Problem: The cancer patient, especially when entering the phase of end of life, finds himself having to manage the prescribed therapy at home. In order to guarantee a correct and effective administration of medications and / or hydration is often essential the support of a caregiver, who finds himself having to deal with previously unknown devices, drugs that need careful monitoring and a symptomatological set difficult to interpret (Vidal et al. , 2016). In this regard, a technique of administration from ancient origins, but still little used, is spreading more and more widely, which is easier to manage in an out-of-hospital setting than other modes of administration: hypodermoclysis (Adem & ALMouaalamy, 2021; Gomes et al. , 2017). It is therefore essential to establish a therapeutic relationship not only with the patient, but also between the healthcare professionals and the caregiver, in order to provide a targeted educational project, with the aim of properly managing the subcutaneous device. Purpose: To highlight the educational approaches aimed at the caregiver most used in clinical practice, with reference to the educational project provided by the nurse aimed at the correct use of subcutaneous access, throughout its management. We will investigate the process of therapeutic education focusing on the practical methods used to address it. Materials and methods: Bibliographic review mainly carried out in the international database MEDLINE (PubMed). Among the articles found were critically analyzed 10: 2 specific about education in the management of hypodermoclysis; 8 about education in general in a home setting. The 10 studies published between 2002 and 2022 bring together the interventions identified in different countries around the world: USA, Saudi Arabia, China, Switzerland, Norway and the UK. The data collection tool is represented by the table with the variability for the comparison of the included studies. Inclusion criteria → Setting: home of the patient in charge of palliative care who needs infusion therapy, continuous or not; Sample: caregivers of home-based cancer patients who have been indicated for subcutaneous therapy (or patient-caregiver diads) of age; Time filter: 2000-2022; Language filter: Italian, English and Spanish. Results: 4 tables were presented to compare the interventions proposed by the authors in the 4 phases useful to plan a complete educational project: preliminary phase, informative process, mostly practical education process and post-educational phase. Discussion: An educational project is proposed to be provided to the caregiver based on the qualitative and quantitative comparison of the interventions identified by the studies analysed, with an integration of what is present in the whole theoretical framework. Interventions are proposed following a chronological order and, as far as possible, priority. Hence the applicability of the hypodermoclysis procedure in a home setting, which follows an informative and educational process based on the latest indications. Conclusion: Hypodermoclysis is a procedure of proven efficacy, but still little used. The possibility of its applicability in clinical practice also by non-professional individuals who care for the patient outside the hospital is concluded. It emerged that there is not a line of thought fully shared by the available scientific literature. Further study of this route of administration could provide many insights in order to provide clear, consistent and standardised guidelines for the proper management of subcutaneous access and an educational plan to be provided to the caregiver by the nurse.
Problema: Il paziente oncologico, soprattutto nel momento in cui entra nella fase di fine vita, si trova a dover gestire la terapia prescritta a domicilio. Al fine di garantire una corretta ed efficace somministrazione di farmaci e/o di idratazione è spesso fondamentale il supporto di un caregiver, che si trova a dover far fronte a dei devices prima sconosciuti, dei farmaci che necessitano di un attento monitoraggio ed un corredo sintomatologico difficile da interpretare (Vidal et al., 2016). A tal proposito, si sta diffondendo sempre di più una tecnica di somministrazione dalle origini antiche ma ancora poco utilizzata, che risulta essere più semplice da gestire in ambito extraospedaliero rispetto ad altre modalità di somministrazione: l’ipodermoclisi (Adem & ALMouaalamy, 2021; Gomes et al., 2017). Diviene quindi indispensabile instaurare una relazione terapeutica non solo con il paziente, ma anche tra i professionisti sanitari ed il caregiver, al fine di fornire un progetto educativo mirato, con l’obiettivo di gestire correttamente il device sottocutaneo. Scopo: Evidenziare gli approcci educativi rivolti al caregiver più utilizzati nella pratica clinica, in riferimento al progetto educativo fornito dall’infermiere finalizzato al corretto utilizzo dell’accesso sottocutaneo, nell’intera sua gestione. Si indagherà il processo di educazione terapeutica ponendo l’attenzione sulle metodiche pratiche utilizzate per affrontarla. Materiali e metodi: Revisione bibliografica svolta principalmente nella banca dati internazionale MEDLINE (PubMed). Tra gli articoli reperiti ne sono stati analizzati in modo critico 10: 2 specifici circa l’educazione nella gestione dell’ipodermoclisi; 8 riguardo l’educazione in generale in un setting domiciliare. I 10 studi pubblicati tra il 2002 e il 2022 raccolgono gli interventi individuati in diverse realtà del mondo: USA, Arabia Saudita, Cina, Svizzera, Norvegia e UK. Lo strumento di rilevazione dei dati è rappresentato dalla tabella con le variabilità per la comparazione degli studi inclusi. Criteri di inclusione → Setting: domicilio dell’assistito in carico alle cure palliative che necessita di terapia infusiva, continua o meno; Campione: caregivers di pazienti oncologici gestiti a domicilio a cui è stata indicata la terapia sottocutanea (o diadi paziente-caregiver) maggiorenni; Filtro temporale: 2000-2022; Filtro linguistico: italiano, inglese e spagnolo. Risultati: Sono state riportate 4 tabelle per confrontare gli interventi proposti dagli autori nelle 4 fasi utili a pianificare un progetto educativo completo: fase preliminare, processo informativo, processo di educazione perlopiù pratica e fase post-educativa. Discussione: Viene proposto un progetto educativo da fornire al caregiver basato sul confronto qualitativo e quantitativo degli interventi individuati dagli studi presi in analisi, con un’integrazione di quanto presente nell’intero quadro teorico. Gli interventi vengono proposti seguendo un ordine cronologico e, per quanto possibile, di priorità. Da qui ne deriva l’applicabilità della procedura dell’ipodermoclisi in un setting domiciliare, che fa seguito ad un processo informativo ed educativo basato sulle più recenti indicazioni. Conclusione: L’ipodermoclisi risulta essere una procedura di comprovata efficacia, ma tutt’oggi poco utilizzata. Si conclude la possibilità di una sua applicabilità nella pratica clinica anche da parte di individui non professionisti che assistono il paziente in ambito extra-ospedaliero. È emerso che non è presente un filone di pensiero condiviso in toto dalla letteratura scientifica disponibile. Potrebbe essere fonte di numerosi spunti l’ approfondimento dello studio circa questa via di somministrazione, per ottenere delle linee guida chiare, omogenee e standardizzate per una corretta gestione di un accesso sottocutaneo e un progetto educativo da fornire al caregiver da parte dell’infermiere.
Ipodermoclisi e cure palliative a domicilio: progetto educativo al caregiver di paziente oncologico
SELVA, CAROLINA
2021/2022
Abstract
Problem: The cancer patient, especially when entering the phase of end of life, finds himself having to manage the prescribed therapy at home. In order to guarantee a correct and effective administration of medications and / or hydration is often essential the support of a caregiver, who finds himself having to deal with previously unknown devices, drugs that need careful monitoring and a symptomatological set difficult to interpret (Vidal et al. , 2016). In this regard, a technique of administration from ancient origins, but still little used, is spreading more and more widely, which is easier to manage in an out-of-hospital setting than other modes of administration: hypodermoclysis (Adem & ALMouaalamy, 2021; Gomes et al. , 2017). It is therefore essential to establish a therapeutic relationship not only with the patient, but also between the healthcare professionals and the caregiver, in order to provide a targeted educational project, with the aim of properly managing the subcutaneous device. Purpose: To highlight the educational approaches aimed at the caregiver most used in clinical practice, with reference to the educational project provided by the nurse aimed at the correct use of subcutaneous access, throughout its management. We will investigate the process of therapeutic education focusing on the practical methods used to address it. Materials and methods: Bibliographic review mainly carried out in the international database MEDLINE (PubMed). Among the articles found were critically analyzed 10: 2 specific about education in the management of hypodermoclysis; 8 about education in general in a home setting. The 10 studies published between 2002 and 2022 bring together the interventions identified in different countries around the world: USA, Saudi Arabia, China, Switzerland, Norway and the UK. The data collection tool is represented by the table with the variability for the comparison of the included studies. Inclusion criteria → Setting: home of the patient in charge of palliative care who needs infusion therapy, continuous or not; Sample: caregivers of home-based cancer patients who have been indicated for subcutaneous therapy (or patient-caregiver diads) of age; Time filter: 2000-2022; Language filter: Italian, English and Spanish. Results: 4 tables were presented to compare the interventions proposed by the authors in the 4 phases useful to plan a complete educational project: preliminary phase, informative process, mostly practical education process and post-educational phase. Discussion: An educational project is proposed to be provided to the caregiver based on the qualitative and quantitative comparison of the interventions identified by the studies analysed, with an integration of what is present in the whole theoretical framework. Interventions are proposed following a chronological order and, as far as possible, priority. Hence the applicability of the hypodermoclysis procedure in a home setting, which follows an informative and educational process based on the latest indications. Conclusion: Hypodermoclysis is a procedure of proven efficacy, but still little used. The possibility of its applicability in clinical practice also by non-professional individuals who care for the patient outside the hospital is concluded. It emerged that there is not a line of thought fully shared by the available scientific literature. Further study of this route of administration could provide many insights in order to provide clear, consistent and standardised guidelines for the proper management of subcutaneous access and an educational plan to be provided to the caregiver by the nurse.File | Dimensione | Formato | |
---|---|---|---|
Selva_Carolina_1229864.pdf
accesso aperto
Dimensione
697.78 kB
Formato
Adobe PDF
|
697.78 kB | Adobe PDF | Visualizza/Apri |
The text of this website © Università degli studi di Padova. Full Text are published under a non-exclusive license. Metadata are under a CC0 License
https://hdl.handle.net/20.500.12608/37805