Turkiye Klinikleri Journal of Nursing Sciences

.: REVIEW
Demanslı Yaşlı Hastalar İçin İleri Bakım Planlama Süreci ve Hemşirenin Rolü: Geleneksel Derleme
Advanced Care Planning Process for Elderly Patients with Dementia and the Role of the Nurse: Traditional Review
Serap CANLIa, Yeşim ÇETİNKAYA ŞENa, Sultan UĞURb
aAnkara Üniversitesi Haymana Meslek Yüksekokulu, Yaşlı Bakım Programı, Ankara, Türkiye
bAnkara Şehir Hastanesi, Bilkent Fiziksel Tıp ve Rehabilitasyon Kliniği, Ankara, Türkiye
Turkiye Klinikleri J Nurs Sci. 2022;14(4):1232-9
doi: 10.5336/nurses.2022-89482
Article Language: TR
Full Text
ÖZET
 Yaşlı bireylerin birçoğu, demans dâhil olmak üzere karmaşık pek çok bilişsel bozukluğa sahiptir. Demans, damar yapısında meydana gelen bozulmaya bağlı olarak ortaya çıkan dejeneratif ve ilerleyici bir hastalıktır. Demans, biyolojik yaşlanmanın olağan sonuçlarının ötesinde bilişsel işlevde bozulmaya yol açmaktadır. Dünya çapında tüm hastalıklar arasında önde gelen yedinci ölüm nedenidir. Üstelik yaşlı bireylerde engelliliğin ve bağımlılığın başlıca sorumlularındandır. Demansı olan yaşlı hastalar, hem hastalık ilerledikçe artan bilişsel gerileme hem de yaşlanmanın doğasından kaynaklanan yetersizliklerle bakım konusunda yüksek önceliklidir. Bu nedenle 'ileri bakım planlama' önemlidir. İleri bakım planlama; hasta, hasta yakınları ve sağlık profesyonelleri arasında, bireyin yaşam sonu bakımı da dâhil olmak üzere gelecekteki tedavi ve bakım yaklaşımlarına yönelik dinamik bir diyalog sürecidir. Demanslı yaşlı hastaya bakım bir ekip çalışmasıdır. Ancak hemşirelik yaklaşımı, hasta bakımının her alanında olduğu gibi demanslı yaşlı hastaların bakımında da beklenti açısından yüksek sorumluluk gerektirir. Hemşireler, hastaları ve ailelerini uzun süredir tanımaları, onların değerlerine ve tedavi tercihlerine yakından şahit olmaları nedeniyle ileri bakım planlama sürecinde önemli bir rol üstlenmelidir. Hemşireler, demansın henüz ilk semptomları ortaya çıkmadan ve hastalığın teşhisinden sonra bakım sürecini yürütebilecek konumdadır. İleri bakım planlamasına yönelik olarak ülkemizde boşluk olduğu düşünülmektedir. Bu çalışmada, demanslı yaşlı hastalar için ileri bakım planlama sürecinin gerekliliği ve bu süreçte hemşirenin rolü tartışılacaktır.

Anahtar Kelimeler: Demans; ileri bakım planlama; yaşlı; hemşireler
ABSTRACT
 Most of older people have many complex cognitive disorders including dementia. Dementia is a degenerative and progressive disease that occurs due to the deterioration in the vascular structure. Dementia leads to cognitive dysfunction beyond the usual consequences of biological aging. It is the seventh leading cause of death among all diseases worldwide. Moreover, it is one of the main responsible of disability and addiction in elderly individuals. Elderly patients with dementia are a high priority for care, because of increasing cognitive impairment as the disease progresses and age-related deficiencies. Therefore, 'advanced care planning' is important. It is a dynamic process of dialogue between patients, their relatives and healthcare professionals, in which the individual talks about their future treatment and care, including end-of-life care. Caring for the elderly patient with dementia is a teamwork. However, nursing requires high responsibility in terms of expectations in the care of elderly patients with dementia, as in all areas of patient care. Nurses should play an important role in the advanced care planning process, as they have known patients and their families for a long time and closely witnessed their values and treatment preferences. Nurses are in a position to carry out the care process before the first symptoms of dementia appear and after the diagnosis of the disease. It is thought that advanced care planning for elderly patients is very inadequate in our country. In this study, the necessity of the advanced care planning for elderly patients with dementia and the role of the nurse in this process are discussed.

Keywords: Dementia; advance care planning; aged; nurses
REFERENCES:
  1. United Nations Department of Economic and Social Affairs, Population Division [Internet]. UN 2017. [Cited: January 01, 2021]. World population prospects the 2017 revision. Available from: [Link] 
  2. Türkiye İstatistik Kurumu [İnternet]. TÜİK 2021. [Erişim tarihi: 11.12.2021]. İstatistiklerle yaşlılar 2021. Erişim linki: [Link] 
  3. London Prince M, Wimo A, Guerchet M, Gemma-Claire A, Yu-Tzu W, Matthew P. World Alzheimer Report 2015. The global impact of dementia: an analysis of prevalence, incidence, cost and trends. London: Alzheimer's Disease International; 2015. Cited: Jun 02, 2020. Available from: [Link] 
  4. World Health Organization. WHO 2012. Dementia. A public health priority. Geneva: World Health Organisation; 2012. Cited: Jun 08, 2020. Available from: [Link] 
  5. Gale SA, Acar D, Daffner KR. Dementia. Am J Med. 2018;131(10):1161-9. [Crossref]  [PubMed] 
  6. Lopez OL, Kuller LH. Epidemiology of aging and associated cognitive disorders: Prevalence and incidence of Alzheimer's disease and other dementias. Handb Clin Neurol. 2019;167:139-48. [Crossref]  [PubMed] 
  7. Wolters FJ, Ikram MA. Epidemiology of dementia: the burden on society, the challenges for research. Methods Mol Biol. 2018;1750:3-14. [Crossref]  [PubMed] 
  8. Piers R, Albers G, Gilissen J, De Lepeleire J, Steyaert J, Van Mechelen W, et al Advance care planning in dementia: recommendations for healthcare professionals. BMC Palliat Care. 2018;17(1):88. [Crossref]  [PubMed]  [PMC] 
  9. Dixon J, Karagiannidou M, Knapp M. The effectiveness of advance care planning in ımproving end-of-life outcomes for people with dementia and their carers: a systematic review and critical discussion. J Pain Symptom Manage. 2018;55(1):132-50.e1. [Crossref]  [PubMed] 
  10. World Health Organization. WHO 2011. Palliative care for older people: better practices. WHO Regional Office For Europe, 67. Cited: Jun 08, 2020. Available from: [Link] 
  11. National Council for Palliative Care. National Council for Palliative Care Response to the all parliamentary group on dementia 2012 inquiry: Improving dementia diagnosis rates in the UK. 1st ed. London: NCPC; 2012. Cited: July 08, 2020. Available from: [Link] 
  12. van der Steen JT, Radbruch L, Hertogh CM, de Boer ME, Hughes JC, Larkin P, et al; European Association for Palliative Care (EAPC). White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliat Med. 2014;28(3):197-209. [Crossref]  [PubMed] 
  13. Sampson EL, Burns A, Richards M. Improving end-of-life care for people with dementia. Br J Psychiatry. 2011;199(5):357-9. [Crossref]  [PubMed] 
  14. Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Database Syst Rev. 2009;2009(2):CD007209. [Crossref]  [PubMed]  [PMC] 
  15. Brazil K, Carter G, Cardwell C, Clarke M, Hudson P, Froggatt K, et al. Effectiveness of advance care planning with family carers in dementia nursing homes: a paired cluster randomized controlled trial. Palliat Med. 2018;32(3):603-12. [Crossref]  [PubMed] 
  16. Carter G, McLaughlin D, Kernohan WG, Hudson P, Clarke M, Froggatt K, et al. The experiences and preparedness of family carers for best interest decision-making of a relative living with advanced dementia: a qualitative study. J Adv Nurs. 2018;74(7):1595-604. [Crossref]  [PubMed] 
  17. Sellars M, Chung O, Nolte L, Tong A, Pond D, Fetherstonhaugh D, et al. Perspectives of people with dementia and carers on advance care planning and end-of-life care: a systematic review and thematic synthesis of qualitative studies. Palliat Med. 2019;33(3):274-90. [Crossref]  [PubMed]  [PMC] 
  18. Rietjens JAC, Sudore RL, Connolly M, van Delden JJ, Drickamer MA, Droger M, et al; European Association for Palliative Care. Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care. Lancet Oncol. 2017;18(9):e543-e51. [Crossref]  [PubMed] 
  19. Hammes BJ, Rooney BL. Death and end-of-life planning in one midwestern community. Arch Intern Med. 1998;158(4):383-90. [Crossref]  [PubMed] 
  20. Teixeira AA, Hanvey L, Tayler C, Barwich D, Baxter S, Heyland DK; Canadian Researchers at End of Life Network (CARENET). What do Canadians think of advanced care planning? Findings from an online opinion poll. BMJ Support Palliat Care. 2015;5(1):40-7. [Crossref]  [PubMed]  [PMC] 
  21. Selwood A, Senthuran S, Blakely B, Lane P, North J, Clay-Williams R. Improving outcomes from high-risk surgery: a multimethod evaluation of a patient-centred advanced care planning intervention. BMJ Open. 2017;7(2):e014906. [Crossref]  [PubMed]  [PMC] 
  22. MacKenzie MA, Smith-Howell E, Bomba PA, Meghani SH. Respecting choices and related models of advance care planning: a systematic review of published evidence. Am J Hosp Palliat Care. 2018;35(6):897-907. [Crossref]  [PubMed]  [PMC] 
  23. Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ, et al. Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. J Pain Symptom Manage. 2017;53(5):821-32.e1. [Crossref]  [PubMed]  [PMC] 
  24. Harrison Dening K, King M, Jones L, Vickerstaff V, Sampson EL. Advance care planning in dementia: do family carers know the treatment preferences of people with early dementia? PLoS One. 2016;11(7):e0159056. [Crossref]  [PubMed]  [PMC] 
  25. Span M, Smits C, Groen-van de Ven L, Jukema J, Cremers A, Vernooij-Dassen M, et al. Towards an interactive web tool that supports shared decision making in dementia: identifying user requirements. International Journal On Advances in Life Sciences. 2014;6(3&4):338-49. [Link] 
  26. Dening KH, Jones L, Sampson EL. Advance care planning for people with dementia: a review. Int Psychogeriatr. 2011;23(10):1535-51. [Crossref]  [PubMed] 
  27. The Irish Hospice Foundation. Dementia guidance document 2: advance care planning and advance healthcare directives with a person with dementia. Dublin: The Irish Hospice Foundation; 2016. Cited: January 07, 2021. Available from: [Link] 
  28. Bernacki RE, Block SD; American College of Physicians High Value Care Task Force. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med. 2014;174(12):1994-2003. [Crossref]  [PubMed] 
  29. Jimenez G, Virk AK, Tan WS, Car J, Ho AHY, Low CK. Overview of systematic reviews of advance care planning: Summary of evidence and global lessons. Journal of Pain & Symptom Management. 2018;56(3):436-59.e25. [Crossref]  [PubMed] 
  30. Boddy J, Chenoweth L, McLennan V, Daly M. It's just too hard! Australian health care practitioner perspectives on barriers to advance care planning. Aust J Prim Health. 2013;19(1):38-45. [PubMed] 
  31. Visser M, Deliens L, Houttekier D. Physician-related barriers to communication and patient- and family-centred decision-making towards the end of life in intensive care: a systematic review. Crit Care. 2014;18(6):604. [Crossref]  [PubMed]  [PMC] 
  32. Izumi S. Advance care planning: the nurse's role: a consistent, system-wide approach can normalize the process, dispelling fears and misconceptions. American Journal of Nursing. 2017;117(6):56-61. [Crossref]  [PubMed] 
  33. Ke LS, Huang X, O'Connor M, Lee S. Nurses' views regarding implementing advance care planning for older people: a systematic review and synthesis of qualitative studies. J Clin Nurs. 2015;24(15-16):2057-73. [Crossref]  [PubMed] 
  34. Allen JK. Increasing nurses' knowledge of advance care planning.. [Doctoral Project Approval]. Las Vegas: School of Nursing The Graduate College University of Nevada; 2020. Cited: January 05, 2022. Available from: [Link] 
  35. Advance Care Planning (ACP) for people with dementia in all care settings. England: NHS; 2018. Cited: 25.012.2021. Available from: [Link] 
  36. Robinson L, Hughes JC, Daley S, Keady J, Ballard C, Volicer L. End-of-life care and dementia. Rev Clin Gerontol. 2005;15(2):135-48. [Crossref] 
  37. Houben CHM, Spruit MA, Groenen MTJ, Wouters EFM, Janssen DJA. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc. 2014;15(7):477-89. [Crossref]  [PubMed] 
  38. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010;340:c1345. [Crossref]  [PubMed]  [PMC] 
  39. Molloy DW, Guyatt GH, Russo R, Goeree R, O'Brien BJ, Bédard M, et al. Systematic implementation of an advance directive program in nursing homes: a randomized controlled trial. JAMA. 2000;283(11):1437-44. [Crossref]  [PubMed] 
  40. Caplan GA, Meller A, Squires B, Chan S, Willett W. Advance care planning and hospital in the nursing home. Age Ageing. 2006;35(6):581-5. [Crossref]  [PubMed] 
  41. Robinson L, Dickinson C, Rousseau N, Beyer F, Clark A, Hughes J, et al. A systematic review of the effectiveness of advance care planning interventions for people with cognitive impairment and dementia. Age Ageing. 2012;41(2):263-9. [Crossref]  [PubMed]  [PMC] 
  42. Feinberg LF, Whitlatch CJ. Decision-making for persons with cognitive impairment and their family caregivers. Am J Alzheimers Dis Other Demen. 2002;17(4):237-44. [Crossref]  [PubMed] 
  43. Winblad B, Amouyel P, Andrieu S, Ballard C, Brayne C, Brodaty H, et al. Defeating Alzheimer's disease and other dementias: a priority for European science and society. Lancet Neurol. 2016;15(5):455-532. [Crossref]  [PubMed] 
  44. Ferri CP, Prince M, Brayne C, Brodaty H, Fratiglioni L, Ganguli M, et al; Alzheimer's Disease International. Global prevalence of dementia: a Delphi consensus study. Lancet. 2005;366(9503):2112-7. [Crossref]  [PubMed]  [PMC] 
  45. Cooper C, Balamurali TB, Livingston G. A systematic review of the prevalence and covariates of anxiety in caregivers of people with dementia. Int Psychogeriatr. 2007;19(2):175-95. [Crossref]  [PubMed] 
  46. Cooper C, Selwood A, Blanchard M, Walker Z, Blizard R, Livingston G. The determinants of family carers' abusive behaviour to people with dementia: results of the CARD study. J Affect Disord. 2010;121(1-2):136-42. [Crossref]  [PubMed] 
  47. Livingston G, Barber J, Rapaport P, Knapp M, Griffin M, King D, et al. Clinical effectiveness of a manual based coping strategy programme (START, STrAtegies for RelaTives) in promoting the mental health of carers of family members with dementia: pragmatic randomised controlled trial. BMJ. 2013;347:f6276. [Crossref]  [PubMed]  [PMC] 
  48. Advance Care Planning Desicions [Internet]. Nous Foundation, Inc. © 2008-2022. [Cited: February 12, 2022]. How nurses facilitate the advance care planning process. Available from: [Link] 
  49. Flanders SA. Nurses as educators. Effective patient education: Evidence and common sense. Medsurg Nursing. 2018;27(1):55-8. [Link] 
  50. Shepherd J, Waller A, Sanson-Fisher R, Clark K, Ball J. Knowledge of, and participation in, advance care planning: a cross-sectional study of acute and critical care nurses' perceptions. Int J Nurs Stud. 2018;86:74-81. [Crossref]  [PubMed] 
  51. Christensen KL, Winters CA, Colclough Y, Oley E, Luparell S. Advance care planning in rural montana: exploring the nurse's role. J Hosp Palliat Nurs. 2019;21(4):264-71. [Crossref]  [PubMed] 
  52. HPNA Position Statement Advance Care Planning. J Hosp Palliat Nurs. 2018;20(5):E1-3. [Crossref]  [PubMed] 

.: Up To Date

.: Process List

Login

 Forgot your password?

 New Registration  

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