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4MODERN APPROACHES TO EDUCATIONAL AND METHODOLOGICAL WORK ON PROVIDING
PALLIATIVE AND HOSPITAL ASSISTANCE
Rusina S.,
Candidate of Medical Sciences, Associate Professor of the Department of Nervous Diseases, Psychiatry and Medical Psychology. of S.M. Savenko Higher educational institution of Ukraine "Bukovynian State Medical University", Chernivtsi, Ukraine Nikoryak R.
Aspirant of the National Medical Academy of Postgraduate Education of Shupyk,
Kyiv, Ukraine DOI: 10.5281/zenodo.7049716
ABSTRACT
In recent decades, the number of terminally ill patients, as well as elderly patients and children with disabilities, has been growing rapidly in the world. Due to unrelenting pain and severe disorders of the functions of organs and systems caused by such chronic progressive incurable diseases, most of them end their own biological life in suffering and torment. Palliative patients need adequate analgesia and symptomatic treatment, professional care, moral, psychological and spiritual support, according to modern approaches and concepts.
Keywords: severe mental illnesses, palliative patients, hospice care.
Formulation of the problem.
Educational and methodological work on thematic improvement courses for palliative and hospice care doctors, in particular psychiatrists, has become extremely important in connection with the increase in severe cases of depression, patients with a continuously progressive course of schizophrenia, anorexia nervosa, severe and profound mental retardation, neuropsychiat-ric diseases and degenerative lesions of the nervous system (including Alzheimer's disease, Pick's disease).
In order to increase the professional training of psychiatrists to work with severe (palliative) patients, it became necessary to create these courses with the involvement of experienced teachers.
Analysis of recent research and publications.
The modern information society and the growing prevalence of incurable diseases, in particular, mental diseases, make high demands on the professional training of future specialists in the field of medicine. The development of a strategy for providing assistance to Ukrainians in each medical field is an integral part of the work of a higher educational medical institution of Ukraine to train medical personnel aimed at a positive shift, as well as in palliative and hospice care for patients with severe mental disorders, which, unfortunately, cannot be cured generally known methods.
The purpose of the article.
Since the beginning of the 21 st century in Ukraine, the problem of developing palliative and hospice care for the population has become one of the most pressing medical, social and humanitarian problems of society. Palliative care is a comprehensive approach, the goal of which is to ensure the highest possible quality of life of palliative patients and their family members, by preventing and alleviating suffering due to early detection and accurate diagnosis of pain symptoms and disorders of vital activity, carrying out adequate treatment measures, symptomatic (adjuvant) therapy and care, provision of psychological, social, spiritual and moral support, regardless of the disease, age, social status, nationality, religious and political beliefs, place of residence of the patient, etc. (1).
Palliative care is based on a complex interdisciplinary assessment of the patient's physical condition, the degree of pain syndrome and disorders of vital functions, psycho-emotional, cognitive and cultural characteristics, the maximum possible and comprehensive consideration of the needs and wishes of the patient and his family, the prognosis of disease progression and life expectancy. The provision of palliative care begins from the moment of diagnosis of an incurable progressive disease and a limited life prognosis and continues until the end of the family's grieving period.
Primary palliative care is palliative care that is provided to palliative patients at the primary level of health care provision in outpatient clinics or at home by general practitioners-family medicine, district doctors and polyclinic specialists.
General palliative care is palliative care provided to palliative patients by specialist doctors in accordance with their specialization on an outpatient basis and in inpatient health care facilities of the second and third level.
Specialized palliative care is complex multidisci-plinary medical, social and psychological care, which is provided to palliative patients in health care institutions of the special type "Hospice", in departments and palliative care wards of inpatient treatment and prevention institutions by doctors and junior medical specialists who have received special training in the provision of palliative and hospice care, and at home by specialists of specialized multidisciplinary mobile teams of palliative care with the involvement of medical psychologists, social workers and other specialists, as needed, as well as volunteers, close relatives or guardians of the patient (2).
Palliative care should provide quality life to patients with progressive diseases and a limited life expectancy, as well as to members of their families by preventing and alleviating suffering, thanks to early and accurate diagnosis of the condition and problems, adequate treatment (pain syndrome, severe life disorders, etc.), providing psychological and social support and spiritual support.
In Ukraine, as part of the primary care reform, the Ministry of Health has developed a list of responsibilities of a general practitioner - family medicine, which also includes the tasks of providing palliative care: assessment of pain intensity and treatment of pain syndrome, prescribing narcotic analgesics, psychotropic substances and precursors, and issuing prescriptions on them (3).
In general, in many countries, to become a doctor of palliative medicine, you need to study for a specialty for 2-2.5 years (interrupted course) and have at least 5 years of relevant experience (for example, in Great Britain).
In the USA, after 1-2 years of postgraduate study, doctors can specialize in palliative medicine at 50 departments of higher medical institutions.
In Poland, it takes up to 3 years to get a palliative medicine doctor's certificate.
According to the recommendations of the WHO and authoritative international non-governmental professional organizations, when providing PCD, it is necessary to apply a holistic multidisciplinary and interdisciplinary approach, in which medical professionals, non-medical professionals (social workers, psychologists, lawyers, etc.) and volunteers, friends and relatives of the patient, complementing each other, coordinate among themselves all types of care provided to the palliative patient, as well as to his family members (4).
The purpose of training in the thematic improvement courses of psychiatrists: to increase their professional knowledge and skills in the field of early detection and accurate diagnosis of pain symptoms and disorders of vital activity, carrying out adequate treatment measures, symptomatic (adjuvant) therapy and care with the provision of psychological and spiritual assistance to patients, who are in a serious mental and somatic state.
Highlighting previously unresolved issues.
Under the modern conditions of the development of medicine, the problem of providing health care with highly qualified personnel is of particular importance, since the level of medical care and the effectiveness of the health care system as a whole will depend on the quality of the training of doctors and the level of their professional training. All over the world, it is believed that there are three basic conditions for a strategy for the successful development of palliative and hospice care. These include the state policy on the development and implementation of this direction at all levels of medical care, ensuring the availability of medicines for palliative patients (including analgesics), as well as the training of qualified personnel.
Thus, the solution to this problem is entrusted to the Ministry of Health (MOH) with the presence in their department of a sufficient number of diagnostic and treatment facilities with professionally trained medical personnel for palliative and hospice care and the Ministry of Education and Science (MES) using the potential of Higher Medical educational institutions in the development of effective state programs for the diagnosis, treatment, prevention and provision of assistance
for incurable diseases, which must have a scientific basis, which became the impetus for the creation of improvement courses for psychiatrists from this direction.
Presenting main material.
Improving the professional skills of doctors - psychiatrists on thematic improvement courses fulfills the needs of health care of Ukraine in the training of doctors capable of providing palliative patients with adequate pain relief and symptomatic treatment, professional care, moral-psychological and spiritual support, in accordance with modern approaches and concepts.
Thematic improvement courses are held at the Department of Nervous Diseases, Psychiatry and Medical Psychology at the Bukovyna State Medical University by the Educational and Scientific Institute of Postgraduate Education on the basis of the standard curriculum and work program developed at the course of psychiatry and medical psychology.
The created curriculum corresponds to the classroom hours available in the quantitative indicator, namely, lectures, seminars, practical classes and extracurricular hours allocated to the independent work of the cadets.
In accordance with the work program, psychiatrists attend lectures, practical and seminar classes. At the preparatory stage, control of the initial level of preparation for practical training is carried out using standardized questions and test tasks. During the class, cadets improve their theoretical knowledge and practical skills and abilities in providing assistance to palliative patients who are in severe mental conditions, need medical assistance and meet the requirements of the specialist's qualifications. Each cadet prepares a presentation on the chosen topic of the seminar session. The working training program for psychiatrists provides for the study of clinical manifestations during the courses:
- heboidity, catatonic stupor, paranoid excitement in the continuously progressive course of schizophrenia;
- agitation and states of physical (refusal of food) exhaustion in prolonged severe depressions;
- severe and profound mental retardation;
- anorexia nervosa with cachexia;
- neuropsychiatry diseases (vascular and traumatic genesis);
- senile dementia;
-degenerative lesions of the nervous system (including Alzheimer's disease, Pick's disease).
Important attention is also paid to the provision of qualified assistance to palliative patients who are in the psychiatric departments of the regional psychiatric hospital.
So, the main thing in educational and methodical work is the improvement of the cadets' knowledge of general palliative care, which is provided to palliative patients by specialist doctors, namely, psychiatrists on an outpatient basis and in inpatient health care institutions of the second and third levels.
Conclusions and offers
In psychiatric activity, palliative and hospice care is a new direction towards which the developed program of thematic improvement of psychiatrists is di-
rected. Thus, the ultimate goal of the thematic improvement courses for psychiatrists is to increase the level of their practical training in providing professional psychiatric care to palliative patients of all age groups who have mental disorders against the background of malignant neoplasms in the III-II stage of the disease, HIV infection/AIDS, congenital developmental disabilities (mental retardation), a severe course of schizophrenia and depressive states, cachectic anorexia, atrophic-de-generative progressive diseases and post-traumatic conditions that cannot be cured by modern and available methods and means, are accompanied by severe pain symptoms, severe disorders of vital activity and include symptomatic treatment , professional care, moral, psychological and spiritual support in the terminal stage of the disease or in the case of a limited life prognosis, a doubtful prognosis of recovery or improvement of the condition, or a full restoration of vital functions.
References
1. Palliative and hospice care: textbook/ Yu.V. Voronenko, Yu.I. Gubskyi, V.M. Knyazevich and others.; edited by: Yu.V. Voronenko, Yu.I. Hubskyi. -Vinnytsia: New Book, 2017. - 392 p.
2. Gubskyi Y.I., Tsarenko A.V., Baranovska G.A. etc. Palliative and hospice medicine: medico-demographic and clinical aspects // Collection. of science employees' work. NMAPO named after P.L. Shupyka -K., 2011. - Vol. 20, book 2. - P. 723-733.
3. Knyazevich V.M., Tsarenko A.V., Yakovenko I.V., Bratsiun O.P. National strategy for the development of the palliative care system in Ukraine until 2022: state of implementation, problems and prospects. October 10-11, 2013 / Edited by V.M. Knyazevicha, T.P. Garnyk - K., 2013. - P. 3-9.
4. Tsarenko A.V., Gubskyi Y.I., Tolstyh O.I. International experience of providing palliative and hospice care // The place of folk and non-traditional medicine in palliative care: Proceedings of the International Scientific and Practical Conference. October 10-11, 2013 / Edited by V.M. Knyazevicha, T.P. Garnyk - K., 2013. - P. 91-96.
