Yoğun bakım ünitesinde yatan obstetrik ve jinekolojik olguların retrospektif olarak analizi ve bu hastalara bakım veren hemşirelerin görüşleri
Analysis of retrospective of obstetric and gynecological cases in intensive care unit and views of nurses that give care to these patients
Yazar: NEZİHA ATEŞ
Danışman: DOÇ. DR. KERİME DERYA BEYDAĞ
İstanbul Okan Üniversitesi / Sağlık Bilimleri Enstitüsü / Hemşirelik Ana Bilim Dalı
Derece: Yüksek Lisans, 2018
Konu: Hemşirelik = Nursing
Dizin: Hasta bakımı = Patient care ; Hemşirelik bakımı = Nursing care ; Jinekoloji = Gynecology ; Obstetrik = Obstetrics ; Retrospektif çalışmalar = Retrospective studies ; Yoğun bakım = Intensive care ; Yoğun bakım üniteleri = Intensive care units

Özet:
ÖZET

Bu çalışma, multidisipliner genel yoğun bakım ünitesinde takip edilen obstetrik ve jinekolojik olguları retrospektif olarak değerlendirerek, kabul nedenlerini ve klinik sonuçlarını araştırmak ve bu hastalara bakım veren hemşirelerin görüşlerini incelemek amacıyla retrospektif tanımlayıcı ve niteliksel tipte bir çalışmadır.
İki aşamada gerçekleştirilmiş olan çalışmanın ilk aşamasında, Bakırköy Dr.Sadi Konuk Eğitim Araştırma Hastanesi Anesteziyoloji ve Reanimasyon Kliniği Yoğun Bakım Ünitesinde Haziran 2012 - Haziran 2016 yılları arasında obstetrik ve jinekolojik nedenlerle yatan toplam  73 hasta retrospektif olarak incelenmiştir. Çalışmanın ikinci aşaması, nitel desende yapılmış, yoğun bakım ünitesinde çalışan ve araştırmayı kabul eden 42 hemşire, ebe, sağlık memuru ile görüşülmüştür. Araştırma, 1 Nisan - 1 Haziran 2016 tarihleri arasında, Bakırköy Dr.Sadi Konuk Eğitim Araştırma Hastanesi  Anesteziyoloji ve Reanimasyon Kliniği Yoğun Bakım Ünitesinde gerçekleştirilmiş, verilerin değerlendirilmesinde tanımlayıcı istatistiksel yöntemleri olarak sayı, yüzde, ortalama, standart sapma kullanılmıştır. Araştırmada elde edilen nitel içerik, nitel analiz yöntemleri ile analiz edilmiştir. 
Yoğun bakıma kabul edilen obstetrik hastaların yaş ortalaması, 31,47 yaş, mortalite oranı %7,5 ve en sık kabul nedeninin HELLP Sendromu/ Eklampsi/ Preeklampsi (%40) olduğu, hastaların %20'sinde hastalığa eşlik eden kardiyak problemler varlığı ve %85'inin gebeliğin ikinci trimesterında ve sezeryan ile doğum yaptıkları belirlenmiştir. Yoğun bakıma kabul edilen jinekolojik hastaların yaş ortalaması 65,60 yaş, mortalite oranı  %21,3 ve en sık kabul nedeninin Over Ca (% 48,5) olduğu ve hastaların %12,1'inde sağlık hizmeti ile ilişkili enfeksiyonlar ve sepsisin komplikasyon olarak ortaya çıktığı saptanmıştır. Çalışmaya katılan hemşirelerin %66,7'si 1-10 jinekolojik ve obsterik hastaya yoğum bakımda bakım verdiğini, %57,1'i jinekolojik ve obstetrik yoğun bakım hastasına bakım vermeyi tercih etmediğini, %73,8'si obstetrik ve jinekolojik hastaya bakım vermede kendini yeterli görmediğini, %66,7'si bu hastalara bakım verme konusunda spesifik eğitime ihtiyaç duyduklarını ifade etmiştir. Çalışanların obstetrik ve jinekolojik hastaya bakmayı tercih edenlerin "Hasta ayırımı yapmıyorum" ve "Hastaların genç ve sağlıklı olması" yanıtlarının ağırlıklı verildiği;  bakımı tercih etmeme nedenleri arasında "bilgi eksikliği" ve "hastaya bakmak istememesi" yanıtlarının ağırlıklı olduğu görülmektedir. Obstetrik ve jinekolojik hastaya bakmada kendini yeterli görmeme nedenleri incelendiğinde "Az karşılaştığımız hastalar" ve "Bakım vermede yetersizim" yanıtları ağırlıktadır. Obstetrik ve jinekolojik nedenlerle yatan hastaya bakım vermenin diğer hastalara bakım vermekten farklı görme nedenleri incelendiğinde "Tanı ve klinikleri diğer hastalardan farklı" ve "Psikolojik nedenden" yanıtları verilmiştir. 

Anahtar Kelimeler: Yoğun bakım ünitesi, Obstetrik hasta, Jinekolojik hasta, Obstetrik ve jinekolojik yoğun bakım, Hemşire, Görüş.

Abstract:
This study is a retrospective descriptive and qualitative type study to investigate the reasons of acceptance and clinical outcomes of obstetric and gynecologic cases followed in multidisciplinary general intensive care unit retrospectively and to examine the opinions of nurses giving care to these patients.
A total of 73 patients with obstetric and gynecological reasons were studied retrospectively at the Department of Anesthesiology and Reanimation Clinic Intensive Care Unit of Bakırköy Dr.Sadi Konuk Research and Training Hospital during the first phase of the two-stage study. The second phase of the study was interviewed with 42 nurses, midwives, health officers who were qualitatively selected, working in the intensive care unit and accepting research. The study was carried out between April 1 and June 1, 2016 in the Department of Anesthesiology and Reanimation Clinic of Bakırköy Dr.Sadi Konuk Research and Training Hospital. Number, percentage, mean, standard deviation were used as descriptive statistical methods in evaluating the data. The qualitative content obtained in the research was analyzed by qualitative analysis methods.
The mean age of the obstetric patients was 31.47 years, the mortality rate was 7.5% and the most common reason was HELLP Syndrome / Eclampsia / Preeclampsia (40%), 20% of the patients had cardiac problems accompanying the disease, Of pregnancies are in the second trimester of pregnancy and they have been delivered by cesarean section. The gynecologic patients who accepted intensive care were 65,60 years old, mortality rate 21,3%, and the most frequent cause was Over Ca (48,5%) and 12,1% of the health related infections and sepsis complication . It was stated that 66.7% of the nurses participated in the study gave 1-10 gynecological and obstetric care to the gynecological care, 57.1% did not prefer gynecological and obstetric intensive care, 73.8% did not care for the obstetric and gynecological patients 66.7% of them stated that they needed specific training in the care of these patients. The respondents who prefer to look at obstetric and gynecological patients are mostly given the answers "I do not make a patient" and "The patients are young and healthy". "lack of information" and "unwillingness to look at the patient" are the main reasons for not choosing to care. When examining the reasons for not seeing enough in obstetric and gynecological patients, the answers are "Patients we rarely encounter" and "Inability to give care". "Diagnosis and clinics are different from other patients" and "Psychological reasons" were given when the reasons for giving patients with obstetric and gynecological reasons differ from those given to other illness care.

Key words: Intensive care unit, Obstetric patient, Gynecologic patient, Obstetric and gynecological intensive care, Nurse, Opinion.







ABSTRACT
                 

ANALYSIS OF RETROSPECTIVE OF OBSTETRIC AND GYNECOLOGICAL CASES IN INTENSIVE CARE UNIT AND VIEWS OF NURSES THAT GIVE CARE TO THESE PATIENTS

This study is a retrospective descriptive and qualitative type study to investigate the reasons of acceptance and clinical outcomes of obstetric and gynecologic cases followed in multidisciplinary general intensive care unit retrospectively and to examine the opinions of nurses giving care to these patients.
A total of 73 patients with obstetric and gynecological reasons were studied retrospectively at the Department of Anesthesiology and Reanimation Clinic Intensive Care Unit of Bakırköy Dr.Sadi Konuk Research and Training Hospital during the first phase of the two-stage study. The second phase of the study was interviewed with 42 nurses, midwives, health officers who were qualitatively selected, working in the intensive care unit and accepting research. The study was carried out between April 1 and June 1, 2016 in the Department of Anesthesiology and Reanimation Clinic of Bakırköy Dr.Sadi Konuk Research and Training Hospital. Number, percentage, mean, standard deviation were used as descriptive statistical methods in evaluating the data. The qualitative content obtained in the research was analyzed by qualitative analysis methods.
The mean age of the obstetric patients was 31.47 years, the mortality rate was 7.5% and the most common reason was HELLP Syndrome / Eclampsia / Preeclampsia (40%), 20% of the patients had cardiac problems accompanying the disease, Of pregnancies are in the second trimester of pregnancy and they have been delivered by cesarean section. The gynecologic patients who accepted intensive care were 65,60 years old, mortality rate 21,3%, and the most frequent cause was Over Ca (48,5%) and 12,1% of the health related infections and sepsis complication . It was stated that 66.7% of the nurses participated in the study gave 1-10 gynecological and obstetric care to the gynecological care, 57.1% did not prefer gynecological and obstetric intensive care, 73.8% did not care for the obstetric and gynecological patients 66.7% of them stated that they needed specific training in the care of these patients. The respondents who prefer to look at obstetric and gynecological patients are mostly given the answers "I do not make a patient" and "The patients are young and healthy". "lack of information" and "unwillingness to look at the patient" are the main reasons for not choosing to care. When examining the reasons for not seeing enough in obstetric and gynecological patients, the answers are "Patients we rarely encounter" and "Inability to give care". "Diagnosis and clinics are different from other patients" and "Psychological reasons" were given when the reasons for giving patients with obstetric and gynecological reasons differ from those given to other illness care.

Key words: Intensive care unit, Obstetric patient, Gynecologic patient, Obstetric and gynecological intensive care, Nurse, Opinion.