Avtonomija odločanja pacientov ob koncu življenja in vključenost medicinskih sester : diplomsko delo

Skok, Tajda (author), Bobnar, Albina (mentor), Sotler, Robert (reviewer)

Uvod: Cikel življenja vsako osebo pripelje do smrti. Nenehen tehnološki napredek medicine tega ne more preprečiti, vendar z najučinkovitejšimi metodami in tehnikami le podaljšuje življenje pacientov, ne glede na njihovo kakovost življenja. V izogib temu lahko osebe v času polne zavesti podajo izjavo o vnaprej izraženi volji in oskrbi ter s tem zaščitijo lastno avtonomijo pri odločanju. Pomembno je, da se ob koncu življenjske dobe vsake osebe izvaja kakovostna zdravstvena nega ter se upoštevajo želje in vrednote osebe, ki jih je izrazila vnaprej. Medicinske sestre pri zdravstveni oskrbi pacienta lahko ščitijo njihovo avtonomijo, ko je ta zaradi vplivov družinskih članov ali zdravstvene obravnave ogrožena. Namen: Namen diplomskega dela je predstaviti izkušnje medicinskih sester z avtonomijo odločanja pacientov o oskrbi ob koncu življenja in smrti. Metode dela: Uporabljena je bila deskriptivna metoda dela s pregledom strokovne in znanstvene literature. Literaturo smo iskali v prosto dostopnih podatkovnih bazah Medline in CINAHL, pregledali smo tudi internetni arhiv Obzornika zdravstvene nege in Onkologije za obdobje petih let. Literaturo smo iskali v času od oktobra 2019 do januarja 2020. Uporabili smo ključne besede v angleščini, ki smo jih kombinirali z Boolovim operatorjem AND. V analizo smo zajeli 20 člankov. Kakovost člankov je bila ocenjena s pomočjo CASP-sistema. Kot dodaten vir smo uporabili eno knjigo, Kodeks etike v zdravstveni negi in oskrbi Slovenije in Zakon o pacientovih pravicah. Rezultati: Ugotovili smo, da je avtonomija pacientov lahko ogrožena s strani tako medicinskega kot tudi s strani družinskega paternalizma. Kljub vnaprej izraženi volji in oskrbi se ta vedno ne upošteva zaradi interesov drugih oseb. Medicinske sestre imajo pomembno vlogo pri zaščiti pacientove avtonomije in ustvarjanju za pacienta udobnega okolja, saj so tiste, ki prevzamejo skrb za umirajočega pacienta. Razprava in sklep: Vnaprej izražena volja in oskrba sta se izkazali kot pozitivne v zvezi z odločanjem o medicinskih postopkih pri pacientih ob koncu življenja. Medicinske sestre so mnenja, da je oskrba ob koncu življenja bolj obvladljiva, kadar so želje in vrednote pacienta znane, čeprav samostojno niso vključene v pogovore vnaprej izražene volje in oskrbe. Še vedno je prisoten strah pred avtoritativnim položajem zdravnikov v praksi.

• Language: Slovenian
• Keywords: diplomska dela, zdravstvena nega, vnaprej izražena volja in oskrba, avtonomija, oskrba ob koncu življenja
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [T. Skok]
• Year: 2020
• Number of pages: 44 str., [7] str. pril.
• PID: 20.500.12556/RUL-121184
• UDC: 616-083
• COBISS.SI-ID: 30713603
• Publication date in RUL: 01.10.2020

Secondary language

• Language: English
• Title: Patients' decision making autonomy at the end of life and involvement of nurses : diploma work

Abstract

Introduction: Inevitably, every life cycle brings a person to death. Constant medical technological progress cannot change this fact. The most efficient and advanced methods and techniques only prolong patients' life regardless of its quality. In order to avoid such state, persons can, in full consciousness, make a statement of pre-expressed will and care, thus protecting their own autonomy. It is vital that at the end of each person's life, quality nursing care is provided and that the wishes and values of the person expressed in advance are taken into account. Nurses can protect patient's autonomy during patient care when said autonomy is compromised by the influence of patient's family members or medical treat-ment. Purpose: The purpose of this thesis is to present nurses' experience with the auto-nomy of patients' decision-making on end-of-life care and care at death. Methods: A des-criptive method of work with a review of professional and scientific literature was used. Literature in the freely accessible Medline and CINAHL databases and the Internet archive of the Review of Nursing and Oncology for the period of five years was searched. Litera-ture was searched in the period from October 2019 to January 2020. English keywords were used, combined with the Boolean operator AND. 21 professional articles were inc-luded in the analysis. Article quality was assessed using the CASP system. One book was used as an additional source, The Code of Ethics in Nursing and Care of Slovenia and the Patients' Rights Act. Results: It has been found that patients' autonomy can be compromi-sed by both medical and family paternalism. Despite the pre-existing will, this is not taken into account due to other persons' interests. Nurses have an important role to play in protec-ting patient's autonomy and creating a comfortable environment as they are the ones who take care of a dying patient. Discussion and conclusion: Pre-expressed will and care pro-ved to be positive in deciding on medical procedures in end-of-life patients. Even though nurses themselves do not independently engage in conversations about pre-expressed will and end-of-life care, they do believe that end-of-life care is more manageable when the patient's wishes and values are known. In practice, fear of doctor's authoritative position is still very much present.

• Keywords: diploma theses, nursing care, pre-expressed will and care, autonomy, end-of-life care