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COVID-19 salgını sırasında perinatal ruh sağlığı: Obstetrik bakım sağlayıcılarının gözlem ve deneyimlerinin tematik analizi

Yıl 2023, Cilt: 6 Sayı: 2, 288 - 298, 30.09.2023
https://doi.org/10.52538/iduhes.1214197

Öz

Amaç: Bu çalışmanın amacı, kadın hastalıkları ve doğum alanında çalışan sağlık personelinin, pandeminin gebe ve doğum sonrası annelerin psikososyal sağlıklarına yansımalarına ilişkin gözlem ve deneyimlerine açıklık getirmektir.
Gereç ve Yöntem: Araştırma, Akdeniz Üniversitesi Hastanesi ve Kahramanmaraş Sütçü İmam Üniversitesi Kadın Hastalıkları ve Doğum Servisi, Doğumhanede görev yapan, araştırmaya katılmayı gönüllü olarak kabul eden hekim, ebe ve hemşire unvanlarına sahip 19 sağlık personeli ile gerçekleştirilmiştir. ve kadın doğum klinikleri. Veriler, Eylül-Ekim 2020 tarihleri ​​arasında yarı yapılandırılmış derinlemesine görüşme formu aracılığıyla toplanmıştır.
Bulgular: Sağlık personelinin COVID-19 pandemisinin perinatal ruh sağlığı üzerindeki etkilerine ilişkin deneyim ve gözlemleri iki ana tema ile açıklanmıştır. Bu temalar, pandeminin anne psikolojisine yansımaları nedeniyle obstetrik bakımdaki değişiklikler, gebe ve lohusa annelerin izlemindeki değişiklikler ve pandemi sürecinde annelerin psikososyal sağlıklarındaki değişiklikler nedeniyle bakımda yaşanan zorluklardır. .
Sonuç: Sağlık profesyonellerine göre gebe ve lohusa kadınların pandemiden psikososyal olarak etkilendikleri, kendi sağlıkları ve bebeklerinin sağlığı konusunda endişe duydukları belirlendi. Ayrıca annelerin kontrollerini ertelediği, pandemi hastanesinde tedavi olmak istemedikleri, maske, mesafe ve hijyen kurallarına uymadıkları da belirlendi.

Destekleyen Kurum

TÜBİTAK

Proje Numarası

120K416

Kaynakça

  • Anjum, S., Ullah, R., Rana, M.S., Ali Khan, H., Memon, F.S., Ahmed, Y., Jabeen, S., Faryal, R. COVID-19 pandemic: A serious threat for public mental health globally, Psychiatr Danub. 2020; 32(2): 245-250.
  • Braun, V., Clarke, V. Using thematic analysis in psychology, Qual Res Psychol. 2006; 3: 77-101.
  • Chen, H., Guo, J., Wang, C., Luo, F., Yu, X., Zhang, W. Clinical characteristics and intrauterine vertical transmission potential of COVID‐19 infection in nine pregnant women: a retrospective review of medical records, Lancet. 2020; 395(10226): 809– 815.
  • Chua, M.S.Q., Lee, J.C.S., Sulaiman, S., Tan, H.K. From the frontline of COVID‐19–how prepared are we as obstetricians? A commentary, BJOG. 2020; 127: 786-788.
  • Creswell, J.W., Miller, D.L. “Determining validity in qualitative inquiry”, Theory İnto Practice.2000; 39: 124-130.
  • Coxon, K., Turienzo, C.F., Kweekel, L., Goodarzi, B., Brigante, L., Simon, A., Lanau, M.M. The impact of the coronavirus (COVID-19) pandemic on maternity care in Europe, Midwifery. 2020; 88: 102779.
  • Demir, R. COVID-19 Tanılı bir Gebenin Doğum Öncesi ve Doğum Sonrası Duygu, Düşünce ve Kaygıları. Gevher Nesıbe Journal Of Medıcal And Health Scıences. 2022; 7(21): 43-48.
  • Fryer, K., Delgado, A., Foti, T., Reid, C.N., Marshall, J. Implementation of obstetric telehealth during COVID-19 and beyond. Matern Child Health Journal. 2020; 24(9):1104-1110.
  • Gildner, T.E., Thayer, Z.M. Birth plan alterations among American women in response to COVID‐19, Health Expect. 2020:23: 969-971.
  • Hall, S. COVID vaccines and breastfeeding: what the data say. Nature, 2021; 594(7864): 492-494.
  • Hermann, A., Fitelson, E.M., Bergink, V. Meeting maternal mental health needs during the COVID-19 pandemic, JAMA Psychiatry. 2021;78: 123-124.
  • Hu, Y. Social Work Intervention for Anxiety and Depression among Medical Workers during the COVID-19 Pandemic:" Internet Plus Music Therapy", Psychiat Danub. 2021; 33: 634-638.
  • Jamieson, D.J., Steinberg, J.P., Martinello, R.A., Perl, T.M., Rasmussen, S.A. Obstetricians on the coronavirus disease 2019 (COVID-19) front lines and the confusing world of personal protective equipment, Obstet Gynecol. 2020; 23(4): 1257-1263.
  • Kaya, H., Ayık, B., Tasdelen, R., Ercis, M., Ertekin, E. Social support promotes mental health during the COVID-19 outbreak: a cross-sectional study from Turkey, Psychiatr Danub. 2021; 33(2): 217-224.
  • Kocak, M., Baltaci, N. Psychosocial Problems and Nursing Care of Pregnancy During the Covid-19 Pandemic Process. Journal of Samsun Health Sciences. 2021;6(1): 41-49.
  • Korukcu, O., Ozkaya, M., Boran, O.F., Bakacak, M. Factors associated with antenatal depression during the COVID‐19 (SARS‐CoV2) pandemic: A cross‐sectional study in a cohort of Turkish pregnant women, Perspect Psychiat Care. 2021; 58(1): 61-70
  • Lazzari, C., Shoka, A., Nusair, A., Rabottini, M. Psychiatry in time of COVID-19 pandemic, Psychiatr Danub. 2020; 32(2): 229-235.
  • Matvienko-Sikar, K., Meedya, S., Ravaldi, C. Perinatal mental health during the COVID-19 pandemic, Women Birth. 2020; 33(4): 309-310.
  • McLaurin-Jiang, S., Garner, C.D., Krutsch, K., Hale, T.W. Maternal and child symptoms following COVID-19 vaccination among breastfeeding mothers. Breastfeed Med. 2021; 16(9): 702-709.
  • Mızrak Şahin, B., Can, M. (2020). Yeni tip Koronavirüs (COVİD-19) pandemisinde toplumsal izolasyon gerekliliğinin gebeler üzerindeki psikososyal etkisi. Gürhan N, (Ed.), Pandemide Psikiyatri Hemşireliği içinde (s. 40-43). Ankara: Türkiye Klinikleri.
  • Mukhtar, S., Rana, W. Biopsychosocial-Spiritual Model of COVID-19 for Healthcare Practitioners Amidst and Post-COVID-19. Psychiatr Danub. 2021; 33(4): 595-599.
  • Nazik, F., Yüksekol, Ö,D., Baltaci, N., Ulucan, M. pregnant women receiving prenatal care and the impact of the Covıd-19 pandemic. Journal of TOGU Health Sciences. 2022; 2(2): 111-122.
  • Ollivier, R., Aston, M., Price, S., Sim, M., Benoit, B., Joy, P., Iduye, D., Nassaji, N.A. Mental health, parental concerns during COVID-19: The experiences of new mothers amidst social isolation, Midwifery. 2021; 94: 102902.
  • Palacios, R., Patiño, E.G., de Oliveira Piorelli, R., Conde, M.T.R.P., Batista, A.P., Zeng, G., Gast, C. Double-blind, randomized, placebo-controlled Phase III clinical trial to evaluate the efficacy and safety of treating healthcare professionals with the adsorbed COVID-19 (inactivated) vaccine manufactured by Sinovac–PROFISCOV: A structured summary of a study protocol for a randomised controlled trial. Trials. 2021; 21, 1-3.
  • Perl, S.H., Uzan-Yulzari, A., Klainer, H., Asiskovich, L., Youngster, M., Rinott, E., Youngster, I. SARS-CoV-2–specific antibodies in breast milk after COVID-19 vaccination of breastfeeding women. JAMA.2021; 325(19): 2013-2014.
  • Pountoukidou, A., Potamiti-Komi, M., Sarri, V., Papapanou, M., Routsi, E., Tsiatsiani, A.M. Vlahos, N., Siristatidis, C. Management and Prevention of COVID-19 in pregnancy and pandemic obstetric care: A review of current practices, Healthcare. 2021: 9(4): 467.
  • Rao, S.P., Minckas, N., Medvedev, M.M., Gathara, D., Prashantha, Y.N., Estifanos, A.S., Silitonga, A.C., Jadaun, A.S., Adejuyigbe, E.A., Brotherton, H., Arya, S., Gera, R., Ezeaka, C.V., Gai, A., Gobezayehu, A.G., Dube, Q., Kumar, A., Naburi, H., Chiume, M., Tumukunde, V., Medhanyie, A.A., Plange-Rhule, G., Shabini, J., Ohuma, E.O., Tadele, H., Gebriel, F., Hadgu, A., Alamineh, L., Mehta, R., Molyneux, E., Lawn, J.E. Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers’ voices and experiences, BMJ Glob Health. 2021; 6(3): e004347.
  • Renfrew, M., Cheyne, H., Craig, J., Duff, E., Dykes, F., Hunter, B., Lavender, T., Page, L., Ross-Davie, M., Spiby, H., Downe, S. Sustaining quality midwifery care in a pandemic and beyond, Midwifery. 2020; 88: 102759.
  • Republic of Turkey Ministry of Health (2023). COVID-19 vaccine information platform. Online https://covid19asi.saglik.gov.tr/TR-85118/17-inaktif-covid-19-asisi-emzirme-doneminde-uygulanabilir-mi.html#:~:text=17.-,%C4%B0naktif%20COVID%2D19%20a%C5%9F%C4%B1s%C4%B1%20emzirme%20d%C3%B6neminde%20uygulanabilir%20mi%3F,annelere%20a%C5%9F%C4%B1%20uygulanmas%C4%B1%20tavsiye%20edilmektedir.
  • Republic of Turkey Ministry of Health (2018). Antenatal Care Management Guide. Online https://hsgm.saglik.gov.tr/depo/birimler/Kadin_ve_Ureme_Sagligi_Db/dokumanlar/rehbler/dogum_oncesi_bakim_2020.pdf
  • Rocca-Ihenacho, L., Alonso, C. Where do women birth during a pandemic? Changing perspectives on safe motherhood during the COVID-19 pandemic, J Glob Health Sci. 2020; 2(e4):1-9
  • Semaan, A., Audet, C., Huysmans, E., Afolabi, B., Assarag, B., Banke-Thomas, A., Blencowe, H., Caluwaerts, S., Campbell, R.O.M., Cavallaro, F.L., Chavane, L., Day, L.T., Delamou, A., Delvaux, T, Graham, W.J., Gon, G., Kascak, P., Matsui, M., Moxon, S., Nakimuli, A., Pembe, A., Radovich, E., van der Akker, T., Benova, L.Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and new-born health professionals facing the COVID-19 pandemic, BMJ Glob Health. 2020; 5(6): e002967.
  • Shenton, A.K. Strategies for ensuring trustworthiness in qualitative research projects, Educ Inform. 2004; 22(2): 63-75.
  • Thapa, S.B., Mainali, A., Schwank, S.E., Acharya, G. Maternal mental health in the time of the COVID‐19 pandemic, Acta Obstet Gynecol. 2020; 99: 817-818.
  • Unal, E., Atik, D., Gozuyesil, E. Covid-19 pandemic and women. Haliç Üniv Sağ Bil Der. 2021; 4(1): 1-8. Wilson, A.N., Ravaldi, C., Scoullar, M.J., Vogel, J.P., Szabo, R.A., Fisher, J.R., Homer, C.S.E. Caring for the carers: Ensuring the provision of quality maternity care during a global pandemic, Women Birth. 2020; 34(3): 206-209.
  • Wynd, C.A., Schmidt, B., Schaefer, M.A. Two quantitative approaches for estimating content validity.West J Nurs Res. 2003; 25(5): 508-518.

Perinatal mental health in the time of the COVID-19 pandemic: Thematic analysis of obstetric care providers’ observations and experiences

Yıl 2023, Cilt: 6 Sayı: 2, 288 - 298, 30.09.2023
https://doi.org/10.52538/iduhes.1214197

Öz

Background: The aim of this study is to clarify the observations and experiences of health personnel working in the field of obstetrics on the reflections of the pandemic on the psychosocial health of pregnant and postpartum mothers.
Subjects and Methods: The research was carried out with 19 health personnel, who have the titles of physicians, midwives, and nurses, who voluntarily agreed to participate in the study, working in Akdeniz University Hospital and Kahramanmaras Sutcu Imam University gynaecology service, delivery room and obstetrics clinics. The data were collected between September and October 2020 through a semi-structured in-depth interview form.
Results: The experiences and observations of health personnel on the effects of the COVID-19 pandemic on perinatal mental health were explained with two main themes. These themes are changes in obstetric care due to the reflections of the pandemic on the psychology of mothers, changes in the follow-up of pregnant and postpartum mothers, and difficulties encountered in care due to changes in the psychosocial health of mothers during the pandemic process.
Conclusion: According to health professionals, it was determined that pregnant and postpartum women were affected psychosocially by the pandemic, and they were worried about their own health and that of their babies. In addition, it was understood that the mothers delayed their controls, did not want to be treated in the pandemic hospital, and did not comply with the mask, distance, and hygiene rules.

Proje Numarası

120K416

Kaynakça

  • Anjum, S., Ullah, R., Rana, M.S., Ali Khan, H., Memon, F.S., Ahmed, Y., Jabeen, S., Faryal, R. COVID-19 pandemic: A serious threat for public mental health globally, Psychiatr Danub. 2020; 32(2): 245-250.
  • Braun, V., Clarke, V. Using thematic analysis in psychology, Qual Res Psychol. 2006; 3: 77-101.
  • Chen, H., Guo, J., Wang, C., Luo, F., Yu, X., Zhang, W. Clinical characteristics and intrauterine vertical transmission potential of COVID‐19 infection in nine pregnant women: a retrospective review of medical records, Lancet. 2020; 395(10226): 809– 815.
  • Chua, M.S.Q., Lee, J.C.S., Sulaiman, S., Tan, H.K. From the frontline of COVID‐19–how prepared are we as obstetricians? A commentary, BJOG. 2020; 127: 786-788.
  • Creswell, J.W., Miller, D.L. “Determining validity in qualitative inquiry”, Theory İnto Practice.2000; 39: 124-130.
  • Coxon, K., Turienzo, C.F., Kweekel, L., Goodarzi, B., Brigante, L., Simon, A., Lanau, M.M. The impact of the coronavirus (COVID-19) pandemic on maternity care in Europe, Midwifery. 2020; 88: 102779.
  • Demir, R. COVID-19 Tanılı bir Gebenin Doğum Öncesi ve Doğum Sonrası Duygu, Düşünce ve Kaygıları. Gevher Nesıbe Journal Of Medıcal And Health Scıences. 2022; 7(21): 43-48.
  • Fryer, K., Delgado, A., Foti, T., Reid, C.N., Marshall, J. Implementation of obstetric telehealth during COVID-19 and beyond. Matern Child Health Journal. 2020; 24(9):1104-1110.
  • Gildner, T.E., Thayer, Z.M. Birth plan alterations among American women in response to COVID‐19, Health Expect. 2020:23: 969-971.
  • Hall, S. COVID vaccines and breastfeeding: what the data say. Nature, 2021; 594(7864): 492-494.
  • Hermann, A., Fitelson, E.M., Bergink, V. Meeting maternal mental health needs during the COVID-19 pandemic, JAMA Psychiatry. 2021;78: 123-124.
  • Hu, Y. Social Work Intervention for Anxiety and Depression among Medical Workers during the COVID-19 Pandemic:" Internet Plus Music Therapy", Psychiat Danub. 2021; 33: 634-638.
  • Jamieson, D.J., Steinberg, J.P., Martinello, R.A., Perl, T.M., Rasmussen, S.A. Obstetricians on the coronavirus disease 2019 (COVID-19) front lines and the confusing world of personal protective equipment, Obstet Gynecol. 2020; 23(4): 1257-1263.
  • Kaya, H., Ayık, B., Tasdelen, R., Ercis, M., Ertekin, E. Social support promotes mental health during the COVID-19 outbreak: a cross-sectional study from Turkey, Psychiatr Danub. 2021; 33(2): 217-224.
  • Kocak, M., Baltaci, N. Psychosocial Problems and Nursing Care of Pregnancy During the Covid-19 Pandemic Process. Journal of Samsun Health Sciences. 2021;6(1): 41-49.
  • Korukcu, O., Ozkaya, M., Boran, O.F., Bakacak, M. Factors associated with antenatal depression during the COVID‐19 (SARS‐CoV2) pandemic: A cross‐sectional study in a cohort of Turkish pregnant women, Perspect Psychiat Care. 2021; 58(1): 61-70
  • Lazzari, C., Shoka, A., Nusair, A., Rabottini, M. Psychiatry in time of COVID-19 pandemic, Psychiatr Danub. 2020; 32(2): 229-235.
  • Matvienko-Sikar, K., Meedya, S., Ravaldi, C. Perinatal mental health during the COVID-19 pandemic, Women Birth. 2020; 33(4): 309-310.
  • McLaurin-Jiang, S., Garner, C.D., Krutsch, K., Hale, T.W. Maternal and child symptoms following COVID-19 vaccination among breastfeeding mothers. Breastfeed Med. 2021; 16(9): 702-709.
  • Mızrak Şahin, B., Can, M. (2020). Yeni tip Koronavirüs (COVİD-19) pandemisinde toplumsal izolasyon gerekliliğinin gebeler üzerindeki psikososyal etkisi. Gürhan N, (Ed.), Pandemide Psikiyatri Hemşireliği içinde (s. 40-43). Ankara: Türkiye Klinikleri.
  • Mukhtar, S., Rana, W. Biopsychosocial-Spiritual Model of COVID-19 for Healthcare Practitioners Amidst and Post-COVID-19. Psychiatr Danub. 2021; 33(4): 595-599.
  • Nazik, F., Yüksekol, Ö,D., Baltaci, N., Ulucan, M. pregnant women receiving prenatal care and the impact of the Covıd-19 pandemic. Journal of TOGU Health Sciences. 2022; 2(2): 111-122.
  • Ollivier, R., Aston, M., Price, S., Sim, M., Benoit, B., Joy, P., Iduye, D., Nassaji, N.A. Mental health, parental concerns during COVID-19: The experiences of new mothers amidst social isolation, Midwifery. 2021; 94: 102902.
  • Palacios, R., Patiño, E.G., de Oliveira Piorelli, R., Conde, M.T.R.P., Batista, A.P., Zeng, G., Gast, C. Double-blind, randomized, placebo-controlled Phase III clinical trial to evaluate the efficacy and safety of treating healthcare professionals with the adsorbed COVID-19 (inactivated) vaccine manufactured by Sinovac–PROFISCOV: A structured summary of a study protocol for a randomised controlled trial. Trials. 2021; 21, 1-3.
  • Perl, S.H., Uzan-Yulzari, A., Klainer, H., Asiskovich, L., Youngster, M., Rinott, E., Youngster, I. SARS-CoV-2–specific antibodies in breast milk after COVID-19 vaccination of breastfeeding women. JAMA.2021; 325(19): 2013-2014.
  • Pountoukidou, A., Potamiti-Komi, M., Sarri, V., Papapanou, M., Routsi, E., Tsiatsiani, A.M. Vlahos, N., Siristatidis, C. Management and Prevention of COVID-19 in pregnancy and pandemic obstetric care: A review of current practices, Healthcare. 2021: 9(4): 467.
  • Rao, S.P., Minckas, N., Medvedev, M.M., Gathara, D., Prashantha, Y.N., Estifanos, A.S., Silitonga, A.C., Jadaun, A.S., Adejuyigbe, E.A., Brotherton, H., Arya, S., Gera, R., Ezeaka, C.V., Gai, A., Gobezayehu, A.G., Dube, Q., Kumar, A., Naburi, H., Chiume, M., Tumukunde, V., Medhanyie, A.A., Plange-Rhule, G., Shabini, J., Ohuma, E.O., Tadele, H., Gebriel, F., Hadgu, A., Alamineh, L., Mehta, R., Molyneux, E., Lawn, J.E. Small and sick newborn care during the COVID-19 pandemic: global survey and thematic analysis of healthcare providers’ voices and experiences, BMJ Glob Health. 2021; 6(3): e004347.
  • Renfrew, M., Cheyne, H., Craig, J., Duff, E., Dykes, F., Hunter, B., Lavender, T., Page, L., Ross-Davie, M., Spiby, H., Downe, S. Sustaining quality midwifery care in a pandemic and beyond, Midwifery. 2020; 88: 102759.
  • Republic of Turkey Ministry of Health (2023). COVID-19 vaccine information platform. Online https://covid19asi.saglik.gov.tr/TR-85118/17-inaktif-covid-19-asisi-emzirme-doneminde-uygulanabilir-mi.html#:~:text=17.-,%C4%B0naktif%20COVID%2D19%20a%C5%9F%C4%B1s%C4%B1%20emzirme%20d%C3%B6neminde%20uygulanabilir%20mi%3F,annelere%20a%C5%9F%C4%B1%20uygulanmas%C4%B1%20tavsiye%20edilmektedir.
  • Republic of Turkey Ministry of Health (2018). Antenatal Care Management Guide. Online https://hsgm.saglik.gov.tr/depo/birimler/Kadin_ve_Ureme_Sagligi_Db/dokumanlar/rehbler/dogum_oncesi_bakim_2020.pdf
  • Rocca-Ihenacho, L., Alonso, C. Where do women birth during a pandemic? Changing perspectives on safe motherhood during the COVID-19 pandemic, J Glob Health Sci. 2020; 2(e4):1-9
  • Semaan, A., Audet, C., Huysmans, E., Afolabi, B., Assarag, B., Banke-Thomas, A., Blencowe, H., Caluwaerts, S., Campbell, R.O.M., Cavallaro, F.L., Chavane, L., Day, L.T., Delamou, A., Delvaux, T, Graham, W.J., Gon, G., Kascak, P., Matsui, M., Moxon, S., Nakimuli, A., Pembe, A., Radovich, E., van der Akker, T., Benova, L.Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and new-born health professionals facing the COVID-19 pandemic, BMJ Glob Health. 2020; 5(6): e002967.
  • Shenton, A.K. Strategies for ensuring trustworthiness in qualitative research projects, Educ Inform. 2004; 22(2): 63-75.
  • Thapa, S.B., Mainali, A., Schwank, S.E., Acharya, G. Maternal mental health in the time of the COVID‐19 pandemic, Acta Obstet Gynecol. 2020; 99: 817-818.
  • Unal, E., Atik, D., Gozuyesil, E. Covid-19 pandemic and women. Haliç Üniv Sağ Bil Der. 2021; 4(1): 1-8. Wilson, A.N., Ravaldi, C., Scoullar, M.J., Vogel, J.P., Szabo, R.A., Fisher, J.R., Homer, C.S.E. Caring for the carers: Ensuring the provision of quality maternity care during a global pandemic, Women Birth. 2020; 34(3): 206-209.
  • Wynd, C.A., Schmidt, B., Schaefer, M.A. Two quantitative approaches for estimating content validity.West J Nurs Res. 2003; 25(5): 508-518.
Toplam 36 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Hemşirelik
Bölüm Makaleler
Yazarlar

Öznur Körükcü 0000-0001-5840-9114

Nurşen Adak 0000-0001-8748-9678

Ömer Faruk Boran 0000-0002-0262-9385

Meltem Özkaya 0000-0002-1004-6040

Çağrı Elmas 0000-0002-8194-3523

Murat Bakacak 0000-0003-4398-7055

Kamile Kabukcuoğlu 0000-0002-7479-833X

Proje Numarası 120K416
Erken Görünüm Tarihi 18 Eylül 2023
Yayımlanma Tarihi 30 Eylül 2023
Gönderilme Tarihi 4 Aralık 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 6 Sayı: 2

Kaynak Göster

APA Körükcü, Ö., Adak, N., Boran, Ö. F., Özkaya, M., vd. (2023). COVID-19 salgını sırasında perinatal ruh sağlığı: Obstetrik bakım sağlayıcılarının gözlem ve deneyimlerinin tematik analizi. Izmir Democracy University Health Sciences Journal, 6(2), 288-298. https://doi.org/10.52538/iduhes.1214197

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