Odnos medicinskih sester v paliativni oskrbi do umiranja in smrti - Gnezda, Petra (P. Gnezda, 2018)
Uvod: Medicinske sestre, ki so zaposlene na paliativnih oddelkih, se v okviru svojega poklicnega delovanja pogosto srečujejo z umiranjem in smrtjo bolnikov, za katere skrbijo. Delo z umirajočimi in soočanje s smrtjo pri njih povzroči različne odzive. Namen: Namen raziskave je preučiti odnos medicinskih sester, ki so zaposlene na paliativnih oddelkih, do oskrbe umirajočih, umiranja in smrti. V do dosedanjih raziskavah se je izkazalo, da so z odnosom medicinskih sester do oskrbe umirajočih, umiranja in smrti povezani nekateri dejavniki (znanje, starost, delovne izkušnje in stik z umirajočimi), zato smo želeli preučiti, kakšen pomen tem dejavnikom pripisujejo medicinske sestre zaposlene na paliativnih oddelkih v Sloveniji. Prav tako nas je zanimalo njihovo pojmovanje dela na področju paliativne oskrbe. Metoda dela: Uporabljena je bila deskriptivna metoda raziskovanja. Za zbiranje podatkov smo uporabili polstrukturirani intervju. Pri sami izvedbi intervjujev nam je bil v pomoč seznam tem oziroma glavnih vprašanj odprtega tipa. V raziskavi je sodelovalo 18 medicinskih sester, zaposlenih na paliativnih in neakutnih oddelkih v 6 bolnišnicah v Sloveniji. Za analizo podatkov smo uporabili kvalitativno analizo vsebine (Graneheim, Lundman, 2004). Rezultati: Skozi kvalitativno analizo vsebine intervjujev so se izoblikovale tri teme, ki služijo kot odgovor na zastavljena raziskovalna vprašanja, in sicer: umiranje in smrt, paliativna oskrba ter dejavniki. Medicinske sestre, ki so sodelovale v raziskavi, najpogosteje umiranje in smrt pojmujejo kot nekaj naravnega oziroma kot del življenja ter imajo pozitiven odnos do dela na področju paliativne oskrbe. Njihovo doživljanje in sprejemanje umiranja in smrti bolnika sta odvisni od značilnosti bolnika ter načina umiranja. Izkazalo se je, da medicinske sestre težje in bolj stresno doživljajo nenadno nepričakovano smrt, težko smrt, smrt mlajšega bolnika, bolnika, s katerim so dlje časa v stiku in s katerim navežejo tesnejši osebni odnos, ter soočanje s stiskami in čustvenimi reakcijami bolnikovih bližnjih. Največ intervjuvank je znanje izpostavilo kot najpomembnejši dejavnik, ki je povezan z njihovim odnosom do umiranja, smrti in oskrbe umirajočih. Razprava in sklep: Vsem stiskam in negativnim čustvenim reakcijam, ki se pojavijo ob soočanju z umiranjem in smrtjo bolnikov, se medicinske sestre ne morejo v popolnosti izogniti. Pomembno pa je, da so take reakcije kratkotrajne in da pri njih ne povzročajo zapoznelih čustvenih reakcij. Z raziskavo smo zaznali, da ima znanje pomembno vlogo pri odnosu medicinskih sester do umiranja in smrti, sprejemanju umiranja in smrti bolnikov ter oskrbi umirajočih bolnikov. V prihodnje bi bilo zato potrebno večjo pozornost nameniti izobraževanju medicinskih sester s področja paliativne oskrbe. Prav tako bi bilo potrebno večjo pozornost nameniti zagotavljanju pogojev za izvajanje kakovostne paliativne oskrbe tako na paliativnih kot tudi akutnih oddelkih, da smrt ne bo kot odrešitev, ampak naravni dogodek ob koncu življenja. Introduction: Nurses that work in departments of palliative care often deal with dying and death of patients as part of their profession. Such working conditions, however, elicit different responses. Purpose: The purpose of our research is to study what attitude do the nurses that work in palliative care have towards care of dying patients, the process of dying and death as such. As research to date has shown that this attitude is influenced by several factors (knowledge, age, working experience and contact with dying patients), our goal was to establish how important these factors are for nurses that work in departments of palliative care in Slovenia. We were also interested in what is their concept of working in palliative care. Methodology: In our research, descriptive research method was used and data was collected by semi-structured interviews. A list of general subjects or open-ended questions was used in conducting the interviews. 18 nurses that work at departments of palliative and non-acute care in six Slovenian hospitals took part in the survey. Qualitative content analysis was used to analyse the data (Graneheim, Lundman, 2004). Results: Qualitative content analysis revealed three subjects that can simultaneously be regarded as answers to the specified research questions, i.e. dying and death, palliative care and relevant factors. The majority of nurses that participated in the research see dying and death as a natural phenomenon or part of life and have a positive attitude towards working in the field of palliative care. Their experience and acceptance of a patient’s death and dying depend on the patient’s characteristics and how they passed away. The results also revealed that nurses experience more difficulties and higher stress in the case of a sudden unexpected death, difficult death, death of a young patient or a patient they were in contact with for an extended period and with whom they formed a closer, more personal relationship, and when they witness distress and emotional responses of the deceased’s relatives. The factor that the largest part of interviewees singled out as the most important one with regard to their attitude towards dying, death and palliative care was knowledge. Discussion and Conclusion: It is impossible for nurses to completely avoid distress and negative emotional responses when they face dying and death of patients. What is important, however, is that these are short-term responses that are not followed by delayed emotional responses. Our research revealed that knowledge plays an important part in the nurses’ attitude towards dying and death, acceptance of dying and death of patients, and care of dying patients. In the future, greater emphasis should therefore be placed on education of nurses in the field of palliative care. Furthermore, more attention should be given to ensuring appropriate conditions for quality palliative care in departments of palliative and acute care, for such an approach would make it possible to no longer see death as deliverance from suffering, but rather as a natural end to life.