Pielęgniarka specjalizująca się w leczeniu ran, mgr Agata Korgól, w rozmowie z Forum Leczenia Ran mówi o tym, w jaki sposób prowadzi zdalną opiekę nad pacjentami z trudno gojącymi się ranami, jakie wiążą się z tym wyzwania oraz jakie perspektywy widzi dla tej formy opieki po zakończeniu pandemii koronawirusa.
Marta Bogucka, ForumLeczeniaRan.pl: Czy pandemia była głównym czynnikiem, przez który zdecydowała się Pani na świadczenie zdalnych konsultacji? Czy już wcześniej korzystała Pani z tej formy opieki nad pacjentami?
mgr Agata Korgól: Jeszcze przed rozpoczęciem pandemii wielokrotnie zgłaszali się do mnie pacjenci, ale również pracownicy ochrony zdrowia, którzy dysponowali jedynie zdjęciami ran i potrzebowali porad w zakresie leczenia. Pandemia bardzo nasiliła ten trend i w tej chwili bardzo dużo osób poszukuje pomocy w tej formie.
Jak wielu pacjentów od momentu wybuchu pandemii zdecydowało się na zdalne konsultacje? Czy dzięki nim może Pani pomagać pacjentom również spoza swojego regionu?
Wielu z pacjentów, u których prowadzę zdalne leczenie, to członkowie grupy facebookowej „Ratunek dla rany niegojącej się” założonej przez panią Elżbietę Szkiler. Jestem moderatorem i redaktorem tej grupy. Często zdarza się, że pacjenci publicznie proszą w grupie o pomoc, po czym rozpoczynam z nimi dalsze konsultacje i leczenie w prywatnej rozmowie. W części przypadków proces leczenia jest dostępny dla wszystkich grupowiczów. Sądzę, że od początku pandemii udzieliłam już ok. 200-250 porad. Dzięki grupie możemy wspierać osoby z całej Polski, zdarzają się czasem nawet pacjenci zza granicy.
Jakie jest nastawienie Pani pacjentów do takiej formy opieki?
Większość pacjentów preferuje kontakt bezpośredni, nie zawsze jest to jednak możliwe. W Polsce jest niestety wiele regionów, gdzie dostęp nawet do podstawowej opieki zdrowotnej jest utrudniony, nie mówiąc już o tak specjalistycznych świadczeniach jak leczenie trudno gojących się ran. W takich przypadkach pacjenci są wdzięczni za każdą formę opieki.
A jakie jest Pani nastawienie?
Osobiście preferuję połączenie wizyt osobistych i konsultacji zdalnych, szczególnie w przypadku pacjentów niemobilnych. Taka hybrydowa forma opieki odpowiada również pacjentom, ponieważ czują się zaopiekowani, pozostają ze mną w stałym kontakcie, a jednocześnie ograniczają koszty, np. dojazdów.
Jakie są dla Pani najtrudniejsze wyzwania związane z prowadzeniem konsultacji online?
Nie każdą ranę da się i nie każdą powinno się prowadzić zdalnie. Szczególnie w przypadku ran, które są rozległe, pokryte martwicą, zachęcam pacjentów do bezpośredniego kontaktu ze specjalistą. Zdarzały się przypadki, w których musiałam odmówić zdalnej opieki.
Dużą trudnością jest ocena stanu rany na podstawie zdjęcia. Często pacjenci czy opiekunowie nie wiedzą, jak prawidłowo je wykonać. Do takiej oceny trzeba też zawsze podchodzić z pewną rezerwą. W taki sposób nie da się określić głębokości przetok i kieszeni, muszę wtedy ufać ocenie opiekuna.
Dużym wyzwaniem jest prowadzenie kompresjoterapii. Nie da się za pośrednictwem komputera czy telefonu nauczyć kogoś prawidłowego bandażowania. Pacjentów wymagających tej formy terapii szczególnie zachęcam do wizyt bezpośrednich.
Czy zdalny kontakt z pacjentem również może stanowić wyzwanie?
Tak, komunikacja z pacjentem za pośrednictwem komputera lub telefonu też może sprawiać trudności, zwłaszcza na początku terapii. Muszę uważać na to, by instrukcje, które przesyłam pacjentom, były zrozumiałe, napisane prostym, przejrzystym językiem. Pacjent nie zrozumie porady napisanej profesjonalnym, medycznym żargonem. Muszę też zdawać sobie sprawę, że to, co dla mnie jest oczywiste, dla pacjenta może takie nie być, dlatego każda czynność, która powinna zostać wykonana, musi być jasno i precyzyjnie zapisana. Teraz, kiedy mam już pewne doświadczenie w tej formie opieki, łatwiej mi przewidzieć błędy i problemy, jakie pacjent może napotkać. Wciąż jednak zdarza się, że coś mnie zaskoczy.
A co z Pani pacjentami? Czego oni musieli się nauczyć?
Zależy mi na tym, by moi pacjenci byli dobrze wyedukowani. Uważam, że dzięki temu bardziej sumiennie stosują się do zaleceń i nie szukają alternatywnych metod leczenia. Przekazuję im wiedzę odnośnie leczenia miejscowego – stosowania opatrunków i antyseptyków, o zasadach ich doboru. Edukacja obejmuje również leczenie przyczynowe. Moi pacjenci wiedzą, dlaczego zalecam im konkretny zabieg lub badanie, czemu one służą, jakie mają przynieść efekty.
Dzięki temu po zakończeniu leczenia moi pacjenci dysponują obszerną wiedzą, zawsze jednak podkreślam, że wciąż jest to tylko wycinek profesjonalnej wiedzy. Pacjenci nie powinni sami udzielać rodzinie czy znajomym porad na zasadzie „Mi pomogło, może tobie też pomoże”.
Czy przy zdalnym leczeniu ran częściej zdarzają się komplikacje?
Komplikacje i powikłania mogą się zdarzyć zarówno w opiece klasycznej, jak i zdalnej. Nie zauważyłam, żeby przy tej drugiej formie opieki powikłania były częstsze. Kiedy prowadzi się leczenie na żywo, oczywiście łatwiej jest zauważyć niepokojące objawy. Przy opiece zdalnej bardzo jednak podkreślam, by pacjenci byli uczuleni na wszelkie niepokojące zmiany. Jeśli coś dzieje się z raną, od razu dają mi znać, nie czekają do kolejnej wizyty.
Czy obecnie, kiedy sytuacja pandemiczna nieco się ustabilizowała, pacjenci nadal korzystają u Pani z takiej formy konsultacji? Czy Pani zdaniem taki rodzaj porad pielęgniarskich zostanie z nami również po pandemii?
Zapotrzebowanie na konsultacje on-line się nie zmniejszyło. Myślę, że ta forma leczenia zostanie z nami już na stałe. Problemy z dostępnością do opieki medycznej w niektórych regionach nie są związane jedynie z epidemią. Pacjenci wciąż będą potrzebować naszej pomocy.
Czy Pani zdaniem upowszechnienie opieki zdalnej może mieć pozytywny wpływ na system opieki zdrowotnej?
Upowszechnienie zdalnej opieki jest zdecydowanie zjawiskiem pozytywnym. Oszczędza czas specjalistów, pozwalając im objąć opieką większą liczbę pacjentów. Skraca kolejki do gabinetów, dzięki czemu pacjenci, którzy wymagają bezpośredniego kontaktu z lekarzem, nie muszą czekać. W kontekście opieki prywatnej opieka zdalna znacznie obniża koszty, jakie ponosi pacjent. Opieka zdalna zmniejszy również wykluczenie, dotyczące szczególnie osób z terenów wiejskich, które często nie mają fizycznej możliwości dostać się do specjalisty.
mgr Agata Korgól, pielęgniarka, specjalistka w dziedzinie leczenia ran
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