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Hemşirelik Öğrencilerinin COVID-19 Fobisinin Yordayıcısı Olarak Belirsizliğe Karşı Tahammülsüzlükleri ve Sağlık Anksiyeteleri

Yıl 2022, Cilt: 5 Sayı: 1, 49 - 59, 06.04.2022
https://doi.org/10.38108/ouhcd.911750

Öz

Amaç: Araştırmada hemşirelik öğrencilerinin COVID-19 fobilerinin yordayıcısı olarak, belirsizliğe karşı tahammülsüzlükleri ve sağlık anksiyetelerinin değerlendirilmesi amaçlanmıştır.
Yöntem: Kesitsel tipteki araştırmanın veri toplama aşaması, Ocak-Mart 2021 tarihlerinde bir devlet üniversitesinin hemşirelik bölümü tüm sınıflarından 184 öğrencinin katılımı ile gerçekleştirilmiştir. Veriler, “Öğrenci Tanıtım Formu”, “COVID-19 Fobisi Ölçeği”, “Belirsizliğe Karşı Tahammülsüzlük Ölçeği”, “Sağlık Anksiyetesi Ölçeği” ile toplanmıştır. Ölçek puanlarının artması sırasıyla; yüksek düzeyde koronofobiyi, belirsizliğe tahammülsüzlüğü ve sağlık anksiyetesini göstermektedir. Araştırmada bağımsız iki örneklem t testi (Independent t Test), One Way ANOVA, Pearson Korelasyonu ve yordayıcıların tespiti için Çoklu Doğrusal Regresyon analizleri kullanılmıştır. Araştırmada güven aralığı %95, istatistiksel olarak anlamlılık düzeyi p<0.05 olarak kabul edilmiştir.
Bulgular: Öğrencilerin genel COVID-19 fobisi puan ortalaması 6.39±18.11’dir. Sınıf arttıkça koronafobinin azaldığı belirlenmiştir. Ayrıca cinsiyeti kız olan, ilde yaşayan, akademik başarısı yüksek, geleceğe yönelik kariyer hedefi olan öğrenci hemşirelerin COVID-19 fobisi ölçek puanları daha yüksek bulunmuştur (p<0.05). En sık yaşanan kaygı; ölüm/hastalanma, ekonomi, klinikten uzak olma ve mesleki yetersizlik şeklinde sıralanmıştır. COVID-19 fobileri ile belirsizliğe karşı tahammülsüzlükleri ve sağlık anksiyeteleri arasında anlamlı ilişki bulunmuştur (p<0.05). Araştırmada kullanılan ölçek/alt ölçeklerin, COVID-19 fobisi puanlarına ilişkin varyansın %53’ünü açıkladığı görülmüştür
(p<0.05, R2=0.53).
Sonuç: Öğrencilerin gereksinimlerinin tespit edilmesi, bunlara ilişkin danışmanlık yapılması, korku ve anksiyetelerini kontrol etmeleri hususunda desteklenmeleri, yönlendirilmeleri, terapi programlarının planlanması önerilmektedir.

Destekleyen Kurum

Destekleyen kurum bulunmamaktadır

Proje Numarası

Proje numarası bulunmamaktadır

Teşekkür

İstatistiksel desteği için istatikçi hocama teşekkür ederim.

Kaynakça

  • Alsubaie S, Temsah MH, Al-Eyadhy AA, Gossady I, Hasan GM, Al-Rabiaah A, ve ark. (2019). Middle East Respiratory Syndrome Coronavirus epidemic impact on healthcare workers’ risk perceptions, work and personal lives. The Journal of Infection in Developing Countries, 13, 920-926.
  • Ausin B, Munoz M, Castellenos MA, Garcia S. (2020). Prevalence and Characterization of Specific Phobia Disorder in People over 65 Years Old in a Madrid Community Sample (Spain) and its Relationship to Quality of Life. International Journal of Environmental Research and Public Health, 17, 1915. doi:10.3390/ijerph17061915
  • Arpaci I, Karatas K, Baloglu M. (2020). The development and initial tests for the psychometric properties of the COVID-19 Phobia Scale (C19P-S). Personality and Individual Differences, 164, 110108. doi:10.1016/j.paid.2020.110108
  • Aydemir Ö, Kirpinar I, Sati T, Uykur B, Cengisiz C. (2013). Sağlık Anksiyetesi Ölçeği'nin Türkçe için Güvenilirlik ve Geçerlilik Çalışması. Archives of Neuropsychiatry/Noropsikiatri Arsivi, 50, 325-331.
  • Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, ve ark. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research, 287, 1-5.
  • Carleton RN, Norton MPJ, Asmundson GJ. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale, Journal of Anxiety Disorders, 21, 105-117.
  • Duan L, Zhu G. (2020). Psychological interventions for people affected by the COVID-19 epidemic. The Lancet Psychiatry, 7, 300-302.
  • Ekiz M. (2020). Koronavirüs Karantinasında Günlük Tutan Üniversite Öğrencileri Üzerine Nitel Bir Araştırma. Gazi Beden Eğitimi ve Spor Bilimleri Dergisi, 25, 387-401.
  • Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, ve ark. (2020). Mental health problems and social media exposure during COVID-19 outbreak. Plos One, 15, 0231924. doi:10.1371/journal.pone.0231924
  • Garcia M, Lipskiy N, Tyson J, Watkins R, Esser ES, Kinley T. (2020). Centers for Disease Control and Prevention 2019 novel coronavirus disease (COVID-19) information management: addressing national health-care and public health needs for standardized data definitions and codified vocabulary for data exchange. Journal of the American Medical Informatics Association, 27, 1476-1487.
  • Hossain MM, Sultana A, Purohit N. (2020). Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Epidemiology and Health, 42, doi:10.4178/epih.e2020038.
  • Huang L, Lei W, Xu F, Liu H, Yu L. (2020). Emotional responses and coping strategies in nurses and nursing students during COVID-19 outbreak: A comparative study. PLoS One, 15, e0237303. doi:10.1371/journal.pone.0237303
  • Islam MA, Barna SD, Raihan H, Khan MNA, Hossain MT. (2020). Depression and anxiety among university students during the COVID-19 pandemic in Bangladesh: A web-based cross-sectional survey. PloS One, 15, e0238162. doi:10.1371/journal.pone.0238162
  • Kang L, Li Y, Hu S, Chen M, Yang C, Yang CX, ve ark. (2020). The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. The Lancet Psychiatry, 7, 14. doi:10.1016/S2215-0366(20)30047-X
  • Keyes A, Deale A, Foster C, Deale D. (2020). Time intensive cognitive behavioural therapy for a specific phobia of vomiting: A single case experimental design. Journal of Behavior Therapy and Experimental Psychiatry, 66, 101523. doi:10.1016/j.jbtep.2019.101523
  • Kim SC, Sloan C, Montejano A, Quiban C. (2021). Impacts of Coping Mechanisms on Nursing Students’ Mental Health during COVID-19 Lockdown: A Cross-Sectional Survey. Nursing Reports, 11, 36-44.
  • Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. (2020). Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ,369. Doi:10.1136/bmj.m1 642.
  • Kochuvilayil T, Fernandez RS, Moxham LJ, Lord H, Alomari A, Hunt L, ve ark. (2021). COVID‐19: knowledge, anxiety, academic concerns and preventative behaviours among Australian and Indian undergraduate nursing Students: A cross sectional study. Journal of Clinical Nursing, 30, 882-891.
  • Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, ve ark. (2020). Progression of mental health services during the COVID-19 outbreak in China. International Journal of Biological Sciences, 16, 1732-1738.
  • Li X, Lv S, Liu L, Chen R, Chen J, Liang S, ve ark. (2020). COVID-19 in Guangdong: Immediate Perceptions and Psychological Impact on 304,167 College Students. Frontiers in Psychology, 11, doi: 10.3389/fpsyg.2020.02024.
  • Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, ve ark. (2020). Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Research, 287, 112921. doi:10.1016/j.psychres.2020.112921
  • Mahmud MS, Rahman MM, Masud-Ul-Hasan M, Islam MA. (2021). Does ‘COVID-19 phobia’stimulate career anxiety?: Experience from a developing country. Heliyon, 7, doi:10.1016/j.heliyon. 2021. e06346.
  • Mertens G, Gerritsen L, Duijndam S, Salemink E, Engelhard IM. (2020). Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020. Journal of Anxiety Disorders, 74, 102258. doi:10.1016/j.janxdis.2020.102258
  • Özden G, Parlar Kiliç S. (2021). The Effect of Social Isolation during COVID-19 Pandemic on Nutrition and Exercise Behaviors of Nursing Students: Ecology of Food and Nutrition, 1-19.doi:10.1080/03670244. 2021.1875456
  • Qi J, Yang X, Tan R, Wu X, Zhou X. (2020). Prevalence and predictors of posttraumatic stress disorder and depression among adolescents over 1 year after the Jiuzhaigou earthquake. Journal of Affective Disorders, 261, 1-8.
  • Quittkat HL, Düsing R, Holtmann FJ, Buhlmann U, Svaldi J, Vocks S. (2020). Perceived impact of COVID-19 across different mental disorders: A study on disorder-specific symptoms, psychosocial stress and behavior. Frontiers in Psychology, 11. doi: 10.3389/fpsyg.2020.586246
  • Ramos-Lira L, Rafful C, Flores-Celis K, Rios JM, Garcia-Andrade C, Gasca MLR, ve ark. (2020). Emotional responses and coping strategies in adult Mexican population during the first lockdown of the COVID-19 pandemic: An exploratory study by sex, Salud Mental, 43, 243-251.
  • Roehr B. (2013). American Psychiatric Association explains DSM-5: BMJ, 346, 3591.
  • Rothan HA, Byrareddy SN. (2020). The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity, 109, 102433. doi:10.1016/j.jaut.2020.102433
  • Saddik B, Hussein A, Sharif-Askari FS, Kheder W, Temsah MH, Koutaich RA, ve ark. (2020). Increased levels of anxiety among medical and non-medical university students during the COVID-19 pandemic in the United Arab Emirates. Risk Management and Healthcare Policy, 13, 2395-2406.
  • Sarıçam H, Erguvan F, Akın A, Akça M. (2014). Belirsizliğe tahammülsüzlük ölçeği (BTÖ-12) Türkçe formu: Geçerlik ve güvenirlik çalışması. Route Educational and Social Science Journal, 1, 148-157.
  • Steinberg JW, Daniel J. (2020). Depression as a major mental health problem for the behavioral health care industry. Journal of Health Sciences Management and Public Health, 1, 44-49.
  • Sun L, Sun Z, Wu L, Zhu Z, Zhang F, Shang Z, ve ark. (2020). Prevalence and risk factors of acute posttraumatic stress symptoms during the COVID-19 outbreak in Wuhan, China, MedRXiv, doi:10.1101/2020.03.06.20032425.
  • Tabachnick BG, Fidell LS, Ullman JB. (2007). Using multivariate statistics, Beşinci Basım, Pearson Boston, MA. Walter LA., McGregor AJ. (2020). Sex-and Gender-specific Observations and Implications for COVID-19. Western Journal of Emergency Medicine, 21, 507-509.
  • Wang C, Cheng Z, Yue XG, McAleer M. (2020). Risk management of COVID-19 by universities in China, Multidisciplinary Digital Publishing Institute. doi:10.3390/jrfm13020036
  • Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, ve arlk. (2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry, 7, 228-229.
  • Xiao C. (2020). A novel approach of consultation on 2019 novel coronavirus (COVID-19)-related psychological and mental problems: structured letter therapy. Psychiatry Investigation, 17, 175-176.

Intolerance to Uncertainty and Health Anxiety as the Predictors of Nursing Students’ COVID-19 Phobis

Yıl 2022, Cilt: 5 Sayı: 1, 49 - 59, 06.04.2022
https://doi.org/10.38108/ouhcd.911750

Öz

Objective: To evaluate nursing students’ intolerance to uncertainty, health anxiety as predictors of COVID-19 phobias.
Methods: The data collection of the cross-sectional study was carried out by “Student Introduction Form”, “COVID-19 Phobia Scale”, “Intolerance to Uncertainty Scale”, “Health Anxiety Scale” with 184 students from all classes of the nursing department of a state university on January-March 2021. The increase in scale scores shows high coronophobia, high level of intolerance to uncertainty, health anxiety. Independent t test, One Way ANOVA, Pearson Correlation, Multiple Linear Regression analyzes were used. The confidence interval in the study was determined as 95%, the statistical significance level was accepted as p<0.05.
Results: The general COVID-19 phobia score average of the students is 68.39±18.11. It was determined that the higher the grade, the lower the scale scores. In addition, the scale scores of student whose gender is female, live in provinces/Southeastern Anatolia Region, have high academic success, have career goals were found to be higher (p<0.05). The most common anxiety was expressed as death / illness, economical, being far from clinic and occupational inadequacy, respectively. A significant relationship was found between COVID-19 phobias and their intolerance to uncertainty, health anxiety (p<0.05). It was determined that the scales/subscales used in the study explained 53% of the variance regarding COVID-19 phobia scores (p<0.05, R2=0.53).
Conclusion: The needs of the students should be determined, the students should be consulted, therapy programs should be planned.

Proje Numarası

Proje numarası bulunmamaktadır

Kaynakça

  • Alsubaie S, Temsah MH, Al-Eyadhy AA, Gossady I, Hasan GM, Al-Rabiaah A, ve ark. (2019). Middle East Respiratory Syndrome Coronavirus epidemic impact on healthcare workers’ risk perceptions, work and personal lives. The Journal of Infection in Developing Countries, 13, 920-926.
  • Ausin B, Munoz M, Castellenos MA, Garcia S. (2020). Prevalence and Characterization of Specific Phobia Disorder in People over 65 Years Old in a Madrid Community Sample (Spain) and its Relationship to Quality of Life. International Journal of Environmental Research and Public Health, 17, 1915. doi:10.3390/ijerph17061915
  • Arpaci I, Karatas K, Baloglu M. (2020). The development and initial tests for the psychometric properties of the COVID-19 Phobia Scale (C19P-S). Personality and Individual Differences, 164, 110108. doi:10.1016/j.paid.2020.110108
  • Aydemir Ö, Kirpinar I, Sati T, Uykur B, Cengisiz C. (2013). Sağlık Anksiyetesi Ölçeği'nin Türkçe için Güvenilirlik ve Geçerlilik Çalışması. Archives of Neuropsychiatry/Noropsikiatri Arsivi, 50, 325-331.
  • Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, ve ark. (2020). The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research, 287, 1-5.
  • Carleton RN, Norton MPJ, Asmundson GJ. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale, Journal of Anxiety Disorders, 21, 105-117.
  • Duan L, Zhu G. (2020). Psychological interventions for people affected by the COVID-19 epidemic. The Lancet Psychiatry, 7, 300-302.
  • Ekiz M. (2020). Koronavirüs Karantinasında Günlük Tutan Üniversite Öğrencileri Üzerine Nitel Bir Araştırma. Gazi Beden Eğitimi ve Spor Bilimleri Dergisi, 25, 387-401.
  • Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, ve ark. (2020). Mental health problems and social media exposure during COVID-19 outbreak. Plos One, 15, 0231924. doi:10.1371/journal.pone.0231924
  • Garcia M, Lipskiy N, Tyson J, Watkins R, Esser ES, Kinley T. (2020). Centers for Disease Control and Prevention 2019 novel coronavirus disease (COVID-19) information management: addressing national health-care and public health needs for standardized data definitions and codified vocabulary for data exchange. Journal of the American Medical Informatics Association, 27, 1476-1487.
  • Hossain MM, Sultana A, Purohit N. (2020). Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Epidemiology and Health, 42, doi:10.4178/epih.e2020038.
  • Huang L, Lei W, Xu F, Liu H, Yu L. (2020). Emotional responses and coping strategies in nurses and nursing students during COVID-19 outbreak: A comparative study. PLoS One, 15, e0237303. doi:10.1371/journal.pone.0237303
  • Islam MA, Barna SD, Raihan H, Khan MNA, Hossain MT. (2020). Depression and anxiety among university students during the COVID-19 pandemic in Bangladesh: A web-based cross-sectional survey. PloS One, 15, e0238162. doi:10.1371/journal.pone.0238162
  • Kang L, Li Y, Hu S, Chen M, Yang C, Yang CX, ve ark. (2020). The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. The Lancet Psychiatry, 7, 14. doi:10.1016/S2215-0366(20)30047-X
  • Keyes A, Deale A, Foster C, Deale D. (2020). Time intensive cognitive behavioural therapy for a specific phobia of vomiting: A single case experimental design. Journal of Behavior Therapy and Experimental Psychiatry, 66, 101523. doi:10.1016/j.jbtep.2019.101523
  • Kim SC, Sloan C, Montejano A, Quiban C. (2021). Impacts of Coping Mechanisms on Nursing Students’ Mental Health during COVID-19 Lockdown: A Cross-Sectional Survey. Nursing Reports, 11, 36-44.
  • Kisely S, Warren N, McMahon L, Dalais C, Henry I, Siskind D. (2020). Occurrence, prevention, and management of the psychological effects of emerging virus outbreaks on healthcare workers: rapid review and meta-analysis. BMJ,369. Doi:10.1136/bmj.m1 642.
  • Kochuvilayil T, Fernandez RS, Moxham LJ, Lord H, Alomari A, Hunt L, ve ark. (2021). COVID‐19: knowledge, anxiety, academic concerns and preventative behaviours among Australian and Indian undergraduate nursing Students: A cross sectional study. Journal of Clinical Nursing, 30, 882-891.
  • Li W, Yang Y, Liu ZH, Zhao YJ, Zhang Q, Zhang L, ve ark. (2020). Progression of mental health services during the COVID-19 outbreak in China. International Journal of Biological Sciences, 16, 1732-1738.
  • Li X, Lv S, Liu L, Chen R, Chen J, Liang S, ve ark. (2020). COVID-19 in Guangdong: Immediate Perceptions and Psychological Impact on 304,167 College Students. Frontiers in Psychology, 11, doi: 10.3389/fpsyg.2020.02024.
  • Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, ve ark. (2020). Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Research, 287, 112921. doi:10.1016/j.psychres.2020.112921
  • Mahmud MS, Rahman MM, Masud-Ul-Hasan M, Islam MA. (2021). Does ‘COVID-19 phobia’stimulate career anxiety?: Experience from a developing country. Heliyon, 7, doi:10.1016/j.heliyon. 2021. e06346.
  • Mertens G, Gerritsen L, Duijndam S, Salemink E, Engelhard IM. (2020). Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020. Journal of Anxiety Disorders, 74, 102258. doi:10.1016/j.janxdis.2020.102258
  • Özden G, Parlar Kiliç S. (2021). The Effect of Social Isolation during COVID-19 Pandemic on Nutrition and Exercise Behaviors of Nursing Students: Ecology of Food and Nutrition, 1-19.doi:10.1080/03670244. 2021.1875456
  • Qi J, Yang X, Tan R, Wu X, Zhou X. (2020). Prevalence and predictors of posttraumatic stress disorder and depression among adolescents over 1 year after the Jiuzhaigou earthquake. Journal of Affective Disorders, 261, 1-8.
  • Quittkat HL, Düsing R, Holtmann FJ, Buhlmann U, Svaldi J, Vocks S. (2020). Perceived impact of COVID-19 across different mental disorders: A study on disorder-specific symptoms, psychosocial stress and behavior. Frontiers in Psychology, 11. doi: 10.3389/fpsyg.2020.586246
  • Ramos-Lira L, Rafful C, Flores-Celis K, Rios JM, Garcia-Andrade C, Gasca MLR, ve ark. (2020). Emotional responses and coping strategies in adult Mexican population during the first lockdown of the COVID-19 pandemic: An exploratory study by sex, Salud Mental, 43, 243-251.
  • Roehr B. (2013). American Psychiatric Association explains DSM-5: BMJ, 346, 3591.
  • Rothan HA, Byrareddy SN. (2020). The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. Journal of Autoimmunity, 109, 102433. doi:10.1016/j.jaut.2020.102433
  • Saddik B, Hussein A, Sharif-Askari FS, Kheder W, Temsah MH, Koutaich RA, ve ark. (2020). Increased levels of anxiety among medical and non-medical university students during the COVID-19 pandemic in the United Arab Emirates. Risk Management and Healthcare Policy, 13, 2395-2406.
  • Sarıçam H, Erguvan F, Akın A, Akça M. (2014). Belirsizliğe tahammülsüzlük ölçeği (BTÖ-12) Türkçe formu: Geçerlik ve güvenirlik çalışması. Route Educational and Social Science Journal, 1, 148-157.
  • Steinberg JW, Daniel J. (2020). Depression as a major mental health problem for the behavioral health care industry. Journal of Health Sciences Management and Public Health, 1, 44-49.
  • Sun L, Sun Z, Wu L, Zhu Z, Zhang F, Shang Z, ve ark. (2020). Prevalence and risk factors of acute posttraumatic stress symptoms during the COVID-19 outbreak in Wuhan, China, MedRXiv, doi:10.1101/2020.03.06.20032425.
  • Tabachnick BG, Fidell LS, Ullman JB. (2007). Using multivariate statistics, Beşinci Basım, Pearson Boston, MA. Walter LA., McGregor AJ. (2020). Sex-and Gender-specific Observations and Implications for COVID-19. Western Journal of Emergency Medicine, 21, 507-509.
  • Wang C, Cheng Z, Yue XG, McAleer M. (2020). Risk management of COVID-19 by universities in China, Multidisciplinary Digital Publishing Institute. doi:10.3390/jrfm13020036
  • Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, ve arlk. (2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry, 7, 228-229.
  • Xiao C. (2020). A novel approach of consultation on 2019 novel coronavirus (COVID-19)-related psychological and mental problems: structured letter therapy. Psychiatry Investigation, 17, 175-176.
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Hemşirelik
Bölüm Araştırma
Yazarlar

Fatma Dilek Turan 0000-0001-6130-6896

Proje Numarası Proje numarası bulunmamaktadır
Erken Görünüm Tarihi 6 Nisan 2022
Yayımlanma Tarihi 6 Nisan 2022
Gönderilme Tarihi 25 Nisan 2021
Yayımlandığı Sayı Yıl 2022 Cilt: 5 Sayı: 1

Kaynak Göster

APA Turan, F. D. (2022). Hemşirelik Öğrencilerinin COVID-19 Fobisinin Yordayıcısı Olarak Belirsizliğe Karşı Tahammülsüzlükleri ve Sağlık Anksiyeteleri. Ordu Üniversitesi Hemşirelik Çalışmaları Dergisi, 5(1), 49-59. https://doi.org/10.38108/ouhcd.911750