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DİYABETİK HASTALARDA İNSÜLİN KORKUSU ÜZERİNE HEMŞİRELİK UYGULAMALARININ ETKİSİ: SİSTEMATİK BİR DERLEME

Yıl 2025, Cilt: 4 Sayı: 1, 12 - 27, 30.06.2025

Öz

Enjeksiyon korkusu, belirlenen çeşitli faktörlerle ilişkilidir. Bu faktörler iki ana endişeye dayandırılabilir: geçmiş deneyimler ve bilgi eksikliği. Bireylerin enjeksiyon süreci, gereklilikleri ve insülin tedavisinin faydaları hakkında yeterli bilgiye sahip olmamaları, insülin enjeksiyonu yapma konusunda isteksizlik göstermeleriyle ilişkilendirilmiştir. Bu sistematik derleme, insülin tedavisi gören diyabet hastalarında enjeksiyon korkusu olarak tanımlanan ‘’psikolojik insülin direncini’’ kırmaya yönelik girişimsel uygulamaların etkinliğini analiz etmeyi amaçlamaktadır. Literatür taraması sırasında PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) akış şeması kullanılmıştır. Tarama, 2002-2023 yılları arasında İngilizce yayınlanmış çalışmalarla sınırlı tutulmuş ve 15 Kasım - 30 Mayıs 2024 tarihleri arasında Scopus, PubMed, Science Direct, Web of Science, Medline, Ebscohost ve Cochrane Library veri tabanlarından yapılmıştır. Derlemeye 13 randomize kontrollü çalışma ve 1 yarı deneysel çalışma olmak üzere toplam 14 çalışma dahil edilmiştir. Enjeksiyon uygulamalarının etkinliği, diyabet eğitim programları, daha dar veya daha kısa iğnelerin kullanımı, iğnesiz enjeksiyonlar, stres yönetimi stratejileri (örneğin stres aşılamaya dayalı teknikler, lavanta yağı) ve insülin tedavisi gören diyabetli bireyler için eğitim desteğinin etkinliği doğrulanmıştır. Özellikle kendi kendine yönetim müdahalesine ihtiyaç duyan hastalar için pratik uygulamalar önemlidir. Bu derleme, diyabetli hastaların öz yeterliliğini sürdürmeye yönelik yeni programların daha fazla araştırılması gerektiğini ve bu sayede tedavi sonuçlarının iyileştirilerek hastaneye yatış oranlarının ve genel sağlık maliyetlerinin azaltılabileceğini önermektedir. PROSPERO: CRD42024546430

Kaynakça

  • Aleali, A. M., Payami, S. P., Latifi, S. M., Yazdanpanah, L., Hesam, S., Hacıddin, N. (2018). Evaluation of psychological resistance to insulin treatment in type II diabetic patients. Diabetes Metab Syndr, 12(6), 929-932. https://doi.org/10.1016/j.dsx.2018.05.017
  • Atalla, H. R. (2016). Effectiveness of nursing intervention regarding self-insulin administration among diabetic patients. Clinical Nursing Studies, 4(2), 57-63. https://doi.org/10.5430/cns.v4n2p57
  • Bağriaçik, E., & Bayraktar, N. (2022). Evaluation of the effect of training given according to Pender's Health Promotion Model on psychological insulin resistance. Human Nutrition & Metabolism, 29, 200153. https://doi.org/10.1016/j.hnm.2022.200153
  • Cahn, A., Akirov, A., & Raz, I. (2018). Digital health technology and diabetes management. J Diabetes, 10(1), 10-17. https://doi.org/10.1111/1753-0407.12606
  • Chang, S. Y., Chiang, H. C., Su, H. M., Lin, S. C., & Liu, C. J. (2014). Reducing the incidence of needlestick injuries due to insulin pen injectors among self-users. J Nurs. Hu Li Za Zhi, 61(4), 74-82. https://doi.org/10.6224/jn.61.4.74
  • Choomai, A., Wattanapisit, A., & Tiangtam, O. (2021). Effects of an actual insulin injection demonstration on insulin acceptance among patients with T2DM: A pragmatic randomized controlled trial. Rom J Intern Med, 59(2), 151-158. https://doi.org/10.2478/rjim-2020-0040 Davoudi, Z., Chouhdari, A., Mir, M., & Akbarian, F. (2020).
  • Attitude and compliance with the onset of insulin therapy in patients with type 2 diabetes. Shiraz E-Medical Journal, 21(6), e95408. https://doi.org10.5812/semj.95408
  • De Berardis, G., Scardapane, M., Lucisano, G., et al. (2018). Efficacy, safety and acceptability of the new pen needle 34G × 3.5 mm. Curr Med Res Opin, 34(9), 1699-1704. https://doi.org/10.1080/03007995.2018.1491396
  • Demı˙rağ, H., Hı˙ntı˙stan, S., & Bulut, E. (2022). The effect of topically administered lavender aromatherapy on insulin injection pain. Turk J Med Sci, 52(6), 1845-1853. https://doi.org/10.55730/1300-0144.5531
  • Ghavami, T., Kazeminia, M., & Rajati, F. (2022). The effect of lavender on stress in individuals: A systematic review and meta-analysis. Complementary Therapies in Medicine, 68, 102832. https://doi.org/10.1016/j.ctim.2022.102832
  • Hermanns, N., Ehrmann, D., Schall, S., Maier, B., Haak, T., & Kulzer, B. (2017). The effect of an education programme (MEDIAS 2 BSC) on non‐intensive insulin treatment regimens. Diabet Med, 34(8), 1084-1091. https://doi.org/10.1111/dme.13346
  • Holton, S., Rasmussen, B. S., Turner, J., Steele, C., Ariarajah, D., Hamblin, S., Crowe, S., et al. (2022). Nurse, midwife and patient perspectives and experiences of diabetes management in an acute inpatient setting: a mixed-methods study. BMC Nursing, 21(1). https://doi.org/10.1186/s12912-022-01022-w
  • Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., Ioannidis, J. P. A., et al. (2015). The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Annals of Internal Medicine, 162(11), 777-784. https://doi.org/10.7326/M14- 2385
  • Iwanaga, M., & Kamoi, K. (2009). Patient perceptions of injection pain and anxiety: A comparison of Novofine gauge tip 6mm and Micro Fine Plus gauge 5mm needles. Diabetes Technology & Therapeutics, 11(2), 81–86. https://doi.org/10.1089/dia.2008.0027. PMID: 19848573
  • Ji, L., Chen, L., Wang, Y., Ma, Z., Ran, X., Sun, Z., Xu, X., et al. (2019). Study protocol for a prospective, multicenter, randomized, open-label, parallel-group clinical trial comparing the efficacy and safety of a needle-free insulin injector and a conventional insulin pen in controlling blood glucose concentrations in Chinese patients with type 2 diabetes mellitus (The FREE study). Diabetes Therapy, 10(4), 1247-1257. https://doi.org/10.1007/s12325- 019-00951-4
  • Ji, L., Gao, L., Chen, L., Wang, Y., Ma, Z., Ran, X., Sun, Z., et al. (2020). Insulin delivery with a needle-free insulin injector versus a conventional insulin pen in Chinese patients with type 2 diabetes mellitus: A 16-week, multicenter, randomized clinical trial (the FREE study). EClinicalMedicine, 27, 100547. https://doi.org/10.1016/j.eclinm.2020.100547
  • Koonmen, L. A., Lennie, T. A., Hieronymus, L., Rayens, M. K., Ickes, M. J., Miller, J. & Mudd‐ Martin, G. (2023). Covid-19 impact predicts diabetes distress among individuals with type 2 diabetes. The Science of Diabetes Self-Management and Care, 49(5), 392-400. https://doi.org/10.1177/26350106231196300
  • Kruger, D. F., LaRue, S., & Estepa, P. (2015). Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 8, 49–56. https://doi.org/10.2147/DMSO.S71923
  • Li, X., Ge, J., & He, L. (2023). Influence of self-practice oriented teaching plus psychological intervention on blood glucose level and psychological state in patients with Type 2 diabetes mellitus on insulin therapy. Evid Based Complement Alternat Med, 2023, 9867917. https://doi.org/10.1155/2023/9867917. PMID: 37387984; PMCID: PMC10307469 McMurtry, C. M., Taddio, A., Noel, M., Antony, M. M., Odels, C. T., Asmundson, G. J. G., Pillai Riddell, R., et al. (2016). Exposure-based interventions for the management of individuals with high levels of needle fear across the lifespan: A clinical practice guideline and call for further research. Cognitive Behaviour Therapy, 45(3), 217-235. https://doi.org/10.1080/16506073.2016.1157204
  • Millan, R. R. A. (2015). Myths and misconceptions about insulin therapy among latinos/ hispanics with diabetes: a fresh look at an old problem. Journal of Diabetes &Amp; Metabolism, 06(01). https://doi.org/10.4172/2155-6156.1000482
  • Misnikova, I. V., Gubkina, V. A., Lakeeva, T. S., & Dreval, A. V. (2017). The impact of proper insulin injection technique training on glycemic control. Diabetes Ther, 8(6), 1309-1318. https://doi.org/10.1007/s13300-017-0315-y
  • Pérez‐Fernández, A., Fernández‐Berrocal, P., & Gutiérrez‐Cobo, M. J. (2023). The relationship between well‐being and hba1c in adults with type 1 diabetes: a systematic review. Journal of Diabetes, 15(2), 152-164. https://doi.org/10.1111/1753-0407.13357
  • Sanz-Pastor, A. G., Enríquez, A. J., Bao, A. S., & Ampudia‐Blasco, F. J. (2024). Current barriers to initiating insulin therapy in individuals with type 2 diabetes. Frontiers in Endocrinology, 15. https://doi.org/10.3389/fendo.2024.1366368
  • Sheno, B. W. and Reja, A. (2021). Knowledge, practice, and attitude of patients and physicians towards insulin therapy in type 2 dm: a cross sectional study in tash patients and physician from various universities in ethiopia. https://doi.org/10.21203/rs.3.rs-1064545/v1
  • Shi, Y., Wang, C., Sevick, M. A., Bao, H., Xu, X., Jiang, Y., Zhu, Z., et al. (2024). Diabetes distress and associated factors among chinese americans with type 2 diabetes in new york city. Diabetes, Metabolic Syndrome and Obesity, Volume 17, 2845-2853. https://doi.org/10.2147/dmso.s459478
  • Skovlund, S., Lyness, W., & Nicklasson, L. (2002). PDB10: A cross-over randomized controlled trial to compare psychological barriers to insulin self-injection with the Innolet and vial/syringe. Value in Health, 5(6), 549. https://doi.org/10.1016/s1098-3015(10)61447-7
  • Stockl, K., Ory, C., Vanderplas, A., Nicklasson, L., Lyness, W., Cobden, D., Chang, E. (2007). An evaluation of patient preference for an alternative insulin delivery system compared to standard vial and syringe. Current Medical Research and Opinion, 23(1), 133-146. https://doi.org/10.1185/030079906x159524
  • Sugai, K., Shikuma, J., Hiroike, S., Abe, H., & Suzuki, R. (2023). Successful introduction of sensor‐augmented pump therapy in a patient with diabetes and needle phobia: A case report. Journal of Diabetes Investigation, 14(11), 1318-1320. https://doi.org/10.1111/jdi.14061 Valentini, M., Scardapane, M., Bondanini, F., Bossi, A., Colatrella, A., Girelli, A., Ciucci, A., et al. (2015). Efficacy, safety and acceptability of the new pen needle 33G × 4 mm: AGO 01 study. Current Medical Research and Opinion, 31(3), 487-492. https://doi.org/10.1185/03007995.2014.993025
  • Vlachou, E., Ntikoudi, A., Owens, D. A., Nikolakopoulou, M., Chalimourdas, T., & Cauli, O. (2022). Effectiveness of cognitive behavioral therapy-based interventions on psychological symptoms in adults with type 2 diabetes mellitus: An update review of randomized controlled trials. Journal of Diabetes and Its Complications, 36(5), 108185. https://doi.org/10.1016/j.jdiacomp.2022.108185
  • Wang, W., Men, L., Wang, Y., Shi, C., Yin, H., Li, H., Zhou, H., et al. (2024, May 8). Effect of needle-free injection on psychological insulin resistance and insulin dosage in patients with type 2 diabetes. Frontiers in Endocrinology, 15, 1379830. https://doi.org/10.3389/fendo.2024.1379830
  • Xing, Y., Xie, X., Xu, J., Liu, J., He, Q., Yang, W., Zhang, N., et al. (2019). Efficacy and safety of a needle-free injector in Chinese patients with type 2 diabetes mellitus treated with basal insulin: A multicentre, prospective, randomised, crossover study. Expert Opinion on Drug Delivery, 16(9), 995-1002. https://doi.org/10.1080/17425247.2019.1649251
  • Youngwanichsetha, S. (2021). The effect of online computer assisted instruction on knowledge, self-efficacy, and satisfaction of nursing students. International Journal of Nursing Education, 14(1), 181-185. https://doi.org/10.37506/ijone.v14i1.17772.

EFFECT OF NURSİNG PRACTİCES ON INSULİN FEAR İN DİABETİC PATİENTS: A SYSTEMATİC REVİEW

Yıl 2025, Cilt: 4 Sayı: 1, 12 - 27, 30.06.2025

Öz

Fear of injection is associated with several identified factors. These factors can be attributed to two main concerns: past experiences and a lack of knowledge. This systematic review aims to analyze the effectiveness of interventional practices to break 'psychological resistance to insulin,' defined as the fear of self-injection in diabetic patients undergoing insulin treatment. While searching the literature, the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) flowchart was used. The search was limited to studies published in English between 2002 and 2023, from 15 November to 30 May 2024, in the databases “ Scopus, PubMed, Science Direct, Web of Science, Medline, Ebscohost, and Cochrane Library Fourteen studies, including 13 randomized controlled trials and one quasi-experimental study, were included in the review. The effectiveness of injection administration, , diabetes education programs, use of narrower or shorter needles; needle-free injections; stress management strategies (for example, stress inoculation-based techniques, lavender oil). and training support for individuals with diabetes undergoing insulin treatment was confirmed. Practical demonstrations are important, especially for patients who require self-management intervention. This review suggests that new programs to maintain the self-efficacy of diabetic patients should be further investigated to improve outcomes and reduce hospitalizations and overall costs. PROSPERO: CRD42024546430

Kaynakça

  • Aleali, A. M., Payami, S. P., Latifi, S. M., Yazdanpanah, L., Hesam, S., Hacıddin, N. (2018). Evaluation of psychological resistance to insulin treatment in type II diabetic patients. Diabetes Metab Syndr, 12(6), 929-932. https://doi.org/10.1016/j.dsx.2018.05.017
  • Atalla, H. R. (2016). Effectiveness of nursing intervention regarding self-insulin administration among diabetic patients. Clinical Nursing Studies, 4(2), 57-63. https://doi.org/10.5430/cns.v4n2p57
  • Bağriaçik, E., & Bayraktar, N. (2022). Evaluation of the effect of training given according to Pender's Health Promotion Model on psychological insulin resistance. Human Nutrition & Metabolism, 29, 200153. https://doi.org/10.1016/j.hnm.2022.200153
  • Cahn, A., Akirov, A., & Raz, I. (2018). Digital health technology and diabetes management. J Diabetes, 10(1), 10-17. https://doi.org/10.1111/1753-0407.12606
  • Chang, S. Y., Chiang, H. C., Su, H. M., Lin, S. C., & Liu, C. J. (2014). Reducing the incidence of needlestick injuries due to insulin pen injectors among self-users. J Nurs. Hu Li Za Zhi, 61(4), 74-82. https://doi.org/10.6224/jn.61.4.74
  • Choomai, A., Wattanapisit, A., & Tiangtam, O. (2021). Effects of an actual insulin injection demonstration on insulin acceptance among patients with T2DM: A pragmatic randomized controlled trial. Rom J Intern Med, 59(2), 151-158. https://doi.org/10.2478/rjim-2020-0040 Davoudi, Z., Chouhdari, A., Mir, M., & Akbarian, F. (2020).
  • Attitude and compliance with the onset of insulin therapy in patients with type 2 diabetes. Shiraz E-Medical Journal, 21(6), e95408. https://doi.org10.5812/semj.95408
  • De Berardis, G., Scardapane, M., Lucisano, G., et al. (2018). Efficacy, safety and acceptability of the new pen needle 34G × 3.5 mm. Curr Med Res Opin, 34(9), 1699-1704. https://doi.org/10.1080/03007995.2018.1491396
  • Demı˙rağ, H., Hı˙ntı˙stan, S., & Bulut, E. (2022). The effect of topically administered lavender aromatherapy on insulin injection pain. Turk J Med Sci, 52(6), 1845-1853. https://doi.org/10.55730/1300-0144.5531
  • Ghavami, T., Kazeminia, M., & Rajati, F. (2022). The effect of lavender on stress in individuals: A systematic review and meta-analysis. Complementary Therapies in Medicine, 68, 102832. https://doi.org/10.1016/j.ctim.2022.102832
  • Hermanns, N., Ehrmann, D., Schall, S., Maier, B., Haak, T., & Kulzer, B. (2017). The effect of an education programme (MEDIAS 2 BSC) on non‐intensive insulin treatment regimens. Diabet Med, 34(8), 1084-1091. https://doi.org/10.1111/dme.13346
  • Holton, S., Rasmussen, B. S., Turner, J., Steele, C., Ariarajah, D., Hamblin, S., Crowe, S., et al. (2022). Nurse, midwife and patient perspectives and experiences of diabetes management in an acute inpatient setting: a mixed-methods study. BMC Nursing, 21(1). https://doi.org/10.1186/s12912-022-01022-w
  • Hutton, B., Salanti, G., Caldwell, D. M., Chaimani, A., Schmid, C. H., Cameron, C., Ioannidis, J. P. A., et al. (2015). The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Annals of Internal Medicine, 162(11), 777-784. https://doi.org/10.7326/M14- 2385
  • Iwanaga, M., & Kamoi, K. (2009). Patient perceptions of injection pain and anxiety: A comparison of Novofine gauge tip 6mm and Micro Fine Plus gauge 5mm needles. Diabetes Technology & Therapeutics, 11(2), 81–86. https://doi.org/10.1089/dia.2008.0027. PMID: 19848573
  • Ji, L., Chen, L., Wang, Y., Ma, Z., Ran, X., Sun, Z., Xu, X., et al. (2019). Study protocol for a prospective, multicenter, randomized, open-label, parallel-group clinical trial comparing the efficacy and safety of a needle-free insulin injector and a conventional insulin pen in controlling blood glucose concentrations in Chinese patients with type 2 diabetes mellitus (The FREE study). Diabetes Therapy, 10(4), 1247-1257. https://doi.org/10.1007/s12325- 019-00951-4
  • Ji, L., Gao, L., Chen, L., Wang, Y., Ma, Z., Ran, X., Sun, Z., et al. (2020). Insulin delivery with a needle-free insulin injector versus a conventional insulin pen in Chinese patients with type 2 diabetes mellitus: A 16-week, multicenter, randomized clinical trial (the FREE study). EClinicalMedicine, 27, 100547. https://doi.org/10.1016/j.eclinm.2020.100547
  • Koonmen, L. A., Lennie, T. A., Hieronymus, L., Rayens, M. K., Ickes, M. J., Miller, J. & Mudd‐ Martin, G. (2023). Covid-19 impact predicts diabetes distress among individuals with type 2 diabetes. The Science of Diabetes Self-Management and Care, 49(5), 392-400. https://doi.org/10.1177/26350106231196300
  • Kruger, D. F., LaRue, S., & Estepa, P. (2015). Recognition of and steps to mitigate anxiety and fear of pain in injectable diabetes treatment. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 8, 49–56. https://doi.org/10.2147/DMSO.S71923
  • Li, X., Ge, J., & He, L. (2023). Influence of self-practice oriented teaching plus psychological intervention on blood glucose level and psychological state in patients with Type 2 diabetes mellitus on insulin therapy. Evid Based Complement Alternat Med, 2023, 9867917. https://doi.org/10.1155/2023/9867917. PMID: 37387984; PMCID: PMC10307469 McMurtry, C. M., Taddio, A., Noel, M., Antony, M. M., Odels, C. T., Asmundson, G. J. G., Pillai Riddell, R., et al. (2016). Exposure-based interventions for the management of individuals with high levels of needle fear across the lifespan: A clinical practice guideline and call for further research. Cognitive Behaviour Therapy, 45(3), 217-235. https://doi.org/10.1080/16506073.2016.1157204
  • Millan, R. R. A. (2015). Myths and misconceptions about insulin therapy among latinos/ hispanics with diabetes: a fresh look at an old problem. Journal of Diabetes &Amp; Metabolism, 06(01). https://doi.org/10.4172/2155-6156.1000482
  • Misnikova, I. V., Gubkina, V. A., Lakeeva, T. S., & Dreval, A. V. (2017). The impact of proper insulin injection technique training on glycemic control. Diabetes Ther, 8(6), 1309-1318. https://doi.org/10.1007/s13300-017-0315-y
  • Pérez‐Fernández, A., Fernández‐Berrocal, P., & Gutiérrez‐Cobo, M. J. (2023). The relationship between well‐being and hba1c in adults with type 1 diabetes: a systematic review. Journal of Diabetes, 15(2), 152-164. https://doi.org/10.1111/1753-0407.13357
  • Sanz-Pastor, A. G., Enríquez, A. J., Bao, A. S., & Ampudia‐Blasco, F. J. (2024). Current barriers to initiating insulin therapy in individuals with type 2 diabetes. Frontiers in Endocrinology, 15. https://doi.org/10.3389/fendo.2024.1366368
  • Sheno, B. W. and Reja, A. (2021). Knowledge, practice, and attitude of patients and physicians towards insulin therapy in type 2 dm: a cross sectional study in tash patients and physician from various universities in ethiopia. https://doi.org/10.21203/rs.3.rs-1064545/v1
  • Shi, Y., Wang, C., Sevick, M. A., Bao, H., Xu, X., Jiang, Y., Zhu, Z., et al. (2024). Diabetes distress and associated factors among chinese americans with type 2 diabetes in new york city. Diabetes, Metabolic Syndrome and Obesity, Volume 17, 2845-2853. https://doi.org/10.2147/dmso.s459478
  • Skovlund, S., Lyness, W., & Nicklasson, L. (2002). PDB10: A cross-over randomized controlled trial to compare psychological barriers to insulin self-injection with the Innolet and vial/syringe. Value in Health, 5(6), 549. https://doi.org/10.1016/s1098-3015(10)61447-7
  • Stockl, K., Ory, C., Vanderplas, A., Nicklasson, L., Lyness, W., Cobden, D., Chang, E. (2007). An evaluation of patient preference for an alternative insulin delivery system compared to standard vial and syringe. Current Medical Research and Opinion, 23(1), 133-146. https://doi.org/10.1185/030079906x159524
  • Sugai, K., Shikuma, J., Hiroike, S., Abe, H., & Suzuki, R. (2023). Successful introduction of sensor‐augmented pump therapy in a patient with diabetes and needle phobia: A case report. Journal of Diabetes Investigation, 14(11), 1318-1320. https://doi.org/10.1111/jdi.14061 Valentini, M., Scardapane, M., Bondanini, F., Bossi, A., Colatrella, A., Girelli, A., Ciucci, A., et al. (2015). Efficacy, safety and acceptability of the new pen needle 33G × 4 mm: AGO 01 study. Current Medical Research and Opinion, 31(3), 487-492. https://doi.org/10.1185/03007995.2014.993025
  • Vlachou, E., Ntikoudi, A., Owens, D. A., Nikolakopoulou, M., Chalimourdas, T., & Cauli, O. (2022). Effectiveness of cognitive behavioral therapy-based interventions on psychological symptoms in adults with type 2 diabetes mellitus: An update review of randomized controlled trials. Journal of Diabetes and Its Complications, 36(5), 108185. https://doi.org/10.1016/j.jdiacomp.2022.108185
  • Wang, W., Men, L., Wang, Y., Shi, C., Yin, H., Li, H., Zhou, H., et al. (2024, May 8). Effect of needle-free injection on psychological insulin resistance and insulin dosage in patients with type 2 diabetes. Frontiers in Endocrinology, 15, 1379830. https://doi.org/10.3389/fendo.2024.1379830
  • Xing, Y., Xie, X., Xu, J., Liu, J., He, Q., Yang, W., Zhang, N., et al. (2019). Efficacy and safety of a needle-free injector in Chinese patients with type 2 diabetes mellitus treated with basal insulin: A multicentre, prospective, randomised, crossover study. Expert Opinion on Drug Delivery, 16(9), 995-1002. https://doi.org/10.1080/17425247.2019.1649251
  • Youngwanichsetha, S. (2021). The effect of online computer assisted instruction on knowledge, self-efficacy, and satisfaction of nursing students. International Journal of Nursing Education, 14(1), 181-185. https://doi.org/10.37506/ijone.v14i1.17772.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Dahili Hastalıklar Hemşireliği
Bölüm Derlemeler
Yazarlar

Samineh Esmaeilzadeh 0000-0001-7390-499X

Mehmet Aygün 0009-0009-4438-7204

Nazanin Gharaeimilani 0009-0001-6116-2308

Yayımlanma Tarihi 30 Haziran 2025
Gönderilme Tarihi 29 Mart 2025
Kabul Tarihi 2 Haziran 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 4 Sayı: 1

Kaynak Göster

APA Esmaeilzadeh, S., Aygün, M., & Gharaeimilani, N. (2025). EFFECT OF NURSİNG PRACTİCES ON INSULİN FEAR İN DİABETİC PATİENTS: A SYSTEMATİC REVİEW. İstanbul Rumeli Üniversitesi Sağlık Bilimleri Dergisi, 4(1), 12-27.