| Abstract | Palijativna skrb je pristup kojim se bolesnicima suočenima sa smrtonosnom bolešću i njihovim obiteljima poboljšava kvaliteta preostalog života. Ona započinje kada su iscrpljene klasične metode liječenja ili kada su znaci širenja zloćudne bolesti dostigli takav stupanj da ih bolesnik teško podnosi. Riječ je o holističkoj/cjelokupnoj brizi za bolesnika i njegove najbliže. Takva skrb može se realizirati samo u timskoj suradnji liječnika s medicinskim sestrama, socijalnim radnicima, fizioterapeutima, ljekarnicima, duhovnicima i volonterima. Nazivom palijativna skrb obuhvaća se aktivnost cijelog uvriježenog naziva multidisciplinarnog tima.
Palijativna medicina je nova je grana medicine koja proučava i liječi bolesnika sa aktivnom, progresivnom, uznapredovalom bolešću ograničene prognoze. Brine se za optimalnu kvalitetu života do smrti, i u prvom je redu, područje liječničkog interesa.
Glavni cilj istraživanja je bio u sklopu dva mjeseca, koliko je trajalo istraživanje, doznati koliko je u tom periodu palijativnih bolesnika bilo zaprimljeno u sustav Interne klinike Kliničke bolnice Dubrava. Specifični ciljevi bili su: doznati dijagnoze palijativnih bolesnika , na kojim su odjelima smješteni i liječeni, te gdje su upućeni po odlasku/otpustu iz Kliničke bolnice Dubrava.
Korist provedenog istraživanja je u dokazivanju potrebe i činjenici da je organizacija palijativne skrbi i danas više nego opravdana te da veliki broj palijativnih bolesnika dolazi u Internu kliniku preko Odjela hitnog prijema te na odjele Klinike. Potrebe za palijativnom skrbi sve su veće stoga bi u Kliničkoj bolnici Dubrava dobra organizacija iste i upućivanje takvih pacijenata na palijativne odjele olakšalo rad zdravstvenom osoblju (liječnicima i medicinskim sestrama) te poboljšalo skrb za navedene bolesnike u našoj bolnici.
Istraživanje je provedeno pomoću anonimnog anketnog upitnika na 100 zdravstvenih djelatnika (liječnici, medicinske sestre te učenici medicinske škole), raspon godina bio je od 16-65 godina, u vremenskom periodu od dva mjeseca (01.01.2019.-01.03.2019.g.). Ankete su podijeljene u KB Dubrava na : Odjelu hitnog internističkog prijema, Zavodu za neurologiju, Zavodu za gastroenterologiju te na Zavodu za Endokrinologiju, dijabetes i bolesti metabolizma. Podaci o stvarnom broju i dijagnozama palijativnih bolesnika dobiveni su od glavne medicinske sestre u Službi za kvalitetu i planirani bolnički otpust. Rezultati istraživanja prikazani su pomoću deskriptivne statistike. Podaci su obrađeni u programu za statističku obradu SPSS 22.0.
Istraživanje je pokazalo da :
- Ispitanici su upoznati sa pojmom palijativne skrbi
- Organizacija palijativne skrbi u Kliničkoj bolnici Dubrava nije uspostavljena na zadovoljavajućem nivou te ima prostora za poboljšanje i napredak
- Potrebna je uspostava palijativnih odjela u Kliničkoj bolnici Dubrava (KBD)
- Država je najodgovornija za organizaciju i implementaciju palijativne skrbi u zdravstveni sustav Republike Hrvatske
- Obitelj je neizostavna i najbitnija sastavnica interdisciplinarnog tima palijativne skrbi
- Skrb o palijativnim bolesnicima puno je zahtjevnija od skrbi za akutnog bolesnika
- Dobro organiziran sustav palijativne skrbi poboljšao bi skrb o palijativnim bolesnicima te istovremeno ostavio više vremena za rad sa akutnim bolesnicima
- Iako su najčešće dijagnoze palijativnih bolesnika maligne bolesti, poglavito u terminalnoj fazi, ne smiju se zaboraviti niti drugi bolesnici sa kroničnim, progresivnim bolestima ( npr. neurološka oštećenja, demencije, kardiomiopatije ) kojima je također potrebna stalna zdravstvena/palijativna skrb
- Organizacija palijativne skrbi pruža adekvatno zbrinjavanje palijativnog bolesnika koji tada ne prolazi njemu uzaludne i nesvrsishodne postupke, koji se inače provode u akutnoj(kurativnoj skrbi), a koji istovremeno ne osiguravaju palijativnom bolesniku kvalitetu preostalog života
- Iz razloga sve većih potreba za palijativnom skrbi, neophodna je izgradnja hospicija i uspostava palijativnih odjela u bolnicama, kako u Zagrebu, tako i u ostalim većim gradovima Republike Hrvatske
- Potrebna je kontinuirana edukacija iz palijativne skrbi/medicine uz naglasak na promicanje i važnost palijativne skrbi |
| Abstract (english) | Palliative care is an approach that improves the quality of survival for patients suffering from lethal illness and their families. It begins when classical methods of treatment are exhausted or when the signs of malignant disease spread to such a degree that the patient is severely subjected to it. It is about holistic/total care for the patients and its closest. Such care can be realized only in the team collaboration of physicians with nurses, social workers, physiotherapists, pharmacists, spirituals and volunteers. The name of palliative care includes the activity of the entire common name of the interdisciplinary team.
Palliative medicine is a new branch of medicine that studies and treats patients with active, progressive and advanced disease with limited prognosis. Iti s concerned about the optimal quality of the life to death, and in the first place, the area of medical interest.
The main purpose of the research was to study how much of the palliative patients had been received in the Clinical hospital Dubrava in the Internal clinic during the two months of the research. Specific goals were: to know the diagnosis of palliative patients, where they were located and treated, and where they were referred at the time of departure/discharge from Clinical hospital Dubrava.
The benefit of the conducted research is to prove the need and the fact that the organization of palliative care is still more than justified and that a large number of palliative patients came to the Clinic through the emergency department and the clinic departments.
The need for palliative care is increasing, therefore in Clinical hospital Dubrava a good organization and the referral of such patients to palliative departments has made it easier for health staff (doctors and nurses) to improve their health care for these patients in our hospital.
The survey was conducted by anonimous questionnaires on hundred healthcare professionals (doctors,nurses and school children), ranging frm 16-65 years, over the period of two months (01.01.2019.-01.03.2019.). The surveys were divided into the Department of Emergency, the Department of Neurology, the Department of Gastroenterology and the Department of Endocrinology, Diabetes and Metabolic diseases. The actual numbers and the diagnoses of palliative patients were obtained from the Main nurse at the Quality Department and planned hospital discharge.
The results of the research are presented using descriptive statistics and data are processed in the SPSS 22.0 statistical program.
Research has shown that :
- The respondents are familiar with the concept of palliative care
- The palliative care organization at Clinical Hospital Dubrava was not established at a satisfactory level and there is plenty of space for improvement and progress
- It is necessary to establish palliative departments at Dubrava Clinical Hospital
- The State is the most responsible for the organization and implementation of palliative care in the Health Care system of the Republic of Croatia
- The family is the indispensable and essential component of the interdisciplinary team of palliative care
- Palliative patients Care is much more demanding in compare with acute patient care
- A well-organized palliative care system would improve the care of palliative patients and at the same time leave more time to work with acute patients
- Although the most common diagnosis of palliative patients are malignant diseases, especially in the terminal phase, other patients with chronic, progressive diseases ( neurological damage, dementia, cardiomyopathy) should not be forgotten- they also need permanent health/palliative care
- The palliative care organization provides adequate care for a palliative patient who then does not undergo useless and unenforceable procedures that are usually carried out in acute (curative) care, while at the same time not providing the palliative patient with the quality of the remaining life
- Due to the growing needs for palliative care, it is necessary to build hospice and establish palliative departments in the hospitals, in Zagreb as well as in other major cities of the Republic of Croatia
- Continuous palliative care/medicine education is need, with emphasis on promoting and importance of palliative care/medicine |
