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YOUTUBE VIDEOS AS A SOURCE OF INFORMATION ON INTRAMUSCULAR INJECTION APPLICATION WITH THE Z TECHNIQUE: CONTENT, QUALITY AND RELIABILITY ANALYSIS

Yıl 2024, Cilt: 12 Sayı: 3, 786 - 800, 21.10.2024
https://doi.org/10.33715/inonusaglik.1446136

Öz

YouTube videos about intramuscular injection with the Z technique were evaluated for content, quality and reliability. A search of YouTube was made on 13 November 2023 using the keywords of “Z technique” and “intramuscular injection”. 40 videos that fulfilled the inclusion criteria were assessed for usefulness using the Z Technique Intramuscular Injection Administration Checklist (ZIAC), reliability using the Quality Criteria for Consumer Health (DISCERN), and quality using the Global Quality Scale (GQS) scores. Most of the videos used in the study belonged to individual content producers. The videos were determined to be of medium quality, and reliability, but their usefulness was not at the desired level based on their ZIAC, DISCERN, and GQS scores (respectively; 16.92±2.72; 2.92±0.763; 3.03±0.77). Furthermore, the videos' usefulness (ZIAC), reliability (DISCERN), and quality (GQS) scores all showed a strong positive correlation. It was determined that the dorsogluteal region was preferred in 48.1% of the videos (n=13), and the region was determined correctly in 67.5% of the videos (n=27). To provide the most reliable information to healthcare professionals, particularly nurses, it is recommended that expert nurses and educators create qualified videos about the use of intramuscular injection with the Z technique and share them on YouTube.

Proje Numarası

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Kaynakça

  • Abdelkhalek, W. S. S. (2019). The effect of shot blocker and Z–Track techniques on reducing the needle pain and anxiety associated with intramuscular injection. International Journal of Nursing Didactics, 9(12), 31-38. https://doi.org/10.15520/ijnd.v9i12.2777
  • Abedin, T., Ahmed, S., Al Mamun, M., Ahmed, S.W., Newaz, S., Rumana, N. and Turin, T.C. (2015). YouTube as a source of useful information on diabetes foot care. Diabetes Res Clin Pract, 110(1), e1-e4. https://doi.org/10.1016/j.diabres.2015.08.003
  • Annutto, A. (2023). “Improving patient safety associated with intramuscular injection by educating nurses on recommended practice: a quality ımprovement project”. [Master’s thesis, University of New Hampshire]. https://scholars.unh.edu/thesis/1684/
  • Aydin, M.A. and Akyol, H. (2020). Quality of information available on YouTube videos pertaining to thyroid cancer. J Cancer Educ, 35(3), 599-605. https://doi.org/10.1007/s13187-019-01502-9
  • Ayinde, O. and Ross, J. D. (2020). Factors associated with severity and resolution of intramuscular injection site pain following treatment for uncomplicated gonorrhoea: a prospective cohort study of GToG trial participants. Sexual Health, 17(3), 255-261. https://doi.org/10.1071/SH19176
  • Baş, D.Y. and Keçeci, A. (2023). Barriers of Nurses’ about ‘Z-Track Method ’Which is Used in Intramuskuler Injections Applications. Akd Nurs J, 2(1), 1-9. https://doi.org/10.59398/ahd.1123694
  • Bernard, A., Langille, M., Hughes, S., Rose, C., Leddin, D. and van Zanten, S.V. (2007). A systematic review of patient inflammatory bowel disease information resources on the world wide web. American Journal of Gastroenterology, 102(9), 2070–2077.
  • Centers for Disease Control and Prevention. (2023). ACIP vaccine administration guidelines for ımmunization. centers for disease control and prevention. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html
  • Charnock, D., Shepperd, S., Needham, G. and Gann, R. (1999). Discern: An instrument for judging the quality of written consumer health information on treatment choices. Journal of Epidemiology & Community Health, 53(2), 105–111. https://doi.org/10.1136/jech.53.2.105
  • Culha, Y., Seyhan Ak, E., Merder, E., Ariman, A. and Culha, M.G. (2021). Analysis of the YouTube videos on pelvic floor muscle exercise training in terms of their reliability and quality. Int Urol Nephrol. 53, 1-6. https://doi.org/10.1007/s11255-020-02620-w
  • Çoban, G.İ., Şirin, M., Kavuran, E. ve Çiftçi, B. (2015). Üniversite hastanesinde hemşirelerin oral ilaç uygulama güvenliğini tehdit eden faktörlerin incelenmesi. Gümüşhane Univ Sağlık Bilim Derg, 4(1), 28.
  • Davis, L.L. (1992). Instrument review: Getting the most from a panel of experts. Applied Nursing Research, 5(4), 194–197. https://doi.org/10.1016/S0897-1897(05)80008-4.
  • Dinc, L. (2011). Parenteral ilaçlar. (T.A. Asti ve A. Karadağ, Ed.) Klinik Uygulama Becerileri ve Yöntemleri. Ankara: Nobel kitabevi.
  • Drozd, B., Couvillon, E. and Suarez, A. (2018). Medical YouTube videos and methods of evaluation: literature review. JMIR Med Educ, 4(1), e3.
  • Ellaway, R.H., Fink, P., Graves, L. and Campbell, A. (2014). Left to their own devices: medical learners’ use of mobile technologies. Med Teach, 36(2), 130-138. https://doi.org/10.3109/0142159X.2013.849800
  • Elsaid, R.A.A. and Abdelkhalek, W.S.S. (2019). The Effect of shot blocker and Z –track techniques on reducing the needle pain and anxiety associated with intramuscular injection. Int J Nurs Didact, 9(12), 31-38.
  • Ferhatoglu, M.F., Kartal, A., Ekici, U. and Gurkan, A. (2019). Evaluation of the reliability, utility, and quality of the information in sleeve gastrectomy videos shared on open access video sharing platform YouTube. Obes Surg, 29, 1477-1484. https://doi.org/10.1007/s11695-019-03738-2
  • Gaikwad, H.S., Sindhu, A. and Sarda, N. (2017). Comparison of efficacy and safety of intravenous iron sucrose and intramuscular iron sorbitol therapy in patients with anemia during pregnancy in a developing country. Asian J Med Sci, 8(5), 31-35. https://doi.org/10.3126/ajms.v8i5.17426
  • Garside, M.J., Fisher, J.M., Blundell, A.G. and Gordon, A.L. (2018). The development and evaluation of mini-gems–short, focused, online e-learning videos in geriatric medicine. Gerontol Geriatr Educ, 39(2), 132-143. https://doi.org/10.1080/02701960.2016.1165217
  • Gittens, G. and Bunnell, T. (2009). Skin disinfection and its efficacy before administering injections. Nursing Standard, 23(39), 42.
  • Kara, D., and Güneş, Ü.Y. (2016). The effect on pain of three different methods of intramuscular injection: A randomized controlled trial. International Journal of Nursing Practice, 22(2), 152-159. https://doi.org/10.1111/ijn.12358
  • Kaşıkçı, M.K. and Akın, E. (2021). Hemşirelik Bakım Kavramı (1. Baskı). İstanbul: İstanbul Tıp Kitabevleri.
  • Kaya, N. and Palloş, A. (2012). Parenteral Drug Management. (Atabek Aştı, T. & Karadağ, A. Ed.). İstanbul: Akademi Basın ve Yayıncılık.
  • Kocayiğit, H. and Bal, N.Ş. (2022). Percutaneous dilatational tracheostomy: evaluation of YouTube videos. Anaesthesiologie, 71(Suppl 2), 219-223.
  • Larkin, T.A., Ashcroft, E., Elgellaie, A. and Hickey, B.A. (2017). Ventrogluteal versus dorsogluteal site selection: A cross-sectional study of muscle and subcutaneous fat thicknesses and an algorithm incorporating demographic and anthropometric data to predict injection outcome. Int J Nurs Stud, 71, 1-7. https://doi.org/10.1016/j.ijnurstu.2017.02.017
  • Lee, J.S., Seo, H.S. and Hong, T.H. (2014). YouTube as A source of patient information on gallstone disease. World J Gastroenterol, 20(14), 4066- 4070. https://doi.org/10.3748/wjg.v20.i14.4066
  • Madathil, K.C., Rivera-Rodriguez, A.J., Greenstein, J.S. and Gramopadhye, A.K. (2015). Healthcare information on YouTube: a systematic review. Health Informatics J, 21(3), 173-194. https://doi.org/10.1177/1460458213512220
  • Mehta, D.R., Pillai, A. and Singh, A.P. (2014). An observational study of safe injection practices in a tertiary care teaching hospital. Int J Appl Res, 2(5), 733-737.
  • Milutinović, D., Tomić, S., Puškaš, V., Brestovački-Svitlica, B. and Simin, D. (2018). Frequency of application and level of nurses’ knowledge on administering intramuscular injections into the ventrogluteal site. Med Pregl, 71(suppl. 1), 59-64. https://doi.org/10.2298/MPNS18S1059M
  • Sabuncu, N., Alpar, Ş.E., Karabacak, Ü., Karabacak, B.G., Şenturan, L., Orak, N.Ş. ve Şahin, A.O. (2015). Hemşirelik Esasları: Temel Beceriler Rehberi (2. baskı). İstanbul: İstanbul Tıp Kitabevi.
  • Sblendorio, E. (2023). IM vaccine administrations including the adoption of “Zeta-track technique” & “Without aspiration slow injection technique” (ZTT & Wasit): A prospective review. Front Nurs, 10(1), 21–42. https://doi.org/10.2478/fon-2023-0003
  • Srividya, B.P., Nagabushan, H. and Drupad, H.S. (2015). Assessment of knowledge among health care providers regarding intramuscular injection administration. Asian J Pharm Clin Res, 8(1), 220-222.
  • Taddio, A., Ipp, M., Thivakaran, S., Jamal, A., Parikh, C., Smart, S., Sovran, J., Stephens, D. and Katz, J. (2021). Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine, 30(32), 4807-4812. https://doi.org/10.1016/j.vaccine.2012.05.011
  • Tatlı, Z., Aydın, A., Şimşek, P., Özdemir, M., Gölbaşı, S., Karacan, S., Gürsoy, A. and Gündüz, A. (2018). Hemşirelerin ve hemşirelik öğrencilerinin bilişim teknolojilerini kullanma durumları. Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi, 1(1), 18-27.
  • Tosun, H. and Tosun, A. (2022). An information source for blood pressure measurement: YouTube analysis. Turk J Cardiovasc Nurs, 13(30), 28-35. https://doi.org/10.5543/khd.2022.212437
  • Zeyrek, A. Ş., Takmak, Ş., Kurban, N. K., and Arslan, S. (2019). Systematic review and meta‐analysis: Physical‐procedural interventions used to reduce pain during intramuscular injections in adults. Journal of Advanced Nursing, 75(12), 3346-3361. https://doi.org/10.1111/jan.14183
  • World Health Organization. (2015). WHO guideline on the use of safety-engineered syringes for intramuscular, intradermal and subcutaneous injections in health care settings. https://iris.who.int/bitstream/handle/10665/250144/9789241549820-eng.pdf?sequence=1
  • Wynaden, D., Tohotoa, J., Omari, O.A., Happell, B., Heslop, K., Barr, L. and Sourinathan, V. (2015). Administering intramuscular injections: How does research translate into practice over time in the mental health setting?. Nurse Educ Today, 35(4), 620-624. https://doi.org/10.1016/j.nedt.2014.12.008

Z Tekniği ile İntramüsküler Enjeksiyon Uygulama Konusunda Bilgi Kaynağı Olarak YouTube Videoları: İçerik, Kalite ve Güvenilirlik Analizi

Yıl 2024, Cilt: 12 Sayı: 3, 786 - 800, 21.10.2024
https://doi.org/10.33715/inonusaglik.1446136

Öz

Z tekniği ile intramüsküler enjeksiyon uygulama konusundaki YouTube videoları, içerik, kalite ve güvenilirlik açısından değerlendirildi. 13 Kasım 2023 tarihinde “Z tekniği” ve “intramüsküler enjeksiyon” anahtar kelimeleri kullanılarak YouTube’da arama yapıldı. Dahil edilme kriterlerini karşılayan 40 videonun yararlılığı Z Tekniği ile İntramüsküler Enjeksiyon Uygulaması Kontrol Listesiyle (ZİUK), güvenilirliği Tüketici Sağlığı Bilgileri için Kalite Kriterleri (DISCERN) ve kalitesi Küresel Kalite Skalası (GQS) puanlarına göre değerlendirildi. Araştırmada kullanılan videoların çoğu bireysel içerik üreticilerine aitti. Videoların ZİUK, DISCERN ve GQS puanları dikkate alındığında orta düzey güvenirlik ve kalitede olduğu fakat yararlılıklarının istenilen düzeyde olmadığı belirlendi (sırasıyla; 16.92±2.72; 2.92±0.763; 3.03±0.77). Ayrıca videoların yararlılık (ZİUK), güvenirlik (DISCERN) ve kalite (GQS) skorlarının pozitif yönde güçlü korelasyona sahip olduğu saptandı. Videonun %48.1’inde (n=13) dorsogluteal bölgenin tercih edildiği ve videoların %67.5’inde (n=27) bölge tespitinin doğru yapıldığı belirlendi. Başta hemşireler olmak üzere sağlık profesyonellerine en güvenilir bilgileri sunabilmek için, alanında uzman hemşire ve eğitimcilerin Z tekniği ile intramüsküler enjeksiyon uygulamasına yönelik nitelikli videolar üretmeleri ve YouTube’da paylaşmaları önerilmektedir.

Etik Beyan

Bu çalışmada, yalnızca kamuya açık veriler kullandığı için etik kurul onayı gerektirmemektedir.

Destekleyen Kurum

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Proje Numarası

-

Teşekkür

-

Kaynakça

  • Abdelkhalek, W. S. S. (2019). The effect of shot blocker and Z–Track techniques on reducing the needle pain and anxiety associated with intramuscular injection. International Journal of Nursing Didactics, 9(12), 31-38. https://doi.org/10.15520/ijnd.v9i12.2777
  • Abedin, T., Ahmed, S., Al Mamun, M., Ahmed, S.W., Newaz, S., Rumana, N. and Turin, T.C. (2015). YouTube as a source of useful information on diabetes foot care. Diabetes Res Clin Pract, 110(1), e1-e4. https://doi.org/10.1016/j.diabres.2015.08.003
  • Annutto, A. (2023). “Improving patient safety associated with intramuscular injection by educating nurses on recommended practice: a quality ımprovement project”. [Master’s thesis, University of New Hampshire]. https://scholars.unh.edu/thesis/1684/
  • Aydin, M.A. and Akyol, H. (2020). Quality of information available on YouTube videos pertaining to thyroid cancer. J Cancer Educ, 35(3), 599-605. https://doi.org/10.1007/s13187-019-01502-9
  • Ayinde, O. and Ross, J. D. (2020). Factors associated with severity and resolution of intramuscular injection site pain following treatment for uncomplicated gonorrhoea: a prospective cohort study of GToG trial participants. Sexual Health, 17(3), 255-261. https://doi.org/10.1071/SH19176
  • Baş, D.Y. and Keçeci, A. (2023). Barriers of Nurses’ about ‘Z-Track Method ’Which is Used in Intramuskuler Injections Applications. Akd Nurs J, 2(1), 1-9. https://doi.org/10.59398/ahd.1123694
  • Bernard, A., Langille, M., Hughes, S., Rose, C., Leddin, D. and van Zanten, S.V. (2007). A systematic review of patient inflammatory bowel disease information resources on the world wide web. American Journal of Gastroenterology, 102(9), 2070–2077.
  • Centers for Disease Control and Prevention. (2023). ACIP vaccine administration guidelines for ımmunization. centers for disease control and prevention. https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html
  • Charnock, D., Shepperd, S., Needham, G. and Gann, R. (1999). Discern: An instrument for judging the quality of written consumer health information on treatment choices. Journal of Epidemiology & Community Health, 53(2), 105–111. https://doi.org/10.1136/jech.53.2.105
  • Culha, Y., Seyhan Ak, E., Merder, E., Ariman, A. and Culha, M.G. (2021). Analysis of the YouTube videos on pelvic floor muscle exercise training in terms of their reliability and quality. Int Urol Nephrol. 53, 1-6. https://doi.org/10.1007/s11255-020-02620-w
  • Çoban, G.İ., Şirin, M., Kavuran, E. ve Çiftçi, B. (2015). Üniversite hastanesinde hemşirelerin oral ilaç uygulama güvenliğini tehdit eden faktörlerin incelenmesi. Gümüşhane Univ Sağlık Bilim Derg, 4(1), 28.
  • Davis, L.L. (1992). Instrument review: Getting the most from a panel of experts. Applied Nursing Research, 5(4), 194–197. https://doi.org/10.1016/S0897-1897(05)80008-4.
  • Dinc, L. (2011). Parenteral ilaçlar. (T.A. Asti ve A. Karadağ, Ed.) Klinik Uygulama Becerileri ve Yöntemleri. Ankara: Nobel kitabevi.
  • Drozd, B., Couvillon, E. and Suarez, A. (2018). Medical YouTube videos and methods of evaluation: literature review. JMIR Med Educ, 4(1), e3.
  • Ellaway, R.H., Fink, P., Graves, L. and Campbell, A. (2014). Left to their own devices: medical learners’ use of mobile technologies. Med Teach, 36(2), 130-138. https://doi.org/10.3109/0142159X.2013.849800
  • Elsaid, R.A.A. and Abdelkhalek, W.S.S. (2019). The Effect of shot blocker and Z –track techniques on reducing the needle pain and anxiety associated with intramuscular injection. Int J Nurs Didact, 9(12), 31-38.
  • Ferhatoglu, M.F., Kartal, A., Ekici, U. and Gurkan, A. (2019). Evaluation of the reliability, utility, and quality of the information in sleeve gastrectomy videos shared on open access video sharing platform YouTube. Obes Surg, 29, 1477-1484. https://doi.org/10.1007/s11695-019-03738-2
  • Gaikwad, H.S., Sindhu, A. and Sarda, N. (2017). Comparison of efficacy and safety of intravenous iron sucrose and intramuscular iron sorbitol therapy in patients with anemia during pregnancy in a developing country. Asian J Med Sci, 8(5), 31-35. https://doi.org/10.3126/ajms.v8i5.17426
  • Garside, M.J., Fisher, J.M., Blundell, A.G. and Gordon, A.L. (2018). The development and evaluation of mini-gems–short, focused, online e-learning videos in geriatric medicine. Gerontol Geriatr Educ, 39(2), 132-143. https://doi.org/10.1080/02701960.2016.1165217
  • Gittens, G. and Bunnell, T. (2009). Skin disinfection and its efficacy before administering injections. Nursing Standard, 23(39), 42.
  • Kara, D., and Güneş, Ü.Y. (2016). The effect on pain of three different methods of intramuscular injection: A randomized controlled trial. International Journal of Nursing Practice, 22(2), 152-159. https://doi.org/10.1111/ijn.12358
  • Kaşıkçı, M.K. and Akın, E. (2021). Hemşirelik Bakım Kavramı (1. Baskı). İstanbul: İstanbul Tıp Kitabevleri.
  • Kaya, N. and Palloş, A. (2012). Parenteral Drug Management. (Atabek Aştı, T. & Karadağ, A. Ed.). İstanbul: Akademi Basın ve Yayıncılık.
  • Kocayiğit, H. and Bal, N.Ş. (2022). Percutaneous dilatational tracheostomy: evaluation of YouTube videos. Anaesthesiologie, 71(Suppl 2), 219-223.
  • Larkin, T.A., Ashcroft, E., Elgellaie, A. and Hickey, B.A. (2017). Ventrogluteal versus dorsogluteal site selection: A cross-sectional study of muscle and subcutaneous fat thicknesses and an algorithm incorporating demographic and anthropometric data to predict injection outcome. Int J Nurs Stud, 71, 1-7. https://doi.org/10.1016/j.ijnurstu.2017.02.017
  • Lee, J.S., Seo, H.S. and Hong, T.H. (2014). YouTube as A source of patient information on gallstone disease. World J Gastroenterol, 20(14), 4066- 4070. https://doi.org/10.3748/wjg.v20.i14.4066
  • Madathil, K.C., Rivera-Rodriguez, A.J., Greenstein, J.S. and Gramopadhye, A.K. (2015). Healthcare information on YouTube: a systematic review. Health Informatics J, 21(3), 173-194. https://doi.org/10.1177/1460458213512220
  • Mehta, D.R., Pillai, A. and Singh, A.P. (2014). An observational study of safe injection practices in a tertiary care teaching hospital. Int J Appl Res, 2(5), 733-737.
  • Milutinović, D., Tomić, S., Puškaš, V., Brestovački-Svitlica, B. and Simin, D. (2018). Frequency of application and level of nurses’ knowledge on administering intramuscular injections into the ventrogluteal site. Med Pregl, 71(suppl. 1), 59-64. https://doi.org/10.2298/MPNS18S1059M
  • Sabuncu, N., Alpar, Ş.E., Karabacak, Ü., Karabacak, B.G., Şenturan, L., Orak, N.Ş. ve Şahin, A.O. (2015). Hemşirelik Esasları: Temel Beceriler Rehberi (2. baskı). İstanbul: İstanbul Tıp Kitabevi.
  • Sblendorio, E. (2023). IM vaccine administrations including the adoption of “Zeta-track technique” & “Without aspiration slow injection technique” (ZTT & Wasit): A prospective review. Front Nurs, 10(1), 21–42. https://doi.org/10.2478/fon-2023-0003
  • Srividya, B.P., Nagabushan, H. and Drupad, H.S. (2015). Assessment of knowledge among health care providers regarding intramuscular injection administration. Asian J Pharm Clin Res, 8(1), 220-222.
  • Taddio, A., Ipp, M., Thivakaran, S., Jamal, A., Parikh, C., Smart, S., Sovran, J., Stephens, D. and Katz, J. (2021). Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine, 30(32), 4807-4812. https://doi.org/10.1016/j.vaccine.2012.05.011
  • Tatlı, Z., Aydın, A., Şimşek, P., Özdemir, M., Gölbaşı, S., Karacan, S., Gürsoy, A. and Gündüz, A. (2018). Hemşirelerin ve hemşirelik öğrencilerinin bilişim teknolojilerini kullanma durumları. Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi, 1(1), 18-27.
  • Tosun, H. and Tosun, A. (2022). An information source for blood pressure measurement: YouTube analysis. Turk J Cardiovasc Nurs, 13(30), 28-35. https://doi.org/10.5543/khd.2022.212437
  • Zeyrek, A. Ş., Takmak, Ş., Kurban, N. K., and Arslan, S. (2019). Systematic review and meta‐analysis: Physical‐procedural interventions used to reduce pain during intramuscular injections in adults. Journal of Advanced Nursing, 75(12), 3346-3361. https://doi.org/10.1111/jan.14183
  • World Health Organization. (2015). WHO guideline on the use of safety-engineered syringes for intramuscular, intradermal and subcutaneous injections in health care settings. https://iris.who.int/bitstream/handle/10665/250144/9789241549820-eng.pdf?sequence=1
  • Wynaden, D., Tohotoa, J., Omari, O.A., Happell, B., Heslop, K., Barr, L. and Sourinathan, V. (2015). Administering intramuscular injections: How does research translate into practice over time in the mental health setting?. Nurse Educ Today, 35(4), 620-624. https://doi.org/10.1016/j.nedt.2014.12.008
Toplam 38 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Hemşirelik Esasları
Bölüm Araştırma Makalesi
Yazarlar

Ebru Baysal 0000-0002-8831-3065

Selin Demirbağ 0000-0002-4606-5171

Proje Numarası -
Erken Görünüm Tarihi 12 Ekim 2024
Yayımlanma Tarihi 21 Ekim 2024
Gönderilme Tarihi 2 Mart 2024
Kabul Tarihi 4 Temmuz 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 12 Sayı: 3

Kaynak Göster

APA Baysal, E., & Demirbağ, S. (2024). YOUTUBE VIDEOS AS A SOURCE OF INFORMATION ON INTRAMUSCULAR INJECTION APPLICATION WITH THE Z TECHNIQUE: CONTENT, QUALITY AND RELIABILITY ANALYSIS. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi, 12(3), 786-800. https://doi.org/10.33715/inonusaglik.1446136