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COVID-19 Pandemisinin Hemşirelerin Belirsizliğe Tahammülsüzlük Düzeyine Etkisi

Year 2024, Volume: 11 Issue: 1, 52 - 60, 28.03.2024
https://doi.org/10.31125/hunhemsire.1358987

Abstract

Amaç Bu araştırma COVID-19 pandemisinin hemşirelerin belirsizliğe tahammülsüzlük düzeylerine etkisini belirlemek amacıyla yapılmıştır
Gereç ve Yöntem: Tanımlayıcı tipteki bu araştırmanın evrenini Türkiye'de herhangi bir sağlık kuruluşunda çalışan hemşireler oluşturmuştur. Araştırmanın anket formu Nisan - Haziran 2022 tarihleri arasında sosyal medya araçlarında paylaşılmış ve çalışma örneklemine toplam 341 hemşire dahil edilmiştir. Verilerin toplanmasında Sosyodemografik Form ve Belirsizliğe Tahammülsüzlük Ölçeği (BTÖ-12) kullanılmıştır. Verilerin değerlendirilmesinde sayı, yüzdelik dağılım, Mann Whitney U testi ve Kruskal Wallis Varyans analizi yöntemlerinden yararlanılmıştır
Bulgular: Çalışma kapsamına alınan hemşirelerin BTÖ toplam puan ortalaması 39.83±8.749 olup orta düzey bulunmuştur. Hemşirelerin %64.5’i pandemi sürecinde gelir değişikliği yaşamadığını, %96.5’i pandemi nedeniyle ödenen ödemelerin tatmin edici olmadığını ve %31.1’i pandemi nedeniyle 1-3 gün fazla mesai çalıştığını belirtmiştir. Pandemi döneminde gelir değişikliği arasında medyan toplam BTÖ puanı açısından istatistiksel olarak anlamlı fark olduğu saptanmıştır (p=0.000). Pandemi sürecinde hasta/hasta yakını tarafından şiddete maruz kalma, çalışma arkadaşlarıyla diyalog azaltma ve yakınlaşmamayı tercih etme arasında medyan toplam BTÖ puanı açısından istatistiksel olarak anlamlı fark olduğu saptanmıştır (p<0.05).
Sonuç: COVID-19 salgınının psikolojik etkilerinin yüksek olduğu görülmektedir. Salgında en ön saflarda çalışan sağlık çalışanlarının zihinsel ve fiziksel iyilik hali üzerindeki olumsuz etkileri kaldırmak amacıyla destek programlarına gereksinim duyulmaktadır.

References

  • Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan. China. J Med Virol. 2020;92(4):441-7.
  • Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et l. A pneumonia out break associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.
  • Perlman S. Another decade, another coronavirus. N Engl J Med. 2020; 382(8):760-2.
  • World Health Organization (WHO). Coronavirus. [Internet]. 2020 [Erişim Tarihi 25 Nisan 2022]. Erişim adresi: https://www.who.int/health-topics/coronavirus#tab=tab_1
  • Al-Mohaissen M. Awareness among a Saudi Arabian university community of Middle East respiratory syndrome coronavirus following an outbreak. East Mediterr Health J. 2017;23(5):351-60.
  • Jiang S, Shi Z, Shu Y, Song J, Gao GF, Tan W, et al. A distinct name is needed for the new coronavirus. Lancet. 2020;395(10228):949.
  • Lehmann M, Bruenahl CA, Löwe B, Addo MM, Schmiedel S, Lohse AW, et al. Ebola and psychological stress of health care professionals. Emerg Infect Dis. 2015;21(5):913-4.
  • Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the ınitial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Research Public Health. 2020;17(5):1729.
  • T.C. Sağlık Bakanlığı. Türkiye'de mevcut durum. [Internet]. 2022 [Erişim Tarihi 25 Nisan 2022]. Erişim adresi: https://covid19.saglik.gov.tr/
  • Choi KR, Skrine Jeffers K, Cynthia Logsdon M. Nursing and the novel coronavirus: Risks and responsibilities in a global outbreak. J Adv Nurs. 2020;76(7):1486-7.
  • Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. Depression after exposure to stressful events: Lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry. 2012;53(1):15-23.
  • Lung FW, Lu YC, Chang YY, Shu BC. Mental symptoms in different health professionals during the SARS attack: A follow-up study. Psychiatr Q. 2009;80(2):107-16.
  • Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry. 2009;54(5):302-11.
  • World Health Organization. Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020. Geneva: World Health Organization. 2016. p. 56.
  • Alavi N, Omrani M. What is depression? What is anxiety? Online cognitive behavioral therapy. Springer, Cham. 2019;(pp.17–31).
  • Tovilovic S, Novovic Z, Mihic L, Jovanovic V. The role of trait anxiety in induction of state anxiety. Psihologija. 2009;42(4):491-504.
  • Geçgin FM, Sahranç Ü. The relationships between intolerance of uncertainty and psychological well-being. SUJE. 2017;7(4):739-55.
  • Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7(3):e14.
  • Satici B, Saricali M, Satici SA, Griffiths MD. Intolerance of uncertainty and mental wellbeing: serial mediation by rumination and fear of COVID-19. Int J Ment Health Addict. 2020; 20:2731-42.
  • Aydın A, Özcan EB. Covid-19 pandemi sürecinde sağlık çalışanlarında belirsizliğe tahammülsüzlük, ruminatif düşünme biçimi ve psikolojik sağlamlık düzeyleri. Çukurova Med. J. 2021;46(3):1191-200.
  • Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Res. 2020; 288:112954.
  • Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Arch. Clin. Infect. Dis. 2020;15.e102848.
  • Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.
  • Carleton RN, Norton MA, Asmundson GJG. Fearing the unknown: A short version of the intolerance of uncertainty scale. J Anxiety Disord. 2007;21(1):105-17.
  • Sarıçam H, Erguvan FM, Akın A, Akça MŞ. Belirsizliğe Tahammülsüzlük Ölçeği (BTÖ-12) Türkçe formu: geçerlik ve güvenirlik çalışması. RESS JOURNAL. 2014;1(3):148-57.
  • Pak H, Süsen Y, Nazlıgül MD, Griffiths M. The Mediating Effects of Fear of COVID-19 and Depression on the Association Between Intolerance of Uncertainty and Emotional Eating During the COVID-19 Pandemic in Turkey. Int J Ment Health Addict. 2022;20(3):1882-96.
  • Voitsidis P, Gliatas I, Bairachtari V, Papadopoulou K, Papageorgiou G, Parlapani E, et al. Insomnia during the COVID-19 pandemic in a Greek population. Psychiatry Res. 2020;289:113076.
  • Keleşoğlu F, Adam Karduz FF. Covıd-19 süreçlerinde kişilerarası duygu düzenleme stratejileri ve belirsizliğe tahammülsüzlük üzerine bir araştırma CIJE. 2022;11(2):321-36.
  • Parlapani E, Holeva V, Nikopoulou VA, Sereslis K, Athanasiadou M, Godosidis A, et al. Intolerance of uncertainty and loneliness in older adults during the covıd-19 pandemic. Front. Psychiatry. 2020;11:842.
  • Duman N. Üniversite öğrencilerinde covıd-19 korkusu ve belirsizliğe tahammülsüzlük. The Journal of Social Science. 2020;4(8):426-37.
  • Turan FD. Hemşirelik öğrencilerinin COVID-19 fobisinin yordayıcısı olarak belirsizliğe karşı tahammülsüzlükleri ve sağlık anksiyeteleri. Ordu University J Nurs Stud. 2022; 5(1):49-59
  • del Valle MV, Andrés ML, Urquijo S, Yerro-Avincetto M, López-Morales H, Canet-Juric L. Intolerance of uncertainty over COVID-19 pandemic and its effect on anxiety and depressive symptoms. Rev. Inter. Psicol. 2020;54(2):1-17.
  • Afshari D, Nourollahi-Darabad M, Chinisaz N. Demographic predictors of resilience among nurses during the COVID-19 pandemic. Work (Reading, Mass.). 2021;68(2):297-303
  • García-Fernández L, Romero-Ferreiro V, Padilla S, Lahera G, Rodriguez-Jimenez R. Different emotional profile of health care staff and general population during the Covıd-19 outbreak. Psychol Trauma. 2022;14(2):266-72.
  • Zhang X, Jiang Z, Yuan X, Wang Y, Huang D, Hu R, et al. Nurses reports of actual work hours and preferred work hours per shift among frontline nurses during coronavirus disease 2019 (COVID-19) epidemic: A cross-sectional survey. Int Nurs Stud Adv. 2021;3:100026
  • Güdük Ö, Güdük Ö, Vural A. Covıd-19 küresel salgınında sağlık çalışanlarının belirsizliğe tahammülsüzlüğünün değerlendirilmesi. Hacettepe Sağlık İdaresi Dergisi. 2021;24 (1):139-50.
  • Patterson PD, Runyon MS, Higgins JS, Weaver MD, Teasley EM, et al. Shorter versus longer shift durations to mitigate fatigue and fatigue-related risks in emergency medical services personnel and related shift workers: A systematic review. Prehosp Emerg Care. 2018;22(1): 28-36.
  • Kasap EU, Çerçi S, Akdoğan TA, Balkan Mİ, Özdal N, Kopuz SN. COVID-19 pandemi sürecinde hemşirelerin tükenmişlik düzeylerinin değerlendirilmesi. Güncel Hemşirelik Araştırmaları Dergisi. 2023;3(2):74-84.
  • Gezginci E, Öztaş B. (2021). Cerrahi birimlerde çalışan hemşirelerin tükenmişlik ve yenilikçilik düzeyleri arasındaki ilişkinin incelenmesi. Hacettepe Sağlık İdaresi Dergisi.2021; 24(2):361-374.
  • Mertens G, Gerritsen L, Duijndam S, Salemink E, Engelhard IM. Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020. J Anxiety Disord. 2020;74:102258.
  • Aksoy YE, Koçak V. Psychological effects of nurses and midwives due to COVID-19 outbreak: The case of Turkey. Arch Psychiatr Nurs. 2020;34(5):427-33.
  • Smith BM, Twohy AJ, Smith GS. Psychological inflexibility and intolerance of uncertainty moderate the relationship between social isolation and mental health outcomes during COVID-19. J Contextual Behav Sci. 2020;18:162-74.
  • Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. 2020;66:1-8.
  • Öztürk İ, Akalın S, Özgüner İ, Şakiroğlu M. Covid-19 salgınının ve karantinanın psikolojik etkileri. Turkish Studies. 2020;15(4):885-903.
  • Bakioğlu F, Korkmaz O, Ercan H. Fear of Covıd-19 and positivity: Mediating role of intolerance of uncertainty, depression, anxiety, and stress. Int J Ment Health Addict. 2020;19(6):2369-82.

The Impact of the COVID-19 Pandemic on Nurses' Level of Intolerance to Uncertainty

Year 2024, Volume: 11 Issue: 1, 52 - 60, 28.03.2024
https://doi.org/10.31125/hunhemsire.1358987

Abstract

Aim: This study aims to determine the impact of the COVID-19 pandemic on nurses' intolerance of uncertainty.
Material and Methods: The population of this descriptive study consisted of nurses working in any health institution in Turkey. The survey form of the study was shared on social media tools between April and June 2022 and a total of 341 nurses were included in the study sample. The sociodemographic Form and Intolerance of Uncertainty Scale (ITS-12) were used to collect the data. Number, percentage distribution, the Mann-Whitney U test, and the Kruskal Wallis Variance analysis methods were used in the evaluation of the data.
Results: The mean total score of the nurses included in the study was 39.83±8.749 and was found to be moderate. 64.5% of nurses stated that they did not experience any income change during the pandemic, 96.5% stated that the payments paid due to the pandemic were not satisfactory, and 31.1% stated that they worked overtime for 1-3 days due to the pandemic. A statistically significant difference was found in terms of the median total IUS score between income changes during the pandemic period (p=0.000). It has been determined that there is a statistically significant difference in terms of the median total IUS score between experiencing violence from a patient/patient's relative, reducing dialogue with colleagues, and preferring not to approach during the pandemic process (p<0.05).
Conclusion: It is seen that the psychological effects of the COVID-19 pandemic are high. To mitigate the adverse effects on the mental and physical well-being of healthcare workers on the frontlines during the pandemic, there is a need for support programs.

References

  • Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan. China. J Med Virol. 2020;92(4):441-7.
  • Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et l. A pneumonia out break associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.
  • Perlman S. Another decade, another coronavirus. N Engl J Med. 2020; 382(8):760-2.
  • World Health Organization (WHO). Coronavirus. [Internet]. 2020 [Erişim Tarihi 25 Nisan 2022]. Erişim adresi: https://www.who.int/health-topics/coronavirus#tab=tab_1
  • Al-Mohaissen M. Awareness among a Saudi Arabian university community of Middle East respiratory syndrome coronavirus following an outbreak. East Mediterr Health J. 2017;23(5):351-60.
  • Jiang S, Shi Z, Shu Y, Song J, Gao GF, Tan W, et al. A distinct name is needed for the new coronavirus. Lancet. 2020;395(10228):949.
  • Lehmann M, Bruenahl CA, Löwe B, Addo MM, Schmiedel S, Lohse AW, et al. Ebola and psychological stress of health care professionals. Emerg Infect Dis. 2015;21(5):913-4.
  • Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the ınitial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Research Public Health. 2020;17(5):1729.
  • T.C. Sağlık Bakanlığı. Türkiye'de mevcut durum. [Internet]. 2022 [Erişim Tarihi 25 Nisan 2022]. Erişim adresi: https://covid19.saglik.gov.tr/
  • Choi KR, Skrine Jeffers K, Cynthia Logsdon M. Nursing and the novel coronavirus: Risks and responsibilities in a global outbreak. J Adv Nurs. 2020;76(7):1486-7.
  • Liu X, Kakade M, Fuller CJ, Fan B, Fang Y, Kong J, et al. Depression after exposure to stressful events: Lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry. 2012;53(1):15-23.
  • Lung FW, Lu YC, Chang YY, Shu BC. Mental symptoms in different health professionals during the SARS attack: A follow-up study. Psychiatr Q. 2009;80(2):107-16.
  • Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry. 2009;54(5):302-11.
  • World Health Organization. Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020. Geneva: World Health Organization. 2016. p. 56.
  • Alavi N, Omrani M. What is depression? What is anxiety? Online cognitive behavioral therapy. Springer, Cham. 2019;(pp.17–31).
  • Tovilovic S, Novovic Z, Mihic L, Jovanovic V. The role of trait anxiety in induction of state anxiety. Psihologija. 2009;42(4):491-504.
  • Geçgin FM, Sahranç Ü. The relationships between intolerance of uncertainty and psychological well-being. SUJE. 2017;7(4):739-55.
  • Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7(3):e14.
  • Satici B, Saricali M, Satici SA, Griffiths MD. Intolerance of uncertainty and mental wellbeing: serial mediation by rumination and fear of COVID-19. Int J Ment Health Addict. 2020; 20:2731-42.
  • Aydın A, Özcan EB. Covid-19 pandemi sürecinde sağlık çalışanlarında belirsizliğe tahammülsüzlük, ruminatif düşünme biçimi ve psikolojik sağlamlık düzeyleri. Çukurova Med. J. 2021;46(3):1191-200.
  • Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Res. 2020; 288:112954.
  • Nemati M, Ebrahimi B, Nemati F. Assessment of Iranian nurses’ knowledge and anxiety toward COVID-19 during the current outbreak in Iran. Arch. Clin. Infect. Dis. 2020;15.e102848.
  • Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-33.
  • Carleton RN, Norton MA, Asmundson GJG. Fearing the unknown: A short version of the intolerance of uncertainty scale. J Anxiety Disord. 2007;21(1):105-17.
  • Sarıçam H, Erguvan FM, Akın A, Akça MŞ. Belirsizliğe Tahammülsüzlük Ölçeği (BTÖ-12) Türkçe formu: geçerlik ve güvenirlik çalışması. RESS JOURNAL. 2014;1(3):148-57.
  • Pak H, Süsen Y, Nazlıgül MD, Griffiths M. The Mediating Effects of Fear of COVID-19 and Depression on the Association Between Intolerance of Uncertainty and Emotional Eating During the COVID-19 Pandemic in Turkey. Int J Ment Health Addict. 2022;20(3):1882-96.
  • Voitsidis P, Gliatas I, Bairachtari V, Papadopoulou K, Papageorgiou G, Parlapani E, et al. Insomnia during the COVID-19 pandemic in a Greek population. Psychiatry Res. 2020;289:113076.
  • Keleşoğlu F, Adam Karduz FF. Covıd-19 süreçlerinde kişilerarası duygu düzenleme stratejileri ve belirsizliğe tahammülsüzlük üzerine bir araştırma CIJE. 2022;11(2):321-36.
  • Parlapani E, Holeva V, Nikopoulou VA, Sereslis K, Athanasiadou M, Godosidis A, et al. Intolerance of uncertainty and loneliness in older adults during the covıd-19 pandemic. Front. Psychiatry. 2020;11:842.
  • Duman N. Üniversite öğrencilerinde covıd-19 korkusu ve belirsizliğe tahammülsüzlük. The Journal of Social Science. 2020;4(8):426-37.
  • Turan FD. Hemşirelik öğrencilerinin COVID-19 fobisinin yordayıcısı olarak belirsizliğe karşı tahammülsüzlükleri ve sağlık anksiyeteleri. Ordu University J Nurs Stud. 2022; 5(1):49-59
  • del Valle MV, Andrés ML, Urquijo S, Yerro-Avincetto M, López-Morales H, Canet-Juric L. Intolerance of uncertainty over COVID-19 pandemic and its effect on anxiety and depressive symptoms. Rev. Inter. Psicol. 2020;54(2):1-17.
  • Afshari D, Nourollahi-Darabad M, Chinisaz N. Demographic predictors of resilience among nurses during the COVID-19 pandemic. Work (Reading, Mass.). 2021;68(2):297-303
  • García-Fernández L, Romero-Ferreiro V, Padilla S, Lahera G, Rodriguez-Jimenez R. Different emotional profile of health care staff and general population during the Covıd-19 outbreak. Psychol Trauma. 2022;14(2):266-72.
  • Zhang X, Jiang Z, Yuan X, Wang Y, Huang D, Hu R, et al. Nurses reports of actual work hours and preferred work hours per shift among frontline nurses during coronavirus disease 2019 (COVID-19) epidemic: A cross-sectional survey. Int Nurs Stud Adv. 2021;3:100026
  • Güdük Ö, Güdük Ö, Vural A. Covıd-19 küresel salgınında sağlık çalışanlarının belirsizliğe tahammülsüzlüğünün değerlendirilmesi. Hacettepe Sağlık İdaresi Dergisi. 2021;24 (1):139-50.
  • Patterson PD, Runyon MS, Higgins JS, Weaver MD, Teasley EM, et al. Shorter versus longer shift durations to mitigate fatigue and fatigue-related risks in emergency medical services personnel and related shift workers: A systematic review. Prehosp Emerg Care. 2018;22(1): 28-36.
  • Kasap EU, Çerçi S, Akdoğan TA, Balkan Mİ, Özdal N, Kopuz SN. COVID-19 pandemi sürecinde hemşirelerin tükenmişlik düzeylerinin değerlendirilmesi. Güncel Hemşirelik Araştırmaları Dergisi. 2023;3(2):74-84.
  • Gezginci E, Öztaş B. (2021). Cerrahi birimlerde çalışan hemşirelerin tükenmişlik ve yenilikçilik düzeyleri arasındaki ilişkinin incelenmesi. Hacettepe Sağlık İdaresi Dergisi.2021; 24(2):361-374.
  • Mertens G, Gerritsen L, Duijndam S, Salemink E, Engelhard IM. Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020. J Anxiety Disord. 2020;74:102258.
  • Aksoy YE, Koçak V. Psychological effects of nurses and midwives due to COVID-19 outbreak: The case of Turkey. Arch Psychiatr Nurs. 2020;34(5):427-33.
  • Smith BM, Twohy AJ, Smith GS. Psychological inflexibility and intolerance of uncertainty moderate the relationship between social isolation and mental health outcomes during COVID-19. J Contextual Behav Sci. 2020;18:162-74.
  • Shechter A, Diaz F, Moise N, Anstey DE, Ye S, Agarwal S, et al. Psychological distress, coping behaviors, and preferences for support among New York healthcare workers during the COVID-19 pandemic. Gen Hosp Psychiatry. 2020;66:1-8.
  • Öztürk İ, Akalın S, Özgüner İ, Şakiroğlu M. Covid-19 salgınının ve karantinanın psikolojik etkileri. Turkish Studies. 2020;15(4):885-903.
  • Bakioğlu F, Korkmaz O, Ercan H. Fear of Covıd-19 and positivity: Mediating role of intolerance of uncertainty, depression, anxiety, and stress. Int J Ment Health Addict. 2020;19(6):2369-82.
There are 45 citations in total.

Details

Primary Language Turkish
Subjects Public Health Nursing, Nursing Workforce, Nursing (Other)
Journal Section Research Article
Authors

Eylül Gülnur Erdoğan 0000-0002-4770-385X

Zeynep Irmak Kaya 0000-0002-3954-1985

Early Pub Date March 28, 2024
Publication Date March 28, 2024
Submission Date September 13, 2023
Published in Issue Year 2024 Volume: 11 Issue: 1

Cite

Vancouver Erdoğan EG, Irmak Kaya Z. COVID-19 Pandemisinin Hemşirelerin Belirsizliğe Tahammülsüzlük Düzeyine Etkisi. JOHUFON. 2024;11(1):52-60.