Abstract | Palijativna medicina, relativno nova grana medicine, bavi se liječenjem i suzbijanjem simptoma maligne i uznapredovale bolesti, poboljšavanjem kvalitete života bolesnika te kontrolom boli. Rezultate palijativne medicine možemo izmjeriti odsutnosti boli te zadovoljstvom bolesnika i njegove obitelji. Iako je palijativna medicina prvenstveno dio liječničke domene, neizbježno je sudjelovanje medicinske sestre i multidisciplinarnog tima u djelovanju holističkim pristupom unutar palijativne skrbi. Začeci hospicija i palijativne skrbi u Hrvatskoj sežu u daleku prošlost, kada se u Zadru otvara prvi ksenodohij, ustanova za skrb nemoćnih. Palijativni multidisciplinarni tim sastoji se od cijelog niza stručnjaka; liječnika, medicinske sestre, psihologa, farmaceuta, fizioterapeuta, anesteziologa, duhovnika, svećenika, socijalnog radnika. Bol kao zaštitni mehanizam organizma je sveprisutna u palijativnih bolesnika i time je jedna od glavnih zadaća medicinske sestre prepoznati je te umanjiti ili u potpunosti ukloniti. Bol klasificiramo prema brzini javljanja, uzroku, jačini, patofiziološkim promjenama, kvaliteti te duljini trajanja. Također, fiziološki i psihološki utjecaji određuju konačan doživljaj boli i prag tolerancije. Medicinska sestra detektira bol kod bolesnika promatranjem ponašanja te uz pomoć jednodimenzionalnih i multidimenzionalnih skala. Kod palijativnih pacijenata, metode ublažavanja kronične boli moraju nastupati preventivno, kontinuirano i biti primijenjene već kod niskog intenziteta. Te metode možemo klasificirati na farmakološke, nefarmakološke te invazivno anesteziološko liječenje. Sestrinska procjena boli podrazumijeva procjenu faze boli, bolesnikova ponašanja i prepoznavanje utjecaja boli na bolesnika. Nužno je utvrditi čimbenike koji utječu na pojavnost boli i bolesnikov odgovor na njih. Glavno vodeće obilježje boli je izjava pacijenta o postojanju boli te na nju je medicinska sestra dužna djelovati. Intervencije medicinske sestre moraju biti usmjerene prema ublažavanju i kontroli bola. Prikupljanje podataka, planiranje i provođenje plana zdravstvene njege, primjena i održavanje farmakoterapije, pružanje emocionalne i psihološke podrške pacijentu ali i njegovoj obitelji, komunikacija, smanjenje anksioznosti, kutana stimulacija, masaža, krioterapija i termoterapija, muzikoterapija, terapija kućnim ljubimcima, distrakcija sa boli, uklanjanje osjećaja usamljenosti, vođena vizualizacija i meditacija, individualizirana edukacija pacijenta i obitelji i druge individualizirane nefarmakološke metode suzbijanja boli u okviru sestrinskih kompetencija su neke od najvažnijih sestrinskih tehnika za kontrolu boli. Po sprovedenim intervencijama smanjivanja i suzbijanja boli, medicinska sestra evaluira učinkovitost intervencija u svrhu procjene kvalitete istih te eventualnih izmjena ili nastavak jednakih metoda. Očekivani ishodi su smanjen intenzitet boli te pacijentov povećan stupanj tolerancije i pozitivno sučeljavanje sa boli u svrhu kvalitetnijeg života i obavljanja svakodnevnih životnih aktivnosti bez osjećaja nemoći i stalnog sputavanja. Važno je naglasiti da medicinska sestra mora djelovati unutar svojih kompetencija. |
Abstract (english) | Palliative medicine, a relatively new branch of medicine, deals with the treatment and suppression of symptoms of malignant and advanced diseases, improving the quality of life of patients and controlling pain. The results of palliative medicine can be measured by the absence of pain and the satisfaction of the patient and his family. Although palliative medicine is primarily a part of the medical domain, the participation of the nurse and the multidisciplinary team in acting with a holistic approach within palliative care is inevitable. The beginnings of hospice and palliative care in Croatia go back to the distant past, when the first xenodochium, an institution for the care of the infirm, was opened in Zadar. The palliative multidisciplinary team consists of a whole range of specialists; doctor, nurse, psychologist, pharmacist, physiotherapist, anesthesiologist, clergyman, priest, social worker. Pain, as a protective mechanism of the body, is ubiquitous in palliative patients, and thus one of the main tasks of the nurse is to recognize it and reduce it or eliminate it completely. We classify pain according to the speed of onset, cause, intensity, pathophysiological changes, quality and duration. Also, physiological and psychological influences determine the final experience of pain and the threshold of tolerance. The nurse detects pain in patients by observing behavior and with the help of unidimensional and multidimensional scales. For palliative patients, chronic pain relief methods must be preventive, continuous and applied already at low intensity. These methods can be classified into pharmacological, non-pharmacological and invasive anesthetic treatment. Nursing assessment of pain involves assessing the stage of pain, the patient's behavior and recognizing the impact of pain on the patient. It is necessary to determine the factors that influence the occurrence of pain and the patient's response to them. Major defining characteristic of pain is the patient's statement about the existence of pain, and the nurse must act on it. Nursing interventions must be aimed at alleviating and controlling pain. Data collection, planning and implementation of a health care plan, application and maintenance of pharmacotherapy, providing emotional and psychological support to the patient and his family, communication, anxiety reduction, cutaneous stimulation, massage, cryotherapy and thermotherapy, music therapy, pet therapy, distraction from pain, eliminating the feeling of loneliness, guided visualization and meditation, individualized education of the patient and family and other individualized non-pharmacological methods of pain control within nursing competence are some of the most important nursing techniques for pain control. After the implemented interventions to reduce and suppress pain, the nurse evaluates the effectiveness of the interventions in order to assess their quality and possible changes or continuation of the same methods. The expected outcomes are reduced pain intensity and the patient's increased degree of tolerance and positive confrontation with pain for the purpose of a better quality of life and performing daily life activities without feeling powerless and constantly hindered. It is important to emphasize that the nurse must act within her competences. |