#1
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êàê ñêàçàòü ðîäèòåëÿì î ñìåðòè ðåáåíêà?
Íè â îäíîé äðóãîé âðà÷åáíîé îòðàñëè òàê ÷àñòî âðà÷ íå ñòàëêèâàåòñÿ ñî ñìåðòüþ ðåáåíêà, ÊÀÊ Â ÍÅÎÍÀÒÎËÎÃÈÈ.
Ó íàñ â ðîä.äîìå íåò ïñèõîëîãà... Î ñìåðòè ðåáåíêà ðîäèòåëÿì ñîîáùàåò âðà÷. Êàê ñêàçàòü ÝÒÎ ðîäèòåëÿì? Êàê ñäåëàòü ýòî ãðàìîòíî, ÷òîáû íå áûëî ïñèõîëîãè÷åñêîé òðàâìû, ÷òîáû íå áûëî íåíóæíûõ æàëîá, ÷òîáû ñàì âðà÷ ïîñëå ÝÒÎÃÎ ñìîã ðàáîòàòü? |
#2
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Êîððåêòíî, äåëèêàòíî ñ ñî÷óâñòâèåì. Ñîñòðàäàÿ è ñîáîëåçíóÿ.
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#3
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Óâàæàåìàÿ Îëüãà, êðîìå òîãî, ñ÷èòàþ, ÷òî íåîáõîäèìî ñîîáùàòü î òðàãåäèè ñîâìåñòíî ñ àäìèíèñòðàòîðîì, íà÷ìåäîì, çàâ. îòäåëåíèåì, àêóøåðîì, ñòàðøèì êîëëåãîé.
Âìåñòå âû íàéäåòå ïðàâèëüíûå ñëîâà, ïðåäîñòàâèòå âñþ ïîëíîòó èíôîðìàöèè, ñìîæåòå ïîääåðæàòü ðîäèòåëåé è ðîäñòâåííèêîâ â ãîðå. Ñ óâàæåíèåì, Àíäðåé. |
#4
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Çíàêîìà ñ òåì, êàê ñîîáùàòü î ïàòîëîãèè ó íîâîðîæäåííîãî.
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Ñ óâàæåíèåì, Ïîëèíà Ëüâîâíà Öåíòð ðàííåé ïîìîùè Äàóíñàéä Àï ñàéò http://www.downsideup.org Ôîðóì http://downsideup.wiki/ru/forum/theme |
#5
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Âñå ñèå, êîíå÷íî, ïðàâèëüíî, íî ê îòâåòó íå ïðèáëèçèò íè íà éîòó. Ïðîñòèòå, óâàæàåìûé Àëåêñåé Àíàòîëüåâè÷, ýòî âñå ðàâíî, ÷òî íà âîïðîñ ïàöèåíòà â êîíñóëüòàòèâíîì ðàçäåëå îòâåòèòü îäíèì ñëîâîì «ëå÷èñü».
Îëüãà, ïîñòàðàéòåñü íàéòè êíèãó À.Â. Ãíåçäèëîâà «Ïóòü íà Ãîëãîôó». Ê ñîæàëåíèþ â ñåòè ÿ åå íå âèäåë – ïðåäñòàâëåíû áîëåå åãî «Òåðàïåâòè÷åñêèå ñêàçêè» - òîæå âåùü äîñòîéíàÿ, íî íå ê ýòîé òåìå. À ìîé ýêçåìïëÿð… çíàë áû, êòî çà÷èòàë – çàñòàâèë áû ïîëíîå ñîáðàíèå Äîíöîâîé ñúåñòü… Àíäðåé Âëàäèìèðîâè÷, âðà÷-ïñèõèàòð, ïñèõîòåðàïåâò, îñíîâàòåëü ïåðâîãî õîñïèñà è ïðîñòî çàìå÷àòåëüíûé ÷åëîâåê. «Ïóòü», äàâíî íå ïåðåèçäàâàâøèéñÿ – åãî î÷åðêè î ðàáîòå â õîñïèñå.  ÷àñòíîñòè, Àíäðåé Âëàäèìèðîâè÷, îïèñûâàåò 10 âèäîâ ðåàêöèè ïàöèåíòà íà èçâåñòèå î íåèçëå÷èìîì çàáîëåâàíèè îò èïîõîíäðè÷åñêîãî äî ýéôîðè÷åñêîãî. Ðàññìàòðèâàÿ âàðèàíòû ÷åðåç ïðèçìó ñòàäèé ïðèíÿòèÿ ïî Êþáëåð-Ðîññ, À äàåò ÷åòêèå è ïîíÿòíûå ðåêîìåíäàöèè ïî òàêòèêå îáùåíèÿ ñ ïàöèåíòîì. Õîòÿ êíèãà è ïîñâÿùåíà ðàáîòå ñî âçðîñëûìè ïàöèåíòàìè, ïîëàãàþ, ÷òî îáùèå ïðèíöèïû (äà è òàêòèêà) ïðèìåíèìû è â îïèñàííîé Âàìè òÿæåëîé ñèòóàöèè. Ïîèùèòå – íå ïîæàëååòå. È ïîñìîòðèòå ýòó òåìó â íåé íåìàëî èíòåðåñíîãî. À â ïëàíå îæèâèòü äèñêóññèþ, âîò êàêîé âîïðîñ ÿ ïðåäëîæèë áû ê îáñóæäåíèþ – óâàæàåìûé Àëåêñåé Àíàòîëüåâè÷, ïèøåò ïîñòóëàò, èçâåñòíûé íàì ñî ñòóäåí÷åñêîé ñêàìüè – «ñîïåðåæèâàòü è ñî÷óâñòâîâàòü». Êàçàëîñü áû òåçèñ íåîñïîðèìûé. Íî â ïîñëåäíèå ãîäû îí íå ðàç çàñòàâëÿë ìåíÿ ñåðüåçíî çàäóìàòüñÿ. Äåëî âîò â ÷åì: «Ñî» îçíà÷àåò âìåñòå – âìåñòå ïåðåæèâàòü, âìåñòå ÷óâñòâîâàòü, âìåñòå íåñòè (è ðàçäåëÿòü) áîëü. Íî. - ýòè÷íî ëè òðåáîâàòü îò âðà÷à ñòðàäàòü îò áîëè, åìó íå ïðèíàäëåæàùåé. Ïðè ýòîì ïîíèìàÿ, ÷òî åãî ñòðàäàíèÿ íè÷óòü íå îáëåã÷àò ñòðàäàíèÿ áëèçêèõ óìåðøåãî, - êàêîå êîëè÷åñòâî ñòðàäàíèé ïðèäåòñÿ âûíåñòè âðà÷ó, ñëåäóþùåìó ïðîïèñàííîé ìàêñèìå – óâû, ñìåðòü ïàöèåíòà – íå ñòîëü ðåäêîå ñîáûòèå, êàê íàì áû ýòîãî õîòåëîñü. Îòêóäà æå âçÿòü ñèëû íà ïåðåæèâàíèå òàêîãî êîëè÷åñòâà áîëè. - è íå çäåñü ëè, íå â óìåíèè ëè àáñòðàãèðîâàòüñÿ îò ÷óæîé áîëè åæèò îäèí èç êîðíåé äðóãîé òåìû Îëüãè – Ýìîöèîíàëüíîãî âûãîðàíèÿ? Íå îòñþäà ëè ïðîôåññèîíàëüíûé è íåðåäêî îòâðàòèòåëüíûé öèíèçì, êîòîðûé ïðè âäóì÷èâîì ðàññìîòðåíèè – ñóòü åñòü çàùèòíûé ìåõàíèçì îò òîãî ñàìîãî ÝÂ? À ÷òî åñëè ðàññìîòðåòü äðóãîé òåçèñ – âðà÷, ñòðåìÿùèéñÿ ñîõðàíèòü ïñèõè÷åñêîå çäîðîâüå è ëè÷íîñòü, êàê òàêîâóþ, äîëæåí óìåòü àáñòðàãèðîâàòüñÿ îò ÷óæîé áîëè, íî (ñåé÷àñ ìåíÿ ïðîêëÿíóò) – óìåòü ïðîôåññèîíàëüíî äåìîíñòðèðîâàòü ñî÷óâñòâèå è ñîñòðàäàíèå òàì, ãäå ýòî äåéñòâèòåëüíî íåîáõîäèìî. Êàê Âàì, êîëëåãè? P.S.  ìåäèöèíå êàòàñòðîô, êîòîðóþ ÿ íåìíîæêî () ïðåïîäàþ åñòü ïðèíöèï – âðà÷ íèêîãäà íå ðàáîòàåò â î÷àãå – åãî ìåñòî íà ãðàíèöå áåçîïàñíîé çîíû. Íèêòî íå ìîæåò ïîòðåáîâàòü, ÷òîáû âðà÷ ïëàòèë çà æèçíü ïàöèåíòà ñâîåé æèçíüþ. Êàæäûé ðàç ïðèõîäèòñÿ äîëãî îáúÿñíÿòü. À ýòî ÿâëåíèå òîãî æå ïîðÿäêà…
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Ñ óâàæåíèåì, Âàëåðèé Âàëåðüåâè÷ Ñàìîéëåíêî |
#6
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Öèòàòà:
Öèòàòà:
Ê ñîæàëåíèþ, íå âñåãäà âîçìîæíûé â ðåàëüíîé æèçíè. Âåäü, ìåæäó âðà÷îì è ïàöèåíòîì ( îñîáåííî, åñëè ðå÷ü èäåò î ìàëåíüêîì ãîðîäå, ãäå "âñå äðóã-äðóãà çíàþò" ) ñêëàäûâàþòñÿ, ïîä÷àñ, íå ñîâñåì ôîðìàëüíûå "îòíîøåíèÿ" ( íå ñåêñ ). Íî ýòîìó íàäî ó÷èòüñÿ. Ðàáîòàòü âðà÷îì áåç ýòîãî íå òî ÷òî áû íåëüçÿ, íî î÷åíü ñëîæíî. È ìîæíî ïîïàñòü â î÷åíü ñëîæíóþ ñèòóàöèþ, âïëîòü äî òîãî, ÷òî ïîòåðÿòü áîëüíîãî, êîòîðîãî ìîæíî áûëî áû ñïàñòè. |
#7
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ß ñòàëêèâàþñü ñ íåîáõîäèìîñòüþ ãîâîðèòü ïàöèåíòêàì î ïîðîêàõ ðàçâèòèÿ ïëîäà èëè ñ íåîáõîäèìîñòüþ ñêàçàòü ÷òî áåðåìåííîñòü çàìåðëà...Íå ñîâñåì îäíî è òîæå.. Íî áîëü è ãîðå êàæäîãî ÷åëîâåêà ñèëüíî ïîòîìó ÷òî ýòî åãî ãîðå.
Ñëîæíî ïîðîé ïîäáðàòü ñëîâà.Íî, ÈÌÕÎ íóæíî îáúÿñíÿòü è ïðîñòî íàõîäèòü èìåííî òå ïðàâèëüíûå ñëîâà... Ãîðþ ïîìî÷ü òðóäíî.Äëÿ íèõ ýòî òðàãåäèÿ äëÿ æèçíè ñòàòèñòèêà... Öèòàòà:
Èìåííî ïðîôåññèîíàëüíîå ñî÷óâñòâèå ýòî êîãäà íå ïðîñòî ãëàäèòü ïî ãîëîâå, íî îáúÿñíÿòü( íà ñêîëüêî ýòî âîçìîæíî) ÷òî íóæíî ñäåëàòü ÷òî áû ñèòóàöèÿ íå ïîâòîðèëàñü...( îïÿòü æå íàñêîëüêî ýòî âîçìîæíî..) Öèòàòà:
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#8
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INTERACTION WITH THE FAMILY AFTER DEATH - SPECIFIC CONSIDERATIONS Section 8 of 10
Violent reactions from survivors are rare. However, be aware of this possibility and protect yourself. As with a potentially violent psychiatric patient, do not allow your access to the room exit to become blocked. If possible, arrange for another health professional to accompany you. Often, survivors already suspect that their loved one is dead. When interacting with the family after death, consider the following suggestions: Use the child's name when speaking with survivors. Speak in short sentences. Use plain language—avoid medical jargon. Avoid euphemisms for death (eg, "gone to a better place"); use the word dead. Try to make eye contact and speak to all survivors, not just the most vocal ones. Look for nonverbal communication from survivors and remember to use it as a health professional. Be aware of your body language. Try to sit. Touching an arm or shoulder can be appropriate. If expressions of anger are directed at you or other health professionals, try to accept them without fighting back. The survivor may just be venting. If survivors have gross misconceptions, attempts at education are reasonable. If resistance is encountered, it is probably wise to return to the subject at another time and place. Do not "hit and run." If you say something hard, remain with survivors long enough for them to absorb it emotionally. Try to be comfortable with silence. Sometimes doing nothing is actually doing something. Your presence alone can help survivors. Accept the family's discomfort. You can support survivors in their pain, but removal of the pain is not within your abilities as a health professional. Do not speak philosophically or attempt to find a silver lining in discussing the death. ------ SELF-CARE FOR HEALTH PROFESSIONALS Section 9 of 10 Physicians need not be embarrassed if a pediatric death produces strong feelings within them. What kind of person is totally dispassionate in the circumstances of a child's death? Do not hesitate to seek assistance from family, friends, clergy, and other professionals. Emotional defenses are a natural reaction to a stressful situation. Physicians who are aware of their defenses are less likely to take actions that may be harmful to survivors (first do no harm). If physicians feel frustrated or uptight over failure to save a patient, it may be wise to reset one's perception of success. Although the goal of resuscitation (and the physician's role as a health professional) is to give the patient the best opportunity for recovery, the outcome is beyond the physician's control. If physicians feel angry because the death is due to abuse or neglect, it may be helpful to remember the limits of the physician's role. Health professionals have heard only one side of the history. Others (ie, police, courts, juries) have the responsibility to conduct an investigation, adjudicate, and assign guilt. Directing anger at the situation, but not at any individual, can avoid the possibility of causing great harm by placing guilt on the wrong person. A health team debriefing after a death can have many benefits. Strengths and weaknesses of the resuscitation can be assessed with the goal of improving future patient care. Each team member can have an opportunity to ask questions or offer comments. ------- [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ----- Åñëè íóæåí ïåðåâîä, òî ïîçæå. Ñåé÷àñ ïðîñòî íåò âðåìåíè. |
#9
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ß ïðîñòî âûõîæó è ðàññêàçûâàþ âñå ÷åñòíî è îòêðîâåííî.
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#10
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Öèòàòà:
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#11
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Öèòàòà îò Èðèíû Ãåííàäüåâíû Òðàñêîâåöêîé
Öèòàòà:
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#12
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Âàëåðèé Âàëåðüåâè÷!
Îãðîìíàÿ áëàãîäàðíîñòü çà Âàøè "ðàçìûøëåíèÿ âñëóõ"!  ãëóáèíå äóøè, ÿ èìåííî òàê è äóìàëà! Ïîñëåäíèé ìîé ñëó÷àé:  1- 00 óìåð ðåáåíîê ñ âðîæäåííûìè àíîìàëèÿìè - ÿ âûëîæèëàñü,ðàáîòàÿ ñ ðåáåíêîì, à ïîòîì îáúÿñíÿÿ ðîäèòåëÿì è ðîäñòâåííèêàì êàê è ïî÷åìó, ÷åðåç 10 ìèíóò ðîæäàåòñÿ êðàéíå òÿæåëûé ñ êîòîðûì ðàáîòàþ äî óòðà. Çàòåì äâîå ñóòîê - "âûïàäåíèå èç æèçíè". Ñïàñèáî îãðîìíîå âñåì êîëëåãàì, êòî ïîääåðæàë òåìó - äëÿ ìåíÿ ìåíÿ - ýòî ïðåêðàñíàÿ ó÷åáà è ðóêîâîäñòâî ê äåéñòâèþ îñîáåííîñòü ñèòóàöèè â ðîä.äîìå â òîì. ÷òî æåíùèíà ïîñëå ðîäîâ íàõîäèòñÿ â ñîñòîÿíèè "ïîñëåðîäîâîãî ñòðåññà" è íå ñîâñåì àäåêâàòíà, èíîãäà ñîîáùàòü ïðèõîäèòñÿ íî÷üþ, êîãäà ðÿäîì íè ñîöèîëîãà. íè ïñèõîëîãà. íè ñòàðøåãî îðäèíàòîðà.... êàê ÝÒÎ ñêàçàòü, ÷òîáû ó ìàòåðè íå áûëî ðåàêòèâíîãî ïñèõîçà è íå âûçâàëî èçìåíåíèé â ïîâåäåíèè ìàòåðåé. íàõîäÿùèõñÿ ñ íåé â îäíîé ïàëàòå? |
#13
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Àëåêñàíäð Ñåðãååâè÷, ñïàñèáî çà ññûëêó!
Ó ìåíÿ òîæå áûëà ñèòóàöèÿ: ìàëü÷èê èç ÷å÷åíñêîé ñåìüè óìåð îò âðîæäåííîãî ïîðîêà ñåðäöà(ïîäòâåðæäåí ðåíòãåíîëîãè÷åñêè è êîíñóëüòàíòîì). Íî ìàëü÷èê - åäèíñòâåííûé â ñåìüå - îñòàëüíûå äåâî÷êè. Îòåö áåëàã ñ ïèñòîëåòîì ïî ðîä.äîìó è ãðîçèëñÿ âñåõ ïîóáèâàòü. ìíå äîñòàëîñü áîëüøå âñåõ - ÿ ñîîáùèëà åìó î ñìåðòè ðåáåíêà. È íèêòî èç êîëëåã, íè çàâåäóþùàÿ îòäåëåíèåì. íè ñòàðøèé îðäèíàòîð íå õîòåëè õîòÿ áû ñòîÿòü ñî ìíîþ ðÿäîì. êîãäà ÿ ðàçãîâàðèâàëà ñ îòöîì. Íàâåðíîå, âñå æå äîëæåí áûòü îïðåäåëåííûé ðåãëàìåò ïîâåäåíèÿ ñîòðóäíèêîâ ðîä.äîìà â ñèòóàöèÿõ ñìåðòè ðåáåíêà. Ìîæåò îí ãäå-òî åñòü? Íàâåðíîå íà èíîñòðàííûõ ñàéòàõ? Ñïàñèáî Äîêòîðó Èðèíå ïîñèæó, ïåðåâåäó. Ñïàñèáî åùå ðàç êîëëåãàì. Ïîñëå äèñêóññèè ñîñòàâëþ ðóêîâîäñòâî ê äåéñòâèþ äëÿ ñåáÿ è áóäó ðàáîòàòü! |
#14
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Õîðîøèé ïðèìåð öèâèëèçîâàííûõ âçàèìîîòíîøåíèé ìåæäó ïàöèåíòîì è âðà÷îì ïðèâåë Ëåîíèä Êðèâñêèé (ðóññêèé êîíñóëüòàíò-àíåñòåçèîëîã èç Âåëèêîáðèòàíèè) :
Öèòàòà:
Öèòàòà:
Öèòàòà âçÿòà ñ ðóñàíåñòà : http://www.rusanesth.com/bboard/view...t=7122&start=0 |
#15
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SELF-CARE FOR HEALTH PROFESSIONALS Section 9 of 10
ÑÀÌÎÇÀÙÈÒÀ ÂÐÀ×À. Êðàòêèé ïåðåâîä. Âðà÷ íå äîëæåí ÷óâñòâîâàòü ñåáÿ ñìóùåííûì îò òîãî, ÷òî ñìåðòü ðåáåíêà-ïàöèåíòà âûçûâàåò â íåì ñèëüíûå ÷óâñòâà. Íå ñòåñíÿéòåñü èñêàòü ïîìîùè ó ñåìüè, äðóçåé, êîëëåã è ïðîôåññèîíàëîâ. Ýìîöèîíàëüíàÿ çàùèòà - íîðìàëüíàÿ ðåàêöèÿ íà ñòðåññ. Âðà÷è, îñîçíàþùèå íåîáõîäèìîñòü ýòîé çàùèòû, ìåíüøå ðèñêóþò íàâðåäèòü ðîäñòâåííèêàì óìåðøåãî ðåáåíêà. Åñëè âðà÷ îùóùàåò ñâîþ áåñïîëåçíîñòü â ðåçóëüòàòå íåóäàâøåéñÿ ïîïûòêè ñïàñòè ðåáåíêà, íàäî âñïîìíèòü òå ïîïûòêè, êîòîðûå áûëè óñïåøíû. Öåëü ðåàíèìàöèè è ðîëü âðà÷à - ïðåäîñòàâèòü áîëüíîìó âñå âîçìîæíûå øàíñû íà âûæèâàíèå, îäíàêî, ðåçóëüòàò îò âðà÷à íå çàâèñèò. ( Äåëàé, ÷òî äîëæåí, è áóäü, ÷òî áóäåò ). Åñëè âðà÷ ÷óâñòâóåò ãíåâ îò òîãî, ÷òî ñìåðòü ðåáåíêà ÿâèëàñü ðåçóëüòàòîì ïëîõîãî îáðàùåíèÿ ñ ðåáåíêîì, òî íàäî ïîìíèòü, ÷òî ðîëü âðà÷à â ýòîé ñèòóàöèè îãðàíè÷åíà. Âñå îñòàëüíîå - ðîëü äðóãèõ ñëóæá ( ïîëèöèè, ñîöèàëüíûõ ñëóæá è ò.ä.) Êîìàíäíûé "ðàçáîð ïîëåòîâ" ïîñëå ñìåðòè ïàöèåíòà î÷åíü ïîëåçåí. Åãî îñíîâíàÿ öåëü - áóäóùèé ïàöèåíò. Êàæäûé ÷ëåí êîìàíäû ìîæåò çàäàâàòü âîïðîñû è êîìåíòèðîâàòü îáñóæäàåìóþ ñèòóàöèþ. |