CANCER PATIENT CARE IN SYSTEMIC THERAPY

Onkološka zdravstvena nega je kompleksno in razvejano področje zdravstvene nege, na katerega vplivajo tudi druge specialne vede. Rak je splošno ime za obsežno skupino različnih bolezni, katerih glavna značilnost je nenadzorovana razrast spremenjenih, rakastih celic. Benigen tumor je grajen iz celic, podobnih normalnim, in lahko raste omejeno. Nasprotno pa so maligni tumorji rakasti. Grajeni so iz nenormalnih celic, ki se neurejeno in nenadzorovano širijo. Razraščajo se v sosednja tkiva in tvorijo zasevke. Na nastanek raka spadajo različni dejavniki okolja, kot so: prehrana, starost, kajenje, izpostavljenost sevanju, virusi, imunske bolezni itd… Onkološko obolenje lahko zdravimo na različne načine, med katerimi so najpomembnejši kirurški posegi, obsevanje, zdravljenje z zdravili in imunsko zdravljenje. Kemoterapija ali zdravljenje s citostatiki pomeni zdravljenje z zdravili, ki uničujejo nenormalne, bolne celice ali preprečujejo njihovo rast. Biološka terapija deluje tarčno-točno na določeno mesto v ali na celici. Hormonsko zdravljenje temelji na znižanju ravni ženskih in moških spolnih hormonov oziroma zasedbi hormonskih receptorjev, na katere se vežejo spolni hormoni, kar zavre rast in zasevanje raka. Sistemska terapija pa ima tudi stranske učinke, katere je mogoče v veliki meri omiliti ali celo preprečiti s pravilnim preventivnim delovanjem celotnega zdravstvenega tima. Velika pomanjkljivost citostatikov je, da ne kvarijo samo rakastih celic, temveč uničujejo, oz. poškodujejo tudi celice zdravih tkiv, zlasti tistih, katerih celice se hitro razmnožujejo. To vpliva na nastanek neželenih učinkov citostatskega zdravljenja. Nekateri neželeni učinki sistemskega zdravljenja, tisti, ki so vidni tudi drugim, kot je npr. izpadanje las, lahko vplivajo na bolnikovo psihično stanje. Namen diplomskega dela je predstaviti teoretična izhodišča onkološke zdravstvene nege bolnika pri sistemski terapiji, predstaviti odnos bolnik – rak, opisati teorijo Jean Watson in predstaviti njeno uporabo v zdravstveni negi onkološkega bolnika s sistemsko terapijo. Uporabili smo teoretično raziskovanje na podlagi pregleda strokovne literature ter odgovorili na zastavljena raziskovalna vprašanja. Ugotovili smo, da sodobna praksa v zdravstveni negi onkološkega pacienta vključuje obvladovanje procesa zdravstvene nege in sposobnost zagotoviti, da znajo medicinske sestre biti vodnik, da znajo vrednotiti prakso zdravstvene nege ter, da so sposobne kritičnega razmišljanja. Z raziskovalnimi vprašanji smo ugotavljali kateri koncepti v zdravstveni negi so pomembni iz teorije Jean Watson in zakaj, katere negovalne diagnoze so najbolj izpostavljene in s čim se povezujejo, v čem je prednost in zakaj bi uporabili teorijo Jean Watson pri zdravstveni negi onkološkega bolnika s sistemsko terapijo. Teorija Jean Watson poudarja spoštovanje enkratnosti in individualnosti vsakega posameznika, njegove pravice in hkrati odgovornosti, da izbira med možnostmi, ki zajemajo življenjske vrednote in zdravje.Oncology nursing is a complex and wide-spreading area of health care and is influenced by other special sciences. Cancer is a common name for extensive variety od diseases with one main common denominator, that is uncontrolled growth of mutated cancer cells. Benign tumors are built from cells, which are close to normal and have only limited growth capability. Malign tumors are cancer forms, which consist of abnormal cells that devide and spread unevenly and uncontrollably. Cancer can be caused by various factors of the enviroment, like: food, age, smoking, radiation exsposure, viruses, immune diseases, etc... Oncological illness can be treated in different ways, among the most important ones are surgery, irradiation, treatment with medications and immune treatment. Chemotherapy or treatment with cytostatics is a treatment with medications, which destroy abnormal, sick cells or prevent their growth. Biological therapy acts target-exact in the certain places inside and outside the cell. Hormone treatment is based on reducing the female and male sex hormones level or presence of hormone receptors onto which sex hormones are bound and that slows down growth and spreading of cancer. Systemic therapy has side effects as well, which can be fairly moderated or even prevented by accurate and preventive functioning of the whole medical ensamble. A major disadvantage of cytostatics is that not only they damage cancer cells, but they destroy or damage cells in healthy tissues as well, especially in those with fast reproductive cells. This effects the inducing of unwanted side effects by cytostatic treatment. Some unwanted side effects caused by systemic treatment, which are visible to others, such as hair loss for example, can influence patients psychological state. The purpose of this thesis is to introduce theoretical starting points of patients oncology nursing care for systemic therapy, to introduce patient-cancer relation, to discribe Jean Watson\u27s theory and to enlighten it\u27s use in oncology patient nursing with systemic therapy. We used theoretical research based on the examinaton of expert literature and gave answeres to raised questions of the research. Our foundings were that modern praxis in oncology patient nursing includes nursing process maneging and the abilitiy of assuring that nurses can play the guiding role, they can evaluate the nursing praxis and they are capable of critical assessemnet. With research questions we were determining what concepts from Jean Watson’s theory are important in nursing and why, which nursing diagnoses are the most exposed ones and what do they relate to, what is the advantage and why would the Jean Watson’s theory be used in oncology patient nursing with systemic therapy. Jean Watson’s theory emphasizes the respect of uniqueness and individuality of every person, his rights and at the same time the responsibility to choose between possibilities which effect life values and health