Hastalıklarda Belirsizlik Teorisi Temelli Yapılan Hemşirelik Girişimlerinin Kanserli
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Dosyalar
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışma Mishel’in Hastalıklarda Belirsizlik Teorisi temelli yapılan hemşirelik girişimlerinin
kanserli çocuklara bakım verenlerin belirsizlik, umutsuzluk, baş etme ve uyumlarına etkisini incelemek
amacıyla yapıldı.
Tekrar ölçüm (ön test-son test-izlem), paralel grup (deney-kontrol), randomize kontrollü
deneysel bir tasarımda yapılan çalışma, etik kurul ve kurum izinleri alındıktan sonra 29 Kasım 2017-15
Temmuz 2019 tarihleri arasında yapıldı. Çalışmanın veri toplama ve uygulama süreci ise iki Tıp
Fakültesi Hastanesinin Çocuk Onkoloji ve Hematoloji Klinik ve polikliniklerinde 15 Ocak 2019-15
Temmuz 2019 tarihlerinde 46 katılımcıyla (Girişim Grubu-GG:23; Kontrol Grubu-KG=23) yapıldı.
Bakım verenlere çalışma hakkında bilgi verilerek aydınlatılmış onamları alındı. GG ve KG’nin homojen
olduğu istatistik yöntemler kullanılarak belirlendi (p>0,05). Çalışmada basit randomizasyon yöntemi
kullanıldı, başka bir akademisyen tarafından bilgisayar temelli basit rasgele sayılar üretilerek gruplar
belirlendi. Araştırmacı dışında bir hemşire opak zarflara sıra numarası verdi, uygun atama kartını (GG
ya da KG yazan) zarfın içine yerleştirdi ve zarfları kapattı. Bakım verenlerin ön test ölçümlerinden
sonra, zarflar açılarak bakım verenlerin gruplara atamasını yapıldı. Kontrol grubu hastanelerde kabul
edilen standart hemşirelik bakımını aldı. Girişim grubuna teori temelli geliştirilen protokole uygun
olarak, 6 modül (10 oturum) ve toplam 200 dakikadan oluşan eğitim ve danışmanlık verildi. Veriler
Bilgi Formu, Mishel’in Hastalıklarda Belirsizlik Ölçeği-Ebeveyn/Çocuk Formu (MHBÖ-E/ÇF), Beck
Umutsuzluk Ölçeği (BUÖ), Baş Etme ve Uyum Süreci Ölçeği (BUSÖ) kullanılarak toplandı. Çalışma
verilerinin normal dağılıma uygunluğu Shapiro-Wilks, Skewness ve Kurtosis istatistikleri ile belirlendi.
Tanımlayıcı istatistikler, Yates düzeltmeli ki-kare test, Fisher’s exact test, bağımsız gruplarda t testi,
tekrarlı ölçümlerde çok (iki) yönlü varyans analizi kullanıldı. İstatistiksel anlamlılık p<0,05 olarak kabul
edildi.
Çalışmada GG’nin son test MHBÖ-E/ÇF puan ortalamasının (73,30±13,65) KG’den daha
düşük olduğu (83,00±15,48) gruplar arası farkın orta derecede etki büyüklüğü ile istatistiksel olarak
anlamlı olduğu belirlendi [t:-2,253; d:0,66; %95 CI: (-18,371)-(-1,020); p: 0,029]. Çalışmada GG’nin
izlem ölçüm MHBÖ-E/ÇF puan ortalamasının (68,69±14,25) KG’nin puan ortalamasından
(75,00±16,54) daha düşük olduğu (daha az belirsizlik algısı) ancak farkın istatistiksel olarak anlamlı
olmadığı saptandı [t:-1,404; d:0,41; %95 CI:(-15,568)-(2,791); p:0,167]. Grup*zaman etkisi
incelendiğinde, bakım verenlerin GG ve KG gruplarında olmasına bağlı olarak zamanla belirsizlik
algılarının %95 güç, büyük etki büyüklüğü ile anlamlı derecede azaldığı belirlendi (F:8,319; %95 güç,
np
2
: 0,16; p:0,001).
Çalışmada GG’nin son test BUÖ puan ortalamasının (5,56±2,93) kontrol grubunun son test
puan ortalamasından (8,34±4,78) daha düşük olduğu (daha az umutsuzluk algısı yaşadığı), gruplar arası
farkın orta (büyüğe yakın) etki büyüklüğü ile istatistiksel olarak anlamlı olduğu belirlendi [t:-2,378;
d:0,70; %95 CI: (-5,155)-(-0,411); p: 0,022]. Ayrıca GG’nin izlem ölçümdeki puan ortalamasının
(3,95±1,79), KG’nin puan ortalamasından (6,26±4,26) daha düşük olduğu (daha az umutsuzluk algısı
viii
yaşadığı), gruplar arası farkın orta-büyüğe yakın etki büyüklüğü ile istatistiksel olarak anlamlı olduğu
saptandı [t:-2,387; d:0,71; %95 CI: (-4,277)-(-0,332); p: 0,021]. Grup ve zamanın umutsuzluk algısı
üzerine ortak (grup*zaman) etkisinin istatistiksel olarak benzer olduğu belirlendi [F:1,756; p=0,179].
Çalışmada GG’nin son test (145,91±11,82) ve izlem ölçüm (150,26±16,30) BUSÖ puan
ortalamaların KG’nin son test (139,47±21,82) ve izlem ölçümdeki (143,30±16,09) puan
ortalamalarından daha yüksek olduğu (etkili baş etme ve uyum algısı daha yüksek), ancak her iki
ölçümde de gruplar arası farkın istatistiksel olarak anlamlı olmadığı belirlendi (p>0,05). Grup ve
zamanın baş etme ve uyum algısı üzerine ortak (grup*zaman) etkisi incelendiğinde grup zaman
etkileşiminin istatistiksel olarak benzer olduğu belirlendi [F:1,167; p=0,316].
Kanser tanısı alan çocuğun bakım verenlerine yönelik Mishel’in Hastalıklarda Belirsizlik
Teorisi temelli verilen hemşirelik girişimlerinin, bakım verenlerin belirsizlik algılarına grup*zaman
etkisi içinde istatistiksel olarak anlamlı etkilediği belirlendi. Ayrıca GG’nin umutsuzluk algısının son
test ve izlem ölçümde KG’den istatistiksel olarak daha düşük olduğu saptandı. Sonuç olarak Mishel’in
Hastalıklarda Belirsizlik Teorisi temelli verilen hemşirelik girişimlerinin bakım verenlerin belirsizlik,
umutsuzluk ve baş etme uyumlarını olumlu açıdan destekleyebileceği düşünülmektedir.
This study was conducted to investigate the effects of nursing interventions based on Mishel’s Uncertainty in Ilness Theory on the uncertainty, hopelessness, coping and adaptation for care givers of children with cancer. Randomized Controlled experimental design study, which had repeated measures (pretest-post test-follow up) and parallel group (intervention-control), was done between 29th November 2017-15th July 2019 after getting approval of ethical committee and written institutional permissions. Data collection and implementation of study was conducted with 46 participants (Intervention Group-IG: 23; Control Group-CG= 23) between 15th of January 2019-15th of July 2019 in Pediatric Oncology and Hematology Clinics and outpatient clinics of two Medical Faculty Hospitals. Prior to getting informed consents of caregivers, information about the study was given. IG and CG was found homogeneuous by using statistical methods (p>0.05). The simple randomization method was used in the study, computer-based simple random numbers were generated by another academician to define groups. Another nurse wrote numbers the opaque envelopes, placed the cards (which were written IG or CG) in the envelopes and closed them. After the pre-test measurements of the caregivers, the envelopes were opened, and the caregivers were assigned to the groups. The control group received the standard nursing care that accepted at the hospitals. Intervention group was given 6 modules (10 sessions) and total 200 minutes education and consultancy according to protocol that was developed based on theory. Data were collected via Information Form, Mishel's Uncertainty in Illness Scale-Parent/Child Form (PPUS), Beck Hopelessness Scale (BHS), Coping and Adaptation Process Scale (CAPS). Normal distribution of study were explored by using Shapiro-Wilks, Skewness and Kurtosis statistics. Descriptive statistics, Yates-corrected chi-square test, Fisher's exact test, independent samples t test, repeated measures twoway analysis of variance were used. Statistical significance was accepted as p<0.05. In the study, it was determined that PPUS post test mean score of IG (73.30 ± 13.65) was lower than CG (83.00 ± 15.48) and the difference between groups was statistically significant with a moderate effect size [t:-2.253; d: 0.66; 95% CI:(-18.371)-(-1.020); p: 0.029]. In the study, it was found that PPUS follow-up mean score of IG (68.69±14.25) was lower (less uncertainty perception) than CG (75.00±16.54), but the difference was not statistically significant [t:-1.404; d: 0.41; 95% CI: (-15.568)- (2.791); p: 0.167]. When group*time effect was examined, it was determined that the perceptions of uncertainty decreased significantly over time with 95% power and large effect size, depending on the caregivers being in the IG and CG groups (F: 8.319; 95% power, np 2 : 0.16; p: 0.001). In the study, it was determined that BHS posttest mean score of IG (5.56±2.93) was lower (less hopelessness perception) than the CG (8.34±4.78), the difference between the groups statistically significant with medium effect size [t:-2,378; d: 0.70; 95% CI: (-5.155)-(-0.411); p: 0.022]. In addition, the follow-up mean score of IG (3.95±1.79) was lower (less hopelessness perception) than the CG (6.26±4.26) for BHS, the difference between the groups statistically significant with close to medium- x large effect size [t:-2.387; d:0.71; 95% CI: (-4.277)-(-0.332); p: 0.021]. It was determined that group*time were statistically similar [F: 1.756; p=0.179]. In the study, the mean scores of the IG for posttest (145.91±11.82) and the follow-up test (150.26±16.30) of CAPS were higher than posttest (139.47±21.82) and in the follow-up measurement (143.30±16.09) of CG, but the difference were not statistically significant. Also group*time effect on coping and adaptation perception was examined, it was determined that group time interaction was statistically similar [F: 1.167; p: 0.316]. It was determined that nursing interventions, which was based on the Mishel’s Uncertainty in Illness Theory and given to care givers of children with cancer, had statistically significant effect on care giver’s perception of uncertainity according to group * time effect. In addition, it was determined that the posttest and follow-up mean scores of perception of hopelessness for IG was statistically lower than the CG. As a result, it is thought that nursing interventions based on Mishel’s Uncertainty in Illness Theory can positively support caregivers' uncertainty, hopelessness and coping adaptations.
This study was conducted to investigate the effects of nursing interventions based on Mishel’s Uncertainty in Ilness Theory on the uncertainty, hopelessness, coping and adaptation for care givers of children with cancer. Randomized Controlled experimental design study, which had repeated measures (pretest-post test-follow up) and parallel group (intervention-control), was done between 29th November 2017-15th July 2019 after getting approval of ethical committee and written institutional permissions. Data collection and implementation of study was conducted with 46 participants (Intervention Group-IG: 23; Control Group-CG= 23) between 15th of January 2019-15th of July 2019 in Pediatric Oncology and Hematology Clinics and outpatient clinics of two Medical Faculty Hospitals. Prior to getting informed consents of caregivers, information about the study was given. IG and CG was found homogeneuous by using statistical methods (p>0.05). The simple randomization method was used in the study, computer-based simple random numbers were generated by another academician to define groups. Another nurse wrote numbers the opaque envelopes, placed the cards (which were written IG or CG) in the envelopes and closed them. After the pre-test measurements of the caregivers, the envelopes were opened, and the caregivers were assigned to the groups. The control group received the standard nursing care that accepted at the hospitals. Intervention group was given 6 modules (10 sessions) and total 200 minutes education and consultancy according to protocol that was developed based on theory. Data were collected via Information Form, Mishel's Uncertainty in Illness Scale-Parent/Child Form (PPUS), Beck Hopelessness Scale (BHS), Coping and Adaptation Process Scale (CAPS). Normal distribution of study were explored by using Shapiro-Wilks, Skewness and Kurtosis statistics. Descriptive statistics, Yates-corrected chi-square test, Fisher's exact test, independent samples t test, repeated measures twoway analysis of variance were used. Statistical significance was accepted as p<0.05. In the study, it was determined that PPUS post test mean score of IG (73.30 ± 13.65) was lower than CG (83.00 ± 15.48) and the difference between groups was statistically significant with a moderate effect size [t:-2.253; d: 0.66; 95% CI:(-18.371)-(-1.020); p: 0.029]. In the study, it was found that PPUS follow-up mean score of IG (68.69±14.25) was lower (less uncertainty perception) than CG (75.00±16.54), but the difference was not statistically significant [t:-1.404; d: 0.41; 95% CI: (-15.568)- (2.791); p: 0.167]. When group*time effect was examined, it was determined that the perceptions of uncertainty decreased significantly over time with 95% power and large effect size, depending on the caregivers being in the IG and CG groups (F: 8.319; 95% power, np 2 : 0.16; p: 0.001). In the study, it was determined that BHS posttest mean score of IG (5.56±2.93) was lower (less hopelessness perception) than the CG (8.34±4.78), the difference between the groups statistically significant with medium effect size [t:-2,378; d: 0.70; 95% CI: (-5.155)-(-0.411); p: 0.022]. In addition, the follow-up mean score of IG (3.95±1.79) was lower (less hopelessness perception) than the CG (6.26±4.26) for BHS, the difference between the groups statistically significant with close to medium- x large effect size [t:-2.387; d:0.71; 95% CI: (-4.277)-(-0.332); p: 0.021]. It was determined that group*time were statistically similar [F: 1.756; p=0.179]. In the study, the mean scores of the IG for posttest (145.91±11.82) and the follow-up test (150.26±16.30) of CAPS were higher than posttest (139.47±21.82) and in the follow-up measurement (143.30±16.09) of CG, but the difference were not statistically significant. Also group*time effect on coping and adaptation perception was examined, it was determined that group time interaction was statistically similar [F: 1.167; p: 0.316]. It was determined that nursing interventions, which was based on the Mishel’s Uncertainty in Illness Theory and given to care givers of children with cancer, had statistically significant effect on care giver’s perception of uncertainity according to group * time effect. In addition, it was determined that the posttest and follow-up mean scores of perception of hopelessness for IG was statistically lower than the CG. As a result, it is thought that nursing interventions based on Mishel’s Uncertainty in Illness Theory can positively support caregivers' uncertainty, hopelessness and coping adaptations.
Açıklama
Anahtar Kelimeler
bakım veren, çocuk, hemşirelik girişimi, kanser, Mishel’s Hastalıklarda Belirsizlik Teorisi
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Özkan, S., (2020). Hastalıklarda Belirsizlik Teorisi Temelli Yapılan Hemşirelik Girişimlerinin Kanserli. (Doktora Tezi). Selçuk Üniversitesi, Sağlık Bilimleri Enstitüsü, Konya.
