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„Pielęgniarki to przyszłość leczenia ran w Polsce” – wywiad z Anną Mirosz

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„Leczenie ran trudno gojących się to nie tylko dobór odpowiedniego opatrunku, ale holistyczne spojrzenie na pacjenta i rozwiązanie wielu jego zdrowotnych problemów. Kluczową rolę w opiece nad chorym ogrywają dziś wykwalifikowane pielęgniarki” – podkreśliła w wywiadzie dla portalu ForumLeczeniaRan.pl mgr Anna Mirosz, członek zarządu Stowarzyszenia Naukowego Leczenia Ran.

Natalia Janus, ForumLeczeniaRan.pl: Jak długo zajmuje się Pani leczeniem ran?

Anna Mirosz: W zawodzie pielęgniarki  pracuję 37 lat, natomiast leczeniem ran zajmuję się ponad 10 lat.

Po tylu latach doświadczenia, jakie aspekty w leczeniu ran trudno gojących się wskazałaby Pani jako najważniejsze?

– Przede wszystkim holistyczne spojrzenie na pacjenta. Leczenie ran to nie tylko dobór odpowiedniego opatrunku, to rozwiązanie wielu zdrowotnych problemów pacjenta, m.in. kwestii niedożywienia, często występującej u osób starszych, a w znaczny sposób opóźniającej proces gojenia.

Jest Pani członkiem zarządu Stowarzyszenia Naukowego Leczenia Ran. Dlaczego zaangażowała się Pani w tę działalność?

– Jestem zaszczycona tym, że mogę współpracować z wieloma specjalistami, ekspertami z różnych dziedzin medycyny. Zaangażowałam się w prace SNLR, aby pogłębiać wiedzę na temat leczenia ran trudno gojących się, jak również dzielić się własną wiedzą i doświadczeniem. W Polsce problem ten dotyczy ponad pół miliona osób, dlatego tak ważna jest aktualna wiedza personelu medycznego, by pomóc pacjentowi. Opieka nad raną przewlekłą to moja pasja, oddałam tej dziedzinie wiele lat życia zawodowego.

Dlaczego akurat leczenie ran?

– Przez wiele lat pracowałam w oddziale Chirurgii Ogólnej, kiedy przeszłam do pracy w Poradni Chirurgicznej zobaczyłam jak wiele osób w różnym wieku ma problem z raną przewlekłą. Chęć pomocy takim pacjentom sprawiła, że zaczęłam dokształcać się w tej dziedzinie i zdobywać aktualną wiedzę medyczną dotyczącą leczenia ran. Z każdego kursu czy konferencji przywoziłam nowe informacje, które wykorzystywałam w codziennej pracy i byłam szczęśliwa, kiedy rany zaczynały się goić. Ta praca daje ogromną radość i prawdziwą satysfakcję, jest też wyzwaniem.

Od 2015 roku w SPZOZ, w którym pracuję istnieje Zespół ds. profilaktyki i leczenia ran przewlekłych, którego mam zaszczyt być przewodniczącą. W Zespole działają lekarze i pielęgniarki różnych specjalności, którzy na co dzień pracują w oddziałach szpitalnych i poradniach. Konsultujemy się ze sobą, aby omawiać poszczególne przypadki trudnych ran i wyszukiwać jak najlepsze rozwiązania dla pacjenta. Pracujemy tylko na opatrunkach specjalistycznych i postępujemy według wytycznych leczenia ran.

mgr Anna Mirosz, pielęgniarka specjalizująca się w leczeniu ran, w 2020 roku prowadząca cyklu „Postępowanie z raną przewlekłą”

Standardy leczenia ran w Polsce się zmieniają?

– Pracuję w Szpitalu Powiatowym i jestem z tego dumna. Stale aktualizowana wiedza moja i moich koleżanek, kolegów lekarzy sprawiała, że osiągamy coraz lepsze efekty w gojeniu, zamykaniu się ran przewlekłych. Zawsze mamy na uwadze dobro pacjenta i poprawę jakości jego życia. Każda wygojona stopa cukrzycowa to powód do radości nie tylko dla pacjenta, ale i dla nas, zespołu lekarsko-pielęgniarskiego, który się nim zajmował.

Jaką rolę pielęgniarki odgrywają w takim zespole lekarsko-pielęgniarskim podczas leczenia rany?

– Wykwalifikowane pielęgniarki to przyszłość leczenia ran. Moim zdaniem, ich rola jest ogromna. Zakres ich wiedzy i kompetencji wraz z udziałem innych członków zespołu terapeutycznego jest kluczem do całkowitego wygojenia się ran. Już od pierwszego kontaktu z pacjentem pielęgniarka realizuje określone zadania do zapewnienia pełnej opieki nad chorym. Zbiera wywiad, zarówno na temat choroby podstawowej, chorób współistniejących, przyjmowanych leków oraz dotychczasowego leczenia miejscowego rany. Jest on kluczowy w postawieniu diagnozy pielęgniarskiej, ustaleniu celów opieki i wdrożeniu planu pielęgnacji nad pacjentem i raną.

Musimy pamiętać o tym, że jako pielęgniarki jesteśmy samodzielnymi profesjonalistami w swoich dziedzinach. Oprócz rozległej wiedzy, empatii i wielu innych cech musimy również być asertywne. Zawsze z pełnym profesjonalizmem przekazuję niezbędną wiedzę danemu pacjentowi i wymagam od niego i jego rodziny współpracy, która polega na zaangażowaniu się w proces leczenia oraz przestrzegania zaleceń.

26 maja rusza cykl webinarów "Postępowanie z raną LIVE"
Dr hab. n. med. Marek Kucharzewski, Prezes Stowarzyszenia Naukowego Leczenia Ran oraz mgr Anna Mirosz, pielęgniarka specjalizująca się w leczeniu ran, członek Zarządu Stowarzyszenia Naukowego Leczenia Ran

SNLR planuje wspierać pielęgniarki w samodzielności w leczeniu ran?

– Oczywiście, jako SNLR prowadzimy cykl bezpłatnych konferencji regionalnych z cyklu „Postępowanie z raną przewlekłą” dla pielęgniarek w różnych miastach w całej Polsce. Obecnie z powodu epidemii realizacja tych spotkań w formie stacjonarnej nie jest możliwa, dlatego od 26 maja ruszyliśmy z cyklem webinarów o leczeniu ran dostępnych dla pielęgniarek i nie tylko. Dodatkowo oczywiście tworzymy wytyczne, standardy, procedury, zalecenia czyli ,,narzędzia’’ do pracy dla pielęgniarek zajmujących się raną trudno gojącą się.

Skoro jesteśmy już przy zaleceniach, warto wspomnieć, że współtworzyła Pani Stanowisko SNLR w spr. opieki nad raną trudno gojącą się w okresie epidemii COVID-19. Jak wygląda Pani praca z pacjentami w opiece domowej podczas epidemii?

– Każdy z moich pacjentów otrzymał zalecenia zmiany opatrunku w wersji pisemnej, schematy postępowania z raną autorstwa SNLR, jak również otrzymał mój numer telefonu. Jesteśmy w stałym kontakcie. Sami pacjenci lub ich bliscy wykonują zdjęcie rany podczas każdej zmiany opatrunku i przesyłają do mnie. W ramach e-porady wypisywane są leki i opatrunki specjalistyczne do kontynuacji leczenia.

Moi pacjenci są bardzo obowiązkowi, zdyscyplinowani, wyedukowani. Jestem z nich dumna. Zawsze im to mówię. Wiedzą, że mogą zadzwonić do mnie w razie niepokoju.

Opiekuje się Pani pacjentami z różnymi ranami, jednak największym zainteresowaniem naukowym darzy Pani zespół stopy cukrzycowej – dlaczego? 

– Tak, to prawda, leczenie zespołu stopy cukrzycowej jest moja pasją. Kiedy zaczęłam pracować w poradni chirurgicznej miałam niewielką wiedzę na temat leczenia ZSC. Przerażał mnie fakt, że w tak krótkim czasie z małej rany może powstać duże owrzodzenie, które może zakończyć się amputacją. Moi pacjenci mieli jeszcze mniejszą wiedzę na temat profilaktyki.

Czas oczekiwania na wizytę w specjalistycznej poradni leczenia stopy cukrzycowej wynosił wtedy kilka miesięcy. A pacjent z zespołem stopy cukrzycowej nie może tyle czekać, bo straci nogę, a nawet życie. Dlatego postanowiłam zdobyć odpowiednią wiedzę w tym temacie, aby pomóc pacjentom zarówno w profilaktyce, jak i leczeniu, współpracując ze specjalistami z różnych dziedzin.

Czy można uchronić pacjenta przed amputacją kończyny?

– Źródła podają, że 85% amputacji poprzedza owrzodzenie, więc musimy dotrzeć z edukacją do wszystkich osób chorych na cukrzycę i nauczyć ich zasad szeroko rozumianej profilaktyki. To jedyna szansa na uratowanie kończyn dolnych przed amputacją.

Kiedy najlepiej rozpocząć tę edukację pacjenta?

– Moim zdaniem edukacja powinna rozpocząć się od momentu wykrycia cukrzycy. Pacjent powinien mieć stałe wizyty np. raz w miesiącu u edukatora w cukrzycy. Wciąż spotykam pacjentów, których wiedza na ten temat jest niewystarczająca. Zgłaszają się do poradni już z owrzodzeniem cukrzycowym i nie znają przyczyny jego powstania.

Pacjentów z jakimi ranami zapamiętała Pani najlepiej?

– Pamiętam większość wygojonych ran w poradni, ale najbardziej pamiętam tych pacjentów którym udało się uratować kończynę przed amputacją. Każda rana jest inna, każdy pacjent jest inny, dlatego ja i moje koleżanki dostosowujemy indywidualnie sposób przekazania informacji do pacjenta. Nasze postępowanie ma na celu zachęcenie pacjenta do współpracy, bo tylko wtedy będzie szansa na wygojenie rany. Pacjent musi zrozumieć istotę choroby, zaakceptować ją i przestrzegać zaleceń w przeciwnym razie nie będziemy w stanie mu pomóc. Pacjent jest przecież tak naprawdę członkiem zespołu, który zajmuje się jego raną. Leczenie to nasze wspólne wyzwanie.

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