Zdravstvena nega pacienta, obravnavanega po načelih kirurgije s pospešenim okrevanjem : diplomsko delo

Mujdžić, Ajda (author), Ravljen, Mirjam (mentor), Pintar, Tadeja (comentor)

Uvod: Kirurgija s pospešenim okrevanjem je k pacientu usmerjena zdravstvena oskrba, v kateri sodelujejo strokovnjaki anestezije, kirurgije, zdravstvene nege, dietetike, psihologije in fizioterapije. Njena ključna načela so: predoperativno svetovanje in informiranje pacienta, prehransko zdravljenje, opuščanje predoperativnega čiščenja črevesa, perioperativna uporaba epiduralne in neopioidne analgezije ter zgodnja mobilizacija. Namen: Namen diplomskega dela je na teoretični ravni predstaviti zdravstveno nego pacienta, obravnavanega po načelih kirurgije s pospešenim okrevanjem. Cilji so predstaviti načela kirurgije s pospešenim okrevanjem, jo primerjati s klasično kirurško obravnavo, opisati njene značilnosti pri pacientu s kolorektalno boleznijo, opisati vlogo medicinske sestre ter predstaviti njene naloge pri izbranih temeljnih življenjskih aktivnostih. Metode: Opravljen je bil sistematični pregled znanstvene in strokovne literature v angleškem in slovenskem jeziku z omejitvami zadetkov na polno besedilo, znanstvene in strokovne recenzirane revije, na objavo v časovnem obdobju med letoma 2008 in 2018. Iskanje je potekalo po podatkovnih bazah CINAHL in PubMed, v spletnem brskalniku Google Scholar in prek vzajemne bibliografsko-kataloške baze podatkov COBISS+. Rezultati: Kirurgija s pospešenim okrevanjem je najbolj raziskana pri kolorektalnih operacijah. Enakovreden člen multidisciplinarnega tima je pacient; ob dobri obveščenosti lahko sodeluje pri sprejemanju z znanjem podprtih odločitev, kar pripomore k večjemu zadovoljstvu, zmanjša neželene zaplete in vodi k realizaciji ciljev kirurgije s pospešenim okrevanjem. Vsi postopki se zapisujejo v protokol obravnave – klinično pot. Razprava in zaključek: Raziskave so pokazale, da se stroški zdravljenja pacientov, obravnavanih po načelih kirurgije s pospešenim okrevanjem, občutno znižajo v primerjavi s stroški zdravljenja pacientov, obravnavanih po tradicionalnih metodah zdravljenja. Kljub z dokazi podprtim rezultatom se kirurgija s pospešenim okrevanjem v Sloveniji in svetu uvaja počasi. Implementacija protokola kirurgije s pospešenim okrevanjem v klinično prakso zahteva povezovanje vseh elementov predoperativne in pooperativne obravnave.

• Language: Slovenian
• Keywords: k pacientu usmerjena zdravstvena oskrba, medicinska sestra, izbrane temeljne življenjske aktivnosti
• Work type: Bachelor thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2018
• PID: 20.500.12556/RUL-103691
• COBISS.SI-ID: 5204140
• Publication date in RUL: 21.09.2018

Secondary language

• Language: English
• Title: Nursing care of a patient treated according to enhanced recovery after surgery principles : diploma work

Abstract

Introduction: Enhanced recovery after surgery is a patient centred health care, which includes experts in anesthesia, surgery, nursing, dietetics, psychology and physiotherapy. Its key principles are pre-operative counseling and patient information, nutrition, abandonment of pre-operative bowel cleansing, perioperative use of epidural and non-opioid analgesia and early mobilization. Purpose: Purpose of the diploma is to present health care of a patient, treated according to the principles of enhanced recovery after surgery at the theoretical level. The goals are to present the principles of enhanced recovery after surgery, to compare method with classical surgical treatment, to describe its characteristics in a patient with colorectal disease, to describe the role of nurse and to present its tasks in selected basic life activities. Methods: A systematic review of scientific literature in English and Slovene languages was used with limitations of articles with full text, scientific revised magazines, publications in the period between 2008 and 2018. The search was made in CINAHL and PubMed databases, Google Scholar web browser and the COBISS+ national bibliographic database. Results: Enhanced recovery after surgery is most studied in colorectal surgery. An equivalent member of the multidisciplinary team is a patient. With good information he can take knowledge supported decisions, which contributes to greater satisfaction, reduces unwanted complications and leads to the realization of the goals. All procedures are recorded in the treatment protocol. Discussion and conclusion: Studies have shown that the costs of treatment under the principles of enhanced recovery after surgery are significantly reduced compared to the costs of treatment according to traditional treatment methods. Despite evidence-based results, enhanced recovery after surgery is being slowly introduced in Slovenia and the world. Implementation of the treatment protocol into clinical practice requires the integration of all pre and post-operative treatment elements.

• Keywords: patient centred health care, nurse, selected basic life activities