Yoğun bakımdaki başarının sırrı: Fedakârlık

Hastanelerde yoğun bakım ünitesi sayısı arttı. Diğer servislerden hemşireler yoğun bakımda hizmet vermeye başladı. Deneyimli hemşire oranı yüzde 25’e düştü. Deneyimli hemşireler, zamanı unuttu. Yoğun bakım hemşireleri meslektaşlarına rehberlik için çalışma saatlerinin ötesine geçti.

Covid-19 salgınında pandemi hastaneleri, mevcut yoğun bakım ünitelerine yenilerini ekledi. Mevcut sağlık personeli yetersiz kalınca diğer servislerden yoğun bakım ünitelerine takviye yapıldı. Türk Yoğun Bakım Hemşireleri Derneği’nin raporuna göre, yoğun bakımlardaki deneyimli yoğun bakım hemşiresi oranı yüzde 25’e düştü. Derneğin başkanı Ebru Kıraner, deneyimli hemşirelerin rehberlik etmek için mesai saatlerini uzattıklarını belirterek, "Türkiye'nin yoğun bakımdaki başarısında sağlık personelinin üstün gayretinin payı var. Deneyimli hemşireler, hastalarını yalnız bırakmamak için mesai saatinin dışında da saatlerce çalışıyor" dedi.

HEMŞİRELERİN YARISININ YOĞUN BAKIM EĞİTİMİ YOK

Yoğun bakım, hastanelerin en hassas alanı. Yoğun bakım hemşireleri, temel hemşirelik eğitiminin yanı sıra bir de yoğun bakım hemşireliği için eğitim alıyorlar. Bu eğitimi almak da yetmiyor. Yoğun bakım hemşireliği deneyim gerektiriyor. Pek çok ülke yoğun bakım hemşiresi sıfatını beş yıllık deneyimin ardından veriyor. Yoğun Bakım Hemşireleri Derneği’nin raporunda salgın döneminde deneyimli yoğun bakım hemşirelerinin ünitedeki oranının yüzde 25’e düştüğü belirtildi. Dernek Başkanı Ebru Kıraner, yoğun bakım hemşirelerinin çok özel bir eğitimden geçtiğini anlattı: “Lisans mezunları yoğun bakımlarda çalışmak için Sağlık Bakanlığı’nın sertifika programına katılıyor. Yoğun bakımlarda çalışan hemşirelerin yaklaşık yarısının sertifikası yok. Dünyada bu eğitimle ilgili öneri bin 200 saatin altına düşmemesi. Türkiye’deki koşullarda bu eğitim 240 saat. Eğitime katılanlar bir sınava giriyorlar ve kazanmaları halinde sertifika hakkı elde ediyorlar. Sağlık Bakanlığı 2019 bitmeden bütün hemşirelerin bu sertifikaya sahip olmasını hedefledi ancak bu hedef gerçekleşmedi. Hemşireler bu programda, yoğun bakımda kullanılan solunum cihazı, karaciğer destek, böbrek destek cihazlarıyla ilgili ve normal hastane servislerinde olmayan yüksek riskli ilaçların kullanımıyla ilgili eğitim alırlar. Kendini hiç ifade edemeyen, bütün ihtiyaçlarının hemşireler tarafından karşılandığı hastalardan söz ediyoruz. Sonuç olarak temel hemşirelik eğitiminin üstüne kritik hastaya nasıl bakılır eğitimi de yoğun bakım için gerekiyor.”

TEMEL İHTİYAÇLAR İÇİN BİLE ZAMAN YOK

Salgın döneminde hemşireler, eğitim almaksızın yoğun bakım ünitelerinde görevlendirildi. Ebru Kıraner, bu hemşirelerin desteğe ihtiyacı olduğunu söyledi. “Yetkin hemşireler, diğer servislerden yoğun bakıma gelen meslektaşları için de çaba harcamak zorunda. 8 hastalı bir ünitede bir tek deneyimli hemşire var. Bu hemşire, yemek, tuvalet gibi insani ihtiyaçlarını karşılayamayacak durumda. Çünkü, yoğun bakım şartlarında her an ani ve acil bir durum gelişebilir. Deneyimsiz hemşire, cihazdan alarm sesi geldiğinde doğru olanı yaptığını sanarak aslında hata yapabilir.”

'TEMELİMİZ SAĞLAM'

Deneyimli yoğun bakım hemşireleri çözüm için fedakarlığa hazır. Derneğin raporunda “Başka kliniklerden görevlendirilen hemşirelerin en az 40 saatlik süre ile yoğun bakım ünitelerine oryantasyonları sağlandıktan sonra, ‘ünitede yeterli sayıda deneyimli/rehber hemşire varsa’ deneyimli/rehber yoğun bakım hemşirelerine esnek mesai uygulamasının yapılmasını öneriyoruz” ifadesi yer aldı. Ebru Kıraner, yoğun bakım hemşireliğinin temelinde fedakarlık kültürünün olduğuna dikkat çekti. “Yıllardır böyle ciddi sorunlarla bu mesleği sürdürüyoruz. İhtiyacı olan insanların iyileştiğini görmekten başka maddi ve manevi hiçbir getirisi yok. 15-20 yıldır bu yalnızca bu motivasyonla çalışan hemşireler var. O temel çok sağlam. Esnek çalışma sadece hemşireler için değil hasta güvenliği açısından da riskleri daha aza indirebilir. Ama bu kadar sınırlı sayıda deneyimli hemşire ile bunun çok da mümkün olamayacağını biliyoruz. Dünya Yoğun Bakım Hemşireleri Federasyonu’nun hazırladığı rehberde onların da aynı sorumları yaşadığını gördük.”

'SAAT KAVRAMI YOK'

Kıraner’e “Yoğun bakımlarda bunca sorun Türkiye’nin başarısının nereden kaynaklanıyor?” diye sorduk. “Bu sonuç deneyimli yoğun bakım hemşirelerinin üstün gayretiyle alınıyor. Haftada 40 saat çalışması gereken deneyimli hemşireler 48 saat, 56 saat çalıştılar. Yoğun bakım bir ekip işi. Bugüne kadar da bütün yokluklara, sıkıntılara rağmen dünyadaki pek çok ülkeden iyi iş çıkarıyorduk. İnsanlar aynı kültüre sahip çıktılar. Başka kliniklerden gelen hemşirelere de rehberlik için büyük gayret gösterdiler. Saat kavramı yok oldu.”

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