Çiçek Fadıloğlu

Hopelessness in Turkish cancer inpatients: the relation of hopelessness with psychological and disease-related outcomes.

The purpose of this study was to investigate the hopelessness level and the relationship of depression, anxiety and disease-related factors to the presence of hopelessness among Turkish patients with cancer. Ninety-five patients hospitalized for cancer treatments were recruited for current study. Data were collected by using a demographic questionnaire, the Pain Numeric Rating Scale, the Beck Hopelessness Scale, and the Hospital Anxiety Depression Scale. The mean hopelessness score was 5.20+/-4.39. There were significant differences in terms of hopelessness between the patients who had metastasis and pain as compared with those without metastasis and pain (p<0.05). There were also found that significant correlation between hopelessness and depression and between hopelessness and anxiety (r=0.721; r=0.645, respectively, p<0.001). Foreword stepwise multiple regression analysis revealed that the independent predictors of hopelessness were depression score and thr presence of metastasis (F=55.133; p<0.001). The findings suggest that levels of hopelessness among cancer patients with pain and metastasis are higher than among those without pain and metastasis, and that the severity of pain, anxiety, and depression is positively correlated with hopelessness level. The assessment of hopelessness, pain, anxiety and depression levels of the patients with cancer should be an essential part of health care practice. Therefore, when arranging care assessment, to evaluate hopelessness could help professionals to appropriately refer patients to further psychological care resources.

The Effects of Self–Pain Management on the Intensity of Pain and Pain Management Methods in Arthritic Patients

The aims of this study were to investigate the effects of pain management education on the intensity of pain and frequency of utilization of pain management methods in two groups of patients with arthritis of different pathogenesis and clinical features, and to compare whether a significant difference existed between the two groups. The study was carried out between September 2007 and June 2008 on 30 female patients with gonarthrosis and 30 female patients with rheumatoid arthritis (RA) followed at the rheumatology outpatient clinic of a university hospital. Data on sociodemographic characteristics and those related with the illness were collected using a special survey. Each patient was given information about the features, causes, and treatment of the arthritis and how to cope with pain, emphasizing the importance of pain management methods. The intensity of pain and efficacy of pain management methods were assessed using the McGill Pain Questionnaire and the Pain Management Inventory at baseline and the second and sixth weeks after the education. The SPSS (v15.0) statistical package was used for statistical analysis. After education, significant improvements in pain intensity scores compared with baseline scores were observed in both groups (p < .05), and there was no significant difference between the RA and gonarthrosis groups. Among the various pain management methods, the education program led to significantly more utilization of massaging the painful area, exercising, and using complementary methods to control stress in both groups of patients, and there was no significant difference between the groups. In conclusion, the pain management education given in this study alleviated the intensity of pain and significantly increased the use of some pain management methods in both gonarthrosis and RA cases.

An analysis of the cultural problems encountered during caregiving by the nurses working in two different regions of Turkey

The aim of this study was to identify the cultural problems encountered during caregiving by the nurses working in two university hospitals located in western and eastern Turkey. This descriptive, comparative study was conducted between July 2008 and October 2009 with 338 nurses who volunteered to take part in the study. The study data were collected using an individual description questionnaire consisting of 10 questions and another questionnaire consisting of 14 questions to identify the cultural problems encountered by nurses when giving care. The study showed with respect to training received on transcultural nursing that only 59 nurses had this training, but the percentage was higher in the nurses working at the hospital in the west (54.2%) (P > 0.05). It was found that a large number of nurses in the sample group (n = 286) gave care to at least one individual from another culture, but the percentage was significantly higher in the nurses working in the west (56.7%) than in the nurses working in the east (43.3%) (P   0.05). The problem experienced in this area was mostly because of the fact that patients ‘did not speak Turkish’ (63.8%). In conclusion, the nurses gave care to patients from different cultures, and most of them had trouble when giving care to patients from different cultures.

Examining the Effect of the Case Management Model on Patient Results in the Palliative Care of Patients With Cancer

Purpose: We aimed to investigate the improvement in symptoms, quality of life, patient and family satisfaction with care, and direct costs resulting from a palliative care program based case management model. Methods: The research was implemented at the Medical Oncology Clinic hospital of a University between September 2009 and September 2011. The research sample consisted of a total of 44 patients (22 control and 22 intervention group). The research tools were the Edmonton Symptom Diagnosis System, the Karnofsky Performance Scale, the EORTCQLQ-C30 Quality of Life Scale, a patient and family satisfaction form, and a patient cost record form. Results: The difference between total symptom mean scores and the sub-dimension symptoms of pain, fatigue, nausea, depression, anxiety, lack of appetite, lethargy, well-being, dyspnea, and constipation post-hospitalization and post-discharge of patients in the control and experimental groups were found to be statistically significant (p < 0.05). The level of decrease in symptom severity in the experimental group patients was more than in the control group (p < 0.000). The satisfaction level of patients and family in the palliative care based case management service was higher than that for conventional service in the control group (p < 0.05). No statistical difference was detected between the experimental and control groups regarding health costs and duration of hospitalization (p > 0.05). Conclusion: We provided a better symptom control, improved the patient s quality of life (excluding physical and congnitive functions), and patient and family satisfaction levels were higher in the palliative care based case management intervention group, but direct health costs were not affected.

Investigation into the use of complementary and alternative medicine and affecting factors in Turkish asthmatic patients.

AIMS The purpose of this study was to examine the frequency of complementary and alternative medicine usage in asthmatic patients living in the west of Turkey, the most frequently used complementary and alternative medicine methods and socio-demographic factors affecting this and factors related to the disease. BACKGROUND While the rate of complementary and alternative medicine usage in asthmatic patients and the reasons for using it vary, practices specific to different countries and regions are of interest. Differing cultural and social factors even in geographically similar regions can affect the type of complementary and alternative medicine used. METHODS Two hundred asthmatic patients registered in the asthma outpatient clinic of a large hospital in Turkey and who had undergone pulmonary function tests within the previous six months were included in this study, which was planned according to a descriptive design. The patients filled out a questionnaire on their demographic characteristics and complementary and alternative medicine usage. RESULTS The proportion of patients who reported using one or more of the complementary and alternative medicine methods was 63·0%. Of these patients, 61·9% were using plants and herbal treatments, 53·2% were doing exercises and 36·5% said that they prayed. The objectives of their use of complementary and alternative medicine were to reduce asthma-related complaints (58%) and to feel better (37·8%). The proportion of people experiencing adverse effects was 3·3% (n = 4). Factors motivating asthmatic patients to use complementary and alternative medicine were the existence of comorbid diseases and a long period since diagnosis (p < 0·05). No statistically significant difference was found between the use of complementary and alternative medicine and the severity of the disease, pulmonary function test parameters, the number of asthma attacks or hospitalisations because of asthma within the last year (p > 0·05). RELEVANCE TO CLINICAL PRACTICE Understanding by nurses of the causes and patterns of the use of complementary and alternative medicine in asthmatic patients helps them in directing patient care and patient safety. Nurses should conduct comprehensive diagnostics in the light of complementary and alternative medicine use, and they should be aware of the potential risks.

Investigation into Complementary and Integrative Health Approaches for Turkish Patients with Gastrointestinal Cancer

The study was conducted to determine the levels of usage of complementary and integrative health (CIH) approaches and the symptoms experienced by Turkish patients with gastrointestinal cancer. A descriptive study was conducted on 81 patients with gastrointestinal cancer attending the medical oncology department of an oncology hospital. In the data collection stage, the patient description form that prepared by the researchers and the “Edmonton Symptom Assessment Scale” were used. Data were evaluated via Chi-square and student t test. It was determined that 55.6% of the patients with gastrointestinal cancer applied at least one CIH approaches, and these CIH approaches were praying (80.0%), herbal medicine (57.7%), a special diet (40.0%), therapeutic touch (15.6%), exercise (13.3%) and psychotherapy (4.4%). 68.8% of patients who used the CIH approach stated that they applied the CIH approaches in order to supplement the medical treatment, and 91.1% stated that they did not inform health employees about that they using the CIH approach. It was also found that the use of CIH approaches was not related to socio-demographic characteristics, disease characteristics and experienced symptoms. It is very important that patients with gastrointestinal cancer be questioned in terms of CIH approaches used.

A Case of Heart Failure in the Framework of King's Theory of Goal Attainment

ÖZET Hemşirelikte kuram ve modellerin kullanılmasıyla, hemşirelik eğitimi ve bakımında kalitenin arttırılması sağlanmış ve bütüncül bakımı esas alan uygulamalar geliştirilmesine rehberlik edilmiştir. Bakım kalitesinin artmasını sağlayan yeni modellerin uygulamaya aktarılabilir olması çok önem taşımaktadır. Diyabet, hipertansiyon, kalp yetersizliği gibi birçok kronik hastalıkta uygulanabilir olan modellerden biri de Imogene King’in “Amaca Ulaşma Kuramı”dır. Kuram, hemşirelik bakımına kritik düşünme sürecini getirerek klasik hemşirelik bakımının daha geniş bir yelpazeye sahip olmasını sağlamakta ve kalp yetersizliği gibi çoklu semptomların var olduğu hastalık sürecinde daha etkin ve hızlı semptom yönetimini mümkün hale getirebilmektedir. Buna ek olarak; Amaca Ulaşma Kuramında, bireyin kendi bakımına katılımı sağlanmakta, yapabileceği kısa ve uzun vadeli hedefler, bu hedeflere ne derecede ulaşıldığı ve hedeflere ulaşmadaki eksiklikler belirlenmektedir. Bu nedenle kalp yetersizliği gibi yaşam biçimi değişikliğinin ve hastanın kendi bakımına katılmasının çok gerekli olduğu hastalıklarda etkin bir model olabileceği düşünülmektedir. Tüm bu düşüncelerden yola çıkılarak amaç; Amaca Ulaşma Kuramı çerçevesinde kalp yetersizliği hastalarına yönelik bir bakım yönetimi örneği geliştirmektir.

Düzeltme: Geriatride ileri direktifler

Ileri direktifler; bireyin karar vermesinin uygun olmadigi kosullarda veya iletisim kurulamadigi durumlarda (koma, vb.) saglik bakimina yonelik ne isteklerinin belirtildigi yazili belgelerdir. Yaslilarin pek cogu kronik hastaliklari ve komorbid durumlari nedeni ile yasamdan izolasyon, bilinmeyen korkusu, hata yapilacagi korkusu, bagimsizligin kaybolacagi korkusu, olum surecinin iyi olmamasi korkusu yasamaktadirlar. Bu neden ile yaslilarin cogu kendi tedavisinin seciminde yer almak ve yapilacak tum uygulamalarda aktif bir rol almak istemektedirler. Saglik bakim direktifleri ve ileri direktifler, yasli bireyin ozellikle bagimli hale geldigi durumlarda otonomisini arttiran tek yoldur. Bu makalede; ileri direktif ve ileri saglik direktiflerin tanimi, karar sureclerinde saglik profesyonellerinin rolleri, ileri direktif sureclerinin aciklanmasi ve direktiflere yonelik yasal surecler aciklanmaktadir.

Pain management of elderly in nursing homes

OBJECTIVES The aim of this study was to determine pain management status of the elderly in nursing homes. METHODS The descriptive study sample included 82 elderly who presented to two nursing homes in İzmir between February-July 2012. In this study, Elderly Identification Form, Mini-Mental Scale, McGill Pain Scale (MAS) and Pain Management Inventory were used as the data collection tool. RESULTS It was determined that the highest rates of complaints the elderly individuals had were knee pain (64.6%) and headache (58.5%) in this study. Of the elderly people participating in the study, 96.3% took pain relievers for pain management and according to their statements, of the pain management methods they used, resting and directing attention to something else (X=5.76±0.87) and taking prescribed pain relievers (X=5.69±0.87) were very beneficial. CONCLUSION In elderly individuals, it is important to use pharmacological and non-pharmacological methods for pain management. Therefore, it is recommended to determine the most frequently used methods for pain management by the elderly and to integrate them into the care plan.

557 THE RELATIONSHIP OF PAIN AND HOPELESSNESS IN PATIENTS WITH CANCER

Objective: The aim of the study was to compare the level of hopelessness between patients with cancer who have pain and those who have not. Method: A cross-sectional and descriptive correlational design was used in this study. A hundred thirty six patients who were hospitalized for cancer treatments and palliative care at Tülay Aktaş Oncology Hospital of Ege University School of Medicine between December 2005 and March 2006 were recruited to current study. Of them 95 patients completed information on the measures of hope and pain. Hopelessness was assessed with the Beck Hopelessness Scale (BHS). Data were analyzed by using descriptive statistics, chi square test, t test, ANOVA and Pearson’s correlation test. Results: There were no statistical differences between patients who have pain and those who have not in terms of sociodemographic variables. Patients who have pain had advanced disease by means of disease stage and occurrence of metastasis than the ones who have no pain (respectively p = 0.019, p = 0.030). Levels of hopelessness were statistically higher in patients with pain than the patients without pain (p = 0.047). When the patients with pain separated into three groups in terms of pain severity (mild-moderate-severe), it was found that pain severity did not affect the level of hopelessness (F = 0.370, p = 0.693). Similarly no correlation was found between pain severity and hopelessness in current study (r = 0.180, p = 0.175). Conclusion: Perception of pain in cancer patients increases hopelessness.