Araştırma Makalesi
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Basınç ülseri olan evde bakim hizmeti alan hastaların klinik özellikleri ve beslenme ile ilişkili faktörlerin değerlendirmesi

Yıl 2021, Cilt: 6 Sayı: 1, 7 - 12, 03.04.2021

Mustafa Çetiner Selma Akkaya Arı Neslihan Eşkut Özgül Ocak Sibel Canbaz Kabay Handan Işın Özışık Karaman

https://doi.org/10.22391/fppc.776139
Cited By: 1

Öz

Giriş: Bu çalışmada, Kütahya ilinde evde sağlık hizmeti alan basınç ülserli hastaların demografik ve klinik özelliklerini belirlemenin yanında beslenme ile ilişkili olan faktörlerin basınç ülser dereceleriyle ilişkisinin incelenmesi amaçlandı.
Yöntem: Bu çalışma retrospektif ve kesitsel niteliktedir. Aralık 2016 ve Mayıs 2017 tarihleri arasında Kütahya Sağlık Bilimleri Üniversitesi Evliya Çelebi Eğitim ve Araştırma Hastanesi evde sağlık hizmetleri biriminde kayıtlı ve düzenli olarak evde sağlık hizmeti sunulan 500 hastanın dosyaları retrospektif olarak tarandı. Bunlardan basınç ülserli olan 63 hasta çalışmaya dahil edildi.
Bulgular: Çalışmaya 26 (%41,3) erkek ve 37 (%58,7) kadın olmak üzere toplam 63 hasta dahil edildi. Basınç ülseri olan hastaların yaş ortalamaları 74,41±12,30 (yıl) bulundu. Hastaların 36’sı (%57,1) serebrovasküler hastalığa, 5’i (%7,9) demansa, 9’u (%14,3) maligniteye, 8’i (%12,7) osteoartrite, 4’ü (%6,3) periferik vasküler hastalığa, 1’i (%1,6) geçirilmiş trafik kazasına sahip olup, büyük kısmı (%62,1) nörolojik hastalık sekeli nedeni ile bakım hastası olan gruptur. Tüm hastalar incelendiğinde en fazla bası yeri olan bölge sakrumdu (%35,3). Laboratuvar değerlerinden hemoglobin düzeyinin bası derecesi ile ilişkili olduğu görüldü (Tek yönlü varyans analizi, p=0,019). Beslenme ile ilişkili diğer parametreler ile basınç ülser evresi arasında anlamlı ilişki saptanmadı.
Sonuç: Serebrovasküler hastalık sekelli hastalar evde bakım hizmeti alan hastaların önemli bir kısmını oluşturmaktadır. Düşük hemoglobin basınç ülser şiddetini arttırmaktadır. Bu nedenle basınç ülseri oluşumuna katkıda bulunan risk faktörlerinin belirlenmesi ve bunların önlenmesine yönelik çabalar evde sağlık hizmeti biriminin öncelikli hedefi olmalıdır.

Anahtar Kelimeler

Bası ülser evde bakım hizmetleri beslenme durumu

Kaynakça

  • 1. Ozturk A, Gurlek A, Arslan A, Fırat C, Fariz A. [Our Clinical Experiences in Pressure Sore in a period of 10 years] (in Turkish). Turgut Ozal Tıp Merk Derg. 2006; 13(4):243-8. https://dergipark.org.tr/tr/pub/totm/issue/13111/157965
  • 2. Bergquist S. Pressure ulcer prediction in older adults receiving home health care: implications for use with the OASIS. Adv Skin Wound Care. 2003;16(3):132-9. http://doi.org/10.1097/00129334-200305000-00011
  • 3. Allman RM. Pressure ulcer prevalence, incidence, risk factors, and impact. Clin Geriatr Med. 1997;13(3):421-36 https://www.ncbi.nlm.nih.gov/pubmed/9227937
  • 4. Lyman V. Successful heel pressure ulcer prevention program in a long-term care setting. J Wound Ostomy Continence Nurs. 2009;36(6):616-21 http://doi.org/10.1097/WON.0b013e3181bd813e
  • 5. Demirci Sahin A, Seyrek S, Erturk A, Bayındır Artantas A. [Pressure ulcers among home care patients and their demographic features] (in Turkish). Konuralp Med J. 2017;9(1):14-8 http://doi.org/10.18521/kts.286610
  • 6. Capon A, Pavoni N, Mastromattei A, Di Lallo D. Pressure ulcer risk in long-term units: prevalence and associated factors. J Adv Nurs 2007;58(3):263-72 http://doi.org/10.1111/j.1365-2648.2007.04232.x
  • 7. Khor HM, Tan J, Saedon NI, Kamaruzzaman SM, Chin AV, Poi PJ, et al. Determinants of mortality among older adults with pressure ulcers. Arch Gerontol Geriatr. 2014;59(3):536-41 https://doi.org/10.1016/j.archger.2014.07.011
  • 8. Ferrell BA, Josephson K, Norvid P, Alcorn H. Pressure ulcers among patients admitted to home care. J Am Geriatr Soc. 2000; 48(9):1042-7 https://doi.org/10.1111/j.1532-5415.2000.tb04778.x
  • 9. Landi F, Onder G, Russo A, Bernabei R. Pressure ulcer and mortality in frail elderly people living in community. Arch Gerontol Geriatr. 2007;44(1):217-23 https://doi.org/10.1016/j.archger.2007.01.030
  • 10. Sikar Akturk A, Atmaca E, Zengin S, Bayramgurler D. [Prevalence and clinical features of pressure ulcers in patients receiving home health care services in the city of Kocaeli] (in Turkish). Turk derm. 2010;44:128-31 https://doi.org/10.4274/turkderm.44.128
  • 11. Cayır Y, Avsar UZ, Avsar U, Cansever Z, Khan AS. [Characteristics of patients who receive home health services and expectations of caregivers] (in Turkish). Konuralp Med J. 2013;5(3):9-12 https://doi.org/10.18521/ktd.56044
  • 12. Horn SD, Bender SA, Ferguson ML, Smout RJ, Bergstrom N, Taler G, et al. The national pressure ulcer long-term care study: pressure ulcer development in long-term care residents. J Am Geriatr Soc. 2004;52(3):359–67 https://doi.org/10.1111/j.1532-5415.2004.52106.x
  • 13. Soini H, Routasalo P, Lagstrom H. Characteristics of the mini-nutritional assessment in elderly home-care patients. Eur J Clin Nutr. 2004;58(1):64–70 https://doi.org/10.1038/sj.ejcn.16017448
  • 14. Eglseer D, Manuela Hödl M, Lohrmann C. Nutritional management of older hospitalised patients with pressure injuries. Int Wound J. 2019;16(1): 226-32 https://doi.org/10.1111/iwj.13016
  • 15. Citty SW, Cowan LJ, Wingfield Z, Stechmiller J. Optimizing Nutrition Care for Pressure Injuries in Hospitalized Patients. Adv Wound Care (New Rochelle). 2019; 8(7): 309-22 https://doi.org/10.1089/wound.2018.0925
  • 16. Iizaka S, Okuwa M, Sugama J, Sanada H. The impact of malnutrition and nutrition-related factors on the development and severity of pressure ulcers in older patients receiving home care. Clin Nutr. 2010;29(1):47-53 https://doi.org/10.10196/j.clnu.2009.05.018
  • 17. Saghaleini HD, Dehghan K, Shadvar K, Sanaie S, Mahmoodpoor A, Ostadi Z. Pressure ulcer and nutrition. Indian J Crit Care Med. 2018;22(4):283-9 https://doi.org/10.4103/ijccm.IJCCM_277_17
  • 18. Beger T. [Decubitus ulcers in intensive care: prevention of risk factors] (in Turkish). Intensive Care J. 2004;4(4):244-53 http://www.yogunbakimdergisi.org/managete/fu_folder/2004-04/2004-4-4-244-253.pdf
  • 19. Artico M, Dante A, D’Angelo D, Lamarca L, Mastroianni C, Petitti T, et al. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: a retrospective chart review. Palliat Med. 2018;32(1):299-7 https://doi.org/10.1177/0269216317737671
  • 20. Alves AGP, Borges JWP, Brito MA. Assessment of risk for pressure ulcers in intensive care units: an integrative review. Rev Pesqui Cuid Fundam. 2014;6(2):793-4 https://doi.org/10.9789/2175-5361.2014v6n2p793
  • 21. Neloska L, Damevska K, Nikolchev A, Pavleska L, Petreska-Zovic B, KostovM. The association between malnutrition and pressure ulcers in Elderly in long-term care facility. Open Access Maced J Med Sci. 2016;4(3):423-27 https://doi.org/10.3889/oamjms.2016.094
  • 22. Karahan A, A Abbasoğlu A, Işık SA, Çevik B, Saltan Ç, Elbaş NO, et a. Factors affecting wound healing in individuals with pressure ulcers: a retrospective study. Ostomy Wound Manage. 2018;64:32-9 https://doi.org/10.25270/owm.2018.2.3239
  • 23. Anthony D, Alosaimi D, Shiferaw WS, Korsah K, Safari R. Prevalence of pressure ulcers in Africa: A systematic review and meta-analysis. J Tissue Viability 2021;30(1):137-45 https://doi.org/10.1016/j.jtv.2020.10.003
  • 24. Cevik A, Basat O, Ucak S. [Evaluation of nutritional status and its effect on biochemical parameters in elderly people admitted to home health care services] (in Turkish). SEEAH. Med Bull 2014;48(2):132-9 https://doi.org/10.5350/SEMB.20140507030931
  • 25. Saghaleini SH, Dehghan K, Shadvar K, Sanaie S, Mahmooodpoor A, Ostadi Z. Pressure ulcer and nutrition. Indian J Crit Care Med. 2018;22(4):283-9 https://doi.org/10.4103.ijccm.IJCCM_277_17
  • 26. Taylor C. Importance of nutrition in preventing and treating pressure ulcers. Nurs Older People. 2017;29(6):33-9 https://doi.org/10.7748/nop.2017.e910
  • 27. Bergquist-Beringer S, Gajewski BJ. Outcome and assessment information set data that predict pressure ulcer develop¬ment in older adult home health patients. Adv Skin Wound Care. 2011;24(9):404-14 https://doi.org/10.1097/01.ASW.0000405215.4992.a9
  • 28. Mathus-Vliegen EM. Old age, malnutrition, and pressure sores: an ill-fated alliance. J Gerontol A Biol Sci Med Sci. 2004; 59(4): 355-60 https://doi.org/10.1093/gerona/859.4.M355
  • 29. Kurtulus Tosun Z, Boluktas RP. [Pressure ulser prevelance and effecting factors among eldery patients in invasive care units] (in Turkish. J Turk Soc Crit Care Nurs. 2015;19(2):43-53 https://dergipark.org.tr/tr/pub/ybhd/issue/26493/278797
  • 30. Ulker Efteli E, Yapucu Gunes U. A prospective, descriptive study of risk factors related to pressure ulcer development among patients in intensive care units. Ostomy Wound Manage. 2013;59(7):22-7 https://www.ncbi.nlm.nih.gov/pubmed/23846003

Evaluation of clinical features and the factors related to nutrition in home care patients with pressure ulcer

Yıl 2021, Cilt: 6 Sayı: 1, 7 - 12, 03.04.2021

Mustafa Çetiner Selma Akkaya Arı Neslihan Eşkut Özgül Ocak Sibel Canbaz Kabay Handan Işın Özışık Karaman

https://doi.org/10.22391/fppc.776139
Cited By: 1

Öz

Introduction: In this study, we aimed to determine the demographic and clinical characteristics of patients with pressure ulcers who received home health care in Kutahya city and to investigate the relationship between the factors related to nutrition and pressure ulcer grades.
Methods: This study is designed as a retrospective and cross-sectional. The files of 500 patients who were registered at home health services unit of Kutahya Health Sciences University Training and Research Hospital between December 2016 and May 2017 were reviewed retrospectively. Of these, sixty-three patients with pressure ulcers were included in the study.
Results: In this study, 26 (41.3%) were male and 37 (58.7%) were female. The mean age of the patients with pressure ulcers was 74.41 ± 12.30 (years). 36 patients (57.1%) had cerebrovascular disease, 5 patients (7.9%) had dementia, 9 patients (14.3%) had malignancy, 8 patients (12.7%) had osteoarthritis, 4 patients 6.3%) had peripheral vascular disease, and 1 patient (1.6%) had previous traffic accident. The majority (62.1%) were neurological disease-sequenced and nursing-care group. When all the patients were examined, the region with the most pressure was the sacrum (35.3%). Hemoglobin level was found to be related to pressure ulcer grade (One-way ANOVA, p = 0.019). There was no significant relationship between other nutrition-related parameters and pressure ulcer stage.
Conclusion: Patients with cerebrovascular disease constitute a significant proportion of patients receiving home care services. Low hemoglobin increases the severity of the pressure ulcer. Therefore, determining risk factors that contribute to pressure ulcer formation and efforts to prevent them should be the primary target of the home health care unit.

Anahtar Kelimeler

Pressure ulcer home care services nutrional status

Kaynakça

  • 1. Ozturk A, Gurlek A, Arslan A, Fırat C, Fariz A. [Our Clinical Experiences in Pressure Sore in a period of 10 years] (in Turkish). Turgut Ozal Tıp Merk Derg. 2006; 13(4):243-8. https://dergipark.org.tr/tr/pub/totm/issue/13111/157965
  • 2. Bergquist S. Pressure ulcer prediction in older adults receiving home health care: implications for use with the OASIS. Adv Skin Wound Care. 2003;16(3):132-9. http://doi.org/10.1097/00129334-200305000-00011
  • 3. Allman RM. Pressure ulcer prevalence, incidence, risk factors, and impact. Clin Geriatr Med. 1997;13(3):421-36 https://www.ncbi.nlm.nih.gov/pubmed/9227937
  • 4. Lyman V. Successful heel pressure ulcer prevention program in a long-term care setting. J Wound Ostomy Continence Nurs. 2009;36(6):616-21 http://doi.org/10.1097/WON.0b013e3181bd813e
  • 5. Demirci Sahin A, Seyrek S, Erturk A, Bayındır Artantas A. [Pressure ulcers among home care patients and their demographic features] (in Turkish). Konuralp Med J. 2017;9(1):14-8 http://doi.org/10.18521/kts.286610
  • 6. Capon A, Pavoni N, Mastromattei A, Di Lallo D. Pressure ulcer risk in long-term units: prevalence and associated factors. J Adv Nurs 2007;58(3):263-72 http://doi.org/10.1111/j.1365-2648.2007.04232.x
  • 7. Khor HM, Tan J, Saedon NI, Kamaruzzaman SM, Chin AV, Poi PJ, et al. Determinants of mortality among older adults with pressure ulcers. Arch Gerontol Geriatr. 2014;59(3):536-41 https://doi.org/10.1016/j.archger.2014.07.011
  • 8. Ferrell BA, Josephson K, Norvid P, Alcorn H. Pressure ulcers among patients admitted to home care. J Am Geriatr Soc. 2000; 48(9):1042-7 https://doi.org/10.1111/j.1532-5415.2000.tb04778.x
  • 9. Landi F, Onder G, Russo A, Bernabei R. Pressure ulcer and mortality in frail elderly people living in community. Arch Gerontol Geriatr. 2007;44(1):217-23 https://doi.org/10.1016/j.archger.2007.01.030
  • 10. Sikar Akturk A, Atmaca E, Zengin S, Bayramgurler D. [Prevalence and clinical features of pressure ulcers in patients receiving home health care services in the city of Kocaeli] (in Turkish). Turk derm. 2010;44:128-31 https://doi.org/10.4274/turkderm.44.128
  • 11. Cayır Y, Avsar UZ, Avsar U, Cansever Z, Khan AS. [Characteristics of patients who receive home health services and expectations of caregivers] (in Turkish). Konuralp Med J. 2013;5(3):9-12 https://doi.org/10.18521/ktd.56044
  • 12. Horn SD, Bender SA, Ferguson ML, Smout RJ, Bergstrom N, Taler G, et al. The national pressure ulcer long-term care study: pressure ulcer development in long-term care residents. J Am Geriatr Soc. 2004;52(3):359–67 https://doi.org/10.1111/j.1532-5415.2004.52106.x
  • 13. Soini H, Routasalo P, Lagstrom H. Characteristics of the mini-nutritional assessment in elderly home-care patients. Eur J Clin Nutr. 2004;58(1):64–70 https://doi.org/10.1038/sj.ejcn.16017448
  • 14. Eglseer D, Manuela Hödl M, Lohrmann C. Nutritional management of older hospitalised patients with pressure injuries. Int Wound J. 2019;16(1): 226-32 https://doi.org/10.1111/iwj.13016
  • 15. Citty SW, Cowan LJ, Wingfield Z, Stechmiller J. Optimizing Nutrition Care for Pressure Injuries in Hospitalized Patients. Adv Wound Care (New Rochelle). 2019; 8(7): 309-22 https://doi.org/10.1089/wound.2018.0925
  • 16. Iizaka S, Okuwa M, Sugama J, Sanada H. The impact of malnutrition and nutrition-related factors on the development and severity of pressure ulcers in older patients receiving home care. Clin Nutr. 2010;29(1):47-53 https://doi.org/10.10196/j.clnu.2009.05.018
  • 17. Saghaleini HD, Dehghan K, Shadvar K, Sanaie S, Mahmoodpoor A, Ostadi Z. Pressure ulcer and nutrition. Indian J Crit Care Med. 2018;22(4):283-9 https://doi.org/10.4103/ijccm.IJCCM_277_17
  • 18. Beger T. [Decubitus ulcers in intensive care: prevention of risk factors] (in Turkish). Intensive Care J. 2004;4(4):244-53 http://www.yogunbakimdergisi.org/managete/fu_folder/2004-04/2004-4-4-244-253.pdf
  • 19. Artico M, Dante A, D’Angelo D, Lamarca L, Mastroianni C, Petitti T, et al. Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: a retrospective chart review. Palliat Med. 2018;32(1):299-7 https://doi.org/10.1177/0269216317737671
  • 20. Alves AGP, Borges JWP, Brito MA. Assessment of risk for pressure ulcers in intensive care units: an integrative review. Rev Pesqui Cuid Fundam. 2014;6(2):793-4 https://doi.org/10.9789/2175-5361.2014v6n2p793
  • 21. Neloska L, Damevska K, Nikolchev A, Pavleska L, Petreska-Zovic B, KostovM. The association between malnutrition and pressure ulcers in Elderly in long-term care facility. Open Access Maced J Med Sci. 2016;4(3):423-27 https://doi.org/10.3889/oamjms.2016.094
  • 22. Karahan A, A Abbasoğlu A, Işık SA, Çevik B, Saltan Ç, Elbaş NO, et a. Factors affecting wound healing in individuals with pressure ulcers: a retrospective study. Ostomy Wound Manage. 2018;64:32-9 https://doi.org/10.25270/owm.2018.2.3239
  • 23. Anthony D, Alosaimi D, Shiferaw WS, Korsah K, Safari R. Prevalence of pressure ulcers in Africa: A systematic review and meta-analysis. J Tissue Viability 2021;30(1):137-45 https://doi.org/10.1016/j.jtv.2020.10.003
  • 24. Cevik A, Basat O, Ucak S. [Evaluation of nutritional status and its effect on biochemical parameters in elderly people admitted to home health care services] (in Turkish). SEEAH. Med Bull 2014;48(2):132-9 https://doi.org/10.5350/SEMB.20140507030931
  • 25. Saghaleini SH, Dehghan K, Shadvar K, Sanaie S, Mahmooodpoor A, Ostadi Z. Pressure ulcer and nutrition. Indian J Crit Care Med. 2018;22(4):283-9 https://doi.org/10.4103.ijccm.IJCCM_277_17
  • 26. Taylor C. Importance of nutrition in preventing and treating pressure ulcers. Nurs Older People. 2017;29(6):33-9 https://doi.org/10.7748/nop.2017.e910
  • 27. Bergquist-Beringer S, Gajewski BJ. Outcome and assessment information set data that predict pressure ulcer develop¬ment in older adult home health patients. Adv Skin Wound Care. 2011;24(9):404-14 https://doi.org/10.1097/01.ASW.0000405215.4992.a9
  • 28. Mathus-Vliegen EM. Old age, malnutrition, and pressure sores: an ill-fated alliance. J Gerontol A Biol Sci Med Sci. 2004; 59(4): 355-60 https://doi.org/10.1093/gerona/859.4.M355
  • 29. Kurtulus Tosun Z, Boluktas RP. [Pressure ulser prevelance and effecting factors among eldery patients in invasive care units] (in Turkish. J Turk Soc Crit Care Nurs. 2015;19(2):43-53 https://dergipark.org.tr/tr/pub/ybhd/issue/26493/278797
  • 30. Ulker Efteli E, Yapucu Gunes U. A prospective, descriptive study of risk factors related to pressure ulcer development among patients in intensive care units. Ostomy Wound Manage. 2013;59(7):22-7 https://www.ncbi.nlm.nih.gov/pubmed/23846003
Toplam 30 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma Makalesi (Original Article)
Yazarlar

Mustafa Çetiner 0000-0002-4420-6452

Selma Akkaya Arı 0000-0003-2021-5802

Neslihan Eşkut 0000-0003-1882-8992

Özgül Ocak 0000-0001-8276-0174

Sibel Canbaz Kabay 0000-0003-4808-2191

Handan Işın Özışık Karaman

Yayımlanma Tarihi 3 Nisan 2021
Gönderilme Tarihi 19 Eylül 2020
Kabul Tarihi 7 Ocak 2021
Yayımlandığı Sayı Yıl 2021Cilt: 6 Sayı: 1

Kaynak Göster

APA Çetiner, M., Akkaya Arı, S., Eşkut, N., Ocak, Ö., vd. (2021). Evaluation of clinical features and the factors related to nutrition in home care patients with pressure ulcer. Family Practice and Palliative Care, 6(1), 7-12. https://doi.org/10.22391/fppc.776139
AMA Çetiner M, Akkaya Arı S, Eşkut N, Ocak Ö, Canbaz Kabay S, Özışık Karaman HI. Evaluation of clinical features and the factors related to nutrition in home care patients with pressure ulcer. Fam Pract Palliat Care. Nisan 2021;6(1):7-12. doi:10.22391/fppc.776139
Chicago Çetiner, Mustafa, Selma Akkaya Arı, Neslihan Eşkut, Özgül Ocak, Sibel Canbaz Kabay, ve Handan Işın Özışık Karaman. “Evaluation of Clinical Features and the Factors Related to Nutrition in Home Care Patients With Pressure Ulcer”. Family Practice and Palliative Care 6, sy. 1 (Nisan 2021): 7-12. https://doi.org/10.22391/fppc.776139.
EndNote Çetiner M, Akkaya Arı S, Eşkut N, Ocak Ö, Canbaz Kabay S, Özışık Karaman HI (01 Nisan 2021) Evaluation of clinical features and the factors related to nutrition in home care patients with pressure ulcer. Family Practice and Palliative Care 6 1 7–12.
IEEE M. Çetiner, S. Akkaya Arı, N. Eşkut, Ö. Ocak, S. Canbaz Kabay, ve H. I. Özışık Karaman, “Evaluation of clinical features and the factors related to nutrition in home care patients with pressure ulcer”, Fam Pract Palliat Care, c. 6, sy. 1, ss. 7–12, 2021, doi: 10.22391/fppc.776139.
ISNAD Çetiner, Mustafa vd. “Evaluation of Clinical Features and the Factors Related to Nutrition in Home Care Patients With Pressure Ulcer”. Family Practice and Palliative Care 6/1 (Nisan 2021), 7-12. https://doi.org/10.22391/fppc.776139.
JAMA Çetiner M, Akkaya Arı S, Eşkut N, Ocak Ö, Canbaz Kabay S, Özışık Karaman HI. Evaluation of clinical features and the factors related to nutrition in home care patients with pressure ulcer. Fam Pract Palliat Care. 2021;6:7–12.
MLA Çetiner, Mustafa vd. “Evaluation of Clinical Features and the Factors Related to Nutrition in Home Care Patients With Pressure Ulcer”. Family Practice and Palliative Care, c. 6, sy. 1, 2021, ss. 7-12, doi:10.22391/fppc.776139.
Vancouver Çetiner M, Akkaya Arı S, Eşkut N, Ocak Ö, Canbaz Kabay S, Özışık Karaman HI. Evaluation of clinical features and the factors related to nutrition in home care patients with pressure ulcer. Fam Pract Palliat Care. 2021;6(1):7-12.

Cited By

Validity and Reliability of Turkish Version of the Pressure Ulcer Management Self‐Efficacy Scale for Nurses
İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi
https://doi.org/10.33715/inonusaglik.1063082

Family Practice and Palliative Care      ISSN 2458-8865       E-ISSN 2459-1505