Behaviors Inventory-30 total average of score of patients and nurses were high. It was found out that patients and nurses perceived nursing care positively and no difference were found between the nursing care behaviors and nurses perceptions of the two groups. Patients regarded nurses as respectful of others, having professional knowledge and skills and also accessible for individuals. While the perceptions of care by nurses are positive, nurses have emphasized that there are many factors that affect quality care in the negative direction. Nurses are among the factors that affect care negatively; the number of nurses is low, the workload is high and the number of patients is high as the main factors. Conclusion: Good nurses behavior has a positive effect on patient satisfaction and their care in every hospital. Further research is needed, however, to generate more knowledge on the relationship between caring behaviors, patient outcomes, and nurses. Key Words: Nursing care, ethical, caring behaviors

135 [OP-29] LEVELS OF TENDENCY IN MALPRACTICE AMONG NURSES WORKING IN MARMARIS PRIVATE AHU HOSPITAL Fatma Birgili¹, Meral Ekinci², Aysu Ak Tuncel² ¹ Muğla Sıtkı Koçman University Faculty of Health Sciences ² Private Ahu Hospital Aim: This study aims to determine the level the factors that affect medical error proneness among nurses. Methods: Sample of the descriptive and analytic study was composed of 44 voluntary nurses employed in a the Private Ahu Hospital in Marmaris / Muğla between May-June 2017 Malpractice Trend Scale in Nursing developed by Özata and Altunkan (2010) and Nurse Identification Form were used as data collection tools in the study. Descriptive data of the study was analyzed for percentages and averages and Kruskal Wallis and Mann-Whitney U tests were utilized in data analysis. Results: The mean age of the nurses participating in the study was ± 9.70, the mean age of the study was 8.09 ± 7.71, 77.3% were women and 68.2% were high school graduates. It has been determined that all of the nurses are trained against medical errors. Mean score for the scale was found to be ±11.57 and total scores for sub scales Medicine and Transfusion Practices, Hospital Infections, Patient Monitoring and Material Safety, Falls and Communication were determined to be 86.47±4.49, 58.20±3.17, 42.34±3.10, 24.25±1.42 and 23.86±2.04 respectively. There was a statistically significant difference between the trends of medical malpractice according to the number of nurses working clinics and clinics (p<0.05), however no meaningful difference was determined for educational status factor (p>0.05). Conclusion: As a result of this study, it was determined that the level of medical malpractice tendency of the nurses was low and the low number of nurses working in the clinic was low, increasing the tendency to medical malpractice. Key Words: Medical errors, medical error tendency, nurse, related factors

136 [OP-30] COMPARISON OF ETHICAL DECISION MAKING LEVELS OF NURSES WITH THEIR PROFESSIONAL BEHAVIORS Mağfiret Kaşıkçı¹, Bahar Çiftçi¹, Emrah Ay¹ ¹ Atatürk Üniversity, Nursing Faculty Aim: The study was conducted to investigate the relationship between ethical decision making levels and professional behaviors of nurses. Methods: The study population consisted of 153 Bachelor's degree nurses working in Ataturk University Research Hospital between May and August The sample of the study consisted of 72 nurses who met the inclusion criteria and selected by simple random sampling method among the probabilistic sampling methods. The data were collected by the researchers through face-to-face interviews with nurses using the "Behavioral Inventory Related to Professionalism in Nursing" and "Nursing Ethical Dilemma Test" after making necessary explanations at the relevant hospital. The data were evaluated by frequency, percentage calculations, mean, standard deviation and Pearson correlation analysis. Results: According to research findings, it was determined that 63.9% of the nurses was working for 1-5 years, 54.2% was years old, 84.7% was female and 88.9% was service nurse. The level of professionalism (3.90±1.66) of the nurses was found to be lower than the average; however, the principal thinking (45.73±6.29) and practical thinking (23.11±3.82) levels of the nurses were found to be higher than the average. Nurses were found to be familiar with similar situations of dilemmas (16.54±2.24). In addition, no correlation was found between nurses' professional behaviors and the level of ethical decision making (r= ) (p>0.05). Conclusion: It was found that nurses had moderate decision making skills in the face of ethical dilemmas, that they were familiar with ethical dilemmas, and that there was no correlation between nurses' professional behaviors and ethical decision making levels. In order to increase the ethical decision making skills of nurses, it is recommended to improve the courses and trainings about ethical decision making in the nursing education curriculum and to support the ethical decision making powers of the working nurses through in-service training. Key Words: Nursing, Ethical decision making, Professionalism

137 [OP-31] EVALUATION OF THE STATUS OF ETHICAL VALUES OF NURSES IN A STATE HOSPITAL IN IZMIR Begüm Es, Nurgül Güngör ¹ Celal Bayar University Health Sciences Institute Aim: Ethics includes values and ideals. (Berkelely&Ludlow, 2008:9). Ethical evaluation, that are happening or past events conditions processes, focused on the ethical dimension, take an analytical approach; that is, concrete situations in which ethical principles and rules which determine refers to realized or potential ethical issues on the agenda of (Kadıoğlu, 2007: 86-88). There are ethical codes of the nursing profession, and this Code of ethics and in accordance with their colleagues, subordinates and superiors are expected to behave ethically towards both their patients and their relatives both self. The purpose of this study nurses ' ethical values, susceptibility to examine the status. Methods: The descriptive type of research in the north of Izmir Menemen public hospital affiliated with the Union and working in a government hospital after receiving the necessary legal permissions written and verbal meanings are taken with 113 nurses who agree to participate in the research was conducted. Collected data on socio-demographic form developed by the and Mr. Kaya 5-point likert type consists of 16 items, susceptibility and ethical values scale was used. Scale of three sub-fields consists of. Love and respect sub-area 8 from the item justice, honesty sub-area 5 items, collaboration, sub-area 3 consists of items collected all the items and the scale total score is calculated. The scores obtained from the scale of increasing susceptibility to ethical values is increasing. 16 to be taken from the scale the lowest score the highest score is 80. Validity and reliability of the scale cronbach α value of 0.90 and reviewed Mr. Kaya. For this study, cronbach α value of 0.84 tour. The data SPSS 16.0 program using frequency, percentage, average, standard deviation, t-test, Mann Whitney U and kruskal Wallis tests were used. Results: Nurses the average age of 37,4± 9,05%. Women % 92,9 and %52.2 undergraduate. The task with an average of 16.6 years ± 10,4 as were found. Nurses are the scale of sub-groups the mean score; an average of 30.5± 2,6 (Min=26, Max= 36) points in the bottom area of love and respect and justice, honesty sub-space points, an average of 17,0± 3,5 (Min=9, Max=24), cooperation in the sub-points of the area, an average of 10.6± 2,3 (Min= 6, max= 15). Ethical values nurses susceptibility scale total score 58,2± 6,8 ( Min=47, Max=71). Ethical values nurses susceptibility scale scores and age, gender, year of study, work, service, and level of education was observed a statistically significant difference between (p>0.05). However, the ones with the

138 College of nurses and graduate graduation high school and associate degree graduates than those of cooperation and ethical values, it is revealed that the total score is high susceptibility scale. Again, The and 37 under the age of nurses, years of experience, persons who are 16 years and under age 37, 17 years and over and those who have over a year of work, according to love, respect, justice and honesty and it will make no significant difference in the total score determined that there is not a high level. Conclusion: Nurses have a predisposition to ethical values, to be obtained from points slightly above the average of the scale. The nurses ' age, years of experience and training decreases as the level of susceptibility to ethical values is increasing at a level that will not create a significant difference. Key Words: Nursing, ethical values

139 [OP-32] A STUDY OF THE ETHICAL SENSITIVITY OF NURSES Bilgi Gulseven Karabacak¹, Ünzile Taşkın¹, Fatma Öz¹ ¹ Marmara University Faculty of Health Sciences, Department of Nursing Aim: The study was conducted to identify sensitivity of the nurses to ethical issues and to examine the factors that affect them in descriptive and cross-sectional manner. Methods: The population of the research was formed by all the nurses working in a public hospital in Istanbul between December 2012 and May A sample selection was not made in the research. It was targeted to reach the entire population. 123 nurses we were able to reach and who agreed to participate in the study, formed the sample. Personal Information Form and Moral Sensitivity Questionnaire-MSQ were respectively used for data collection. The collected data were evaluated using descriptive statistical methods (frequency, percentage, mean) and Mann-Whitey U and Kruskal Wallis H tests were applied in the comparison of the data. Results: The MSQ scores were 94.14±27.55 in average. The mean scores of the subscales of MSQ were found 19.0 ± 8.46 for the autonomy subscale, 13.1 ± 4.95 for the beneficence subscale, 13.9 ± 6.09 for the holistic approach subscale, 12.9 ± 3.95 for the conflict subscale, 13.2 ± 4.68 for the practice subscale and 9.74 ± 5.72 for the orientation subscale. When MSQ scores were compared according to demographic characteristics, these significant differences were determined; in the practice subscale according to the age group (X2=7.13, p<0.05) and marital status of the nurses (Z=-2.19, p<0.05), in the holistic approach subscale according to the gender (Z=-2.30, p<0.05), in the orientation subscale according to the education levels (X2=0.39, p<0.05), in the autonomy (x2=12.01, p<0.001) and the holistic approach subscales (X2=7.72, p<0.05) according to the working clinic. Conclusion: It was concluded that the ethical sensitivities of the nurses were moderate, the ethical sensitivity increased in parallel with the age and education level, higher in women, married and surgical nurses. Key Words: Ethics, ethical sensitivity, nursing

140 [OP-33] EXAMINATION OF ETHICAL SENSITIVITY OF NURSES IN INTERNAL CLINICS: AN EXAMPLE OF UNIVERSITY HOSPITAL Dilek Yılmaz 1, Fatma Düzgün 2,, Derya Uzelli Yılmaz 3, Esra Akın Korhan 3, Yurdanur Dikmen 4, 1 Uludag University, Faculty of Health Sciences 2 Uludag University, Health Practice and Research Center Hospital 3 Izmir Katip Celebi University, Faculty of Health Sciences 4 Sakarya University, Faculty of Health Sciences Aim: The aim of this study is to examine the ethical sensitivities of nurses working in internal clinics and the variables that affect them. Methods: This descriptive and cross-sectional study was conducted in the internal clinics of a university hospital. The sample of the research was composed of 100 nurses who could be reached on the dates of the research and voluntarily participated in the research. Research data was collected through "Nurse Promotion Form" and "Moral Sensitivity Questionnaire". In order to conduct the study, written permission was obtained via from the author who conducted the Turkish validity and reliability studies in our country. Approval was obtained from the ethics committee of the university and written / verbal approval was obtained from the nurses. In evaluating the data; Mann-Whitney U test, Kruskall Wallis test and Spearman correlation analysis were used. Results: The average age of the nurses participating in the survey was ± 7.39 years, 75% were married, 83% were undergraduates, ± 8.04 years were working, 16% were working in nephrology and hemodialysis clinics, 74% have taken nursing ethic lectures during their undergraduate degree,70% of them are not members of a professional association. The total score obtained from the moral sensitivity questionnaire of the nurses included in the study was determined as ± Average points of the questionnaire sub-dimensions; the autonomy subscale was ± 5.59, the utility subscale was ± 4.28, the holistic approach was ± 4.30, the conflict subscale was ± 3.48, the application subscale was ± 4.38, and the orientation subscale was 8.47 ± There was no statistically significant difference (p>0.05) between the level of education of the nurses, the marital status, the clinical status of the nurses and the moral sensitivity total score of the nursing ethics (p>0.05), whereas the ethical sensitivities of nurses who were members of any professional association were significantly

141 higher (p<0.05). In addition, there was a significant relationship between age and duration of working years of nurses and moral sensitivity (p<0.05). Conclusion: As a result, ethical sensitivity of the nurses participating in the research are moderate As for the subsections of autonomy, conflict and benefit; ethical sensitivity is low. Key Words: Ethics, ethical sensitivity, nursing ethics

142 [OP-34] THE VALIDITY AND RELIABILITY STUDY OF MORAL DISTRESS QUESTIONNAIRE FOR NURSES Şebnem Çınar Yücel¹, Fatma Orgun¹, Eda Ergin², İsmet Eşer¹, Yasemin Üstün 1 ¹ Ege University, Faculty of Nursing ² Celal Bayar University, Faculty of Health Sciences Aim: The purpose of this study is to test the validity and reliability of the Turkish version of the Moral Distress Questionnaire (MDQ) for nurses. Methods: The sample of this methodological study comprised 150 nurses working in the internal medicine and surgery clinics of a university hospital between February and June Data were collected using the personal information form and the "MDQ" for nurses. The MDQ for nurses is a Likert-type scale and contains 11 items. The Turkish version of the scale was developed through the translation-back translation method. For validity; expert opinion on the content validity was obtained. Whereas internal consistency analysis was conducted for reliability, the test-retest correlation was performed for invariance against time. Results: Experts opinions were consistent with each other (Kendall W: 0.500, p = 0.00). In the present study, the value of 0.73 calculated as the Kaiser-Meyer-Olkin Measure of Sampling Adequacy and the sample test size value for Bartlett's test of Sphericity (X: , p <0.001) were found to be quite adequate for factor analysis. As a result of the Principal Component Analysis, the items were grouped under three factors. Since the standard weights of the items 3, 9 and 15 were very low, they were removed from the scale, and the values given in the previous sentence were as follows: X2/Sd: 1.920, GFI:0.949, CFI:0.907, NFI: 0.834, RMSEA: The total variance increased to %. Cronbach alpha was 0.707, and the item-total correlation coefficient was between and The scale s invariance against time was high (r = 0.984). Conclusion: In this present study, the Turkish version of the MDQ was found to be valid and reliable for Turkish society. It is recommended that the MDQ for nurses should be used in future studies to be conducted with nurses to investigate of issues of ethical dilemma. Key Words: Moral distress questionnaire, ethics, nursing

143 [OP-35] THE EFFECT OF NURSES OCCUPATIONAL SATISFACTION ON ETHICAL SENSITIVITY Seyhan Çıtlık Sarıtaş¹, Zeliha Büyükbayram 2, Esra Anuş Topdemir 1 ¹ İnönü University, Institute of Health Sciences 2 Siirt University, Health of High School Aim: This is a descriptive study that examines the effect of nurses occupational satisfaction levels on ethical sensitivity. Methods: The population of the study included the nurses in Diyarbakır Gazi Yaşargil Research and Training Hospital (n=550). The sample included 148 nurses who agreed to participate. The data were collected between April and June 2017 using a personal introduction form, the Minnesota Satisfaction Questionnaire and the Ethical Sensitivity Questionnaire. The data were analyzed using descriptive statistics, independent groups t-test, the Mann-Whitney U test, the Kruskal-Wallis test and correlation analysis. Results: The nurses' mean age was 30.79±6.09 years. Of them, 75.7% were females and 58.1% were married, while 80.4% were university graduates and 52% worked in internal units. Also, 53.4% of the participants had been working for five years at most, 70.3% had received training on ethics, 61.5% had received in-service training, and 44.6% had chosen to be a nurse due to job opportunities. Their mean score on the Minnesota Satisfaction Questionnaire was 51.91±11.28, and 33.16±7.42 on internal satisfaction and 18.75±5.08 on external satisfaction. Their mean score on the Ethical Sensitivity Questionnaire was 91.55±21.66 and their subdimension mean scores were 18.72±6.72 for autonomy,13.00±4.50 for providing benefits, 13.55±5.03 for holistic approach, 12.81±3.73 for conflict, 13.10±4.83 for practice and 8.87±4.19 for orientation. University graduates' mean score on the Minnesota Satisfaction Scale was higher, and the difference among the groups was significant (p<0.05). External satisfaction by gender was also significant. Conclusion: The occupational satisfaction of the nurses was normal, and their ethical sensitivity was moderate. There were negative correlations between total score on the Ethical Sensitivity Questionnaire and internal satisfaction, and the Minnesota Satisfaction Questionnaire total score and the autonomy subdimension score. Key Words: Ethics, nursing, occupational satisfaction

144 [OP-36] NURSES PERCEPTION OF PROFESSIONAL VALUES IN TURKEY Gülhan Erkuş¹, Leyla Dinç¹ ¹ Hacettepe Universty, Faculty of Nursing Aim: In the current complex healthcare system, nurses are confronted with unknown boundaries and new practice questions that require an understanding of core nursing values. Perception of professional values varies according to social and cultural context, and working conditions. To examine the professional values of nurses in Turkey. Methods: A cross-sectional study was conducted on 310 nurses employed at four public, three university hospitals and one private hospital in May-June Following ethical approval of the institutional committee, permissions of hospital directories, and informed consents of participants data were collected using a data collection form and Turkish version of the Nurses Professional Values Scale-Revised. Results: Nurses descriptions of value included a worth attributed to something, respectfulness, importance, and morality or conscience. Nurses had higher scores for perception of professional values ( ± 17.36), and education level and length of professional experience associated with nurses scores. Love for human beings was described as the most important value for nursing; trust and justice were on top of ten personal and professional values. Altruism, responsibility and obedience to authority were less rated professional values. The most difficult decision made while providing care, which conflicted with professional values were described by 68 nurses, and these were reported as having to stop or breaking caring for a terminal patient, giving bad news to a patient, and knowing that care hurts the patient. Conclusion: Overall results indicated strong professional value orientation of participants; however nurses expressed difficulties in making decisions that conflict with their professional values during patient care. Further studies across the country, using both the NPVS-R and other culture-specific and reliable instruments are recommended. Key Words: professionalism, value, nursing, professional values, culture

145 [OP-37] DOES CLINICAL NURSING EFFECT THE LEVEL OF LIFE SATISFACTION? Ayşe Demiray 1, Cansu Kanca 2, Hatice Turan 3, Hilal Yıldız 1 1 Düzce University Faculty of Health Sciences 2 T. C. Ministry of Health Baltalimani Metin Sabanci Bone Diseases Education and Research Hospital 3 Blacksea Ereğli State Hospital Nursing has been one of the occupational groups based on the principle of altruism during the history of the profession. Membership of the American Association of Colleges of Nursing (AACN) '' One of our professional values expressed in '' Higher Education in Nursing for Professional Nursing and the Essentials of University Education '' is to be concerned with the welfare and wellbeing of ourselves ''. Life satisfaction is the individual's achievement in comparison with their goals and what they have now. Surveys show that life satisfaction is positively or negatively affected by many concepts of the individual It is observed that most of the studies on life satisfaction are made on elderly individuals and on individuals working in national education. The level of individualism and life satisfaction were compared and evaluated with different parameters but there was no study in domestic and foreign literature about the study of altruism and life satisfaction level in nursing. For this reason, it is aimed to determine whether or not altruism levels have an effect on life satisfaction in this study. In this descriptive plan, the demographic survey questionnaire, Life Satisfaction and Individualism scale will be used in this study. Data analysis will be done with SPSS statistical program. In the evaluation of the data, the results and the solution proposal will be shared using statistical methods appropriate to the research data. Key Words: Key words, specificity, life satisfaction, nursing

146 [OP-38] INVESTIGATION OF THE RELATIONSHIP BETWEEN ETHICAL SENSITIVITY AND PROFESSIONAL VALUES IN DIALYSIS NURSES Hicran Yıldız¹, İlknur Yalçın², Gülcan Canberk², Özlem Şahin², Kadriye Çiçek², Fatma Düzgün², Aparslan Ersoy² ¹ Uludağ University Faculty of Health Sciences ² Uludağ University Faculty of Medicine Aim: This study was conducted to examine the relationship between ethical sensitivity and professional values in dialysis nurses. Methods: All nurses working in public and private dialysis centers in Bursa in 2017 and 64 nurses who accepted to participate in this study constituted the sample of descriptive research. The data were collected using the "General information form" prepared in the direction of the literature and reliability and validity of "Moral Sensitivity Scale" by Hale Tosun, the "Professional Values Scale of Nurses" by Rengin Acaroğlu and the "Hierarchy of Values Hierarchy" by Türkyılmaz and Aydemir. In the SPSS 22.0 program, the data were evaluated using percentages, averages, Pearson correlation tests. For conducting the study, after the institution permits, permission was obtained from Uludag University Medical Faculty Ethics Committee. Results: The mean age was 35.25±7.54 and 92.3% of cases were females. 35.4% of the cases were graduated from health vocational high school. 38.5% of the cases have graduated in the last ten years. 21.5% have an individual with health staff. 86.2% of the cases are clinically nursing. The mean years of professional work were 14,06±7,66 years in the cases and the mean year of the study in the dialysis unit was 10,00±6, % of the cases were educated about ethics and 18.5% were educated about values. When we look at the ranking of the values of the cases, it is determined that peace of conscience is in the first place. The mean total score of the ethical sensitivity scale of the cases was 86.35± The ethical sensitivity subscales of the subjects were found to have the lowest score in the orientation sub-dimension(9.43±5.25) and the highest score in the autonomic sub-dimension(18.43±8.53). The total score of the professional values of the cases is 96.33± The mean scores of the subscales of the items were as follows: maintenance subscale 57.15±9.53, professional subscale 28.30±5.04 and confidence subscale 10.87±1.81. It has been determined that there is a significant relationship between the holistic approach from the ethical sensitivity scale sub-dimensions and professionalism from the sub-

147 dimensions of the professional values scale; conflict and maintenance with professional values total score; practice and professionalism (p<0.05). Conclusion: It is determined that there is a relationship between ethical sensitivity and professional values. It is considered that this situation must be taken into account in order to ensure the development of professional values and ethical sensitivity. Key Words: Ethical sensitivity, professional values, dialysis, nurse

148 [OP-39] ROLE AND RESPONSIBILIY DILEMMAS OF FORENSIC PSYCHIATRIC NURSES: SYSTEMATIC REWIEW Gül Dikeç 1, Leyla Baysan Arabacı 2, Gülsenay Taş 2 ¹ İstinye University Faculty of Health Sciences, Department of Nursing 2 Katip Celebi University Faculty of Health Sciences, Department of Nursing Aim: Aim of this review is to scrutinize studies relating to role and responsibility dilemmas of forensic psychiatric nurses (FPNs). Methods: The study was conducted by handling with 16 qualitative, quantitative and review studies published between 2006 and 2016 by searching EBSCOHOST (42), Türk Psikiyatri Dizini (2), Cochrane Library (1), Pubmed (8) and Wiley Library (11) databases between dates of January-February On examination of these articles, a check list which is preferred for systematic reviews developed by York University Institute of National Health Sciences was used. Results: At the end of systematic review, finding/results of 16 articles were presented as a table in this review. In published studies, it was determined that forensic psychiatry nursing roles were not clear, and nurses working in this field had skills in areas of making mental assessment, preventing aggression, violence management, medication treatment administration and enabling legal and medical balance. Also, it was determined in conducted studies that roles of FPNs were examined under themes of trust to therapy, confidence vs. fear, transference vs. countertransference, win vs. lose, use vs. abuse, success vs. failure. Conclusion: In conducted studies, it was determined that forensic psychiatry nurses had conflicts about their roles in units they work and that their roles were not clear. Definition of role and responsibilities of nurses working in these units will contribute to the quality of care for patients. Key Words: forensic psychiatric nursing and roles, responsibility dilemmas of forensic psychiatric nurses, forensic psychiatric nursing and role dimensions

149 [OP-40] DETERMINATION OF OPINIONS ON ETHICAL ISSUES OF TRANSPLANTATION UNIT NURSES DURING PROCESS ARISING TRANSPLANTATION: PILOT STUDY Hicran Yıldız¹, İlknur Yalçın², Gülcan Canberk², Özlem Şahin², Kadriye Çiçek², Fatma Düzgün², Aparslan Ersoy² ¹ Uludag University Faculty of Health Sciences, Department of Nursing ² Uludag University, Faculty of Medicine Hospital Aim: This study was conducted to examine the relationship between ethical sensitivity and professional values in dialysis nurses. Methods: All nurses working in public and private dialysis centers in Bursa in 2017 and 64 nurses who accepted to participate in this study constituted the sample of descriptive research. The data were collected using the "General information form" prepared in the direction of the literature and reliability and validity of "Moral Sensitivity Scale" by Hale Tosun, the "Professional Values Scale of Nurses" by Rengin Acaroğlu and the "Hierarchy of Values Hierarchy" by Türkyılmaz and Aydemir. In the SPSS 22.0 program, the data were evaluated using percentages, averages, Pearson correlation tests. For conducting the study, after the institution permits, permission was obtained from Uludag University Medical Faculty Ethics Committee. Results: The mean age was 35.25±7.54 and 92.3% of cases were females. 35.4% of the cases were graduated from health vocational high school. 38.5% of the cases have graduated in the last ten years. 21.5% have an individual with health staff. 86.2% of the cases are clinically nursing. The mean years of professional work were 14,06±7,66 years in the cases and the mean year of the study in the dialysis unit was 10,00±6, % of the cases were educated about ethics and 18.5% were educated about values. When we look at the ranking of the values of the cases, it is determined that peace of conscience is in the first place. The mean total score of the ethical sensitivity scale of the cases was 86.35± The ethical sensitivity subscales of the subjects were found to have the lowest score in the orientation sub-dimension (9.43±5.25) and the highest score in the autonomic sub-dimension(18.43±8.53). The total score of the professional values of the cases is 96.33± The mean scores of the subscales of the items were as follows: maintenance subscale 57.15±9.53, professional subscale 28.30±5.04 and confidence subscale 10.87±1.81. It has been determined that there is a significant relationship between the holistic approach from the ethical sensitivity scale sub-dimensions and professionalism from the sub-

150 dimensions of the professional values scale; conflict and maintenance with professional values total score; practice and professionalism (p<0.05). Conclusion: It is determined that there is a relationship between ethical sensitivity and professional values. It is considered that this situation must be taken into account in order to ensure the development of professional values and ethical sensitivity. Key Words: Ethical sensitivity, professional values, dialysis, nurse

151 [OP-41] ARE NURSES BIASED AGAINST OBESE PATIENTS? ARE NURSES BIASED AGAINST OBESE PATIENTS? Meryem Türkan Erer¹, Gülay Altun Uğraş 1, Zübeyde Usanmaz 2 ¹ Mersin University, Health of High School 2 Mersin University, Health Research and Application Center Aim: This study is planned to determine the biases of nurses caring for obese patients and to improve suggestions for improving care quality of obese patients. Methods: 370 nurses (95.8%) working in a university hospital and fitting into research criteria made up the sample of this study. Data have been collected between February-May 2017 using data collection form and GAMS-27 Obesity Prejudice Scale (GAMS-27 OPS). Percent, average, standard deviation and chi-square statistical methods have been used in data analysis. Results: Out of 70.1% of nurses caring for obese patients, only 27.3% have stated to have taken an education about obesity. GAMS-27 OPS mean score of nurses is 73.26±9.82, and 64.3% has been identified as bias inclined and 10.3% as biased. While age, gender, education status and marital status of nurses do not affect scale points, education taken for obese patient care is determined to decrease the bias incline. Conclusion: Study results have shown most of the patients to be bias inclined, few to have taken education for obese patient care, and education to decrease bias incline against obese patients. The nurses being biased against obese individuals may negatively affect the quality of care given to this patient group. This study shows the education and courses to be given to patients may be effective in decreasing the bias against obese patients. Key Words: Bias, Obesity, Nurse, GAMS-27 OPS

152 [OP-42] NURSES' APPROACHES TO ETHICAL DILEMMAS: AN EXAMPLE OF A PUBLIC HOSPITAL Nilüfer Demirsoy¹, Aysun Türe Yılmaz², Ömür Şaylıgil¹ ¹ Eskişehir Osmangazi University, Faculty of Medicine ² Eskişehir Osmangazi University, Faculty of Health Sciences Aim: Ethical codes and ethical principles which internationally accepted in nursing practices include consistency as it provides a standard in practices by determining the behavior and attidutes of the nurse. Besides, it also supports professional motivation by giving the nurse autonomy. Ethical decision making process in nursing; determination of the problem, deciding on the right action include a logical and professional process of evaluating action in terms of ethical principles and codes, in situations involve lots of ethical options. Nurses in the presentation of health care services; they need ethical and legal grounds to protect their patients, their colleagues and themselves. In order to make an ethically correct decision ethical theories, ethical principles take in consideration, patients and their relatives need to be evaluated from a holistic point of view. In this study, the ethical conflicts faced by the nurses working in the secondary health care facility in Eskişehir were investigated with the Nursing Ethical Dilemma Test and the relationship between the conflicts and the types was determined by identifying the ethical problem. For this purpose, the original name was "Nursing Dilemma Test" developed by Patricia Crisham in 1981,the scale was used as "Nursing Ethical Dilemma Test" in Turkish, translates by Birgün CERİT in Methods: The data were evaluated in the SPSS statistical program, Pearson correlation and descriptive statistical techniques were used in the analysis. Results: 233 nurses working in a secondary health care facility in Eskişehir were reached. The average age is 32,53 ± 6, (85%) of the nurses are female and 35 (15%) are male. 105 (45,1%) are bachelor's degree. The average number of patients given daily care in clinics is 12,81±8, (62,2%) experienced an ethical dilemma in their unit,205 (88,0%) were educated to solve the ethical problem,and 150 (64,4%) expressed that they felt self sufficient to solve the ethical dilemmas. Nurses' Principle Thinking average point (17,64 ± 11,34); Practical Thinking average point (6,16± 5,07) was determined that found to be well below the average in both types of points. The average point of the nurses actualized as 13,86± 3,91 where the section

153 was determined whether they had experience of a similar dilemma in the past. The point from 6 to 17 shows that participants are familiar with a similar dilemma. Conclusion: When the obtained data were analyzed,it was determined that the nurses frequently encountered situations with ethical problems during their professional lives,but they were nor sufficient to take ethical principles into account when deciding an ethical issues,and the most basic reason was not at the level of prefence with environmental factors. Increased frequency of encountering ethical problems in clinical practice,ethical decision making and assuming responsibility for decision making of nurses,the existence of individual and professional values in these processes is very important in terms of nursing care services. Key Words: Nursing ethical dilemma test, nursing, ethical decision making

154 [OP-43] PROFESSIONAL VALUES AND AFFECTING FACTORS OF NURSES IN A PUBLIC HOSPITAL Aysun Türe Yılmaz¹, Nilüfer Demirsoy², Ömür Şaylıgil² ¹ Eskişehir Osmangazi University, Faculty of Health Sciences ² Eskişehir Osmangazi University, Faculty of Medicine Aim: This study was descriptively done todeterminetheprofessionalvalues of thenursesworking in Eskişehir Yunus Emre StateHospital, andthefactorshavinginfluence on them. Methods: The scale,of which original name is Nurses' Professional Values Scale, developed in 2000 by Darlene Weisand Mary Jane Schank, translated intoturkish as Hemşirelik Profesyonel Değerler Ölçeği-HPDO, of whichturkish Reliability Validity was performed by Nuray Şahin Orak, Şule Ecevit Alpar in 2012, wasused in this study receiving permission from scale writers. The total score of thes cale can range from 44 to 220. The higher scores suggests that nurses attach more importance to Professional values and ethical issues. The scale includes 5 factors,classified as human dignity, responsibility, mobility, trustand autonomy Results : 323 nurses working in Eskişehir Yunus Emre State Hospital were reached. Theaverage of agewas 32,14 ± 7, (84.2%) of the nurses were females, 173 (53.6%) were married, and 200 (61.9%) had a bachelor's degree. 133 (41.2%) were working in the internal units, and 243 (75.2%) were workingfor 40 hours per week on average. 264 (61.7%) voluntarily selected their profession, and 186 (57.6%) were satisfied with their profession. Cronbach's α value was found as as a wholefor HPDO, and found similar with the confidence values determined for the original scale and other relevant instruments. The HPDO scale total score average was found as ± Conclusion: It was determined that the scores that the nurses got from the Professional valuesscale were above medium-level. A society, profession or group be come dependentif their values are identified by another society, profession or group. Therefore, each group, profession or culture should protectits own values, and arrange them in accordance with its own understandings and needs. Key Words: Professional values, nursing, ethics

155 [OP-44] THE RELATIONSHIP BETWEEN CRITICAL THINKING LEVELS AND ETHICAL SENSITIVITY OF NURSERIES Özlem Albayrak ¹, Elanur Uludağ ², Mağfiret Kaşıkçı³ ¹ Recep Tayyip Erdogan University School of Health, Department of Nursing ² Gumushane University School of Health, Department of Nursing ³ Ataturk University, Faculty of Nursing Aim: Nursing is a profession that is responsible for understanding the health and illness situation, planning and implementing individualized individual initiatives, from the beginning of the life to the death of the individual. With the progress in science and technology being integrated into the field of health, nurses are faced with more complex situations. They are in a state of critical thinking and decision making in complex events. It is expected that nurses will be able to make correct and ethical decisions in the face of situations they meet. However, in order for nurses to be able to make correct decisions about the definition and resolution of ethical problems, the ethical sensitivities defined as the ability to distinguish ethical issues must be developed. Ethical awareness is possible through maintaining professional competence and demonstrating behavior appropriate to the ethical codes of the profession and by developing critical thinking skills. Methods: This descriptive study is composed of 239 students who study in Recep Tayyip Erdoğan University School of Health Nursing Department and volunteer to participate. As a means of data collection in the survey, the Personal Information Form consisting of 13 questions, the California Critical Thinking Tendency Scale and the Moral Sensitivity Questionnaire, which were prepared in the light of the related literature, were used. Results: The relationship between California Critical Thinking Tendency Scale and Moral Sensitivity Questionnaire averages was found to be low but there was a positive relationship between them. Conclusion: It is important for nurses to be able to see all options in order to reach the right decision in the decision-making process. Ethical decision-making involves assessing the individual's problems and using critical thinking skills in the decision-making process based on the evidence they obtain. They should develop more systematic and quality care and critical thinking skills in clinical decision-making

156 Key words: Profession, critical thinking, nursing

157 [OP-45] MORAL DEVELOPMENT LEVEL OF THE PROFESSIONALS AND THE AFFECTING FACTORS: NURSE SAMPLE Ayla Ünsal¹, Aybike Bahçeli², Sevinç Köse Tuncer³, Serap Sökmen³, Papatya Karakurt³ ¹ Ahi Evran Ahi Evran University School of Health ² Bozok University School of Health ³ Erzincan University Faculty of Health Sciences, Department of Nursing Aim: The current study was planned in descriptive model to identify moral development level of nurses and the affecting factors. Methods: The study population was composed of all the nurses who worked at three hospitals located in a province. No sampling method was used in the study; those nurses who were employed at these hospitals and volunteered to participate in the study (N=314). The data of the study were gathered using a Personal Information Form and Moral Development Scale for Professionals The data of the study were gathered between March and May 2016 after the necessary explanations were made by the researchers to the nurses and oral informed consents of those who volunteered to participate in the study were obtained by distributing. For the statistical analyses of the data; percentages, means, standard deviations, t test, one way variance analysis were employed. Results: It was found that the participant nurses were averagely aged 21.34±2.1 years and had a professional experience of 0-5 years (98; 31.2%). It was identified that more than half of the nurses chose the nursing profession willingly (171; 54.5%) and told that social environment was effective in choosing the nursing profession, (108; 28%). When working-characteristics of the nurses were examined, it was seen that most of them did not make medical errors (261; 83.1%). It was noted that mean score of the nurses obtained from Moral Development Scale for Professionals was 3.97 ± 0.60 (min:2.08- max: 5) and that scores of Moral Development Scale of nurses changed statistically and significantly according to some personal variables (p< 0.05). Conslusions: It was identified that moral development level of nurses was above the average and at a good level and that some variables affected the moral development level of nurses. Key Words: Moral, professional, nurse

158 [OP-46] RELATIONSHIP BETWEEN BURNOUT LEVELS OF NURSES AND THEIR TENDENCY TO MAKE MEDICAL ERRORS Papatya Karakurt¹, Rabia Hacıhasanoğlu Aşılar¹, Arzu Yıldırım¹ ¹ Erzincan University, School of Health Aim: This study was conducted to determine the relationship between burnout levels of nurses and their tendency to make medical errors. Methods: This descriptive and relationship seeking type study was composed of 150 nurses working in hospital between March 2016 and May The data were collected through desriptive characteristics form, Scale of Tendency toward Medical Malpractice in Nursing and Maslach Burnout. The data were analyzed using number, percentage, mean, Variance analysis, Kruskall Wallis and Mann Whitney-U test, while t test and correlation analysis were used in the independent groups. Results: It was found that the participant nurses were averagely aged 32.86±6.31 years. It was determined that 30% of the nurses have made medical errors during the study period and 34.7% were not satisfied with the working environment. Nurses mean score of emotional exhaustion subdimension of the Maslach Burnout Inventory was found as 20.59±7.71, mean score of depersonalization subdimension as 7.30±4.50 and mean score of reduced personal accomplishment as 18.23±4.18 and it was found that the burnout levels of the nurses were at moderate degree. It was determined that the mean score that the nurses received from the Scale of Tendency toward Medical Malpractice in Nursing was 4.41 ± A significant poor negative correlation was found between the burnout levels of the nurses and their tendencies towards medical malpractice. Conclusion: While the tendency of nurses to make medical errors seems to be low, it was determined that the tendency to make medical errors increases as the levels of burnout increase. Since nurses are included in the group who are at risk for burnout among the health care workers, it may be advisable to provide trainings and take measures to prevent burnout and tendency to medical malpractice. Key Words: Nurse, burnout, medical malpractice

159 [OP-47] EXAMINATION OF PROFESSIONAL VALUES OF OPERATING ROOM NURSES Sinem Geçit¹, Türkan Özbayır¹ ¹ Ege Üniversitesi Hemşirelik Fakültesi Cerrahi Hastalıkları Hemşireliği Anabilim Dalı Amaç: Bu araştırma ameliyathane hemşirelerinin profesyonel değerlerinin incelenmesi amacı ile yapılan tanımlayıcı bir çalışmadır. Yöntem: Araştırmanın örneklemini Bursa da bir Eğitim ve Araştırma Hastanesi nde görev yapan ameliyathane hemşirelerinden çalışmaya katılmayı kabul eden 72 hemşire oluşturdu. Araştırmanın verileri tarihleri arasında toplandı. Veriler hemşirelere Anket Formu verilerek toplandı. Anket Formu katılımcıların sosyodemografik verilerini içeren Birey Tanıtım Formu ve Hemşirelerin Profesyonel Değerleri Ölçeği olmak üzere iki bölümden oluşmaktadır. Veriler in analizinde sayı ve yüzdelik dağılımı içeren tanımlayıcı istatistikler, gruplar arası karşılaştırmada ise bağımsız örneklem t testi ve ANOVA testleri kullanılmıştır. Araştırma öncesi Ege Üniversitesi Hemşirelik Fakültesi Bilimsel Etik Kurulu ve araştırmanın yapıldığı Eğitim ve Araştırma Hastanesi Etik Kurulu ndan yazılı izin alınmıştır. (Etik Onay Kodu: 62 ve 160). Bulgular: Araştırmaya katılan hemşirelerin %94.4 ü (n=68) kadın, %44.4 ü (n=32) yaş grubunda ve üniversite mezunu, %62.5 i (n=45) evli, %63.9 unun gelir düzeyi orta düzeyde, %36.1 i (n=26) 0-5 yıl ameliyathane hemşireliği çalışma deneyimine sahip, %55.6 sı (n=40) bir ayda saat çalışmakta ve %81.9 u (n=59) daha önce etik konusunda eğitim almıştır. Araştırmada hemşirelerin profesyonel değerler puanı ortalaması olarak saptanmıştır. Hemşirelerin cinsiyeti, medeni durumu ve etik hakkında eğitim alma durumu ile hemşirelerin profesyonel değerleri ölçeği puan ortalaması arasında istatistiksel olarak anlamlı bir fark bulunmamıştır (p>0.05). Hemşirelerin öğrenim durumu, gelir durumu ve çalışma yılı ile hemşirelerin profesyonel değerleri ölçeği puan ortalaması arasında istatistiksel olarak anlamlı bir fark bulunmamıştır (p>0.05). Sonuç: Ameliyathane hemşirelerinin profesyonel değerler ölçeğinden aldıkları puanlar profesyonel değerlere ve etik konulara önem verdiklerini göstermektedir. Tüm hemşirelere olduğu gibi ameliyathane hemşirelerine de profesyonel değerler ve etik ile ilgili eğitimlerin devamlılığının sağlanması ve bu konuda daha kapsamlı araştırmaların yapılması önerilmektedir. Key Words: Profesyonel değerler, ameliyathane hemşireliği, etik

160 [OP-48] THE RELATIONSHIP BETWEEN NURSE S JOB SATISFACTION AND ORGANIZATIONAL ETHICAL CLIMATE Ceren Sonakın 1 Yasemin Ergün 1 ¹ Marmara University Faculth of Health Aim: The research was conducted descriptively and analytically to determine the relationship between job satisfaction of nurses and the ethical climate of their institutions. Methods: The study was applied to 432 nurses working in the Ministry of Health Education and Research Hospitals in İstanbul. The data were collected by using the "Introductory Form" to describe the individual and professional characteristics of the nurses,, the "Ethical Climate Scale" to describe the ethical climate of their institutions " and the "Job Satisfaction Scale" to assess job satisfaction. Results: The majority of the nurses(88%) participating in the survey were found out to be female and 33.3% had bachelor s degree. More than half of the nurses (72.2%) work as shifts and service nurses (86.1%). While 41% of nurses choose the profession voluntarily, 38% do not consider choosing the same profession again. A statistically significant difference was observed between the ethical climate and job satisfaction levels according to marital status, position, reason for choosing this job, and status of choosing the same job again of the sampled nurses, but no significant difference was observed according to gender. As a result of the research, it was determined that the nurses' level of ethical climate perception (2.91) and their job satisfaction values (3.06) were moderate. Conclusion: In line with the results obtained, it was observed that the level of job satisfaction increased while the ethical climate value increased. Key Words: Ethical climate, job satisfaction, nurse

161 [OP-49] INVESTIGATION OF NURSES ETHICAL SENSITIVITY LEVELS AND RELATED FACTORS Fatma Orgun 1, Leyla Khorshid 1, Esra Akın Korhan 2, Nermin Ersoy 3 ¹ Ege University, Faculty of Nursing 2 Katip Celebi University Faculty of Health Science, Department of Nursing 3 Kocaeli University, Faculty of Medicine Aim: The values and principles upon which today's nursing based on, oblige nurses with some ethical tasks and establish guide rules for their profession. All these rules play a key role in solving the ethical problems nurses face. For nurses to be able to recognize these ethical issues and to make ethical decisions their ethical sensitivities must be developed. In the study, it was aimed to determine nurses' ethical sensitivity levels and related factors. Methods: In the study which descriptive type planned, the data were collected using the "Nurse Recognition Form" and " Byrd s Nursing Ethical Sensitivity Test". This study was conducted with 164 nurses who accepting to participate in the research and working in medical and surgical clinics of a university hospital in İzmir with the survey which is face-to-face interview method, between Results: 55.5% of the nurses participating in the study are in the age group of (91), 51.8% are married (85), 84.1% have bachelor s degree (138) and 72% stated that their incomes equal to their expenses (118). It has been determined that the average number of years of work is 9.15, the majority is working as a service nurse (136) and that there is no area of expertise (143). While 34.1% (56) of the nurses stated that they had received ethical education, 44.5% (73) they stated that they did not receive. It was found that the ethical sensitivity levels of the nurses included in the study were avarage (20.63±3.01). According to the results of variance analyze and t-test, it was found that the ethical sensitivity levels of nurses did not differ in variables such as age, working year and place of duty (p<.05). Conclusion: As a result of the study, it is thought that nurses have avarage sensitivity and education activities should be continued to improve their ethical sensitivity. For this reason, it can be suggested that each of the nurses should examine the ethical studies related to their specific areas and it can be included ethical and ethical sensitivity in the in-service trainings.

162 Key Words: Nursing, ethical sensihivity [OP-50] PEER LEARNING AND ETHICS IN NURSING EDUCATION Buket Şimşek Arslan¹, Ahmet Göktaş¹, Kadriye Buldukoğlu¹ ¹ Akdeniz University Faculty of Health Sciences, Department of Nursing Many methods are used for nursing education to be effective and to reach its goals. One of these methods is peer learning. Peer learning is defined as assisting an individual who is from the same social group and is not a professional educator in the learning process of other individuals. It is stated that peer learning, which has been used for 20 years in the field of teaching, can be used as an effective method in the clinical education of nursing students when some standards are developed and well structured and measured. Studies on the use of peer education are increasing day by day. Studies indicate that there are advantages and disadvantages of using peer learning. Although the use of peer learning in nursing education has many positive aspects, it can lead to ethical problems if not planned well. These ethical problems can be confronted in terms of both the individual receiving care, the student and the peer mentor. For this reason, peer learning should be carried out by selecting suitable students and peer mentors who will not have disagreements between the professional educators and the institutions where there are sufficient professional educators. Responsibilities of the student and peer mentor should be determined by the professional educator. It should be stated that the professional educator is responsible for both the student and the peer mentor, and the peer mentor is responsible for the student. If well planned and supervised, peer learning can be used as an effective teaching method in nursing education and ethical problems that may arise can be prevented. Key Words: Peer learning, ethics, nursing education

163 [OP-51] PREVENTING DEFENSIVE MEDICINE OF FIRST RESPONDERS IN DISASTER SETTINGS Iskra Alexandra Nola¹, Ana Borovecki¹, Ignaas Devisch², M. Murat Civaner³ ¹ University of Zagreb, School of Medicine, Andrija Stampar School of Public Health ² Ghent University, Ethics and Philosophy of Medicine ³ Uludag University, School of Medicine Healthcare workers including might be unaware of their legal liability while they respond to a medical emergency, which could be crucial especially when assisting in other countries. Therefore experts from the fields of public health and emergency medicine voice their concern over potential individual and organizational liability issues because the requirements and limitations of laws in the context of mass-scale disasters are not clear enough. Although every country needs to have a regulation for protection of providers in the times of emergency situations and disasters, existing legislations, regulations and statements were not sufficient for providing adequate protection to healthcare workers in recent cases. In this presentation, we propose a framework which could be helpful to reduce exposure to unfair legal claims for first responder healthcare volunteers in the acute phase after a disaster, and prevent defensive medicine practices while providing healthcare services in disaster settings. Key Words: Disaster medicine, disaster bioethics, duty to care, defensive medicine, legal liability, health law

164 [OP-52] ETHICAL EDUCATION IN NURSING IN TURKISH Büşra Aleyna Önver¹, Rabia Mina Abbak¹ 1 Ankara Yıldırım Beyazıt University Faculty of Health Sciences Aim: The need for the nursing profession is universal. Ethics education plays an important role in nursing practice, in the development of ethical awareness and responsibility.the purpose of this review is to determine the level of competence in ethics education given in nursing in Turkey Methods: After the screening of the subject between ; Full-text Turkish and foreign articles, book chapters were used to prepare this review in the literature. Results: Ethics is defined as a group of ethical principles or a group of values that governs the behavior of a person or profession as a Word. Ethics education must provide nurses with tools to accomplish such critical reflection. The aim of ethics course in nursing education is; To improve the ability of students to think freely and scientifically; Nurses who know themselves to educate themselves and develop themselves in the awareness of their responsibilities, free and autonomous, away from prejudices and dogmatic ideas, who see themselves in society, suspect and question, Ethical education in our country is given to third or fourth grades in undergraduate education under the names of "Medical Ethics and Nursing","Nursing History and Deontology" in some schools while ethical issues are integrated in applied courses in some schools. The names, contents, years of study and hours of study are different from each other in nursing education schools. It is carried out by nursing academicians who are not experts in the field of ethics, close to the whole of the ethical courses in the nursing schools. In a study conducted by Görgülü and Dinç, 94.8% were found. Conclusion: The ethics course in nursing should be given by experts and different methods should be developed to improve the quality of education. The maintenance of nursing practices professionally and the increase in the quality of care depends on the ethical equipment. Key Words: Ethic, nursing, nursing education, education.

165 [OP-53] ETHICS EDUCATION IN NURSING UNDERGRADUATE PROGRAMS: A TURKISH PROFILE Semra Açıksöz¹, Cevriye Özdemir¹, Merdiye Şendir¹ ¹ University Health Sciences, Faculth of Nursing Aim: This research was conducted in order to determine the characteristics of ethics courses given in nursing undergraduate programs in Turkey. Methods: The universe of this descriptive study consisted of nursing education faculties and colleges (N=118) in Turkey. The research data were obtained by examining the program information packs on the web pages of the universities under the guidance of a structured information form developed by the researchers. Nursing curriculum programs of state and foundation universities in our country, the time of the ethics course for nursing, weekly course hours, compulsory or elective status, general objectives and contents of the course, teaching methods, measurement and evaluation tools, and lecturing staff characteristics were evaluated. Results: Evaluation of the nursing curriculum revealed that the name of ethics/deontology course in nursing varied between institutions. The theoretical content of the courses consisted of the historical process and beliefs/practices related to health in Turkey, nursing laws, nursing laws, regulations and arrangements in Turkey, national and international organizations in health and nursing, ethical concepts and principles, ethics in health services and nursing, and ethical decision-making. The ethics/deontology course in nursing is theoretically given in all institutions and the purpose of the course is to teach the ethical concepts and principles related to nursing, relevant laws and regulations, and the structure and problems of nursing in our country. The lessons delivered with the face-to-face method were also supported by discussion, questionanswer, and case study sessions. The ethics course was compulsory in 77.7% of the educational institutions, elective in 16.9% and both compulsory and elective in 5.4%. The course was provided as 2 lessons per week in 93.1% and 3 per week in 6.9%. The ethics course was delivered in the first year in 15.2% of the institutions, the second year in 29.6%, the third year in 46.7% and the fourth year in 8.5%. The ethics courses were provided by nursing faculty members in all of the institutions. Conclusion: We concluded that the ethics course in nursing should be scheduled through integration with other curriculums during undergraduate education. In addition, case studies with

166 practical application should be planned besides theoretical education within the scope of the ethics program and should be updated as time goes on. Key Words: Nursing education, ethics, education-training

167 [OP-54] ETHICS EDUCATION IN NURSING: LITERATURE REVIEW Cevriye Özdemir¹, Semra Açıksöz¹, Merdiye Şendir¹ ¹ University Health Sciences, Faculth of Nursing Aim: The aim of this literature survey was to quantitatively and qualitatively evaluate research on ethics education in nursing in our country and to guide future studies by emphasizing its importance. Methods: The study universe consisted of 78 studies that were accessed by scanning the electronic databases of the University of Health Sciences (n=12), Ulakbim (National Academic Network and Information Center), national database (n=29), the national thesis center (n=16), the Turkish medical index (n=5), Google Scholar (n=16), PubMed (n=10), the Web of Science and the web pages of scientific meetings. Full-text articles published in Turkish and English in the last fifteen years ( ), found with a search using the "nursing", "ethics", "nursing researches", "education" and Turkey keywords, were selected. A total of nine full-text studies were finally included in the sample of the study, taking into account the sample used, inclusion of nurses, and the evaluation of ethics education. Results: Seven of the nine studies that examined ethics education in nursing in Turkey between 2002 and 2017 were of the descriptive type and two were compilation articles. Four of the studies were carried out with the student nurses, two with nursing staff and one with nurses. A questionnaire had been used to obtain socio-demographic data and scales customized for Turkey were used as data collection tools. It was determined that the ethics/deontology course name, duration and content varied in the institutions where the studies were carried out. The importance of ethics education in nursing and the need for training to be ongoing were emphasized. We therefore believe that ethics education in nursing undergraduate programs should be clinically focused, interdisciplinary and supported by postgraduate training. Conclusion: We found a limited number of studies evaluating ethics education in Turkey and more studies are needed. The ethics course should be a separate course that is integrated into other nursing specialty areas and ethics education should be continued during clinical practice. Key Words: Nursing, ethics, education, nursing research, Turkey

168 [OP-55] ANALYSIS OF TURKISH VALIDITY AND RELIABILITY OF NURSING EFFECTIVENESS OF ETHICS EDUCATION SCALE Çağatay Üstün¹, Esra Akın Korhan², Derya Uzelli Yılmaz² ¹ Ege University Faculty of Medicine ² Izmir Katip Çelebi University Faculty of Health Sciences Aim: This research was carried out methodologically to analyze validity and reliability of Nursing Effectiveness of Ethics Education Scale which was developed by Vynckier et al. to determine nursing students effectiveness of ethics education states, for Turkish society. Methods: The research sampling was carried out with the third and fourth class two hundred and thirty students who enrolled to nursing philosophy and ethics course. A form related to Student Description Form and Nursing Effectiveness of Ethics Education Scale were used to collect research data. Language equivalence, content validity, and structure validity were used in the study of scale s validity, and Content Validity Index was applied in evaluation of expert opinion. In the analysis of the data, Cronbach's alpha was used to determine the number, percentage, mean, Pearson moment product, two half-split reliability analysis, item-total correlation analysis, descriptive factor analysis (AFA), confirmatory factor analysis (DFA) reliability coefficients were calculated. Results: The average age of the students who participated in our research is ± 1.77, 77.4% is female and 65.6% is Anatolian high school graduate. As a result of this study, the Kaiser- Meyer-Olkin test 0.94, Bartlett sphericity test (p<0.01) were significant. Accordingly, there are high correlations between the variables. Exploratory factor analysis conducted it is concluded that factor 3 of the scale. The cronbach's Alpha reliability coefficient of the scale was found to be Conclusion: It can be said that, Nursing Effectiveness of Ethics Education Scale, which was intended to be brought in Turkey by analyzing the validity and the reliability, is a scaling instrument with a quite adequate validity and reliability indicators and in addition, this scale can be used safely for the determine nursing students effectiveness of ethics education states. Key Words: Nursing, ethics education, methodological study

169 [OP-56] IN NURSING LICENSE EDUCATION PROGRAMS LOCATION OF ETHICS EDUCATION IN NURSING Ebru Dığrak¹, Pelin Calpbinici² ¹ Ankara Etimesgut Şehit Sait Ertürk Public Hospital ² Nevşehir Hacı Bektaş University, Semra ve Vefa Küçük Health College Nursing Aim: The ability of nurses to make ethical decisions, ıt is possible to achieve clinical decisionmaking, critical thinking and problem-solving skills before graduating from nursing education programs (1). Therefore, "ethics in nursing" should be given as a separate course in nursing programs. This study aims at evaluating the curriculum place of ethics lesson in nursing in nursing undergraduate programs in our country. Methods: In this study, document analysis, which is one of the qualitative research types, was used. 122 universities offering nursing degree programs in Turkey were included in the research. İn the first stage, according to the "2017-ÖSYS Higher Education Programs and Guidelines for Quotas", the universities giving the nursing degree program in Turkey were identified. In the second stage, the nursing curricula of the web sites of the nursing departments were reached. The data collection process was completed between July 24 and July 30, 2017 and the data were evaluated. Results: According to data of the Council of Higher Education, there are a total of 122 universities including 84 state universities and 38 foundation universities nursing degree programs in our country. There are a total of 132 nursing undergraduate programs in the nursing undergraduate programs, including 72 Health Sciences Faculty, 45 School of Health, 9 Nursing Faculty and 6 Nursing Schools. When nursing undergraduate programs in our country examine curriculums; It was determined that "ethics in nursing" is taught in 33 schools, that it is integrated with courses that contain ethical issues in 70 schools and that ethics courses and subjects are not included in 29 schools. Lessons that include ethical issues; Values and Ethics in Nursing, History and Ethics of Nursing, Ethics and Patients Rights in Nursing, Ethics and Deontology in Nursing, History of Nursing, Deontology and Ethics, Ethics in Health Sciences, Medikal Ethics and Patient Rights, Medikal Ethics, Professional Responsibility and Ethics, Vocational Ethic and Akhism, Nursing Deontology, History of Nursing and Deontology with History of Nursing, Deontology and Laws. Ethics lessons in nursing are given as mandatory in 20 schools and

170 elective in 13 schools. To be given lessons that contain ethical lessons are 8 optional, 63 mandatory (Table 2). Ethics lessons are usually taught in the third grade, two hours a week. Conclusion: When the nursing degree programs examined the curriculum, it was determined that ethical education in nursing was integrated with few other schools or other courses related to other nursing. The lack or inadequacy of ethics courses in nursing in our country will negatively affect their understanding of the situations that require professional ethics and responding to the requirements related to moral evaluation. Key Words: Nursing, ethics education, nursing education

171 [OP-57] EFFECTS ON ETHICAL PREDISPOSITION WITH PROBLEM SOLVING SKILLS OF ETHICAL COURSE AND RELATIONSHIP BETWEEN: HEALTH STUDENTS SAMPLE Ebru KILINÇ 1, Özgür ALPARSLAN 2 1 I Gaziosmanpaşa University, Faculty of Health Sciences 2 I Gaziosmanpaşa University, Faculty of Health Sciences Aim: This research was carried out to investigate the effect of ethics course on the problem solving skills and ethical predispositions of Health College students, and evaluate the relationship between them. Methods: The study was conducted in descriptive and cross-sectional type (20 April 5 May, 2016). While the universe of the study consisted of first and fourth year Health College students from nursing and midwifery departments (N=245), the sampling was made up of 107 midwifery and 148 nursing students. The data were collected using a personal information form, the Ethical Values Predisposition Scale (EVPS), and the Problem Solving Inventory(PSI). Necessary permission was obtained from the ethics committee and related institutions at the outset. The students were informed about the purpose of the study and their consents were obtained. Students, who volunteered to participate in the study, filled in the forms themselves. The data were analyzed on computer using number, percentage, mean, t test, ANOVA, and correlation analysis. Results: 45.1% of the students who participated in the study had taken ethics course previously, however, 54.9% had not taken it. The score of first grade students from the EVPS was ± 10.32, and it was 70.4±10.27 for the fourth grade students. The difference between the grades was significant (p=0.047). The score for predisposition to ethical values in females was 69.05±9.26, while it was 64.56±14.59 in males. The difference between the groups was significant (p=0.02). The score obtained from the "Ethical Collaboration" subscale for students who selected their department willingly was 12.28±2.77, whereas it was 11.50±3.09 for students who selected the department unwillingly. The difference between the groups was significant (p<0.05). The scores for problem solving skills inventory in females and males were found to be 86.02±21.72 and ±24.28 respectively, and the difference between genders was determined to be significant (p<0.01). It was found that the correlation between justice-honesty subscale of the EVPS and the subscales of PSI was significant (p<0.05).

172 Conclusion: It can be stated as a result of the study that ethics course given during education improves the ethical behaviors of students, and that receiving ethics course has a positive effect on ethical decision making. Key Words: Predisposition to Ethical Values, Problem Solving, Midwifery, Nursing

173 [OP-58] AN ANALYSIS OF POSTGRADUATE NURSING THESES ON ETHIC IN TURKEY Kamile Kırca 1, Esra Doğan Yılmaz 1, Hüsna Özveren 1 1 Kırıkkale University, Faculty of Health Science, Department of Nursing Aim: In the research, it was aimed to examine the postgraduate nursing theses studies on ethics in Turkey. With this research, the studies completed in the field of ethics; To search literature for new studies to be done in the area of ethics and to make a resource for the stages of topic selection and to contribute to the formation of more qualified studies by revealing the problems and deficiencies in scientific studies done in the field of ethics. Methods: In order to collect the data in the research, firstly the area literature was scanned and then the database of the National Higher Education Council National Thesis Center was scanned with the keywords "ethics", "nurses", "nursing ethics". As a result of the screening, 36 theses on ethics involving nurses between were identified and citation information of these theses was reached. Results: 33 of the thesis works are descriptive. The data were gathered with a questionnaire form developed by the researcher and developed scales related to ethics. 26 of the theses were held at the master's level and 10 at the doctoral level. The majority (19 theses) were found to have been made in the last five years. Ethical sensitivity (8 thesis), ethical issues (6 theses), ethical climate (4 theses), ethical education (3 theses), ethical decision making (3 theses), ethical behavior (2 theses) and ethical dilemmas (2 theses) were studied in theses. In addition to this, Medical History and Ethics Department and Department of Business Administration have also been interested in ethical issues in nursing. Conclusion: Ethics in nursing is one of the most frequently studied topics in recent years. Ethical counseling and ethical training are proposed to reduce ethical problems and plan more work to increase ethical sensitivity. Key Words: Ethics, nurse, nursing ethics

174 [OP-59] ETHICAL DECISION-MAKING PROCESSES AND BURNOUT LEVELS OF NURSES STUDIED POSTGRADUATE EDUCATION Eylem Paslı Gürdoğan¹, Ezgi Kınıcı¹, Berna Aksoy¹ ¹ Trakya University, Faculty of Health Sciences Aim: The aim of this study was to determine the ethical decision-making processes and burnout levels of nurses studied postgraduate education. Methods: This study was carried out with nurses studying postgraduate education in nursing department of a university and working in a hospital (n=40). Data were collected using the questionnaire form, Nusing Dilemma Test and Burnout Measure-Short Version. Data were assessed by using percentage, mean, Student's t, One Way Anova tests and Pearson's correlation analysis by using SPSS-20 package program. Results: The mean age of the paticipitants in the study was ± 3.86, 84,5% of them was master degree students and 32.5% of them worked internal medicine clinics. Of the nurses, 65% sometimes thought to quit nursing profession, 60% took ethics lesson in their both undergraduate and postgraduate educations, 50% experienced sometimes ethical dilemma, 65% found partially adequate themselves in recognizing and solving ethical problems, and 47.5% thought ethical dilemmas affecting their productivity. It was found that there were negatively correlations between practical consideration and principled thinking scores (r=-.323, p=.042), and between practical consideration score and their familiarity with similar situations (r=-.333, p=.036). The nurses mean score on the scales were statistically significant different from nurses thoughts about quitting nursing profession, situation on nurses' living ethical dilemmas, their thoughts about forced drug application and giving respiratory support to someone refusing treatment (p<.05). Conclusion: Many of the nurses experince ethical dilemmas and live burnout. In ethical decision-making, nurses give more importance moral principles than environmental factors and as levels of their familiarity with ethical dilemmas increase, the importance given environmental factors increase. Nurses' thoughts of quit their profession, their ethical dilemmas, and the thoughts of them about some ethical dilemmas have an effect on their practical considerations, situaitons on familiarity with ethical dilemmas and burnout levels. Key Words: Ethical decision-making, burnout, education

175 [OP-60] DEALING WITH DIFFICULT NURSING STUDENTS Handan Eren¹, Fatma Ayhan² ¹ Karamanoglu Mehmetbey University, Faculty of Health Sciences ² Karamanoglu Mehmetbey University, Faculty of Health Sciences As anger becomes more pervasive in society, student anger becomes so in higher education, and unacceptable behaviour is on the rise in the academic setting. A study was conducted by Lashley and de Meneses (2001) almost a quarter of the nursing instructors serveyed reported objectionable physical contact between students and instructors. In addition to being yelled at both in the classroom (52.8%) and in the clinical setting (42.8%). Usually these incidents are the results of entanglement of societal ills, inadequate parenting, societal pressures, and violence of media. There are some applications to deal with these students; role modelling, education, emotional support, mentoring, developing immediacy skills, and honing feedback skills (Ehrmann, 2005; Luparell, 2005; Smart, 2014). But some behaviors demand more pressing intervention. In these situation, we need to bear in mind that the Code of Ethics for Nurses calls for respectful relationships with professional colleagues as well as patients (Luparell, 2005). To sum up, nursing educators can encounter difficult students and they forced to plan for aggressive behavior in their courses, Focusing on resolution of anger and conflict will benefit those students in need of guidance, and there has been a need for new studies and strategies for dealing with difficult nursing students. Key Words: Agressive, difficult student, nursing

176 [OP-61] VIEWS OF NURSING STUDENTS ON REFLECTION OF ETHICS COURSE DURING THEIR UNDERGRADUATE STUDY ON THE CLINICAL PRACTICES Fatma Tanrikulu¹, Handenur Gündoğdu¹, Nasibe Yağmur Filiz¹, Yurdanur Dikmen¹ ¹ Sakarya University Faculty of Health Sciences Aim: This research has been conducted to review the views of senior nursing students on reflection of ethics course during their undergraduate study on the clinical practices. Methods: Having been conducted as a qualitative study, the sample of this research consists of 15 senior students who study at the Department of Nursing at Faculty of Health Sciences of Sakarya University and are volunteer to take part in the research. The research has been carried out through focus group interview, which is one of the qualitative research data collection methods. The data obtained from two focus group interviews have been analyzed by using the thematic analysis method. Results: The nursing students, who have attended the research, have stated that the ethics courses that they receive during their undergraduate study were narrated theoretically and claimed that the course can be remembered longer when it is told through sample cases. Students have indicated that they have a difficult time to understand the course for there are a lot of students in the ethics course and the lecturer uses the traditional training methods and they fail to reflect the information provided in the ethics course on the clinical practices. The students present that they face problems concerning the ethical principles such as justice, autonomy/respect for the individual, privacy in the clinical practices and showed that lack of nurses in the clinics, over workload of the nurses, having no authority as a student nurse and communication problems with the patient/patient relative/healthcare staff are the factors that pave the way for such problems. Conclusion: As a result, nursing students have expressed that the ethics course during their undergraduate study is significant, however, it negatively reflects on the clinical practices for the course is provided in groups with the traditional teaching methods. In this context, we suggest that ethics courses for nursing should be provided in small groups through sample cases with innovative teaching strategies. Key Words: Nursing students, ethics course, clinical practice

177 [OP-62] ETHICS IN NURSING EDUCATION: AN EVALUATION Rana Can¹, Funda Can¹, Hatice Tambağ¹ ¹ Mustafa Kemal University, Health of High School Aim: In nursing, in addition to knowledge and skill at the core of quality care, sensitivity to moral dimension of having and maintaining professional ethical values is important. Ethical education in nursing requires nurses to identify the ethical problems they will encounter in their candidates in practice and to use the ethical decision-making process correctly and effectively; By their individual and professional values they play an effective role in the solution of ethical problems. The aim of this study is to make an assessment of ethics-related courses in the curriculum of nursing schools that provide undergraduate education at the national level. Methods: The data of the study were collected by accessing the colleges of health sciences, health sciences and nursing faculties through official internet sites of all universities providing nursing education in Turkey. Schools' nursing curriculum and related course content were scanned one by one; Related courses related to ethics were determined in nursing; These courses were assessed and categorized in terms of context, state of being compulsory / elective course, weekly course hours and topic contents. Results: The official web site of the faculty / health siences faculty / nursing faculty has been reached at 101 national level undergraduate nursing education at the national level. ıt was found that 46 universities have nursing history and deontology courses and 40 universities have one of the three courses of nursing ethics, health sicence ethics and vocational ethics. It has been found that aforomentioned courses take place as compulsory ın curriculum and the courses which are theoretical last 2 hours in general. It is observed that in the 11th college, there are courses related to ethics in nursing as an elective course as well as compulsory ethics / deontology course. At fifteen colleges, it was seen that one of the deontology / ethics courses was the only elective. None of the four universities found any course related to ethics education in the course curriculum. Conclusion: It has been seen that the length of the course of ethics / deontology, the content and the name changed from school to school. Almost all universities have found ethics courses. It is thought that the courses discussed in the last year in the curriculum based on the ethical issues specific to the nursing field are expected to increase the ethical sensitivity of the nursing students who are candidates for the last grade profession.

178 Key Words: Nursing, ethics education, deontology

179 [OP-63] EXAMINATION OF POSTGRADUATE DISSERTATIONS ON NURSING ETHICS IN TURKEY Nevin Doğan¹, Zehra Göçmen Baykara² ¹ Siirt University School of Health, Department of Nursing ² Gazi University Faculty of Health Sciences, Department of Nursing Aim: This study was conducted to examine postgraduate dissertations on nursing ethics in Turkey. Methods: In the study, the data were collected firstly by reviewing the literature and then scanning keywords like ethics, nursing ethics, ethics education, ethical sensitivity on the National Thesis Center Database of the Higher Education Council. As a result of the review, 86 relevant dissertations were determined in the Institute of Health Sciences between 1993 and 2016 and identity information of these dissertations was reached. In the study, a total of 26 dissertations with sufficient data in their identity information were evaluated. Results: It was determined that 12 of the dissertations were postgraduate, 14 were doctoral and a great majority of them (20 dissertations) were conducted within the last 7 years. 14 of the dissertations were descriptive, 9 were analytical, and 3 were methodological. The dissertations were generally conducted by using data collection form prepared by the researcher and various scales primarily as ethical sensitivity questionnaire, ethical dilemma questionnaire and ethical climate scale were used as data collection tools. Sample group of the dissertations consisted of mostly nurses (minimum 30, maximum 432 nurses) and it was determined that nursing instructors and students, other medical team members, pregnant women, patients and caregivers were also included in studies. The dissertations mainly examined factors regarding ethical sensitivity of nurses and ethical problems experienced by nurses. In both dissertations, ethics education and curriculum development studies were conducted. The dissertations also examined ethical issues like informed consent, attitudes of healthcare personnel toward end-life decisions, care ethics, hope management ethics in geriatrics, declaration of crime in health, physical privacy and ethical decision-making. Conclusion: It may be asserted that the concept of ethics has become an important field of interest in nursing studies in recent years. It was observed that dissertations on nursing ethics were descriptive and quantitative postgraduate studies; whereas, doctoral dissertations were generally qualitative studies conducted with larger sample groups. However, it would be

180 beneficial to increase doctoral studies in the field of nursing in order to increase ethical sensitivity and emphasize the importance of clinical ethics. It is also recommended to conduct practical studies emphasizing the importance of nursing ethics in undergraduate and postgraduate education. Key Words: Ethics, nursing and ethics, dissertations

181 [OP-64] EXPECTATIONS AND PERCEPTIONS OF NURSING STUDENTS ABOUT ETHICS COURSE Nevin Utkualp 1, Aylin Palloş 1, Hicran Yıldız 1, Aysel Özdemir 1, Neriman Akansel 1 ¹ Uludag University Aim: The purpose of the study was to evaluate the students' expectations and perceptions about the course. Methods: The descriptive study was conducted with 191 students in Uludag University Faculty of Health Sciences Nursing Department who were trained in and accepted to participate in the study. The data were collected using a data collection form containing the demographic characteristics of the students. Relationships between categorical variables were analyzed by chi-square test. Comparisons of continuous variables between groups were made by t test and Mann-Whitney U tests for independent groups; by ANOVA and Kruskal Wallis tests for more than 2 groups. Results: 80.2% of the students who participated in the study had taken ethics lessons and 19.8% of them did not receive ethics education yet. 32.4% of the students emphasized that they faced the experience of ethical problem in clinical practice without taking this course. It was determined that 89.2% of the nurses who took ethics lessons in our study were female and 10.8% were male. Female students were more interested in "euthanasia" that included ethical problems (p = 0.024). However, male students were more interested in patient rights (p = 0.044). There was no significant difference between students' level of knowledge and genders after taking ethics lessons (p = 0,970). It was observed that students were more sensitive especially to "organ donation" in ethical issues in low socioeconomic status (p = 0.041). Conclusion: It is considered that "nursing ethics" is important in terms of structuring the curriculum within the scope of continuous improvement in nursing education Key Words: Nursing, nursing education, expectation, perception

182 [OP-65] NECESSITY OF CLINICAL ETHICS COURSE IN NURSING UNDERGRADUATE EDUCATION: AN EVALUATION FROM STUDENT NURSES Nuray Demirci Güngördü 1, Çağatay Üstün 2 ¹ Recep Tayyip Erdogan University School of Health, Department of Nursing 2 Ege University, Faculty of Medicine Aim: Ethical dilemmas frequently occur in the field of health. For this reason, providing nurses with ethical training in the undergraduate program is an important requirement for nurses who are among the important elements of the medical team. One of the main points to consider in this context is the quality of ethical education that nurses should take. In our country, in the nursing undergraduate program, ethics education is generally given as 28 hours including 2 theoretical lectures per week within 14 weeks of academic calendar and this lecture does not include clinical practice. From this point of view, the objective of the research is to reveal whether clinical ethics education is necessary or not in the nursing curriculum in terms of nurse candidates point of view. Methods: The study is a qualitative research. Study group of the research consists of 11 participants, 4 th grade students from Health College of Recep Tayyip Erdogan University, who volunteered to participate in the research. The data were gathered with semi-structured data form prepared by researchers. The obtained data were analyzed by descriptive analysis method. In order for the study to be carried out, the approval was received by the Ethics Committee of Non- Invasive Clinical Investigations from Recep Tayyip Erdogan University (Decree No: 2017/84). In addition, informed consent was obtained from each participant. Results: As a result of the research, participants found that it was important to have ethical education in the nursing curriculum. However, almost all the participants stated that the ethics lesson should be conducted as a separate course, not within Nursing History and Ethics course. Similarly, they pointed out that ethics should be applied course in nursing. When the reason for this was questioned, the themes were set as to distinguish between right and wrong in the ethical dilemmas they experience in the clinic, to make conscience judgment, to improve ability for empathy and to keep the information permanent by discussing the theoretical information on the case. Cunclucion: In the light of the collected data, the ethical subject in nursing should be divided into two different parts as theoretical and practical (applied) and so as to develop ethical

183 awareness in the profession, scientific activities such as panels, forums, symposiums and congresses should be organized at regular intervals. Key Words: Student nurse, undergraduate education, clinical ethics course

184 [OP-66] INVESTIGATION OF BEING FAIRLY AND MORAL DILEMMA SITUATIONS OF NURSING AND MIDWIFERY STUDENTS WHO TOOK ETHICS COURSE Sevgi Nehir Turkmen¹, Nurgül Güngör Tavşanlı¹, Hatice Irmak¹, Dilek Çeçen¹ ¹ Manisa Celal Bayar University Faculty of Health Sciences, Department of Nursing Aim: The aim of the study was to examine being fairly and moral dilemmas in nursing and midwifery students who took ethics course. Methods: Permission has been obtained from the ethics committee of the university before starting the study. The universe of the research is composed of 694 students in April-May education year-4th grade nursing-midwifery students studying at Manisa Celal Bayar University Faculty of Health Sciences. The sample of the research was 255 students. Data were collected using the "Fairness Scale" and the "Moral Dilemma Test". Data were evaluated by SPSS 21.0 packet program with number, percentage, t test, ANOVA test. Results: The average age of the students is 21,77 ± 1,75, 51,8% of the students are over 22 years old, 85,1% are girls, 60,7% are in the nursing department and 76,5% are income balanced. When the profession ethics most strongly adopted by the students is examined; 77,4% respect autonomy, 88,2% fairness, 92,2% no harm, 90,6% respect for life 71,0%, 81.2% were honest, 88.2% had respect for privacy, 76.1% had kept secrets, 60.0% had regard for specialization, 84.7% had avoided discrimination The most strongly adopted. When the results of the students' dilemma test were examined, 53.3% of the 3rd year students, 68.9% of the boss dilemma test and 67.4% of the Heinz dilemma test showed good child tendency in the dilemma test of the students. In the neighbors' dilemma test, 54.1% of the third-year students showed a tendency towards law and order. In the physician's dilemma test, 58.3% of the 4th grade students showed a tendency to law and order. In the boss dilemma test, 73.3% of 4th grade students, 54.2% of Neighbor dilemma test and 79.2% of Heinz dilemma test showed good child tendency. It was determined that the students who were 21 years or below had a fairly high level of fairness and community sub-domain scores compared to those 22 years or over (t = 2,631 p = 0.009). When the relationship between the gender of students and the fairness scale subscales was examined, it was found that female students' scores of fairness scale total scores (t = -3,410 p = 0,001) were significantly higher than male students.

185 Conclusion: The majority of the students support the idea that the individual must comply with the rules and be a good person. The majority of students still " accepted by the group" showed a good trend that the child is the main objective. It has been determined that students take care to take ethical principles into account when deciding on ethical issues. Key Words: Fairness, moral dilemma, ethics, student

186 [OP-67] EVALUATION OF NURSES ATTITUDES IN MEDICAL ERRORS Nigar Ünlüsoy Dinçer 1, Serpil İnce 2, Rana Can 3 1 Ankara Yıldırım Beyazıt University Faculty of Health Sciences 2 Akdeniz University Faculty of Nursing 3 Mustafa Kemal University Faculty Hatay Health College Nursing Aim: The services at hospitals which are the most complicated enterprises of today s world must possess high safety and zero error. Nevertheless, medical errors issue arises as a growing problem in health care field. Medical errors mostly appear within preoperative and postoperative complications. Error specification and examination of causes are profoundly important for the development of solution proposals. The specification of health professionals attitudes towards medical errors have high importantance for the reduction of error rates within this context. Determination of human attitudes towards errors can increase the controllability by predicting behaviours of nurses and necessary precautions can be taken. This study was conducted to detect the nurses attitudes towards medical errors. Methods: This study was conducted with 120 volunteers who were actievely working during the research period (April 10 July 30) among 207 nurses of a Training Research Hospital. Ethics committee approval, institute approval and written consent of participants were obtained. Sociodemographic Questionnaire Form and Scale of Attitudes Towards Medical Errors were used as data collection tools. Results: The age average of participants was 38.93±5.34. It was found that 93.3% of nurses were females, 80% were married, 47.5% had bachelor s degree, 38.3% had been working for 21 years or more and 42.5% works at specified units ( emengency, intensive care, surgery). The total score average of participants was found as 3.27±0.32. The score averages for sub scales were determined as 2.62± 0.80 for medical error perception, 3.55±0.36 for medical error approach and 3.72±0.53 for medical error causes. The total score average shows that nurses have a positive attitude. Conclusion: It was found that nurses have a high awareness level towards medical errors and importance of failure notice. The low score average (under 3) of medical error approach sub scale indicates negative attitude of nurses towards errors. Key Words: Nurse, medical error, attitude

187 [OP-68] EXAMINATION THESIS IN THE FIELD OF NURSING ETHICALLY IN TURKEY Nihal Gördes Aydoğdu¹, Zuhal Bahar 2, Kübra Pınar Gürkan¹, Ayşe Çal 3, Dilay Açıl¹, Burcu Cengiz 1 ¹ Dokuz Eylül University, Faculty of Nursing ² Koç University, Faculty of Nursing 3 Ondokuz Mayıs University, Faculty of Health Sciences Aim: This study was conducted in an attempt to examinate the ethically of theses in the field of nursing in Turkey. Methods: In this retrospective and descriptive study, the theses were reached by scanning the National Thesis Center, which is a website of the Turkish Higher Education Institution (YÖK). In the study, full texts of doctoral theses with experimental/quasi-experimental research design in the field of nursing were scanned. The theses were evaluated via a questionnaire form that was developed by researchers in the light of the literature, in terms of the universities where they were done, year of completing, research type, ethics committee and Institution permit, informed consent, privacy and confidentiality of personal information of research subjects. The data were evaluated by using the SPSS 21.0 software via numbers and percentages. Results: Within the scope of the study, 720 doctoral theses were reached in the field of nursing at national thesis center between ; 470 thesis according to criteria were examined. It was determined that 59.1% of the theses examined were in the experimental design, 17% were in the field of gynecology and obstetrics nursing, and 56.2% were thesis supervisor professors. When the theses are evaluated in terms of ethics; 90.2% of them were taken institutional approval, 85.5% of the ethics committee approval and 65.3% of them contained informed consent forms. 89.6% of the theses do not specify how to keep the data belonging to the participants in the informed consent forms; at 51.8% there is a statement that information will be kept confidential about data. In addition, 51.3% of the theses indicate the right to withdraw with informed consent forms, 72.3% do not pay participation fee and 75.9% do not have contact information of researcher. Conclusion: It is seen that doctoral theses made in experimental and semi-experimental design in our country in the field of nursing have deficiencies in the framework of internationally accepted rules of publication. For this reason, it is recommended that new researchers be taught

188 the ethical rules related to the conduct and publication of the research during undergraduate and postgraduate education. Key Words: Nursing, doctoral thesis, ethic

189 [OP-69] GESTASYONEL DIABETES MELLITUS (GDM): ETHICS IN COUNSELING AND SCIENTIFIC RESEARCHES Nuran Nur Aypar¹, Merlinda Aluş Tokat¹ ¹ Dokuz Eylül University Faculty of Nursing To discuss the ethical problems in counseling and conducting scientific research related to GDM. GDM can cause short and long term maternal and fetal complications. Therefore, appropriate counseling should be given to women about the management of GDM complications during the antepartum period. Ethics is defined as a group of moral principles or set of values that govern the behavior of an individual or a profession. In this respect, the ethical principles and respect for autonomy must be considered together in the consulting process. At the beginning of ethical principles comes utility and autonomy. The utility of maternal and fetus, and maternal autonomy are important for ethical values. Because fetal autonomy is not present, the fetus should be protected by the mother and health personnel. Evidence-based information should be provided for the utility principle in the consulting process. Women should be informed about the diagnosis, treatment, monitoring and lifestyle changes of gestational diabetes. If the woman does not accept the propositions in the direction of the evidence, we must also offer other options. Thus, we behave in accordance with the principle of autonomy. In our country, the news in the media affected pregnants related to diagnosis of GDM and some of them refuse to take the test. In these process, we must provide appropriate counseling to make self decisions. The consulting process should be continued that in the light of evidence at the postpartum period and at the level required for the risk of developing Type 2 diabetes. But at every stage, pregnant decisions must be respected without ignoring the principle of autonomy. New mothers do not pay attention to diabetes as much as they do during pregnancy, especially after having a healthy baby. Nurses should provide that women feel free in the process by providing appropriate counseling. When we look at the scientific researches, there are ethical dilemmas in the researches about GDM. Is it a correct approach to deprive the control group of patients from treatment or counseling? Reapitng research related to treatments with evidence is it time and economic loss? The lack of a single answer to these questions leads to ethical dilemmas. It is possible to achieve positive pregnancy and postpartum results by establishing a professional relationship between women and health professionals based on ethical principles and by taking evidence based interventions.

190 Key Words: Ethichs, ethich dilemma, GDM, nursing

191 [OP-70] COMMUNICATION PROBLEMS AND ETHICAL DIMENSIONS IN CONTEXTABLISHED IN THE BIRTH OF CONTINUOUS WOMEN REFUGEES- Ruşen Öztürk 1, Özlem Güner 1 ¹ Ege University Faculty of Nursing Following the anti-regime demonstrations in March 2011, the developments in Syria have created one of the world's greatest human crises. The Syrians, who had to leave their country, started the greatest migration movement of the 21st century and were described as one of the largest migratory waves in recent history. Currently, the number of refugees in Turkey has exceeded 3.4 million. This situation makes Turkey the largest refugee population in the world. Migration that affects social, cultural and physical society and individuals has very important effects on health and health variables. Worldwide wars and migrations are the main factors that increase reproductive health problems. Within the resulting demographic changes of migration, current health services face language barriers in meeting the health needs of migrant groups. The presence of language barriers in intercultural communication leads to negative outcomes in health care Especially, birth process, empathy and relief are very important, and sensitivity is an important period. For this reason, it is very important to have professional interpreters in health care centers to overcome language barriers. Little use of the interpreter during birth is one of the most important reasons for lowering quality of care. In our country, however, a health care service can not be offered in this way during childbirth. This leads to a double-sided prob- lem that affects both health care professionals who are in health care and Syrian women. Health care can also bring about negative attitudes towards refugees due to reduced quality of care and increased workload of health professionals. This review aims to address the ethical dimension of Syrian refugee women and health professionals towards the problem of communication. Key Words: Ethical dimensions, refugees, women health

192 [OP-71] INVESTIGATION OF FACTORS AFFECTING ETHICAL SENSITIVITY OF MIDWIVES Şükran Çakır 1, Emine Öztürk 1, Selda İldan Çalım ¹ Celal Bayar University Faculty of Health Science, Department Aim: Ethical sensitivity enables midwifes to recognize, interpret and respond appropri-ately to the concerns of those receiving professional services. The purpose of this study is to examine the factors that influence the ethical sensitivity of midwives. Methods: The type of this study is descriptive and cross-sectional. The research of universe consisted of all midwives (N=118) working at Manisa Merkezefendi Devlet Hastanesi and 105 midwives who agreed to participate in the study. We used the Individual Presentation Form, and Moral Sensitivity Questionnaire (MSQ) whose validity and reliability by made Hale Tosun (2005) for the data collection tools. The data were collected by means of a low MSQ score indicates a high ethical sensitivity. The cronbach alpha value of the study was Analysis of the data was done in SPSS 15.0 package program. Results: The mean age of the midwives participating in the study was 41,5±5,7 (min=26, max=61). The proportion of midwives who received undergraduate and above education (52,4%) is higher than those who have associate degree and below education (47,6%). Midwives stated that they didn t receive education on ethics after graduation (39,0%). The proportion of those who encountered an ethical problem in working life was 68,6%. Midwives didn t have any idea about the existence of an ethics committee in the hospital (59,0%). Midwives MSQ total score average was 95,7±24,8 (min=49, max=164). It was found that the midwives MSQ total point average (101,5±26,8) indicating that there is no ethics committee in the hospital is higher than the others and the ethical sensitivity is low (p=0,001). "Benefit" and "holistic approach" scores of the undergraduates and above education with MSQ subscales were lower than the others and higher ethical sensitivity (p<0,05). The "holistic approach" MSQ subscale of midwives in the unit related to midwifery area was lower and the ethical sensitivity was higher (p=0,030). The total score average of the MSQ "holistic approach" subscale (p<0,05), which working in the same unit for seven years or longer, is low. The scores of the MSQ sub-dimensions (autonomy, benefit, holistic approach, practice and orientation) were lower and ethical sensitivity was higher in those who stated that there was ethics committee in the institution (p<0,05). Conclusion: According to the ADA subscale scores, the ethical sensitivity of midwifes who have education level undergraduate and above, working in their own field, having a lot of

193 experience in the unit they work in and knowledge about the institutional ethics committee was found higher. Key Words: Midwife, Ethics, Ethical sensitivity.

194 [OP-72] COMMUNICATION IN INFERTILITY CLINIC: WHAT DO WOMEN AND NURSES THINK? Sevcan Fata 1, Merlinda Aluş Tokat 1 ¹ Dokuz Eylül University Faculty of Nursing Aim: Evaluating the opinions about communication of women who taking infertility treatment and nurses. Methods: It was conducted with three women and three nurses in infertility clinic in Izmir. Semi-structured in-depth interview method was used. Data will continue to be collected until the codes repeat. The obtained data were read by the researchers three times and codes, sub-themes and themes were created. Results: A total of 10 themes, 14 sub-themes and 56 codes were determined. In interviews with nurses, verbal communication sub-theme such as adjusting voice tone to individual, empathy, clarification of information and non-verbal communication sub-theme such as eye communication were highlighted under the theme of positive communication skills. Establishing negative sentences was a sub-theme for verbal communication under negative communication skills theme. Nurse-based such as professional experience and knowledge of nurse and patientbased such as willing patient were sub-themes under factors affecting positively communication. Factors affecting negatively communication contains nurse-based sub-theme such as intense work and patient-based sub-theme such as waiting for a long time. Suggestions for effective communication theme includes codes such as creating a trust environment. In terms of women, verbal communication sub-theme such as clear sentences of nurses and nonverbal communication sub-theme such as using body language were determined under positive communication skills theme. Expressions such as using of high-pitched tone were involved in negative communication skills theme. According to the women, factors affecting positively communication theme includes codes such as nurse personality, patient-nurse mutual respect, nurse-team mutual respect. Expressions such as not allowing social life of nurses to work took part in suggestions for effective communication theme. Conclusion: Positive communication in infertility clinics was very important for comfortable passing of the process instead of stressful. So, evaluating communication in terms of nurses and women will be a guide for providing a positive communication environment. Key Words: Nursing, communication, infertility

195 [OP-73] ADVANCED AGE PREGNANCIES AND ETHICAL AWARENESS Sümeyye Bakır 1, Aylin Taner 2, Özlem Demirel Bozkurt 1 ¹ Ege University Faculty of Nursing 2 Muğla Sıtkı Koçman University Scool of Nursing 1 Ege University Faculty of Nursing This survey was planned with the aim of creating awareness of the ethical questions raised by advanced maternal age in pregnancy. Methods: The study was conducted by carrying out an examination of the relevant literature. Findings: The risk of the emergence of genetic defects increases with advanced maternal age pregnancies. For this reason, advanced maternal age is a significant factor causing ethical questions in such topics as reproductive aid techniques, pregnancy, and pre and post-natal care. It has been reported that one topic of recent discussion, frozen embryo transfer, has resulted in an increase in the frequency of post-term pregnancy, macrosomia. Another topic of discussion is that although oocyte and sperm donation have not gained acceptance in this society, it has been stated that there should at least be a knowledge of such topics. One indication of preimplantation genetic diagnosis (PGD) is the advanced age of the mother. If no limit is applied to PGD or the limit is determined by the possibilities presented by genetic screening tests, people may be directed to reproductive aid treatment techniques in order to be able to have children in the normal way. Another ethical problem, that of surrogate motherhood, is not seen very positively from the viewpoint of the traditional family. Other problems occur in relation to the ability to continue an advanced age pregnancy and to giving birth. However, the termination of pregnancy also creates an ethical dilemma in that it deprives the fetus of the right to life. Conclusion: In adapting to the rapid developments in the field of reproductive health, we as health workers must be aware of the ethical dilemmas which we may experience. There is a need for more work on advanced age pregnancy and its ethics in order to solve the ethical dilemmas. Key Words: Age pregnancies, ethical awareness

196 [OP-74] INVESTIGATIONS OF MISSED CARE IN NEONATAL INTENSIVE CARE UNITS; A HOSPITAL EXAMPLE Ayşe Kahraman 1, Figen Yardımcı 1 ¹ Ege University Faculty of Nursing Aim: Missed nursing care is defined as a failure to fulfill the necessary duties due to insufficient time, number of staff and / or job confusion. This study was conducted to determine the missed nursing care services and related factors in neonatal intensive care units. Methods: Nurses working in neonatal intensive care unit of seven hospitals in İzmir province created the universe of the descriptive study. Six of the seven hospitals did not allow to work for a variety of reasons. The study was done in an institution where permission is granted. Nurses who accepted to participate in the sampling study (n: 72) were taken. The data were collected between March 2017 and June 2017 using the Nurse Promotion Form and the MISSCARE Survey. The nurses were asked to complete the questionnaire, taking into account the patient care activities they had applied in their last shift. Results: 29.2% of the nurses stated that they were between the ages of (the average age was ± 6.48), 50% were undergraduates and 59.8% were in the most recent daytime shift. Nurses' experience of neonatal intensive care unit was 4.93 ± 4.03, weekly average working time was ± 6.13, and mean number of patients treated was 3.08 ± % of the nurses participating in the study stated that they would be enrolled in the care, 15.3% had the participation in the participation of the parents and 13.9% stated that they did not meet the preparatory nursing services very often. The reason why nursing care services were not satisfied was that 55.6% of the nurses did not function properly when necessary, 84.7% were in urgent patient situations, 75% were not equal in patient sharing, 56.9% were inadequate in number of nurses, 50% As an unexpected increase in patient concentration. Conclusion: It has been determined that there are important deficiencies in basic nursing care services in neonatal intensive care unit. It is predicted that deficiencies can be reduced by solving the causes of the health system. Key Words: Missed care, nursing, neonatal intensive care unit

197 [OP-75] THE RELATIONSHIP BETWEEN LEVELS OF BURNOUT NURSES TO ETHICAL SENSITIVITY IN PEDIATRICS DEPARTMENT Emral Gülçek¹, Filiz Polat², Rukuye Aylaz³ 1 Siirt University School of Health, Department of Nursing ² Adıyaman University School of Health, Department of Nursing ³ Inönü University Faculty of Health Sciences, Department of Nursing Aim: The purpose of this study was conducted cross-sectional to determine the relationship between burnout and ethical sensitivity of nurses in the field of pediatrics. Methods: The researcher 's universe consisted of nurses working at the Public Hospitals Institution of Diyarbakır Children' s Disease Hospital of Turkey, but a total of 150 nurses were included in the survey because nurses were not allowed to participate in the research and during the period in which the data were collected. Since all of the universe was targeted for research, no sampling method was used. A questionnaire including the demographic characteristics of the nurses prepared by the researcher, the Moral Sensitivity Scale and the Maslach Burnout Inventory were used to collect the data. Data; Between April 2017 and May 2017, a face-to-face interview was conducted by the researcher, verbally acknowledged by the nurses. In the analysis of the data, number, percentage, t test, ANOVA and correlation analysis were used in independent groups. Results: The burnout and ethical sensitivity of the nurses participating in the study were found to be moderate. It has been determined that the total ethical sensitivity score is not related to age, marital status, education status, duration of vocational study, pre- and post-graduate ethics, but age and occupational duration are related to some sub-dimensions of ethical sensitivity. Conclusions: It was determined that the burnout and ethical sensitivities of the nurses participating in the study are moderate. In line with these results, approaches such as increasing the salary of the nurses in terms of service provided satisfactorily in accordance with today's economic conditions, supporting scientific activities in nursing and making employee satisfaction evaluations effective are effective in decreasing the burnout level. can. It is recommended that postgraduate and continuing education programs be organized so that the ethical sensitivity of nurses can be increased and therefore ethical problems can be recognized and solved. Key words: Nursing, burnout, ethics

198 [OP-76] INVESTIGATION OF OPINIONS ABOUT DEATH, TERMINAL PERIOD AND PALLIATIVE CARE IN INTERN NURSES TO PEDIATRIC CLINICS:FOCUS GROUP DISCUSSION Nurdan Akçay Didişen 1, Hatice Uzşen 1, Dilek Zengin 1, Hamide Nur Çevik Özdemir 1, Satı Bozkurt 1 ¹ Ege University Faculty of Nursing Amaç: Ülkemizde ölüm kavramı algılayışı ya da terminal dönem bireye bakım veren hemşirelik öğrencileri ile yapılmış araştırma bulgularına rastlanmamıştır. Bu nedenle ülkemizde bu konuyla ilgili görüşlerinin incelendiği araştırmalara gereksinim vardır. Bu araştırmanın amacı, hemşirelik öğrencilerinin terminal dönemdeki hastaya, palyatif bakım verme ve ölüm ile ilgili duygu ve düşüncelerini belirlemektir. Gereç Yöntem: Çalışma nitel ve nicel araştırma desenleri kullanılarak oluşturulan karma bir modeldir. Çalışmada, nitel araştırmalarda kullanılan veri toplama yöntemlerinden biri olan odak grup görüşmesi yöntemi kullanılacaktır. Araştırma, Haziran Ocak 2017 tarihleri arasında Ege Üniversitesi Hemşirelik Fakültesi intörn hemşireleri ile gerçekleştirilmiştir. Araştırmanın evrenini Ege Üniversitesi Hemşirelik Fakültesi İntörn Hemşireleri (4.sınıf öğrencileri), örneklemini ise Ege Üniversitesi Tıp Fakültesi Çocuk Hastanesi Kardiyoloji Servisi, Çocuk Yoğun Bakım Ünitesi ve Tülay Aktaş Onkoloji Hastanesi Pediatrik Onkoloji Servisinde intörnlük uygulaması yapan 13 intörn hemşire oluşturmuştur. Araştırma verileri, araştırmacılar tarafından literatür taranarak geliştirilen veri toplama formu ile toplanacak olup, odak grup görüşmesinde elde edilen veriler tematik analiz yöntemi kullanılarak analiz edilmiştir. Bulgular: Araştırmada öğrencilerin odak grup çalışmasında intörnlük uygulaması süresince terminal dönemdeki pediatrik hastaya palyatif bakım verdikleri, ölüm olayını yaşadıkları, ölüm karşısında en çok üzüntü, korku, çaresizlik duyguları yaşadıkları belirlenmiştir. Öğrencilerin çoğu ilk başta şok olduğunu, ne olduğunu anlayamadığını hastayı ailesiyle birlikte ele aldıklarında, onların üzüntülerine şahit olduklarında ölüm olayını idrak ettiklerini belirtmişlerdir. Sonuç: Bu araştırma bakım kalitesini arttırmak için ölüm, terminal dönem, palyatif bakım ile ilgili daha kapsamlı bir eğitim müfredatının da hemşirelik eğitimine eklenmesi açısından önemlidir. Key Words: Ölüm, öğrenci, odak grup, hemşirelik

199 [OP-77] PEDIATRIC HEMATOLOGY-ONCOLOGY NURSES OPINIONS ABOUT TELLING CANCER DIAGNOSIS TO CHILDREN Selmin Şenol 1, Seda Ardahan Sevgili 1, Hamide Nur Çevik Özdemir 1 1 I Ege University, Faculty of Nursing Aim: Dünya Kanser Veritabanı (GLOBOCAN) verilerine göre 2012 yılında Dünya da toplam 14,1 milyon yeni kanser vakası gelişmiş ve 8,2 milyon kansere bağlı ölüm olmuştur. Türkiye de ise her yıl yaklaşık 159 bin kişi kanser tanısı almaktadır. Çocuklara/ailelerine tanıları konusunda ilk bilgiyi, prognozu paylaşmak tüm sağlık bakım profesyonelleri için istenmeyen ancak kaçınılamaz bir durumdur. Çocuklara/ailelerine kanser tanısını söylemek duygu yükü olan zorlayıcı bir görevdir. Bu görevde profesyonel sağlık çalışanlarında çoğu kez korku, endişe ve hüzün duygusu yaşanmaktadır. Bu çalışmanın amacı, hemşirelerin bakım verdikleri çocuklara/ailelerine kanser tanılarına ilişkin bilgi verilmesine yönelik eğilimlerini, tercihlerini, bu tercihleri etkileyen faktörleri belirleyerek, çocuk/aile için daha etkin bir hemşirelik yaklaşımını planlayabilmektir. Methods: Araştırma tanımlayıcı ve yüz yüze görüşmenin yapıldığı karma tipte olup, bir üniversitenin Pediatrik Hematoloji ve Onkoloji (PHO) servislerinde çalışan hemşirelerle(n:18) Nisan-Haziran 2017 tarihleri arasında yapılmıştır. Çalışmada araştırmacılar tarafından oluşturulan iki form kullanılmıştır; ilki tanımlayıcı bilgi formu, diğeri Kanser Tanısının Açıklanmasına İlişkin Hemşire Görüşleri Soru Formu dur. Results: Çalışmaya katılan hemşirelerin yaş ortalamaları 31.2±7.20'dir ve %94.4 ü (n:17) kadındır. Hemşirelerin sadece %5.6 sı (n:1) SML mezunudur. Mesleğinin ilk beş yılında olanlar %55.6 (n:10)'dır ve %77.8 i (n:14) bu birimde 1-5 yıldır çalışmaktadır. Çocuğun, kendisine tanısı hakkında bilgi vermesi istendiğinde hemşirelerin %66.7 si (n:12) hiçbir bilgi vermeyeceğini belirtmiştir. Sadece üç hemşire, tanının "hemşire ve doktorun birlikte" ekip olarak çocuğa/aileye söylenmesi görevini vurgulamıştır. Kanser tanısının aileye/çocuğa ilk kez açıklanması sırasında hemşirelerin %38.9 u (n:7) "hiçbir duygu ifadesi göstermeden" söylenmesi gerektiğini düşünmektedirler. Conclusion: PHO hemşireleri, kanser tanısını direkt olarak söylemekten kaçınma eğilimi göstermekte ve duygu ifade sıkıntısı yaşamaktadırlar. Ayrıca, çocuk/aileye hastalık süreciyle ilgili tüm bilgileri ekibin birlikte vermesi gerektiğine de dikkat çekilmiştir. Key Words: Çocuk, kanser, hemşire, tanının söylenmesi

200 [OP-78] THE RELATION BETWEEN ETHICAL SENSITIVITY AND CRITICAL THINKING DISPOSITION OF NURSING STUDENTS Aynur Kızılırmak¹, Pelin Calpbinici 1 ¹ Nevşehir Hacı Bektaş Veli University, School of Health Aim: The study was conducted to determine the relation between ethical sensitivity and critical thinking of nursing students. Methods: The study was conducted at nursing department in a health vocational college of a university. Universe of the study was constituted from 324 students at 2nd, 3th and 4thclass in education session, spring term. Sample choosing wasn t done and 233 students who accepted to participate to the study were taken to the study and so 72% of the universe were reached. Data was collected with Personal Information Form that prepared by the researcher in the direction of literature, Ethical Sensitivity Scale Adapted for Nursing Students (ESSANS) and California Critical Thinking Dispositions Inventory (CCTDI). Data was evaluated by using descriptive statistics and Spearman correlation for investigating relation between variables with SPSS 20 package program and also p<0.05 was accepted as significant. Before the study, required consents of ethical committee, institute and participants were obtained. Results: In the study average age of the students was21.54±2.00, 72.1% of them were girls and 27.9% of them were boys. It is determined that 68.7% of the students met ethical problems and of them; 77.5% lived this problem about giving information to patients about disease and 74.3% lived problem about care applications. Of the students; ESSANS score mean was4.63±0.57, as subscale score means; interpersonal orientation was 5.72±0.80,ethical dilemma experiment was 3.44±1.12, helpfulness was 4.61±0.89, ethical content formation was12±0.71, modified autonomy was 4.60±0.87, consulting expert information was 4.69±1.02. CCTDI score mean was ±22.94, for its sub-dimension score means; seeking truth was34.81±7.85, openmindedness was 41.44±8.02, analyticalness was 47.44±6.34, systematicity was 42.17±7.46, selfconfidence was41.48±8.48, curiousness was 45.26±7.65.There wasn t a significant relation between ESSANS and CCTDI score means of the students (r = 0.004; p>0.005). However, when the relation between sub-dimensions ofessansand CCTDI; it is found that there was significant difference between interpersonal orientation with seeking truth and analyticalness; ethical dilemma experiment with open-mindedness and systematicity; ethical content formation with seeking truth and open-mindedness; modified autonomy with self-confidence; consulting expert information with analyticalness and curiousness, as statistically (p<0.05).

201 Conclusion: It is determined that ethical sensitivity of nursing student was neuter, critical thinking disposition was low. There wasn t a significant relation between their ethical sensitivity and critical thinking dimension but there was a significant relation between some sub-dimensions. Key Words: Ethical sensitivity, nursing education, ethic in nursing, nursing students, critical thinking

202 [OP-79] A STUDY ON THE MORAL SENTİTİVİTY OF NURSİNG STUDENTS: KOCAELİ EXAMPLE Pervin Şahiner ¹, Belgin Babadağlı¹, Nermin Ersoy² ¹ Kocaeli University Faculty of Health Sciences, Department of Midwifery ² Kocaeli University, Faculty of Medicine Aim: To be able to distinguish emotions, facts and values from each other requires moral motivation as well as cognitive capacity. For this reason, moral sensitivity and moral motivation are assumed to be the core of the health care service, and health care professionals are concerned with having moral motivation, observing moral values, and being aware of their own roles and responsibilities. However, it is important that the moral sensitivities are developed so that they can cope with the difficult situations they often encounter with women's special moments. Methods: In the first and last year midwifery students of Kocaeli University Health Science Faculty, the Moral Sensitivity Questionnaire (MSQ) was applied. Turkish validity and reliability of this scale Yilmaz Şahin et al. Results: A total of 128 midwifery students participated in the study. The moral sensitivity of the students was found to be neutral, and there was a significant difference between the class and sensitivities of the subscales defined as interpersonal orientation, experiencing ethical dilemmas, expressing benevolence, structuring moral meaning and professional knowledge. There was no correlation between socio-demographic characteristics and moral sensibility score of the students. Conclusion: The level of moral sensitivity of midwifery students suggests that the content of ethical education in midwifery education needs to be watched. Key Words: Midwifery, moral sensitivity, ethics education

203 [OP-80] NEEDLESTICK /SHARPS INJURIES CASES AND RELATED FACTORS OF NURSING STUDENTS DURING CLINICAL PRACTICES Seher Satılmış¹, Aynur Uysal Toraman² ¹ Usak Ayşe Ana School of Professional and Technical Anadolu ² Ege University, Faculty of Nursing Aim: This study is planned as a descriptive study in order to analyze needlestick /sharps injuries cases and related factors of nursing students in Uşak University Nursing Department during clinical practices. Methods: Universe of the study consists of 462 students studying at Uşak University Nursing Department in Uşak city center. Since the purpose is toreachall the universe, no sampling method is used The 402 nursing students who volunteered to participate in the research sample constituted the research participation rate of 89%. The data were collected by a question naire constructed for this study. Data are obtained through a survey form by there searc her between 15th May and 30th June, Inevaluation of thedata SPSS 16.0 package programme is used. Results: The meanage was 21,2±2,07 and most of were female (76.1-%). 44,8 % of the students reported that they experienced needlestick /sharps injuries during clinical practices, however; 51,7 % of them reported that they did not. 58,7 % of the students reported that they had information about security measures about heal thrisks in practiceareas, however, 41,3 % of them reported that they did not have. 60,2 % of the students stated that they did not have Hepatitis B vaccination and 76,4 % of them stated that they did not have tetanus vaccination. 37.8% of the students had a needlestick /sharpsinjuries 30.6% twice, 31.7% had three and more injuries. A statically significant difference was identified between the class that the nursing students study and needlestick /sharps injuries cases, (X²=13,946, p=0,003). Class degree increases needlestick tool injuries in increasing the rate of 1,48, according to the needlestick of information about those without security measures to protect the health status instrument injuries are more frequent than 4,2 times. According to logistic regression analysis, needlestick /sharps injuries them important factor is determined on the status of information security measures. A total of 51.7% of needlestick /sharps injuries were said to have goneun reported in any official report. It was determined that the class that the students were educated was effective in receiving occupational health and safety information and reporting nurses' needlestick /sharpsinjuries (p <0.05). In order to apply the work; Ege University Faculty of Nursing Scientific Ethics Committee has been

204 obtained permission. Permission was obtained from Uşak University Rectorate for the application of the research. In addition, before the survey was applied to students, the reasons for the research, the usefulness to be obtained without research, the time required for the questionnaire were explained and the oral approvals were taken. Conclusion: Inlight of these findings, nursing students, school administration and health institutions by needlestick /sharps injuries to the necessary training required priornotifications about occupational health and safety measuresto be made. Key Words: Needlestick /sharpsinjuries; nursing student; securitymeasures

205 [OP-81] ANALYZING THE MORAL SENSITIVITY AND CRITICAL THINKING TENDENCY OF NURSING AND MEDICAL STUDENTS Serap Parlar Kılıç¹, Gülendam Karadağ², Cihat Demirel³, Nermin Kılıç 3 ¹ Fırat University, Faculty of Health Sciences ² Dokuz Eylül University, Faculty of Nursing ³ Fırat University, Institute of Health Sciences Aim: The purpose of this study is to analyze the moral sensitivity and critical thinking tendency of nursing and medical students. Methods: This descriptive study was conducted with 231 nursing students and 110 medical students studying at Nursing Department in the Faculty of Health Sciences and Faculty of Medicine, Fırat University during the spring term of the academic year of The data were collected by using a questionnaire with 17 questions, Moral- Sensitivity Questionnaire, and California Critical Thinking Disposition Inventory and analyzed through Shaphiro Wilk test, Student t test and Chi square test. Results: 67.4% of the students were nursing students and 32.6% were medical students. It was reported that 59.3% did not encounter any ethical problem in their student life, and 16.9% of those encountering any ethical problem were unable to solve that problem. It was determined that 39.1% did not encounter any ethical problem in their student life, and 19.1% of those encountering any ethical problem stated they were unable to solve that problem. It was revealed that in both groups, the critical thinking disposition (Medical=212.02±29.34; Nursing=203.74±30.62) was low; however, medical students had higher scores of critical thinking disposition than nursing students and there was a statistically significant difference between them (p<0.05). Based on this result, it can be asserted that medical students had a higher critical thinking disposition. When examining the scores obtained by the students from Moral- Sensitivity Questionnaire, it was found that the moral sensitivities of the students were at moderate level (Medicine=87.1±24.26; Nursing=95.5±23.92). However, it was determined that medical students had lower total score and subscale scores of the moral sensitivity questionnaire than nursing students and there was a statistically significant difference between them (p<0.05). Based on this result, it can be asserted that the medical students had a higher level of moral sensitivities.

206 Conclusion: It is very important to include ethical and critical thinking more in curriculum and to organize continuous education programs following graduation in order for the nursing and physician candidates to be aware of their professional awareness. Key Words: Moral sensitivity, critical thinking, tendency

207 [OP-82] NURSING AND MIDWIFERY STUDENTS OPINIONS ON ABORTION WHO HAVE TAKEN COURSES RELATED TO ETHICS Gönül Akgün 1, Zülfiye Bıkmaz 1, Özlem Özdemir 1 1 / Kırklareli University, Health of High School Aim: To determine 3rd and4th year Nursing and Midwifery students opinions on abortion who are studying at a university Health School and who have taken courses related to ethics, and the socio-demographic characteristics that affect these opinions. Methods: The design of the research is descriptive. All students studying in the 3rd and 4th grade of Midwifery at School of Health constitute the universe of study. Data analysis was conducted with the non-probability sampling method on 165 students(71.7%,n=230). Who volunteered to take part in the study.permission from the institution was obtained for the study to be performed. SPSS 20 software was used in the analyses.descriptive statistics and comparative analyzes were used in the evaluation of the data. Results: The mean age is21.82±1.65(min=19,max=32).67.9%are nursing students and85.5% are females.52.7% has worked on a case of abortion during their internship and49.7% didn t participate inthe application of abortion.of the participants,4.8% had the opinion that all physicians,99.4% that only Specialists in Obstetrics and Gynecology,11.5% that midwives and 2.4% that nursing students can perform an abortion procedure(multiple choices has been selected).90.3%of the participants(n:149) think that abortion is not a method of family planning.21.8%(n:36)ofthe participants expressed the opinion that abortions could be performed in all involuntary pregnancies,87.9%(n=145) expressed the opinion that abortion has to be performed in cases of medical necessity,21.8%(n=36)expressed the opinion that abortion can be performed in cases of out-of-marriage pregnancies,99.1%(n=105,n=106)expressed the opinion that abortion has to be performed in the cases of rape,and1.8%(n=3) expressed the opinion that abortion should never be performed(multiple choices has been selected).it was found that the opinions that the fetus is an individual who has the chance to survive and live(xf2=6,226,p=0,040)and the opinions about abortion(xp2=10,052,sd=2,p=.006)were influenced by providing treatment and care to the aborted female patient.no relation was found with socio-demographic characteristics such as educational status and origins of parents(p>0,05). Conclusion: It s thought that the trainings given at the level of knowledge are insufficient in producing the desired output.given the influence of experience in the formation of

208 knowledge,it s anticipated that qualified education for attitude change can only be achieved with fewer groups of students. Key Words: Nursing and midwifery students, abortion, ethics

209 [OP-83] PERCEPTIONS OF NURSING STUDENTS TOWARDS ETHICAL BEHAVIORS OF FACULTY MEMBERS Ülkü Güneş¹, Elçin Ülker Efteli², Gül Şahbudak¹ ¹ Ege University, Nursing Faculty ² Mehmet Akif Ersoy University Faculty of Health Sciences Aim: To examine how nursing students perceive the ethical and unethical behaviors of faculty members in the classroom and during the interactions in the clinical practice. Methods: The study population consisted of 466 students who accepted to participate in the study (N = 1149) in the 2nd, 3rd, and 4th classes of Ege University Faculty of Nursing. Data were collected using "Individual Presentation Form" and "Perception Scale for Ethical and Non- Ethical Behaviors of Faculty Members of Nursing Students" developed by Arslan and Dinç (2016). The 32-item scale is a one-dimensional measure of the 3-point Likert type with the "I agree", "I do not agree" and "Undecided" options for each item. The total score range that can be taken from the scale is As the score increases, ethical attitude increases. Results: Second-grade students had higher ethical perception score. It was determined that there was a statistically significant difference between the classes according to total mean scores of the scale (p <0.001). Male students had lower perception scores than females (p <0.001). Most of the students agreed with statements regarding educators professional qualities such as those concerning up-to-date subject knowledge, class management and authority, and positive personal qualities, including respecting students confidentiality and private lives and avoidance of discrimination.students have found unethical that educators arrives late or leaves the class early (71.9%), uses rude words and swear during teaching (79.4%), uses university facilities for personal interests (76.4%). The students stated that the educators should have clinical teaching skills (93.3%) and should obtain informed consent from the patients when providing nursing care involving violation of bodily integrity (89.7%). Conclusion: As a result of the study, it can be said that the perceptions of the students about the ethical and unethical behaviors of the instructors in the classroom and the clinical environment are high. Key Words: Academic ethics, ethics, nursing education

210 [OP-84] ATTITUDES OF ACADEMICIAN NURSES TO ACADEMIC ETHICAL VALUES AND RELATED FACTORS Duygu Yıldırım 1, Merve Kırşan 1, Servet Kıray 1, Esra Akın Korhan 2, Fisun Şenuzun Aykar 3, Çağatay Üstün 4 1 / İzmir Katip Çelebi University, Institute of Health Sciences 2 / İzmir Katip Çelebi University, Faculty of Health Sciences 3 / Ege University, Faculty of Nursing 4 / Ege University, Faculty of Medicine Aim: This study was conducted with the aim of determining the attitudes of academician nurses towards academic ethical values and related factors. Methods: This survey designed as a descriptive, which was conducted in two different public universities of Turkey between May and June 2017.The sample of the survey included 103 nurse academicians who volunteered to participate in the survey.the data were collected using the "Descriptive Features Information Form" and "Academic Ethics Values Scale" developed by Sevim (2014). For conducting the survey, initially, written permission was obtained from the author, written approval from the university ethics committee and the institutions where the survey was conducted and verbal consents from the academicians.data obtained study were evaluated with the SPSS 20.0 package program.when evaluating the data, number, percentage, mean±standard deviation, One-way ANOVA, Independent Sample T test, Bonferroni and Tukey test were used. Results: The mean age of the participating academicians was found to be 35.7±9.6 (min:23, max:65), 95% were female, 51.5% were working in the position of research assistant.the attitudes of the academicians in respect to the academic ethics values were observed to be at high level positively ( ± 11.01).Examining the sub-dimensions of the scale, the highest mean attitude score was detected for the sub-dimension of "teaching process-oriented values (58.66 ±5.27)" while the lowest mean attitude score was detected for the sub-dimension of "scientific researchoriented values (21.16±3.80).There was no statistically significant difference between the total item scores of the scale and the ethics education status of the academicians (p>0.05).participants who worked as assistant professors were found to have higher score total item scores than participants in other academic duties and the difference between them was statistically significant (p<0.05).

211 Conclusion: As a result of this study, the attitudes of the nurse academicians on the academic ethics values were found to be at high level positively.

212 [OP-85] INVESTIGATION OF ACADEMICIANS ATTITUDES AND BEHAVIORS WITH REGARDS TO ACADEMIC ETHICAL VALUES Sevgi Pakiş Çetin 1, Kıvan Çevik 1 1 / Manisa Celal Bayar University, Faculty of Health Sciences Aim: This study was conducted to investigate the attitudes and behaviors of academicians with regards to academic ethical values. Methods: This descriptive cross-sectional study comprised 65 academicians who are working at the Faculty of Health Sciences, Faculty of Sports Sciences, Medical Faculty Department of Basic Medicine of the Manisa Celal Bayar University Institute of Health Sciences and volunteered to participate in the study. The data of the study were collected using the Academician Information Form and the The Scale of Academic Ethical Values. Results: The mean score the academicians obtained from the The Scale of Academic Ethical Values was ± The comparison of the mean scores The Scale of Academic Ethical Values in terms of the academicians sociodemographic characteristics revealed that the academic ethical values level was higher in the aged 36 years and above academicians ± 9.26, in the married academicians ± 18.45, in the academicians who had child ± 10.16, in the academicians who were 52 months and over in academic working time ± 12.75, in the academicians who were 97 months and over in total working time ± 10.46, in the academicians who were instructor excluding research assistant ± 9.73, in the academicians who had course load ±10.36, in the academicians who conducted administrative function ±8.55. This difference was found to be statistically significant. Conclusion: According to the results of the study, the mean score of The Scale of Academic Ethical Values of the academicians working at the units affiliated to the Institute of Health Sciences was above average and this result had high sensitivity level. Key Words: Academicians, academic ethical values, ethics

213 [OP-86] ACADEMIC ETHICS VALUES OF NURSE ACADEMICIANS Yildiz Denat¹, Yurdanur Dikmen², Gülşah Gürol Arslan³ ¹ Adnan Menderes Unıversıty, Faculty of Nursing ² Sakarya Unıversıty, Faculty of Health Sciences ³ Dokuz Eylul Unıversıty, Faculty Of Nursing Aim: This research was conducted to examine the attitudes of nurse academicians towards the academic ethics values. Methods: This survey, which was designed as a descriptive and cross-sectional, was conducted in three different public universities of Turkey between March and June The sample of the survey included 132 nurse academicians from different universities with different titles who volunteered to participate in the survey. The data were collected using the "Information Form" and "Academic Ethics Values Scale" developed by Sevim (2014) in our country. For conducting the survey, firstly, written permission was obtained from the author via , written approval from the university ethics committee and the institutions where the survey was conducted and verbal consents from the academicians. When evaluating the data, number, percentage, mean ± standard deviation, Kruskal Wallis test, and Mann-Whitney U test were used. Results: The mean age of the participating academicians was found to be 35.40±8.93 years. Of them, 52.3% were in the age range of years, 92.4% were female, 18.9% were working in the position of assistant professor and 72% were working in a Nursing Faculty. Of the academicians, 43.2% had been working as an academician for 2-5 years and their mean working year was determined to be 9.27±8.21 years. The attitudes of the participating academicians in respect to the academic ethics values were observed to be at high level positively ( ± 20.44). Examining the sub-dimensions of the scale, the highest mean attitude score was detected for the sub-dimension of " teaching process-oriented values (61.85±9.57)" while the lowest mean attitude score was detected for the sub-dimension of "community-oriented values (28.32 ± 3.46)". Considering the titles of the academicians, significant differences were found between the total score of Academic Ethics Values Scale and the mean scores of the sub-dimensions of " scientific research-oriented values" and "teaching process-oriented values" (p < 0.05). However, as the age and academic experience year increase, the mean score of the sub-dimension of "teaching process-oriented values" was found to increase significantly (p<0.05). Conclusions: As a result of the data obtained, the attitudes of the participating nurse academicians on the academic ethics values were found to be at high level positively. Considering

214 the other sub-dimensions of ethics values, the academicians can be said to act more sensitively in the sub-dimension of teaching process-oriented academic ethics values. Also, the academicians with professor title were determined to constitute the most sensitive group in terms of perceiving academic ethics values, and they were followed by the assistant professors and academicians with the title of doctorate.

215 [OP-87] AN ETHICAL DILEMMA IN PSYCHIATRIC CLINICS: PHYSICAL RESTRAINT Mehtap Çöplü 1, Fatma Ayhan 1 1I Karamanoğlu Mehmetbey University, Faculty Of Health Sciences Physical restraint is one of the control methods used to prevent patients and employees in psychiatric clinics from suffering from conflict. Physical restraint is defined as 'the use of any physical method that restricts the movement, the freedom of movement of the individual, or the movement of his / her body'. Physical restraint, which means holding the patient by hand and restricting movement to control devastating and violent behavior; is carried out before solation, mechanical and chemical detection. Restriction (detection) practices are suggested to be both physically and psychologically adversely affecting both the patient and the healthcare worker, as well as benefiting from the prevention of violence and the security of the treatment environment. For example, when physical therapy requires close follow-up and is slow-acting, physical detection is the cornerstone of weakening. For this reason, it is stated that detection applications are caused by ethical dilemma. The most specific ethical issues that arise in the field of psychiatry are those related to the protection and respect of the patient's autonomy. Physical restraint is an intensely controversial process due to ethical and legal issues affecting patient autonomy and dignity. Applying restrictions to manage the patient who is at risk of violence, patient autonomy for nurses, protecting human dignity and creating ethical dilemmas related to informed consent. In an effort to identify the knowledge, attitudes, goals and practices of nurses in Malaysia and the factors that affect these variables, nurses have never informed the family about the use of physical restraints for most patients, or that they do not explain why the patient is restricted. The findings of a study conducted by the psychiatric nurses in Sudan to evaluate their attitudes and practices to physical restraint in patients with mental illnesses revealed that a fourth of the nurses did not agree with the statement "family members are entitled to refuse restrictions". This also demonstrates the need to increase the patient's rights and awareness of ethical issues in order to be protected from assault allegations. Key Words: Physical restraint, ethical dilemma, nursing

216 [OP-88] ETHICAL PROBLEMS IN MENTAL HEALTH SERVICES IN THE LIGHT OF FINANCIAL OPPORTUNUTIES Leyla Baysan Arabacı¹, Gülsenay Taş¹, Dilek Ayakdaş Dağlı¹ ¹ İzmir Katip Çelebi University of Health Sciences In general, health financing involves use of financial resources in the health sector. The aim of health financing is to create adequate and sustainable resources to ensure that all individuals are able to access health services financially(1).the hospital services, the provision of trained staff support, the equipment needed for care and treatment, and all these expenses, provided by the financial resources allocated for health.it is also possible to acquire new medical devices, conduct research on diseases, and provide individuals with access to new treatment methods. Inadequate financial resources means failure to meet basic care and treatment services for patients, which in turn can lead to ethical problems.however, health services must be an equitable for every individual. Spending on mental health services accounts for 5% to 18% of total health spending in countries and this rate is increasing day by day in OECD countries(2).health financing constituted 8.9%(3)of GDP in Finland in 2011, and 9.1% of GDP in Sweden in The mental health expenditures made by the Ministry constituted 10.0% of the total health budget(4).in Italy, where each region has administrative autonomy, some regions allocate more than 5% of the health budget to mental health services, while in some regions this rate is lower(5).while mental illness is responsible for23% of total illness burden in England, only 13% of health expenditures are used in mental health services(6). In our country, total health expenditures constitute 5.4% of GDP in 2015(7). However, it is not known exactly how much is spent on mental health services, and this ratio is estimated to be low.according to National Mental Health Action Plan, mental health care cost is estimated to be approximately 1.67 billion for next years(8). Compared to other countries, it can be said that the financial budget which allocated for mental health services is not sufficient. This means that hospitals, medical devices, materials can not be renewed, unhealthy environment conditions, failure to fulfill the requirements of mental health care and lead to ethical problems.these ethical problems are that the basic living necessities can not be met in a manner worthy of human dignity; autonomy, harm, justice and equality (9). For this reason, the impossibility of health financing is an issue that must be urgently intervened in order to solve the ethical problems related to material insufficiencies and to provide a quality mental health service.at this point, it should be noted that health care workers,especially nurses who are involved in mental health services are responsible for having ethical sensitivity and being actively involved in health policies.

217 Key Words: Ethics, financial resources, mental health, mental health services

218 [OP-89] ATTITUDES TOWARDS PERCEPTION OF WORK ETHICS OF NURSES WORKING IN MANISA MENTAL HEALTH AND DISEASES HOSPITAL Sevgi Nehir Türkmen¹, Çağatay Üstün ², Hatice Irmak¹ ¹ Celal Bayar University Faculty of Health Sciences, ² Ege University Faculty of Medicine Aim: The aim of the study is to reveal the attitudes towards their perception of work ethics of the nurses working at the Manisa Mental Health and Diseases Hospital. Methods: Permission was obtained from the ethics committee of the university before starting the study. The universe of the research is composed of nurses working in Manisa Mental Health and Diseases Hospital between April and May In the research, it was aimed to reach the entire universe and not to select a sample. The sample of the research was composed of 72 nurses. Research data; The information form was collected using "Nursing Ethical Dilemma Test (NEDT)". The data were evaluated using the SPSS 21.0 package program with number, percent, and mann whitney U test. Results: The mean age of the nurses was ± % of nurses were femaled, 62.5% were married, 47.2% were associate degree graduates and ± 7.31 years of professional working years. When the vocational ethics most strongly adopted by nurses are examined; 87.5% benefited, 83.3% respecting autonomy, 97.2% being fair, 94.4% not being harmed, 94.4% respecting life, 84.7% informing and getting approval, 86.1% respect privacy, 87.5% confidentiality, 81.9% respect professionalism and 88.9% avoid discrimination. It was determined that the majority of the nurses (66.7%) were to "apply the anomaly newborn revitalization initiative", and the majority of the nurses (79.2%) preferred the "nurses forcibly apply the action". Nurses (79.2%) should give "respiratory support" to a patient who has a common tumor at the third level and does not want to have any medical intervention. The fourth dilemma is that a nursing working in a pediatric clinic has to adapt to this clinic by another nurse who starts a new relative rather than taking the time to care for the infant despite the limited resources. Nurses (48.6%) responded to this dilemma "should allow the nurse time to adjust". In the fifth dilemma, it was determined that the majority of the nurses (65.3%) "should report the drug mistake". In the last dilemma, 44.4% of the nurses responded that "the nurse should respond to the patient's questions, although the physician and the patient's family are not informed about the diagnosis of a patient with a fatal disease. It was determined that 80.6% of the nurses were familiar with

219 similar dilemmas and 19.4% were not familiar with similar dilemmas. It was determined that nurses had a PD (Principles of Thinking) mean average is ± 6.85 and PD (Practical Thinking) mean average is ± Conclusion: İt was determined that nurses took care to take into account the ethical principles that they frequently encounter with ethical problems in their professional sense and decide on such ethical problems. Key Words: Nursing, ethical decision making, work ethics

220 [OP-90] THE IMPORTANCE OF ETHICAL EDUCATION IN PSYCHIATRIC NURSES Nihal Güngör 1 Şeyda Dülgerler 1 ¹ Ege University, Faculty of Nursing It is possible for nurses to provide the highest level of care, to have dynamically changing information, to be able to show the necessary sensitivity to human and ethics, to update professional knowledge and skills, and to act in accordance with professional ethics. Professionalism is possible with ethical awareness and sensitivity. Ethics in the field of health; These values include ethical principles such as goodness, truthfulness, usefulness, autonomy and knowingly not damaging. Ethical education in nursing should help the nurses to identify what problems are causing ethical difficulties in their professional lives and to develop the skills needed to cope with the ethical problems they face; To trust themselves in ethical decision-making; Confidence in their own possessions and the knowledge they have gained. In addition; Ethical education is also important in terms of reaching the resources necessary to reach the solution of the ethical problems that they may face while practicing their profession. Because of the wide variety of psychiatric patient groups, there is a need for concepts that are beyond the generally accepted medical ethics. It is very important to determine and apply the ethical principles of psychiatric nurses because patients in psychiatric patient groups are exposed to abuse or neglect. Nurses need to decide on many issues during patient care practices. It is thought that psychiatric nurses should be more careful for this patient group which is special when the nurses working in psychiatry field are taken into consideration. This article is compiled to show the importance of ethics education in psychiatric nursing. Psychiatric nurses should use scientific knowledge related to nursing in the decision-making process when they will make a decision about the patient, to know ethical theories and principles, to act according to ethic code and psychiatric nursing rules. For this reason, the ethical issue should be examined carefully and thoroughly during psychiatric nursing education. In addition, these ethical principles should be reminded repeatedly during the training of the nurses and the importance of the ethical principles should be emphasized during the training of the nursing students. Key Words: Ethics, psychiatric nurses, ethical education

221 [OP-91] STIGMA AND ETHICS Gamze Göke Arslan¹, Şebnem Çınar Yücel¹ ¹ Ege University, Faculty of Nursing Stigma has been described as "the behavior valuing a stigmatized individual less, or as the perception of stigmatized people as less desirable or not at all as a human"(1,2). Stigma related to chronic diseases such as HIV/AIDS, tuberculosis, psychiatric disorders is a serious problem for individuals with these disorders and their families(3). The obligation to notify AIDS cases, conducting screening in business applications, lack of confidentiality, not employing individuals with AIDS in certain professions, restriction of immigration and international travel of those people and deportation of people with HIV lead to the loss of the respectability or status of those individuals or to the stigmatization of them in society, or diminish their value in society(4). That other people in the same environment with a person with tuberculosis are screened for tuberculosis because tuberculosis is contagious violates the patient s confidentiality. Because patients with tuberculosis do not have the right to refuse treatment, the principle of respect for the autonomy of the patient is violated since the community s benefit is considered in the forefront. Individuals being diagnosed with a psychiatric illness cause them to be stigmatized as "mental patients" or "dangerous people", or to be perceived as "people others cannot be sure of what they will do and when they will do"(5). In conclusion, health personnel s negligence to provide care for patients with HIV/AIDS and tuberculosis because they not want to get infected, humiliation of the patient, conducting of some diagnostic tests without the approval of the patient, labeling of the patient in patient records, discharging of the patient earlier and ill treatment of the patient in front of his/her family members cause ethical problems(4). It is recommended that while providing healthcare, nurses should take into account ethical principles of medicine such as justice, respect for autonomy, protection of confidentiality, and nonmaleficence. Key Words: Stigma, nursing, ethics

222 [OP-92] COMMUNICATION AND COMMUNICATION PROBLEMS WITHIN HEALTH TEAM Remziye Cici¹, Nadiye Barış Eren¹ ¹ Hitit University, Health of High School Teamwork is important in terms of providing safe and effective care to patients. While the team understanding and work is realized, various problems might occur when the healthcare team members do not adapt to their new roles and demonstrate traditional roles. Ethical problems are complicated; they require making a moral judgement and choice, do not have simple and absolute solutions, and cause an individual to experience dilemma. It is important to use appropriate approaches and effective communication strategies for the solutions to the problems. Factors such as health professionals deficient knowledge, hierarchy differences, contradictory roles and responsibilities, uncertainties and power struggles could cause communication conflicts. This conflict is generally between the doctor and nurse, and traditional doctor-dominant order is known to have an important role in this case. Communication problems in the health team cause breakdowns in the workflow, loss of time in the patient treatment and care, delays in the intervention for patients getting worse, and dangers in patient safety. It is reported in a study (n: 459) that transfer was performed without completing the transfer procedures in 28.8% of the patients, critical information about their case was neglected in 19.2% of the patients, and critical information in the patient care plan was not fully submitted in 14,2% of the patients. For good communication, individuals need to know about their values, emotions, responsibilities, be aware of the communication patterns they use, and have knowledge of the communicationenhancing techniques. Communication-related problems could be minimised if the right communication techniques are used with the right people, at the right time, in the right dose, in a right way, and with the right techniques. Effective communication in the health team enhances coordination of the care, which enables to share the appropriate information on time and increases the services provided. Key Words: Communication, communication problems, patient, health team

223 [OP-93] NURSE AND PHYSICIAN COOPERATION: EXAMINATION OF SUPREME COURT OF APPEALS DECISIONS Yakup Gökhan Doğramacı¹'² ¹ Gaziemir Nevvar Salih İşgören Public Hospital ² Medipol University, Institue of Social Sciences Aim: Team cooperation between nurses and physicians is inevitable in medical practice. Our work was carried out in order to evaluate Supreme Court of Appeals decisions on ethical issues arising from the cooperation between nurses and physicians. Methods: Decisions of the Supreme Court of Appeals have been screened concerning the cooperation of the nurses and the physicians. 17 decisions have been evaluated that can serve as an example in terms of ethics and responsibilities. Results: When the 17 decisions were examined, the following findings were obtained: Physicians have individual and team liabilities, in the cases of injection neuropathy; the nurse is not liable for the proper injection, also the trainee nurse is not liable for the proper injection, nurse and physician are liable for forgetting gauze, the physician should guide and advise the nurse on follow-up, the nurse who complies with the physician's instructions is not liable. Although the nurse makes incorrect data entry, the physician is liable for the control. Conclusion: According to Supreme Court decisions; physicians have general obligation to supervise, but on the other hand nurses have independent liabilities from physicians due to their professional obligations. Key Words: Cooperation, supreme court, decisions

224 [OP-94] DETERMINATION OF RELATIONSHIP BETWEEN CULTURAL INTELLIGENCE AND COMPASSION IN NURSING FACULTY STUDENTS OF ATATURK UNIVERSITY Esin Kavuran¹, Afife Yurttaş ¹, Mağfiret Kaşıkcı¹, Özlem Şahin Altun¹ ¹ Atatürk Üniversitesi Nursing Faculty Aim: the aim of this study was to determine relationship between cultural intelligence and compassion in nursing students.culture is total full features of the spiritual, material, intellectual, and emotional features and it is not only composed of life-styles, but also including, human rights, value systems, traditions and beliefs. Compassion is considered valuable in the medical profession as an ethical principle, a protection for the right of patients, and an important quality that patients seek in their service providers. Compassion is the capacity for being moved by the suffering of others and wanting to help alleviate it. Compassion may mediate the health benefits and relationships. The monitoring and management of the level of compassion across relationships may be critical to the preservation of the health benefits and the prevention of the health hazards of relationships. Methods: The research method applied a descriptive and its population was composed of of Ataturk University of Nursing Faculty students who were 1130 students.the sample size was determined of 898 students. Research data were collected through a questionnaire, and Cultural Intelligence and Compassion Scale. After data collection, SPSS software was used and data analysis was performed with descriptive statistics and statistical test. Results: The average score of the students' Cultural Intelligence Scale was ± 6.42, Compassion Scale score was ± 6.69, and no statistically significant relationship was found neither between the age of the students and the scale of compassion nor between the education level of their father and the cultural intelligence scale (p <0.05) Conclusion: Results showed that there is a direct significant relationship between Cultural Intelligence and the Compassion in students in Ataturk University of Nursing Faculty (p<0.05) Key Words: Cultural intelligence, compassion, nursing students

225 [OP-95] ETHICAL ISSUES IN INFECTIOUS DISEASES REQUIRING CONTACT ISOLATION Ayşe Akbıyık 1, Esra Akın Korhan 1 ¹ Izmir Katip Çelebi University Faculty of Health Sciences Aim: In this study, it was aimed to investigate the ethical problems in contact isolation applied to patients with multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug- resistant (PDR) bacterial infections. Methods: In this systematic review, an examination was made of all the researches published until July 2017 which could be accessed on databases: PubMed, Science-Direct, Google Scholor, Google Academic, CAB-Direct, ProQuest Central, Taylor and Francis with the key words contact isolation, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococci, MDR, XDR, PDR, medical ethic, ethical issues, ethical dilemmas, ethical concern, ethical challenge,temas izolasyonu, metisiline dirençli Staphylococcus aureus (MRSA), vancomisin dirençli enterokok, çoklu ilaç dirençli, yaygın ilaç dirençli, pan-ilaç direnci, tıbbi etik, etik sorun, etik ikilem, etik kaygı, etik zorluk. Results: As a result of the survey, 1497 items of data have been reached. There was examined summary of 13 data which contain one and more specified keywords in the title and/or summary. One of these surveys met the study criteria. In this study, which is a case report with an MRSA positive patient requiring contact isolation at the rehabilitation center, it has been reported that members of the rehabilitation team experienced ethical dilemmas about approaching this disease. In the study was found that isolation practices limit patients autonomy due to who be isolated and subject to active surveillance MRSA culture tests without taking their consent; the principle of beneficence was compromised the fact that the patients were not sent to the rehabilitation center Conclusion: Patients who are taken into contact isolation use these concepts for themselves such as Behind Barriers, Living within four walls, Being with Others, Being MRSA positive. Although patient isolation is an important reason to prevention of infection transmission to other patients, should be taken into account in the ethical approach to these emotions experienced by isolated patients. It may be useful suggestions including attention to the design of the isolation environment, presence of health personnel and psychological support systems equipped with adequate infection control knowledge to improve of the effects of isolation on patients and their

226 families. In addition, conducting research on ethical issues in contact isolation will contribute to the identification of ethical issues and possible solutions to these problems Key Words: Contact isolation, multidrug-resistant, ethical issues

227 [OP-96] MORAL DISTRESS IN NURSES Pelin Calpbinici¹, Ebru Dığrak² ¹ Nevşehir Hacı Bektaş Veli Üniversitesi Semra ve Vefa Küçük Health College Nursing ² Etimesgut Şehit Sait Ertürk State Hospital Nurses are frequently confronted with ethical dilemmas in their nursing practice. It is reported that nurses experience moral distress as a result. The current paper aims to discuss the concept of moral distress that frequently arises in nursing practices. This study is a compilation and it was compiled by searching the relevant recent literature. The concept of moral distress was first defined by Jameton in 1984 as the distress which "arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action". In 2008, the American Association of Colleges of Nursing (AACN) emphasized the significance of moral distress, pointing out that it is an important problem that is often ignored. Some studies on the subject matter reported that nurses experience a high level of moral distress.numerous factors influence the moral distress suffered by nurses in healthcare environments. The first of these is individual characteristics that include a nurse's worldview, experience and relationships, and the second is organizational factors including lack of communication and cooperation among team members, increasing workload due to insufficient number of personnel, limited resources, lack of administrative support, and a negative ethical climate. Impacts of moral distress on nurses manifest very diversely involving physical, psychological and social impacts. This can extend from feelings of discomfort and sadness, anxiety, embarrassment to feelings of guilt, fear, mourning and depression. Feelings related to weakness such as hopelessness, feeling incapable, self-accusation and self-depreciation may also occur. Physical indications include an increase in heart rate, headache, sleeplessness or GIS signs. It can also lead to moral problems such as moving away from individual values and beliefs, moral discomfort or a conflict between emotions and values. Following these psychological and physical complaints, nurses may suffer from decreasing job satisfaction, exhaustion, quitting, or a decrease in the quality and quantity of nursing care. The concept of moral distress is a significant ethical problem experienced by nurses that influences the quality, quantity and cost of care and treatment. In this context, moral distress in nurses can be alleviated by identification of individual and organizational factors that lead to

228 moral distress, training, improvement of working environment, interdisciplinary cooperation and support systems. Key Words: Ethics, moral distress, nursing

229 [OP-97] ETHICAL SENSITIVITY OF NURSING STUDENTS IN PATIENT CARE PRACTICES Nimet Ovayolu¹, Özlem Ovayolu¹, Merve Gülpak², Ayşe Aslı Oktay², Sema Aytaç³ ¹ Gaziantep University, Faculty of Healthc Sciences ² Kahramanmaraş Sütçü İmam University, Kahramanmaraş High School of Health ³ Gaziantep Public Health Directorate Aim: It is necessary that nursing students have developed ethical sensitivity in order to define ethical problems and make the most accurate decisions during undergraduate study.for this reason,the aim of the study is to determine the ethical sensitivity of nursing students in patient care practices. Methods: The study was planned in the Descriptive Design and was conducted with 160 students who were at the 3rd and 4th Grades and who received Nursing History and Deontology classes between the dates April-June 2017.The students were willing to participate in the study and met the inclusion criteria.the data were collected with the Question Form and the Ethical Sensitivity Questionnaire (ESQ). Results: 77.5% of the students who participated in the study were female;22.5% were male; and the mean age was 21.7±1.5.In addition,57.5% of the students stated that they felt devotion to their profession; and 51.9%stated that they chose the nursing department with their free will.73.8% of them stated that they knew the professional ethical codes;83.8% stated that they did not follow any publishing on ethics;61.9% stated that they knew that there was an Ethical Board in the institution they worked as interns;52.5% stated that they had ethical dilemmas in patient care practices;and 51.6% of those who stated that they had ethical dilemmas stated that they could not resolve these ethical dilemmas.it was determined that the mean score received by the students from the scale was 91.7±25.2;and when the gender and working sub-dimension of the scale were compared,it was determined that the ethical sensitivity of the male students was higher(p<0.05). Conclusion: In this study,it was determined that the ethical sensitivity of the students who were included in the study was at the medium level.it was also determined that nearly half of the students had ethical problems, and the majority of those who had ethical problems could not resolve them Key Words: Ethical sensitivity, nursing students

230 [OP-98] EXAMINING THE RELATION BETWEEN THE PREDISPOSITION TO ETHICAL VALUES AND DEVOTION TO NURSING PROFESSION IN STUDENT NURSES Özlem Ovayolu¹, Nimet Ovayolu¹, Sema Aytaç², Merve Gülpak³, Gülendam Karadağ⁴, Uğur Doğan⁵, Ayşe Aslı Oktay 3 ¹ Gaziantep University, Faculty of Health Science ² Gaziantep Public Health Directorate, Şahinbey Community Health Center ³ Kahramanmaraş Sütçü İmam University Kahramanmaraş High School of Health ⁴ Dokuz Eylül University, Faculty of Nursing ⁵ Kilis 7 Aralık University Health Services Vocational School Aim: The study was conducted for the purpose ofdetermining the relation between the predisposition to ethical values and devotion to nursing profession of the student nurses. Methods: The study was conducted in the Descriptive Design with the nursing department students of the health sciences faculty of a state university. The study population consisted of the students studying at nursing department of the university; andthe sampling of the study consisted of 320 students who were willing to participate in the study and who studied at the 3rd and 4thGrades.Before the study started, Informed Consents were received from the students, and a written permission was received from the Ethical Board.The data of the study were collected with the Question Form, Predisposition to Ethical Values Scale (PEVS),and Devotion to Profession in Nursing Scale (DPNS).The total score that may be received from the PEVS is within the range, and the total score that may be received from the DPNS is within range.high scores show that the devotion to ethical values and professional values is strong.the data obtained were assessed withthe Pearson Correlation Analysis. Results:It was determined that the mean age of the students was 22,1±1,3;49,4% were those who chose their department willingly; however,39,4% did not feelas belonging to nursing profession.it was also determined that the mean score of the students in PEVS was 66,3±12,5;and the mean score of the students in DPNS was 65,7±10,0.It was found out that there was a significant relation between the predisposition to ethical values and the devotion to nursing profession(p<0.01).

231 Conclusion: It was determined that the scores of predisposition to ethical values and the scores of devotion to nursing profession were over the medium level;and there is a relation between the predisposition to ethical values and devotion to profession levels.

232 [OP-99]THE PROBLEMS OF FINAL YEAR STUDENTS IN NURSING DEPARTMENT IN INTERNSHIP PRACTICE, THEIR ATTITUDES AND ETHICAL CONSIDERATIONS Ayşe Gümüşler Başaran¹ ¹ Recep Tayyip Erdoğan University Health College Nursing Aim: Gaining practical skills by practicing in the hospital, correct learning of nursing practices, management of clinical functioning and reaching to a level that can provide service independently are among the objectives of the education for nursing students. In this study, it was aimed to determine the situations which may cause problems for nursing profession and students that students experience during the hospital practice, and to determine their attitudes and ethical considerations. Methods: The study was a cross-sectional study consisting of 64 students, 40 female students and 24 male students registered in the nursing department internship program. The data were collected in the last week of the semester with a questionnaire developed by the researcher. In the questionnaire form, students were questioned about the problems they encountered during the practice and their attitudes towards these problems. Percentage, mean, standard deviation, chisquare test were used in the statistical analysis of the data. Results: 62% of the students who participated in the study were females and 38% were males. 54.7% of the students had problems during practice and the gender did not make a difference in having a problem (p=0.270). The ratio of having communication problems were 31.3%, care and treatment problems were 37.5% and hygiene problems were 10.9%. The students experienced communication problems with patients at most with a ratio of 18.8% and the gender did not make a difference in having communication problem (p=0.781). It was noted that preparing medicines ahead of time with a ratio of 28.1%, 3.4±4.2 hours on average, not implementing the treatment on time with a ratio of 26.6%, making someone to work instead with a ratio of 14.2%, not making necessary nursing attempts with a ratio of 6.3%, and applying wrong medication with a ratio of 4.7% were the problems experienced during care and treatment and the gender did not make a difference (p=0.286). 1.6% of the students stated that the treatment was not applied because there was no medicine in the pharmacy and 1.6% stated that they were forced to run errands other than nursing. 37.1% thought that they were having problems because they were students. When their attitudes were examined, 65% of those who had communication problems stated that they stayed calm and did nothing, that they were adapted in the preparation of

233 medicines ahead of time with a ratio of 38.9% and objected at the same ratio, but the situation did not change. It was reported that application of wrong medication to the patient was in the first place as a problem in terms of ethics with a ratio of 50%. Conclusion: Half of the students are having problems during the application process, which is important in the achievement of correct behavior. Key words: Nursing, student, nursing practices

234 [OP-100] A STUDY ON THE MORAL SENTİTİVİTY OF NURSİNG STUDENTS: KOCAELİ EXAMPLE Pervin Şahiner ¹, Belgin Babadağlı¹, Nermin Ersoy² ¹ Kocaeli University Faculty of Health Sciences, Department of Midwifery ² Kocaeli University, Faculty of Medicine Aim: To be able to distinguish emotions, facts and values from each other requires moral motivation as well as cognitive capacity. For this reason, moral sensitivity and moral motivation are assumed to be the core of the health care service, and health care professionals are concerned with having moral motivation, observing moral values, and being aware of their own roles and responsibilities. However, it is important that the moral sensitivities are developed so that they can cope with the difficult situations they often encounter with women's special moments. Methods: In the first and last year midwifery students of Kocaeli University Health Science Faculty, the Moral Sensitivity Questionnaire (MSQ) was applied. Turkish validity and reliability of this scale Yilmaz Şahin et al. Results: A total of 128 midwifery students participated in the study. The moral sensitivity of the students was found to be neutral, and there was a significant difference between the class and sensitivities of the subscales defined as interpersonal orientation, experiencing ethical dilemmas, expressing benevolence, structuring moral meaning and professional knowledge. There was no correlation between socio-demographic characteristics and moral sensibility score of the students. Conclusion: The level of moral sensitivity of midwifery students suggests that the content of ethical education in midwifery education needs to be watched. Key Words: Midwifery, moral sensitivity, ethics education

235 [OP-101] DETERMINING THE IMPACT OF NURSING STUDENTS MORAL SENSITIVITY ON THEIR LEVELS OF PROFESSIONAL ATTITUDE Zehra Göçmen Baykara¹, Ceyda Su Gündüz², Gülcan Eyüboğlu² ¹ Gazi University Faculty of Health Sciences ² Gazi Üniversitesi Institute of Health Sciences Aim: To create the perception of professionalism beginning from their education, it is essential to increase the awareness of nursing students. The aim of this research is to determine the impact of the moral sensitivity of nursing students on their levels of professional attitude. Methods: The descriptive research sample comprised 528 voluntary students studying in their 1st, 2nd, 3rd or 4th year during the academic year at Gazi University, Faculty of Health Sciences, Department of Nursing.The research data was collected using the Descriptor Characteristics Form, Professional Attitude Scale for Nursing Students and Moral Sensitivity Questionnaire. The university s written consent was obtained, together with the oral consents of the nursing student volunteers. Percentages, t-test, one-way analysis of variance, Pearson correlation and multiple regression analysis were used to analyze the data. Results: The point averages of the students were 3.98±.54 (1-5) for the Professional Attitude Scale and 2.76±.71 (1-5) for the Moral Sensitivity Questionnaire. It was determined that the students satisfaction with being a nursing student, gender, job guarantee as the motive for choosing this major and moral sensitivity levels had a significant impact on total number of points for professional attitude and the scientific contribution sub-dimension point (p<.05). It was also observed that the students year of study and the qualification/continuing education sub-dimension points for Professional Attitude Scale had a significant impact on the total number of points regarding moral sensitivity (p<.05). Conclusion: The professional attitudes of the students were determined to be above the average, and it was further determined that the students had an average level of moral sensitivity, and that moral sensitivity had an impact on the levels of professional attitude. Consequently, it is very important to establish a perception of professionalism and moral sensitivity during the early years of a nursing student s education. Key Words: Moral sensitivity, professionalism, attitude, nursing students

236 [OP-102] DETERMINATION OF AWARENESS LEVELS OF NURSING STUDENTS TOWARDS ENVIRONMENTAL ETHICS Derya Uzelli Yılmaz¹, Ismet Eşer² ¹ Izmir Katip Çelebi University, Faculty of Health Science ² Ege University, Faculty of Nursing Aim: The aim of this study was to determine the level of awareness for the environmental ethics of nursing students. Methods: In this study, prepared in descriptive design, data were collected with Student Information Forms and the Environmental Ethics Awareness Scale. Relevant approvals have been taken from the university and the participants. The universe of the study constituted nursing students (N=834) enrolled at the Izmir Katip Celebi University during the Academic Year, the sample of the study consisted of 498 students who consented to participate in the research. The data were collected over the period May-June, The data were evaluated with the SPSS 19 program, using numbers and percentage distribution, the t-test, and ANOVA analysis. Results: It was determined that 80.5% (n = 393) of the students were female, 71.1% were Anatomical High School graduates, 39.1% were living in metropolis and ± 1.44 of age average. The students total mean scores on the Environmental Ethics Awareness Scale was ±7.39. The study found a significant correlation between level of awareness for the environmental ethics and gender, the high school students graduated from and living place (p<0.005). There was no statistically significant difference between the scale total mean score averages of the first (102.39±7.41), second (103.24±6.80), third (102.73±7.65) and fourth grade (102.32±7.84) students (p<0.005). Conclusion: The findings of the study show that nursing students' awareness levels of environmental ethics are high.

237 [OP-103] ATTITUDES TOWARDS GOOD DEATH PERCEPTION OF NURSING S STUDENTS Duygu Bayraktar¹, Ülkü Güneş¹, Burcu Bayraktar¹, Leyla Khorshtd¹ ¹ Ege University, Faculty of Nursing Aim: This descriptive study was made with the aimed to examined the attitudes towards good death perception of senior nursing students and the factors affecting it. Methods: The population of the study was consists of the senior students (N=393) studying in the Nursing Faculty of a university in Totally 315 students who agree to participate in the study were consisted the sample. Data in the study was collected using a questionnaire and the Good Death Scale. The Kruskal Wallis and Mann Whitney U tests were used for data analysis. Written consent was obtained from the ethics committee, institution and students. Results: The average age of the surveyed students was years, 85.4% of them were female student. It was found that 86.7% of the students have the experience in intensive care, 79.4% of them given care for the patient in the terminal period, 64.1% of them did not consider themselves enough to care of the patient in the terminal period, 60.3% of them received educated about death, 93.7% of them thought that good death was very important for the patient, 94.6% of them defined good death as the patient's life ending with the least suffering. The mean score on the Good Death Scale of students was found to be It was determined that student s gender, studying experience in the intensive care, get training about death, and the significance grade of good death affected perceptions towards good death. It was found that students who have experience studying in intensive care, who get training about death, who thinking that good death is very important and female students have positive attitudes towards good death perceptions. Counclusion: Nursing students' attitudes towards good death perceptions were found to be very positive. In the nursing education, students should be informed detailed about the terminal period, ethical dimensions of care should be discussed. Key Words: Death, death perception, nursing student

238 [OP-104] STUDYING THE ETHICAL DECISION MAKING LEVELS OF MIDWIFERY STUDENTS Ebru KILINÇ 1, Özgür ALPARSLAN 2 1 I Gaziosmanpaşa University, Faculty of Health Sciences 2 I Gaziosmanpaşa University, Faculty of Health Sciences Aim: The study was conducted to investigate the ethical decision-making levels of midwifery students based on whether they had taken the ethics course. Methods: The universe of the study, which was planned in descriptive and cross-sectional type (20 April-20 May 2017), consisted of students from Gaziosmanpaşa University Midwifery Department (n = 305). The sampling, on the other hand, involved 246 students who agreed to participate in the study. The data collection procedure included an information form gathering personal information about students, Ethical Dilemma Test and Wrong Medication Administration Test intending to determine ethical decision making level, and informed consent form. Necessary permissions were obtained from the ethics committee and the institution for the implementation of the study. The data were analyzed through computer software using number, % distributions, and chi-square test. The statistical significance level was taken as p <0.05. Results: 46.3 % of midwifery students took ethics course, while 53.7 % had not taken the course, yet % of the students who took the ethics course and 17.0 % of those who had not taken the course defined the meaning of the word ethics as professional rules, whereas 44 % of the students who took the course and 11 % of those who had not taken it reported they had an ethical dilemma. It was determined that the students who took the ethics course made a right decision about the ethical dilemmas questioned in the five items of the 13-item ethical dilemma test, and that the difference between them was significant (p <0.05). No significant difference was observed regarding taking the ethics course in items questioning termination of pregnancy, surrogate motherhood, newborn s right to life, gender selection, meaning of abortion, concept of euthanasia, the right to life of a newborn with severe malformation, and elective cesarean practices (p> 0.05). The students who took the ethics course made significantly right decisions about ethical issues in informed consent cases and wrong medication administration cases (p <0.05). Conclusion: According to the results of the study, it can be stated that the ethics course given in midwifery education improves students' ethical decision making skills.

239 Key Words: Ethics education in midwifery, ethical dilemma, ethical decision making

240 [OP-105] THE IMPACT OF MORAL SENSITIVITIES AND PROFESSIONAL VALUES OF NURSING STUDENTS ON CARE PERCEPTION Diğdem Lafcı¹, Ebru Yıldız¹, Kübra Akkaya¹, Gamze Çolak¹ ¹ Mersin University, Health of High School Aim: This study was conducted to investigate the effect of nursing students' perceptions of moral sensitivities and the care given by professional values towards the nursing profession. Methods: Research planned as descriptive; conducted between May and June 2017 with 195 students studying in the third and fourth grades of the School of Health Nursing Department of a public university. In the collection of data, "Individual Presentation Form", " The Moral Sensitivity Scale ", " Nurses Professional Values Scale " and " Individualized Care Scale-A-Nurse Version " were used. Results: It was found that 55.4% of the students did not voluntarily choose the profession, 31.8% met ethical problems during implementation and 38.7% solved the problems they faced with help. The mean score of the students taken from the scales; The Moral Sensitivity Scale was ± 28.32, the Nurses Professional Values Scale ± and the Individualized Care Scale-A-Nurse Version was ± There was a significant positive correlation between the professional values and the individualized care abilities mean scores. The providing benefits, holistic approach, orientation and autonomy subscale mean scores of the The moral sensitivity scale were found high in male students (p <0.05). Individualized care, clinical status and decision making mean scores were found to be high in female students (p <0.05). The providing benefiting, holistic approach and autonomy subscale mean scores of the moral sensitivity scale and professional values mean scores were found to be higher in those who willingness to choose occupation (p <0.05). Conflict and autonomy subscale mean scores of the moral sensitivity scale were found higher in the 4th grade (p <0.05). Take action, security and autonomy subscale mean scores of the professional values scale were found to be higher in those who like clinical practice (p <0.05). Conclusion: It was determined that as the professional values increased, the individualized care skills of the students increased. In order to increase the quality of the care given to the patient, it is important that to gain professional values to the students and to eliminate the deficiencies of them in this area. Key Words: Moral sensitivity, professional values, nursing students

241 [OP-106] EVALUATION OF MORAL APPROACHES SAME AS TWO SEPARATE GROUPS FROM NURSING STUDENTS Elanur Uludağ 1, Dicle Tuba Musa 2, Yasemin Aygün 2 1 I Instructor Gümüşhane University, Faculty of Health Sciences 2 I Gümüşhane University, Faculty of Health Sciences Aim: This study was conducted with the aim of evaluating the moral approach of two groups of nursing students to be the same. Methods: This descriptive study was undertaken between May and June, The population of the study was consisted of the first and third year students (n = 200) who studied at nursing school, Faculty of Health Sciences, Gümüşhane University and the study participants (n = 144) who accepted to fill the study questionnaire. The data were collected through a questionnaire that assessed the socio-demographic characteristics and ethical approach created by researchers. Results: The analysis of the data was made by considering the significance level p <0.05 in the SPSS 23.0 package program. In the evaluation of the data, number-percentage distribution, t-test, ANOVA test and multiple response analyzes for multiple responses were used. It was identified that 72.2% of the participated students were female, 54.2% are between the ages of 17-20, 50.7% are in the first grade, 57.6% are in the ethics courses and 24.3% of them lived in Black Sea Region, 20.1% of them lived in Southeastern Anatolia Region. Did the 'nurse' in the case study have fulfilled the ethical principles in different working classifications? If the answer to the question "No," which violates the ethical principles, "p = (p <0.05)", the difference is statistically significant and it is seen that it is higher in the first grade students. In addition, 52.6% of the respondents who answered "personal decision and informed approval" and 75.8% of those who pointed out "do not harm and benefit" from the multiple answers given to this question were 58.8% seen as the first-year student. '' Did the nurse fulfill ethical principles? 53.5% of the first year students were "injured-not harmed", 64.7% of them were "personal decision" and "unfavorable" when compared to the multiple answers given in the question "Which ethics principles did you answer?" And 58.3% of them pointed out ethical principles such as 'conscientious behavior'. 52.2% of the first grade students answered from the physician, 57.1% from the other nurses, 46.9% from the hospital ethics committee gave answers in the multiple answers given to the nurses who should receive help from the sources in the hospital. 47.8% of the students in the class, 42.9% of the respondents were from other nurses, and 53.1% from the hospital ethics committee.

242 Conclusion: In terms of the answers given to the study questions, it can be concluded that the students who are in different groups are unstable in terms of ethics and ethics. Key Words: Ethics in nursing, nursing students, ethical decision, ethical approach

243 [OP-107] THE CORRELATION BETWEEN THE ATTITUDES OF NURSING STUDENTS TOWARD GENDER ROLES AND THEIR PERCEPTIONS OF CARE BEHAVIORS Emine Pınar Martlı 1 - Nigar Ünlüsoy Dinçer 2 1 I Kırıkkale University Health Services Vocational Hight School 2 I Yıldırım Beyazıt University Faculty of Health Science Aim: It is important for the prospective position of nursing profession to find out how students have care behaviors concerning the roles attributed to woman and man in the society, as well as how they evaluate the care. The purpose of this study was to determine the correlation between the attitudes of nursing students toward gender roles and their perceptions of care behaviors. Methods: This was a descriptive and correlational study. The first-year and fourth-year nursing students (N=1590) studying at four state universities located in the provincial borders of Ankara in Turkey were included in the study (n=541). As the data collection tool, three forms were used: Descriptive Characteristics Form, Gender Role Attitudes Scale (GRAS) and Caring Assessment Questionnaire (CES). Results: While mean score obtained by the students participating in the study from Egalitarian Gender Role attitude was ±6.08, their mean score for Traditional Gender Role attitude was ±5.9. It was found that while the highest mean score of the students was 81.24±22.6 and in the subscale of Trusting Relationship subscale among the subscales of Caring Assessment Questionnaire, the lowest mean score was 22.90±7.7 and in the subscale of Anticipates. There was a very weak direct correlation between the Egalitarian Gender Role Attitude and Accessibility, Comfort, Trusting Relationship, and Monitors and Follows caring assessment. Additionally, there was a very weak direct correlation between Traditional Gender role, Gender Role in Marriage, Male Gender Role and Trusting Relationship caring assessment (p<0.05). There was a statistically significant difference between the first-year and fourth-year students in terms of Egalitarian Gender Role, Gender Role in Marriage, and Accessibility, Trusting Relationship and Monitors and Follows caring assessment (p<0.05). There was no statistically significant difference between the students having the experience of providing care to a patient relative before starting to work in profession and those who did not have this experience in terms of gender role attitude and caring assessment.

244 Conlusion: It was observed that students having egalitarian gender role attitude among gender roles have a higher care behaviors. Key Words: Caring assessment, education, nursing

245 [OP-108] NURSING STUDENTS' WILLINGNESS TO PROVIDE CARE TO PEOPLE LIVING WITH HIV/AIDS Erdal Ceylan¹, Ayşegül Koç¹ ¹ Yıldırım Beyazıt University Faculty of Health Sciences Aim: Nurses are still one of the most important health care professionals in HIV/AIDS prevention and caring people living with HIV (PLWH). However, studies have shown that nurses and nursing students desire to provide care to PLWH are not at the desired level. The literature on this subject in our country is rather limited. For this reason, this study was planned to examine nursing students' desire to provide care to PLWH. Methods: The sample of the research consisted of 339 students who had studied at Yıldırım Beyazıt University Nursing Department and had at least one internship in the hospital. Data collection form that prepared by researchers in accordance with the literature has been used to collect data. Percent, median, Kruskall Wallis, Spearman's rho and Mann Whitney U tests were used to evaluate the data. Results: One quarter of respondents stated that they didn t want to take care of PLWH in the hospital, 31.6% would change the place they worked if they had to constantly care PLWH; 25.7% didn t want substance abusers and homosexuals with high risk of HIV/AIDS transport to be their patients; and 63% stated that the idea of caring PLWH caused tension in themselves. Statistically significant relationship was found between getting HIV/AIDS course, caring PLWH before, knowing transmission ways of HIV, and desire to care PLWH. The most desired nursing implementations were giving oral medicine, changing patients clothes and measurement of vital signs while most undesirables were cleaning the patients stool, opening a new vein way and nasogastric aspiration. Conclusion: In accordance with the principles of "Justice/Equality" and Non- Harmfulness/Utility, nursing students must acquire the responsibility of providing nursing care in a holistic and equal manner, regardless of race, religion, gender, belief, social/economic situation, political opinion and kind of disease as well. Key Words: HIV/AIDS, ethics, nursing care, willingness

246 [OP-109] ETHICAL PROBLEMS EXPERIENCED BY TURKISH PEOPLE LIVING WITH HIV/AIDS Erdal Ceylan¹, Ayşegül Koç¹ ¹ Ankara Yildirim Beyazit Unıversity Faculty of Health Sciences, Department of Nursing Aim: Aim of this study is to examine the ethical problems experienced by people living with HIV/AIDS (PLWHA) in Turkey. Methods: Google database was searched with the key words of "HIV/AIDS, ethical issues, violations of rights ". Articles, reports of associations, news and reports about violations of rights against PLWHA in Turkey were examined. Results: Ethical problems experienced by Turkish PLWHA were examined as social, vocational, healthcare-related, media-related and law-related issues. Social issues are; associating AIDS to sex, illness, death, forbidden or taboo attitudes; not renting house to PLWHA and forcing them to remove from their houses. PLWHA are also deprived of basic rights such as marriage, education, treatment and travel. Looking at vocational problems; HIV testing is required before recruitment, the positive ones aren t hired, exposed to harassment and exposed to pressure to resign. In healthcare services, PLWHA are faced with the denial of their treatment, violation of the principle of medical data confidentiality, humiliating attitudes/behaviours and taking unnecessary prevention measures by healthcare professionals, HIV testing without permission, early discharge and stigmatization of patients on records. These approaches are violation of the health care provider's obligation to provide treatment/care and the right of individuals to receive health care. Media-related ethical issues are; biased and stigmatized media publications containing hate speech; publicly disclosure of the patient's face and personal information, and finally, using blood, sexuality, cachectic patients, and images that resemble death in HIV/AIDS related news. Examples of ethical problems encountered in law and politics are; elimination of PLWHA in some occupational groups, international travel and migration restrictions, and the deportation of PLWHA from the coutry. Conclusion: In order to protect PLWHA from any ethical violation, the society must be informed about HIV/AIDS, prejudices should be removed and, stigmatization and discrimination prevention regulations should be made. Key Words: HIV/AIDS, ethical issues, violations of rights

247 [OP-110] DETERMINING THE RELATIONSHIP BETWEEN NURSING STUDENTS PROFESSIONAL VALUES AND THEIR MORAL SENSITIVITY Eylem Paslı Gürdoğan¹, Berna Aksoy¹, Ezgi Kınıcı¹ ¹ Trakya University,Faculty of Health Science Aim: This study was conducted to determine the relationship between moral sensitivities and professional values of nursing students at a university. Methods: The research was descriptive. It carried out with nursing students at Faculty of Health Sciences in Trakya University (N=512). The data were collected by using a descriptive form and Moral Sensitivity Questionnaire-MSQ and analysed with frequency, percentage, average, standard deviation, crosstabs, Student t test and ANOVA by using SPSS-22 package programme on computer. Results: The average age of the participants was ± 1.15, 86.8% were female, 34.7% were first-year students and 69.8% were willing to nursing percent of students stated that they experienced ethical problems during clinical practice. There was a significant difference between the students grades and the ethical dilemma encountered (X²= 55.26, p<0.05). The mean score of the students' moral sensitivity questionnaire was ± In the views on professional values, 58.4% of the students stated accuracy, 57.5% of them equality, 53.6% of the students stated that freedom value is extremely important. Regarding the aesthetic value, 30.8% of the students were not significant and 5.7% of them stated that they did not care at all. Aesthetic value is not important compared to 30.8% of students. There was a statistically significant difference between the students grade and the level of moral sensitivity (p<0.05). When the relation between the moral sensitivities of students and their views on aesthetic value was examined, it was found that the moral sensitivities of the students who regarded aesthetic value as extremely important were higher than the students who evaluated it as insignificant (F=2.947, p<0.05). Conclusion: The moral sensitivities of students were high. Aesthetic value seems to be less important, while most students think that values of rightness, freedom and equality for the nursing profession are extremely important. Key Words: Nursing students, moral sensitivity, professional values

248 [OP-111] ETHICAL VALUES OF THE INCLINATION IN UNIVERSITY STUDENTS AND RELATED FACTORS Filiz Taş 1 1 Kahramanmaraş Sütçü İmam University, Kahramanmaraş Health of High School Aim: To present values and ideals in a wide range of ethics and morality, the intention of the individual, the freedom of will, preferences, responsibility consciousness and attainment. In recent times, social moral decadence, ethical and moral values have been overlooked, and young people need to understand ethical concepts and moral values more (1-5). The purpose of this study is; It is possible to determine the extent to which young people who are studying at university have ethical and moral values that they are supposed to possess. Methods:The students' universe of Kahramanmaraş Sütçü Imam University was the universe of the research, and the sample was 655 students who agreed to participate in the research. Research data were collected during May-June. The "Information on Susceptibility to Ethical Values", which consists of 16 items, was used by Kaya 2015 (1), with a publicity form consisting of 17 questions about the socio-demographic characteristics of the students and validity and reliability by the students. Scale was prepared with a 5-point Likert type and consisted of three sub-factors; Factor - 1 Love, respect (1-8), Factor - 2 Justice, honesty (9-13), Factor - 3 Cooperation (14-16). The ethics committee has been approved for the research. Forms were administered by face-toface interview method and verbal approval was obtained from the students before negotiations were held. The data were evaluated in Statistic package program. Results: The average age of the participants was 21.0 ± % of the students were female, 26.6% were male. 33.5% said that they read in the verbal section, 32.8% stayed in the country, 8.4% worked at the same time while reading, and 25.6% were not satisfied with the school life. According to the statistical analysis, the students were found to have a mean of The Inclınatıon To Ethıcal Values Scale ± 7.4 points, 35.4 ± 4.2 factor - 2 (Justice) dimension: 21.5 ± 3.4, factor - 3 (cooperation) dimension: 11.7 ± 2.6 They got points. It was determined that there was a significant relationship between sex and the part of the reading and Factor - 1, between the working status and Factor - 3 (p <0.05). Conclusion: In the study, the students were scored above the average in all three dimensions from the propensity score to the ethical values. Ethic; It is necessary to give young people who are more flexible and easier to change in the face of changing social conditions to gain the

249 consciousness to distinguish norms and norms that constitute the society and good and evil in terms of ethics during the university education years since they cover the values that constitute the basis of individual and social relations. Key Words: University students, ethics, ethical values

250 [OP-112] INVESTIGATION OF ETHICAL SENSITIVITY AND EMPATHY LEVELS OF SENIOR CLASS STUDENTS OF NURSING SCHOOL Gülay Taşdemir Yiğitoğlu¹, Gülbanu Zencir¹, Fadime Gök¹ ¹ Pamukkale University, Faculty of Health Sciences Aim: The aim of this descriptive study is to determine the ethical sensitivities and empathy levels of senior class nursing students. Methods: The sample of the study consisted of 147 (66%) volunteered students of the Department of Nursing of a Faculty of Health Sciences, who participated in the study between the dates of May The data were collected through a questionnaire containing sociodemographic characteristics of the students, the Moral Sensitivity Survey, and the Basic Empathy Scale. Mean, standard deviation, number, percentage, Kruskal-Wallis, Mann-Whitney-U, and Independent Sample-t tests were used in the evaluation of the data. Results: The average age of the students in the study was ± It was determined that 83.0% of the students were female, 89.8% were not working, 48.3% had less than Turkish Liras of personal monthly income, and 59.2% of them were graduates of Anatolian High Schools. 32.7% of the participants stated their mother's attitudes as democratic-participant, 27.2% as overprotective; and as for the attitudes of their fathers, 30.6% of them stated that it was democraticparticipant and 20.4% of them were in a controlling attitude. Average cognitive empathy subscale scores of the students were ± 2.66 and the average sensory empathy subscale scores were ± 4.61 and the average total empathy scores were ± The average score of ethical sensitivity of the participants in the study was found to be ± It was found that there was a statistically significant difference in the empathy levels according to the income status of the participants, the high school where they had studied, the place where they lived the longest, the communication status in the family, and the status of receiving education about empathy (p<0.05). It was determined that the difference in the level of ethical sensitivity was statistically significant in terms of the working status of the students, education status of their mothers, attitudes of their mothers, their father's working status, family communication, family health status, reasons for preferring the nursing, preference order and satisfaction level of students (p<0.05). It was identified that there was no relationship between the level of empathy and ethical sensitivity of the students included in the study (p>0.05, r = ).

251 Conclusion: It was determined that the empathy and the ethical sensitivity of the students included in the study were at moderate levels. It is thought that the provision of continuing education programs related to ethical sensitivity and empathy to nurses during their education and after graduation will be very important in terms of developing awareness in nurses. Key Words: Ethical sensitivity, empathy level, nursing students

252 [OP-113] THE RELATIONSHIP BETWEEN NURSING STUDENTS BURNOUT LEVELS AND THEIR PROFESSIONAL VALUES Gülcihan Arkan 1, Yaprak Sarıgol Ordın 1, Meryem Öztürk Haney 1 1 I Dokuz Eylul University, Faculty of Nursing Aim: This study was conducted to investigate the relationship between nursing students burnout levels and their professional values which will have a great influence on their professional behaviors in the future, and to obtain the data that will shed light on educational programs. Methods: This cross-sectional descriptive study was conducted with undergraduate students of a Nursing Faculty in Izmir, a province in the western part of Turkey. The study data were collected from 469 students who agreed to participate in the study between April 2007 and June To collect the study data, the Socio-Demographic Characteristics Questionnaire, the Maslach Burnout Inventory-Student Form assessing burnout levels of the students and the Nurses Professional Values Scale - Revised assessing the development of nursing values. Data were analyzed using the descriptive statistics, t test, one way variance and correlation analysis. Permission to conduct the study was obtained from the authors of the scales and the university ethics committee. Results: Of the participants, 79.1% (n = 371) were female. Their mean age was ± The second year students mean burnout scores were significantly higher than those of other students (p <0.05). The mean personal accomplishment scores of the participants living in districts were significantly higher than those of the participants living in the city center and villages (12.05 ± 2.88) (p <0.05). Of the participants, those who did not choose nursing willingly, who were not pleased with studying in the nursing department, who were not members of an association, who did not receive training on professional values and who did not participate in social activities achieved significantly higher mean scores for exhaustion, depersonalization and personal accomplishment and significantly lower mean scores for professional values (p < 0.05). There was a positive relationship between exhaustion, depersonalization and personal accomplishment scores of the participants, and a negative correlations between their professional values and exhaustion scores (p <0.05). Conclusion: The nursing students professional values decreased as their burnout levels increased. To reduce the burnout (exhaustion) levels of the students, the curriculum should be revised, to have fewer students in each classroom precautions should be taken, and to promote

253 students motivation, various social activities should be organized. It is also recommended that this topic should be included in the course content to improve students professional values, and students should be encouraged to join professional associations and to participate in the congresses. Key Words: Professional values, ethics, burnout, nursing students

254 [OP-114] THE EXPERIENCE OF THE PARTICIPATION OF A STUDENT NURSE IN THE CARE OF A CLOSE RELATIVE: A QUALITATIVE STUDY Handan Eren¹ ¹ Karamanoğlu Mehmetbey University, High School of Health, Department of Nursing Aim: Nurses need to act in line with ethical principles to be able to cope with these issues and care for in respect of individual and personality and integrity, respecting rights and privacy. Apart from these, acquiring knowledge from their own experience will give them the opportunity to learn their real professional practice and to keep an eye on the care they give to the patient. For this reason, this study was carried out in order to examine the reflection of nursing students attending their education on the aspect of their participation in the care of a close relative. Methods: Qualitative research method was used in the study. In the study conducted using oneto-one interview method, five open-ended questions were collected and voice-recorded data were analyzed by thematic analysis method. Results: The student stated that the experience of participation in close care contributed to some changes in the view of the profession. The student stated that there are differences in some points between care given during nursing education and care given now and stated that it filled the nursing practice with cause and effect relation. The student informed me that there were some ethical problems in the clinical practice and nursing care that the nurses gave to their siblings in the current period. After this process, the student informed that he / she would give care in patient care considering these ethical problems. Conclusion: It has been seen that the researcher has encountered some ethical problems related to nursing care in the process up to this experiment and that the experience of the student has developed positively. From here, it is suggested that students should have activities to improve their empathy levels during the education process and give them spiritual guidance in nursing practice. Key Words: Nursing student, nursing care, care experience

255 [OP-115] DETERMINATION OF ALTRUISM LEVELS OF NURSING STUDENTS Handan Eren¹, Ayşe Sonay Türkmen¹ ¹ Karamanoğlu Mehmetbey University Health of Sciences Aim: The research was conducted to determine the levels of altruism of nursing students. Methods: This study, between May 02 and June 06, 2017 the date, was carried out studying at the Health Sciences Faculty Department of Nursing students who were accepted to participate (n: 238). For collecting the data, the socio-demographic form, Altruism Scale were used to. Data were analyzed by using SPSS 20.0 package program. Results: The average age of the students in the department of nursing is ± The distribution of the students according to their classes was similar. Students 27.7% third grader, which is 56.3% two or three brothers, which is 75.6% to be a General/Anatolian High School graduate was determined. Nursing students Altruism Scale average score was determined 66.21± Family subscale score of Altruism Scale for nursing students was 17.28±3.90, social subscale score was 17.39±3.96, helpfulness subscale score ± 3.83 responsibility subscale score was determined as ± When the scale subscale mean scores were compared, it was determined that there was a significant difference between the groups according to the educational status of the father, the class that the student continued, age and satisfaction with the school. Conclusion: Nursing students altruism levels were found to be above the average and were affected by some demographic characteristics. Key Words: Altruism, nursing students, nursing

256 [OP-116] DETERMINATION OF ETHICAL PROBLEMS ENCOUNTERED BY NURSING STUDENTS DURING CLINICAL PRACTICES Nilay Orkun 1, İsmet Eşer 1 1 Ege University, Faculty of Nursing Aim: This descriptive cross-sectional study was conducted to identify the ethical problems faced by students of the nursing faculty of a university during clinical practices. Methods: 1080 students created population of the research. 650 students who were attending a nursing faculty and accepted to participate in the study comprised the study sample. The study data were collected between May 2017 and June 2017 using the "Questionnaire prepared by the researchers. The data were analyzed with the Statistical Package for Social Science (SPSS) The descriptive statistical analysis and chi-square test were used in the assessment of the data. Results: Most of the students who participated in the study, were female. The participating students mean age was The most common ethical problem faced by students during the clinical practices was Order of unused material for the patient on the patient and Recording of files as if they were not done in clinical care. Most of the problems during the clinical practices arose between the students and nurses. These ethical problems mostly arose due to the nurses heavy workload. To solve these ethical problems, most of the students proposed that training on ethical problems should be given. Conclusion: Our study results revealed that the participating students encountered ethical problems during the clinical practices. In order to solve these ethical problems encountered by most of the students, case reports regarding ethical issues should be included in the undergraduate program of the nursing education. In addition, in clinics, protocols addressing ethical problems should be developed. It is recommended that ethical issues should be included in the in-service training of health care professionals. Key Words: Ethical problem, student, clinical practice.

257 [OP-117] ETHICAL PROBLEMS EXPERIENCED BY NURSES WORKING IN INTENSIVE CARE UNITS Duygu Soydaş Yeşilyurt¹, Filiz Tuncel Sağlam², Eylem Paslı Gürdoğan¹, Ümmü Yıldız Fındık¹, Ayşe Gökçe Işıklı² ¹ Trakya University Faculth of Sciences ² Trakya University Health Research and Application Center Aim: The aim of this study was to determine the ethical problems experienced by nurses working in intensive care units. Methods: This descriptive study was conducted in February-March 2017 with 55 volunteer nurses working in intensive care units of a university hospital. For data collection, a questionnaire form prepared by the researchers in accordance with the literature was used. Statistical analysis were completed in the SPSS 20.0 program using descriptive analyses. Results: In this study, it was determined that the mean age of the nurses working in intensive care units was 29.80±5.36, 90.9% were female, 72.7% were bachelor degree graduated, 20.0% was working in a neonatal intensive care unit, 60.0% had 0 to 5 years of professional experience. It was found that 67.3% of the nurses be educated about ethics. The most frequent ethical problems experienced by nurses working in intensive care units were determined as transferring the practices that have to be fulfilled by the physicians to the nurses (90.9%), transporting of stable patients to the clinics in order to accept critically ill patients (80.0%), the lack of a fair approach to the acceptance of visitors and attendants among patients (80.0%), refusing the patient's the treatment and care practices (80.0%). Conclusion: According to the results of the study, nurses working in intensive care units frequently experience the ethical problems. We recommend that the ethical problems be solved by the manager nurses. Key Words: Ethical problems, intensive care units, nursing

258 [OP-118] THE EFFECT OF INTENSIVE CARE UNIT NURSES ANXIETY LEVELS ON ETHICAL SENSITIVITY Serdar Sarıtaş¹, Esra Anuş Topdemir 1, Zeliha Büyükbayram 2 ¹ İnönü University, Institute of Health Sciences 2 I Siirt University, Health of High School Aim: This is a descriptive study that examines the effect of intensive care unit nurses anxiety levels on ethical sensitivity. Methods: The population included the nurses in Diyarbakır Gazi Yaşargil Research and Training Hospital (n=184). The sample included 70 nurses who agreed to participate in the study. The data were collected between April 2017 and June 2017 using a personal introduction form, the Beck Anxiety Inventory and the Ethical Sensitivity Questionnaire. The data were analyzed using descriptive statistics, independent groups t-test, the Mann-Whitney U test, the Kruskal-Wallis test and correlation analysis. Results: The nurses' mean age was 31.15±5.24 years, and 81.4% of them were females. Of them, 77.1% were married and 84.3% were university graduates. Of the nurses, 57.1% worked in internal intensive care clinics, 78.6% had been working for five years at most, and 42.9% were partially satisfied with the units where they worked. Of them, 55.7% worked day and night shifts, 45.7% were satisfied with their work, and 54.3% had received training on ethics. Their mean score on the Beck Anxiety Inventory was 18.65±9.73 and 96.24±24.24 on the Ethical Sensitivity Questionnaire, while the total subdimension scores were 20.07±7.00 for autonomy, 13.00±4.90 for providing benefits, 14.51±5.28 for holistic approach, 13.10±3.99 for conflict, 14.10±4.98 for practice, and 10.14±4.99 for orientation. The mean score on the Ethical Sensitivity Scale for satisfaction with the unit of service was high, and the difference between the mean scores on Ethical Sensitivity Questionnaire was statistically significant (p<0.05). The orientation subdimension mean score was significant in relation to gender, and the autonomy subdimension was significant in relation to marital status (p<0.050). Conclusion: The nurses had moderate levels of anxiety and ethical sensitivity, while there was no significant correlation between their age and anxiety and ethical sensitivity. Key Words: Anxiety, ethics, nursing

259 [OP-119] THE IMPACT OF NURSE S ETHICAL SENSITIVITY LEVELS ON THEIR APPROACHES TO ISSUES SPECIFIC TO INTENSIVE CARE UNIT Gökçe Arslan 1, Esra Uğur 1 ¹ Acıbadem Health Group Altunizade Hospital Aim: Ethical problems are the problems which have no definite solution, leaving a person in a dilemma and need to be constructed in a moral judgment. Intensive care nurses during their professional practice are confronted with ethical issues that concern individuals who have vital problems. The purpose of this study is to determine the impact of nurses ethical sensitivity levels on their approaches to issues specific to intensive care unit. Methods: Sample of the study was 161 intensive care nurses who are working in a healthcare group in Istanbul. Research data were obtained by using the Ethical Sensitivity Scale Questionnaire (ESSQ), Demographics Form, and Approaches to Ethical Issues Questionnaire. The data obtained from the study were analyzed with SPSS 22.0 package program, using the descriptive statistics, chi square, students t-test and ANOVA methods were conducted, and p 0,05 was considered as statistically difference. Results: Total ESSQ score of nurses were found to be The scores obtained from the subdimensions as follows: 21 points in the autonomy subscale, points in the benefit subscale, points in the holistic approach subscale, points in the conflict subscale, points in the application subscale, and 9.9 points in the orientation subscale. It has been defined that the educational status, the duration of employment term and the understanding of ethics education status variables have an effect on the ethical sensitivity levels of the nurses. In the intensive care units, it has been observed that nurses see physicians as decision makers in need of ethical situations, and also the informed consent-a problem which is seen in intensive care unit, fair sharing of limited resources, and the approaches of nurses towards nurse's disability status in ethical situations also effects their point of stand to the required situation. Conclusion: In order to increase the ethical sensitivity of nurses and to support them in solving ethical problems, some multidisciplinary case examples are suggested such as increasing their professional competence, raising awareness about basic ethical principles and legal regulations, apart from that, strengthening the team and the team work understanding. Key Words: Ethical sensitivity, ethical approach, intensive care nursing, nursing ethics

260 [OP-120] THE RELATIONSHIP BETWEEN ETHIC SENSITIVITY AND BUSINESS SATISFACTION OF INTENSIVE CARE NURSES Emral Gülçek¹, Fatma Karasu², Rukuye Aylaz³ ¹ Siirt University School of Health, Department of Nursing ² Kilis 7 December University School of Health, Department of Nursing ³ Inönü University Faculty of Health Sciences, Department of Nursing Aim: The purpose of this study was conducted in cross-sectional fashion to determine the relationship between ethical sensitivity of intensive care nurses and job satisfaction. Methods: The researchers' universe was formed by 100 public nurses working in the Public Hospitals Institution of Diyarbakır Pediatrics Hospital Yenidoğan, Big and Intermediate Intensive Care, but 80 nurses were included in the research because nurses did not want to participate in the investigation and to participate in the research. Since all of the universe was targeted for research, no sampling method was used. In the collection of data, a questionnaire including the demographics of the nurses prepared by the researcher, the Ahlaki Sensitivity scale and the Minnesota Job Satisfaction scale were used. Data; Between April 2017 and May 2017, a face-to-face interview was conducted by the researcher, verbally acknowledged by the nurses. In the analysis of the data, number, percentage, t test, ANOVA and correlation analysis were used in independent groups. Results: It was determined that the job satisfaction of the intensive care nurses participating in the study was normal and the ethical sensitivities were moderate. It was determined that the total ethical sensitivity score was not related to age, marital status, education status, duration of intensive care study, duration of vocational study, pre- and post-graduate ethics, but age and occupational duration were related to some sub-dimensions of ethical sensitivity. Conclusion: It was determined that the intensive care nurses participating in the study had a normal level of job satisfaction and a moderate level of ethical sensitivity. In line with these results, intensive care nurses' planning and evaluation of the initiatives to increase professionalism and job satisfaction, To make the process more systematic and to create motivation programs for nurses. It is recommended that postgraduate and continuing education programs be organized so that the ethical sensitivity of intensive care nurses can be increased and therefore ethical problems can be recognized and solved. It is also thought that it is important to conduct studies

261 in larger groups in order to determine the different variables affecting the ethical sensitivities of intensive care nurses. Key Words: Nursing, job satisfaction, ethics

262 [OP-121] EXAMINATION OF ATTITUDES AND BEHAVIORS OF INTENSIVE CARE NURSES FOR END-OF-LIFE CARE Sultan Özel Yalçınkaya¹, Fatma Tanrıkulu², Nasibe Yağmur Filiz², Handenur Gündoğdu², Yurdanur Dikmen² ¹ AIBÜ Izzet Baysal Mental Health and Diseases Training and Research Hospital ² Sakarya University, Faculty of Health Sciences, Department of Nursing Aim: This study was conducted in order to examine the behaviors and attitudes of intensive care nurses for end-of-life care. Methods: The sample of this study included 58 intensive care nurses who were working in the intensive care unit of a public hospital and were volunteer to participate in the research. The data were collected using the "Nurse Introduction Form" and " Behaviors and Attitudes of Intensive Care Nurse for End-of-Life Care Scale" which was developed by Zomorodi and Lynn (2011) and was adapted to Turkish by Yalcinkaya (2016). Frequency, percentage, arithmetic mean, standard deviation, Independent t Test and One Way ANOVA Test were used to analyze the data. For the research, written permission was obtained from the university ethics committee and the institution in which the study would be carried out. Also, the nurses who agreed to participate in the study were informed about the aim of the research and data collection forms and then their written consents were obtained. Results: The mean age of the participating nurses was ± 4.86 years. Of them, % 65.5 had bachelor's degree, 44.8% worked as intensive care nurse for 2-4 years, 75.9% chose the profession of nursery willingly and 70.7% were determined to be satisfied with her/his profession. The mean of Attitude and Behaviors of Intensive Care Nurse for End-of-Life Care Scale total score was 52.65±7.36. Examining the scores regarding the sub-domains showed that the mean of attitude sub-domain score was 33.75±4.25 while the mean of behavior sub-domain was determined to be 18.89±5.11.A statistically significant difference was found between the attitude of intensive care nurses for end-of-life care and status of satisfaction with the profession. However, no significant difference could be detected among gender, the school from which s/he was graduated, working period in intensive-care unit and the means of attitudes and behaviors of intensive care nurses for end-of-life care total score. Conclusion: Finally, the attidute and behaviors of intensive care nurses for end-of-life care were determined to be at moderate level. This condition revealed the need for supporting the

263 information and practice of intensive care nurses about end-of-life care. In this respect, it may be suggested to develop the integrated in-service programs for end-of-life care, to create written guidelines including end-of-life care in the intensive care unit and to assess the reflection of these guidelines on the outcomes of care. Key Words: Attitude, behavior, end-of-life care, intensive care nurse

264 [OP-122]AN EVALUATION OF THE APPROACH OF INTENSIVE CARE NURSES TOWARDS TERMINAL PATIENTS AND THEIR ETHICAL BEHAVIOR Gülbanu Zencir¹, Fadime Gök¹, Gülay Taşdemir Yiğitoğlu¹, Züleyha Öztürk² ¹ Pamukkale University Faculty of Health Sciences ² Pamukkale University Headquarters of Hospitals Aim: This descriptive research aims at evaluating the approach of intensive care nurses towards terminal patients and their ethical behavior. Methods: The research sample was composed of 96 (73%) nurses that worked in the intensive care clinics of a University Hospital. The data was collected by the researchers via the survey form that was specifically prepared. For the assessment of the data, means, standard deviance, numbers and percentages were used. Results: Of the nurses 93,8 % were females and their age average was ±6,86. Of the nurses 66,7% stated that they had worked in the intensive care unit for 5 years and less, and 61,5% of them reported that they did not remember the number of the patients that they lost during this period. The nurses described their feelings they felt when they lost their first patients as I was so sad" (46,9%), I felt sorrow and despair (19,8%), and I felt fear, failure and anger (26%). When their feelings at the moment of a recent death were asked, 64,6% of the nurses replied as my feelings vary according to the age and illness of the patient, while 25,0% of them said I ve got used to it, I do not feel anything anymore. It was found out that 34,4% of the nurses did not answer the question which asked how do you deal with your negative feelings while giving care to a dying patient? ; 20,8% answered that question as I try to do my best for the patient ; and that 17,7% said I refrain from establishing a sentimental bond and I just do my duty. 38,5% of the nurses answered the question What do you usually think while giving care to a terminal patient? as he/she is occupying space for other patients in need ; 30,2% said they deserve the same care as all other patients ; 20,8% replied I m doing my last duty for him/her and 10,4% answered as I m wasting my effort, it is a loss of time. 48,9% of the nurses did not want to give care to a terminally ill patients while 78,1% of them found it difficult to answer the patients that asked am I going to die?.

265 Of the nurses 94,8% were found to be respectful to at all times, and 90,6% of them were identified as always honest. While 81% of them stated that they would tell the truth even if it lead to their alienation, 58,3% of them pointed that would side with their friends no matter what the situation was. Conclusion: It was revealed that nurses got more rational in later years of their career while their earlier attitude towards death was more sentimental. When their behavior was questioned in ethical terms, a great majority of them said they were trying to assist everyone that needed help, they acted honestly in every situation, but they behaved in a protective way in situations that concerned their friends. Key words: Ethical behavior, nurse, approach to death

266 [OP-123] OPINIONS OF INTENSIVE CARE NURSES ABOUT FUTILE TREATMENT AND INTERVENTIONS ELDERLY PATIENTS UNDERGO İsmet Eşer¹, Nilay Orkun¹, Perihan Çetin² ¹ Ege University Faculty of Nursing ² Katip Çelebi University Health Services Vocational Hight School Aim: This descriptive study was conducted to determine the opinions of the nurses working in intensive care units about the futile treatment and interventions undergone by elderly patients. Methods: The population of the study consisted of 123 nurses working in intensive care units of a Training and Research Hospital in İzmir between March 15, 2015 and May 15, Of them, 75 who volunteered to participate in the study comprised the study sample. The study data were collected using the Data Collection Form. In the statistical analysis of the data, descriptive statistics and the test for the significance of the difference between two means were used. Results: The mean age of the participants was Of them, 54.7% were employed in the anesthesiology unit, 84% were female, and 57.3% had the bachelor's degree. Their mean length of service was years in the profession and years in the intensive care units. While almost half of the nurses (49.3%) defined the futile treatment as 'Treatment whose harm is more than its benefit and 77.3% of them provided futile treatment. According to 38.7% of the participants, the reason suggesting that treatments provided for elderly patients were futile was "Treatments are not likely to respond expectations". According to 38.7% of the participants, treatments provided for elderly patients were futile because "Treatments are not likely to respond expectations". While 65.3% of the participants stated that it was physicians who decided to provide futile treatment, 41.4% said that this decision should be given by the health team. Of the participants, 68% considered that providing futile treatment was not appropriate, 64% experienced an ethical dilemma during their practices. Of the participants who experienced ethical dilemmas, 70.8% could not deal with the ethical dilemmas they experienced. Conclusion: It was determined that elderly patients underwent futile treatment in intensive care units, and that most of the nurses did not approve this practice and therefore they experienced ethical dilemmas. Nurses do not take part in the decision-making phase of futile treatment. In Turkey, institutional and legal policies should be established for the decision-making and

267 implementation process of the futile treatment, and nurses should have a say in making decisions of futile treatment. Key words: Elderly patient, futile treatment, nurse, ethics

268 [OP-124] CRITICAL CARE NURSES APPROACHES TO ETHICAL PROBLEMS: ETHICAL DILEMMA QUESTIONNAIRE FOR PATIENT CARE - CRITICAL CARE VERSION (ECNQ-CCV) TURKISH VERSION Nilüfer Demirsoy¹, Aysun Türe Yılmaz² ¹ Eskişehir Osmangazi University, Faculty of Medicine ² Eskişehir Osmangazi University, Faculty of Health Sciences Aim: Health services increasingly become more complex, which causes new ethical problems to arise, parallel to science and technology.the fact that nurses face with problems that affect care service as well in their working life, and that many individuals are likely affected from the consequences of these problems, which has made ethical decision-making mechanisms compulsory to be involved in these issues. Ethical decision-making is defined as a logical process involving to make morally the best decision by systematic thinking in a situation where conflicting options exist. Ethical decision-making is important with regard to be aware of the ethical problems that arise in the field of health, and to show a professional approach to ethical issues. In order to explain the origin of ethical conflicts experienced in critical care units,the Turkish adaptation of the EthicalConflict in NursingQuestionnaire-Critical CareVersion (ECNQ- CCV)" form dated 2013, developed by AnnaFalcó- Pegueroles, PhD, MHSc, RN who attempted to suggest a conceptual model that includes the variables of conflict type, and also "exposure to conflict was made. In the study, the ethical conflicts of the nurses working in the ciritical care unit of Eskisehir Osmangazi University Medical Faculty Training and Research Hospital were determined by the form,and their leves of ethical conflict exposure were analysed, and the relationship between these levels and the types of ethical conflict and ethical situation were evaluated. Methods: The sample group was formed by the nurses working at the critical Care Units of Eskisehir Osmangazi University Medical Faculty Training and Research Hospital. The forward and backward translations of the English version of ECNQ-CCV were made. All steps for the cultural adaptation process were carried out by an expert committee. ECNQ-CCV consists of 19 nursing scenarios that may cause ethical conflict in the critical care environment. Ethical conflict exposure was assessed through the Ethical Conflict Exposure Index (IEEC). IEEC is a specific index developed to provide a reference value for each participant by combining the density and the frequency of each scenario in ECNQ-CCV. The statistical program of LISREL and

269 confirmatory factor analysis were performed to determine the validity. The Internal consistency was assessed using Cronbach's α and Item-total correlations for reliability. Results: 118 nurses working in the critical care units of ESOGU Training and Research Hospital were reached. The average of age was 30 ± 6, (74.6%) of the nurses were females, 30 of those (25.4%) were male. 62 (52.5%) of those had a bachelor's degree. The average number of patients, daily cared in the intensice care units, was 8,20±4,30 on average. While 101 (85.6%) stated to have experienced an ethical dilemma in the unit they worked, 61 (51.7%) of those stated to have been trained to solve the ethical problem,72(61.0%) stated to feeel insufficient to solve the ethical dilemmas. Cronbach's α value realized as as a whole for ECNQ-CCV, and the realibility identified for the original scale and other relevant instruments was found above the values. But, the IEEC index average was assessed at a lower level than the original form. The levels of exposure to ethical conflict of critical care unit nurses in this sample were determined as below medium-level. Conclusion : The Turkish version of ECNQ-CCV has been defined as a valid and reliable tool for use in critical care units, with acceptable psychometric properties. It can be used to assess ethical conflicts in critical Care nurses. Key Words: Ethical conflict, critical Care, nursing

270 [OP-125] ETHICAL PROBLEMS ENCOUNTERED BY THE INTENSIVE CARE NURSES AND EFFECTS OF THESE PROBLEMS ON THEIR STRESS LEVELS Didem Öndaş Aybar¹, Serap Parlar Kılıç² ¹ Fırat University Institute of Health Sciences ² Fırat University Faculty of Health Sciences Aim: The purpose of this study is to determine the ethical problems encountered by nurses working in the intensive care units and the effects of these problems on stress levels of nurses. Methods: The sample of this descriptive study consisted of 144 nurses working in the intensive care units (ICU) of a university hospital. Introductory information form, Perceived Stress Scale, and Form on Ethical Problems Experienced by Intensive Care Nurses were used to collect the data of the study. The analyses were carried out by using Mann-Whitney U test and t test. Results: The mean age of the nurses was 29.06±4.02, the mean of years of working in ICU was 4.39± % of the nurses stated that they received training on ethics. The highest rate of ethical problems experienced was respectively found as; Giving extra workload to those in the lower segments of the professional hierarchy (91.0%), Assigning the practices, required to be implemented by the physician, to the nurses (90.3%) and Taking the stable patients to the services to provide more space for the patients in more critical situation (80.6%). The ethical problems having the highest mean score for being regarded by the nurses were respectively found as; Giving extra workload to those in the lower segments of the professional hierarchy (7.22±2.85), Assigning the practices, required to be implemented by the physician, to the nurses (6.97±2.77) and Talking about the issue of organ donation with the family of the patient with cerebral death (6.90±2.74). The perceived stress scale mean score of the nurses was 22.38±4.52 and only those encountering the ethical problem Giving extra workload to those in the lower segments of the professional hierarchy obtained a higher mean score from the perceived stress scale compared to those who did not (p<0.05); and those encountering the ethical problem Talking about the issue of organ donation with the family of the patient having cerebral death had lower mean score from the perceived stress scale than those who did not and there was a statistically significant difference between them (p<0.05). Conclusion: It was determined that intensive care nurses encountered ethical problems frequently, they regarded most of these ethical issues at moderate level, and ethical problems affected the perceived stress of nurses.

271 Key Words: Nurse, ethics, stress, intensive care units

272 [OP-126] INVESTIGATIONS ON THE ETHICAL DECISION MAKING SITUATIONS IN CLINICAL CASES OF LAST CLASS NURSING STUDENTS IN THE NURSING DEPARTMENT Çağatay Üstün¹, Sevgi Nehir Türkmen², Hatice Irmak² ¹ Ege University Faculty of Medicine ² Celal Bayar University Faculty of Health Sciences Aim: This study aimed to determine the ethical decision making situations in the clinical cases of the last class nursing students in the nursing department Methods: Permission was obtained from the ethics committee of the university before starting the study. The universe of the research is composed of 299 students who were educated at Manisa Celal Bayar University Faculty of Health Sciences in April academic year. The sample of the research is composed of 177 participants. The data were collected using the questionnaire and the "Nursing Ethical Dilemma Test" (NEDT), and the data were analyzed by the number, percentage, t test with SPSS 15.0 package program. Results: The average age of the students is ± % of the students are female students. It was determined that the students (58.8%) were to "apply an anomaly new nature recreation initiative", while the students in the second dilemma preferred to "force the nurse to apply drugs" despite the rejection of the patient (43.5%). In the third dilemma, it is observed that most patients who have a widespread tumor and do not want to have any medical intervention are indicated to "give respiratory support" (77.4%). The fourth dilemma is that a nurse working in a pediatric clinic has to adapt to a clinic by another nurse who starts a new relative rather than taking the time to care for babies, despite limited resources. Approximately half (54.8%) of the students involved in this dilemma responded that "the nurse should have time to adjust." In the fifth dilemma, 75.1% of the students stated that they should "report a drug mistake". In the last dilemma, it was determined that 49.2% of the students pointed to the option "nurses should answer the patient's questions", although the physician and the family were not informed about the diagnosis of a patient with a fatal disease. It was determined that 48.6% of the students were familiar with the ethical dilemmas and 51.4% were not familiar with the ethical dilemmas. It was determined that PD (Principles of Thinking) score averages (45.87 ± 7.59) and PD (Practical Thinking) points average (18.25 ± 3.80) were determined. İt was found that the ethical dilemma test ID scores of the students aged 23 and below were significantly higher than those who were

273 23 years or over (t = p = 0.015). When the sex and ethical dilemma test ID scores of the students were examined, it was found that the scores of ethical dilemma test ID scores of female students were significantly higher than male students (t = p = 0.005). Conclusion: Nursing students should act according to certain ethical criteria besides their personal attitudes and attitudes in the decision making process about the ethical problems they will have in the clinic. Our research was carried out on 299 students at Manisa Celal Bayar University Faculty of Health Sciences. More than half of the students did not encounter situations with ethical problems frequently during their student life. It was determined that the students took care to take ethical principles into account when deciding on ethical issues. Key Words: Nursing ethics, ethical decision making, nursing student

274 [OP-127] ANALYSIS OF METHAPHORS FOR BASIC CONCEPTS OF NURSING IN ULUDAG UNIVERSITY NURSING STUDENTS Hava Gökdere Çinar¹, Dilek Kara Yılmaz¹, Beyzanur İşbay¹, Mustafa Eryılmaz¹ ¹ Uludag University, Faculty of Health Sciences, Department of Nursing Aim: The concept is the basic building block of theory and is used to convey ideas. The concept helps to shape a contest / situation in our minds. Nursing has some basic concepts such as health, disease, human, environment, care and nursing. Metaphor analysis contributes to revealing how concepts are perceived because concepts can change the meaning according to the place, time and even the person who uses it. Metaphors are useful to express what is meant to be spoken in less words, more accentuated and personally specific. For this reason, our research is based on the idea of analyzing the metaphors developed by the first year nursing department students who have already taken a step into the nursing profession so that we can understand how they perceive health, illness, human, environment, care and nursing concepts. Methods: This study was conducted with 74 1st year nursing department students of Uludag University Faculty of Health Sciences in spring semester who accepted to participate in the research. Participant information form was used when collecting research data. It was questioned with open-ended questions which concept, to what and why they likened to in this form. Results: 28 metaphors related to the health concept (15 positive, 7 negative and 6 both positive and negative), 28 related to the disease concept(28 negative), 28 related to the human concept (5 positive, 12 negative and 11 both positive, 30 related to the concept of nursing (23 positive, 4 negative and 3 both positive and negative, 25 related to the concept of care (12 positive, 7 negative and 17 both positive and negative) and 38 related to the concept of the environment (12 positive, 7 negative and 17 both positive and negative) were reproduced at the end of the research. At the highest levels, health was likened to jewel of 16.2%, nursing to family of 16.2%, disease to restless life of 8.1%, human to care of 22.9%, to the environment of 10.8%, to the nature of 9.4%. Conclusion: It was attempted to understand how students perceive professional concepts through the conceptualization of concepts. Nursing department students perceive nursing profession, care and health as positive, human and disease concepts as negative and environment as positive and negative. Key Words: Nursing, health, disease, environment, care, human, student, concept, metaphor

275 [OP-128] DETERMINATION OF PROFESSIONAL VALUES AND MORAL SENSITIVITY OF NURSING STUDENTS Dilek Özden¹, İlkin Yılmaz¹ ¹ Dokuz Eylül University, Faculty of Nursing Aim: Professional values acquired in nursing education provide the development of ethical sensitivity. The aim of the study is to determine the development of professional values and ethical sensitivities of students at the class level. Methods: The sample of the descriptive study was composed of second, third and fourth grade students (n=642) who received undergraduate education ( academic year, spring term) at a nursing faculty. The data of the study were collected with the "Nursing Professional Values Scale (NPVS) and the "Moral Sensitivity Questionnaire(MSQ)". Percentage, mean, correlation, One-way Anova, Student-t test were used for the evaluation of the data. Results: The mean age of the students was 21.62±1.55 and 78.3% of the students were female. The mean NPVS score of the students was found to be ±18.95 and the MSQ score was found to be 90.77± MSQ mean scores of autonomy (20.48±6.66), beneficence (11.99±4.18), application (11.81±3.06), holistic approach (1.38±4.82), conflict (11.81±3.06), orientation (9.67±4.35) was below the average. NPVS mean scores of human honor (46.84±7.13), responsibility (28.68±4.69), mobility (20.45±3.56), security (16.91±2.67) and autonomy (16.97±2.80) were above the average. As the class level progressed, NPVS all subscale scores and MSQ conflict dimension scores increased (p<0.05). There is a statistically significant negative correlation between the NPVS and the MSQ total scores (r=-.276; p<.001). The scores of the students who felt themselves belonged to the nursing profession (74.1%) were lower than other sub-dimensions of the MSQ, except for the benefits and application dimensions (p<0.05). The scores of all subscales of NPVS were statistically higher (p<0.05). Conclusion: It has been found that the professional values and moral sensitivity levels of the students are at a good level. Supporting ethical issues in nursing students with classroom and inclass case discussions every year will enable students to develop their ethical sensitivity and integrate them with professional values. Key Words: Nursing, student, professional values, moral sensitivity

276 [OP-129] EXAMINATION OF NURSING STUDENTS MORAL SENSITIVITIES Ülku Güneş¹, Leyla Baran¹, Huri Öztürk¹ ¹ Ege University, Faculty of Nursing Aim: The moral sensitivity of a person is constantly evolving and changing as a product of his/her life. Nursing students have moral sensitivity at a certain level even when they start their education. However, it is necessary to examine how they experience the moral problems and the levels of nursing students moral sensitivity. The purpose of this study is to determine the moral sensitivity levels of student nurses. Methods: The data were collected from the 3rd and 4th grade students (n=449) who agreed to participate the research at a nursing faculty of university from April to June 2017(N=712). "Individual Knowledge Form" prepared by researchers and "Modified Moral Sensitivity Questionnaire for Student Nurses" (MMSQSN) was developed by Comrie and the validity reliability of its Turkish version was studied by Yilmaz Sahin were used for the collection of the data. The MMSQSN is a 7-point Likert type scale that includes six subdimensions and 30 items. The total score varies between 30 and 210 and higher scores indicate higher ethical sensitivity, and lower scores indicate lower ethical sensitivity. Scale score averages are evaluated as (very important), (important), (neutral), and less than 3.1 (unimportant). Mean, standard deviation, correlation analyzes were performed for the analysis of data. Results: The average age of the students is 22.43±1.1 and most of them (64.4%) are the third year students. The MMSQSN total score average was neutral (4.95±0.58). The subscores were important in the subdimensions of "Interpersonal Orientation"(5.63±0.88) and "Getting Expert Opinion"(5.03±0.88). The other subscores were neutral in the subdimensions of "Experiencing the Ethical Dilemma"(4.00±1.18), "Beneficence"(4.84±0.82), "Creating Ethical Meaning"(4.88±0.69) and "Modified Autonomy"(4.80±0.85). Conclusion: It was determined that the students moral sensitivities were neutral level and our findings were similar to the Comrie s and Yilmaz Sahin s study results. Key Words: Moral sensitivity, nursing, student

277 [OP-130] A GROUP OF NURSING STUDENTS VIEWS RELATED TO THE PATIENT S WELL-BEING IN THE INTRAOPERATIVE PERIOD Nuray Demirci Gungordu¹, Sema Kocan², Cagatay Ustun³ ¹ Recep Tayyip Erdogan University Health College Nursing ² Recep Tayyip Erdogan University Health Services Vocational School ³ Ege University Faculty of Medicine Aim: Nursing is a corporate and practical profession based on science and art (1). Nurses working in the perioperative area need to apply ethical principles to provide patients with their rights, health, well-being and safety. Ethical decisions are particularly important for patients who are under anesthesia, comatose, dependent on all life activities, unable to make their own decisions (2,3). Especially in intraoperative period, operating room nurses may encounter some ethical problems. In this context, the research was planned to evaluate the ethical dilemmas with which the student nurses practicing in the operating room may face for providing patients wellbeing within the scope of internship for nursing of surgical diseases. The question: How do the student nurses perceive the impact of intraoperative period on the patient s well-being? forms the problem statement. Methods: Working group of the research consisted of students having taken the lesson Nursing History and Ethics in the fall semester of academic year, and also 42 volunteer sophomores, from the Department of Nursing (Health College-University of RTE), within the scope of clinical internship of Surgical Nursing in the spring semester of academic year. The research is a qualitative study and document analyzing method(one of a Qualitative Research Methods) was applied for collecting the data. The document analyzing includes analyses of the written and printed documents related to the subjects which would be studied(4). In this context, a question form structured by the researchers was created and he students were asked to answer those questions in writing. The answers were analyzed by Descriptive Analysis Method. The research received approval from RTE University Medical Faculty Clinical Research Ethics Committee for the study to have been carried out (Decree no: 2014/98). Also, the research was carried out by obtaining each participant s informed consent. Results: At the end of the research, six main themes were created: concerns about surgery, respect for the individual values, dialogues far removed from surgery during intraoperative period, perception of the patient as an object herself, patient s privacy and music in the operating room. It was determined that the patients were anxious about surgery resulting from

278 unknown fear; respect for individual values varied by attitude of the surgical team, type of the surgery and anesthesia applied to the patient; conversation about the patient or disease, healthcare staff or current issues in the intraoperative period; the patient s being perceived as an object varied by the anesthesia type and the patient herself according to the healthcare staff; as for music playing during surgery, it was usually changed by the decision of the pysicians. Key Words: Intraoperative period, patient well-being, qualitative research, document analysis

279 [OP-131] INVESTIGATION OF BEING FAIRLY AND MORAL DILEMMA SITUATIONS OF NURSING AND MIDWIFERY STUDENTS WHO TOOK ETHICS COURSE Sevgi Nehir Turkmen¹, Nurgül Güngör Tavşanlı¹, Hatice Irmak¹, Dilek Çeçen¹ ¹ Manisa Celal Bayar University Faculty of Health Sciences, Department of Nursing Aim: The aim of the study was to examine being fairly and moral dilemmas in nursing and midwifery students who took ethics course. Methods: Permission has been obtained from the ethics committee of the university before starting the study. The universe of the research is composed of 694 students in April-May education year-4th grade nursing-midwifery students studying at Manisa Celal Bayar University Faculty of Health Sciences. The sample of the research was 255 students. Data were collected using the "Fairness Scale" and the "Moral Dilemma Test". Data were evaluated by SPSS 21.0 packet program with number, percentage, t test, ANOVA test. Results: The average age of the students is 21,77 ± 1,75, 51,8% of the students are over 22 years old, 85,1% are girls, 60,7% are in the nursing department and 76,5% are income balanced. When the profession ethics most strongly adopted by the students is examined; 77,4% respect autonomy, 88,2% fairness, 92,2% no harm, 90,6% respect for life 71,0%, 81.2% were honest, 88.2% had respect for privacy, 76.1% had kept secrets, 60.0% had regard for specialization, 84.7% had avoided discrimination The most strongly adopted. When the results of the students' dilemma test were examined, 53.3% of the 3rd year students, 68.9% of the boss dilemma test and 67.4% of the Heinz dilemma test showed good child tendency in the dilemma test of the students. In the neighbors' dilemma test, 54.1% of the third-year students showed a tendency towards law and order. In the physician's dilemma test, 58.3% of the 4th grade students showed a tendency to law and order. In the boss dilemma test, 73.3% of 4th grade students, 54.2% of Neighbor dilemma test and 79.2% of Heinz dilemma test showed good child tendency. It was determined that the students who were 21 years or below had a fairly high level of fairness and community sub-domain scores compared to those 22 years or over (t = 2,631 p = 0.009). When the relationship between the gender of students and the fairness scale subscales was examined, it was found that female students' scores of fairness scale total scores (t = -3,410 p = 0,001) were significantly higher than male students.

280 Conclusion: The majority of the students support the idea that the individual must comply with the rules and be a good person. The majority of students still " accepted by the group" showed a good trend that the child is the main objective. It has been determined that students take care to take ethical principles into account when deciding on ethical issues. Key Words: Fairness, moral dilemma, ethics, student

281 [OP-132] INVESTIGATION ON PROBLEM-SOLVING PERCEPTIONS AND MORAL SENSITIVITY OF INTERN NURSE Nurhan Çingöl¹, Mehmet Karakaş¹, Ebru Çelebi¹, Seher Zengin¹ ¹ Abant İzzet Baysal University, Bolu School of Health, Department of Nursing Aim: This study was conducted to examine the relationship between problem solving perceptions and moral sensitivities of intern nurses. Methods: 180 intern students of the nursing department in spring semester of academic years have formed the population, whereas 131 students have formed the sample. The data of the descriptive study, student presentation form, have been collected by Problem Solving Inventory (PSI) adapted by Taylan (1990)1, 2 and Moral Awareness Questionnaire (MAQ) adapted by Tosun (2005)3. Data analysis has been carried out with SPSS 20.0 program. Results: The average age is 22.2% and 77.9% of participants are female. It has been determined that 95.4% of the students had taken the ethics course, 41.3% found the curricular ethics education satisfactory, 64.9% knew the ethics codes and 55.7% of them experienced ethical dilemmas during the internship period. It has been determined that the students' average scores of PSI total score was ± and MAQ total score was ± It has been determined that the students (% 77.1) who voluntarily selected nursing profession have a significantly higher means of holistic approach of PSI s sub dimensions and orientation scores. It has been found that there is a significant relationship between the total score average of the PSI and autonomy, holistic approach, conflict and orientation from sub dimensions of MAQ, as well as the total score average of MAQ and the self-confidence subscale in problem-solving of PSI (p <0.05). Conclusion: It has been determined that moral sensitivities of the participants and perceptions of their problem-solving capabilities were at moderate level and there was a significant relationship between problem-solving perceptions of the students and their moral sensitivities. In this sense, initiatives toward increasing the ethical sensitivity of the students during the development of students' problem-solving capabilities has been suggested. Key Words: Intern nurses, moral sensitivity, problem solving perception

282 [OP-133] A COMPARISON OF NURSING STUDENTS ' ATTITUDES REGARDING HIV/AIDS Nurten Alan ¹, İsmet Eşer² ¹ Dokuz Eylül University, Faculty of Nursing ² Ege Eylül University, Faculty of Nursing Aim: This study aims at comparing the attitudes of 1. (n=136) and 4. (n=77) Nursing Faculty students towards AIDS. Methods: For data collection, the AIDS Attitude Scale, developed by Bliwise et al. (1991) and adapted to Turkish society by Çimen et al. (2005). The data are taken from students who are willing to participate. For data analysis, percentages, averages, ANOVA and t tests were used. It was found out that the fear of contagion of the senior students is lower than that of the first graders and family and area of residence has no influence on the AIDS attitudes of students. It was detected that female students adopt a more positive attitude in terms of feelings (p= 0.006) and professional resistance (p= 0.031). Results: Finding their knowledge sufficient has an influence on the professional resistance and negative feelings subdimension points of the students. The fear of resistance of the students that consider HIV/AIDS as a threat for themselves or their country was higher and their general attitude was more negative (p= 0.001). As the willingness of the students to give care increased, their negative feelings decreased (p= 0.000). It s of vital importance that the fear of nursing students be lessened for the protection of patient rights and increasing the quality of nursing care. The students must be informed more and a safe working environment where precautions against contagion are taken must be created. In order to be able to monitor the change in the knowledge and attitude of the students regarding Conclusion: HIV/AIDS, researches should be carried out periodically and necessary plannings should be done in accordance with the results. Qualitative studies examining the reasons of the negative attitude of students can be carried out. Key Words: Nursing; education, HIV/AIDS, attitude, willingness to care

283 [OP-134] EVALUATING THE EFFECTIVENESS OF ETHICS EDUCATION FOR NURSING STUDENTS Esra Akın Korhan¹, Burcu Ceylan¹, Ayşe Akbıyık¹, Derya Uzelli Yılmaz¹ ¹ İzmir Katip Çelebi University, Faculty of Nursing Aim: The purpose of the study was to evaluate the effectiveness of the ethics education provided to nursing students and to understand how much the methods used in the education and the subject content contributed to effectiveness. Methods: This research was a descriptive study. The study sample constituted the 89 students who have taken the course on "Nursing Philosophy and Ethics". Data were collected with "Effectiveness of Ethics Education in Nursing Scale (EEENS)" and "Data Collection Form" that was prepared in the direction of literature. Results: The overall mean score received by EEENS was 58.36±13.71 while the mean score on the moral self-development subscale was 16.52±3.86, 30.64±7.47 on the ethical reasoning/decision-making competence development subscale and 10.86±2.53 on the ethical behavior development subscale. Among the teaching techniques used in the ethics education program, the methods that made the most contribution to effectiveness are discussion method, question-answer method and problem-based education method. The subjects that made the most contribution to effectiveness from among the subject matter taught in the course are ethical principles, examples from daily life and ethics of care. Conclusion: The course on nursing philosophy and ethics given in the undergraduate nursing curriculum is effective in providing students with ethical awareness and sensitivity. Key Words: nursing, nursing education, ethics education

284 [OP-135] DETERMINATION OF MIDWIFERY AND NURSING STUDENTS OPINIONS ON INFORMED CONSENT Özlem Özdemir¹, Zülfiye Bıkmaz¹, Gönül Akgün¹ ¹ Kırklareli Üniversitesi Sağlık Yüksekokulu, Kırklareli Türkiye Aim: The purpose of this study is to determine the opinions of the 3rd and 4th year Nursing and Midwifery students on informed consent who are studying at a university Health School and who have taken courses related to ethics, and the socio-demographic characteristics that affect these opinions. Methods: The design of the research is descriptive. All students studying in the 3rd and 4th grade of Midwifery at School of Health constitute the universe of study. Data analysis was conducted with the non-probability sampling method on 135 (58.7%,N:230)students who volunteered to take part in the study. Permission from the institution was obtained for the study to be performed. SPSS 20 software was used in the analyses. Descriptive statistics and comparative analyzes were used in the evaluation of the data. Results: The average age of the participants was21.95±1.50(min:20,max:30),62.2%were nursing students and 88.9%were females. 89.6% believe that every person has the right to life. 89.6%of them stated that they d observed the provision of informed consent during their internship experience. The most well-nown where informed consent is given was specified as the preoperative period(n=122,95.31%). 56.3%(n:76)of respondents answered"correct"tothe statement that informed consent"is usually verbal in existing practices". 51.1%(n:69) found the statement "The content is determined at the request of the patient" to be necessary. It was found that informed consent on the statements "is usually verbal in existing practices"(xf2=p<0,05) and "The content is determined at the request of the patient"and the opinions on informed consent were influenced by the status of observing the provision of informed consent, and there was a statistically significant difference(xf2=p<0,05). Conclusion: It s considered that the theoretical information given in the course environment isn t sufficient for learning and sufficient information on judicial and administrative penalties for inappropriate applications isn t provided. It s believed that information can t be sufficient alone, and there s a need for initiatives in order to change the established perception that"keeping records is an ordinary procedure"in order to change this result. Key Words: Midwifery, nursing, informed consent, ethics

285 [OP-136] LIFE PERCEPTIONS OF PEOPLE WITH STOMA: A QUALITATIVE RESEARCH Sema Kocan¹, Nuray Demirci Gungordu², Cagatay Ustun³, Ayla Gursoy⁴, Aysel Kahraman⁵ ¹ Recep Tayyip Erdogan University Health Services Vocational School ² Recep Tayyip Erdogan University Health College Nursing ³ Ege University Faculty of Medicine ⁴ Cyprus International University Faculty of Health Sciences ⁵ Ege University Medical Faculty Hospital Aim: Individuals with stoma can face many physical, psychosocial, emotional and sexual problems. In addition, these patients should be assessed ethically in terms of information and autonomy (3). Identification of the problems experienced by patients with stoma and the resolution of this finding will lead to the maintenance of ethical approach and the development of care and attention to take care of the patients. The purpose of this research is to reveal underlying social reality of an individual with stoma by making an interview revealing the feelings, thoughts and perception of life while living with stoma. The questions How do individuals with stoma maintain their daily lives?, Are there any problems that individuals with stoma experience in their daily lives?, If so, what are they?, How do individuals having stoma perceive their stoma?, Did Stoma affect the relationships of individuals? If so, how did it affect it? form the problem statement. Methods: The working group consisted of 4 female and 10 male patients with stoma (ileostomy, colostomy) followed by stomatherapy unit of a university hospital in the west of our country. The research was carried out by adopting phenomenology method. Criterion sampling method(one of a purposive sampling methods) was adopted in the research. Each of the participants had face-toface individual interview. In the research, semi-structured interview form was adopted as data collection tool and the data was recorded with a voice recorder. The collected data were analyzed by descriptive analysis method. The research received approval from Ege University Medical Faculty Clinical Research Ethics Committee to be carried out (Decree no: 14-6/22). Also, the research was carried out by obtaining each participant s informed consent. Results: At the end of the research, four main themes were created: quality of the given information, change in lifestyle, anxiety about the future and type of stoma. It was

286 determined that some of the patients with stoma could not get enough information before the surgery, some of them did but that caused them to have misperception and needless fear, and so information received by the patients was not effective. When the experiences resulting from stoma of the patients were examined, subthemes change in social life, change in private life, change in clothing, change in nutrition, change in working life and change in sleeping pattern were formed. Conclusion: According to the collected data, it was determined that the information given to the patient in the preoperative period was not significant and that whether the stoma was temporary or permanent, it affected both their daily lives and perceptions for the future. However, it was determined that the patients had adequate support from the stoma care nurses in terms of adjustment to stoma after the surgery. In this context, minimizing the problems patients may encounter after both preoperative and postoperative periods, being given the adequate information to the patient, integrated approach towards the patient for the expected perception, creating new solutions for the problem, supporting special working groups that require expertise such as stoma care nursing may be advisable. It is an anticipated situation that this will be beneficial to the process of evaluating, understanding the patient s mood and following the procedure. Key Words: Stoma, stoma care nurse, qualitative research

287 [OP-137] THE PRACTICE DIMENSION OF PRISON NURSING: AN EXAMPLE FROM CENTRAL ANATOLIA Nuray Demirci Gungordu¹, Fatma Küçüksümbül², Cagatay Ustun³ ¹ Recep Tayyip Erdogan University Health College Nursing ² Karamanoglu Mehmet Bey University Health Sciences Faculty ³ Ege University Faculty of Medicine Aim: The duties, authority and responsibilities of the prison nurse are defined in the Statute Regarding the Amendment of the Nursing Statute (No ). Due to the nature of the working environment of nurses employed in prisons, their occupational experiences will differ from other areas of nursing. This research was planned in order to determine how prison nurses perceive nursing and the social reality underlying prison nursing. Problem Sentence: The research problem sentence consists of the question How do nurses perceive working in prisons, which house individuals with a high probability of exhibiting risky behavior and that are therefore regarded as a difficult area of care? Methods: The research sample consisted of three male nurses working in a prison in Central Anatolia. The study was performed using a phenomenological (case science) design, a qualitative research method. Face-to-face individual interviews were held with each participant. A semistructured interview form was used as a data collection tool. The collected data were analyzed using descriptive analysis. The Ethical Dimension of the Research: Informed consent forms were received from the nurses participating in the study, together with written permission from the institution where they worked. Results: Nurses in prison work between and 17.00, although this may sometimes vary. The nurses stated that their telephones were always open to communication and that they were obliged to attend when called on to do so. However, nurses received no time off in lieu or payment in return for overtime worked. This is ethically unacceptable. Two of the nurses in the study stated that they had received training to work in prisons from ministry-affiliated education centers, while one reported having received no training. Nurses regard working in prison as a difficult situation since working with convicted criminals excluded from society leads to psychological and physiological exhaustion. When this situation, described as difficult, was examined in ethical terms, nurses views were categorized as not being valued, communication problems, exposure to risky behavior, restriction of personal rights, and institution-related

288 deficiencies. In addition we determined that the prison physician visited for as little as 2 h a week, that nurses therefore assumed greater responsibilities and that nurses professional knowledge and skills need to be improved in order to be able to intervene early in potential emergency situations. The activities of nurses in prisons were classified under six main headings, Medication management, Order issues, Coordination, Holistic patient care, Invasive procedures and Water analyses. Endocrine system diseases, cardiovascular diseases, Respiratory tract diseases and Psychiatric disorders were most commonly seen among both male and female prisoners. Conclusion: In the light of the data obtained, we would recommend that nurses working in prisons be supported in terms of professional development and motivation, that their responsibilities be clarified, and that prison workers and inmates be given psychological support at regular intervals. Key Words: Prison nursing, nursing, prison nursing practice

289 [OP-138] CHALLENGES OF INTERNATIONAL STUDENTS IN A FACULTY OF HEALTH SCIENCES Sevgin Samancioglu¹, Ayla Aydın² ¹ Gaziantep University Faculty of Health Sciences, Department of Nursing ² Gaziantep University Şahinbey Practice and Research Hospital Aim: International students add value to the universities, as well as socio-cultural and scientific areas. In this study, it was aimed to determine the adaptation to the academic and social life, teaching members, other students, and challenges of international students who are studying at Gaziantep University Faculty of Health Sciences. Methods: All international students (n = 63) were included in the study and verbal permission was obtain. A total of 55 questions were addressed to the students using the interview technique. The obtained data were analyzed using the SPSS 21.0 package program. We used percentage and average for the characteristics of the students and parametric or nonparametric tests for other analyzes. Results: Most of the students are female (73%), 27% of them are male. 6.3% of these students are married. The average age is ± 2.15 years % of these students are citizens of Syria, 25.39% are citizens of Turkmenistan, and the rest of them are Kazakhstan, Kyrgyzstan, Afghanistan, Palestine and Somali citizens % of the students are in their first year in the faculty. It was determined that international students had problems in understanding and speaking Turkish, handling of the courses, assessment and evaluation process about exams, teaching staff, and other students. 82.5% of them stated that they had a good education in this faculty. It s stated that they were not able to follow the course (71.4%) and 87.3% of them had difficulty in following the discussions in the class and 84.1% of them is working with other students while they are in practice in the hospital. 85.7% of the international students stated that Turkish students were helping while they were studying. 77.8% of the students require additional time during the exams. 76.2% of the students said they learned more in Turkey than in their country they came. 84.1% of the students stated that the examination system is different. When we asked what they do when they didn t understand the issues in the class, they stated that did not care about this situation (46%), wanted the lesson to be told more slowly (69.8%), asked the questions to be repeated (69.8%) and expected the friend / lecturer to explain the situation

290 correctly (85.7%). In addition, compliance and expectations of students vary according to the class they are studying. Conclusion: Language problems are the most common problems among international students. Students who are not good at Turkish language are less likely to adapt faculty life. They also have more problems about education. For this reason, various activities such as a special counseling unit or orientation program for the development of Turkish language for these students should be planned. Key Words: International students, nursing, adaptation, undergarduate

291 [OP-139] DETERMINING THE STATUS OF NEWLY GRADUATED NURSES BEING SUBJECTED TO VERBAL AND PHYSICAL VIOLENCE IN THE FIELDS OF APPLICATION Sevgul Donmez¹, Eylem Karakuş 1 ¹ Gaziantep University Faculty of Health Sciences Aim: This research was planned to determine the status of newly graduated nurses being subjected to verbal and physical violence in the fields of application during undergraduate education. Methods: Research was carried out descriptively between June and August 2017 with 267 nurses who subscribed to Internet sites and groups that were constituted related to nursing profession. As a data collection tool an online prepared Identification Form containing 22 questions was used. During evaluation of data average, number and percentage were used. Necessary approval was obtained from authorities. Results: The mean age of participants is ± 2.07 years; 85.0 % are women and 84.6 % are singles. It was identified that 84.6 % of nurses were exposed to verbal violence, 2.2 % to physical violence and 4.9 % sexual violence throughout the undergraduate education. It was observed that victims of verbal and physical violence were mostly received violence from patients relatives and victims of sexual harassment from patients. The nurses that were exposed to one of the verbal, physical or sexual violence experienced following feelings; 76.4 % anger, 64.4 % alienation from profession, 53.2 % disappointment, 43.8 % anxiety, 41.2 % humiliation, 29.6 % desperation, 25.5 % fear and 24.1 % crying. It was discovered that of the nurses that were subjected to verbal, physical or sexual violence 50.6 % had tried to overcome violence herself, 47.6 % had moved off the setting, 40.4 had shared the violence with the team members or the instructor, 28.5 % had waited the elimination of even, 10.5 % had called for help and 8.2 % had re-talked to violator when the environment calmed down. When the job performance of nurse who suffered from violence was scrutinized it was observed that 79.0 % s motivation has decreased; 58.1 % thought that their profession was not respected; 36.7 % delineated from occupation, 32.6 % changed the point of view about the community they serve; 19.9 % thought that they cannot overcome the difficulties of the occupation and 19.5 though to quit occupation. Conclusion: It was determined that the type of violence that nurses often expose to at the fields of application was verbal violence, they frequently received violence from patient relatives and their post-violence job performance and professional perception were influenced negatively.

292 [OP-140] PROFESSIONAL VALUES AND INFLUENCING FACTORS IN NURSING Tuğba Dündar¹, Belma Toptaş 1, Sevgi Özsoy¹, Hilmiye Aksu ¹ ¹ Adnan Menderes University, Faculty of Nursing Aim: The purpose of this study is to determine the factors affected the professional values of the nurses. Methods: The universe of the research carried out as a descriptor was formed by nurses working in inpatient clinics of the three public hospital and one university hospital in Aydın. it is formed 225 nurses the sample calculated using layered sampling method. Data were collected by face-toface interview method between February and April 2017 usingprofessional Values Scale in Nursing (NQS) and questionnaire about occupational characteristics. The dependent variable of the study was HMRS score, the independent variables were: hospital, level of education, duty at hospital, working clinic, occupational satisfaction status, occupational, hospital and clinic working years. In the analysis of the data, descriptive statistics, parametric and non-parametric tests were used. Results: Nurses are ± 8.30 years old, 92% of them are women and 55.2% of them are undergraduate. 38% of respondents are in university hospital, 70% are in less than 5 years in the same clinic, 79.2% are working in shifts. 22.8% of the nurses have a working year of 21 years and over, 28.4% have less than 5 years, 44.4% of them in specialized units and 44% of them are working as service nurses. 82% are working with their own will in clinic. 75.6% have voluntarily selected the profession, and 60% are satisfied with the profession. The mean HMRS score of the nurses was ± and there was statistically significant difference between the task performed in hospital, education status, shift type and hospital and the score of HMRS scores (p <0.05). There was no significant relationship between nurses' clinical and clinical work with their own will, occupational desires, occupational satisfaction, ethical meetings and HMRS scores. Conclusion: Nurses that working in university hospital, graduate degree, only daytime work and be responsible nursing service increase their professional values positively. The nursing profession, which is made up of professionalized individuals, interacts personally with people. It is important for nurses to comply with ethical principles, values and rules in their professional practice. For this reason, it is important to increase the education levels of the nurses, to increase the number of working nurses and to decrease the night work rates to show ethical behaviors. Key Words: Nurse, professional values, affecting factors

293 [OP-141] EVALUATION OF ETHICAL SENSITIVITY OF THE STUDENTS IN DIFFERENT EDUCATION PROGRAMS IN THE FIELD OF HEALTH: A COMPARATIVE STUDY Seval Ağaçdiken Alkan¹, Yasemin Özyer², Cansev Bal Kaplan², Zeliha Koç¹ ¹ Ondokuz Mayıs University, Samsun Health of High School ² Ondokuz Mayıs University, Institute of Health Sciences Aim: This study has been carried out in order to compare the ethical sensitivity levels of bachelor of science and undergraduate degree students in the health field. Methods: This study, which is a descriptive and comparative research, was conducted in Artvin Çoruh University Faculty of Health Sciences and Health Services Vocational High School at the same university. 550 students in the Nursing Department, Elderly Care, First-aid and Emergency Assistance Programs have constituted the universe of the study. A total of 323 students were included in the study; 101 of whom were at Nursing Department, 93 of whom were at Elderly Care Program and 129 of whom were at First-aid and Emergency Assistance Program; and who voluntarily accepted to participate in the study and continued to be students in their programs during the data collection process. The study used the demographic data form and the Moral Sensitivity Questionnaire (MSQ). Results: 58.5% of participants were women, 75.2% were at age group and 31.2% were studying in the Nursing Department. According to the scale total score averages, it was determined that the ethical sensitivities of the students participating in the study in each of the 3 programs were in a high level. It was determined that; there was a statistically significant difference between the score averages of MSQ total score averages, autonomy, and conflict and practice subscale scores of the students who have been studying in nursing department and other programs; and this difference was in accordance with the average score of the Nursing Department (p<0.05). It was found that there was no statistically significant difference between the groups in terms of the other sub-dimensions. Conclusion: It was noted that the ethical sensitivities of the students of Nursing Department were higher than those in the associate s degree program. Key Words: Ethical sensitivity, nursing, bachelor of science degree education, associate s degree education

294 [OP-142] HOW DOES VIOLENCE TOWARDS HEALTHCARE WORKERS AFFECT STUDENTS' OPINIONS ON THEIR PROFESSION and PATIENTS? Setenay Yalınbaş¹, Filiz Bulut², M. Murat Civaner² ¹ Uludağ University, Faculty of Medicine ² Uludağ University, Faculty of Medicine Son yıllarda çeşitli nedenlere bağlı olarak artan şiddet olayları ile özellikle okul, kamu kuruluşları ve hastane gibi alanlarda daha sık karşılaşılmaktadır. Bir çalışmada, sağlık iş kolunda çalışmanın diğerlerine göre 16 kat daha riskli olduğu gösterilmiştir. Örneğin Finlandiya da yapılan bir araştırmaya göre psikiyatri hemşireleri, cezaevi gardiyanları ve polislerden sonra şiddete en çok maruz kalan üçüncü meslek grubudur. Yapılan çalışmalar şiddetin sağlık çalışanlarının sağlığı üzerinde olumsuz etkileri olduğunu, ayrıca iş tatminini ve işe bağlılığı azalttığını göstermektedir. Bu bildiride, tıp fakültesi birinci, üçüncü ve altıncı sınıfta eğitim alan 408 öğrencinin sağlık çalışanlarına yönelik giderek artmakta olan şiddet olayları karşısındaki düşüncelerini, ayrıca mesleğe yönelik bakışlarının nasıl etkilendiğini araştıran bir çalışmanın bulguları sunulmaktadır. Öğrencilerin %55.2'si hasta ya da yakınlarından kendilerine yönelen şiddete maruz kalmış ya da tanık olmuştur. Fiziksel ya da sözlü şiddete uğrayan ya da tanık olan öğrenciler, şiddet sorununun mesleki geleceğe dair kaygılarını artırdığını, insanlara yardımcı olma motivasyonlarını ise düşürdüğünü anlamlı düzeyde daha fazla ifade etmişlerdir. Katılımcılar; şiddete maruz kalmaları durumunda mesleğe bakışlarının ve hastaya yaklaşımlarının nasıl olacağını anlamaya yönelik ifadeler arasında en sık Karar alırken cesaretimi kaybederim (%55.7), Hastalardan soğurum (%55.6) ve Riskli vakalara müdahale etmek istemem (%50.6) ifadelerine katılmışlardır. Bildiride, şiddetin öğrencilerin mesleğe ve hastalara bakışlarını önemli düzeyde olumsuz etkiliyor oluşu, şiddetin nedenleri ve çözümleri üzerine düşünceleri ve ayrıca hasta-hekim ilişkisi üzerine saptamaları tartışılmaktadır. Söz konusu kaygılar ve ilintili tartışmalar hekim adayları açısından olduğu kadar hemşirelik öğrencileri ve hemşirelik mesleği için de önem taşımaktadır. Key Words: Sağlık çalışanları yönelik şiddet, sağlık politikaları, mesleğe bakış

295 [OP-143] THE DEATH UNDER GOOD CARE Esra Akın Korhan 1, Çağatay Üstün 2, Merve Kırşan 3 1 İzmir Katip Çelebi University Institute of Health Sciences 2 Ege University,Faculty of Medicine 3 İzmir Katip Çelebı University Faculty of Health Sciences The concept of good death in recent years is one of the concepts frequently encountered in the western literature, terminally, palliative and end-of- life care. When we examine the definitions of this concept that we frequently encounter, that covers management of symptoms such as pain, nausea and vomiting of patients who are dying or treatment process is not continued and all of the medical interventions necessary for the patient to die in dignity. These interventions include ensuring environmental comfort, sustaining hope and satisfaction, supporting independence, maintaining good relations with health professionals and the family. Despite all these, the notion of good death has become a kind of slogan in countries that support euthanasia especially in western culture. Because according these countries active or passive euthanasia means that end of the anguished and painful life of the person. In this context, it is very important to the defined correctly of this concept or evaluate to be used together with other different concepts. The terminological approach corresponding to the concept of good death in different disciplines has been studied. As a result of the examination, it has been encountered with many terms such as peaceful death, natural death, appropriate death, healthy death, happy death, beautiful death, good ending, good close, good completion, dignified death, socially approved death, accepting death, quick painless death, sudden death, gradual death, meaningful death and smooth death. As a consequence of, we think that it would be more appropriate for nurses in express " good death" as " Death Under Good Care" and handle with this term in the Turkish nursing literature and we offer a suggestion.

296 [OP-144] ETHICAL PROBLEMS IN INTENSIVE CARE: A SYSTEMATIC REVIEW Merve Kırşan 1,Duygu Yıldırım 1, Burcu Ceylan 2, Esra Akın Korhan 2 1 İzmir Katip Çelebi University Institute of Health Sciences 2 İzmir Katip Çelebı University Faculty of Health Sciences Aim: This study was conducted to investigate and to systematically review the data obtained from published studies related to ethical problems in intensive care units. Methods:This study was conducted in Google Scholar, Pubmed, Science Direct, Proquest, Cochrane, EBSCOhost, Clinical Key, Ovid, Web of Science databases limited to between 1 January January 2017 and was searched nationally and internationally with using ethical issue, ethical problems, ethical dilemma, intensive care, intensive care unit, keywords.the 20 publications was evaluated agreement with inclusion criteria in content of study. The publications has been four descriptive, one semi structured-qualitative, one explorative-descriptive- qualitative, one phenomenological, one qualitative-descriptive, three retrospective, one quantitativemulticentre- correlational, one cross-sectional, three qualitative, one cross sectional-descriptivequantitative-analytical, one descriptive-cross sectional, two descriptive-qualitative research design. Results: In these 20 studies included in the study, Ethical Issues Scale, In-Depth/Semi- Structured Interviews, Ethics Experience Scale, Electronic Medical Record, Ethical Dilemma Scale, Questionnaire Of Experiences, Maslach Burnout Inventory (MBI), Nurses Ethical Involvement Survey, Socio-Demographic Data Survey, Ethics Consultation Notes, Values At The Bedside Questionnaire, The Satisfaction With The Resolution Scale, The Perceived Usefulness Of Help Scale, The Ethics Experience Scale, Anonymous Attitudes and Perception Questionnaire, Question Form Of Ethical Dilemmas data collection tools were used for the defining ethical issues in intensive care units. According to the results obtained by examining 20 studies, many ethical problems such as justice, truth telling, privacy, autonomy, resources available, with hold therapy/ withdraw therapy, refusal of treatment, to sign Do Not Resuscitate order, patient transportation, organ transplantation, comunication/conflicts, euthanasia, not considering the quality of patient s life, ınadequate information, cultural issues, treatment decisions,end of life decision, behavior related issues are experienced in intensive care units. Conclusion: Many ethical problems are encountered in intensive care units. The most frequent occurrences of these ethical problems relate to communication, use of resources, to inform the

297 patient diagnosis and prognosis and treatment decisions of patients. Use of resources was the ethical dilemmas reported most often. Key Words: Ethical problems, intensive care

298 [OP-145] IF YOU WERE WHAT WOULD YOU DO? Gülay Oyur Çelik 1, Kemal Erdinç Kamer 2, Sinem Eskidemir 1, Sümeyye Zehir 3 1 İzmir Katip Çelebi University, Faculty of Health Science 2 İzmir Katip Çelebi University, Atatürk Training Research Hospital General Surgery Clinic 3 İzmir Katip Çelebi University, Institıtes of Health Science Operating rooms take attention that they are the places in which the ethical violations occurred most as well as being the units where decision making mechanism is used fastest. Surgical nurses take on the most important task as being the natural supporters of the patients having operation. That s why surgical nurses often have ethical and legal problems. In this context, the study was carried out in order to point out to the ethical and legal problems that the surgical nurses had. The study is a phenomenological designed study and it was carried out with 20 nurses who accepted participating in the study, 10 nurses who had taken the education of the surgical nursing certification program and 10 nurses who hadn t attended these certification programs. The nurses opinions about what they would do for such a situation were asked online by writing only one problem that can be regarded as ethical and legal. The question is shortly includes that what the nurses will do for continuing the operation that has a bad sterilization. In the light of the data collected in the study and in the direction of the answers that the nurses gave, 10 of the nurses stated that they verbally seek the solution of the problem in the clinic while 10 of them stated that they make an attempt on starting the legal process. They stated that the responsible staff could take this action when a legal action was needed and he wouldn t make an attempt for this problem. It is thoughtprovoking that the surgical nurses still have hesitation although they have attempts that they can make ethically and legally under such a problem. Also, it attracts attention that difficulty has been experienced in ethical and legal procedure about the path that would be followed even for the nurses who had taken the education about the issue. Results: Ethical values and the problems about the ethical values are people oriented and difficulties are always experienced in decision making mechanism although it is not very proper to conclude and generalize for a phenomenological study. Key words: Surgical nurses, ethical, legal problem.

299 [OP-146] DEATH AND DYING PATIENT ATTITUDE AND INTEREST LEVELS AMONG NURSES WORKING IN MARMARIS PRIVATE AHU HOSPITAL Fatma Birgili 1, Meral Ekinci 2, Aysu Ak Tuncel 2 ¹ Muğla Sıtkı Koçman University Faculty of Health Sciences 2 Private Ahu Hospital Aim: In this study it was aimed to measure levels of abstaining from death and dying patient attitude among nurses. Methods: Sample of the descriptive and analytic study was composed of 44 voluntary nurses employed in a the Private Ahu Hospital in Marmaris / Muğla between May-June 2017 Approach to Death and Dying Patients Attitude Scale (ADDPAS) developed by Kavas and Öztuna (2011) and Nurse Identification Form were used as data collection tools in the study. Descriptive data of the study was analyzed for percentages and averages and Kruskal Wallis and Mann-Whitney U tests were utilized in data analysis. Results: The mean age of the nurses participating in the study was ± 9.70, mean age of the study was 8.09 ± 7.71, 77.3% of the women, 68.2% of the high school graduates, 45.5% of the nurses were working in the operating room / emergency service. According to the age groups of the nurses, there was a difference between "death and deadly patient avoidance" levels and "communication difficulties with fatal patients and their relatives" (p <0.05). In addition, according to the study positions in the clinic, it was found that there was a difference between "I feel uncomfortable when I talk about the possible consequences of the illness with the relatives of a fatal patient" and "I feel very sorry" when I think of the patient who knows that he was going to die (p <0.05). Conclusion: The results show that vocational education and in-service training of nurses have a positive effect on the attitude and interest level of nurses in their death and their approach to their fathers and relatives. Key Words: Death, dying patient, thanatophobic attitude, nurse, ADDPAS

300 POSTER PRESENTATIONS

301 [PP-01] FERTILITY PROTECTION SURGERY AND ETHICS IN GYNECOLOGIC CANCERS Duygu Barışoğlu¹, Oya Kavlak¹ ¹ Ege University, Faculty of Nursing Aim: Ethical investigation of the fertility protective surgeon. Methods: Compiled by searching the literature. Results: According to the American Cancer Society, approximately 3% of gynecologic tumors are seen in young individuals in the age of reproduction under the age of 40. Surgical treatment of gynecologic cancers negatively affects the quality of life of women, causing deterioration of the body image, damage to the concept of self, and psychological problems that are as severe as depression. Surgical, medical and technological developments in cancer treatments; together with increased survival rates, lead to improvement in quality of life, and it is becoming increasingly important to maintain and maintain fertility. According to the American Society for Clinical Oncology, sperm cryopreservation for men and cryopreservation for embryos for women are accepted as standard fertility protective practices with the highest probability of success. When fertility protective approaches are determined, the patient's need for fertility, patient, age of partner, age of the patient, type of cancer, stage, presence of metastases and treatment are evaluated. There are specific criteria for cancer preventive approach to fertility. The religious, psychosocial, cultural and economic conditions of the patients indicate whether they prefer this practice. Some young patients accept surgery after surgery believing that infertility comes from god. Another ethical problem is that parents have to rush to make mistaken decisions to have children. The ethical dilemma is the decision of what happens to the sperm or egg after the loss of one or both of the parents. Conclusion: Oncology nurses who play a key role in the healthcare team in the treatment of fertility are in charge of training and counseling in the diagnosis, treatment and rehabilitation stages of the patient. Patients should be informed about their positive / negative effects on survival, fertility and quality of life, if any. Key Words: fertilization, surgery, ethics, gynecological cancer.

302 [PP-02] ETHICAL ANALYSIS OF THE CONCEPT OF THE CARRIER MOTHERHOOD Duygu Barışoğlu¹, Şenay Ünsal Atan¹, Oya Kavlak¹ ¹ Ege University, Faculty of Nursing Aim: This paper is designed to evaluate the ethical dimension of the concept of carrier motherhood and the benefits and risks of biological mother, carrier mother and baby. Methods: Literature was compiled by scanning. Results: Infertility creates many biological, psychosocial, economic, ethical and cultural problems in couples. As a medical phenomenon involving assisted reproduction techniques, the concept of carrier motherhood brings many ethical problems. It is called "carrier maternity" that a woman who is pregnant instead of a pregnant mother is conceived and delivered to the mother / family. This concept is one of the problems argued from the ethical side and not reaching the solution from the legal side. The ethical problems related to the subject can be exemplified as "whether the child will draw a line with a biological mother or a genetic mother, the validity of the contracts made in this respect, the child can not be forcibly taken away from the carrier mother". The likelihood of your carrier mother coming to a commercial market position is a concern. In principle, other ethical problems are encountered in practice as opposed to the fact that the carrier mother is away from "natural". It is recommended that the law of the countries be taken into consideration in the solution of the ethical problems and the participating parties should be fully informed in terms of their legal situation. Conclusion: The basic principles of nursing ethics are usefulness, harmlessness, justice, truthfulness and honesty. In this context, it is necessary for nurses to look for solutions to ethical problems arising in the practice of maternity care, taking ethical principles into consideration. It is important to provide counseling services and take their advices before application within the scope of informing and educating individuals. Key Words: Carrier motherhood, ethics, nursing

303 [PP-03] KÖK HÜCRE NAKLİNDE ETİK SORUNLAR, YAKLAŞIMLAR VE HEMŞİRENİN ROLÜ Hilal Karadeniz¹, Muhammet Uğur Baytar¹, Sezer Er Güneri¹ ¹ Ege University, Faculty of Nursing Amaç: Kök hücreler özelleşmemiş, sonsuz bölünebilme özelliğine sahip, farklılaşarak vücudun diğer doku ve organlarını oluşturabilen ana hücrelerdir. Kök hücreler, 20. yüzyılın sonlarına doğru bulunmuş ve günümüzde birçok hastalığın tedavisinde kullanılmaktadır. Nakil için kök hücreler, kişinin kendisinin veya vericinin kemik iliğinden, aferez yoluyla periferik kandan, gönüllü bir kadının ovumu ile hastanın kendi doku çekirdeğinin birleştirilmesiyle elde edilen embriyodan ve kordon kanından elde edilebilmektedir. Özellikle, embriyodan ve kordon kanından kök hücre elde edilmesi, etik sorunlara ve tartışmalara neden olmaktadır. Çalışma, kök hücre naklinde karşılaşılan etik sorunlar ve yaklaşımları inceleyerek, hemşirenin rolüne vurgu yapılması amacıyla hazırlanmıştır. Yöntem: Çalışma EBSCOHOST, MEDLINE, Pubmed ve ScienceDirect veritabanları taranarak makalelerin seçilmesiyle derleme şeklinde hazırlanmıştır. Bulgular: Kök hücre alanında, öncelikle hücrenin elde edilmesi, sonrasında naklin tipine göre etik problemler oluşmaktadır. Özellikle embriyodan kök hücre elde edilmesinde; insanın kobay olarak kullanılması, embriyonun ne zaman insan sayılacağı, kullanılan embriyoların yok edilip edilmemesi, kordon kanı bankaları ve kordon kanının ticarileşmesi, kordon kanından elde edilen kök hücrelerin yeterli olmaması veya yeni kök hücrelere ihtiyaç duyulması halinde aynı donörden tekrar kök hücre nakli istenmesi, gönüllü donör veya otolog nakillerde kişinin sağlık öyküsü alınabiliyorken kordon kanı kullanılan bebeğin henüz sağlık öyküsünün bulunmaması, nakil tiplerinde de donör kişinin kendisi değilse alıcı yararı ve verici yararı üzerine çeşitli etik tartışmalar ortaya çıkmaktadır. Medeni kanuna göre cenin, kişi olarak kabul edilmemekte, sağ olarak doğması koşulu ile hak sahibi olabileceği belirtilmektedir. Dolayısıyla embriyonik kök hücre çalışmaları konusunda düzenleme yapılmamıştır. Sonuç: Kök hücre tedavisinde karşılaşılan etik sorunların çözülmesinde çeşitli ilkeler kullanılarak, üstünden gelinmeye çalışılmaktadır. Kök hücre tedavisi, yeni gelişmesi, çalışmaların devam etmesi ve tedavi sınırlarının, avantajlarının ve dezavantajlarının tam olarak bilinmemesi, etik, tıp ve teoloji gibi birçok alanı ilgilendirmesiyle görüş ayrılıklarının yaşandığı bir alandır. Hemşirenin, alıcı ve donör için doğru danışmanlığı yapabilmesi, tedavi süresince gerekli desteği sağlayabilmesi için

304 kendi rol, sorumluluklarını ve etik problemlerin çözümünde kullanabileceği rehberleri bilmesi gerekmektedir. Key Words: Kök hücre, hemşire, etik

305 [PP-04] CONTENTS OF ETHICS COURSE IN NURSING UNDERGRADUATE PROGRAM; EXAMPLES FROM SOME COUNTRIES Fatma Ayhan¹, Handan Eren² ¹ Karamanoğlu Mehmetbey University, Faculty of Health Sciences ² Karamanoğlu Mehmetbey University, Faculty of Health Sciences Studies are underway for standardization in nursing education in our country and in the world. The aim of this research is to evaluate the content of the ethics course taught in nursing degree programs. Ethical issues actually occurring within the context of nursing education, the areas where the nursing literature has grown have been in relation to (a) student incivility, including disengaged, disinterested, disrespectful, disruptive, defiant, and disturbed behaviors ; (b) concerns with regard to cheating, plagiarism, fabrication of data, and facilitating cheating have received greater attention particularly in the form of technocheating or cyber cheating ; (c) the implications of global migration or immigration of students and poaching faculty from other nations; (d) racism, bigotry, prejudice, intolerance, and injustice in academics; and (e) mobbing, bullying, and violence inthe academic setting. Clearly, globalization has had an impact on the nursing academic arena particularly in the domain of intercultural sensitivity and hospitality. Ethical education should be given in nursing education. Ethical issues related to students in nursing undergraduate education are collected under the category of respect for persons, clinical education in the application environment, student evaluation. In the Nursing undergraduate program in Turkey, ethics courses are generally given under the heading "Nursing History and Deontology". The content of this course at Hacettepe University; Historical development of nursing profession in Turkey, laws and regulations related to nursing in Turkey, regulations and regulations, national and international organizations in health and nursing field, ethical concept and principles, ethical and ethical decision-making in health care and nursing. North Florida Health College In the nursing department, ethics courses in nursing are taught in the second semester. Course content is values clarification (personal, professional, organizational), ethical concepts (autonomy, beneficence, nonmaleficence, veracity, fidelity, ınformed consent), ethical theory (classic (deontology, teleology), (contemporary (ethic of care, feminist ethics, justice ethics, value ethics)), ethical ıssues health (care as a right, allocation of

306 resources, abortion, end of life issues (withdrawing and withholding, euthanasia, principle of double or second effect), vulnerable populations). ethical practice (code for nurses professional organization statements, positions barriers to ethical practice strategies for individual nurses), ethical decision-making (definition of dilemma, ethical decision-making models). Lillebaelt University College ethics course is given as "Nursing, Ethics and Research Based Knowledge" in Denmark. Course contents; Nursing knowledge, ethical and research based knowledge, nursing history, blended learning, learning techniques, clinical decision making, professional development, nursing theory and knowledge, cultural understanding, culture, information writing homework and smile center visit. The content of the ethics course examined above is quite different from each other.

307 [PP-05] ETHICAL PROBLEMS DURING NURSING EDUCATION Nigar Ünlüsoy Dinçer¹, Fadime Tekin¹ ¹ Ankara Yıldırım Beyazıt University, Faculty of Health Science Nurses face many ethical problems in the educational environments where their professional identities are strengthened and the equipment and skills related to professional ethics are developed. Ethical problems in nursing education can be examined three headings as individual, institutional and societal problems. Individual ethical problems; There may be problems caused by the instructor such as the proficiency of the instructor, values and moral conflict, not effective evaluation of the student, academic freedom, authorship and publications related to fraud and plagiarism, as well as ethical problems originating from the students. For example; bullying, racism, privacy and confidentiality are not given importance and the lecturer evaluates by student. Additionally, it can be the ethical problems resulting from the interaction of the students and the instructors such as the misuse of the authority and authorities of the instructors, the exceeding of the role limits and the use of the students to reach the aims of the instructors. Besides, there are also ethical problems related to the institutions where nursing students are educated. Ethical issues originating from the institution can be exemplified by not using the resources available in nursing education fairly, by interfering in the student evaluation process, or by exhibiting a management attitude which is dominated by mobbing. Moreover, problems such as lack of standard of education among institutions, inconsistencies between real education and ideal education, and the stealing of teaching staff of international or national institutions constitute social ethical problems. Individual, institutional and societal awareness needs to be provided in order to solve these ethical problems.therefore, it is suggested to carry out researches on ethical problems in nursing education. Key Words: Nursing, nursing education, ethic

308 [PP-06] ETHICAL ISSUES IN PALLIATIVE CARE Handan Eren¹ ¹ Karamanoğlu Mehmetbey University, Faculty of Health Sciences The population is getting gradually older, and death has become an intervention area in medicine. Palliative care is invaluable to a patients recovery or to ensure their peaceful death. The term of palliative care is refers to those aspects of medical care concerned with the physical, psychosocial and spiritual issues, and palliative care is housed in many ethical problems. In this review, the ethical problems encountered during the palliative care process will be discussed. One of the problems experienced in patients receiving palliative care is pain management. In this process, the pain is not relieved, the human right is in vain. Therefore, the individual must respond quickly to pain. A study which conducted by Yönt at al. (2013), nurses were found to have ethical problems in terms of authority, inadequacy, fairness in resource use, correct decision making, and informing. In particular, when patient monitors are missing, it has been found that patients have had difficulty in connecting the monitör, and having to undertake procedures that the physician has to perform. Another issue among the ethical problems that nurses can live with is physical restraint practices. The protective effect of physical restraint, the benefit of use of restraint, the balance of harm, and whether alternative methods are feasible should be considered by the health personnel. To sum up, it is possible to collect and discuss these issues in such titles as the fair sharing of medical resources, the restriction of life support, and illuminated proclamation. In all cases, nurses are obliged to consider and care for ethical principles during implementation. Key Words: Palliative care, nursing, ethic

309 [PP-07] GEBELİĞİN SONLANDIRILMASINDA ETİK İKİLEM: EŞ İZNİ Aylin Taner, Nurdan Şentürk, Sezer Er Güneri¹ ¹ Ege University, Faculty of Nursing Amaç: Günümüzün tartışmalı konularından biri olan gebeliğin sonlandırılması (kürtaj), ülkemizde evli kadınlar bakımından eş izninin aranması nedeniyle etik ikileme neden olmaktadır. Bu derlemede kürtaj konunda eş izninin gerekliliği konusunda ortaya çıkan etik ikilem ele alınmıştır. Methods: Veri tabanlarında ilgili anahtar kelimeler taranıp, literatür incelemesi yapılarak, derleme şeklinde hazırlanmıştır. Bulgular: Fetüsün yaşama yeteneği kazanmadan herhangi bir nedenle gebeliğin sonlandırılması işlemi olan kürtaj; politik, dinsel, sosyal, yasal ve etik yönden tartışılan bir konudur. Fetüsün yaşama hakkı ve ne zaman insan olarak değerlendirileceği, kürtajın bir aile planlaması yöntemi olarak kullanılması, kürtajın ülkemizde gebeliğin 10. haftasına kadar hak olarak tanınması, kadın hakkı olarak kabul edilip edilmemesi gibi konulara ek olarak ülkemizde 1983 yılı Nüfus Planlaması Hakkında Kanun un 5. maddesine göre evli kişilerin kürtaj için eş izni gerekliği olması birtakım etik ikilemlere yol açmaktadır. Gebelik durumunu kadın izin vermedikçe sağlık personelinin hiç kimseye açıklamaması ve ülkemizin de dahil olduğu uluslararası sözleşmelerce hasta mahremiyeti ve gizliliğine önem verilmesi gerektiği konusunda, eş izni gerekliliği mevzuat ile çelişmektedir. Gebeliğin, kadın bedeninde gerçekleşen bir süreç olması nedeniyle, doğurganlığı konusunda karar vermek kadının temel insan haklarından biri olmakla birlikte, fetüsün fertilizasyonu ve fertilizasyonda spermiyle katkısı olan erkeğin de hakkını ortaya çıkarmaktadır. Bir taraftan, eş rızasının aranması kadının kendi bedeni üzerindeki yetkiyi kısıtlayarak eşine bir sahiplik yetkisi verdiği ve babanın kendi bedeninde gerçekleşmeyen bir süreçte bu denli belirleyici olmasının etik açıdan kabul edilemez bir durum olduğu görüşü savunulmaktadır. Diğer taraftan da kadının eşinin de gebeliğinin devam etmesi veya sona ermesi kararında rol alması gerektiği ve erkeklerin de en az kadınlar kadar bu durumdan etkilendiği görüşü savunulmaktadır. Sonuç: Kürtaj konusu, kadın ve erkek eşitliği sağlanan, cinselliğin tam anlamıyla tanımlandığı toplumlarda, etik ve ahlaki yönden oluşabilecek çıkmazlar açısından biraz olsun çözülebilmektedir. Yasal yönden ise gizlilik ilkesi ile çelişen mevzuat, kadının kendi bedeni üzerindeki hakları kısıtladığı için yasal düzenlemeler yapılması gerekmektedir. Key Words: Eş izni, etik ikilemler, etik

310 [PP-08] GYNAECOLOGIAL EXAMINATION AND PRIVACY Oya Ünder Kavlak¹, Şenay Ünsal Atan¹, Hilal Karadeniz¹, Muhammet Uğur Baytar¹ ¹ Ege University,Faculty of Nursing Aim: Ethical problems can be encountered practices in women's health diseases and childbirth. Gynecological examination is at the forefront practices of women's health diseases and childbirth. During the gynecological examination, various ethical problems can occur, mainly cause of the lack of privacy and autonomy. During the gynecologic examination, the female is down to the littomy position completely naked. For most women, the speculum and manual examination of the genital organs which taught to cover, hide and protect throughout life from birth can have traumatic effects ranging from feelings of anxiety and shame to feelings of humiliation, and may cause women to avoid being examined. This paper has been prepared as a compilation to examine the ethical problems women experience during gynecological examination and to raise awareness about taking precautions. Methods: This notification; EBSCOHOST, MEDLINE, Pubmed, ScienceDirect and Google Scholar databases as a result of the literature search, "Gynecological Examination, Privacy, Autonomy, Ethics" Results: Ethical problems on gynecological examination related to privacy; the negative attitude of the healthcare worker, the examining health worker being a counterstrike, examination position, used instruments, previous negative examination experiences, concern about personal hygiene, embarrassment due to the nakedness of the genital area, negative perception of sexuality and lack of examination experience. Many women have experienced pain, embarrassment, stress during gynecological examination. Although women generally want to do the examination by a female physician, in a study conducted, it has been found that as the level of education increases, the importation of physician gender decreases. Women are particularly concerned that the lack of a specific area to preparation for the examination, the lack of relevance and kindness of the health professionals and the use of the instruments during the examination negatively affect privacy. Conclusion: Inability to provide as much privacy as during gynecologic examinations; The woman has a negative effect on the mental state of the present moment, the progress of the process and the continuity of the examinations. Ensuring adequate privacy before and during the examination and considering the requests of the women for examination will increase the

311 satisfaction of the woman and will ensure continuity of the examinations as well as prevent the ethical problems that may arise and help to progress the process in a healthier way. Key Words: Gynecological examination, privacy, ethics

312 [PP-9] CONSIDERATIONS ABOUT THE EUTHANASIA OF THE PATIENT'S RELATIVES Handan Eren¹, Nadiye Eren² ¹ Karamanoğlu Mehmetbey University, Faculty of Health Sciences ² Hitit University, School of Health Although there are advances in medical treatments and technology, death is a difficult, painful and distressing process which is still difficult for patients and their relatives to cope with. In this process, individuals can demand that their lives might end. Here, the concept of euthanasia is introduced which is defined as the conscious, free will and desire of the lives of the patients who are medically and definitively determined to last until the end of their life, and that the intolerable sufferings that they will not heal and feel are terminated without pain by the physicians. In our country this practice is not legally acceptable but it seems that there are many studies carried out and most of them are concerned with the views of health professionals or students about euthanasia. For this reason, this review has been written in order to examine the studies about the opinions of patient relatives about euthanasia in Turkey and in the world. In Turkey, there was no study involving the opinions of patients' relatives about this subject in the screening using keywords. In studies conducted abroad, a study by Swarte et al. (2003) was seen that the worry of terminal-patient relatives who died with euthanasia, was not much more than the sadness experienced after a natural death process. In another study, close relatives of cancer patients reported to be positive about active euthanasia. As a result, it has been seen that the number of studies involving the views of patients' relatives about euthanasia are limitedit and, the relatives of individuals with cancer have a positive view of euthanasia. Key Words: Euthanasia, relatives of the patient, opinion

313 [PP-10] AN CASE WITH INTENSE ETHICAL PROBLEMS: PATIENT WHO EXPECTING RENAL TRANSPLANTATION AND ETHICAL PROBLEMS Pınar Avşar¹, Zehra Göçmen Baykara² ¹ Ankara Yıldırım Beyazıt University, Faculty of Health Science ² Gazi University, Faculty of Nursing Renal transplantation is a surgical intervention that provides the best possible rehabilitation in chronic renal failure, has a more mental impact on dialysis compared to dialysis and increases the quality of life of patients. Every scientific and technological development for service to humanity brings with it ethical troubles. It is given place to below a patient who are waiting for kidney transplantation and who have ethical problems in the transplantation unit. Case: It has been proposed renal transplantation to S.D. at 11 years of age with a diagnosis of chronic renal failure in the transplantation unit. Family members were assessed as donors, and the siblings of the patient were not considered donors because they did not fill the age of 18. Patient's mother also did not provide tissue compatibility, but it was determined that there was tissue compatibility with the father. Tissue compatibility was not found in the second degree relatives. It was informed about the transplantation process and possible rejection to father. He does not want to be a donor because of the fact that having two children who are obliged to look after, do not find the courage to operate and possible risk of rejection. However, if this fact is known by the family and its surroundings, it is a fear and sadness that it will fall in the status of "the father dragging his child to death" and being condemned by the family and society. Nurse E.M knows that father's tissues are compatible. The father shares this situation only with nurse E.M and wants to help him and not sharing this fact with the family members and discussing this with the physician. The nurse E.M knows that her patient S.D expects results with hope and excitement. The patient S.D meets the nurse E.M and asks if the test results are known. In this presentation, the case will be discussed in the context of ethical dilemmas and ethical principles. Key Words: Kidney transplantation, ethical problems, ethical principles

314 [PP-11] NURSES' ETHICAL EVALUATIONS ABOUT SOCIAL MEDIA SHARINGS RELATED TO WORKING LIFE Merve Çakar¹, Ayşegül Açıl¹, Nagihan İlaslan¹, Tuğba Savaş Yücel², Ayşe Demiray¹ ¹ Düzce University, Faculty of Health Science ² Düzce University Health Practice and Research Center Aim: The present study aimed to examine ethical evaluations about social media sharings of nurses' work life. Ethic is expressed as whole of moral principles and values that regulate the behavior of individuals and professions. The importance of ethics for the nursing profession is increasing. There are ethical principles for nursing profession. Ethical principles for nursing have been determined by the Turkish Nurses Association (TNA) as nonmaleficence/beneficience, autonomy/individual respect, justice/equality, privacy/confidentiality (THD, 2009). With common use of the internet all over the world, the beginning of the age of Web 2.0 reveals the social media concept (Tosyalı and Sütçü, 2016). The widespread use of social media, however, has blurred the boundary between private and public life. For this reason nursing organizations such as ANA, CNA and NCSBN have published guidelines to prevent ethical problems related to the use of social media. In Turkey, ethical principles published by TNA hasn t been mentioned about use of social media. In addition, there were no studies that examined the use of social media by nurses ethically. This study is aimed to complete the deficiencies in literature and to raise awareness in this subject. Methods: The descriptive type of study will be conducted between August and October 2017 with the nurses working at Hospital of Duzce University. The data will be collected through the Personal Information Form prepared by researchers and the Social Media Case Form For Nurses, which is based on the cases in A Nurse s Guide to the Use of Social Media prepared by the National Council of State Boards of Nursing. Results and Conclusions: In analyzing of data, results and recommendations will be shared using statistical methods appropriate to data. Key Words: Ethics, nursing, social media

315 [PP-12] ETHICS OF CARE THEORY AS THE MORAL THEORY FOR NURSES İlkay Boz Ethics of care theory is an important approach for nursing, which offers an alternative perspective on moral philosophy against traditional-ethical-theories. It has been uncovered by non-nursing scientists theorized, although it seems to be specific to nursing. The process of formation and development of ethics of care has started in the 1980s and become a unique, intellectual movement based on the work of authors such as Ruddick, Gilligan, Noddings, Tronto, Held. There are basic features that distinguish ethics of care from traditional ethical theories. Deontological-ethics focuses on ethical principles based on universalizable rules, to determine the behaviors that are obliged to do. Ethics of care comes from the mandatory addiction that comes out of human nature. In the traditional-ethical focusing on the necessity of not being what it is, in the ethics of care, the ethical life must be handled within the world. It focuses on virtues related to caring such as altruism, love, empathy and compassion as moral feelings in relationships. In terms of nursing practice, it is considered that the traditional-ethics approach may be insufficient to handle individuals in an integrated way, and that the ethics of care approach can be a guide in managing nursing ethical dilemmas related to interpersonal relationship based care. Gilligan describes the transitional periods of ethics of care as a shift from selfishness to responsibility, goodness as self-sacrifice and from goodness to truth. This approach overlaps with Watson's Human Caring Theory from nursing theorists. According to Watson, care is an ethical task and the nurse should ask her/himself the following questions: "Who is this individual? How can I clarify the personal values of this individual?, How can I provide an ethical care?" As a result, ethics of care is a moral theory approach that can be adopted as an ethical approach in nursing practice Key Words: Ethics of care theory, moral theory, nursing care

316 [PP-13] REFLECTIONS OF SCIENTIFIC PARADIGM TO ETHIC OF MEDICINE Zeliha Kaya Erten¹, Zübeyde Korkmaz¹, Özlem Ceyhan² ¹ Nuh Naci Yazgan University, Faculty of Health Science ² Erciyes University, Faculty of Health Science He concept of paradigm is an important fact of the history of science. Ever since man existed, he has been struggling to find out what truth and existence are. In doing so, he gave the most attention to information. In the time, people have tried to access information in different ways. This path has been mythology, religion, experimentation and observation. In every period how to reach to information or type of mentality shaped the paradigm, but there is no definition of what the paradigm is. The concept of paradigm is defined as a set of preconceptions about what science is supposed to do and how it should be adopted by the community of scientists. Ethics science is highly influenced by the paradigms of science. The paradigm, which decides how to reach scientific knowledge, has also influenced ethical decision making processes. It is very important to know what ethics are to do ethical evaluation of a behavior. At the interface of the ethics or non-ethics, the answer we are looking for is the paradigms we internalize more. For example, to make the time of a scientist (health staff) who internalized modern scientific thought to be realized, the effect of the 'mind body' duality of Cartesian thought prejudice. Descartes expresses this duality in his own words. "Everything belonging to the mind is outside the body, everything belonging to the body is outside the mind". According to Capra, this idea has kept doctors from considering the psychological aspects of the disease and from treating psychotherapists with the bodies of the patients. At this point, it can be said that when a healthcare individual who internalizes an auditory paradigm is treated only by his / her body, whereas a health-care person who has internalized intellectual paradigms, he can only evaluate the individual with psychology. Throughout history, the most important concepts of ethics have always been mentioned in terms of virtue, goodness, honesty, truthfulness and loyalty. However, the boundaries of these concepts are drawn and the concepts are not filled in enough. For this reason, when it is decided what is good or bad, people tend to decide in the context of the paradigms they internalize. Every scientific knowledge in the medical field has affected the health of the individual and every innovation and treatment method has produced different ethical results. Considering the ethical issues, health personnel who need to work also show an ethical approach in the direction of paradigm and thought structure.

317 Key Words: Science, paradigma, medicine ethic [PP-14] BİLİMSEL PARADİGMALAR VE TIP ETİĞİNE YANSIMALARI Paradigma kavramı bilim tarihinin önemli bir olgusudur. İnsan var olduğundan beri hakikatin ve varlığın ne olduğunu arama çabası içinde olmuştur. Bunu yaparken en çok bilgiye önem vermiştir. Zaman içinde insanlar bilgiye farklı yollardan ulaşmaya çalışmışlardır. Bu yol kimi zaman mitoloji, din, kimi zamansa deney ve gözlem olmuştur. Her dönemde bilgiye nasıl ulaşılacağı veya düşünce şekli o dönemdeki paradigmayı şekillendirmiştir ancak paradigmanın ne olduğuna ilişkin bir tanımlama yapılmamıştır. Paradigma kavramı bilimin ne olduğuna nasıl yapılması gerektiğine ilişkin ve bilim insanları topluluğunca benimsenmiş bir dizi ön kabuller olarak tanımlanır. Etik bilimi, bilimin paradigmalarından oldukça etkilenmiştir. Bilimsel bilgiye nasıl ulaşılacağına karar veren paradigma, etik karar verme süreçlerini de yakından etkilemiştir. Bir davranışı etik değerlendirmesini yapmak için etik olanın ne olduğunu bilmek oldukça önemlidir. Etik olanın yada olmayanın arayışı etkinliğinde, aradığımız cevap daha çok içselleştirdiğimiz paradigmaların kendisidir. Örnek olarak Modern bilimsel düşünceyi içselleştirmiş bir bilim adamı( sağlık personeli) çoğu zaman fark etmeden Kartezyen düşünce açısından önemli olan 'Zihin beden' ikiliğinin etkisi altında kalmaktadır. Descardes bu ikiliği kendi sözleriyle şöyle ifade etmektedir. Zihne ait olan her şey bedenin dışındadır, bedene ait olan her şeyse zihnin dışındadır. Capra'ya göre bu düşünce, doktorları hastalığın psikolojik boyutlarını göz önüne almaktan ve psikoterapistleri hastaların bedenleriyle ilgilenmekten alıkoymuştur. Bu noktada duyumcul bir paradigmayı içselleştirmiş bir sağlık personeli bireyi sadece vücudu ile ele alırken, düşünsel paradigmaları içselleştirmiş bir sağlık personeli ise bireyi sadece psikolojisi ile değerlendirebileceği söylenebilir. Tarih boyunca etiğin en önemli kavramları olan erdem, iyilik, dürüstlük, doğruluk, sadakat gibi kavramlardan her zaman bahsedilmiştir. Ancak bu kavramların sınırları çizilip kavramların içleri yeterince doldurulmamıştır. Bu nedenle de neyin iyi neyin kötü olduğuna karar verilirken bireyler içselleştirdiği paradigmalar bağlamında karar verme eğiliminde olmuşlardır. Tıp alanındaki her bilimsel bilgi bireyin sağlığını etkilemiştir ve her yenilik ve tedavi yöntemi farklı etik sonuçlar doğurmuştur. Etik konuları dikkate alarak çalışması gereken sağlık personeli de içinde bulunduğu düşünce yapısı ve paradigma doğrultusunda etik yaklaşım göstermektedir. Key Words: Bilim, paradigma, tığ etiği

318 [PP-15] LEVEL OF MORAL MATURITY AND EFFECTIVE FACTORS OF INTERN NURSING STUDENTS Fatma Başalan İz¹, Esin Çetinkaya Uslusoy¹ ¹ Süleyman Demirel University, Faculty of Health Science Aim: The aim of this study was to determine moral maturity among intern nursing students. Methods: The data for this descriptive research were collected between April 15 and May 15, 2015 in Isparta. The study sample included 110 of the nursing students attending this school, who agreed to participate in the current research after they were explained the objective and importance of the research. The number for participation in the research was 83. Sociodemographic data form and Moral Maturity Scale in data collection were used. Descriptive statistics were carried out. Independent Sample t-test and One Way ANOVA was used to determine the relationship between the independent variables and Moral Maturity Scale. The Bonferroni correction method was used in the further analyses. A p value less than 0.05 (p<0.05) was considered statistically significant. Results: The mean age of intern nursing students was 22.30±1.42. Of all the study participants, 80% were females, and 97.6% single. 33.7% of the students preferred nursing profession to obtain economic gain. The rate of students who loving nursing profession is 57.8%. The participants' maturity score was between and the mean was ± Conclusion: As a result of the research, it was determined that the students had a higher score than average score the Moral Maturity Scale, that the marital status, economic situation and reasons for choosing the profession affect moral maturity conditions. Key Words: Moral maturity, nursing, students

319 [PP-16] ETHICAL PROBLEMS OBSERVED BY NURSING STUDENTS IN CLINICAL SETTINGS Şengül Yaman 1, Zehra Göçmen Baykara 1, Sevil Güler Demir 1 1 Gazi University Faculty of Health Sciences Human relations are very intense in health care institutions. In these institutions, there are healthcare professionals, several workers and patients with different values. The common goal of healthcare workers is to solve/try to solve health/disease problems of the individuals who need healthcare services. Healthcare workers perform several practices or make decisions about the patient/healthy individual receiving the service. Several decisions are made and applied in these institutions for individuals with different values by the individuals with other values. Therefore, problems associated with ethical values are frequently encountered in these institutions. In the clinical setting, nursing students can closely observe the relations between individuals receiving service and several healthcare professionals, especially nurses. The students observe this relations as both a nursing candidate and a healthy/ill individual needing service. This study was conducted to determine the ethical problems observed by nursing students in the clinical setting. Fifty fourth-year nursing students were participated in the qualitative study. The students in the study directly observed ethical violations for two weeks during their clinical practice and recorded their observations individually in a semi-structured observation form. The observation form was developed by the researchers and given to the students at the beginning and taken at the end of the study. All forms were analyzed by content analysis method, one of the qualitative study methods. Writen consent was taken from the students and the institution, besides the study was approved by the ethics committee. In the study; ethical violations observed by students during clinical practice were listed as four main themes: harm/benefit, justice, respect for autonomy, and respect for privacy/intimacy. Ethical violations associated with harm/benefit; were classified as carelessness/inexperience/neglect, patient safety, and not providing qualified/integrated care. Ethical violations associated with respect for autonomy; were classified as protection of human dignity, respect for beliefs and values, informing and autonomous decisions for treatment and care. Ethical violations associated with justice; were classified as non-discrimination, not looking after personal interest and fair distribution of limited resources. Ethical violations associated with respect for privacy/intimacy; were classified as physiological, psychological and social violations.

320 The study results showed that; service education and different training methods should be provided in order to increase the awareness and sensitivities of healthcare professionals towards ethical violations. Key Words: Ethical, nursing ethics, ethical problems

321 [PP-17] NURSING AND MORAL COURAGE Fatma Tanrıkulu¹, Cansu Koç², Yurdanur Dikmen¹ ¹ Sakarya University,Faculty of Health Science ² Sağlık Bilimleri University Kartal Dr. Lütfi Kırdar Training and Research Hospital In this review in which the concept of moral courage was examined, the definition and significance of moral courage, characteristics of the nurses with moral courage and their awareness on this issue were addressed. It is necessary for the nurses to have the necessary knowledge and skills to present care with quality, to be sensitive about humanistic and moral aspects of care and to provide services in accordance with professional ethics.therefore, the adequacy and quality of care depend on the load of professional knowledge, professional and ethical practices, arrangement, control and management of nursery practices in line with specific policies and standards. Today, the concept of moral courage has emerged for providing adequate care and care with quality and it has become the basic element of moral ethics applications. Moral courage in nursing is described as the ability of nurses to resist against the unethical practices and to fulfill their ethical obligations professionally. In other words, it is to do the right thing in accordance with moral values for the problems encountered by nurses. The characteristics which the nurses with moral courage should have are presented below. The nurses with these characteristics believe that patient care is correct, they make the right decision and ensure the comfort and safety of patient by acting in accordance with their decisions. Hence, nurses obtain relief and comfort as a result of acting in accordance with moral courage and they feel honoured, take courage and feel compassion for the patients they give care for. It is important for nurses to show moral courage against moral problems in terms of developing a moral perspective on the ethical issues faced in nursing practices, being able to protect patient rights and ensuring patient safety. Key Words: Nursing, moral courage, characteristics

322 [PP-18] ETHICAL ISSUES IN ASSISTED REPRODUCTION TECHNIQUES Begüm Kahya¹, Şenay Ünsal Atan¹, Oya Kavlak¹ ¹ Ege University, Faculty of Nursing Aim: The purpose of this report is to examine ethical issues in assisted reproductive techniques in terms of ethical principles and laws. Methods: The literature has been compiled. Results: Assisted reproductive techniques that develop as a solution to infertility can lead to ethical problems. The most important problem in donating gametes or embryos, one of the assisted reproduction techniques, is whether or not the child has the right to learn his parents in the future. The fact that unmarried women or lesbian couples have children is also leading to ethical dilemmas. Donors are banned in our country. In the gametes and embryo freezing processes, divorce of a couple, death of one of the spouses and what happens to the remaining embryo after successful pregnancy are discussed. In our country, freezing is prohibited except in cases of necessity. Gender determination with genetic diagnosis during preimplantation period is another ethical dilemma. Gender selection is not ethical if there is no genetic disease related to sex. During IVF administration, more than one embryo transfer is made to increase success and then fetal reduction is performed in order to reduce the risk for mother and baby. If the fetus is considered to be considered as an individual, his right to life, which is his most basic right, is taken away. Carrier maternity practice is still being debated from the ethical side and there is no legally clear solution. The risk of converting this method to commercial can be a social issue. Most important thing here is how the possible child will meet this situation and whether it will be told to the child. Conclusion: It is concluded that the ethical rules that may apply in the implementation of assisted reproductive techniques are unclear and that studies on eliminating this ambiguity have to be made. Key Words: ethics, assisted reproduction techniques, nursing

323 [PP-19] PALLIATIVE CARE AND ETHICS IN ONCOLOGY Begüm Kahya¹, Oya Kavlak¹ ¹ Ege University, Faculty of Nursing Aim: The purpose of this report is to investigate ethical problems in palliative care. Methods: The literature has been compiled. Results: Issues that lead to ethical dilemmas in palliative care are usually due to poor prognosis. It is often discussed in palliative care, who is to be regarded as a decision maker in the end of life. If the patient isn t able to decide; it isn t known whether the decision maker will take care of patient benefit. In such cases, authorization notification is important. An authorization notification is a notification of who will decide, if it becomes impossible for patients to make decisions about their health. In the event that modern medical treatment is inadequate, the initiation or discontinuation of treatment also leads to ethical dilemmas. If the burdens brought by the intervention are too great, treatment may not be initiated, or treatment termination may be considered, provided that the patient has the ability to make decisions. Because aggressive support treatments to be applied to the patient during this period don t provide benefits to the patient, the patient may suffer additional pain or cause the distressed process to prolong. However, this process shouldn t affect the care given to the patient, the patient should continue to receive medical care. The honorable death of end-stage cancer patients is important ethical responsibilities of the health care team. Sometimes this can be in the form of preserving the integrity of the body, not starting new treatment, using high doses of morphine. Necessary precautions should be taken to avoid adverse effects in the patient. Conclusion: Many ethical dilemmas are encountered in palliative care units. Acquiring ethical counseling on the subject will create solutions that will cover all parties and will provide communication between the parties. Key Words: Palliative care, ethics, nursing

324 [PP-20] DETERMINATION OF THE TURKISH MIDWIFES KNOWLEDGE LEVELS ON THE INTERNATIONAL CODE OF ETHICS FOR MIDWIVES Zülfiye Bıkmaz¹, Özlem Özdemir¹, Gönül Akgün¹, Figen Dığın¹ ¹ Kırklareli University Health of High School Aim: To determine knowledge levels of the Turkish midwives, who are employed in public hospitals affiliated to apublic Hospitals Association, on the international code of ethics for midwives, and examine the factors affecting these levels. Methods: The research was designed in descriptive research method. The midwives working in public hospitals affiliated to a Public Hospital Association have constituted the research population. Data analysis was performed through the non-probability sampling method on the research sample consisting of 62 voluntarily participating midwives(51.7%,n=120). Institutional permission from the Association was obtained to conduct the study. SPSS 20 program was used in the analyses. Descriptive statistics and comparative analyses were used in evaluating the data. Results: The mean age of the participants was42.35±7.9 years(min=22,max=65).of the participants,79.0% were married and 51.6% were associate degree (a two-year program) graduates. The mean year of employment was 21.87±9.19 years (min=0.25,max=45). Of the midwives,64.5% were working in out-field units, 35.0%(n=21) were found to prefer consulting their colleagues for the solution of the ethical dilemmas they experienced, and 96.2% think that a care model should be used when performing midwifery profession.the variables of marital status, career choice style, and social media use periods of the midwives created statistically significantly difference in their knowledge levels on article-based and midwifery practices of the International Code of Ethics for Midwives, development of midwifery knowledge and practice, and professional responsibilities of midwives(p<0.05). Conclusion: It s thought that midwives should be employed in units suitable for their own fields, and that the qualification examination for graduation in midwifery and the relevant post-graduate midwifery trainings approved by the Ministry of Health should be obligatory, as well as that the active use of technology in this educational process is extremely important for their professional development. It s also suggested that ethical councils should be actively employed in hospitals to resolve ethical dilemmas. Key Words: Midwifery, ethical code, training, education, technology

325 [PP-21] DETERMINATION OF THE LEVEL OF KNOWLEDGE OF MIDWIFERY AND NURSING DEPARTMENT STUDENTS ABOUT FORENSIC CASES Zülfiye Bıkmaz¹, Gönül Akgün¹, Özlem Özdemir¹ ¹ Kırklareli University, Health of High School Aim: The purpose of this study is to determine the level of knowledge about forensic cases and the necessity of notification of 3rd and 4th grade students Department of Nursing and Midwifery who are studying at a university Health School and who have taken courses related to ethics. Methods: The design of the research is descriptive. All students studying in the 3rd and 4th grade of Midwifery at School of Health constitute the universe of study. Data analysis was conducted with the non-probability sampling method on 137(59.6%,N=230)students who volunteered to take part in the study. Permission from the institution was obtained for the study to be performed. SPSS 20 software was used in the analyses.descriptive statistics and comparative analyzes were used in the evaluation of the data. Results: The mean age was 21,95±1,47(min=20,max=30). 62.0% were nursing students and 89.1%were females. 93.4%(n=128) of the respondents answered correct to the statement that "the health personnel encountering "an indication that a crime has been committed" are legally obliged to report forensic cases". 70.8%(n=97) of the respondents answered correct to the statement that "the removal of organs and tissues from people who aren t 18 years old and who aren t capable is prohibited". Among the conditions where notification is required; it was found that the students had less knowledge about falling from heights (%83.9,n=115), electricity and lightning strike (73,0%, n=100), burns (67.9%,n=93) and asphyxia causing conditions (66.4%, n=91). Regarding other conditions where notification is required, it was found that they had information on the topic at a rate between 91.2% and 97.1%. Conclusion: Having a sufficient level of knowledge alone is not considered to be enough to make these notifications. It s proposed to conduct field studies on the level of knowledge of employees about what the conditions where notification is required are, and to investigate the obstacles preventing these notifications. Key Words: Midwifery, nursing, notification required conditions, forensic case

326 [PP-22] IS SOCIAL MEDIA A THREAT TO THE PRIVACY PATIENT? Özlem Güner¹, Ruşen Öztürk¹ ¹ Ege University, Fuculty of Nursing Communication and information technologies and the use of the Internet are increasing rapidly in the world. Today there are more than 2 billion Internet users in the world and this corresponds to about 34% of the world population. The Internet has become an integral part of the daily lives of individuals today and has become an important tool in the socialization of people. In many countries of the world, the Internet affects many aspects of society from family and friendship ties to consumption habits, and changes the lifestyles of individuals. One of the most used social networking networks in the world, Facebook's monthly number of users is announced as 1.86 billion as of February billion of users are connected to Facebook from mobile devices such as mobile phones. As of March 2017, according to socialbakers.com's description, there are 42 million Facebook users in Turkey. Turkish Statistical Institute (TURKSTAT) according to the data of 2016, 82.4 percent of the individuals with internet access in Turkey use the Internet to join social groups. Social media, defined by reciprocal interaction, self-content creation and multidimensionality, has become a subject of increasing research in both mass communication and health communication in the last decade. It is possible to say that social media started a new era in the field of health communication with these features which are different from traditional mass media. The ethical problems encountered in new media environments arise from the fact that the ethical problems encountered in the real world are repeated in new media environments, these environments are more easily realized due to their technical characteristics and spread more rapidly. Therefore; The widespread use of social media among health professionals has also brought some ethical concerns. The concern of these concerns is that the inappropriate use of social media will harm patients' privacy and confidentiality. This article has been written to highlight the sensitivity of patients' privacy in the context of increasing social media medicine ethics among health professionals and to contribute to the literature in this area. Key Words: Social media, privacy, patient

327 [PP-23] CONFLICTS OF ETHICAL PRINCIPLES DURING PALLIATIVE CARE: IS IT ABOUT BENEFICENCE? IS IT ABOUT NON-MALEFICENCE? Nadide Embel¹, Nuray Demirci Gungordu², Cagatay Ustun³ ¹ Johns Hopkins Anadolu Medical Center ² Recep Tayyip Erdogan University School of Health ³ Ege University Faculty of Medicine In the palliative care process, it is aimed to keep the quality of life at the highest level by managing the individual in a physiological, psychological, social, cultural and spiritual way. In this process, members of the medical team sometimes experience dilemmas. For a 62-year-old male patient, who is thought to be in the last stage of his life, with HCC (hepatocellular carcinoma) and common metastases, it would be as a matter of being beneficence to the patient proper for cardiopulmonary resuscitation (KPR-CPR) in case of possible respiratory or cardiac arrest. However, the patient s laboratory values and clinical findings can be signal for a patient who is irremediable. Since dealing with the patient s body in this situation is perceived as harming the patient when viewed from different points, CPR for the principle of non-maleficence is not considered appropriate. In our statement, we will discuss the clinic of this patient who is thought to be in the last period of his life in palliative care unit from the ethical and moral point of view. Key Words: Palliative care process, ethical dilemma, ethical principles

328 [PP-24] ETHICS, VIRTUE AND NURSING Derya Emre Yavuz¹, Nefise Bahçecik¹, Şule Ecevit Alpar¹, Semanur Kumral Özçelik¹ ¹ Marmara University, Faculty of Health Science Virtue is the ethical way of thinking. It was formerly regarded as the best conduct of a function by a being that is supposed to perform that function, whereas it was later used to mean superiority or merit. The meaning of being a good human and the content of superiority changed with time and became a synonym for being a good citizen. The latter is now defined as being fair, temperate and wise. Socrates defines virtue as being familiar with self and thus knowing what and not to fear, what to approach and stay clear. He emphasizes that virtue could be learned and taught, that a person with knowledge will behave accordingly and follow good, and that lack of virtue results from negligence and one can only be free by getting to know themselves. The ultimate good is virtue. Virtue is the ethical outcome causative providing individual and social happiness. Virtues including courage, temperance, wisdom and fairness are basic virtues that must observed by the society. A virtuous individual is one that adheres to industriousness, emotional wit, honour, justice, charity, compassion, i.e. common moral values of society. Virtue ethics is a character-focused approach assuming that individuals with good character tend to demonstrate behaviours consistent with their character. Virtue ethics in nursing addresses individual characters of nurses and seeks ways to improve traits that fit to actions that enhance nurses well-being. Virtue is to act with the knowledge of purpose. Virtuous behaviour in care requires having a good personality and also being informed and performing actions that will benefit healthy people/patients without causing harm. Hence, evoking and having confidence, kindness and compassion, common sense, integrity, loyalty, faith, nobility, not valuing one s profits at the cost of patients and honesty are the virtues that nurses as professionals should possess. Key Words: Ethics, virtue, nursing

329 [PP-25] UTILITARIAN ETHICS Semanur Kumral Özçelik¹, Nefise Bahçecik¹, Şule Ecevit Alpar¹, Derya Emre Yavuz¹ ¹ Marmara University, Faculty of Health Science Utilitarianism is an ethics theory supporting the notion that the outcome of an action should be judged as good or bad. According to the utilitarianism, a correct action is a behaviour with the greatest benefit or utility. Utilitarianism is also regarded as consequentialism. According to Bentham s utilitarianist theory, actions should be considered correct if they increase happiness and decrease pain, and they should be regarded as false if they induce opposite outcomes. Utilitarianism renders benefit the principle of ethical behaviour and action, equalling good with beneficial. According to the utilitarian/pragmatist approach, the action that most benefits a person is the best. The value of an action depends on the outcomes of the act. The number of affected individuals and the degree they are affected from the act matter. In utilitarianism, no matter how much individuals actions are conditioned for positive and beneficial outcomes, adverse undesirable consequences besides the benefits may also occur. According to this principle, our attitude and behaviours may shape around being absolutely beneficial or balancing benefits and harm. Ethics is a scientific and humanitarian domain which analyses problems through vital values, guides decisions and actions, channels actions towards truth and goodness, searches ethics norms and causes, and develops theories that explain them. Because nurses find people whose cares they assume as valuable and unique in their beliefs and attitudes, actions and behaviours, they believe that they have the right to receive the upmost care. Utilitarianism, as an ethical principle, requires that nurses act to provide benefits for patients. Following the principle of beneficence, nurses are liable to do right or to support right and to prevent harm. With the awareness that human life is the highest value that needs to be safeguarded, nurses advocate utilitarianism in all their practices towards healthy individuals/patients. Key Words: Utilitarian ethics

330 [PP-26] PSİKİYATRİDE GEÇMİŞTEN BUGÜNE ETİK Leyla Baysan Arabacı¹, Ece Mutlu¹ ¹ İzmir Katip Çelebi University, Faculty of Health Science Amaç: Tarihin her döneminde psikiyatri birimlerinde farklı yaklaşımlar doğrultusunda farklı etik olaylarla karşılaşılmıştır. Bu yazıda, etik ilkeler doğrultusunda karşılaşılan bu etik olgulardan söz edilecektir. Bulgular: Psikiyatri birimlerinde yaşanan bu etik durumlar, tarihsel olarak ilkçağ, ortaçağ, aydınlanma dönemi, 19.yy. ve 20.yy. alt başlıkları altında sunulacaktır. İlkçağlarda yapılan kötü ruhları kovma, otlarla hastaları iyileştirmeye çalışma ve delilik taşının çıkarılması gibi uygulamalar ile yarar sağlama ve zarar vermeme ilkesi ihlal edilmiş, buna karşın Yunan döneminde yaygın olarak kullanılan psikosomatik tedaviler ve Roma Uygarlıklarındaki yazılı hukuk kuralları ile adalet-eşitlik ilkesinin korunması sağlanmıştır. Ortaçağda; Bizanslılarda ruhsal bozukluğa ilgi azalmış ve hastalarla kiliseler ilgilenmiştir. Avrupa da; kötü hijyen koşulları, hastaların dilendirilmesi ve eziyet görmesi gibi vahşi uygulamalarla yarar sağlama, insan onuru ve mahremiyet ilkeleri ihlal edilmiştir. Aydınlanma döneminin başında hastalara şeytanla bağlantı kurduğu gerekçesiyle cezalar verilmiştir. İngiltere ve Amerika da ruhsal bozuklukların tedavisi için hastaneler kurulmuş, hastaların zincirleri çıkarılmış ve keyfi cezalandırmalar kaldırılmıştır. Ancak, Darwin sandalyesi, genital organların haşlanması ve hastaların suya atılması gibi uygulamalar da gerçekleştirilmiştir. Kol gücüne sahip ruhsal bozukluğu olan bireyler hastaneye yatırılmak yerine çalıştırılarak zarar vermeme, mahremiyet ve insan onuru ilkeleri ihlal edilmiştir. 19.yy da cezalandırıcı uygulamaların tamamen kaldırılması ile bu dönemin başında korunan zarar vermeme ilkesi, hastaların cinsel organ ve vücuttaki bezlerine uygulanan enjeksiyonlar ve kötü hijyen koşullarının yanında tüberkülozdan dolayı ölen birçok hastadan dolayı daha sonraki dönemde büyük oranda ihlal edilmiştir. 20.yy da dikkat çeken ilaç keşfine karşılık Nazi uygulamaları, lobotomi, anestezi ve kas gevşetici olmadan, EKT, gaz odası uygulamaları hastaların kendi giysilerini giymelerine izin vermeyerek tek tip kıyafet giydirme, psikiyatri hastanelerinin kapatılması, psikiyatriye ödenen kredilerin kaldırılması gibi uygulamalarla zarar vermeme, insan onuru, eşitlik ve adalet ilkelerinin ihlal edildiği görülmektedir. Sonuç: Günümüzde incinebilir bir hasta grubunun yer aldığı psikiyatri birimlerinde gözlenen bazı uygulamaların, tutumların dayandığı temeli anlamak için tarihe ışık tutmak yararlı olacaktır. Bu yazının, bu konuda literatüre önemli bir katkı sağlayarak, psikiyatri birimlerinde etik anlamda daha duyarlı bir bakımın sunulmasına vesile olacağı düşünülmektedir.

331 Key Words: Etik, etik ilkeler, psikiyatri, tarih

332 [PP-27] ETHICAL DILEMMA IN TERMINATION OF PREGNANCY; SPOUSE S PERMISSION Aylin Taner¹, Nurdan Şentürk², Sezer Er Güneri³ ¹ Muğla Sıtkı Koçman University, Faculty of Health Sciences ² Ege University, Institute of Health Sciences ³ Ege University, Faculty of Nursing Aim: Termination of pregnancy (abortion), one of the controversial topics today, leads to ethical dilemma in our country due to request for spouse s permission in terms of married women. In this compilation the ethical dilemma concerning request for spouse s permission during abortion is discussed. Methods: This compilation was prepared through searching the relevant key words in data bases and searching literature. Results: Abortion, termination of pregnancy for any reason before fetus gets capacity of living, is a topic being debated from political, religious, social, legal and ethical perspectives. In addition to the subjects such as fetus s right of living and when it is going to be assessed as a human, use of abortion as a method of family planning, accepting abortion as a right until 10th week of pregnancy, not accepting it as a woman s right; according to 5th item of 1983 Family Planning Law in our country, the requirement related to spouse s permission for abortion in married couples causes ethical dilemma. Despite that health personnel do not disclose pregnancy to any one unless allowed by women and according to international conventions which our country involves, attaching importance to patient privacy and confidentiality; the necessity of spouse s permission conflicts with regulations. Although pregnancy is a process occurred in woman s body and to decide on fertility is one of the fundamental human rights of woman, fertilization of fetus and contribution of man to fertilization with sperms puts forth the man s right. It is considered an unacceptable situation in terms of ethical perspective that a request for spouse s permission provides man an ownership authority by limiting woman s authority over her body and father s too much decisiveness about the process not developed in his own body. On the other hand, it is thought that woman spouse should play a role on making decision about continuation and termination of pregnancy and men are influenced by this situation at least women. Conclusion: The topic of abortion can be solved, albeit little, in communities where woman man equilibrium was ensured and sexuality was completely defined. Legal regulations must be

333 made since the regulation conflicting with the rule of confidentially limits women s own rights on their bodies. Key Words: Abortion, abortus, Spouse s permission, ethic

334 [PP-28] TÜRKİYE YÜKSEKÖĞRETİM KURULU ULUSAL TEZ MERKEZİ NE KAYITLI HEMŞİRELİK ALANINDA ETİK KONULU TEZLERİN İNCELENMESİ Melek Şahin¹, Prof. Dr. İsmet Eşer² ¹ Muğla Sıtkı Koçman University, Fethiye Health Services Of Vocational School ² Ege Universty, Faculty of Nursing Giriş: Etik, bireysel ve toplumsal davranış kurallarını saptayan, insanların nasıl yaşamaları gerektiğini ve niçin o şekilde yaşamaları gerektiğini tanımlayan bir bilimdir. Sağlıklı/hasta bireye sunulan bakım sürecinde hemşirelerden, mesleklerini icra ederken etik davranışını göz önünde tutmaları beklenmektedir. Hemşireler görevlerini yerine getirirken; etik ilkelerine uymaları gerekir. Sağlık hizmetlerinin giderek karmaşıklaşması, bilim ve teknolojinin paralelinde yeni etik sorunların ortaya çıkması ve hemşirelerin çalışma yaşamında hemşirelik bakımını da etkileyen bu sorunlarla yüz yüze kalması onların karar mekanizmalarının içinde yer almasını zorunlu kılmıştır. Hemşirelerin etik konusunda bilgi sahibi olması ve karşılaştığı hasta bakım sorunlarında etik karar verebilme becerisini kullanarak soruna ilişkin çözüm üretmesi gerekmektedir. Son zamanlarda hızla gelişen teknolojinin sağlık uygulamalarına yansıması sonucunda hemşirelerin karşılaştıkları etik sorunların belirlenmesi ve bunlara güncel çözüm önerilerinin sunulabilmesi için etik konusunda daha fazla akademik araştırmaya ihtiyaç vardır. Hemşirelikte etik çalışmalarının yeni başladığı görülmektedir. Ülkemizde hemşirelik anabilim dallarında etik konusunda yayınlanan tezlerin durumu ile ilgili herhangi bir araştırmaya rastlanılmamıştır. Amaç: Bu çalışmada Türkiye de hemşirelik alanında etik konusunda yapılan yüksek lisans ve doktora tezlerinin incelenmesi amaçlanmıştır. Yöntem: Bu araştırma, Türkiye de hemşirelik alanında etik konusunda yapılan yüksek lisans ve doktora tezlerini sistematik olarak incelenmek amacıyla planlanmıştır. Çalışmanın evreni Yükseköğretim Kurulu Ulusal Tez Merkezi ne kayıtlı yılları arasında etik konusunda Hemşirelik Anabilim Dalları nda yapılan doktora ve yüksek lisans tezlerinden oluşmuştur. Etik anahtar kelimesi kullanılarak Yükseköğretim Kurulu Ulusal Tez Merkezi veri tabanında konu ile ilgili 667 teze ulaşılmış olup araştırmaya dahil edilme kriterlerine uygun olan 16 tez çalışma kapsamında değerlendirilmiştir. Bulgular: Tezlerin üçü doktora ve 13 ü yüksek lisans tezidir. Yüksek lisans tezlerinin dört tanesinin özetine, diğerlerinin tam metnine ulaşılmıştır. Doktora tezlerinin ikisi tanımlayıcı biri geçerlilik güvenilirlik çalışması; yüksek lisans tezlerinin on iki tanesi tanımlayıcı, bir tanesi de karma tiptedir. Tezlerin hemşirelik anabilim dallarına göre dağılımına bakıldığında; doktora

335 tezlerinin tamamı Hemşirelik Esasları Anabilim Dalı nda, yüksek lisans tezlerinin ise beş tanesi Hemşirelik Anabilim Dalın da, üç tanesi Çocuk Sağlığı ve Hastalıkları Hemşireliği Anabilim Dalı'nda, iki tanesi Hemşirelik Esasları Anabilim Dalı nda, bir tanesi Psikiyatri Hemşireliği Anabilim Dalı nda, bir tanesi Hemşirelikte Yönetim Anabilim Dalın da, bir tanesi Acil Tıp Hemşireliği Anabilim Dalı da çalışılmıştır. Çalışmalardan biri sağlık personeli, ikisi hekim ve hemşireler ile diğerleri ise sadece hemşirelerle gerçekleştirilmiştir. Çalışmalar konularına göre incelendiğinde; sekiz tanesinin etik duyarlılık, dört tanesinin etik karar verme, ikisinin etik ikilem, birinin etik iklim, birinin de etik sorun çözme becerisi üzerine yapıldığı saptanmıştır. Sonuç: Tezlerin ağırlıklı olarak Hacettepe Üniversitesi ve Marmara Üniversitesi nde çalışıldığı, Hemşirelik Esasları Anabilim Dalı ve Hemşirelik Anabilim Dallarında çalışıldığı, tanımlayıcı tipte olduğu, veri toplama tekniği olarak anketin kullanıldığı, etik duyarlılık konusunun işlendiği ve hemşire popülasyonu üzerinde çalışıldığı tespit edilmiştir. Farklı popülasyonlarda, farklı etik sorunların ele alındığı ve farklı yöntemlerin kullanıldığı akademik çalışmalara ihtiyaç vardır. Key Words: Etik, hemşirelik, Hemşirelik Anabilim Dalları, doktora tezi, yüksek lisans tezi

336 [PP-29] PSYCHIATRIC MENTAL HEALTH NURSE S PERCEPTIONS OF MORAL DISTRESS Seher Kaşlı¹, Kerime Bademli² ¹ Akdeniz University, Institute Of Health Science ² Akdeniz University, Faculty of Nursing Moral distress specifically refers to the phenomenon of stress associated with ethical dimensions of health care practice. As health care becomes increasingly complex nurses encounter difficult ethical issues in patient care. Ulrich et al. (2007) reported that nurses felt powerless (32.5%) and overwhelmed (34.7%) with ethical issues in the workplace and frustration (52.8%) and fatigue (40%) when they could not resolve ethical issues. Wilkinson (1987) suggested that the frequency of moral distress depends on the type of unit in which nurses work, as well as their definition of what constitutes a moral issue and their values. Nurses working in the psychiatric clinic may experience moral distress due to different reasons. In a study conducted by Austin, Bergum and Goldberg (2003), it was stated that nurses in mental health settings felt distress when they did not respond to the needs of their patients. In the study of moral distress experienced by psychiatric nurses, the situation has been raised to moral distress experienced by nurses clustered into three themes: (a) professional and legal conflict; (b) professional autonomy and scope of practice and (c) standards of care and client autonomy. Moral distress was experienced, however, when participants believed that they had to use coercive practices with clients because medical interventions were insufficient, late in being prescribed, or prescribed for nonmedical reasons. Unresolved moral distress can develop into reactive distress, which is characterized by feelings of powerlessness, guilt, self-criticism, and low self-esteem. Physiological responses such as crying, loss of sleep, nightmares, and loss of appetite are also associated with reactive distress. Unresolved moral distress can impact on the quality of nursing care. For this reason the nurses should be able to express feelings and thoughts about moral distress. Nurses should be able to discuss moral distress. Key Words: Moral distress, nurse, psychiatry nursing, psychiatric care

337 [PP-30] ETHICAL SIDE OF AGE DISCRIMINATİON AT ELDERLY INDIVIDUALS ON THE PROCESS OF BENEFİTİNG HEALTH SERVICES Fethiye Yelkin Alp¹, Şebnem Çınar Yücel² ¹ Dokuz Eylül University, Faculty of Nursing ² Ege Universty, Faculty of Nursing As the elderly person may experience difficulties in monitoring and evaluating progress in treatment, care and technological development, ethical dilemmas in the decisions to be made about them can be a common problem. The issue of age discrimination in benefiting from health services is one of them. The problems that may arise regarding age discrimination are: Should elderly take priority in getting health care? Priority in sourcing limited resources should be given to the elderly or young population? Should age be a deciding factor in access to services? Different attitudes, prejudices, and behaviors that are shown to a person, only because of their age are expressed as elderly discrimination. The term of elderly discrimination was first used by Gerontologist Robert Butler, the president of the American National Institute for Aging in According to the results of surveys of elderly discrimination attitudes of health personnel, It has been determined doctors and nurses have been old age discrimination, in elderly care practices. The cost allocation deadlock in the elderly disease treatment care process is the dilemma of whether age is a criterion for this distinction. In the process of benefiting elderly people's health care services, there are some situations in which ethical decisions should be made. Ethical decision analysis is needed in situations such as; resuscitation of a patient with advanced stage dementia, withholding antibiotics to elderly patients who are bed-dependent stubborn Chronic Obstructive Pulmonary Disease, inpatient care rather than hospital transfer where further examination is required, withdrawal of life support, mechanical ventilation and dialysis.although it is metastatic cancer or Alzheimer's disease in geriatric patients, doing life extension and invasive procedures of patients and their relatives are ethical. In elderly care and treatment, ethical codes should be acted and the value of the elderly should be respected.in this context, in order to change the negative prejudices and values of elderly people, it is recommended that; issues related to geriatrics should be added in educational programs,the roles and responsibilities of the health personnel who give care to the elderly people, should be determined with written protocols, before the deterioration of the cognitive status of the elderly, individual informed consent should be given by life support person, taking into account the principles of autonomous, autonomy.

338 Key Words: Elderly indivudual, age discrimination, ethics in sourcing from health service

339 [PP-31] CHRONIC HEART FAILURE AND PATIENT EDUCATION Bahar Çiftçi¹, Gülçin Avşar¹ ¹ Atatürk University, Faculty of Nursing The patient education refers to supporting independent competence of patients in meeting their own health needs. Patient education includes patients, family members/relatives, nurses and other healthcare team members. Regular provision of patient education yields positive results in terms of both the patient and the country, whereas inadequate patient education can negatively affect patients with heart failure as in all patient groups. Hearth failure (HF) is a frequent clinical syndrome that is associated with abnormalities in the structure or function of the heart and symptoms such as dyspnea, fatigue and fluid retention, causing significant morbidity and mortality as well as incurring costly health expenditures. HF has become a public health problem in developed and developing countries due to its increasing incidence and high mortality rate. Nurses have an important role in reducing morbidity and mortality associated with HF, increasing the quality of life and satisfaction levels of patients, reducing the number of recurrent hospitalizations and hospital stay. It is well known fact that nurses play a significant role in the management of chronic diseases and increase the quality of life of patients by providing education and supporting patients with heart failure, highly affecting patient satisfaction, symptom control and management as well as the quality of life positively. Key Words: Chronic heart failure, patient education

340 [PP-32] HUMAN IMMUNODEFICIENCY VIRUS (HIV) POZİTİF HASTALARIN EŞLERİNİN BİLDİRİLME(ME)SİNİN ETİK AÇIDAN İNCELENMESİ Tuğba Zan¹, Burcu Atlas¹, Sezer Er Güneri¹ ¹ Ege University, Faculty of Nursing Human Immunodeficiency Virus (HIV) epidemisi ayrımcılık, dışlama ve suçlamanın yaygın olduğu; insan hakları konusunda kaygıların yaşandığı, bireylerin onurlarının hiçe sayıldığı bir ortamda hüküm sürmektedir. Hastaların, hastalıkları konusunda aydınlatılması her hekim/hasta arasında olması gereken bir süreçtir. Hekimin bilgilendirme sonra hastanın eşinin de bilgilendirme(me)si etik açıdan ikilemler içerir. Bu derleme, HIV pozitif bireylerin eşlerine hastalığın bildirme(me)sinin etik açıdan değerlendirilmesi amacıyla derleme şeklinde hazırlanmıştır. Dünya Sağlık Örgütü'ne göre, HIV pozitifliği tanısı partnerin zarar görmesini engellemek amacıyla hasta tarafından eşe söylenebilir. Fakat, hastanın rızası olmadan ülkelerin yasal düzenlemeleriyle sağlayacakları standart uygulamayla görevlendirilen birinin HIV pozitif hastanın eşine hastalığı bildirmesi hekim/hasta arasındaki güven ilişkisini zedeleyecektir. Hekimin konuyu partnere iletmesiyle, HIV li kişiye zarar verebileceği bildirilmiştir. Uluslararası HIV/AIDS ve İnsan Hakları Rehberi ne göre, eşin gönüllü olarak bilgilendirilmesi desteklenmektedir. HIV li bireylerin partnerlerinin bilgilendirilmesi için yasal mevzuatın sağlık personeline yetki vermesi, fakat personelin zorunlu tutulmaması gerektiğini savunmuştur. Rujumba ve ark. (2012), HIV li kadınların, şiddet ve enfeksiyonu bulaştırma suçlaması nedeniyle durumlarını eşlerine açıklamadıklarını bildirmiştir. Tshweneagae ve ark. (2015), HIV durumunun partnerlere açıklanmasının, eşinin HIV danışmanlığına motive olabilmesi açısından yararlı olduğunu bildirmiştir. HIV li hastaların bilgileri gizlilik ve mahremiyet nedeniyle hekim tarafından saklanmalıdır. Fakat HIV li hastanın partneriyle cinsel ilişkiye girmesi de başka bir kişinin zarar görmesini sağlayacaktır. HIV durumunun açıklanması, suçlama, boşanma, istismar, ayrımcılık ve damgalama risklerine sahiptir. HIV durumunu bildirmek kolay değildir ve olumlu/olumsuz sonuçlara neden olabilir. Tıp etiği ilkelerinden zarar vermeme, yararlılık, özerklik açısından ikilemler içeren meslek sırrının açıklanmasıyla ilgili durumlardan olan HIV li kişinin eşine bilgi verilmesi sorununun, çözümlenerek, açıklık getiren yasal düzenlemelere gidilmesi gerekmektedir. Key Words: Etik, HIV, bilgilendirme

341 [PP-33] ETHICAL APPROACH IN HOME CARE SERVICES Handan Özdemir¹, Şevkinaz Konak² 1 Ege University, Faculty of Nursing ² Mehmet Akif Ersoy University, Faculty of Health Sciences New trends in today's health care draw attention to the fact that long-term patient care must be provided outside healthcare facilities, usually at home. The purpose of long-term care is to ensure that people who cannot take care of themselves adequately could lead a high quality of life, by protecting their independence, autonomy, participation, performing personal activities and human dignity at a maximum level. Due to many factors such as population s aging and increases in ageing-related chronic diseases and palliative care services, it is inevitable that several problems arise while home care services are rendered. Therefore, the concept of "home care ethics" has been introduced in recent years. The transformation of home care services into industry brings about ethical problems as well. Checking whether the directives given to a patient are followed by the patient is more difficult in the home environment than in the hospital environment. Therefore, the source ethical problems arising during the provision of home care is not only the home care industry but also the caregivers, patients and their relatives, institutions providing home care services and employees of these institutions. Factors affecting ethical decision making are as follows: deciding when to start home care, the patient s and family s participation in the care, need for support systems, interdisciplinary communication difficulties, and lack of ethical committees. During the provision of home care services, taking into account the ethical principles of medicine such as nonmaleficence, beneficence, distributive justice, respect for autonomy, honesty, veracity, confidentiality, privacy and loyalty will guide home care practices and the solution of ethical dilemmas. Key Words: Ethics, home care, ethical approach in home care services

342 [PP-34] KRONİK RUHSAL BOZUKLUĞU OLAN BİREYLERDE ETİK SÜRECİ Ayşegül Bilge¹, Pınar Ünal² ¹ Ege University,Nursing Faculty of Nursing ² Ege University, Institute Of Health Science Etik, toplumun değer yargılarını dikkate alarak bireylerin uygun olmayan davranışlarını belirler. Toplumsal varoluş içerisinde kişilerin topluma, toplumun da kişilere karşı uyması gereken ahlaki kurallar vardır. Toplumun varlığını bireyler oluşturduğundan, bireylerin ahlaki gelişimlerinin ortalaması toplum ahlakını, yani etiği oluşturur. Etik ahlakın vicdan azabı olup, toplumun riskli gruplarında daha da önemli hale gelir. Kronik ruhsal bozukluğu olan bireyler toplumun riskli gruplarındandır. Bu derleme bildiride, etik davranışın psikolojik kökenleri incelenerek, yasal süreçteki gelişimi açıklanmıştır. Kronik ruhsal bozukluklar duygu, düşünce ve davranışlardaki bozukluğun süreklilik durumudur. Toplumda sık görülmeleri, diğer kronik bedensel hastalıklar kadar yeti yitimi ile sonuçlanabilmeleri ve iş gücü kayıpları nedeniyle öncelikli olarak ele alınması gerekli olan hastalıklardandır. Bir toplumun üyesi olmanın en önemli koşulu, var olan ahlaki çerçeveyi öğrenip kabul etmekten başlar. Etik davranışlar ve ahlak önce aileden öğrenilir. Aile toplumun temelidir. Aile içerisinde davranış biçimleri ile ahlak eğitiminin uyumlu olması gerekmektedir. Aksi takdirde bireyin ahlaki gelişimi olumsuz yönde etkilenir. 2.Dünya Savaşı sonrasında ruhsal bozuklukların artması ile tarihte ilk kez insanlığa karşı suçlar kavramı, Nürnberg Şartı nın 6. maddesinde açıklanmıştır. Etiğin yasal süreci Nürnberg mahkemelerinde başlamıştır. Etik ilkeler yıllarca süren tartışmalar sonucunda ortaya çıkmıştır. Yasal düzenlemeler genellikle etik tartışmalardan sonra gerçekleşir. Belli konuya ilişkin etik tartışmalar başlayıp, insanlar bu konu üzerinde yoğunlaştıktan sonra, etik sorunlara yol açan konuların çözümünü sağlayan yasalar düzenlenir. Ruhsal bozukluğu olan bireyler, göstermiş oldukları anormal davranışlar ile ahlaki yargılara yönelik yıllarca sorgulanmıştır. Bu durum aile, toplum ve sağlık personeli tarafından etik ve hastalık belirtisi bağlamında ayırt edilmelidir. Özellikle Toplum Ruh Sağlığı Hemşireleri bu konuda arabuluculuk açısından önemli bir yere sahiptirler. Key Words: Kronik ruhsal bozukluk, etik, hemşire

343 [PP-35] ADALET VE EŞİTLİK ETİK İLKESİ ÇERÇEVESİNDE RUHSAL HASTALARA İÇİN UYGULAMA: MIKNATIS APARATLI ELDİVEN Pınar Ünal¹, Ayşegül Bilge² ¹ Ege University, Institute Of Health Science ² Ege University, Faculty of Nursing Hemşireler görevlerini etik ilkelere göre gerçekleştirirler. Hemşire hizmet verirken, bireylerin gereksinimleri doğrultusunda zamanın, emeğin ve diğer kaynakların adil dağılımını sağlar. Bu ilke adalet ve eşitlik ilkesidir. Bu derleme bildiride, ruhsal hastaların adalet ve eşitlik ilkesi çerçevesinde yaşam standartlarını maksimum düzeye yükseltmek için araştırmacılar tarafından geliştirilen mıknatıs aparatlı eldiven uygulamasının sunulması amaçlanmıştır. Ruhsal hastalar gerek hastalıklarından gerekse ilaç tedavisinin etkisinden öz bakım girişimlerini gerçekleştirmekte zorluk çekerler. Bu doğrultuda gerçekleştirilmiş olan mıknatıs aparatlı eldiven kullanımı, ruhsal hastaların kendine yetebilmesini, elini rahat kullanarak öz bakımını gerçekleştirmesini sağlamaktadır. Eldivenin avuç içi ve parmak uçlarına dizayn edilmiş mıknatıslar sayesinde el kullanımının işlevselliği artar. Eldiven kullanımı ile ilgili en eski veriler Mısır dönemine aittir. Mısır piramitlerinde Kral Tutankamon un mezarında M.Ö yılına ait ketenden yapılmış eldivenler bulunmuştur.eldivenin ne zaman icat edildiği bilinmemekle birlikte kullanım alanları farklı ihtiyaçlara göre belirlenmiştir. Çinliler mıknatıslı eldiveni tarım ve sanayide kullanmak üzere üretmişlerdir. Ruhsal yeti yitimi olan bireylerin ilaçlara ya da psikososyal durumlara bağlı olarak uzuvlarını kullanmada yetersizlikler meydana gelir. Özellikle tremor, distoni gibi belirtiler uç ekstremitelerin rahat kullanımını önler. Elini kullanamadığında, başkalarının yardımına ihtiyaç duyar. Bireylerin hastalıklarına ve tedavilerine yönelik anlayışlarını attırmak, bireysel becerilerini geliştirmek, hayat standartlarını arttırmak, evde kendi bireysel bakımlarını tek başlarına yapabilmelerini sağlamak ve eli etkin kullanabilmek için; mıknatıs aparatlı eldiven etkili bir çözüm olabilir. Mıknatıs aparatlı eldiven el ile kavranan bir cismin elden düşmesini önler ve elin işlevselliğini arttırır. Ruhsal hastaların elinden eşyaları düşürmeden, sabit kalmasını sağlayarak kendi işini görebilmesini sağlamak, kişisel bakımlarını yardımsız yapmalarını kolaylaştırmak toplum ruh sağlığı bakımı için hastaya iyileştirici ortam sunar. Key Words: Ruhsal hasta, etik, hemşirelik, mıknatıs aparatlı eldiven

344 [PP-36] NURSING AND ETHICS Ece Kurt¹, Ayten Zaybak¹ ¹ Ege University, Faculty of Nursing Ethics is a group of moral principles which systemize the behaviors of an individual or a profession. They assume the purpose that science and technology would not damage the society. Professional ethics is defined as the body of rules and necessary behaviors which are required in occupations concerning living creatures. In this review article, the issues of nursing, ethics and occupational ethics are studied in accordance with the related literature. Ethical principles provide guidance for nurses to be aware of the moral aspect of their profession, to develop moral awareness and to offer sufficient and quality care for the society by better comprehending their responsibilities in clinical practices. These include autonomy, beneficence, non-maleficence, honesty, privacy, justice and loyalty. Nurses are expected to make their decisions and carry out practices according to these principles. On the other hand, nurses are known to have ethical dilemmas in many issues such as the reflection of rapidly advancing technology on health care practices, organ transplantation, allocation of limited resources, increase in elderly population, patients rights, definition of death, not being able to inform the patient and the family about diagnosis, treatment and prognosis, conducting abortion or not, failing to be the voice of the patient in cases of caring deadly ill patients with pain and conducting unpermitted studies on patients. It is important to follow ethical decision making steps to avoid these dilemmas. These steps can be listed as problem definition, specification and examination of options, choosing one of the options and proving the accuracy of the choice. Varying responsibilities and the role of nurses in the team bring about ethical problems for nurses and cause them to have conflicts. Therefore, nurses have to decide in line with ethical principles. Key Words: Ethical dilemmas, ethical principles, nursing

345 [PP-37] THE DEFENSIVE ROLE OF THE NURSE Ayşe Aslı Oktay¹, Fadime Yel², Merve Gülpak¹, Filiz Taş² ¹ Kahramanmaras Sütcü Imam University, Kahramanmaras Health High School ² Bartın University, Health Services of Vocational School ² Kahramanmaras Sütcü Imam University, Kahramanmaras Health High School One of the developing and modern roles of a nurse is the defensive role for patient rights.this role takes its basis from human rights and patients rights.a nurse teaches a patient/an individual how to use his/her rights, and defends these rights when the patient is inadequate in defending these rights.the purpose of a defender must be to help people to gain access to services they need, and support decision-making processes.if a person cannot use his/her autonomy, defense is needed in such a situation.since a nurse is the closest member to the patient among the healthcare staff, s/he is the most suitable person that knows the needs of the patient and protects him/her from unfair practices. The defensive role of a nurse consists of the informing of the patient and receiving his/her consent, clearing the medical process from unnecessary explanations and proceedings, avoiding sexual abuse towards the patient, working on behalf of the healthcare staff, and acting on behalf of the patient in general.as the defender of the rights of the patient, the nurse helps them to express them, and protect their rights.in the role of the defender of rights, the nurseacts in processes like informing the patient, helping in decision-making, being his/her spokesperson when needed, and protecting the patient from side effects/complications ofthe diagnoses and treatments.the nurse protects the patient by avoiding physical and/or chemical injuries.in disease and health status, and along the death process, the nurse works to protect the legal rights and patients rights of the patient.the definitive role of the nurse is closely related with ethical values because it is related with human rights and patient rights.this role is connected with the ethical principles of respecting the patients rights and not harming them. The nurse acts in accordance with these responsibilities and ethical principles. Key Words: Defensive, ethic, nursing, role

346 [PP-38] HATALI İLAÇ UYGULAMALARININ ADLİ YÖNÜ Nurten Alan 1 1 Dokuz Eylül University, Faculty of Nursing Hemşireler hastanelerde hastalara ilaç uygulanmasından sorumlu primer sağlık profesyoneli oldukları için önemli bir konumdadırlar. Hasta güvenliğini etkileyen en yaygın hata tipi ilaç hatalarıdır. Çırpı ve arkadaşları, hemşirelerin uygulamalarda karşılaştıkları mesleki hatalar arasında %47 oranıyla ilaç uygulama hatalarını birinci sırada bulmuşlardır. Alan ve Khorshid in yaptığı çalışmada hemşirelerin %34.4 ü kendisine veya bir yakınına yönelik bir tıbbi hata deneyimlemiştir, %50.7 si tıbbi bir hata ile karşılaşmıştır. Sağlık çalışanları hataları önemsemediklerinden veya bildirmeye korktuklarından iletmeyebilirler. İlaç hatalarını önlemek için ilaç hatalarının rapor edilmesi gereklidir. Kök nedenleri, bilgisizlik, deneyimsizlik, iletişim eksikliği, yorgunluk, motivasyon eksikliği, çevresel faktörler, eğitimsizlik. Türk Ceza Kanunu nda kusur tiplerine göre ikiye ayrılmaktadır. Kasıtlı suç; kişi eyleminden doğacak sonucu öngörerek, isteyerek suç işler. Taksirli suç; tedbirsizlik, dikkatsizlik, meslekte acemilik, emir, nizam ve talimatlara uymama nedeniyle yaralamaya ya da ölüme sebep olmaktır. TC K'da hatalı tıbbi uygulamalar, taksirli suçlar kapsamındadır. Görevini yaptığı sırada suçu yetkili makamlara bildirmeyen kişi bir yıla kadar hapis cezası ile cezalandırılır (Md. 280). Madde 24/3 Konusu suç teşkil eden emir hiçbir surette yerine getirilemez. Aksi takdirde yerine getiren ile emri veren sorumlu olur. Madde 24/4 Emrin, hukuka uygunluğunun denetlenmesinin kanun tarafından engellendiği hallerde, yerine getirilmesinden emri veren sorumlu olur. Madde 85: (1) Taksirle ölüm, 2-6 yıla kadar hapis, (2) Birden fazla insana zarar durumunda, 2-15 yıl kadar hapis ile cezalandırılır. (Değişik: 6/12/ /5 md.) Suçun bilinçli taksirle işlenmesi halinde şikâyet aranmaz. Madde 89- (1) Taksirle zarar veren kişi, üç aydan bir yıla kadar hapis veya adlî para ile cezalandırılır. Hatayı önlemek için; lisans ve lisansüstü eğitim, yeterli insan gücü, yasal düzenlemeler yapılmalı, sürekli eğitim verilmeli, sorumluluklar tanımlanmalı, bilişim teknolojileri kullanılmalı, altyapı yetersizlikler giderilmeli, ekip anlayışı benimsenmeli, kalite güvenliği ve bakım standartları geliştirilmeli, tedavi protokolleri oluşturulmalı, birey/toplum bilinçlendirilmelidir. Key Words: Tıbbi hata, ilaç uygulaması, hemşirelik, yasal sorumluluklar

347 [PP-39] REFLECTION OF NURSING VOCATION IN THE NEWSPAPERS: CHANGE IN THE LAST 15 YEARS Evrim Eyikara 1, Gülcan Eyüboğlu 1, Zehra Göçmen Baykara 1 1 Gazi University, Faculty of Health Sciences Aim: Newspapers, which have a significant role among mass media, are also important in terms of providing the society with information and creation of positive/negative perception regarding the nursing.this research has been prepared as a retrospective descriptive research to examine the news in the newspapers regarding the vocation of nursing. Methods: The population of this research is comprised of two newspapers with widest circulation and e-archive.the news published at these newspapers in 2000, 2005, 2010 and 2015 were examined.scans were made at the e-archives with nurse and nursing keywords.the sample was comprised of 2376 directly related news items.the news were grouped under the following four main themes: occupational responsibilities, occupational problems, the image of nurses in the society and individual news.each news item was gathered under the related theme and a thematic analysis was conducted.data were digitized in Excel software; their frequency and percentile values were utilized. Results: 64.14% (n=1524), 15.48% (n=368), 7.28% (n=173) and 13.08% (n=311) of the news items are related to occupational responsibilities of nurses, occupational problems of nurses, the image of nurses in the society and individual news, respectively.it is observed that news related to nurses and nursing have increased in the recent years.most of the news are related to nursing care, improvement of positive nursing image, nurses taking more part in socio-cultural activities and improvement of the art aspect of nurses.moreover, the number of negative news items concerning matters such as violence against nurses and deficiencies in the number of nurses have also started to increase recently. Conclusion: It can be seen that the perceptions on and the problems of the nursing are directly/indirectly being reflected in the printed media.it is considered that this power of media is en essential resource to be utilized to ensure that the vocation of nursing can be accurately reflected on the society. Key Words: News, newspapers, nurse, nursing

348 [PP-40] INFERTILITY AND SEXUAL ETHICS Sümeyye Bakır¹, Oya Kavlak¹ ¹ Ege University, Faculty of Nursing Aim: This review was planned with the aim of creating awareness of the effect of infertility on sexuality and the ethical problems encountered on this topic. Methods: The study was planned by examining the relevant literature. Results: Sexuality is a state of health which provides bodily, sensory, spiritual and social completeness. Infertility, defined as the inability to have children after one year of unprotected sex, is an important factor influencing sexuality. Infertile couples frequently experience sexuality as becoming a duty in order to have children, resulting in such sexual problems as lack of appetite for sex, anorgasmia, a reduction in sexual satisfaction, and dyspareunia. It was found in one study that being infertile for three years or more and having previously had infertility treatment were a primary risk factor for sexual dysfunction.when decisions are necessary from the aspect of medical care, full information must be provided to the couples on the possible approaches including the risks and benefits, and the decision must be left to them. It must be possible to discuss the effects on sexual functioning of chronic diseases such as tuberculosis in the reproductive organs in which pregnancy rates are low. In order for access to techniques assisting reproduction in HIV (+) patients, the limitations must be made clear without discrimination.infertility may result from harm caused by others or even by self-harm. The incidence of infertility can be reduced by education is given on topics such as sexual health, the danger of traditional methods, unsafe abortion and female genital mutilation. Conclusion: Maintaining the sexual health of infertile couples is of great importance in preserving the health of both men and women. It is necessary to find solutions to the patient s benefit on this topic including the ethical problems of professional ethics, human rights, and patients rights. Key Words: Ethic, infertility, sexuality

349 [PP-41] SILENT SCREAM: BREAST IRONING Halime Abay¹, Sena Kaplan¹ ¹ Ankara Yıldırım Beyazıt University, Faculty of Health Science Breast ironing, usually referred to as a form of mutilation, is a harmful cultural practice which aged between 9-15 years old girls breast tissue are compressed with hot and large stones or hammer, other implements in order to suppress and reverse their development by mother, aunt or grandmother. This is commonly practiced in Cameroon and some Africa countries, but it also concerns the whole world because of immigration. About one girl in four undergo breast ironing in Cameroon. It is estimated that 3.8 million teenagers have been affected by breast ironing. Around 1000 girls in the United Kingdom are currently thought to be at risk of this practice. The main purpose of breast ironing is to protect girls from men. The practice is applied to reduce risk of sexual harassment, rape, kindap, early forced marriage, sexually transmitted infections, pregnancy and to continue their education. Teenage girls generally believes that the practice is carried out for her own good. So girls will often remain silent. But breast ironing is a physical child abuse and gender-based violence. Breast ironing cause too many negative physical and psychological health consequences such as tissue damage, pain, infections, severe fever, itching, abscesses, discharge of milk, malformed breasts, difficulty breastfeeding or producing milk and may be related to the breast cancer. Not only it is so harmful, but often proves futile. At the same time, breast ironing constitutes a violation of ethics principles such as beneficence and nonmaleficence, respect for autonomy, informed consent, respect for the right to choose and refuse, justice and equality, respect for people's rights and dignity. Therefore, nurses should creating worldwide awareness about the harmful effects of the practice and to protect patient rights as an advocate. Key Words: Breast ironing, a violation of ethics principles, physical child abuse, gender based violence, people's rights.

350 [PP-42] DOES NURSES HAVE A DUTY TO CARE TO THE PATIENTS OF CRIMEAN-CONGO HAEMORRHAGIC FEVER? Filiz Bulut¹, M.Murat Civaner¹ ¹ Uludağ University, Faculty of Medicine One of the occupational risks of healthcare workers is contracting diseases during healthcare provision. This risk gains more importance in the face of outbreaks and especially the diseases such as SARS and Ebola that has no effective prevention and treatment methods with high mortality rates. Crimean-Congo haemorrhagic fever (CCHF) is one of those diseases which is effective in Turkey especially since the year According to WHO, CCHF virus causes severe viral haemorrhagic fever outbreaks, which have a case fatality rate of up to 40%. The virus is primarily transmitted to people from ticks and livestock animals. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. For the period of , 37 healthcare workers infected with CCHF, while 14 of them were nurses. Five of the infected healthcare workers have lost their lives while three of them were nurses. Whether there is a duty to care for those patients or not is an important debate. Some argue that there is no or limited duty to care against those kind of patients based on several justifications. In this presentation, it is aimed to discuss if there is a duty to care of nurses for CCHF patients, and if so, where the limits for that duty could be drawn especially when the protection measures are inappropriate. Key Words: Nursing, contagious diseases, Crimean-Congo haemorrhagic fever, duty to care, professional ethics

351 [PP-43] WHICH ETHICAL PROBLEMS NURSES FACE IN INTENSIVE CARE UNITS? AN INITIAL REVIEW Bahar Arslan¹'², Filiz Bulut¹, M.Murat Civaner¹ ¹ Uludağ University, Faculty of Medicine ² Union of Public Hospitals, General Secretariat, Bursa Public Hospital Intensive care units (ICU) of hospitals are contexts where various ethical problems occur. Nurses are the healthcare workers who care the patients in ICU continously and therefore might face ethical problems the most. Besides patient care, they frequently find themselves in an environment where they have to carry out many tasks such as writing e-orders, organizing paper works, providing medicine and medical supplies, and even cleaning the floors. However, the studies in the literature are mainly about the problems that physicians and patients face, and the studies focused on nurses very limited in number and scope. Therefore it is important to determine the types of ethical problems that the nurses working in ICUs face is important in order to improve the healthcare and job satisfaction. In this presentation, we aim to present an initial review of ethical problems that the nurses working in ICUs of public and university hospitals face, which is determined by literature knowledge and expert opinions. On the basis of this inital assessment, which also aims to specify the connections between the problems and their possible reasons, it is planned to conduct a qualitative study with nurses working in ICUs which aims to gain a better understanding the ethical problems and analyse them. Key Words: Intensive care unit, nursing, ethical problems, professional ethics, nursing professionalism

352 [PP-44] ETHICAL PROBLEMS, APPROACHES AND ROLE OF NURSING IN STEM CELL TRANSPLANTATION Hilal Karadeniz¹, Muhammet Uğur Baytar¹, Sezer Er Güneri¹ ¹ Ege University, Faculty of Nursing Aim: Stem cells are unspecialized, endlessly divisible, main cells capable of differentiating to form other tissues and organs of the body. Stem cells were found towards the end of the 20th century and are now used in the treatment of many diseases. For transplantation, the stem cells can be obtained from the bone marrow of the individual or donor, the peripheral blood by apheresis, the embryo and the cord blood obtained by joining the volunteer's ovum with the patient's own tissue nucleus. In particular, obtaining stem cells from the embryo and cord blood leads to ethical problems and debates. The study was designed to emphasize the role of the nurse by examining ethical issues and approaches in stem cell transplantation. Methods:The study was compiled by selecting the articles by scanning EBSCOHOST, MEDLINE, Pubmed and ScienceDirect databases. Findings: In the field of stem cells, obtaining the cell firstly, there are ethical problems after the type of transmission. In particular, embryoid stem cells are obtained; When human beings are used as a guinea pig, when the embryo is counted as a human being, when the embryos used are destroyed, when the cord blood banks and the cord blood are commercialized, stem cells obtained from the cord blood are not enough or when new stem cells are needed, Or autologous transfusions, there is no health story yet for the baby using cord blood while the donor person himself is not the type of donor, and a variety of ethical discussions are taking place on the recipient's benefit and donor's benefit. According to the civil law, the fetus is not accepted as a person, and it is stated that it may be right with birth condition. Therefore, there is no regulation on embryonic stem cell studies. Conclusion: Various principles being used trying to overcome ethical problems in stem cell therapy. Stem cell therapy is an area where disagreements arise where new development, continuing studies and treatment boundaries, advantages and disadvantages are not fully known, ethics, medicine and theology. In order to be able to provide the right counseling for the nurse, the recipient and the donor, and to provide the necessary support during the treatment, they need to know their role, responsibilities and guidelines that they can use to solve ethical problems. Key Words: Nurse, ethic, stem cell

353 [PP-45] ETHICAL RESPONSIBILITIES OF NURSES IN HEALTHCARE OF KIDNEY TRANSPLANTATION PATIENTS Filiz Taş, Merve Gülpak In this study the ethical principles and responsibilities of nurses in healthcare of kidney transplantation patients are presented in the light of knowledge of literature. In case of kidney transplantation that is offered as a treatment method for end stage renal disease diagnosis, transplant nurses are responsible for behaving as a supporter of patient and work in the frame of legal, ethical and Professional standards. Transplant nurses should be in search of the upper level of ethical development also should integrate patient care application fields and equal health service. Also they should follow changes in health policies and medical applications for themselves, colleagues and society, compansate demands in the frame of ethical rules, do the mission of supporter at public and national level. A nurse; should consider valuable and unique qualities of each person with respect and compassion, should give importance to family oriented care and should not ignore fears and anxieties of patients and family members before and after transplantation, should protect and support the rights of pateint in order to provide secure and high quality health environment without considering socio-economical statue, ethnic origin or other differences, should have knowledge about actual health policies and regulations for patients, should have sufficient knowledge about interactions of medicines with eachother, complications and precautions, should continuously improve herself in terms of ethics and have capacity of evaluate ethical values and characters of all people without considering their personal properties and living conditions, should provide a working environment basing on ethically secure and qualified health care service with personal efforts and team working, should make scientific researches, improve Professional standards and contribute development of profession via forming health policies, should protect human rights and cooperate with other health professions and society in order to reduce inequality in health, 10) should Express the values of nursery via Professional organizations, protect the integrity of profession and involve social justice principles to nursery and health policies. Key Words: Kidney transplantation, patients, ethical responsibilities of the nurse

354 [PP-46] THE RESPONSIBILITIES OF NURSES IN ETHICAL PROBLEMS Filiz Taş, Ayşe Aslı Oktay Nurses should have necessary knowledge and skills about nursery, behave sensitively about humanity and ethical side of care, continuously develop their Professional sufficiency, provide Professional dicipline and give service with ethical sensitivity suitable to Professional ethics in order to give qualified care. Ethical codes/rules in nursery were developed by aiming to make their Professional ethics different, develop ethcal sensibility as well as being guidance in ethical problems regarding people, groups or society that need care. The identified values are self devotion, esthetics, equality, freedom, honour of human, justice and reality. The expected personal characteristics from nurses are creativity, sensitivity, kindness, protect their rights, selfrespect, confidentiality, hope, reliability, rationality and responsibility. Ethical problems are problems having not simple and certain solutions that cannot be defined as absolute right and wrong, needs to make choice and ethical judgement as well as are complex and causing dilemma in people. In favour of advancements in our present science and technology especially developments in biomedical field, it is possible to make a heart beating again, continue breathing by respirators, change many nonfunctionla organs by transplantation, feed a patient that cannot feed orally via enterally or intravenously for months and continue his life. These facilities cause the line between life and death gradually become uncertain, occurrence of ethical problems, complexification of care functions and confrontation of nurses with ethical problems. Ethics is defined as the total of moral principles that are basis for behaviours of a person, is also a practical application of studies regarding philosophical reflections of social ethical and social norms and applications of ethical phylosophy by asking the question what should I do in this situation?. Ethical codes/rules provide nurses to make logical and perminent decisions by giving a formal process in application of ethical moral philosophy. Professional ethical rules and principles protect nurses against laws and regulations as well as protect individuals given service against applications. In this study it is aimed to gain nurses a point of view by summarizing the responsibilities of nurses in ethical problems in nursery applications in the light of knowledge of literature. Key Words: Ethical issues, nursing responsibilities

355 [PP-47] ETİK SORUNLARDA HEMŞİRENİN SORUMLULUKLARI Hemşirelikte mesleki etik, özellikle hemşirelik uygulamalarında karşılaşılan etik sorunlara yönelik ahlaki bir bakış açısının geliştirilebilmesi, hasta haklarının korunabilmesi ve hasta güvenliğinin sağlanabilmesi açısından önemlidir. Hemşirelerin kaliteli bakım verebilmesi için hemşirelik konusunda gerekli bilgi ve becerilere sahip olması, bakımın insani ve ahlaki yönü konusunda duyarlı davranması, mesleki yeterliliğini sürekli geliştirmesi, iş disiplini sağlaması ve meslek etiğine uygun ahlaki duyarlılıkla hizmet sunması gerekir. Hemşirelikte etik kodlar/kurallar, hemşirelerin mesleğin ahlaki yönünün farkında olması, ahlaki duyarlılık geliştirebilmesi ve bakım hizmetine ihtiyaç duyan kişi, grup ve toplumla ilgili etik sorunlar konusunda karar vermede rehber olması amacıyla geliştirilmiştir. Belirlenen etik değerler; fedakârlık, estetik, eşitlik, özgürlük, insan onuru, adalet ve gerçekliktir. Hemşirelerden beklenen kişisel özellikler ise; yaratıcı, duyarlı, anlayışlı olma, hakkına sahip çıkma, öz saygı, gizlilik, umut, güven, akılcılık ve sorumluluktur. Etik sorunlar, ahlaki bir yargıda bulunmayı ve seçim yapmayı gerektiren, mutlak doğru ya da yanlış olarak tanımlanabilecek kadar basit ve kesin çözümleri olmayan, karmaşık ve kişiyi ikilemde bırakan sorunlardır. Günümüz bilim ve teknoloji alanındaki ilerlemeler, özellikle biyomedikal alandaki gelişmeler sayesinde, duran bir kalbi yeniden canlandırmak, respiratörle solunumu devam ettirmek, işlevini kaybetmiş birçok organı organ nakli yoluyla değiştirmek, ağızdan beslenemeyen bir hastayı aylarca enteral ya da intravenöz yolla beslemek ve yaşamını devam ettirmek olanaklıdır. Bu olanaklar aynı zamanda yaşam ve ölüm arasındaki çizginin giderek belirsizleşmesine, etik sorunların ortaya çıkmasına ve bakım işlevlerinin karmaşıklaşmasına ve hemşirelerin etik sorunlarla yüzleşmek zorunda kalmasına yol açmaktadır. Bireyin davranışlarına temel olan ahlak ilkelerinin tümü olarak belirtilen etik, bu durumda ne yapmam gerekir sorusunu sorarak ahlaki felsefenin sosyal ahlak ve toplum normlarının ve uygulamaların felsefi yansımalarıyla ilişkili çalışmaların pratik uygulamasıdır. Etik kodlar/ kurallar, etik ahlaki felsefeyi uygulamak yolunda resmi bir süreç sunarak, hemşirelere çalışma hayatında etik sorunlar karşısında mantıklı ve kalıcı kararlar vermede imkân sağlar. Mesleki etik kurallar ve ilkeler hemşireleri yasalara, yönetmeliklere karşı koruduğu gibi hizmet verilen bireyleri de uygulamalara karşı korumaktadır. Bu derlemede, hemşirelik uygulamalarında karşılaşılan etik sorunlarda hemşirenin sorumlulukları literatür bilgileri ışığında özetlenerek hemşirelere bakış açısı kazandırmak amaçlanmaktadır.

356 Anahtar Kelimeler: Etik sorunlar, hemşirenin sorumlulukları [PP-48] BREAST CANCER SURGERY WITH AN ETHICAL VIEW Sema Kocan¹, Nuray Demirci Gungordu ¹ Recep Tayyip Erdogan University Health Services Vocational School In many societies, the woman s breast is regarded as a symbol of aesthetic appearance, sexuality, motherhood and baby feeding.in this context, breast cancer can affect women physiologically, psychologically, socially and spiritually. In the studies related to this subject, it is stated that women hide their having breast cancer. The reason for this is that other people feel uncomfortable about knowing that they are breast cancer.starting from this point, it can be said that health professionals should take care to keep the secrets of patients in accordance with the framework of the Non-Destructive Policy of the Medical Ethics Principles (1979). Additionally, it would be right to stick to medical ethics principlesin the whole perioperative process. For example, a patient with a diagnosis of breast cancer who is thought to have an operation should be provided with informed consent on the basis of the principle of respect for autonomy in the preoperative period. It should be explained in a clear and faraway from the medical terminology which surgery will be performed, why the surgery should be performed, what conditions the patient will face if not applied, which treatment methods are available as an alternative to surgery and how the patient's life after surgery will last. As a result of all these explanations, the patient should be asked to verify what she has understood. The patient s consent must be obtained by giving her time. Being informed about surgery can reduce patients fear and worries related to the surgery. Similarly, patient s education related to the surgery in perioperative period must be cared. For example, some exercises should be taught in a preoperative period to prevent the complications that may occur during the postoperative period for a patient who is planned for breast surgery. Doing the exercises taught during this period together with the patient can prevent complications related to the surgery. Another aspect to be paid attention ethically in breast surgery is privacy of the patient during intraoperative period. Privacy of the patient must be care especially when the patient s position is given. In our society, the woman s breast is regarded as a private part. In our country, it is reported that women do not go to mammography or clinical breast test because of their reluctance to show their breast and because of the sense of embarrassment. As a result, when process of breast cancer surgery is evaluated from an ethical point, we consider that it will be

357 helpful for the patient not to harm them, to respect the principle of autonomy and to give importance to patient s education. All members of the medical team should attend to the patient carefully and remember that the benefit of the patient in terms of ethics is paramount. Key Words: Breast cancer, surgery, ethics, principles of medical ethics

358 [PP-49] SOCIAL MEDIA USE IN NURSING PRACTISES WITHIN THE CONTEXT OF PATIENT S PRIVACY Nuray Demirci Gungordu¹, Cagatay Ustun² ¹ Recep Tayyip Erdogan University, Health High School ² Ege University Faculty of Medicine Nowadays, social media emerges as one of the most ideal setting in terms of continuous updating, openness to multithreading and enabling virtual sharing. People can write their thoughts on social media, deliberate over these thoughts and generate new ideas. In addition to personal information, they can share photos, videos, search for and even find work, and live the virtual world in the real world. This situation causes all the attention to direct to this field day by day and form a new conceptual frame over the renewed virtual world(1). According to the usage data of households information technologies of the Turkish Statistical Institute (TURKSTAT) 2016; It is stated that 82.4% of the individuals with internet access in Turkey use internet with the aim of creating profile on social media, sending messages or sharing photos (2). Common usage of the social media tools also brings with it a set of ethical concerns. In this context, unsuitable usage of the social media especially by the nurses damages the work environment, the privacy and confidentiality of the patients and so we are faced with this situation as a serious ethical problem (3). The nurse s sharing on certain things on social media thanks to her occupational identity by ignoring the sore issue such as patient s privacy is contrary to many ethical documents such as Medical Ethics Principles (1979), Patient Rights Regulations (1998 / Amended: 2016) and the Universal Declaration of Human Rights (1948). Such reports, which are reflected in the press, harm the honor of the nursing profession and negatively affect the viewpoint of the society towards the nursing and decrease the confidence in them. Such reports presented in the press damage the honor of the nursing profession and negatively affect the viewpoint of the society towards the nursing and decrease the confidence in them. As a precaution, training and approaches leading to take aim at human dignity, emotion and thought and also approaches leading towards conscientious assessment of the subject may be needed rather than criminal sanction. In this respect, both pre-graduation and post-graduate education and courses should be supported. According to a study including 421 nurses in our country, it was determined that 78.9% of the nurses use the internet and 70.2% of them prefer to use the internet in relation to professional subjects. As we can see from this example, we consider that nurses can be more productive in terms of time management in professional practice thanks to the reduction of social media usage during working hours or completely avoidance. If nurses use social media as a form

359 of communication within the medical team, it may be advisable to create a new institutional framework or system instead. By creating such a system for health workers, the use of social media during working hours can be avoided. As a result, some measures regarding the use of social media in nursing practice should be provided. In case of not taking precautions, we consider that there may be a rise in the rates of medical errors, hospital infection rates, and health violence yet already. Key Words: Patient privacy, social media, nursing, ethics

360 [PP-50] ETHICS LESSON IN NURSING: EXPERIENCE SHARING Zehra Göçmen Baykara 1,Sinan Aydoğan 1 1 Gazi University, Faculty of Health Sciences Nursing is a profession in which person-to-person interactions are very intense. Health care environment is a slippery ground in terms of the emergence of ethical problems and the violations of one's rights. The nurse must always evaluate the decisions and actions taken to make the most reasonable choices in this slippery ground. This process can be only possible through the development of ethical sensitivity and the ability to make ethical reasoning. The foundation of this skill can be only built in the vocational training process. In Turkey, ethics education within the scope of undergraduate programs in nursing is given by lessons such as ethics lesson in nursing, deontology, history of nursing, and ethics lessons and ethical issues discussed within some lessons. The Ethics Lesson in Nursing in the Department of Nursing at Gazi University, Faculty of Health Sciences is a three-hour compulsory lesson given in the fall semester to third-year students. In this lesson, ethical concepts, theories, principles, declarations, and legislations and regulations related to nursing and ethical problems in nursing are analyzed. The aim of this lesson is that the student learns the basic information about the ethics, analyzes the problems faced while providing health care services, and acquires ethical sensitivity and ability of ethical decisionmaking. To reach the effective goals of the Ethics Lesson in Nursing, interactive teaching methods and techniques such as role-play, case discussions, ethical case analysis, ethical thinking / analysis of experienced events, film / video demonstration and discussion, and small-scale working groups are used. In reaching the goals of the lesson, however, there are several obstacles such as inability to conduct small-group studies at the desired level due to excessive class size and inadequate physical facilities. Nonetheless, the Ethics Lesson in Nursing plays a key role in the in-depth understanding and adoption of the nursing philosophy, the correct understanding of care that is the essence of nursing, and the completion of occupational identity. Key Words: Nursing, ethics in nursing, ethics education.

361 [PP-51] APPLICATION OF PHYSICAL RESTRAINT AND ETHIC Büşra Ertuğrul¹, Dilek Özden¹ ¹ Dokuz Eylül University Faculty of Nursing Safety and comfort of intensive care patients should be continued as they are agitated and sedatized. Nurses are the group who face with these applications and spend time with patients mostly. Phsical restraint seem to be an easy solution for problems. However, nurses can face ethical dilemma in proffession obligations such as continuity of patient's outonomy and independence (Bray ve ark. 2004). This is remarkable that phsical restraint is commonly used although it cause many physical and psychological complications and cause ethical dilemmas to nurses. The key points of physical restraint applications are health, physical wellness, outonomy, freedom, respect and self esteem. Uncoutions patients show the behaviour of taking off entubation tubes, intraveneus or urinary cathater. These behaviours of intensive care patients can cause the fail of treatment and care process. These factors lead nurses to the use of physical restraint. When it is considered from the patients perspective, they can feel limited, uncontrolled and mortificated. In this situation, nurses can be unwilling to apply physical restraint taking into account patient honor, outunomy and effect of physical restraint, thus can face dilemma about the principle of non harm - benefit. Decision of treatment and care to intensive care patients is a process that requires continuous assessment. When patient has not a guardian, nurses needs to act according to the best outcomes for the patients according to nursing care standarts. Because of the physical restraint can affect the patient happiness and freedom, nurses should develop the comminucation and recognize the patient before the application. When making the decision, the nurse should identify benefit-harm balance for the patient with the role of the patient rights guard and the priority should be the patient safety and utility. Key Words:Phsical restraint, ethic, patient care, nursing

362 [PP-52] ETHICAL EDUCATION IN NURSING IN TURKISH Emel Top 1, Aliye Bulut 1, Gülay Çelik 1 1 BingölUniversity Faculty of Health Sciences Aim: The need for the nursing profession is universal. Ethics education plays an important role in nursing practice, in the development of ethical awareness and responsibility.the purpose of this review is to determine the level of competence in ethics education given in nursing in Turkey. Methods: After the screening of the subject between ; Full-text Turkish and foreign articles, book chapters were used to prepare this review in the literature. Results: Ethics is defined as a group of ethical principles or a group of values that governs the behavior of a person or profession as a word (Kutlay ve Yılmazlar, 2001). Ethics education must provide nurses with tools to accomplish such critical reflection. The aim of ethics course in nursing education is; To improve the ability of students to think freely and scientifically; Nurses who know themselves to educate themselves and develop themselves in the awareness of their responsibilities, free and autonomous, away from prejudices and dogmatic ideas, who see themselves in society, suspect and question, Ethical education in our country is given to third or fourth grades in undergraduate education under the names of "Medical Ethics and Nursing", "Nursing History and Deontology" in some schools while ethical issues are integrated in applied courses in some schools. The names, contents, years of study and hours of study are different from each other in nursing education schools. It is carried out by nursing academicians who are not experts in the field of ethics, close to the whole of the ethical courses in the nursing schools. In a study conducted by Görgülü and Dinç, 94.8% were found. Conclusion: The ethics course in nursing should be given by experts and different methods should be developed to improve the quality of education. The maintenance of nursing practices professionally and the increase in the quality of care depends on the ethical equipment. Key Words: Ethic, nursing, nursing education, education

363 [PP-53] INTEGRATION OF TECHNOLOGY INTO ETHICS EDUCATION Zehra Göçmen Baykara 1, Deniz ÖZTÜRK 2 1 Gazi University Faculty of Health Sciences 2 Başkent University Faculty of Health Sciences Education technology is the process, in which the technology products manufactured in the field of physical science and the knowledge emerging in the field of behavioral sciences are applied in the educational activities with a systematic approach in order to increase learning levels of the students. This process enhances the perception capacity of the student, raises the access level of each student in terms of learning products, allows the student success to be measured and assessed objectively, gives each student possibilities suitable for his/her own characteristics in learning and reduces the possibility of forgetting what the student learns. In this context, the use of educational technologies becomes compulsory in the ethics courses that are carried out for such purpose that the nursing students apprehend the basic information related to ethics, gain ethical sensitivity, analyze in terms of ethics the problems faced while providing health care service and gain ethical decision making ability.because the ethics course is a course that requires abstract thinking and comprises complex cases that are hard to analyze. Since the targets anticipated from the Ethics course in nursing are at an affective dimension, it is difficult to acquire them. In order to achieve these goals, the student has to actively participate in the course and internalize the subject matter. In order to increase the permanence of ethics teaching and to enable students to take an active role in this course, among the education technologies; types of learning through publication (audio and audiovisual technologies), informatics environments and technologies (computer and internet), simulation applications and distance education applications can be used. It is thought that the fact that students will take a close interest in the technology will facilitate use of technological methods in ethics education and they will become more successful in achieving the goals of the course. Key Words: Ethics education, education methods, education technologies

364 [PP-54] CASE REPORT: ETHICAL OBSTACLES FACED WHEN DEVELOPING A CARE PRODUCT Hülya Leblebicioğlu 1, Leyla Khorshid 1 1 Ege University, Faculty of Nursing An application to an ethical committee was made for a study on the development of a new care product, which was planned to be developed jointly by the Nursing Faculty and Textile Engineering Faculty of a university. As a result of this application to the ethical committee our study was evaluated within the scope of Clinical Investigations of Medical Devices and the researchers and related patients were covered by insurance policy with a price of 2850 euros. In addition to this, there was no legally responsible researcher who was a medical doctor or dentist who had completed his or her specialization in medicine in accordance with the statement of the Drug and Medical Device Committee of the Turkish Ministry of Health that according to relevant provisions in the Medical Deontology Regulations No dated 19/2/1960 and as announced in law No dated 4/4/1928 on the Mode of Practice of Medicine and Medical Sciences, the right of intervention on human beings is accorded only to medical doctors and to dentists, and therefore approval was not given for our clinical research. Moreover, many ethical questions emerge. 1. Because there are very many applications to the Ethics Committee, ethical committee approvals are given very late. Is this delay overwhelming the efforts for innovation of researchers who are in daily intensive work? 2. Are the nursing interventions which are specified in the 2011 nursing regulation with the title of nurse not interventions on the patient? 3. Why has the law on the practice of the Practice of Medicine and Medical Science No 1219 dated 04/04/1928 not been updated, when technology science and industry are developing rapidly? In conclusion, nurses must work hard to increase their visibility under the law. Key Words: Ethics committee, nursing, care product developing

365 [PP-55] ETHICAL PRINCIPLES FOR NURSES USE SOCIAL MEDIA Taner Onay 1, Nadide Embel 2 1 İstinyeUniversity, Faculty of Health Science 2 Johns Hopkins Anadolu Health Center, Clinic of Medical Oncology Social media is a common term used for websites and enabling the information and interest sharing in which internet users communicate with each other online. When it is taken into consideration on the basis of professional usage, social media, which is accepted as a crucial necessity by the society now, can be categorized into professional or personal. While using the social media, nurses, too, can experience ethical dilemmas within this period. Not having the ethical principles, and the standard education about this process cause ethical problems for individuals in the process of internship and working. It is very important to understand the advantages and disadvantages of the social media and the problems that might take place while managing the process for nurses or nursing students. We have attempted to compile the principles below to be paid attention to in the light of related literature for the usage of social media for our country. It is for the sake of nursing, which is still trying to maintain its progress in our country,being a professional job. Ethical Principles for the Usage of Social Media of Nurses It is important to keep in mind that you have ethical and legal obligations so as to protect the patient confidentiality all the time (including on social media). You take full responsibility for everything you share while professing. If your workplace or the institutions regarding your profession do not have any social media policies, it does not exculpate you from any responsibilities whatsoever. It is important to learn whether your workplace has a social media policy. Share something by paying attention to what your post includes in accordance with the social media policies of your workplace. Within these policies, personal usage of equipment and computers of the employer, personal computer usage within the working hours, the types of websites that can be reached by employers computers, social media content sharing rules etc. can be considered. If your workplace doesn t have a social media policy, you are supposed to report to your relevant department that it is firstly necessary to provide the patients confidentiality, privacy and safety, secondly, to protect the employees, thirdly, to develop a contract or procedure about social media shares managing and to emphasize social media policy during the employment procedure in order to protect the corporate identity.

366 It is also important to keep in mind that the patients have confidentiality rights and the workplaces have confidentiality policies. Confidential information must be shared with the patient s informed consent only when it is needed legally and in case the information can cause serious harms when it is revealed. Apart from these very limited exceptions, a nurse is obliged to protect the confidential information. In scientific use, it is necessary to get the patient s consent and not to include any detail to identify the patient personally. You are supposed to report to your workplace when your patient gets in contact with you via social media after the discharge. You must analyse in which level your relation with the patient is. It can ruin your professional and personal relationship with the patient whom you are in contact with via social media. It can damage you and your workplace if this situation cannot be controlled. Nurses are not to share any negative posts on social media about your employers and colleagues. It might severely damage your career to share any offensive comments that include disdain, threats, vulgarity, racism about your employees and colleagues. When you see a post which you think is unethical concerning your profession on social media, you must state that it is unethical to the person who has shared it. When you see such a post, you must make a notice to related organizations in order to give them feedback. You can ensure the protection of the nurse and the employer thanks to the feedback. When the related literature is reviewed, it can be concluded that international nursing institutions have published ethical codes and ethical principles as a solution to the above mentioned problem experienced by nurses. Key Words: Nursing, ethics, social media, Turkey

367 [PP-56] ORGAN TRANSPLANTATION PROCESS: CULTURAL DIMENSION AND THE ROLE OF THE NURSES Burçin Irmak 1, Esra Makal 2, Hülya Bulut 1, Sevil Güler Demir 1 1 Gazi University Faculty of Health Sciences 2 Trakya University Faculty of Health Sciences Today, organ transplantation (OT) is one of the most important developments in surgery. In our country total OTs were in However, when we consider that there are patients awaiting for OT as of July of 2017, it is seen that the requirements of only one fifth of the total patients requiring an operation can be met and the number of cadaver donors is rather less than the live donors. There are some reasons of having insufficient number of live and cadaver donors although the number of patients waiting for OT is high. Lack of knowledge about OT, fear about the transplantation process, assuming that the donated organs shall not be used in an appropriate manner, not to impair the integrity of the body, thinking that being a donor is not to the favor of another, the consent from the family could not have been taken after the brain death of the patient and religious beliefs can be listed amongst the reasons for the low number of transplantations. When we review all of these reasons it can be assumed that cultural features constituting the society are effective on this issue. Culture that is the source of daily life affects health behaviors and disease perception of the individuals. It is known that OT is one of the most important health interventions that are affected by the culture and beliefs of the society. Therefore values, beliefs and socio-cultural values of a society should be considered. Particularly religion, beliefs, lack of knowledge and experiences about OT effect individuals in taking decision of organ donation. Nurses render care services to individuals from various cultures during transplantation process. Nurses should be sensitive to the cultural variance of the patients while they are performing their professional roles like care, training, research, consultancy, decision taker, patient advocacy, relaxing. Within this review how cultural values of the society affect transplantation and the roles of the nurses during this process are discussed. Key Words: Transplantation, nurse, culture, value, roles

368 [PP-57] ETHICS OF THE PROVISION OF THE PALIATIVE CARE Ayten Zaybak 1, Handan Özdemir 1 1 Ege University, Faculty of Nursing The clinical picture of a patient in the terminal phase and the new problems arising due to this picture are of great importance in terms of providing treatment and care. According to the definition brought forward in 1989 and developed in 2002 by the World Health Organization (WHO), palliative care is an approach used to identify, assess and treat the quality of life, pain and other physical, psychosocial and spiritual issues of a patient and his/her family facing problems associated with a life-threatening illness. The content of palliative care does not include only medical applications. In fact, what constitutes the essence and foundation of the palliative care is the ethical approach and the philosophy that supports it. Patients in the terminal phase and/or having a desperate disease, and their relatives constitute the patient profile of the palliative care. Therefore, it is inevitable for the health care personnel who give palliative care to have some ethical responsibilities and to face ethical dilemmas. The basic ethical principles such as nonmaleficence, beneficence, distributive justice and autonomy brought forward by Beauchamp and Childress, who drew the general framework of medical ethics related to this issue, will guide the practice of palliative and end-of-life care, and the solution of ethical dilemmas. In addition, discussing the topic in a hospital ethics committee and / or the provision of counseling by an ethics specialist will ensure the creation of solution alternatives to include all sides and the establishment of a healthy communication between the parties. Key Words: Ethics, palliative care

369 [PP-58] ETHICS IN THE INTENSIVE CARE UNIT Ayten Zaybak 1, Handan Özdemir 1 1 Ege University, Faculty of Nursing Intensive care units are special units equipped with advanced technology devices, aiming to improve critically ill patients health by providing support for them through continuous monitoring and observation. These units where health services are provided with a multidisciplinary team have privilege in terms of patient care. In the intensive care units where critically ill patients are provided with complicated health services, the following issues pave the way for the emergence of many ethical issues: to what extent the opportunities provided by technology are actually needed, increased service costs, admission of patients with more serious health problems to the intensive care unit, effective and fair use of resources, meeting the rising expectations of patients. Ethical problems in intensive care units stem from such factors as decision making, informed consent, whether cardiopulmonary resuscitation should be performed, brain death and organ transplantation, restriction or termination of life support, non-beneficial medical treatment, and fair sharing of medical resources. The most important responsibility of health professionals is to find solutions to ethical issues that arise in line with basic ethical principles. The emerging ethical issues should be addressed together with human rights, patient rights, sharing of limited resources, and effects of life-prolonging interventions on the quality of life. In solving ethical problems, decision-making processes based on ethical principles are needed. In this context, the ethical principles such as beneficence, nonmaleficence, autonomy, informed consent and social justice come to the forefront. Key Words: Ethics, nursing, intensive care

370 [PP-59] THE ROLE AND RESPONSIBILITIES OF NURSES REGARDING INFORMED CONSENT Ayten Zaybak 1, Handan Özdemir 1 1 Ege University, Faculty of Nursing Informed consent is defined in the bioethics terminology dictionary as "a patient able to make decisions clearly accepting the information after being informed about the diagnosis and treatment methods and other interventions he/she would undergo, alternative methods available, and the possible positive and negative consequences of all these methods. Nurses have a special position in ensuring the validity of the informed consent. Particularly, within the framework of the advocacy role of the nurse, a nurse should ensure that the patient is informed about all the treatment processes during the informed consent process, evaluate the effectiveness of the information given, determine the adequacy of the patient, identify deficiencies and act taking these deficiencies into account. Nurses working in the clinical during the informed consent process are faced with problems arising during the fulfillment of the interventions and the research that they will conduct with patients. These problems result from the fact that nurses think that they are incompetent about how they should behave, and that they do not have any responsibilities and thus they do not question anything. In addition, because nurses are afraid to make a mistake, to do anything beyond their duties and responsibilities, to face some negative reactions, or to do something wrong that might put the workplace in trouble, they refrain from taking action even though they have identified the patient s needs and the problem regarding the informed consent. To protect the patient and his/her rights, nurses must be sure that the patient understands the interventions to be carried out and is able to make a decision to give informed consent before they sign the form as a witness. Key Words: Nursing, ethics, informed consent

371 [PP-60] DOES NURSES HAVE A DUTY TO CARE TO THE PATİENTS OF CRİMEAN-CONGO HAEMORRHAGİC FEVER? Filiz Bulut¹, M.Murat Civaner¹ ¹ Uludag University, Faculty of Medicine One of the occupational risks of healthcare workers is contracting diseases during healthcare provision. This risk gains more importance in the face of outbreaks and especially the diseases such as SARS and Ebola that has no effective prevention and treatment methods with high mortality rates. Crimean-Congo haemorrhagic fever (CCHF) is one of those diseases which is effective in Turkey especially since the year According to WHO, CCHF virus causes severe viral haemorrhagic fever outbreaks, which have a case fatality rate of up to 40%. The virus is primarily transmitted to people from ticks and livestock animals. Human-to-human transmission can occur resulting from close contact with the blood, secretions, organs or other bodily fluids of infected persons. For the period of , 37 healthcare workers infected with CCHF, while 14 of them were nurses. Five of the infected healthcare workers have lost their lives while three of them were nurses. Whether there is a duty to care for those patients or not is an important debate. Some argue that there is no or limited duty to care against those kind of patients based on several justifications. In this presentation, it is aimed to discuss if there is a duty to care of nurses for CCHF patients, and if so, where the limits for that duty could be drawn especially when the protection measures are inappropriate. Key Words: Nursing, contagious diseases, Crimean-Congo haemorrhagic fever, duty to care, professional ethics

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