The role of a nurse in the implementation of palliative care for patients

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Introduction. Rapid urbanization and environmental pollution, the possibility of prolonging life with chronic diseases due to the development of medical science, and the decline in the birth rate have led to active demographic aging of the population in many developed countries. Along with the growth of life expectancy, the number of patients suffering from severe and chronic diseases has also increased [2]. In the final period of life, such patients often urgently need palliative care, because this type of patient support does not consist in treating the disease itself (pathogenetic treatment and radical treatment in the terminal stage of the disease are no longer relevant), but in relieving symptoms that worsen the quality of the remaining life. The scope of care for such patients must be expanded: from symptomatic treatment to providing comprehensive medical, psychological, social and spiritual assistance to the patient and his family.
The aim of the work was to analyze students' awareness of the provision of palliative medical care to the population.
Materials and methods of research. The study included a questionnaire survey of 2nd and 3rd year students of the Institute of Nursing Education of the Federal State Budgetary Educational Institution of Higher Education “Voronezh State Medical University named after N.N. Burdenko” of the Ministry of Health of the Russian Federation, studying in the specialty “Nursing”. The study involved 70 students (5 males and 65 females). The respondents were aged 20 to 23 years, with an average age of 21±0.8 years. Their consent to participate in the study was obtained without fail. The selection of students to be surveyed was carried out by random sampling. The subjects were asked to anonymously and voluntarily fill out a questionnaire developed by me. The questionnaire included 10 questions concerning the students’ awareness of the specifics of providing palliative care to patients.
Statistical processing was carried out in the Statistica 10.0 program.
Research results. The students were asked the question: "Are you familiar with the main legislative documents regulating the provision of palliative care to the population in the territory of the Russian Federation?". The following answers were received: 63 students (90%) answered this question affirmatively, 7 (10%) students had inaccuracies in the dates and names of legislative documents. As a result, it can be concluded that almost all students are aware of the regulatory framework for providing palliative care to the population. The students were asked the question: "What types of care are provided to palliative patients?". The following answers were received: medical - 1 student (2%), social - 2 students (4%), psychological - 30 students (42%), all of the above 37 (52%) students. Thus, it can be concluded that most students are aware that palliative patients need psychological, medical and social types of care. The students were asked the question: "What is the main goal of palliative care?" All 70 students (100%) answered "Improving the quality of life of patients with an incurable progressive disease until their death." It can be concluded that all students know the main goal of palliative care.
To the question "Who provides palliative care?", the answers were distributed as follows: medical organizations of various forms of ownership that have a license for this type of medical care answered 65 students (93%), relatives - 3 students (4%), all healthcare institutions - 2 students (3%).
Based on the data obtained, it can be stated that the majority of students know that palliative care is provided by medical organizations of various forms of ownership that have a license for this type of medical activity. Among the main symptoms of palliative patients, students identified depression in first place - 25 students (36%), then pain indicated by 15 students (21%), exhaustion - 10 students (14%), bedsores - 6 students (9%), obesity 4 students (6%), decreased temperature - 5 students (7%), insomnia - 5 students (7%). As a result, it can be concluded that almost all students are familiar with the main symptoms of palliative patients, most often highlighting depression, pain and exhaustion. The students were asked the question: "To what age group do palliative patients most often belong?" The answers were distributed as follows: children under 18 - 3 students (4%), young age (18-45 years) - 5 students (7%), middle age (45-59 years) - 16 students (23%), elderly age (60-74 years) - 20 students (29%), old age (75-90 years) - 25 students (36%), long-livers (over 90 years) - 1 student (1%). From the data obtained, it can be concluded that students are informed about the age structure of palliative patients, naming the most common group - elderly and old age, which corresponds to the literature.
Students were asked the question: "Do you know what a hospice is, its functions, structure and purpose?" All students (100%) answered affirmatively. It can be concluded that all students are aware of the functions, structure and purpose of hospices.
When asked about organizations that cooperate with medical institutions providing palliative medical care, students answered as follows: charitable organizations and funds - 40 students (57%), religious - 23 students (33%), volunteer (volunteer) organizations - 7 (10%) students. Conclusion: students are informed about the cooperation of medical institutions providing palliative care with other organizations, indicating charitable organizations and funds in first place. On the issue of sources of financing palliative medical care in the Russian Federation, students answered as follows: at the expense of a subsidy from the federal budget - 50 students (73%), the regional budget - 10 students (15%), charitable foundations - 7 students (10%), private donations - 3 students (2%).
The survey data shows that students believe that the main sources of financing palliative medical care are the federal and regional budgets, which corresponds to legislative documents.
On the question about the types of assistance that relatives of palliative patients need, the answers were distributed in the following order: psychological - 55 students (79%), medical - 10 students (14%), social - 5 students (7%). Thus, it can be concluded that all students know that relatives of palliative patients also need help, with an emphasis on psychological support.
Conclusion. All students are well informed about the main features of providing this type of assistance. Students know the purpose, legal framework, sources of financing of palliative medical care in Russia. All students are familiar with the main symptoms of palliative patients, indicating depression and pain as the most common. In this regard, students know that palliative patients need psychological, medical and social types of assistance. It is important that students are aware that relatives of palliative patients also need help, with an emphasis on psychological support.

About the authors

Tatyana Dmitrievna Selivanova

Voronezh State Medical University N.N. Burdenko

Author for correspondence.
Email: marinasolunina@gmail.com
ORCID iD: 0000-0002-4248-5750

1st year student of the Faculty of Medicine

Russian Federation, 394036, Russia, Voronezh, st. Studencheskaya, 10

Olga Alekseevna Panina

Voronezh State Medical University named after N.N. Burdenko

Email: media01@list.ru
ORCID iD: 0000-0002-7351-3638

Assistant at the Department of Nursing Organization

Russian Federation, 394036, Russia, Voronezh, st. Studencheskaya, 10

Svetlana Ivanovna Pyatnitsyna

Voronezh State Medical University named after N.N. Burdenko

Email: pyatnitzina.sweta@yandex.ru
ORCID iD: 0000-0003-1889-1457

Assistant at the Department of Nursing Organization

Russian Federation, 394036, Russia, Voronezh, st. Studencheskaya, 10

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