Etični vidiki zdravstvene nege pacientov v enoti intenzivne terapije

diplomsko delo

Neja Frlic (Author), Darja Thaler (Reviewer), Darja Ovijač (Mentor)

Abstract

Uvod: Enota intenzivne terapije predstavlja zelo stresno klinično okolje, kjer se zdravijo življenjsko ogroženi pacienti, ki so pogosto opravilno nesposobni. Tu zdravstveno osebje na dnevni bazi v akutnih in zelo čustvenih situacijah sprejema pomembne odločitve med življenjem in smrtjo pacientov, ob tem pa se lahko soočijo tudi z etično dilemo. Namen: Namen diplomskega dela je proučiti najpogostejše etične izzive, ki se pojavljajo pri oskrbi pacientov v enoti intenzivne terapije in imajo hkrati pomembno vlogo pri zagotavljanju kakovostne zdravstvene nege. Metode dela: Uporabljena je bila deskriptivna metoda s sistematičnim pregledom tuje in domače strokovne ter znanstvene literature. Usmerili smo se na tri glavne etične izzive, ki se pojavljajo pri zdravstveni negi pacienta v enoti intenzivne terapije: avtonomija, dostojanstvo in prekinitev aktivnega zdravljenja. Časovni okvir je zajemal literaturo izdano med letoma 2011 in 2022, katero smo iskali v bazah podatkov Medline, ScienceDirect in Cinahl, v iskalniku Pubmed ter spletnem portalu Google učenjak. V končno analizo smo vključili 9 enot literature. Rezultati: Sodelovanje pacientov v procesu zdravstvene nege je opisano kot pogojeno z njihovim zdravstvenim stanjem in zavestjo. Pacienti v EIT pogosto občutijo izgubo nadzora nad svojim življenjem. Med hospitalizacijo želijo biti vprašani za mnenje, v primeru, da komuniciranja niso zmožni, pa vseeno želijo biti informirani. Pacienti čutijo olajšanje, če jih zdravstveno osebje spodbuja, da sodelujejo v procesu zdravstvene nege in so obravnavani kot člani tima. Žal pride tudi do situacij, ko so s strani zdravstvenega osebja obravnavani kot objekti. Primer te neprijetne situacije je lahko morebitno imenovanje pacientov po številkah posteljnih enot. Kot glavno komponento zagotavljanja dostojanstva, so pacienti izpostavili zagotavljanje intimnosti in zagotavljanje zdravstvene oskrbe brez znakov gnusa in drugih negativnih signalov s strani zdravstvenega osebja. V težkih in neprijetnih situacijah, ki jih pacienti doživljajo tekom hospitalizacije v EIT, jim je v pomoč primerna uporaba humorja, spodbujanje realnega upanja, odkrita komunikacija o njihovi diagnozi in prognozi, najpomembnejši pa je občutek podpore zdravstvenega osebja in biti cenjen kot oseba. Ugotovljeno je bilo, da se je zdravnikom etično in psihološko težje odločiti za odtegnitev kot za opustitev zdravljenja. Najpogostejši razlogi za odtegnitev zdravljenja so večorganska odpoved in slaba prognoza za akutno ali kronično bolezen ter dejstvo, da je za pacienta intenzivno zdravljenje neučinkovito. Odtegnitev zdravljenja najpogosteje predstavlja ukinitev vsega aktivnega zdravljenja, razen protibolečinske terapije, medtem ko je najpogostejša oblika opustitve zdravljenja načelo »ne oživljaj«. Razprava in zaključek: Pri pacientih v EIT se pogosto pojavljajo občutki strahu, nelagodja in nemoči, predvsem zaradi nepoznavanja bolnišničnega okolja, zmanjšanja avtonomnega odločanja, neinformiranosti in nevključenosti v zdravstveno oskrbo. To lahko privede do pasivnosti pacientov in posledično odvisnost od zdravstvenega osebja. Pacient mora imeti tekom hospitalizacije zadostno količino informacij, da lahko prevzame aktivno vlogo in sprejema informirane odločitve. Za zagotovitev dostojne zdravstvene oskrbe mora zdravstveno osebje pacienta spoštovati in nanj gledati kot na osebo, mu zagotoviti intimo ter celostni pristop zdravstvene oskrbe. V primeru odločitve o PAZ je pomembno, da pri pacientu poskrbimo za ustrezno paliativno oskrbo in med drugim poskrbimo za zadostno sedacijo in analgezijo.

Keywords

diplomska dela;zdravstvena nega;avtonomija;dostojanstvo;odtegnitev zdravljenja;opustitev zdravljenja;

Data

Language:	Slovenian
Year of publishing:	2022
Typology:	2.11 - Undergraduate Thesis
Organization:	UL ZF - University College of Health Studies
Publisher:	[N. Frlic]
UDC:	616-083
COBISS:	109662211
Views:	161
Downloads:	50
Average score:	0 (0 votes)
Metadata:

Other data

Secondary language:	English
Secondary title:	Ethical aspects of nursing patients in the intensive care unit
Secondary abstract:	Introduction: The intensive care unit represents a very stressful clinical environment where life-threatening patients, who are often legally incompetent, are treated. Here, on a daily basis, in acute and highly emotional situations, medical staff make important decisions between the lives and deaths of patients. At this point they may also face an ethical dilemma. Purpose: The purpose of this thesis is to study the most common ethical challenges that arise in the care of patients in the intensive care unit and at the same time play an important role in providing quality care. Methods: A descriptive method with a systematic review of foreign and domestic professional and scientific literature was used. We focused on three main ethical challenges that arise in patient care in the intensive care unit: autonomy, dignity, and discontinuation of treatment. The time frame included literature published between 2011 and 2022, which we searched in the Medline, ScienceDirect and Cinahl databases, in the Pubmed search engine and in the Google Scholar web portal. 9 units of literature were included in the final analysis. Results: The participation of patients in the nursing process is described as conditioned by their state of health and consciousness. Patients in the ICU often experience a loss of control over their lives. During hospitalization, they want to be asked for their opinion, but in case they are unable to communicate, they still want to be informed. Patients feel relieved when they are encouraged by the medical staff to participate in the nursing process and are treated as team members. Unfortunately, there are also situations when they are treated as objects. An example of this situation is patient, being called by their bed unit number. As a major component of ensuring dignity, patients highlighted the provision of intimacy and the provision of health care without signs of disgust and other negative signals showed by medical staff. Appropriate use of humor, fostering real hope, open communication about their diagnosis and prognosis, sense of support from medical staff and being valued as a person helped patients survive through difficult and awkward situations experienced during hospitalization at the ICU. It has been found out that it is ethically and psychologically more difficult for physicians to decide to withdraw than to withold treatment. The most common reasons for withdraw treatment are multiorgan failure and poor prognosis for acute or chronic disease, and the fact that intensive treatment is ineffective for the patient. Withdrawal of treatment most often means the abolition of all active treatment, except analgesic therapy, while the most common form of withhold of treatment is the principle "do not resuscitate". Discussion and conclusion: Patients in the ICU often experience feelings of fear, discomfort and helplessness, mainly due to ignorance of the hospital environment, reduced autonomy of decision-making, lack of information and non-involvement in healthcare. This may lead to patient passivity and consequent dependence on medical staff. The patient must have sufficient information during hospitalization to be able to take an active role and make informed decisions. In order to ensure decent medical care, the medical staff must respect and view the patient as a person, provide him with intimacy and a holistic approach to medical care. In case of a decision to withhold or withdraw life-sustaining treatment it is important to provide the patient with appropriate palliative care, including adequate sedation and analgesia.
Secondary keywords:	diploma theses;nursing care;autonomy;dignity;withdrawing treatment;withholding treatment;
Type (COBISS):	Bachelor thesis/paper
Study programme:	0
Embargo end date (OpenAIRE):	1970-01-01
Thesis comment:	Univ. v Ljubljani, Zdravstvena fak., Oddelek za zdravstveno nego
Pages:	27 str.
ID:	15446476