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Medicinske sestre imajo pomembno nalogo za ohranjanje dostojanstva pri pacientih v zadnjih dneh življenja in za njihovo dostojanstveno smrt. Za ohranjanje dostojanstva neozdravljivo bolnega in umirajočega pacienta naj bi zdravstvena nega zajemala širok spekter aktivnosti, ki vplivajo na odpravo ali zmanjšanje dejavnikov, ki lahko zmanjšajo pacientov občutek dostojanstva. Za uspešno ohranjanje dostojanstva je pomembno dobro poznavanje pravnih vidikov, pravic pacientov v zadnjem obdobju življenja in etičnih načel za oskrbo neozdravljivo bolnega in umirajočega pacienta. Medicinske sestre se pri zdravstveni negi neozdravljivo bolnega in umirajočega pacienta pogosto srečajo z različnimi etičnimi dilemami, saj se v tem obdobju srečamo s pomembnimi vprašanji, kot so kvaliteta življenja, pravica do smrti ipd. Namen magistrskega dela je predstaviti spoštovanje bolnikovega dostojanstva in etične dileme medicinskih sester ob koncu življenja pacienta ter pravice pacientov v zadnjem obdobju življenja. Raziskovalna metodologija: Uporabljena je bila kvantitativna metodologija raziskovanja. Podatke smo zbirali s tehniko delno strukturiranih vprašalnikov. V raziskavo je bilo vključenih 121 zaposlenih v zdravstveni negi, potekala pa je na štirih klinikah in desetih kliničnih oddelkih Kirurške in Interne klinike v Univerzitetnem kliničnem centru. Rezultati: Rezultati raziskave so pokazali, da medicinske sestre delno ali slabo poznajo pravice neozdravljivo bolnega in umirajočega pacienta. Kodeks etike medicinskih sester in zdravstvenih tehnikov je pri zdravstveni negi neozdravljivo bolnega in umirajočega pacienta dobro upoštevan. Pravice, ki so opredeljene z ZPacP, so delno upoštevane. Medicinske sestre se pri svojem delu srečujejo z različnimi etičnimi dilemami. Najvišje ocenjena je etična dilema, da navodilo »ne oživljati« sprejme in odredi izključno zdravnik. Zaposleni v zdravstveni negi ohranjajo dostojanstvo pacienta v zadnjih dneh življenja na več načinov, najpogosteje pa s tem, da skrbijo za lajšanje bolečin in drugih fizioloških težav. Statistično značilne razlike v poznavanju pravic neozdravljivo bolnega in umirajočega bolnika glede na doseženo stopnjo izobrazbe medicinskih sester nismo ugotovili. Statistično pomembne razlike glede na delovno dobo so prisotne v primeru etičnih dilem številka 7, 9, 10, 15, 16, 19 in 20. Sklep: Pravice pacientov v zadnjem obdobju življenja so lahko spoštovane in upoštevane le, če jih zdravstveni delavci in pacienti dobro poznajo. Te pravice medicinske sestre slabo poznajo, zato bi bila nujna dodatna izobraževanja s področja zakonodaje in etike. Raziskava kaže, da pacienti niso dovolj informirani. Nujno bi bilo uvesti ukrepe za boljše informiranje pacienta in svojcev. Kar pogosto se dogaja, da se medicinske sestre soočajo z etičnimi dilemami, zato bi bilo potrebno uvesti strokovno pomoč pri etičnih in pravnih dilemah. Kvalitetnejšo zdravstveno nego in več dostojanstva bi lahko zagotavljali pacientom v zadnjih dneh življenja, če bi se izboljšali pogoji dela v zdravstveni negi in bolnišnicah. Nurses have an important role in the maintenance of patient dignity in the final days of their life and in their humane and dignified death. In order to safeguard the dignity of incurable and dying patients, nursing care should include a wide specter of activities affecting the elimination or reduction of those agents that can decrease a patient’s perception of dignity. To successfully safeguard patient dignity it is important for nurses to acquire a sound knowledge of legal aspects, patients’ rights in their final days of life and ethical issues in the care of incurable and dying patients. Nurses who care for incurable and dying patients often face different ethical dilemmas as this period can bring out various questions on the quality of life, the right to death etc. This master thesis aims at presenting the respect for patient dignity and ethical dilemmas of nurses at the end of a patient’s life and the rights of patients in the final period of their lives. Research methodology: A quantitative research methodology was applied. The data were collected through partially structured survey questionnaires. The research encompassed 121 health care employees, and it was carried out in four clinics and ten clinical departments of the Internal Medicine and Surgery Divisions of the University Medical Centre Ljubljana. Results: The results of the research show that nurses possess partial or poor knowledge of the rights of incurable and dying patients. The ethics code of nurses and health technicians is well respected in nursing care of incurable and dying patients. The rights defined by the Patient Rights Act (ZPacP) are partly respected. In their work, nurses are faced with different ethical dilemmas. The highest estimated ethical dilemma is the fact that the decision “do not resuscitate” is taken and ordered solely by a doctor. Health care employees can maintain patient dignity in patients’ final days of life in various ways. The most frequent way is to alleviate the pain and other physiological problems in patients. Statistically significant differences at the knowledge of the rights of the terminally ill and dying patients in relation to the level of educational attainment of nurses were not detected. Statistically significant differences emerging the years of service are present in the case of ethical dilemmas number 7, 9, 10, 15, 16, 19 in 20. Conclusion: Patient right`s at the end-of-life can be respected and considered only if health workers know them very good. Nurses have poor knowledge about this right`s, therefore it would be necessary additional education in the field of law and ethics. Our research show that patients are not sufficiently informed. It is essential to introduce measures to better inform patients and families. Often happens, that nurses are faced with ethical dilemmas, so it would be necessary to introduce professional help to the ethical and legal dilemmas. Higher quality of care and more dignity could provide patients at the last days of life, if they improve working conditions and hospitals. |
