Psychological support to patients with end-stage renal disease on replacement therapy with haemodialysis, and the role of the nurse

Uvod: Število bolnikov s končno ledvično odpovedjo na hemodializi v svetu narašča, in sicer do te mere, da se govori o svetovni razsežnosti problema javnega zdravstva. Zdravljenje s hemodializo bolnikom korenito spremeni življenjski slog, saj je bolnikovo življenje trajno odvisno od nadomestnega zdravljenja ledvične odpovedi. Pri bolnikih s končno ledvično odpovedjo na hemodializi so prisotne spremembe v psihološkem dojemanju, ki imajo negativen vpliv na posameznikovo fizično in psihično dobro počutje. Stresni dejavniki lahko pripeljejo do psiholoških motenj. Poleg družinske podpore je vloga medicinske sestre pri psihološki podpori tem bolnikom ključna. Namen: Namen diplomskega dela je s pomočjo domače in tuje literature predstaviti, kako je s strani medicinske sestre organizirana psihološka podpora bolniku s končno ledvično odpovedjo na nadomestnem zdravljenju s hemodializo in ugotoviti, kako poteka prepoznavanje in preprečevanje psiholoških težav v okviru procesa zdravljenja s hemodializo. Metode dela: Uporabljena je bila deskriptivna metoda dela, ki je temeljila na sistematičnem pregledu domače in tuje znanstvene ter strokovne literature v časovnem obdobju 20062016 po bazah CINAHL, Wiley Online Library in Medline ter COBIB.SI. Razprava in sklep: V organizacijski vertikalni shemi nosi medicinska sestra velik del odgovornosti. Na hemodializnem oddelku začne s psihološko podporo že pri sprejemu bolnika in jo kontinuirano zagotavlja celoten proces zdravljenja. Medicinska sestra mora biti primerno strokovno usposobljena za prepoznavanje številnih psiholoških težav pri bolnikih, da se lahko primerno odzove pri reševanju psiholoških težav. Psihološko podporo s strani medicinske sestre lahko razdelimo v tri stopnje – ocenjevalno stopnjo, spodbudo in podporo. Kakovostna in strokovno utemeljena psihološka podpora je bolnikom s končno ledvično odpovedjo na hemodializi nujno potrebna, zato ji je treba posvetiti več pozornosti na različnih ravneh izobraževanja medicinskih sester. V okviru tega je potrebno, da izobraževanje poleg potrebnih znanj vključuje še pridobivanje veščin s področja strategij za obvladovanje stresa, komunikacijskih tehnik in kriznega menedžmenta. Hkrati je pri tem treba posvetiti pozornost organiziranosti dela medicinske sestre, da ne bi zaradi preobremenjenosti prišlo do izgorevanja na delovnem mestu.Introduction: The number of patients suffering from end-stage renal disease who are receiving haemodialysis is rising so rapidly that it is about to become a global public health care issue. Patients on haemodialysis face a drastic shift in lifestyle because their life becomes permanently dependent on the renal failure replacement treatment. Such patients also experience psychological changes which have a negative impact on their physical and psychological well-being. In addition, stress factors can lead to psychological disorders, which can only be tackled with the support of the family as well as nurses. Purpose: The purpose of this thesis is to use domestic and foreign scientific literature to present the way nurses organise psychological assistance for patients with end-stage renal failure who are undergoing replacement therapy in the form of haemodialysis. Another goal is to determine how they identify and prevent psychological issues during haemodialysis. Methods: This research was based on a descriptive method involving a systematic review of domestic and foreign scientific literature from the period 2006–2016, which is available in the following databases: CINAHL, Wiley Online Library, Medline and COBIB.SI. Discussion and conclusion: Nurses bear a great deal of responsibility in the vertical organisational structure. The haemodialysis unit offers initial psychological support upon admission and continues with it throughout the treatment. However, nurses must be competent for recognising various psychological issues in their patients in order to take adequate action. Psychological support provided by nurses can be divided into three stages: assessment, encouragement and support. Quality psychological support with expert knowledge is crucial for patients with renal failure, which is why more attention should be devoted to it during all the stages of health care education. That being said, nurses should also possess various skills, such as stress management strategies, communication techniques and crisis management, which should not result in nurses burning out in the workplace due to an excessive workload