Turkish Hospitals Research Articles

Characteristics of the injuries of Syrian refugees sustained during the civil war.

During a war, many civilians are severely injured by firearms, bombs, and shrapnel. The triage of war injuries involves difficult and complicated processes requiring surgical procedures and patient monitoring in the Intensive Care Unit (ICU) of hospitals. In this study, we examine the demographic, traumatic, and critical care characteristics of cases injured during the civil war in Syria and requiring emergency surgery. Electronic data of the traumatic, surgical, and ICU monitoring features of 707 patients admitted to Kilis Public Hospital between March 2012 and January 2013 were analyzed retrospectively RESULTS: Most of the patients reported having been injured due to firearms (83.75%). Of the 707 cases studied in this work, 93.2% was male. Male patients reported a mean age of 26.1±12.1 years, while pediatric cases reported a mean age of 11.7±3.41 years. The most frequently injured region of the body was the head-neck region (52.7%). The New Injury Severity Score (NISS) of the cases was 42.5±11.2 and their American Society of Anesthesiologists (ASA) score was 3.2±0.7. The number of cases with intraoperative exitus was 7, while the number of cases who had undergone damage control surgery was 204. The number of cases hospitalized in the ICU during the postoperative period was 233, and the average hospitalization duration in the ICU was 4.67±1.32 days. Among survivor patients, the first 24-hour invasive measurements (i.e., pH, hemoglobin, body temperature, and mean arterial blood pressure) and international normalized ratio were found to be high. The number of blood products used for surviving patients was fewer relative to that used for non-surviving patients, and these NISS of these patients was 29.7±10.1. The mortality rate of all patients followed up in the ICU after emergency surgery was 45%, and neurosurgical cases showed the lowest level of survival (24.1%). The results of this study indicated that head-neck, chest-abdomen, and multiple body injuries are the most widely seen among civilians brought to Turkey because of gunshot injuries sustained during the Civil War in Syria. The number of emergency operations performed in the study sample was high, and critical care follow-up durations were long. In addition, the NISS and ASA scores of mortal cases were fairly high.

Needle Stick and Sharp Injuries among Nurses

The aims of this study are to determine the causes of sharp and needle stick injury in nurses working in a hospital, the use of safety practice exposure, to blood and blood containing material and contributing factors. A selfreport questionnaire was completed by 201 nurses working at three Turkish hospitals. The percentage of nurse’s “44.3% of the nurse’s experience a sharp or needle sticks injury during their professional life”. The most frequently encountered source of injury was injection needles (35.8%) followed by branules (5.5%), and suture needles (3.0%). Injuries occurred most frequently when the nurses were withdrawing a needle from rubber or other resistant material; recapping a used needle and disassembling a device or equipment. The majority of the nurses (74.6%) wear gloves and protective glasses. The study indicates that emphasis on work practice, disposal systems, education strategies and infection control precautions should be employed to reduce NSIs and contributing factors.

An Epidemiological Study Of Pulmonary Hypertension In Turkish Adults

Objective: The present study aims to evaluate the nationwide epidemiological characteristics of adulthood pulmonary hypertension (PH) within whole Turkish population over a period of five years using the registry of the National Health Insurance System. Methods: All individuals aged more than 18 years who were admitted to a Turkish hospital for the first time between 2009 and 2013 with a discharge diagnosis of primary PH (ICD-10 code I27.0) and secondary PH (ICD-10 code I27.2) were identified. Results: The overall annual prevalence of primary PH during adulthood was 9.6 cases per million. When compared with other age groups, the number of individuals aged more than 45 years was significantly higher in adults affected by primary PH during the study period (p=0.001 for all years). The female to male ratio was 2.2:1 for adulthood primary PH throughout the study period. The number of patients settled in the Northwestern Anatolia was significantly higher in the primary PH group (p<0.05 for all years). The overall annual prevalence of secondary PH in adults was 6.0 cases per million. When compared with other age groups, the number of individuals aged more than 45 years was significantly higher in adults affected by secondary PH during the study period (p=0.001 for all years). Conclusion: The prevalence of adulthood PH in Turkey may be higher than that of adulthood PH in Western countries and adulthood PH usually affects Turkish individuals aged over 45 years. Keywords: Adult; epidemiology; pulmonary hypertension

Rehabilitation technology and the reproduction of bodily normality: a critical analysis of robotic gait training in Turkey

This paper focuses on rehabilitation technology, more specifically robotic gait training conducted with a device called ‘Lokomat’ and its impact on the reproduction of bodily normality within the Turkish context. It draws upon an ethnographic study carried out in a major Turkish rehabilitation hospital and the analysis of the Lokomat's media representation in a health-related television programme. Interviews were conducted with 42 persons (11 medical staff, 2 non-medical staff, and 20 current and 9 former patients). The paper argues that the use of technology is shaped by the relevant sociocultural background. This background comprises both the specificities of the Turkish context more generally – such as its especially unwelcoming environment to the disabled body – and the discourses on the Lokomat more specifically, which create a miracle image of this device as facilitating walking. Thus, the Lokomat's presence deepens the normal/abnormal divide and reproduces it as walking/non-walking.

Cervical Cancer, Human Papillomavirus, and Vaccination: Knowledge, Awareness, and Practices Among Turkish Hospital Nurses.

In cancer prevention programs, healthcare professionals are the main resource for ensuring community participation in cervical cancer screening as well as in enhancing individuals' knowledge and practices regarding cervical cancer, human papillomavirus (HPV), and HPV vaccines. This descriptive, cross-sectional study was conducted to determine Turkish hospital nurses' knowledge, awareness, and practices in relation to cervical cancer, HPV, and HPV vaccination. This study was conducted from February 1 to March 30, 2013. A total of 464 nurses working in a university hospital located in the central Black Sea region in northern Turkey participated. Among participating nurses, 13.8% of the nurses underwent cervical cancer screening and 11.6% received Pap smear tests. Reasons for not engaging in cervical cancer screening included lack of sexual activity, not considering themselves to be at risk, and shame (28.2%, 18.3%, and 16.8%, respectively). None of the nurses had received the HPV vaccine; reasons included not having sufficient knowledge about the vaccine and a belief that the vaccine was not very common (57.3% and 20.7%, respectively). Nearly half (44%) stated that they would not recommend the HPV vaccine to their patients because they did not believe they had sufficient knowledge about it (56%). Knowledge about HPV infection and HPV vaccines and willingness to be vaccinated were very low among Turkish hospital nurses. Effective education strategies are needed to improve knowledge needed to support patients to receive effective cervical cancer screening and preventive services.

The Cost Efficiency of Turkish Hospitals: A Stochastic Frontier Analysis

The purpose of this study is to estimate cost efficiencies of public hospitals in Turkey using data for the period 2007 to 2009. Hospital cost efficiencies are estimated using the Stochastic Frontier Analysis method with a translog cost function. The results indicate that performance-based supplementary payment system does not increase the cost efficiency of hospitals. According to the inefficiency effects model, occupancy rates are positively correlated with the efficiency scores. On the other hand, hospitals efficiency is inversely associated with the population and development levels of regions. In addition, there is a positive correlation between the hospital capacity and efficiency.

Measuring family-centred care: working with children and their parents in a Turkish hospital

Rationale, aims and objectives: Family-centred care is the model of care in most children’s hospitals, but is difficult to measure. This study examined health professionals’ attitudes to working with children and with parents in a Turkish hospital. It builds on previous studies, using the same questionnaire, to test a component of family-centred care. Method: The “Working with Families” questionnaire contains scores for working with children and parents and demographic questions. Nurses, doctors and allied health staff working with children in a Turkish paediatric hospital were asked to complete this anonymous questionnaire (response rate 91%). We used Wilcoxon signed rank test to compare the two scores; the influence of demographic characteristics was tested with ANOVA. Results: Participants (N=205) gave more positive mean scores for working with children (4.242, SD=0.53) than parents (2.26, SD=0.8) (p&lt;0.05). Influencing factors were similar to other studies, except for participants having children of their own - those with children gave a less positive mean score for working with parents than working with children (p=0.003); holding a specialist paediatric qualification had a similar effect (p&lt;0.001). Conclusion: Similarly to other studies in this series, health professionals were much more positive about working with children than parents, with much stronger differences. Questions about the applicability of family-centred care as a model of care in this Turkish hospital arise. Theoretically, if family-centred care was being implemented effectively, there would be no difference. Education about family-centred care is needed, as well as further research to investigate why these differences occur.

An epidemiological study of paediatric pulmonary hypertension in Turkey.

The present study aims to evaluate the epidemiological characteristics of paediatric pulmonary hypertension within the entire Turkish population over a period of 5 years using the registry of the National Health Insurance System. All individuals aged <18 years who were admitted to a Turkish hospital for the first time between 2009 and 2013 with a discharge diagnosis of idiopathic pulmonary hypertension and secondary pulmonary hypertension were identified. The overall annual incidence of idiopathic pulmonary hypertension during childhood was 11.7 cases/million, whereas the overall annual incidence of secondary pulmonary hypertension during childhood was 9.5 cases/million. There was a gradual and significant increase in the annual incidence of idiopathic pulmonary hypertension and that of secondary pulmonary hypertension during the 5-year study period (p=0.001 for both). In the years 2012 and 2013, idiopathic pulmonary hypertension was significantly more frequent in children aged <2 years when compared with children aged above 2 years (p=0.002 for both). The male to female ratio was 1.2:1 for idiopathic pulmonary hypertension, whereas the female to male ratio was 1.1:1 for secondary pulmonary hypertension during childhood. The incidence of paediatric pulmonary hypertension in Turkey is higher than those reported for the Western populations. Moreover, no female dominance could be observed. These discrepancies may be attributed to the differences in the study design, study cohort, timing of the study, and the definitions adopted for pulmonary hypertension classification.

Childhood Traumatic Experiences, Dissociative Symptoms, and Dissociative Disorder Comorbidity Among Patients With Panic Disorder: A Preliminary Study

This study assessed childhood trauma history, dissociative symptoms, and dissociative disorder comorbidity in patients with panic disorder (PD). A total of 92 psychotropic drug–naive patients with PD, recruited from outpatient clinics in the psychiatry department of a Turkish hospital, were involved in the study. Participants were assessed using the Structured Clinical Interview for DSM–IV Dissociative Disorders (SCID-D), Dissociation Questionnaire, Panic and Agoraphobia Scale, Panic Disorder Severity Scale, and Childhood Trauma Questionnaire. Of the patients with PD, 18 (19%) had a comorbid dissociative disorder diagnosis on screening with the SCID-D. The most prevalent disorders were dissociative disorder not otherwise specified, dissociative amnesia, and depersonalization disorders. Patients with a high degree of dissociation symptoms and dissociative disorder comorbidity had more severe PD than those without (p < .05). All of the childhood trauma subscales used were correlated with the severity of symptoms of dissociation and PD. Among all of the subscales, the strongest relationship was with childhood emotional abuse. Logistic regression analysis showed that emotional abuse and severity of PD were independently associated with dissociative disorder. In our study, a significant proportion of the patients with PD had concurrent diagnoses of dissociative disorder. We conclude that the predominance of PD symptoms at admission should not lead the clinician to overlook the underlying dissociative process and associated traumatic experiences among these patients.

Predicting Key Factors Affecting Outpatient Satisfaction in Public Hospitals: Evidence from Erzurum, Turkey

The main purpose of this paper is to determine background demographic and socio-economic factors affecting outpatient satisfaction of public hospitals. The present study utilized data from a written-questionnaire administered to six hundred and one adult patients who had received outpatient care at various units of three Turkish pubic hospitals. The dependent variable used in predicting student satisfaction was satisfaction levels of the respondents. Due to the ordinal nature of the dependent variable, an ordered logit model was performed to examine demographic and socio-economic determinants of outpatient satisfaction in Erzurum, Turkey. Ordered logit estimation results revealed that type of hospital, marital status, age group, education level, occupation, residential place, monthly income, and information about private hospitals were statistically significant factors of outpatient satisfaction. This paper attempts to present factors affecting outpatient satisfaction in a municipality which was adopted as the leading health care service provider of its region where little work was done. Considering its geographical location, the results of this substantial region may be a valuable contribution for health care managers and policy makers.

A survey of the patient safety culture of hospital nurses in Turkey

Summary Purpose The purpose of the study was to explore and describe nurses' perceptions of patient safety culture in four Turkish hospitals encompassing a collective total of 1442 beds. Background The importance of minimizing losses due to medical errors in the high-risk health sector and awareness of the risks to patients and health workers has gained prominence in the world, and the concept of a culture of patient safety has become a topic of discussion. Method The safety culture in the hospitals in Turkey was evaluated using the Turkish version of the Hospital Survey on Patient Safety Culture (HSOPSC). A convenience sample of 554 nurses was recruited from the hospitals. Results The highest mean composite score among the 12 dimensions was on teamwork within units, followed by organizational learning/continuous improvement. The lowest mean scores were on non-punitive response to error and frequency of event reporting. Conclusions Many Turkish nurses have negative perceptions towards patient safety culture within their institution. No participants indicated their affiliated institution had a protocol or policy concerning event reporting. Nurse managers need to create a positive safety culture by open communication, mutual trust, shared perceptions of the importance of safety and confidence in the efficacy of preventative measures.

An investigation into the economies of scale in turkish ministry of health hospitals

ABSTRACTThe purpose of this study is to estimate economies of scale in Turkish Ministry of Health hospitals. Turkey is in the process of changing their healthcare system. Estimating economies of scale for Turkish hospitals will help funding decisions as Turkey determines whether to build, expand, or consolidate hospitals. The structural changes currently taking place provide an opportunity to revamp the way healthcare is provided so that access to and efficiency within healthcare can be increased in a cost effective manner. Data are collected from the Ministry of Health. The results suggest there is an optimal size for Turkish hospitals. Also, this study shows that hospitals in certain regions of Turkey are more efficient than other regions. Determining the characteristics of efficient hospitals is important if Turkey is to properly allocate scarce healthcare funding.

Delirium assessment in intensive care units: practices and perceptions of Turkish nurses

As delirium in intensive care unit (ICU) patients is a serious problem that can result in increased mortality and morbidity, routine delirium assessment of all ICU patients is recommended. The severity, duration and outcome of the syndrome are directly related to nurses' continuous assessment of patients for signs and symptoms of delirium. However, studies indicate that very few nurses monitor for delirium as a part of their daily practices. The aim of this study was to identify current practices and perceptions of intensive care nurses regarding delirium assessment and to examine the factors that affect these practices and perceptions. A descriptive, correlational study design was used. Data were collected from five Turkish public hospitals using a structured survey questionnaire. The study sample comprised 301 nurses who agreed to participate. Data were analysed using descriptive statistics. More than half of the nurses performed delirium assessments. However, the proportion of nurses who use delirium assessment tools was quite low. Almost all of the nurses perceived delirium as a problem and serious problem for ICU patients. The patient group least monitored for delirium was that of unconscious patients. Statistically significant differences were found in the proportion of nurses who assessed delirium symptoms and whose care delivery system was patient-centred and perceived delirium as a serious problem. While a majority of ICU nurses perceived delirium as a problem and serious problem, the proportion of those who perform routine delirium assessments was less. It was found that delirium assessment practices of nurses were affected from their perceptions of delirium and the implementation of patient-centred care delivery. It is essential to develop strategies to encourage ICU nurses to perform delirium assessments through the use of delirium assessment tools.

How do Turkish immigrants evaluate cultural sensitivity in a German tertiary hospital?

Culturally adequate medical care is a goal in Germany, but quantitative data concerning inpatients is lacking. Inpatients of a German tertiary hospital: Turkish migrants (T) and Germans (G) were interviewed in their respective native language. 121 T and 121 G were interviewed. 97.5% of T were Muslims, 82.6% of G were Christians. 88.5% of T judged religion as "important" or "very important" (G: 35.8%). 50.8% of T saw their opportunity to pray in the hospital as "bad" or "very bad" (G: 0.9%). Keeping to Islamic dietary rules in the hospital was "difficult" or "very difficult" for 90% of T. For 79.0% of female T care by a same-sex staff was "important" or "very important" (female G: 36.3%, male T: 40.0%, male G: 7.7%). The presence of a same-sex person during examinations or treatments was "much" or "very much" appreciated by 69.7% of female T, if same-sex care was impossible (female G: 25.4%, male T: 28.9%, male G: 6.1%). A retrospective analysis revealed that 5.8% of all 8988 hospital admissions during the period of study recruitment were Turkish migrants. To meet the needs of Turkish migrants German hospitals should improve the opportunity for Muslims to pray. Additionally, the cooperation with local imams should be sought. Precise descriptions of food ingredients or an adapted menu could help T to deal with Muslim dietary commandments. A culturally sensitive hospital should take into account that female as well as male T prefer to be cared of by same-sex physicians and nurses.

Evaluation of Different Thromboplastins and Coagulometers on International Normalize Ratio (INR) Readings for Patients under Stable Oral Anticoagulant Therapy

Background: Variations between various thromboplastin preparations have in the past led to decreased accuracy of INR readings. Because thromboplastin reagents vary widely in composition and manner of preparation, their sensitivity in monitoring oral anticoagulant therapy also vary widely. This study aimed to evaluate different thromboplastins and coagulometers on INR reading for patients under stable oral anticoagulant therapy. Materials and Methods: This was descriptive cross-sectional study; it was conducted in three hospitals (Alshaab teaching hospital, Khartoum teaching hospital, and Turkish hospital). A total of 50 citrated platelets poor plasma samples were collected from 50 Sudanese patients under stable oral anticoagulant therapy then prothrombin time (PT) and INR measurements were performed on three separated laboratories, using different coagulometers and thromboplastins reagents. Results: INR results showed that there was significant difference between INR of the three laboratories (P value=0.00), inspite of there was significant difference observed between INR in Khartoum hospital and Alshaab hospital, also between Alshaab and Turkish hospital (p-value=0.00). There was insignificant difference between INR in Khartoum hospital and Trukish hospital (p-value=0.178). Discussion and Conclusion: our investigation showed that some further efforts are needed to achieve harmonization of INR results among different laboratories because variation would most probably induce the clinician to make a change in warfarin dose. Standardization of instruments, reagents, and controls is warranted to decrease this variation.

Knowledge and practices of nurses concerning intravenous potassium administration in a Turkish hospital

Objective: Based on this literature review, it is clear that intravenous potassium is a potentially toxic electrolyte, which has been responsible for a large number of deaths in hospitals. In Turkey, research on intravenous potassium administration is limited in the available literature. In addition, clinical observations made by the researchers suggests there is knowledge and practice deficiencies among nurses related to potassium administration. Thus, this study aimed to determine how wide the knowledge and practice deficiencies among nurses was concerning intravenous potassium administration in a Turkish Hospital. Design: This was a descriptive study. Setting: This study was conducted in a university hospital in Turkey. Subjects and Method: The sample of this study consisted of a total 105 nurses working in surgery clinics or surgical intensive care units of a university hospital, who volunteered to participate in the study.The questionnaire used in this study was developedby the researchers with the help of material obtained from the literature review. Questionnaires were distributed and collected to participants by researcher. In the calculation of knowledge and practice scores, every correct answer was assigned 1 point, while incorrect answers were assigned 0. Mean, percentage, ANOVA, the kruskal-wallis h test, the mann-whitney u test and pearson correlation were used for data analysis. Results: The mean knowledge score of nurses on intravenous potassium administration was found to be 9.48±3.21, while the mean practice score was 10.85±2.04. These results suggest that the nurses’ knowledge and practice scores were found to be relatively lower compared to 17 which is the highest scores of both knowledge and practice about intravenous potassium administration. It is also important to state that statistically significant and positive relationship was found (r: 0.595; p&lt; 0.05). The majority of the nurses (61.9%) did not know all the elements of a correct potassium order. The differences in nurses’ knowledge scores according to the type of hospital unit and training status on liquid electrolyte balance were found to be statistically significant (p&lt;0.05). Nurses with duration of employment of over 10 years were found to have higher knowledge scores than nurses with employment duration of below four years. This difference was found to be statistically significant (p&lt;0.05). Conclusion: In light of the findings of this study it is recommended that nursing curriculum and in-service training programs in Turkey should address intravenous potassium administration more extensively and that protocols related to intravenous potassium administration be developed and implemented.

Antimicrobial susceptibility and resistance mechanisms of methicillin resistant Staphylococcus aureus isolated from 12 Hospitals in Turkey.

IntroductionMethicillin-resistant Staphylococcus aureus (MRSA) is one of the most important nosocomial pathogens and is also emerging in Turkish hospitals. The aim of this study was to determine the antimicrobial susceptibility profiles of MRSA isolated from Turkish hospitals.Materials and methodsA total of 397 MRSA strains isolated from 12 hospitals in Turkey were included to present study. Antimicrobial susceptibilities were tested using agar dilution method. Presence of ermA, ermB, ermC, msrA, tetM, tetK, linA and aac-aph genes were studied by PCR.ResultsAll strains were susceptible to vancomycin and linezolid. The susceptibility rates for fusidic acid, lincomycin, erythromycin, tetracyclin, gentamycin, kanamycin, and, ciprofloxacin were 91.9%, 41.1%, 27.2%, 11.8%, 8.5%, 8.3% and 6.8%, respectively. Lincomycin inactivation was positive for 3 isolates. Of 225 erythromycin resistant isolates 48 had ermA, 20 had ermC, and 128 had ermA-C. PCR was negative for 15 strains. Of 3 isolates with lincomycin inactivation one had linA and msrA. Of 358 gentamycin resistant isolates 334 had aac-aph and 24 were negatives. Among 350 tetracyclin resistant isolates 314 had tetM. Of 36 tetM negative isolates 10 had tetK.ConclusionMRSA isolates from Turkish hospitals were multiresistant to antimicrobials. Quinolone and gentamycin resistance levels were high and macrolide and lincosamide resistance were relatively low. Susceptibility rates for fusidic asid were high. Linezolide and vancomycin resistance are not emerged. The most common resistance genes were ermA, tetM and aac-aph. Evolution of antimicrobial susceptibilities and resistance genes profiles of MRSA isolates should be surveyed at regional and national level for accurate treatment of patients and to control dissemination of resistance genes.

Examining transformational leadership, job satisfaction, organizational commitment and organizational trust in Turkish hospitals: public servants versus private sector employees

Leadership, job satisfaction, organizational commitment and trust have become important processes for healthcare management in recent years. One of the contemporary human resource management functions in the organizations involves engaging in leadership development, improving organizational trust and organizational commitment and increasing job satisfaction. Considering the rapidly changing healthcare technology and higher levels of occupational complexity, healthcare organizations are increasingly in need of engaging in leadership development in any given area of expertise to address ever-changing nature of the industry and the delivery of quality of care while remaining cost-effective and competitive. This paper investigates the perceptions of both public servants and private sector employees (outsourcing) on transformational leadership, organizational commitment, organizational trust and job satisfaction in Turkish healthcare industry. Additionally, the paper analyzes the predictability of organizational commitment based on employee – both public servants (physicians, nurses, administrative personnel and other healthcare professionals) and private sector employees (outsourcing) (auxiliary services such as administrative assistants, security personnel, kitchen, laundry and housekeeping employees) – perceptions of transformational leadership, job satisfaction and organizational trust. Using a survey instrument with items adopted from the transformational leadership inventory (TLI) [Podsakoff, P. M., MacKenzie, S. B., Moorman, R. H., & Fetter, R. (1990). Transformational leader behaviors and their effects on followers' trust in leader, satisfaction, and organizational citizenship behaviors. Leadership Quarterly, 1, 107–142], the organizational commitment questionnaire [Meyer, J. P., & Allen, N. J. (1997). Commitment in the workplace: Theory, research, and application. Thousand Oaks, CA: Sage], the organizational trust inventory (OTI) [Cummings, L. L., & Bromiley, P. (1996). The occupational trust inventory (OTI): Development and validation. In R. Kramer & T. Tyler (Eds.), Trust in organizations: Frontiers of Theory and Research (pp. 302–330). Thousand Oaks, CA: Sage] and job satisfaction survey (JSS) [Spector, P. E. (1985). Measurement of human service staff satisfaction: Development of the job satisfaction survey. American Journal of Community Psychology, 13, 693–731], this quantitative study was conducted among 2108 healthcare employees (public servants and private employees) in two large government hospitals in Turkey. The study findings indicate a significant difference between the public servants and private sector employees in terms of their perceptions on two dimensions of transformational leadership (being an appropriate model, providing individualized support), overall transformational leadership and one dimension of job satisfaction (communication). The two dimensions of job satisfaction – operating procedures and communication – as well as organizational trust were the significant predictors of organizational commitment of public servants, whereas the two dimensions of leadership – individualized support and fostering the acceptance – as well as the two dimensions of job satisfaction – promotion and contingent rewards – and organizational trust were the significant regressors of organizational commitment of private sector employees. In addition, there is a significant difference between the predictors of the dimensions of organizational commitment (transformational leadership, job satisfaction and organizational trust) in terms of public servants versus private sector employees. Finally, organizational trust has a significant effect on overall organizational commitment as well as its three dimensions for public servants and private employees.

The evaluation of hospital service quality by fuzzy MCDM

This study applies the Multiple Criteria Decision Making (MCDM) to evaluate the service quality of some Turkish hospitals. In general the service quality has abstract properties, which mean that using the previously known measurement approach is insufficient. It is for this reason that the fuzzy set theory is adopted as a research template. In Istanbul, Turkey, there are four B class hospitals classed as private hospitals that are covered by the Social Security Institution (SSI) and for which we propose to represent the service performance measurement using triangular fuzzy numbers. In this study, importance weights of performance criteria are found with AHP. Then, the Multiple Criteria Decision Making methods TOPSIS and Yager's min-max approach are applied to find and rank the crisp performance values. In a second step, an aggregation of performance criteria with OWA and Compensatory AND operators are looked at instead of the TOPSIS method and min-max approach. Thereby numerical applications are supplied by the four methods and the obtained results are compared.

Patient Safety Culture in a Turkish Public Hospital: A Study of Nurses’ Perceptions About Patient Safety

The objective of this study was to investigate nurses’ perceptions about the culture of patient safety in a Turkish public hospital. The study adopted a cross-sectional research design and utilized the hospital survey of patient safety culture. The population studied consisted of approximately 300 nurses from which 200 nurses were surveyed. The response rate was 66.6 % of the population. Nurses responded most positively to two dimensions, hospital management support for patient safety (80 %) and supervisor/manager expectations and actions promoting patient safety (79 %). Four dimensions with a positive response rate of <50 % (‘Frequency of events reported’, ‘Nonpunitive response to error’, ‘Communication openness’ and ‘Hospital handoffs and transitions’) were considered as potential targets for improvement in our study. This study revealed six significant predictors of Overall Perceptions of Safety: Organizational Learning-Continuous Improvement; Communication Openness; Teamwork within Units; Staffing; Frequency of Event Reporting; and the Patient Safety Grade (of the Hospital Unit). Additionally, four significant predictors of the Patient Safety Grade (of the Hospital Unit) emerged: Feedback and Communication about Error; Organizational Learning-Continuous Improvement; Hospital Management Support for Patient Safety; and Supervisor/Manager Expectations and Actions Promoting Safety. Interventions designed to improve the safety culture in Turkish hospitals should be focused on the concerns of staff nurses and the improvement of communication between these nurses and their managers. The determination and evaluation of the patient safety culture level in hospitals should be viewed as a continuous process in Turkey where a need for continuous improvements in the hospital patient safety culture exists. To improve the patient safety level, nurses’ perceptions about patient safety appear to be essential. Nurses are important for the improvement of the patient safety culture in health care organizations. Moreover, some hospitals have recognized that providing patients with safe, high-quality care is fundamental to protecting the financial assets of the institution and therefore, falls within risk management’s role. In this new landscape, risk management and patient safety professionals are engaged in a close working relationship.