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Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi

Yıl 2022, Cilt 11, Sayı 2, 387 - 394, 30.06.2022
https://doi.org/10.37989/gumussagbil.868726

Öz

Dispnenin yönetiminde etkinliği kanıtlanan opiodlerden olan morfin ağrıda olduğu gibi opioid reseptörlerine bağlanarak ventilasyonu, anksiyeteyi ve santral dispne algısını azaltır. Bu çalışmada amaç, palyatif bakım ünitesinde (PBÜ) çalışan hekim ve hemşirelerin dispne tedavisinde morfin uygulamaları ile ilgili yaklaşımlarını incelemekti. Tanımlayıcı araştırmanın evrenini beş hastanenin PBÜ’de çalışan 80 hemşire ve 30 hekim oluşturdu. Çalışmada veri toplama aracı olarak “Tanımlayıcı Özellikler Formu” ve “Hekimlerin/ Hemşirelerin Morfin Kullanımı ile İlgili Yaklaşımları Anketi” kullanıldı. Hemşirelerin 31(%38,8)’i dispneli hasta ile her gün karşılaştıklarını ifade etti. Hemşirelerin 61(%76,3)’i hastalara reçete edilen morfini uygularken diğer ilaçlara göre daha fazla dikkatli olması gerektiğini; 77(%96,3)’si ise solunum deprese edici etkilerinden dolayı hastayı daha sık takip etmesi gerektiğini ifade etti. Hekimlerin yarısı dispneli hasta ile her gün karşılaştıklarını, 18(%60)’i PBÜ’de dispne tedavisinde morfin reçete ettiklerini bildirdi. Hekimlerin 27(%90)’si dispneli hastalarda morfin ilk seçenek tedavi yaklaşımı olmadığını düşündüklerini ifade etti. Dispne yönetimindeki etkinliği kanıtlanmış olsa da, yan etkileri, yasal sorumlulukları, uygulama sırasında karşılaşılabilecek tıbbi hatalar nedeniyle hekimlerin morfinleri reçete ederken, hemşirelerin uygularken tedirgin oldukları görülmüştür.

Kaynakça

  • 1. Fukushi, I, Pokorski, M. and Okada, Y. (2021). “Mechanisms Underlying The Sensation of Dyspnea”. Respiratory Investigation, 59 (1), 66-80. https://doi.org/10.1016/j.resinv.2020.10.007.
  • 2. Chin, C. and Booth, S. (2016). “Managing Breathlessness: A Palliative Care Approach”. Postgraduate Medical Journal, 92 (1089), 393-400. https://doi.org/ 10.1136/postgradmedj-2015-133578.
  • 3. Crombeen, A.M. and Lilly, E. J. (2020). “Management of Dyspnea in Palliative Care”. Current Oncology, 27 (3), 142-145. https://doi.org/10.3747/co.27.6413.
  • 4. Patel, M.S. (2018). “Strategies For The Optimal Management of Dyspnea in Cancer Patients With Advanced Illness”. Oncology, 32 (12), 583-590.
  • 5. Parshall, M.B, Schwartzstein, R.M, Adams, L, Banzett, B.R, Manning, H.L, Bourbeau, J, Calverley, P.M, Gift, A.G, Harver, A, Lareau, S.C, Mahler, D.A, Meek, P.M, O'Donnell, D.E. (2012) “An Official American Thoracic Society Statement: Update on The Mechanisms, Assessment, and Management of Dyspnea”. American Journal of Respiratory and Critical Care Medicine, 185 (4), 435-452. https://doi.org/ 10.1164/rccm.201111-2042ST
  • 6. Thomas, S, Bausewein, C, Higginson, I, Booth, S. (2011). “Breathlessness İn Cancer Patients–İmplications, Management and Challenges”. European Journal Of Oncology Nursing, 5 (5), 459-469. https://doi.org/10.1016/j.ejon.2010.11.013.
  • 7. Gök Metin, Z. ve Arıkan Dönmez, A. (2016). “Dyspnea Management in Patients with Cancer”. Turkish Journal of Oncology, 31 (2), 61-67. https://doi.org/10.5505/tjo.2016.1366.
  • 8. Meriggi, F. (2018). “Dyspnea in Cancer Patients: A Well-known and Neglected Symptom”. Reviews On Recent Clinical Trials, 13 (2), 84-88.
  • 9. Lok, CW. (2016). “Management of Breathlessness in Patients With Advanced Cancer: A Narrative Review”. American Journal of Hospice and Palliative Medicine, 33 (3), 286-290. https://doi.org/10.1177/1049909114554796.
  • 10. Boulanger, A., Clark, A.J, Squire, P, Cui, E, Horbay, G. (2007). “Chronic Pain in Canada: Have We İmproved Our Management of Chronic Noncancer Pain?”. Pain Research And Management, 12 (1), 39-47. https://doi.org/10.1155/2007/762180.
  • 11. Tahmasebi, M. (2022). “Opiophobia in Palliative Care: Conquering The Last Hill”. Archives of Breast Cancer, 1-3. https://doi.org/10.32768/abc.2022911-3.
  • 12. Rogers, J.B, Modi, P. and Minteer, J.F. (2020). “Dyspnea in Palliative Care”. StatPearls [Internet]. (Erişim Tarihi:19.03.2021).
  • 13. Qaseem, A, Snow, V, Shekelle, P, Casey, D.E, Cross, J.T, Owens, DK. (2008). “Evidence-based Interventions to Improve The Palliative Care of Pain, Dyspnea, and Depression at The End of Life: A Clinical Practice Guideline From The American College of Physicians”. Annals of Internal Medicine,148 (2),141-146. https://doi.org/10.7326/0003-4819-148-2-200801150-00009.
  • 14. Allen, S, Raut, S, Woollard, J, Vassallo, M. (2005). “Low Dose Diamorphine Reduces Breathlessness Without Causing A Fall in Oxygen Saturation in Elderly Patients with End-Stage Idiopathic Pulmonary Fibrosis”. Palliative Medicine, 19(2), 128-130. https://doi.org/10.1191/0269216305pm998oa.
  • 15. Currow, D.C, McDonald, C, Oaten, S, Kenny, B, Allcroft, P, Frith, P, Briffa, M, Amy P Abernethy, A.M. (2011). “Once-Daily Opioids For Chronic Dyspnea: A Dose İncrement and Pharmacovigilance Study”. Journal of Pain and Symptom Management, 42 (3), 388-399. https://doi.org/10.1016/j.jpainsymman.2010.11.021.
  • 16. Abdallah, S. J, Wilkinson-Maitland, C, Saad, N, Li, P.Z, Smith, B.M, Bourbeau, J, Jensen, D. (2017). Effect of Morphine on Breathlessness and Exercise Endurance in Advanced COPD: A Randomised Crossover Trial. European Respiratory Journal, 50 (4). https://doi.org/10.1183/13993003.01235-2017.
  • 17. Johnson, M, Woodcock, A, Geddes, D. (1983). “Dihydrocodeine for Breathlessness in Pink Puffers”. The British Journal of Medicine (Clin Res Ed), 286 (6366), 675-677. https://doi.org/10.1136/bmj.286.6366.675.
  • 18. Harris, D. (2019). “Safe and Effective Prescribing for Symptom Management in Palliative Care”. British Journal of Hospital Medicine, 80 (12), C184-C189. https://doi.org/10.12968/hmed.2019.80.12.C184.
  • 19. Pisani, L, Hill, N.S, Pacilli, A.M.G, Polastri, M, Nava, S. (2018). “Management of Dyspnea in the Terminally Ill”. Chest, 154 (4), 925-934. https://doi.org/10.1016/j.chest.2018.04.003.
  • 20. Yardley, I, Yardley, S, Williams, H, Carson-Stevens, A, Donaldson, L.J. (2018). “Patient Safety in Palliative Care: a Mixed-Methods Study of Reports to a National Database of Serious Incidents”. Palliative Medicine, 32 (8), 1353-1362. https://doi.org/10.1177/0269216318776846.
  • 21. Heneka, N, Bhattarai, P, Shaw, T, Rowett, D, Lapkin, S, Phillips, J.L. (2019). “Clinicians’ Perceptions of Opioid Error–Contributing Factors in İnpatient Palliative Care Services: A Qualitative Study”. Palliative Medicine, 33 (4), 430-444. https://doi.org/10.1177/0269216319832799.
  • 22. Heneka, N, Shaw, T, Debra Rowett, D, Lapkin, S., Phillips, J.L. (2018). “Opioid Errors in İnpatient Palliative Cre Services: A Retrospective Review”. BMJ Supportive & Palliative Care, 8 (2), 175-179. https://doi.org/10.1136/bmjspcare-2017-001417.
  • 23. Shaheen, P.E, LeGrand, S.B, Walsh, D, Estfan, B, Mellar P Davis, M.P, Lagman, R.L, Riaz, M, Cheema, B. (2010). “Errors in Opioid Prescribing: a Prospective Survey İn Cancer Pain”. Journal of Pain and Symptom Management, 39 (4), 702-711. https://doi.org/10.1016/j.jpainsymman.2009.09.009.
  • 24. Barnes, H, McDonald, J, Smallwood, N, Manser, R. (2016). “Opioids for the Palliation of Refractory Breathlessness in Adults With Advanced Disease and Terminal İllness”. Cochrane Database of Systematic Reviews, 31, 3 (3), CD011008. https://doi.org/10.1002/14651858.CD011008.pub2.
  • 25. Hadjiphilippou, S, Odogwu, S.E. and Dand, P. (2014). “Doctors’ Attitudes Towards Prescribing Opioids for Refractory Dyspnoea: a Single-Centred Study”. BMJ Supportive & Palliative Care, 4 (2), 190-192. https://doi.org/10.1136/bmjspcare-2013-000565.
  • 26. Janssen, D.J, Hosson, S, Vaate, E, Mooren, K.J, Baas, A.A. (2015). “Attitudes toward Opioids For Refractory Dyspnea in COPD Among Dutch Chest Physicians”. Chronic Respiratory Disease, 12 (2), 85-92. https://doi.org/10.1177/1479972315571926.
  • 27. Young, J, Donahue, M, Farquhar, M, Simpson, C, Rocker, G. (2012). “Using Opioids to Treat Dyspnea in Advanced COPD: Attitudes and Experiences of Family Physicians and Respiratory Therapists”. Canadian Family Physician, 58 (7), e401-e407.
  • 28. Baldemir, R, Akçaboy, E.Y, Çelik, Ş, Noyan, Ö, Akçaboy, Z.N, Baydar, M. (2019). “Doktorların Opioid Kullanımı ve Opiofobiye Yaklaşımlarının Değerlendirilmesi: Bir Eğitim ve Araştırma Hastanesinden Anket Sonuçları”. Ağrı, 31 (1), 23-31.
  • 29. Ben-Aharon, I, Gafter-Gvili, A, Leibovici, L, Stemmer, S.M. (2012). “Interventions for Alleviating Cancer-Related Dyspnea: A Systematic Review and Meta-Analysis”. Acta Oncologica, 51 (8), 996-1008. https://doi.org/10.3109/0284186X.2012.709638.
  • 30. Yamaguchi, T, Matsunuma, R, Suzuki, K, Matsuda, Y, Mori, M, Watanabe, H. (2019). “The Current Practice of Opioid For Cancer Dyspnea: The Result From The Nationwide Survey of Japanese Palliative Care Physicians”. Journal of Pain and Symptom Management, 58 (4),6 672-677. https://doi.org/10.1016/j.jpainsymman.2019.06.006.

Examining the Approaches of Physicians and Nurses Working in Palliative Care Unit Concerning the Use of Morphine in the Dyspnea Treatment

Yıl 2022, Cilt 11, Sayı 2, 387 - 394, 30.06.2022
https://doi.org/10.37989/gumussagbil.868726

Öz

Being among the opioids which have been proven to be effective in the management of dyspnea, morphine reduces ventilation, anxiety and central dyspnea perception by being bound to opioid receptors as in pain. The purpose in this study was to examine the approaches of physicians and nurses working in palliative care unit (PCU) concerning morphine administrations in the dyspnea treatment. The population of the descriptive study comprised 80 nurses and 30 physicians who were working in the PCUs of five hospitals. In the study the “Descriptive Characteristics Form” and “Approaches of Physicians/Nurses Concerning Use of Morphine Survey” were used as data collection tool. Thirty one (38.8%) of the nurses stated that they encountered with patients with dyspnea every day. Of the nurses, 61 (76.3%) indicated that they had to be more careful when administering the prescribed morphine to patients compared to other medicine and 77 (96.3%) indicated that they had to follow patients more frequently due to respiratory-depression impacts. Half of the physicians stated that they encountered with patients with dyspnea every day and 18 (60%) stated that they prescribed morphine in the dyspnea treatment in the PCU. 27 (90%) of the physicians thought that morphine was not the first option treatment approach in patients with dyspnea. Although the effectiveness of morphine in the management of dyspnea has been proved, it has been seen that physicians hesitate when prescribing it and nurses hesitate when applying it due to its side effects, legal responsibilities and medical errors that may be encountered during the administration.

Kaynakça

  • 1. Fukushi, I, Pokorski, M. and Okada, Y. (2021). “Mechanisms Underlying The Sensation of Dyspnea”. Respiratory Investigation, 59 (1), 66-80. https://doi.org/10.1016/j.resinv.2020.10.007.
  • 2. Chin, C. and Booth, S. (2016). “Managing Breathlessness: A Palliative Care Approach”. Postgraduate Medical Journal, 92 (1089), 393-400. https://doi.org/ 10.1136/postgradmedj-2015-133578.
  • 3. Crombeen, A.M. and Lilly, E. J. (2020). “Management of Dyspnea in Palliative Care”. Current Oncology, 27 (3), 142-145. https://doi.org/10.3747/co.27.6413.
  • 4. Patel, M.S. (2018). “Strategies For The Optimal Management of Dyspnea in Cancer Patients With Advanced Illness”. Oncology, 32 (12), 583-590.
  • 5. Parshall, M.B, Schwartzstein, R.M, Adams, L, Banzett, B.R, Manning, H.L, Bourbeau, J, Calverley, P.M, Gift, A.G, Harver, A, Lareau, S.C, Mahler, D.A, Meek, P.M, O'Donnell, D.E. (2012) “An Official American Thoracic Society Statement: Update on The Mechanisms, Assessment, and Management of Dyspnea”. American Journal of Respiratory and Critical Care Medicine, 185 (4), 435-452. https://doi.org/ 10.1164/rccm.201111-2042ST
  • 6. Thomas, S, Bausewein, C, Higginson, I, Booth, S. (2011). “Breathlessness İn Cancer Patients–İmplications, Management and Challenges”. European Journal Of Oncology Nursing, 5 (5), 459-469. https://doi.org/10.1016/j.ejon.2010.11.013.
  • 7. Gök Metin, Z. ve Arıkan Dönmez, A. (2016). “Dyspnea Management in Patients with Cancer”. Turkish Journal of Oncology, 31 (2), 61-67. https://doi.org/10.5505/tjo.2016.1366.
  • 8. Meriggi, F. (2018). “Dyspnea in Cancer Patients: A Well-known and Neglected Symptom”. Reviews On Recent Clinical Trials, 13 (2), 84-88.
  • 9. Lok, CW. (2016). “Management of Breathlessness in Patients With Advanced Cancer: A Narrative Review”. American Journal of Hospice and Palliative Medicine, 33 (3), 286-290. https://doi.org/10.1177/1049909114554796.
  • 10. Boulanger, A., Clark, A.J, Squire, P, Cui, E, Horbay, G. (2007). “Chronic Pain in Canada: Have We İmproved Our Management of Chronic Noncancer Pain?”. Pain Research And Management, 12 (1), 39-47. https://doi.org/10.1155/2007/762180.
  • 11. Tahmasebi, M. (2022). “Opiophobia in Palliative Care: Conquering The Last Hill”. Archives of Breast Cancer, 1-3. https://doi.org/10.32768/abc.2022911-3.
  • 12. Rogers, J.B, Modi, P. and Minteer, J.F. (2020). “Dyspnea in Palliative Care”. StatPearls [Internet]. (Erişim Tarihi:19.03.2021).
  • 13. Qaseem, A, Snow, V, Shekelle, P, Casey, D.E, Cross, J.T, Owens, DK. (2008). “Evidence-based Interventions to Improve The Palliative Care of Pain, Dyspnea, and Depression at The End of Life: A Clinical Practice Guideline From The American College of Physicians”. Annals of Internal Medicine,148 (2),141-146. https://doi.org/10.7326/0003-4819-148-2-200801150-00009.
  • 14. Allen, S, Raut, S, Woollard, J, Vassallo, M. (2005). “Low Dose Diamorphine Reduces Breathlessness Without Causing A Fall in Oxygen Saturation in Elderly Patients with End-Stage Idiopathic Pulmonary Fibrosis”. Palliative Medicine, 19(2), 128-130. https://doi.org/10.1191/0269216305pm998oa.
  • 15. Currow, D.C, McDonald, C, Oaten, S, Kenny, B, Allcroft, P, Frith, P, Briffa, M, Amy P Abernethy, A.M. (2011). “Once-Daily Opioids For Chronic Dyspnea: A Dose İncrement and Pharmacovigilance Study”. Journal of Pain and Symptom Management, 42 (3), 388-399. https://doi.org/10.1016/j.jpainsymman.2010.11.021.
  • 16. Abdallah, S. J, Wilkinson-Maitland, C, Saad, N, Li, P.Z, Smith, B.M, Bourbeau, J, Jensen, D. (2017). Effect of Morphine on Breathlessness and Exercise Endurance in Advanced COPD: A Randomised Crossover Trial. European Respiratory Journal, 50 (4). https://doi.org/10.1183/13993003.01235-2017.
  • 17. Johnson, M, Woodcock, A, Geddes, D. (1983). “Dihydrocodeine for Breathlessness in Pink Puffers”. The British Journal of Medicine (Clin Res Ed), 286 (6366), 675-677. https://doi.org/10.1136/bmj.286.6366.675.
  • 18. Harris, D. (2019). “Safe and Effective Prescribing for Symptom Management in Palliative Care”. British Journal of Hospital Medicine, 80 (12), C184-C189. https://doi.org/10.12968/hmed.2019.80.12.C184.
  • 19. Pisani, L, Hill, N.S, Pacilli, A.M.G, Polastri, M, Nava, S. (2018). “Management of Dyspnea in the Terminally Ill”. Chest, 154 (4), 925-934. https://doi.org/10.1016/j.chest.2018.04.003.
  • 20. Yardley, I, Yardley, S, Williams, H, Carson-Stevens, A, Donaldson, L.J. (2018). “Patient Safety in Palliative Care: a Mixed-Methods Study of Reports to a National Database of Serious Incidents”. Palliative Medicine, 32 (8), 1353-1362. https://doi.org/10.1177/0269216318776846.
  • 21. Heneka, N, Bhattarai, P, Shaw, T, Rowett, D, Lapkin, S, Phillips, J.L. (2019). “Clinicians’ Perceptions of Opioid Error–Contributing Factors in İnpatient Palliative Care Services: A Qualitative Study”. Palliative Medicine, 33 (4), 430-444. https://doi.org/10.1177/0269216319832799.
  • 22. Heneka, N, Shaw, T, Debra Rowett, D, Lapkin, S., Phillips, J.L. (2018). “Opioid Errors in İnpatient Palliative Cre Services: A Retrospective Review”. BMJ Supportive & Palliative Care, 8 (2), 175-179. https://doi.org/10.1136/bmjspcare-2017-001417.
  • 23. Shaheen, P.E, LeGrand, S.B, Walsh, D, Estfan, B, Mellar P Davis, M.P, Lagman, R.L, Riaz, M, Cheema, B. (2010). “Errors in Opioid Prescribing: a Prospective Survey İn Cancer Pain”. Journal of Pain and Symptom Management, 39 (4), 702-711. https://doi.org/10.1016/j.jpainsymman.2009.09.009.
  • 24. Barnes, H, McDonald, J, Smallwood, N, Manser, R. (2016). “Opioids for the Palliation of Refractory Breathlessness in Adults With Advanced Disease and Terminal İllness”. Cochrane Database of Systematic Reviews, 31, 3 (3), CD011008. https://doi.org/10.1002/14651858.CD011008.pub2.
  • 25. Hadjiphilippou, S, Odogwu, S.E. and Dand, P. (2014). “Doctors’ Attitudes Towards Prescribing Opioids for Refractory Dyspnoea: a Single-Centred Study”. BMJ Supportive & Palliative Care, 4 (2), 190-192. https://doi.org/10.1136/bmjspcare-2013-000565.
  • 26. Janssen, D.J, Hosson, S, Vaate, E, Mooren, K.J, Baas, A.A. (2015). “Attitudes toward Opioids For Refractory Dyspnea in COPD Among Dutch Chest Physicians”. Chronic Respiratory Disease, 12 (2), 85-92. https://doi.org/10.1177/1479972315571926.
  • 27. Young, J, Donahue, M, Farquhar, M, Simpson, C, Rocker, G. (2012). “Using Opioids to Treat Dyspnea in Advanced COPD: Attitudes and Experiences of Family Physicians and Respiratory Therapists”. Canadian Family Physician, 58 (7), e401-e407.
  • 28. Baldemir, R, Akçaboy, E.Y, Çelik, Ş, Noyan, Ö, Akçaboy, Z.N, Baydar, M. (2019). “Doktorların Opioid Kullanımı ve Opiofobiye Yaklaşımlarının Değerlendirilmesi: Bir Eğitim ve Araştırma Hastanesinden Anket Sonuçları”. Ağrı, 31 (1), 23-31.
  • 29. Ben-Aharon, I, Gafter-Gvili, A, Leibovici, L, Stemmer, S.M. (2012). “Interventions for Alleviating Cancer-Related Dyspnea: A Systematic Review and Meta-Analysis”. Acta Oncologica, 51 (8), 996-1008. https://doi.org/10.3109/0284186X.2012.709638.
  • 30. Yamaguchi, T, Matsunuma, R, Suzuki, K, Matsuda, Y, Mori, M, Watanabe, H. (2019). “The Current Practice of Opioid For Cancer Dyspnea: The Result From The Nationwide Survey of Japanese Palliative Care Physicians”. Journal of Pain and Symptom Management, 58 (4),6 672-677. https://doi.org/10.1016/j.jpainsymman.2019.06.006.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Bilimleri ve Hizmetleri
Bölüm Araştırma Makaleleri
Yazarlar

Vildan KOCATEPE> (Sorumlu Yazar)
ACIBADEM MEHMET ALİ AYDINLAR ÜNİVERSİTESİ
0000-0001-6928-6818
Türkiye


Özlem ORUÇ Bu kişi benim
İSTANBUL SÜREYYAPAŞA GÖĞÜS HASTALIKLARI VE GÖĞÜS CERRAHİSİ EĞİTİM VE ARAŞTIRMA HASTANESİ
0000-0003-3197-4767
Türkiye


Pınar BAĞCI Bu kişi benim
İSTANBUL SÜREYYAPAŞA GÖĞÜS HASTALIKLARI VE GÖĞÜS CERRAHİSİ EĞİTİM VE ARAŞTIRMA HASTANESİ
0000-0003-0386-6208
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Seyhan YAMAN Bu kişi benim
İSTANBUL SÜREYYAPAŞA GÖĞÜS HASTALIKLARI VE GÖĞÜS CERRAHİSİ EĞİTİM VE ARAŞTIRMA HASTANESİ
0000-0002-5009-9913
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İSTANBUL SÜREYYAPAŞA GÖĞÜS HASTALIKLARI VE GÖĞÜS CERRAHİSİ EĞİTİM VE ARAŞTIRMA HASTANESİ
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İSTANBUL SÜREYYAPAŞA GÖĞÜS HASTALIKLARI VE GÖĞÜS CERRAHİSİ EĞİTİM VE ARAŞTIRMA HASTANESİ
0000-0001-8508-3375
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Destekleyen Kurum yok
Proje Numarası -
Teşekkür -
Yayımlanma Tarihi 30 Haziran 2022
Yayınlandığı Sayı Yıl 2022, Cilt 11, Sayı 2

Kaynak Göster

Bibtex @araştırma makalesi { gumussagbil868726, journal = {Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi}, eissn = {2146-9954}, address = {}, publisher = {Gümüşhane Üniversitesi}, year = {2022}, volume = {11}, number = {2}, pages = {387 - 394}, doi = {10.37989/gumussagbil.868726}, title = {Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi}, key = {cite}, author = {Kocatepe, Vildan and Oruç, Özlem and Bağcı, Pınar and Yaman, Seyhan and Birol, Sevinç and Aydın, Perihan} }
APA Kocatepe, V. , Oruç, Ö. , Bağcı, P. , Yaman, S. , Birol, S. & Aydın, P. (2022). Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi . Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi , 11 (2) , 387-394 . DOI: 10.37989/gumussagbil.868726
MLA Kocatepe, V. , Oruç, Ö. , Bağcı, P. , Yaman, S. , Birol, S. , Aydın, P. "Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi" . Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 11 (2022 ): 387-394 <https://dergipark.org.tr/tr/pub/gumussagbil/issue/70821/868726>
Chicago Kocatepe, V. , Oruç, Ö. , Bağcı, P. , Yaman, S. , Birol, S. , Aydın, P. "Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi". Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 11 (2022 ): 387-394
RIS TY - JOUR T1 - Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi AU - Vildan Kocatepe , Özlem Oruç , Pınar Bağcı , Seyhan Yaman , Sevinç Birol , Perihan Aydın Y1 - 2022 PY - 2022 N1 - doi: 10.37989/gumussagbil.868726 DO - 10.37989/gumussagbil.868726 T2 - Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi JF - Journal JO - JOR SP - 387 EP - 394 VL - 11 IS - 2 SN - -2146-9954 M3 - doi: 10.37989/gumussagbil.868726 UR - https://doi.org/10.37989/gumussagbil.868726 Y2 - 2022 ER -
EndNote %0 Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi %A Vildan Kocatepe , Özlem Oruç , Pınar Bağcı , Seyhan Yaman , Sevinç Birol , Perihan Aydın %T Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi %D 2022 %J Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi %P -2146-9954 %V 11 %N 2 %R doi: 10.37989/gumussagbil.868726 %U 10.37989/gumussagbil.868726
ISNAD Kocatepe, Vildan , Oruç, Özlem , Bağcı, Pınar , Yaman, Seyhan , Birol, Sevinç , Aydın, Perihan . "Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi". Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 11 / 2 (Haziran 2022): 387-394 . https://doi.org/10.37989/gumussagbil.868726
AMA Kocatepe V. , Oruç Ö. , Bağcı P. , Yaman S. , Birol S. , Aydın P. Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2022; 11(2): 387-394.
Vancouver Kocatepe V. , Oruç Ö. , Bağcı P. , Yaman S. , Birol S. , Aydın P. Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2022; 11(2): 387-394.
IEEE V. Kocatepe , Ö. Oruç , P. Bağcı , S. Yaman , S. Birol ve P. Aydın , "Palyatif Bakım Ünitesinde Çalışan Hekim ve Hemşirelerin Dispne Tedavisinde Morfin Kullanımı ile İlgili Yaklaşımlarının İncelenmesi", Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, c. 11, sayı. 2, ss. 387-394, Haz. 2022, doi:10.37989/gumussagbil.868726