Erişkin hastalarda timpanik membran termometresi ile yapılan ölçümlerde kulak kepçe pozisyonunun vücut sıcaklığı ölçüm değerlerine etkisi
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Tarih
2016
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Yayıncı
Ege üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Araştırma, erişkin hastalarda timpanik membran termometresi ile yapılan ölçümlerde kulak kepçe pozisyonunun vücut sıcaklığı ölçüm değerlerine ve rahatlık düzeyini etkisini incelemek amacı ile karşılaştırmalı tanımlayıcı olarak yapılmıştır. Araştırma, Kasım - Aralık 2015 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Hastanesi Acil Servis'ine bu tarihlerde ayaktan başvuran ya da yatarak tedavi gören erişkin hastalarda yapılmıştır. Araştırmanın örneklemini, 18 yaş ve üstü, bilinci açık, iletişim sorunu olmayan, gönüllü, otitis mediası olmayan, ateşi olmayan, ayaktan başvuran ya da yatarak tedavi gören erişkin hastalar (n=147) oluşturmuştur. Ege Üniversitesi Tıp Fakültesi Hastanesi Acil Servis'ine başvuran günlük hasta sayısının fazla olması nedeni ile bu birim seçilmiştir. Araştırmada veriler, Veri Toplama Formu, Görsel Kıyaslama Ölçeği, timpanik membran termometresi ve kronometre kullanılarak toplanmıştır. Verilerin toplanmasında, araştırmaya dahil olma ölçütlerine uygun hastalar belirlendikten sonra araştırma hakkında bilgi verilmiştir, gönüllü olan hastalardan bilgilendirilmiş onam alınmıştır. Hastalarla ilgili tanıtıcı bilgiler, Veri Toplama Formuna kaydedildikten sonra hastanın hangi gruba alınacağı basit randomizasyonla belirlenmiştir, bunun için kura çekilmiştir. A grubundaki hastaların vücut sıcaklığı önce kulak kepçesi pozisyonu değiştirilerek ölçülmüştür. Ölçüm sırasında termometrenin kulak kanalında sıcaklık değişikliğine (sürtünme, plastik koruyucunun ısısının daha düşük olması gibi nedenler) neden olabileceği düşünülerek iki ölçüm arasında 30 saniye ara verilmiştir. Daha sonra ölçme işlemi hastanın kulak kepçesi pozisyonu değiştirilmeden yapılmıştır. B grubundaki hastaların vücut sıcaklığı ölçümü ise, önce kulak kepçesi pozisyonu değiştirilmeden, daha sonra ölçme işlemi hastanın kulak kepçesi pozisyonu değiştirilerek ölçüm yapılmıştır. Her bir vücut sıcaklığı ölçme işleminin süresi kronometre ile belirlenmiştir, işlemin rahatlık düzeyi Görsel Kıyaslama Ölçeği kullanılarak değerlendirilmiştir. Verilerin analizinde Statistical Package of Social Science (SPSS) 16.0 programı kullanılmıştır. Verilerin istatistiksel analizlerinde frekans, yüzde, ortalama, standart sapma hesaplanmış, kulak kepçe pozisyonunun ölçüm değerlerine etkisini incelemek için iki eş arasındaki farkın önemlilik testi kullanılmıştır. Ayrıca Bland Altman yöntemi ile verilere ilişkin grafikler oluşturulmuştur. Sonuçlar %95 güven aralığında, anlamlılık p<0.05 düzeyinde değerlendirilmiştir. Araştırmanın yapılabilmesi için Ege Üniversitesi Hemşirelik Fakültesi Etik Kurulu'ndan ve Ege Üniversitesi Tıp Fakültesi Hastanesinden ve örneklem kapsamına alınan her bir hastadan yazılı izin alınmıştır. Araştırmanın sonucunda ise, Araştırma kapsamına alınan hastaların, yaşları 18 ile 85 arasında değişmekte olup ( =38.93±15.28) %38.4'ünün 18-29 yaş grubunda olduğu , %55.8'inin kadın olduğu saptanmıştır. Yapılan ölçüm değerlerinin gruplara göre ortalamalarına bakıldığında, A grubunda kulak kepçe pozisyonu verilerek yapılan ölçümlerde ortalamanın 36.93 0C, kulak kepçe pozisyonu verilmeden yapılan ölçümlerde ortalamanın 36.69 0C olduğu, B grubunda kulak kepçe pozisyonu verilerek yapılan ölçümlerde ortalamanın 36.99 0C, kulak kepçe pozisyonu verilmeden yapılan ölçümlerde ise ortalamanın 36.62 0C olduğu; pozisyonlara göre ortalamalarına bakıldığında, kulak kepçe pozisyonu verilerek yapılan ölçümlerde ortalamanın 36.96 0C, kulak kepçe pozisyonu verilmeden yapılan ölçümlerde ortalamanın 36.66 0C olduğu saptanmıştır. İki ayrı pozisyonda gerçekleştirilen ölçüm değerlerinin arasındaki farkın 0.30 0C olduğu, Bland Altman grafiği ile incelendiğinde her pozisyona ait grafikte farkların sıfırın etrafında sistematik bir şekilde dağılmadığı, farkların 0.3 değeri etrafında sistematik bir dağılım gösterdiği saptanmıştır. Yapılan ölçümlerin işlem sürelerine bakıldığında, kulak kepçe pozisyonu verilerek yapılan işlemlerin ortalama süresinin 5.51 saniye, kulak kepçe pozisyonu verilmeden yapılan işlemlerin ortalama süresinin ise 4.42 saniye olduğu, iki ayrı pozisyonda yapılan ölçüm işlemlerinin süreleri arasındaki farkın 1.08 saniye olduğu saptanmıştır. Kulak kepçesine pozisyon verilerek yapılan vücut sıcaklığı ölçme işleminden %59.2'sinin "0" düzeyinde rahatsızlık hissettiği saptanmıştır ( =1.13±1.84).
Research was carried out in adult patients comparatively, descriptively to scrutinize the effect that auricle position has on the body's temperature measurement values and on the level of comfort during measurements performed through tympanic membrane thermometer. Research was carried out with adult out-patients or in-patients who referred to Emergency Department of Ege University Medical Faculty between November and December 2015. The sampling of research consisted of volunteer adult patients (18 years old or above) who were receiving therapy as in-patient or out-patient basis and were conscious, lacking communication problem, otitis media or fever (n=147). This unit was selected due to extreme number of daily referrals made to Emergency Department of Ege University Medical Faculty. In research data were collected by using Data Collection Form, Visual Comparison Scale, Tympanic Membrane Thermometer and Chronometer. During data collection, after patients that met inclusion criteria were identified, they were given information related to research and those that were volunteered to participate have provided informed consent. After the introductory data related to patients have recorded on Data Collection Form, to which groups they will be included in were determined through simple randomization (drawing lots). In group A, patients' body temperature was first measured by changing the position of auricle. During measurement (due to reasons such as friction, reduced temperature in plastic protector) 30-second breaks were given between two measurements since thermometer was thought to cause temperature change in ear canal. Later measurement process was performed without changing patient's auricle position. In group B, patients' body temperature measurement was first performed without changing the auricle position and later measurement was performed by changing the auricle position. The length of each body temperature measurement process was determined through chronometer; process's level of comfort was evaluated by using Visual Comparison Scale. Statistical Package of Social Science (SPSS) program version 16.0 was used in the analysis of data. In statistical analyses of data, the frequency, percentage, average and standard deviation were calculated and to investigate their effects on the auricle position measurement values, the significance between two pairs test was used. In addition, graphics related to data were drawn through Bland Altman method. Results were assessed at 95 % confidence interval and at p<0.05 significance level. In order for the research can be performed, Ethical Board of Ege University Nursing Faculty's and Ege University Medical Faculty Hospital's written approvals were obtained and each patient included in the scope of research has provided written informed consent. At the end of research it was identified that ages of the patients included in the scope of research were varied between 18 and 85 years ( = 38.93±15.28); 38.4 % were in 18-29 years age group and 55.8 % were females. When the measurement value averages according to groups were viewed; in group A, the average in measurements performed by providing auricle position was 36.93 0C; in those performed by without providing auricle position was 36.69 0C; whereas in group B, the average in measurements performed by providing auricle position was 36.990C; in those performed by without providing auricle position was 36.620C. When the averages according to positions were examined it was identified that the average in measurements performed by providing auricle position was 36.96 0C; in those performed by without providing auricle position was 36.660C. The difference between measurement values performed at two distinct positions was 0.300C; when the Bland Altman graphic was studied it was observed that the differences on the graphic belonging to each position did not disperse systematically around the zero; however, they demonstrated systematic dispersion around the value of 0.3. When the process duration in measurements was examined it was established that the mean length of time in measurements performed by providing auricle position was 5.51 seconds; in those performed by without providing auricle position was 34.42 seconds; the difference in the length of times between measurement processes performed in two positions was 1.08 second. It was identified that 59.2 % of the body temperature measurements carried out by providing auricle position did not feel any discomfort ( =1.13±1.84).
Research was carried out in adult patients comparatively, descriptively to scrutinize the effect that auricle position has on the body's temperature measurement values and on the level of comfort during measurements performed through tympanic membrane thermometer. Research was carried out with adult out-patients or in-patients who referred to Emergency Department of Ege University Medical Faculty between November and December 2015. The sampling of research consisted of volunteer adult patients (18 years old or above) who were receiving therapy as in-patient or out-patient basis and were conscious, lacking communication problem, otitis media or fever (n=147). This unit was selected due to extreme number of daily referrals made to Emergency Department of Ege University Medical Faculty. In research data were collected by using Data Collection Form, Visual Comparison Scale, Tympanic Membrane Thermometer and Chronometer. During data collection, after patients that met inclusion criteria were identified, they were given information related to research and those that were volunteered to participate have provided informed consent. After the introductory data related to patients have recorded on Data Collection Form, to which groups they will be included in were determined through simple randomization (drawing lots). In group A, patients' body temperature was first measured by changing the position of auricle. During measurement (due to reasons such as friction, reduced temperature in plastic protector) 30-second breaks were given between two measurements since thermometer was thought to cause temperature change in ear canal. Later measurement process was performed without changing patient's auricle position. In group B, patients' body temperature measurement was first performed without changing the auricle position and later measurement was performed by changing the auricle position. The length of each body temperature measurement process was determined through chronometer; process's level of comfort was evaluated by using Visual Comparison Scale. Statistical Package of Social Science (SPSS) program version 16.0 was used in the analysis of data. In statistical analyses of data, the frequency, percentage, average and standard deviation were calculated and to investigate their effects on the auricle position measurement values, the significance between two pairs test was used. In addition, graphics related to data were drawn through Bland Altman method. Results were assessed at 95 % confidence interval and at p<0.05 significance level. In order for the research can be performed, Ethical Board of Ege University Nursing Faculty's and Ege University Medical Faculty Hospital's written approvals were obtained and each patient included in the scope of research has provided written informed consent. At the end of research it was identified that ages of the patients included in the scope of research were varied between 18 and 85 years ( = 38.93±15.28); 38.4 % were in 18-29 years age group and 55.8 % were females. When the measurement value averages according to groups were viewed; in group A, the average in measurements performed by providing auricle position was 36.93 0C; in those performed by without providing auricle position was 36.69 0C; whereas in group B, the average in measurements performed by providing auricle position was 36.990C; in those performed by without providing auricle position was 36.620C. When the averages according to positions were examined it was identified that the average in measurements performed by providing auricle position was 36.96 0C; in those performed by without providing auricle position was 36.660C. The difference between measurement values performed at two distinct positions was 0.300C; when the Bland Altman graphic was studied it was observed that the differences on the graphic belonging to each position did not disperse systematically around the zero; however, they demonstrated systematic dispersion around the value of 0.3. When the process duration in measurements was examined it was established that the mean length of time in measurements performed by providing auricle position was 5.51 seconds; in those performed by without providing auricle position was 34.42 seconds; the difference in the length of times between measurement processes performed in two positions was 1.08 second. It was identified that 59.2 % of the body temperature measurements carried out by providing auricle position did not feel any discomfort ( =1.13±1.84).
Açıklama
Anahtar Kelimeler
Kulak Kepçesi, Vücut Sıcaklığı, Timpanik Membran Filtresi, Auricle, Tympanic Membrane Thermometer
