The role of the nursing care of severe brain injury early rehabilitation

Uvod: Zaradi hude možganske poškodbe skoraj 2% svetovne populacije potrebuje stalno pomoč pri dnevnih aktivnostih do konca življenja. Napredek na področju urgentne in intenzivne medicine omogoča, da je število preživelih poškodovancev vedno večje, zato je ves čas od poškodbe do zaključka rehabilitacije potrebna ustrezna strukturirana obravnava poškodovanega, da bo izid le te čim boljši. Huda možganska poškodba pusti posledice na telesnem, kognitivnem in vedenjsko-čustvenem področju, posledice nastopajo v različnih kombinacijah in prizadenejo poškodovanca in njegovo družino. Rehabilitacija poškodovanca s hudo poškodbo možganov mora biti celostna, kar zajema medicinsko, psihosocialno in poklicno področje. Proces zgodnje in tudi celotne rehabilitacije mora izhajati iz čim bolj natančne ocene funkcijskega stanja pacienta, nujno je kakovostno sodelovanje interdisciplinarnega tima na vseh ravneh (od diagnosticiranja do izvajanja in evalviranja) in vključenost družine. Namen: Namen diplomskega dela je na teoretični ravni predstaviti vlogo zdravstvene nege pri zgodnji rehabilitaciji pacienta s hudo možgansko poškodbo. Cilji diplomskega dela so: opredeliti hudo možgansko poškodbo in možne posledice, pomen zgodnje in neprekinjene rehabilitacije, na podlagi temeljnih življenjskih aktivnosti predstaviti vlogo zdravstvene nege v procesu rehabilitacije v Enoti intenzivne nege, prikazati pomen sodelovanja med različnimi poklicnimi skupinami, prikazati potrebo po raziskovanju obravnavane teme. Metode dela: Uporabljena je bila deskriptivna metoda dela s pregledom znanstvene in strokovne literature v angleškem in slovenskem jeziku, za časovno obdobje med leti 2006 in 2017. Iskanje v angleškem jeziku je potekalo po podatkovnih bazah CINAHL in MEDLINE. Temeljno literaturo v slovenskem jeziku smo iskali s pomočjo vzajemne bibliografsko-kataloške baze podatkov COBIB.SI in z uporabo spletnega brskalnika Google učenjak. Rezultati: V zgodnjo rehabilitacijo pacienta s hudo možgansko poškodbo, ki se izvaja v bolnišnici, je zdravstvena nega neposredno vpletena v vse življenjske aktivnosti pacienta. Cilj zgodnje rehabilitacije je pacient, usposobljen za premestitev v ustanovo za rehabilitacijo. Razprava in zaključek: Delovanje medicinske sestre se skozi pomoč pri izvajanju temeljnih življenjskih aktivnosti dopolnjuje z delovanjem fizioterapevta in delovnega terapevta. Bolj vidno in dokumentirano vlogo zdravstvene nege v zgodnji rehabilitaciji pacienta s hudo možgansko poškodbo v slovenskem prostoru bi lahko dosegli s protokolom obravnave pacienta po težki možganski poškodbi.Introduction: Due to severe brain injury almost 2% of the world population needs constant assistance in daily activities until the end of life. Progress in the field of emergency and intensive medicine allows that the number of survivors increasing, so for the best possible treatment outcomes the entire time from injury to completion of the rehabilitation appropriate structured treatment should be implemented. Severe brain injury leaves consequences on the physical, cognitive and behavioral-emotional area, consequences occur in various combinations and affect the injured person and his family. Rehabilitation must be comprehensive, which includes medical, psychosocial and occupational field. The process of early and total rehabilitation must proceed from the accurate assessment of patient functional status, full cooperation in the multidisciplinary team at all levels (from diagnosis to implementation and evaluation) and the inclusion of the family is essential. Purpose: The purpose of this thesis is to present the role of nursing in the early rehabilitation of patient with severe brain injury on theoretical level. The objectives of the thesis are: to identify severe brain injury and its possible consequences, to present the importance of early and continuous rehabilitation, to explain the role of intensive care nurses in the early rehabilitation process on the basis of basic life activities, to show the importance of cooperation between different professional groups, to demonstrate the need for research topics. Methods: Descriptive method with a review of the scientific literature in English and Slovenian language was used in the time period between 2006 and 2017. Search in English language was performed in the databases MEDLINE and CINAHL. Basic literature in Slovenian language was searched in the national bibliographic catalog database COBIB.SI and by using the web browser Google scholar. Results: Nursing care is directly involved in all life activities in the early rehabilitation of patient with severe brain injury. The aim of early rehabilitation is patient, qualified for transfer to an institution for rehabilitation. Discussion and conclusion: Nursing care and assistance in the basic life activities complement with physiotherapy and occupational therapy rehabilitation. More visible and documented role of nursing in the early rehabilitation of patients with severe brain injury in the Slovenian area could be achieved with the treatment protoco