Turkiye Klinikleri Journal of Nursing Sciences

.: ORIGINAL RESEARCH
Yoğun Bakım Ünitesindeki Çevresel Stresörlerin Hastalar Tarafından Algılanması
Perception of Environmental Stressors in Intensive Care Unit by Patients
Yelda CANDAN DÖNMEZa, Fatma DEMİR KORKMAZa, Sinem GEÇİTa
aEge Üniversitesi Hemşirelik Fakültesi, Cerrahi Hastalıkları Hemşireliği ABD, İzmir, TÜRKİYE
Turkiye Klinikleri J Nurs Sci. 2020;12(2):190-7
doi: 10.5336/nurses.2019-72255
Article Language: TR
Full Text
ÖZET
Amaç: Yoğun bakım ünitesinde yatan hastaların yaşadığı stresörleri belirlemektir. Gereç ve Yöntemler: Tanımlayıcı tipte olan araştırmanın örneklemini Nisan-Aralık 2018 tarihleri arasında bir üniversite hastanesinin genel cerrahi ana bilim dalı yoğun bakım ünitesinde tedavi gören 106 hasta oluşturdu. Araştırmada veriler literatür doğrultusunda araştırmacılar tarafından hazırlanan 'Veri Toplama Formu' ve 'Yoğun Bakım Ünitesi Çevresel Stresörler Ölçeği' kullanılarak toplandı. Veriler, yüzdelik, ortalama, standart sapma, student t-testi ve ANOVA testi ile analiz edildi. Bulgular: Hastaların yaş ortalaması 52,98±12,82 yıl olup %50,9'u kadındır. Hastaların, Yoğun Bakım Ünitesi Çevresel Stresörler Ölçeği puan ortalaması 79,9±31,3 olarak saptandı. Yoğun Bakım Ünitesi Çevresel Stresörler Ölçeği puan ortalaması ile eğitim durumu(p=0,010), daha önce entübe olma deneyimi (p=0,030) ve yoğun bakım ünitesinde kalma süresi (p=0,003) arasında istatistiksel açıdan anlamlı fark saptandı. Hastalarda en fazla stresör olarak algılanan faktörlerin sırasıyla ağrı olması, serum setleri nedeni ile elleri ve kolları hareket ettirememek ve su içememek, en az strese neden olan stresörlerin ise sırasıyla telefon sesini duymak, doktor ve hemşireler tarafından sık sık fizik muayene yapılması ve hemşirelerin makineleri hastalardan daha fazla izlemeleri olarak saptandı. Sonuç: Çalışma sonucunda, hastaların Yoğun Bakım Ünitesi Çevresel Stresörler Ölçeği puan ortalamasının ve stres düzeylerinin çok yüksek olmadığı görülmektedir. Hemşirelerin hasta bakımını planlarken, en fazla strese neden olan ağrı, hareketsizlik ve su içememe gibi stresörleri dikkate alarak bütüncül bir bakım planlamaları önerilmektedir.

Anahtar Kelimeler: Stresör; hasta; yoğun bakım; stres
ABSTRACT
Objective: The aim of this study was to determine the stressors experienced by the patients hospitalized in the intensive care unit. Material and Methods: The sample of this descriptive study consisted of 106 patients who were treated in the intensive care unit of the general surgery department of a university hospital between April-December 2018. Data were collected using the 'Data Collection Form' prepared by the researchers in accordance with the literature and 'Intensive Care Unit Environmental Stressors Scale'. Data were analyzed by percentage, mean, standard deviation, student t test and ANOVA test. Results: The mean age of the patients was 52.98±12.82 years and 50.9% of them were female. The mean score of the Intensive Care Unit Environmental Stressors Scale in the was 79.9±31.3. There was a statistically significant difference between the mean score of Intensive Care Unit Environmental Stressors Scale and educational status (p=0.010), previous intubation experience (p=0.030) and length of stay in intensive care unit (p=0.003). The most commonly perceived stressors in the patients were pain, in ability to move hands and arms and drink water due to serum sets, respectively and stressors causing the least stress were found to hear telephone voices, frequent physical examinations by doctors and nurses, and nurses watching machines more than patients. Conclusions: It was seen that the mean score and stress levels of the patients' Intensive Care Unit Environmental Stressors Scale scores were not high. When planning patient care, it is recommended that nurses identify stressors that cause stress and plan a holistic care.

Keywords: Stressor; patient; intensive care; stress
REFERENCES:
  1. Eşer İ, Khorshid L, Demir Y. [A survey of the factors effecting the critical thinking dispositions of intensive care nurses]. C.Ü. Hemşirelik Yüksekokulu Dergisi. 2007;11:13-22.
  2. Kompanje EJO. The worst is yet tocome. Many elderly patients with chronic terminal illness will eventually die in the emergency department. Intens Care Med. 2010;36(5):732-4. [Crossref]  [PubMed]  [PMC] 
  3. Çınar S, Aslan F, Kurtoğlu T. [Intensive care unit environmental stressors scale: validity and reliability study]. Yoğun Bakım Hemşireliği Dergisi. 2011;15(2):61-6.
  4. Arslan S, Ozer N. Touching, music theraphy and aroma theraphy's effect on the physiological situation of thepatients in intensive care unit. International Journal of Caring Sciences. 2016;9(3):867-75.
  5. Cochran J, Ganong LH. A comparison of nurses 'and patients' perceptions of intensive care unit stressors. J Adv Nurs. 1989;14(12): 1038-43. [Crossref]  [PubMed] 
  6. McKinley S, Coote K, Parbury SJ. Development and testing of a faces scale for the assessment of anxiety in critically ill patients. J Adv Nurs. 2002;41(1):73-9. [Crossref]  [PubMed] 
  7. Özer N, Akyil R. The effect of providing information to patients on their perception of the intensive care unit. Australian Journal of Andanced Nursing. 2008;25(4):71-8.
  8. Tuncay GY, Ucar H. [Opinions of patients on physical environmental features of intensive care units]. Hacettepe University Faculty of Health Sciences Nursing Journal. 2010;17(2):33-46.
  9. Başak T, Uzun Ş, Arslan F. [Investigation of the moral sensibility of intensive care nurses]. Gülhane Tıp Dergisi. 2010;52:76-81.
  10. Yava A, Tosun N, Ünver V, Çiçek H. Patient and nurse perceptions of stressors in the intensive care unit. Stress Health. 2010;27(2): e36-47. [Crossref]  [PubMed] 
  11. Zaybak A, Çevik K. [Stressors in the intensive care unit: perceptions of patients and nurses]. Yoğun Bakım Dergisi. 2015;6:4-9. [Crossref] 
  12. Soehren P. Stressors perceived by cardiac surgical patients in the intensive care. Intensive Care Med. 1997;23:1282-5. [Crossref]  [PubMed] 
  13. Ballard KS. Identification of environmental stressors for patients in a surgical intensive care unit. Issues Ment Health Nurs. 1981;3(1-2):89-108. [Crossref]  [PubMed] 
  14. Aktaş YY, Karabulut N, Yılmaz D, Özkan AS. [Perception of environmental stressors by critical care patients treated in cardiovascular surgery intensive care unit]. Kafkas Tıp Bilimleri Dergisi. 2015;5(3):81-6. [Crossref] 
  15. Karadeniz FT, Kanan N. [The effects of environmental stressors on patients in reanimation intensive care unit]. Yoğun Bakım Hemşireliği Dergisi. 2019;23(1):1-8.
  16. Hweidi IM. Jordanian patients' perception of stressors in critical care units: a questionnaire survey. Int J Nurs Stud. 2007;44(2):227-35. [Crossref]  [PubMed] 
  17. Hweidi IM, Nizamli FM. Stressors in intensive care units in Syria: patiensts' perceptions. J Res Nurs. 2015;20(2):114-26. [Crossref] 
  18. Cornock MA. Stress and the intensive care patient: perceptions of patientsand nurses. J Adv Nurs. 1998;27(3):518-27. [Crossref]  [PubMed] 
  19. Sharmilla T, Chandrakala S, Santha NJ. Comparison of stressors experienced by patients and nurses' perception on thepatients' stressors admitted in ICU. Nurs J India. 2016;12(1):33-5.
  20. Novaes MA, Aronovich A, Ferraz MB, Knobel E. Stressors in ICU: patients evaluation. Intensive Care Med. 1997;23(12):1282-5. [Crossref]  [PubMed] 
  21. Novaes MA, Knobel E, Bork AM, Pavão OF, Nogueira-Martins LA, Ferraz MB. Stressors in ICU: perception of the patient, relatives and health care team. Intensive Care Med. 1999;25(12):1421-6. [Crossref]  [PubMed] 
  22. So HM, Chan DMK. Perception of stressors by patients and nurses of critical care units in Hong Kong. Int J Nurs Stud. 2004;41(1):77-84. [Crossref] 
  23. Pang P, Suen L. Stressors in the ICU: a comparison of patients' and nurses' perceptions. J Clin Nurs. 2008;17(20):2681-9. [Crossref]  [PubMed] 
  24. Pang P, Suen L. Stressors in the intensive care unit: comparing the perceptions of Chinese patients and their family. Stress Health. 2009;25:151-9. [Crossref] 
  25. Rotondi A, Chelluri L, Sirio C, Mendelhson A, Schulz R, Belle S, et al. Patients' recollections of stressful experiences while receiving prolonged mechanical ventilation in an intensive care unit. Crit Care Med. 2002;30(4):746-52. [Crossref]  [PubMed] 
  26. Lee K, Oh H, Suh Y, Seo W. Patterns and clinical correlates of pain among brain injury patients in critical care assessed with the critical care pain observation tool. Pain Manag Nurs. 2013;14(4):259-67. [Crossref]  [PubMed] 
  27. Badır A, Aslan FE. [The problem of pain in intensive care units: an issue of widespread interest]. Yoğun Bakım Hemşireliği Dergisi. 2003;7(1):100-8.
  28. Hewitt J. Psycho-affective disorder in intensive care units: a review. J Clin Nurs. 2002;11(5):575-84. [Crossref]  [PubMed] 
  29. Gültekin Y, Özçelik Z, Akıncı SB, Yorgancı HK. Evaluation of stressors in intensive care units. Turk J Surg. 2018;34(1):5-8.
  30. Nelson JE, Meier DE, Oei EJ, Nierman DM, Senzel RS, Manfredi PL, et al. Self-reported symptom experience of critically ill cancer patients receiving intensive care. Crit Care Med. 2001;29(2):277-82. [Crossref]  [PubMed] 
  31. Simini B. Patients' perceptions of intensive care. Lancet. 1999;354(9178):571-2. [Crossref] 
  32. Puntillo K, Arai SR, Cooper BA, Stotts NA, Nelson JE. A randomized clinical trial of an intervention to relieve thirst and dry mouth in intensive care unit patients. Intensive Care Med. 2014;40(9):1295-302. [Crossref]  [PubMed]  [PMC] 
  33. Uslu Y, Demir Korkmaz F. [Intensive care patients sleep: nursing care]. Hemşirelikte Eğitim ve Araştırma Dergisi. 2015;12(3):156-61. [Crossref] 
  34. Karaman ÖZ, Özer N. The effect of enhancing environmental factors on the quality of patients' sleep in a cardiac surgical intensive care unit. Biological Rhythm Research. 2017;48(1):85-98. [Crossref] 
  35. Engwall M, Fridh I, Johansson L, Bergbom I, Lindahl L. Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit. Intensive Crit Care Nurs. 2015;31(6):325-35. [Crossref]  [PubMed] 
  36. Nesbitt L, Goode D. Nurses perception of sleep in the intensive care unit environment: a literature review. Intensive Crit Care Nurs. 2014;30(4):231-35. [Crossref]  [PubMed] 
  37. Dinlegör Sekmen I, Ünsar S. [Determining the experiences of the patients who were being treated in intensive care unit]. Turk J Cardiovasc Nurs. 2018;9(20):113-9.
  38. Mackin J. Women, stress, andmidlife. Human Ecology. 1995;23:20-2.
  39. Daaleman TP, Perera S, Studenski SA. Religion, spirituality, and health status in geriatric outpatients. Ann Fam Med. 2004;2(1):49-53. [Crossref]  [PubMed]  [PMC] 
  40. Erlen JA, Sereika SM. Critical care nurses, ethical decision-making and stress. J Adv Nurs. 1997;26(5):953-61. [Crossref]  [PubMed] 

.: Up To Date



Login



Contact


Ortadoğu Reklam Tanıtım Yayıncılık Turizm Eğitim İnşaat Sanayi ve Ticaret A.Ş.

.: Address

Turkocagi Caddesi No:30 06520 Balgat / ANKARA
Phone: +90 312 286 56 56
Fax: +90 312 220 04 70
E-mail: info@turkiyeklinikleri.com

.: Manuscript Editing Department

Phone: +90 312 286 56 56/ 2
E-mail: yaziisleri@turkiyeklinikleri.com

.: English Language Redaction

Phone: +90 312 286 56 56/ 145
E-mail: tkyayindestek@turkiyeklinikleri.com

.: Marketing Sales-Project Department

Phone: +90 312 286 56 56/ 142
E-mail: reklam@turkiyeklinikleri.com

.: Subscription and Public Relations Department

Phone: +90 312 286 56 56/ 118
E-mail: abone@turkiyeklinikleri.com

.: Customer Services

Phone: +90 312 286 56 56/ 118
E-mail: satisdestek@turkiyeklinikleri.com

1. TERMS OF USE

1.1. To use the web pages with http://www.turkiyeklinikleri.com domain name or the websites reached through the sub domain names attached to the domain name (They will be collectively referred as "SITE"), please read the conditions below. If you do not accept these terms, please cease to use the "SITE." "SITE" owner reserves the right to change the information on the website, forms, contents, the "SITE," "SITE" terms of use anytime they want.

1.2. The owner of the "SITE" is Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. (From now on it is going to be referred as "Turkiye Klinikleri", shortly) and it resides at Turkocagi cad. No:30, 06520 Balgat Ankara. The services in the "SITE" are provided by "Turkiye Klinikleri."

1.3. Anyone accessing the "SITE" with or without a fee whether they are a natural person or a legal identity is considered to agree these terms of use. In this contract hereby, "Turkiye Klinikleri" may change the stated terms anytime. These changes will be published in the "SITE" periodically and they will be valid when they are published. Any natural person or legal identity benefiting from and reaching to the "SITE" are considered to be agreed to any change on hereby contract terms done by "Turkiye Klinikleri."

1.4. The "Terms of Use" hereby is published in the website with the last change on March 30th 2014 and the "SITE" is activated by enabling the access to everyone. The "Terms of Use" hereby is also a part of the any "USER Contract" was and/or will be done with the users using "Turkiye Klinikleri" services with or without a fee an inseparable.

2. DEFINITIONS

2.1. "SITE": A website offering different kind of services and context with a certain frame determined by "Turkiye Klinikleri" and it is accessible on-line on http://www.turkiyeklinikleri.com domain name and/or subdomains connected to the domain name.

2.2. USER: A natural person or a legal identity accessing to the "SITE" through online settings.

2.3. LINK: A link enabling to access to another website through the "SITE", the files, the context or through another website to the "SITE", the files and the context.

2.4. CONTEXT: Any visual, literary and auditory images published in the "Turkiye Klinikleri", "SITE" and/or any website or any accessible information, file, picture, number/figures, price, etc.

2.5. "USER CONTRACT": An electronically signed contract between a natural or a legal identity benefiting from special services "Turkiye Klinikleri" will provide and "Turkiye Klinikleri".

3. SCOPE OF THE SERVICES

3.1. "Turkiye Klinikleri" is completely free to determine the scope and quality of the services via the "SITE".

3.2. To benefit the services of "Turkiye Klinikleri" "SITE", the "USER" must deliver the features that will be specified by "Turkiye Klinikleri". "Turkiye Klinikleri" may change this necessity any time single-sided.

3.3. Not for a limited number, the services "Turkiye Klinikleri" will provide through the "SITE" for a certain price or for free are;

- Providing scientific articles, books and informative publications for health industry.

- Providing structural, statistical and editorial support to article preparation stage for scientific journals.

4. GENERAL PROVISIONS

4.1. "Turkiye Klinikleri" is completely free to determine which of the services and contents provided in the "SITE" will be charged.

4.2. People benefiting from the services provided by "Turkiye Klinikleri" and using the website can use the "SITE" only according to the law and only for personal reasons. Users have the criminal and civil liability for every process and action they take in the "SITE". Every USER agrees, declares and undertakes that they will not proceed by any function or action infringement of rights of "Turkiye Klinikleri"s and/or other third parties', they are the exclusive right holder on usage, processing, storage, made public and revealing any written, visual or auditory information reported to Turkiye Klinikleri" and/or "SITE" to the third parties. "USER" agrees and undertakes that s/he will not duplicate, copy, distribute, process, the pictures, text, visual and auditory images, video clips, files, databases, catalogs and lists within the "SITE", s/he will not be using these actions or with other ways to compete with "Turkiye Klinikleri", directly or indirectly.

4.3. The services provided and the context published within the "SITE" by third parties is not under the responsibility of "Turkiye Klinikleri", institutions collaborated with "Turkiye Klinikleri", "Turkiye Klinikleri" employee and directors, "Turkiye Klinikleri" authorized salespeople. Commitment to accuracy and legality of the published information, context, visual and auditory images provided by any third party are under the full responsibility of the third party. "Turkiye Klinikleri" does not promise and guarantee the safety, accuracy and legality of the services and context provided by a third party.

4.4. "USER"s cannot act against "Turkiye Klinikleri", other "USER"s and third parties by using the "SITE". "Turkiye Klinikleri" has no direct and/or indirect responsibility for any damage a third party suffered or will suffer regarding "USER"s actions on the "SITE" against the rules of the hereby "Terms of Use" and the law.

4.5. "USER"s accept and undertake that the information and context they provided to the "SITE" are accurate and legal. "Turkiye Klinikleri" is not liable and responsible for promising and guaranteeing the verification of the information and context transmitted to "Turkiye Klinikleri" by the "USER"s, or uploaded, changed and provided through the "SITE" by them and whether these information are safe, accurate and legal.

4.6. "USER"s agree and undertake that they will not perform any action leading to unfair competition, weakening the personal and commercial credit of "Turkiye Klinikleri" and a third party,  encroaching and attacking on personal rights within the "SITE" in accordance with the Turkish Commercial Code Law.

4.7. "Turkiye Klinikleri" reserves the right to change the services and the context within the "SITE"  anytime. "Turkiye Klinikleri" may use this right without any notification and timelessly. "USER"s have to make the changes and/or corrections "Turkiye Klinikleri" required immediately. Any changes and/or corrections that are required by "Turkiye Klinikleri", may be made by "Turkiye Klinikleri" when needed. Any harm, criminal and civil liability resulted or will result from changes and/or corrections required by "Turkiye Klinikleri" and were not made on time by the "USER"s belongs completely to the users.

4.8. "Turkiye Klinikleri" may give links through the "SITE" to other websites and/or "CONTEXT"s and/or folders that are outside of their control and owned and run by third parties. These links are provided for ease of reference only and do not hold qualification for support the respective web SITE or the admin or declaration or guarantee for the information inside. "Turkiye Klinikleri" does not hold any responsibility over the web-sites connected through the links on the "SITE", folders and context, the services or products on the websites provided through these links or their context.

4.9. "Turkiye Klinikleri" may use the information provided to them by the "USERS" through the "SITE" in line with the terms of the "PRIVACY POLICY" and "USER CONTRACT". It may process the information or classify and save them on a database. "Turkiye Klinikleri" may also use the USER's or visitor's identity, address, e-mail address, phone number, IP number, which sections of the "SITE" they visited, domain type, browser type, date and time information to provide statistical evaluation and customized services.

5. PROPRIETARY RIGHTS

5.1. The information accessed through this "SITE" or provided by the users legally and all the elements (including but not limited to design, text, image, html code and other codes) of the "SITE" (all of them will be called as studies tied to "Turkiye Klinikleri"s copyrights) belongs to "Turkiye Klinikleri". Users do not have the right to resell, process, share, distribute, display or give someone permission to access or to use the "Turkiye Klinikleri" services, "Turkiye Klinikleri" information and the products under copyright protection by "Turkiye Klinikleri". Within hereby "Terms of Use" unless explicitly permitted by "Turkiye Klinikleri" nobody can reproduce, process, distribute or produce or prepare any study from those under "Turkiye Klinikleri" copyright protection.

5.2. Within hereby "Terms of Use", "Turkiye Klinikleri" reserves the rights for "Turkiye Klinikleri" services, "Turkiye Klinikleri" information, the products associated with "Turkiye Klinikleri" copyrights, "Turkiye Klinikleri" trademarks, "Turkiye Klinikleri" trade looks or its all rights for other entity and information it has through this website unless it is explicitly authorized by "Turkiye Klinikleri".

6. CHANGES IN THE TERMS OF USE

"Turkiye Klinikleri" in its sole discretion may change the hereby "Terms of Use" anytime announcing within the "SITE". The changed terms of the hereby "Terms of Use" will become valid when they are announced. Hereby "Terms of Use" cannot be changed by unilateral declarations of users.

7. FORCE MAJEURE

"Turkiye Klinikleri" is not responsible for executing late or never of this hereby "Terms of Use", privacy policy and "USER Contract" in any situation legally taken into account as force majeure. Being late or failure of performance or non-defaulting of this and similar cases like this will not be the case from the viewpoint of "Turkiye Klinikleri", and "Turkiye Klinikleri" will not have any damage liability for these situations. "Force majeure" term will be regarded as outside of the concerned party's reasonable control and any situation that "Turkiye Klinikleri" cannot prevent even though it shows due diligence. Also, force majeure situations include but not limited to natural disasters, rebellion, war, strike, communication problems, infrastructure and internet failure, power cut and bad weather conditions.

8. LAW AND AUTHORISATION TO FOLLOW

Turkish Law will be applied in practicing, interpreting the hereby "Terms of Use" and managing the emerging legal relationships within this "Terms of Use" in case of finding element of foreignness, except for the rules of Turkish conflict of laws. Ankara Courts and Enforcement Offices are entitled in any controversy happened or may happen due to hereby contract.

9. CLOSING AND AGREEMENT

Hereby "Terms of Use" come into force when announced in the "SITE" by "Turkiye Klinikleri". The users are regarded to agree to hereby contract terms by using the "SITE". "Turkiye Klinikleri" may change the contract terms and the changes will be come into force by specifying the version number and the date of change on time it is published in the "SITE".

 

30.03.2014

Privacy Policy

We recommend you to read the terms of use below before you visit our website. In case you agree these terms, following our rules will be to your favor. Please read our Terms of Use thoroughly.

www.turkiyeklinikleri.com website belongs to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. and is designed in order to inform physicians in the field of health

www.turkiyeklinikleri.com cannot reach to user’s identity, address, service providers or other information. The users may send this information to the website through forms if they would like to. However, www.turkiyeklinikleri.com may collect your hardware and software information. The information consists of your IP address, browser type, operating system, domain name, access time, and related websites. www.turkiyeklinikleri.com cannot sell the provided user information (your name, e-mail address, home and work address, phone number) to the third parties, publish it publicly, or keep it in the website. Gathered information has a directing feature to be a source for the website’s visitor profile, reporting and promotion of the services.

www.turkiyeklinikleri.com uses the taken information:

-To enhance, improve and maintain the quality of the website

-To generate visitor’s profile and statistical data

-To determine the tendency of the visitors on using our website

-To send print publications/correspondences

-To send press releases or notifications through e-mail

-To generate a list for an event or competition

By using www.turkiyeklinikleri.com you are considered to agree that;

-Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. cannot be hold responsible for any user’s illegal and immoral behavior,

-Terms of use may change from time to time,

-It is not responsible for other websites’ contents it cannot control or the harms they may cause although it uses the connection they provided.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. may block the website to users in the following events:

-Information with wrong, incomplete, deceiving or immoral expressions is recorded to the website,

-Proclamation, advertisement, announcement, libelous expressions are used against natural person or legal identity,

-During various attacks to the website,

-Disruption of the website because of a virus.

Written, visual and audible materials of the website, including the code and the software are under protection by legal legislation.

Without the written consent of Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. the information on the website cannot be downloaded, changed, reproduced, copied, republished, posted or distributed.

All rights of the software and the design of the website belong to Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc.

Ortadoğu Advertisement Presentation Publishing Tourism Education Architecture Industry and Trade Inc. will be pleased to hear your comments about our terms of use. Please share the subjects you think may enrich our website or if there is any problem regarding our website.

info@turkiyeklinikleri.com