VALIDATION OF EDMONTON FRAIL SCALE INTO ELDERLY TURKISH POPULATION.

PURPOSE: The purpose of this methodological study was to assess the validity and reliability of Turkish version of the "Edmonton Frail Scale" (EFS). METHOD: 130 individuals aged 65 and over residing at the Izmir Narlidere Nursing Home between September 2011 - April 2012 who agreed to participate in the study constituted the sample for the research. Individuals with communication problems (deafness, blindness or language barriers) and problems with manual dexterity were not included in the study. The EFS is composed of 11 items, with a minimum score of zero and a maximum score of 17. Initially, the scale was translated into Turkish and then back translated in order to ensure language equivalence. Six experts were consulted with regard to content validity and agreement among the experts was assessed using Kendall's W. When testing the reliability of the EFS, the scale was re-administered to 30 participants two-three weeks after the initial administration in order to determine its consistency over time and agreement between the first and second administration was analysed using the kappa statistic. Pearson's Moment Correlation Coefficient and Cronbach's Alpha were also used to establish reliability. FINDINGS: The overall Cronbach's alpha value for the scale was 0.75. An "item analysis" calculated item-total correlation coefficients of between 0.12-0.65 for scale items, and the item-total correlation for item six was found to be less than 0.20. This item solicits the number of medications used by the subject, and since the number of medications used is significant in the determination of frailty it was not removed from the scale. The scale was found to be highly consistent over time (Kappa (κ) = Min: 0.95, Max: 1.00) CONCLUSION: EFS indicators were found to be sufficiently reliable and valid for the Turkish population. Accordingly, it is recommended that this scale be used in determining the frailty of older individuals.

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.

Comfort and quality of life in patients with breast cancer undergoing radiation therapy.

PURPOSE: Radiation therapy is generally applied after surgery for the treatment of breast cancer, which is among the most frequently observed types of cancer in females. Radiation therapy may have some negative effects on the quality of life due to various side effects such as changes in the skin, mucositis and fatigue. Our study was planned as a descriptive study, in order to examine the relationship between comfort and quality of life in breast cancer patients undergoing radiation therapy. METHODS: This study involved 61 patients with breast cancer undergoing radiation therapy. Data were collected using "Patient Information Form", "Radiation Therapy Comfort Questionnaire" and "EORTC QLQ-BR23". The scales were applied twice, before the start and at the end of treatment. Data were evaluated via Wilcoxon test and Spearman correlation analyses. RESULTS: No statistically significant difference was determined between comfort and quality of life average score before and after radiotherapy (p>0.05). A positive relationship was determined between the pain and symptom quality of life (p<0.05). Although a positive relationship was determined between comfort score and the functional and general quality of life areas, a negative relationship was detected with the symptom quality of life (p<0.01). CONCLUSION: Radiation therapy applied to breast cancer patients did not affect comfort and quality of life, On the contrary, the quality of life of patients increased along with their comfort levels and that comfort levels decreased as the experienced symptoms increased.

Determining the satisfaction levels of the family members of patients with advanced-stage cancer.

OBJECTIVE: The objective of our study was to determine the satisfaction levels of family members of patients with advanced-stage cancer. METHOD: This descriptive study was conducted in the palliative care and medical oncology clinics of a university hospital in the province of Izmir between April of 2011 and January of 2012. The study sample consisted of a total of 145 family members, who were selected from among the family members of patients with advanced-stage cancer receiving palliative treatment. The study data were obtained using the Patient Description Form and Family Satisfaction Scale during face-to-face interviews with patients. RESULTS: Some 67% of patients were female and 33% male, 70% were married, 35% were high school graduates, and 34.5% were housewives. The average total family satisfaction score was 76.87 ± 1.14, and the average scores for the component variables were as follows: information giving 74.37 ± 1.28, availability of care 78.40 ± 1.17, physical care 78.99 ± 1.09, and psychosocial care 74.52 ± 1.30. We found a relationship between the level of satisfaction of family members and (1) gender, (2) occupation, (3) presence of someone supporting the care, and (4) possession of sufficient information about the patient (p < 0.05). SIGNIFICANCE OF RESULTS: Satisfaction levels of participants were determined to be high. We found that family member satisfaction levels were affected by gender and occupation, the existence of someone supporting the care, and possession of sufficient information about the patient.

Nursing students' approaches toward euthanasia.

BACKGROUND: In Turkey, which is a secular, democratic nation with a majority Muslim population, euthanasia is illegal and regarded as murder. Nurses and students can be faced with ethical dilemmas and a lack of a legal basis, with a conflict of religious beliefs and social and cultural values concerning euthanasia. The aim of this study was to investigate undergraduate nursing students' attitudes towards euthanasia. METHOD: The study, which had a descriptive design, was conducted with 600 students. The 1st, 2nd, 3rd, and 4th year nursing students at a school of nursing were contacted in May 2009, and 383 students (63.8% of the study population of a total of 600 students) gave informed consent. Two tools were used in accordance with questionnaire preparation rules. RESULTS: The majority of students were female and single (96.9%), and their mean age was 21.3 ± 1.5 years. A majority (78.9%) stated they had received no training course/education on the concept of euthanasia. Nearly one-third (32.4%) of the students were against euthanasia; 14.3% of the students in the study agreed that if their relatives had an irreversible, lethal condition, passive euthanasia could be performed. In addition, 24.8% of the students agreed that if they themselves had an irreversible, lethal condition, passive euthanasia could be performed. Less than half (42.5%) of the students thought that discussions about euthanasia could be useful. There was a significant relation between the study year and being against euthanasia (p < 0.05), the idea that euthanasia could be abused (p < 0.05), and the idea that euthanasia was unethical (p < 0.05). CONCLUSION: It was concluded that the lack of legal regulations, ethical considerations, religious beliefs, and work experience with dying patients affect nursing students' attitudes towards euthanasia.

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). When the problems experienced by the nurses during caregiving because of cultural characteristics of patients were explored, it was found that they experienced problems mostly in 'communication', and the percentage of those having problems was higher in the nurses working in the west (60.8%) (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.

[Case management based multidisciplinary care protocol in the palliative care of cancer patients]. / Kanser hastasinin palyatif bakiminda vaka yönetimine dayali multidispliner bakim protokolü.

Today, multifaceted approach is needed for the palliative care of advanced stage cancer patients. The main objective for these patients, elimination of pain and other symptoms, psychosocial and spiritual needs are met and to increase the quality of life. We are also faced with the challenge of meeting the physical and psychosocial needs of family members. The purpose of a holistic approach to patient and family who provide effective and quality care, care coordination and case management of a multidisciplinary team approach is based on cooperation. Care protocols specified patient care activities to be carried by the related disciplines to achieve results on a timeline that shows a certain, a multidisciplinary clinical management tool. A lot of care guidelines and protocols developed by a team of experts to contribute to the palliative care activities, and this is thought to be a guiding team members, working with patients.

[Pain management of elderly in nursing homes]. / Huzurevinde yasayan yaslilarda agri yönetimi.

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 Izmir 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.

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.

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.

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.

Reliability and validity of the Turkish version of the Memorial Symptom Assessment Scale in cancer patients.

AIM: The Memorial Symptom Assessment Scale (MSAS) is a multidimensional tool developed to evaluate measure the prevalence, characteristics and distress of common symptoms related to cancer. A validated Turkish version has now become available. The aim of this study was to evaluate its reliability and validity. METHODS: One hundred-twenty patients were included into this study. The MSAS, The Rotterdam Symptom Checklist (RSCL), and Karnofsky Performance Status Scale (KPSS) were used for data collection. Content and criterion validities were examined. Reliability analyses of the MSAS were performed using internal consistency reliability and test-retest reliability. RESULTS: The most frequently reported symptom (90%) was problems with sexual interest or activity. Item-total correlations ranged between 0.03 and 0.64. There was a high correlation between total MSAS and the RSCL (r=0.875, p<0.01). The internal consistency reliabilities of subscales of the MSAS and total MSAS were moderately high, with Cronbach alpha coefficients ranging from 0.71 to 0.84. The MSAS's test - re-test reliability was 0.78. CONCLUSION: The MSAS for cancer patients was determined to be a valid and reliable instrument for the use in the Turkish population. It is recommended that the MSAS-Turkish version can be used as a tool for comprehensive symptom assessment in planning nursing care for cancer patients.

An analysis of nursing and medical students' attitudes towards and knowledge of complementary and alternative medicine (CAM).

AIMS AND OBJECTIVES: This study aims to evaluate and compare nursing and medical students' attitudes and knowledge about complementary and alternative medicine (CAM). BACKGROUND: Despite increased popularity of the use of complementary and alternative medicine, it is not included in nursing and medicine schools' curricula in many countries. DESIGN: A cross-sectional design was used. METHOD: This study's research population included 972 students who were educated at a school of nursing and a faculty of medicine during the academic year 2006-2007. The study used a questionnaire the researchers prepared as data collection form. Pearson chi-square test was used to observe the differences between nursing and medical students. A p-value <0.05 was accepted statistically significant. RESULTS: The population was 49.1% nursing students and 50.9% medical students. Of the nursing students, 57.8% agreed with the statements that complementary and alternative medicine modalities should be integrated into clinical practice, 61.3% agreed for curriculum. Of the medical school students, 32.6% agreed for clinical practice and 37.9% for curriculum. The nursing students had sufficient knowledge of mostly massage and imagery; and medical students had sufficient knowledge of mostly diet therapy, vitamins and prayer. CONCLUSIONS: The results of current study reveal that nursing students adopt more positive attitudes than medical students towards complementary and alternative medicine therapies and that both student groups have limited knowledge of complementary and alternative medicine modalities. RELEVANCE TO CLINICAL PRACTICE: Physicians and nurses play important roles in helping patients use complementary and alternative medicine safely and accurately. Therefore, as future nurses and physicians, nursing and medical students should have sufficient knowledge of and education on complementary and alternative medicine modalities. In this context, handling complementary and alternative medicine on a scientific scale and including it in nursing and medical students' educational programmes should be among the goals and plans in Turkey.

"Caregiver Strain Index" validity and reliability in Turkish society.

OBJECTIVE: The Caregiver Strain Index (CSI) made up of 13 items was developed by Robinson (1983) and assesses the subjective care load of the caregiver. This study was conducted to evaluate its validity and reliability for Turkish society. DESIGN: A cross-sectional descriptive study. PARTICIPANTS: 132 family members providing care for cancer patients. INTERVENTION: CSI was adopted for Turkey and administered twice via face-to- face interviews to 132 family members providing care for cancer patients from the Day Patient Unit of Ege University hospital. The content validity of the "Caregiver Strain Index" Kendall analysis was used while Pearson's moment Correlation Coefficient was applied for the test reset reliability of the scale and Cronbach's Alpha Interpretation statistical analysis tests for internal consistency and rotated factor loading of items of the scale. RESULTS: Validity of the index was found to be 0.41 and test-retest reliability 0.75. While the Cronbach's alpha value of the index for first administration was 0.77, it was found to be 0.73 for the second administration. CONCLUSIONS: At the end of our study, validity and reliability of the index were established, indicating utility in studies for assessing the care load of individuals providing care to cancer patients in Turkish society.

Validity and reliability of a Turkish version of the Fecal Incontinence Quality of Life Scale.

PURPOSE: Anorectal disorders, including fecal incontinence, are a significant healthcare problem that produce bothersome symptoms and adversely affect quality of life. We sought to establish the validity and reliability of a Turkish language version of the Fecal Incontinence Quality of Life Scale (FIQOLS). SUBJECTS AND SETTING: Data were collected at the Fecal Incontinence-Constipation-Biofeedback Clinic, located in the Gastroenterology Department at Ege University School of Medicine Hospital in Izmir, Turkey. The study sample comprised patients with fecal incontinence who attended the clinical assessment and agreed to participate in the study. INSTRUMENTS: A sociodemographic questionnaire form, the 29-item FIQOLS, and the Fecal Incontinence Severity Index (FISI), as well as the 36-Item Short Form Health Survey (SF-36) were administered to subjects. Both the FIQOLS and FISI were translated from English to Turkish by using a back-translation technique. METHODS: Subjects initially completed the FIQOLS, FISI, and the SF-36 at baseline and again after a 2-week interval to allow test-retest reliability measurement. Internal consistency was also measured, using the Cronbach alpha and Spearman-Brown split-half coefficients. Test-retest reliability was evaluated using interclass correlation coefficient testing. The validity of FIQOLS with respect to the SF-36 and FISI was analyzed using Pearson correlation coefficients. RESULTS: Fifty subjects with fecal incontinence participated in the study; their mean age (SD) was 57.1 (+/-15.7) years. Almost two-thirds (66%) were female, and 38% did not complete primary school education. Test-retest reliability analysis revealed an intraclass correlation of r value higher than 0.70 (P < .05). The overall Cronbach alpha coefficient of instrument was .88; the Spearman-Brown split-half value was 0.84 for the first half of the tool and 0.76 for the second half. The Cronbach alpha coefficient for subfactors varied from .56 to .82. The FIQOLS score was found to have a statistically significant (P < .05) correlation with both the FISI and SF-36. CONCLUSION: These findings support the Turkish language version of the FIQOLS as a valid and reliable instrument.

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.

Effects of home-based cardiac exercise program on the exercise tolerance, serum lipid values and self-efficacy of coronary patients.

BACKGROUND: Exercise-based cardiac rehabilitation improves exercise capacity and reduces cardiac risk factors. The purpose of this pilot study was to examine the effects of a home-based cardiac exercise program (HBCEP) on exercise tolerance, serum lipids, and self-efficacy in coronary heart disease patients in Turkey. Self-efficacy theory provided the framework for this study's intervention. DESIGN: The study design was a pre-test and post-test experimental, randomized assignment. METHOD: The study included 30 participants in a home-based cardiac exercise program (HBCEP; mean age=54.7+/-7.8) and 30 in control (C; mean age=52.7+/-6.5). The Phase II cardiac exercise program included three 45-60-min sessions per week for 12 weeks, and the enhancement of self-efficacy through educational sessions and the use of goal setting, modelling, and physiological feedback strategies. Both groups were comparable in their medical regimen, exercise capacity, and other measured variables pre-intervention. At baseline and after 12 weeks, exercise capacity was evaluated by exercise testing using the Bruce Protocol, self-efficacy was measured with the Cardiac Exercise Self Efficacy Index, and serum lipid values were measured. RESULTS: At the completion of the 12-week exercise program, the exercise capacity (P<0.001), total cholesterol (P=0.004), triglycerides (P=0.048), high-density lipoprotein-cholesterol (P=0.001), low-density lipoprotein-cholesterol (P=0.039), and self-efficacy (P<0.001) of the HBCEP Group were significantly improved compared to the control group. CONCLUSION: These results suggest that a first-time HBCEP in Turkey can be successful in having patients adhere to a prescribed exercise program and reduce risk factors. Enhanced self-efficacy may have mediated the improved behavioural outcomes.

[Complementary therapies in palliative cancer care]. / Palyatif kanser bakiminda tamamlayici tedaviler.

The use of complementary and alternative medicine (CAM) has grown in popularity both among the general population and among the cancer patients. Cancer patients often use CAM, which is a treatment that is not commonly used in the conventional setting. However, the prevalence of CAM use appears to vary substantially, with reported frequency of use of at least one CAM therapy ranging from 20% to 83.3%. Complementary medicine has become an important aspect of palliative cancer care. Acupuncture, aromatherapy, homeopathy, hypnotherapy, massage, reflexology, relaxation techniques, and spiritual healing are frequently used forms of treatment. The purpose of this article is to provide information about some complementary therapies that are commonly used by cancer patients in the palliative care.