ministrTa komitetis rekomendacia REC (2003) 24 evropis

Transcrição

ministrTa komitetis rekomendacia REC (2003) 24
evropi s s a b W os w evr s axel m w i f oe b S i
pal iatiu ri m z ru n vel o b is org an iz eb is aTvis
miRebulia ministrTa komitetis mier 2003 wlis 12 noembers
ministrTa warmomadgenelTa 860-e sxdomaze
evropis sabWo
ev ropi s s ab W os w evr s axel m w i f oeb S i
pal iatiu ri m z ru n vel ob is org an iz eb is aTvis
miRebulia ministrTa komitetis mier 2003 wlis 12 noembers
ministrTa warmomadgenelTa 860-e sxdomaze
evropis sabWo
RECOMMENDATION REC (2003) 24
OF THE COMMITTEE OF MINISTERS TO MEMBER STATES
ON THE ORGANISATION OF PALLIATIVE CARE
Adopted by the Committee of Ministers on 12 November 2003
at the 860th meeting of the Ministers' Deputies
COUNCIL Of EUROPE
qarTuli gamocemis redaqtorebi: docenti rema RvamiCava
m.m.k. ioseb abesaZe
mTargmneli da teqnikuri redaqtori: inga SariqaZe
Editors of Georgian edition: Rema Gvamichava, M.D. Ass. Professor
Ioseb Abesadze Ph.D.
Translator and technical editor: Inga Sharikadze
ISBN: 99940 - 0 - 010 - 1
ISBN: 92 - 871 - 5557 - 7 Council of Europe
zogadi mosazrebebi
I. saxelmZRvanelo principebi - - - - - - - - - - - - - - - - - - - 9
II. dawesebulebebi da samsaxurebi - - - - - - - - - - - - - - - - -11
III. politika da organizeba
- - - - - - - - - - - - - - - - - - -12
IV. xarisxis gaumjobeseba da kvleva - - - - - - - - - - - - - - -14
V. ganaTleba da treningi - - - - - - - - - - - - - - - - - - - - -14
VI. ojaxi - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -16
VII. komunikacia pacientsa da ojaxis wevrebTan - - - - - - - - -16
VIII. terminebi, gunduri muSaoba da mzrunvelobis dagegmva - -17
IX. mZime danakargi
- - - - - - - - - - - - - - - - - - - - - - - -18
wevri saxelmwifosadmi paliatiuri mzrunvelobis
organizebisaTvis ganmartebiTi memorandumi
zogadi mosazrebebi - - - - - - - - - - - - - - - - - - - - - - - -20
mokle istoriuli mimoxilva - - - - - - - - - - - - - - - - - - -21
paliatiuri mzrunvelobis zogierTi monacemi evropis qveynebSi25
gansazRvrebebi da ZiriTadi principebi - - - - - - - - - - - - - -31
dawesebulebebi da samsaxurebi - - - - - - - - - - - - - - - - - -44
politika da organizeba
- - - - - - - - - - - - - - - - - - - - -56
CM(2003)130
3
xarisxis gaumjobeseba da kvleva
- - - - - - - - - - - - - - - -60
profesionalebisa da volontiorTa ganaTleba da treningi - -67
komunikacia
- - - - - - - - - - - - - - - - - - - - - - - - - - - -69
terminebi, gunduri muSaoba da mzrunvelobis dagegmva - - - - -75
volontiorebi
- - - - - - - - - - - - - - - - - - - - - - - - - -77
mZime danakargi
- - - - - - - - - - - - - - - - - - - - - - - - - -79
ganmartebiTi leqsikoni - - - - - - - - - - - - - - - - - - - - - -83
gamoyenebuli literatura - - - - - - - - - - - - - - - - - - - -89
ministrTa komiteti, evropis sabWos wesdebis 15-b muxlis
moTxovnebis Tanaxmad,
iTvaliswinebs ra evropis sabWos mizans, miaRwios met erTianobas
mis wevrebs Soris da rom es mizani SesaZloa ganxorcieldes, maT
Soris jandacvis sistemaSi, erTiani wesebis miRebiT;
Segvaxsenebs ra evropis socialuri qartiis janmrTelobis dacvis
uflebis me-11 muxlis, adamianis uflebaTa da biomedicinis konvenciis me-3 muxlis (ETS No 164) moTxovnas, rom kontraqtori mxareebi
unda uzrunvelyofdnen Sesabamisi xarisxis jandacvis Tanabar misawvdomobas; muxli 4-is moTxovnas - nebismieri Careva jandacvis
sferoSi, kvlevis CaTvliT, tardebodes Sesabamisi profesiuli
movaleobebisa da standartebis mixedviT; me-10 muxlSi xazgasmiT
aRniSnuli yoveli adamianis uflebas, flobdes informacias
sakuTari janmrTelobis Sesaxeb;
aRiarebs ra, jandacvis sistemis pacietze orientirebisa da
sakuTar janmrTelobasTan dakavSirebiT gadawyvetilebis miRebaSi
moqalaqeebis monawileobis aucileblobas;
am konteqstSi, Segvaxsenebs ra ministrTa komitetis rekomendacias
wevri qveynebisadmi (rekomendacia #R(2000)5) sakuTari janmrTelobis dacvasTan dakavSirebiT gadawyvetilebis miRebaSi moqalaqeTa da pacientTa monawileobiTi struqturebis ganviTarebis Sesaxeb;
darwmunebulia ra, rom terminaluri pacientisa da momakvdavi
pirovnebis Rirsebis pativiscema da dacva upirveles yovlisa
moicavs Sesaferis garemoSi iseTi saxis mzrunvelobis uzrunvelyofas, rac aZlevs mas Rirseulad gardacvalebis saSualebas;
am konteqstSi, Segvaxsenebs ra saparlamento asambleis rekomendacias 1418 (1999) adamianis uflebebis, terminaluri da momakvdavi
pirovnebis Rirsebis dacvis Sesaxeb;
Segvaxsenebs ra rekomendacia #R(89)13-s, onko-pacientebisaTvis
multidisciplinuri mzrunvelobis organizebis Sesaxeb;
CM(2003)130
5
aRiarebs ra paliatiuri mzrunvelobis Semdgomi ganviTarebis
saWiroebas evropis qveynebSi;
am mimarTebiT, Segvaxsenebs ra 1998 wlis poznanis deklaracias
aRmosavleT evropaSi paliatiuri mzrunvelobis Sesaxeb;
aRiarebs ra, rom samedicino daxmarebaze uflebis mizania
pacientisaTvis janmrTelobis maqsimalurad misawvdomi atmosferos
Seqmna miuxedavad asakisa, eTnikuri warmomavlobisa, ekonomiuri Tu
socialuri statusisa, daavadebis an uZlurebis bunebisa;
iTvaliswinebs ra paliatiuri mzrunvelobis saWiroebis mqone
pacientebis raodenobis zrdas;
iTvaliswinebs ra, evropis farglebSi paliatiuri mzrunvelobis misawvdomobasa da xarisxSi arsebul gansxvavebas, qveynebs Soris
TanamSromloba mimarTuli unda iyos am gansxvavebis daZlevaze.
acnobierebs ra, rom paliatiuri mzrunveloba aris aqtiuri, srulyofili zrunva pacientze Sorswasuli, progresirebadi daavadebiT da misi mizania tkivilisa da sxva simptomebis kontroli,
fsiqologiuri, socialuri da sulieri daxmareba;
acnobierebs ra, rom paliatiuri mzrunvelobis mizania pacientebisa
da maTi ojaxis wevrebisaTvis sicocxlis SesaZlo saukeTeso
xarisxis miRweva;
acnobierebs ra, rom paliatiuri mzrunvelobis mizania daexmaros
daavadebis Sorswasuli, progresirebadi formis mqone mamakacebs,
qalebs, bavSvebs, sicocxlis bolomde SeinarCunon sicocxlis SesaZlo saukeTeso xarisxi da ar gulisxmobs sikvdilis daCqarebas an
Seferxebas;
mxedvelobaSi iRebs ra, rom paliatiuri mzrunveloba ganamtkicebs
sicocxles da ganixilavs sikvdils, rogorc normalur process da
ar xelmZRvanelobs uimedobiTa da fatalizmiT;
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CM(2003)130
mxedvelobaSi iRebs ra, rom paliatiuri mzrunveloba aris jandacvis sistemis janmrTelobis dacvaze yoveli moqalaqis uflebis
ganuyofeli nawili da amdenad, saxelmwifos pasuxismgeblobas warmoadgens paliatiuri mzrunvelobis uzrunveloba yvelasaTvis,
visac igi esaWiroeba;
mxedvelobaSi iRebs ra, rom aucilebelia humanuri gziT ganxorcielebuli xarisxiani mzrunvelobis miRweva, raTa igi gaxdes
pacientze mzrunvelobis umTavresi nawili misi sicocxlis bolos;
acnobierebs ra, rom sococxlis bolos yovel adamians surs jandacvis profesionalebisagan uzrunvelyofili iqnas samedicino
momsaxurebiT, rogorc Rirseuli pirovneba; uzrunvelyofili iqnas
Rirsebis SenarCunebaze, damoukideblobis stimulirebaze, simptomebis Semsubuqebasa da maqsimaluri komfortis miRwevaze mimarTuli
kvalificiuri zrunva;
acnobierebs ra, rom paliatiuri mzrunveloba, iseve rogorc mTeli
samedicino momsaxureba, unda iyos pacientze orientirebuli da
xorcieldebodes misi saWiroebebis, faseulobebisa da arCevanis
gaTvaliswinebiT; rom paliatiur pacientebze mzrunvelobis
umTavres aspeqtebs warmoadgens Rirseba da damoukidebloba,
rekomendacias uwevs wevri qveynebis mTavrobebs:
miiRon paliatiuri mzrunvelobis yovlismomcveli erovnuli politikisaTvis aucilebeli moqmedebis, sakanonmdeblo da sxva normebi.
am mizniT, SesaZleblobis gaTvaliswinebiT miiRon winamdebare
rekomendaciis danarTSi warmodgenili midgomebi, maTi adgilobrivi
garemoebebTan adaptirebiT;
popularizacia gauwion paliatiuri mzrunvelobis sferoSi aqtiurad momuSave organizaciebs, kvleviT institutebsa da sxva saagentoebs Soris saerTaSoriso qselur TanamSromlobas;
mxari dauWiron rekomendaciisa da misi ganmartebiTi memorandumis
aqtiur, mizanmimarTul gavrcelebas, SesaZleblobis SemTxvevaSi
misi Targmnis saSualebiT.
CM(2003)130
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Photo: Làszló Valuska, Hungary
danarTi CM (2003) 24
rekomendacia REC (2003)-s danarTi . . .
zogadi mosazrebebi
maSin, rodesac mraval qveyanaSi jandacvis biujetis udidesi nawili adamianis sicocxlis bolo wlebSi ixarjeba, pacientebi xSirad
ver iReben maTi saWiroebebis Sesabamis zrunvas.
paliatiuri mzrunveloba ar aris mimarTuli specifikur daavadebaze da moicavs periods daavadebis Sorswasuli formis dadgenis
momentidan sicocxlis bolomde, romelic SeiZleba varirebdes
wlebidan ramodenime kviramde an (iSviaTad) dReebamde.
umniSvnelovanesia wevr saxelmwifoebSi iseTi klimatis Seqmna,
romelic aRiarebs paliatiuri mzrunvelobis mniSvnelobas.
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CM(2003)130
sazogadoeba, pacientebisa da maTi ojaxebis CaTvliT, saWiroebs ganaTlebas paliatiuri mzrunvelobis mniSvnelobasTan dakavSirebiT.
gvawvdis ra srul monacemebs evropis ocdaTxuTmeti qveynis Sesaxeb, bolo periodis kvlevam gamoavlina sxvadasxva qveyanaSi paliatiuri mzrunvelobis ganviTarebaSi arsebuli gansxvaveba, romelTa
Sorisac aris variaciebi anazRaurebaSi (iq sadac misaRebia), jandacvis sistemis organizebasa da masSi paliatiuri mzrunvelobis
adgilSi; eTikuri da kulturuli faqtorebis sxvaobaSi; paliatiuri mzrunvelobis ganviTarebaSi erovnuli organizaciebis
rolsa da saerTaSoriso TanamSromlobaSi; muSa jgufis treningebisa da ganviTarebis sakiTxebSi.
I . s a x e l m Z Rv a n e l o p r i n c i p e b i
paliatiuri mzrunvelobis politika unda efuZnebodes evropis
sabWos mier SemoTavazebul Rirebulebebs: adamianis, pacientis
uflebebi, adamianis Rirseba, demokratia, Tanasworoba, solidaroba,
Tanaswori genderuli SesaZleblobebi, monawileoba da arCevanis
Tavisufleba.
paliatiuri mzrunveloba moicavs Semdeg mTavar aspeqtebs;
- simptomebis kontroli;
- fsiqologiuri, sulieri da emociuri daxmareba;
- ojaxis wevrebis daxmareba;
- daxmareba axloblis gardacvalebiT gamowveuli mZime danakargis dros.
rekomendacias ganamtkicebs Semdegi principebi:
1.
paliatiuri mzrunveloba jandacvis sistemis ganuyofeli, sasicocxlo mniSvnelobis mqone nawilia. mis ganviTarebasa da funqcionalur intergirebaze mimarTuli rezervebi CarTuli unda
iqnas jandacvis erovnul strategiebSi.
CM(2003)130
9
2. nebismieri pirovneba, romelsac paliatiuri mzrunveloba
esaWiroeba, unda iRebdes mas yovelgvari Seferxebis gareSe,
misi saWiroebebisa da arCevanis Sesabamis garemoSi.
3. paliatiuri mzrunvelobis amocanas pacientebisaTvis sicocxlis
SesaZlo saukeTeso xarisxis miRweva da SenarCuneba warmoadgens.
4. paliatiuri mzrunveloba mimarTulia Sorswasuli daavadebiT
gamowveul fizikur, fsiqologiur da sulier aspeqtebze; amdenad igi moiTxovs maRalkvalificiuri, adekvaturi resursebiT
aRWurvili interdisciplinuri da multiprofesiuli gundis
monawileobas.
5. mwvave Sualeduri problemebis mkurnaloba xdeba im SemTxvevaSi,
Tu amis survili aqvs pacients da ar xdeba maSin, rodesac igi
upiratesobas paliatiur mzrunvelobas aniWebs.
6.
paliatiuri mzrunvelobis misawvdomoba unda emyarebodes
saWiroebebs. masze gavlenas ar unda axdendes daavadebis tipi,
geografiuli mdebareoba, socialur-ekonomiuri statusi an sxva
msgavsi faqtorebi.
7.
paliatiuri mzrunvelobis saswavlo programebi CarTuli unda
iqnas jandacvis
yvela dainteresebuli profesionalis
treningebSi.
8. unda Catardes mzrunvelobis xarisxis gaumjobesebaze
mimarTuli kvleva. paliatiuri mzrunvelobis yoveli Careva
maqsimalurad unda iqnas gamyarebuli Sesabamisi kvlevebis
monacemebiT.
9. paliatiurma mzrunvelobam unda miiRos adekvaturi da obieqturi dafinanseba.
10. iseve, rogorc jandacvis yvela seqtorSi, paliatiur
mzrunvelobaSi CarTuli samedicino personali srulad unda
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aRiarebdes pacientis uflebebs, Seesabamebodes profesiul movaleobebsa da standartebs; moqmedebdes pacientis interesebis
sruli dacviT.
I I . d aw es eb u l eb eb i d a s am s axu reb i
1.
paliatiuri mzrunveloba aris interdisciplinuri da multiprofesiuli saqmianoba, romelic emsaxureba pacientTa saWiroebebs da ar uaryofs iseTi araformaluri mzrunvelebis monawileobas, rogoricaa ojaxis wevrebi.
2. paliatiuri mzrunvelobis momsaxureba da politika pacients
unda sTavazobdes resursebis farTo speqtrs, rogoricaa: binaze
mzrunveloba, mzrunveloba stacionaris specifikur da saerTo
ganyofilebebSi, dRis stacionarsa da ambulatoriul klinikebSi, saswrafo daxmarebis da droebiTi movlis ganayofilebebSi. aRniSnuli mzrunveloba unda iyos mravalmxrivi, jandacvis sistemis, kulturis Sesabamisi, yuradReba gamaxvilebuli unda iqnas pacientis saWiroebebisa da survilebis cvalebadobaze.
3. daxmarebas unda iRebdnen araformaluri mzrunvelebic. isini ar
unda ganicdidnen iseT socialur marxcs, rogoricaa mzrunvelobasTan dakavSirebiT samsaxuris dakargva. sasurvelia arsebobdes
`mzrunvelobisaTvis Svebulebis~ oficialuri nebarTva.
4. saWiroebis SemTxvevaSi, Sorswasuli, progresirebadi daavadebis
mqone pacientze mzrunvelobaSi CarTuli yvela profesionalisaTvis xelmisawvdomi unda iyos nebismieri saxis eqspertiza.
5. saWiroebis SemTxvevaSi yvela pacientisaTvis, nebismier drosa
da nebismier situaciaSi misawvdomi unda iyos paliatiuri
mzrunvelobis specialistis momsaxureba.
6. saxelmwifo doneze unda iqnas uzrunvelyofili paliatiuri
CM(2003)130
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mzrunvelobis ganviTarebis marTva da momsaxurebaTa swori
koordinacia, pasuxismgeblobis mkafio gadanawilebiT. aRniSnuli
miznis misaRwevad rekomendebulia regionaluri qselebis
Camoyalibeba.
7. pacientebs garantirebuli unda hqondeT paliatiuri mzrunveloba miuxedavad maTi finansuri mdgomareobisa. finansuri da
sxva saxis meqanizmebi adaptirebuli unda iqnes pacientebis
saWiroebebis gaTvaliswinebiT da iZleodes paliatiuri mzrunvelobis uwyvetobis garantias.
8. unda arsebobdes droebiTi movlis forma, romelic gadatvirTvis SemTxvevaSi droebiT daxmarebas SesTavazebs binaze momvlelebs.
I I I . p ol i ti k a d a org a n i z e b a
1.
paliatiuri mzrunveloba unda warmoadgendes qveynis jandacvis
sistemis ganuyofel nawils da amdenad igi unda iyos jandacvis
gegmebisa da im specifikuri programebis elementi, romelic
exeba mag. kibos, Sidss an geriatrias.
2. saxelmwifoebma unda Caataron momsaxurebaTa, eqspertizis
sxvadasxva donis personalisa da profesionalebis treningis
(volontiorebis CaTvliT) saWiroebebis Sefaseba.
3. saWiroebaTa Sefasebis safuZvelze, erovnulma da regionulma
xelisuflebam profesionalebTan, pacientebTan, maTi ojaxis
wevrebTan da warmomadgenlebTan urTierTTanamSromlobiT unda
SeimuSaos da ganaxorcielos paliatiuri mzrunvelobis yovlismomcvli strategia.
4. xelisuflebam rogorc aseTi strategiebis nawilma, unda gansazRvros paliatiuri mzrunvelobis misawvdomobis sakanonmdeblo,
socialur-ekonomiuri, kulturuli, administraciuli da/an
fizikuri barierebi. iniciativebi da programebi unda xorcield12
CM(2003)130
ebodes im barierebis Sesamcireblad, romelTac xSirad uTanasworobamde mivyavarT.
5. kanonmdeblobam unda uzrunvelyos opioidebisa da sxva medikamentebis misawvdomoba, samedicino mizniT maTi farTo SemadgenlobiTa da dozirebiT gamoyenebisaTvis. aradaniSnulebisamebr
gamoyenebis SiSi ar unda aferxebdes aucilebeli da efeqturi
medikamenturi mkurnalobis misawvdomobas.
6. politikuri da socialuri yuradRebis uzrunvelsayofad
rekomendebulia erovnul, regionul da adgilobriv doneze
paliatiuri mzrunvelobis interdisciplinuri fokus jgufebis
an sabWoebis Camoyalibeba pacientebis, ojaxis wevrebisa da
sxvaTa monawileobiT. moqmedebaTa gegmis SesamuSaveblad,
umjobesia aRniSnuli jgufebi TanamSromlobdnen xelisuflebasTan da sxva pirebTan.
7. paliatiuri mzrunvelobis xarisxis monitoringisaTvis aucilebelia saxelmwifo doneze ` monacemTa minimalur nakrebis~ (mmn)
SemuSaveba.
8. Tanasworobis uzrunvelsayofad gansakuTrebuli yuradReba unda
daeTmos arapriviligirebul jgufebze (mag. swavlis SezRudvis
mqone pirebi, patimrebi, usaxlkaroebi da ltolvilebi) paliatiur mzrunvelobas da pacientis saWiroebebTan dakavSirebul
kulturul da eTnikur gansxvavebebs. aseve gansakuTrebuli
yuradReba unda daeTmos paliatiur mzrunvelobas bavSvebSi.
9. profesionali momvlelebi uflebamosili arian miiRon kanonieri
anazRaureba da aRiareba maT mier Sesrulebuli samuSaosa da
kompetenciisaTvis.
10. yovelwliurad unda iqnas gamoqveynebuli saxelmwifo angariSi
paliatiuri mzrunvelobis organizebisa da funqcionirebis
Sesaxeb.
CM(2003)130
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I V . x a r i s x i s g a u m jo b e s e b a d a k v l e v a
1.
xeli unda Seewyos xarisxiani paliatiuri mzrunvelobis
maCveneblebis gansazRvras da SemuSavebas.
2. meTodurad, pacientebis monawileobiTa da arsebul saukeTeso
mtkicebulebebze dayrdnobiT, unda Seiqmnas paliatiuri mzrunvelobis klinikuri praqtikis saxelmZRvaneloebi.
3. xarisxis kontrolisaTvis umTaversia praqtikuli saqmianobis
uwyveti ukugebis auditi.
4. miuxedavad imisa, rom paliatiur mzrunvelobaSi samecniero
kvleva SesaZloa dadges specifikuri eTikuri problemebis
winaSe, samedicino Carevebi unda fasdebodes aRiarebuli,
rogorc xarisxobrivi, aseve raodenobrivi samecniero meTodebis
gamoyenebiT.
5. xeli unda Seewyos saxelmwifo da evropul doneze erTobliv
kvlevas.
6. paliatiuri mzrunvelobis ganviTarebisa da xarisxis Sesaxeb
zusti informaciis Segrovebis, gadamuSavebisa da gavrcelebisaTvis organizebuli unda iqnas dakvirvebis punqti.
V. ganaTleba da treningebi
1.
kvlevisa da ganaTlebisaTvis mniSvnelovania paliatiuri mzrunvelobis akademiuri aRiareba.
2. paliatiuri mzrunveloba CarTuli unda iqnas eqimebisa da
eqTnebis yvela sauniversiteto kursSi. unda SemuSavdes standartuli kurikulumebi, iseve rogorc saaspiranto treningebi
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CM(2003)130
da ganaTleba; unda arsebobdes trening programebi paliatiuri
mzrunvelobis eqspertebisaTvis.
3. xeli unda Seewyos ganaTlebis sferoSi saerTaSoriso
TanamSromlobas. mag. paliatiuri mzrunvelobis im struqturebis cnobaris Sedgena, romelTac erTobliv programebSi monawileobis survili aqvT.
4. paliatiur mzrunvelobaSi CarTulma yvela profesionalma da
araprofesionalma unda gaiaros maTi amocanebis Sesabamisi treningi; treningis yvela doneze maT unda miiRon paliatiur
mzrunvelobaSi konkretuli, ganWvretis unarsa da kulturuli
gansxvavebebis gaTvaliswinebaze mimarTuli zusti instruqciebi.
5. paliatiur mzrunvelobaSi ganaTleba unda iyos monodisciplinuri da aseve interdisciplinuri.
6. paliatiur mzrunvelobaSi ganaTleba unda xorcieldebodes uwyvetad. mag. zedamxedvelobis formiT.
7. paliatiuri mzrunvelobis swavlebisa da treningisaTvis yovel
qveyanaSi unda Seiqmnas sabazo centrebi.
8. idealur variantSi, profesionalebisaTvis unda arsebobdes
ganaTlebis (uwyveti) Semdegi sami done: sawyisi, Sualeduri da
umaRlesi ganaTleba.
9. rekomendebulia qveynebma gansakuTrebuli yuradReba dauTmon paliatiur mzrunvelobasTan dakavSirebiT sazogadoebis ganaTlebas.
10. unda gamoswordes pacientebSi, ojaxebSi, profesionalebsa da
sazogadoebaSi opioidebTan dakavSirebiT arsebuli gaumarTlebeli negatiuri imiji. profesiul ganaTlebaSi, iseve rogorc
sazogadoebriv kampaniaSi, aqcenti unda gakeTdes Zireul gansxvavebaze opioidebis klinikur gamoyenebasa da medikamentebze
potenciuri mavne damokidebulebis sakiTxebze.
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VI. ojaxi
1.
pacientebis axloblebis (umetesad ojaxis wevrebi) daxmarebis
mizania maTi SesaZleblobebis saukeTesod gamoyeneba da ganviTareba pacientisaTvis emociuri da praqtikuli daxmarebis
gasawevad; procesisadmi adaptirebis, mwuxarebasa da danakargTan
Sesagueblad. gansakuTrebuli yuradReba unda mieqces gamofitviT gamowveuli depresiis prevenciasa da mkurnalobas.
VI I . k om u n i k ac i a pac i en tTan d a ojaxTan
1.
paliatiuri mzrunveloba moiTxovs iseT atmosferos, damokidebulebas da momvleli-pacientis urTierTobas, romelic xels
uwyobs informaciis misawvdomobas pacientebisa da ojaxebisaTvis.
2. profesionalebma unda gaiTvaliswinon, Tu ra moculobiT surT
pacientebs miiRon informacia sakuTari mdgomareobis Sesaxeb;
amasTan dakavSirebiT yuradReba unda mieqces kulturul
Taviseburebebs.
3. profesionalebma unda moaxdinon pacientisaTvis informaciis
miwodebis xerxebis adaptireba, im emociuri da SemecnebiTi barierebis gaTvaliswinebiT, rac xSirad dakavSirebulia Sorswasul
da progresirebad daavadebasTan.
4. rodesac sakuTari janmrTelobis, an mSoblebis avadmyofobis
gamo urTierToba gvaqvs bavSvebTan, komunikacia adaptirebuli
unda iqnas asakobrivi specifikis gaTvaliswinebiT.
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VIII. gundi, gunduri muSaoba da
mzrunvelobis dagegmva
1.
paliatiuri mzrunveloba aris interdisciplinuri da multidisciplinuri saqmianoba, romelSic umTavresad CarTuli arian
pacientisa da ojaxis wevrebis fizikuri, fsiqologiuri, sulieri saWiroebebis Sesabamisi kompetenciis mqone eqimi, eqTani da
sxva sferos muSakebi. aseTi gundebis funqcionireba saWiroebs
xelSewyobas.
2. gadawyvetilebis miReba, gansakuTrebiT ki sawyisi individualuri gegmis SemuSaveba, monitoringi da sistematiuri ganxilva
pacientis survilis Sesabamisad, unda xdebodes pacients, ojaxsa da gunds Soris. uzrunvelyofili unda iqnas Sesabamisi komunikacia sxvadasxva saxis momsaxurebas Soris (mkurnaloba da
mzrunveloba).
3. volontiorebi SesaZloa gundis mniSvnelovan wevrebs warmoadgendnen. isini ar asruleben profesionalebis samuSaos, magram
gaaCniaT sakuTari wvlili da kompetencia. unda moxdes
volontiorTa momsaxurebis organizebisa da moxaliseobis procesis xelSewyoba.
4. gundis yvela wevrs unda gaaCndes Tavisi rolis Sesabamisi kompetencia; isini unda icnobdnen sakuTar da aseve gundis sxva wevrebis SesaZleblobebsa da sust mxareebs.
5. pacientisa da ojaxisaTvis umniSvnelovanesia zusti informaciis miReba gundis sxvadasxva wevrebisagan. amdenad, gaugebrobisa da Seusabamobis Tavidan asacileblad mTavaria momvlelebs
Soris informaciis optimaluri gacvla. rekomendebulia koordinatoris xelmZRvanelobis daweseba. garemoebebidan gamomdinare, umjobesia am funqcias asrulebdes pirveladi qselis eqimi.
6. efuZneba ra pacientisa da ojaxis samedicino saidumlosa da
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17
piradulobis uflebebis srul pativiscemas, profesionalebs
Soris mTeli komunikacia pacientsa da mis ojaxTan mimarTebaSi
profesiul saidumlos warmoadgens.
7. paliatiuri mzrunveloba Cveulebriv Zalian sasargebloa, magram
amave dros is SeiZleba iyos Zalian momTxovni. amdenad mzunvelebze zrunva paliatiuri mzrunvelobis umTavres nawils warmoadgens da am sferoSi momuSaveTa Sromis higienas moqmedebaTa
gegmaSi gansakuTrebuli yuradReba unda eqceodes.
IX. mZime danakargi
1.
momsaxureba axloblis gardacvalebiT gamowveuli mZime danakargis dros unda miiRon maT, visac aseTi daxmareba esaWiroeba;
2. yvela profesionali muSaki yuradRebas unda iCendes axloblis
gardacvalebiT gamowveuli garTulebebisa da aRelvebis
niSnebisadmi.
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Communicating with patient and family
CM(2003)130
19
rekomendacia REC (2003) wevri
saxelmwifosadmi paliatiuri mzrunvelobis
organizebisaTvis (axsna-ganmartebiTi memorandumi)
ministrTa komitetis
zogadi mosazrebebi
1. kacobriobis dasabamidan, yoveli sazogadoeba avadmyofi da
momakvdavi adamianebis daxmarebasa da maTTvis komfortis Seqmnas
cdilobda. Cveulebriv, adamianis gardacvalebas Tan axlavs Rrma
mowiweba da mistiuroba. gardacvalebis Semdgomi periodisaTvis
damaxasiaTebelia ritualebisa da tradiciuli wes-Cveulebebis
mkacri dacva. axlobeli adamianis dakargviT gamowveuli glovis
saWiroeba aRiarebulia umetesi sazogadoebebis mier, Tumca
glovis gamoxatva da misi xangrZlivoba sxvadasxva kulturaSi
gansxvavebulia.
2. avadmyofoba da sikvdili aris da yovelTvis iqneba adamianis
sasicocxlo gamocdilebis ganuyofeli nawili. is, Tu ramdenad
veswrafiT momakvdavisa da misi ojaxis wevrebis individualuri
saWiroebebis gansazRvrasa da maTze reagirebas, sazogadoebis
srulyofilebis mniSvnelovan maCvenebels warmoadgens. yovel
SesaZlo SemTxvevaSi xels unda vuwyobdeT daavadebis prevencias. avadmyofobis SemTxvevaSi, ki unda vecadoT aRmovfxraT, an
ukidures SemTxvevaSi SevaferxoT misi progresireba. am
mcdelobaTa paralelurad fsiqologiur, emociur da sulier
daxmarebasTan erTad, pacientebs unda SevTavazoT tkivilisa da
simptomebis marTvis optimaluri done.
3. bolo 2 - 3 aTwleulis ganmavlobaSi damsaxurebuli yuradReba
eTmoba sicocxlis bolos mzrunvelobas. gamoica specifikuri
samedicino Jurnalebi, Camoyalibda organizaciebi profesionalebisa da araprofesionalebisaTvis (rogoricaa evropis paliatiuri mzrunvelobis asociacia), daibeWda erovnuli politikis
rekomendaciebi, mag. irlandiis saxelmwifosa (paliatiuri
mzrunvelobis erovnuli sameTvalyureo komitetis 2001) da aSS-s
medicinis institutis (Field and Cassell 1997).
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CM(2003)130
mokle istoriuli mimoxilva
4. sazRvari sicocxlesa da sikvdils Soris aris kontiniumi
(janmrTelobasa da avadmyofobis monacvleoba), romelic arsebobs dabadebidan gardacvalebamde. sicocxleSi Cven vkvdebiT da
sikvdilisas gveZleva sicocxlis Sansi. mTels msoflioSi jandacvisa da socialuri zrunvis programebi mimarTulia individebis, ojaxebisa da sazogadoebis daxmarebaze, raTa miRweuli
da SenarCunebuli iqnas sicocxlis optimaluri xarisxi. paliatiuri mzrunvelobis konteqstSi, rodesac sicocxlis
xangrZlivoba mkveTrad limitirebulia da vibrZviT darCenili
drois saukeTesod gamoyenebisaTvis, aRniSnuli sakiTxi xdeba
gadaudebeli da saswrafo.
5. kacobriobis dasabamidan avadmyofi da momakvdavi adamianebis daxmarebas yoveli sazogadoeba cdilobda. Tumca, gasuli saukunis
Sua periodamde, samedicino mecnierebas Zalian cota ramis
SeTvazeba Tu SeeZlo tkivilis marTvisa da simptomebis kontrolis mxriv. me-20 saukunis 50-ian wlebSi momakvdavi pacientebis
fsiqologiuri da sulieri saWiroebebis ukeT gagebasTan
Serwymulma medikamenturi Terapiis ganviTarebam, gza gaukvala
paliatiuri mzrunvelobis samsaxurebis Camoyalibebas. paliatiuri mzrunvelobis principebi ufro farTod iqna gagebuli da
gamoyenebuli saukunis meore naxevarSi.
6. Sua saukuneebSi, termini `hospisi~ piligrimebisa da mogzaurebis TavSesafris aRsawerad gamoiyeneboda. evropaSi, kavSiri pospissa da momakvdavi pacientisaTvis gaweul daxmarebas Soris
ukavSirdeba 1842 wels frangi, lioneli qalbatonis J. garnies
saqmianobas. irlandiaSi, irlandieli mowyalebis debma, deda
meri aikenhedis TaosnobiT 1870 wels gaxsnes hospisi dublinSi
da korkSi, SemdgomSi 1905 wels londonSi. es dawesebulebebi
mWidrod iyo dakavSirebuli Sorswasuli da ukurnebeli seniT
daavadebul adamianebze mzrunvelobasTan. Tumca, tkivilisa da
sxva simptomebis marTvis mcdeloba ferxdeboda am simptomebis
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21
bunebis arasakmarisi codniTa da efeqturi medikamentebis naklebobis gamo.
7. 50-ian wlebSi moxda iseTi mniSvnelovani medikamentebis asortimentis wardgena, rogoricaa fsiqotropuli nivTierebebi,
fenoTiazinebi, antidepresantebi da anTebis sawinaaRmdego arasteroiduli preparatebi. am droisaTvis arsebobda meti codna
kiboTi gamowveuli tkivilis bunebisa da mis marTvaSi opioidebis mniSvnelobaze. axali preparatebis misawvdomobam SesaZlebeli gaxada tkivilisa da simptomebis ufro efeqturi marTva.
8. opioidebis gamoyenebis maCveneblebis mixedviT, arsebobda udidesi winaaRmdegoba, romelic maTi aradaniSnulebisamebr gamoyenebasa da dausabuTebeli SiSidan gamomdinareobda. gazviadebulma
wuxilma iseT sakiTxebTan mimarTebaSi, rogoricaa wamalze damokidebulebis mavne Cveva, tolerantoba da sunTqvis garTuleba,
samedicino praqtikaSi maTi Sesaferisi gamoyeneba Seaferxa. aseT
SiSs Tanabrad iziarebda rogorc samedicino sazogadoebis bevri
warmomadgeneli, aseve mTlianad sazogadoeba. saxelmwifo doneze mniSvnelovani gaugebroba arsebobda aRniSnuli nivTierebebis
Terapiul rolsa da potenciur mavne damokidebulebas Soris.
zogierT qveyanaSi opioidebis gamoyeneba kanonmdeblobiT iyo
akrZaluli, sxva qveynebSi ki legalizebuli. Tumca, maTi misawvdomoba daniSvnis, Senaxvisa da ganawilebis gadaWarbebulad
biurokratiuli marTviT ferxdeboda. sasicocxlo mniSvneloba
aqvs im faqts, rom Cven vswavlobT istoriis Secdomebze. ar
unda arsebobdes aranairi gaugebroba opioidebis klinikur
gamoyenebasa da maTze potenciur mavne damokidebulebas Soris.
9. Tanamedrove hospisisa da paliatiuri mzrunvelobis evolucia
mniSvnelovnad ganapiroba deim sisli saundersis xedvam, gambedaobam da pasuxismgeblobam. iyo ra eqTani, socialuri muSaki da
eqimi, igi miCneuli da aRairebulia Tanamedrove hospisuri
moZraobis pionerad. muSaobda ra ramodenime weli londonSi,
wminda jozefis saxelobis hospisSi, deim sislim 1967 londonSi
daaarsa wminda kristoferis sax. hospisi. es iyo pirveli
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Tanamedrove saswavlo-kvleviTi hospisi. deim sislim Tavisi profesiuli da piradi cxovreba Sorswasuli da progresirebadi
seniT daavadebul pacientebze zrunvasa da Seswavlas miuZRvna.
man gansazRvra da pasuxi ipova im naklovanebebze, romelic
momakvdavi adamianisa da misi ojaxis wevrebis saWiroebebis
dakmayofilebaSi arsebobda. igi aqcents akeTebda yoveli pacientisa da misi ojaxis saWiroebebze. deim sisli saundersma gvaswavla pacientze, ojaxze mzrunveloba da namdvili interdisciplinuri gunduri muSaobis saWiroeba. saocrad mokle droSi man
gardaqmna jandacvis es sfero da eWvqveS daayena mravali negatiuri midgoma da crurwmena. mokled rom vTqvaT, man moaxdina
Zireuli cvlilebebi imaSi, Tu rogor vpasuxobT momakvdavi
pacientebisa da maTi ojaxebis sxvadasxva saWiroebas.
10. wminda jozefis saxelobis hospisi yovelTvis iRwvoda jandacis
dawesebulebebSi paliatiuri mzrunvelobis principebis popularizaciisaTvis. codnisa da gamocdilebis gavrcelebis es
enTuziazmi vrceldeboda ara marto gaerTianebul samefoze, aramed mTels msoflioSi. msoflios yvela kontinentidan jandacvis profesionalebi swavlobdnen wminda jozefis hospisSi da
axlad miRebul codnasa da Cvevebs iyenebdnen sakuTar qveynebSi.
ar arsebobs paliatiuri mzrunvelobis erTi modeli, romelic
misaRebia yvela situaciisaTvis. Tumca, paliatiuri mzrunvelobis ZiriTadi principebi, romlebic gansakuTrebul mniSvnelobas
yoveli pacientisa da misi ojaxis saWiroebebs aniWeben, universaluria. is, Tu rogor xdeba am amocanebis Sesruleba, gansxvavdeba ara marto qveynebs, aramed SesaZloa regionebs Sorisac.
11. rodesac ganvixilavT paliatiuri mzrunvelobis ganviTarebas
msoflios sxvadasxva qveyanaSi, aRsaniSnavia Tu ra didi gavlenis moxdena SeuZlia Tundac erT motivirebul pirovnebas.
Cveulebriv, erT pirovneba, romelic acnobierebs, rom arsebobs
mzrunvelobis ukeTesi gza, axdens cvlilebis stimulirebas.
xSirad, piradi gamocdilebis gamo, es pirovneba moqmedebs
rogorc katalizatori da sxvebsac ganawyobs cvlilebebis
ganxorcielebisaTvis. ar aris SesaZlebeli an swori sxvadasxva
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23
qveyanaSi paliatiuri mzrunvelobis ganviTarebis katalogis
Sedgena. sakmarisia imis Tqma, rom paliatiuri mzrunvelobis samsaxurebi amJamad viTardeba yvela kontinentze, Tumca sxvadasxva tempiTa da xarisxiT.
12. paliatiuri mzrunveloba ar niSnavs institucionalur mzrunvelobas. mniSvnelovanwilad, igi warmoadgens mzrunvelobis filosofias, romelic misaRebia mzrunvelobis yvela dawesebulebisaTvis. Cveulebriv, Cven vxvdebiT Temze dafuZnebul gundebs, romelic mzrunvelobas axorcielebs binaze, an moxucebulTa saxlSi. aseve, Cven vxvdebiT paliatiuri mzrunvelobiT
uzrunvelyofas zogadi profilis saavadmyofoebSi. idealur
SemTxvevaSi, pacientebs eqnebaT arCevani da saSualeba Tavad
airCion mzrunvelobis adgili, mag. saxli, hospisi, saavadmyofo.
SesaZlebelobis SemTxvevaSi pacientebs unda SeeZloT mzrunvelobis miReba sxvadasxva dawesebulebaSi, maTi klinikuri
saWiroebebisa da sakuTari arCevanidan gamomdinare.
13. garkveuli drois Semdeg hospisis pacientebisa da maTi ojaxebis konkretuli saWiroebebi yvela kontinentis jandacvis programebis yuradRebis centrSi eqceva da iwvevs diskusias. maSin,
rodesac paliatiuri mzrunvelobis ZiriTadi principebi universaluria, dadgenili amocanebis miRwevis meTodebi sxvadasxva
qveyanaSi SesaZloa gansxvavdebodes. yovel qveyanaSi, sakuTari
specifikuri saWiroebebis Sefaseba da Sesabamisi dagegmva warmoadgens jandacvis organizatorTa pasuxismgeblobis sakiTxs.
paliatiuri mzrunvelobis samsaxurebis samomavlo dagegmvasTan
mimarTebaSi, unda gaviTvaliswinoT warsulis gakveTilebi.
nebismieri mcdeloba fokusirebuli unda iqnas yoveli pacientisa da misi ojaxis wevrebis sicocxlis optimaluri xarisxis
miRwevasa da SenarCunebaze. individualuri, instituciuri da
jgufuri dRis ganawesebi unda eqvemdebarebodes pacientebisa da
maTi ojaxebis saWiroebebs.
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pal i ati u ri m z ru n vel ob i s z og i erTi
m o n a c e m i e v r op u l q v e y n e b S i
14. bolo drois kvlevebi gvawvdian monacemebs evropis qveynebSi
paliatiuri mzrunvelobis ganviTarebis msgavsebebsa da gansxvavebebze. aRmosavleT evropisa da centraluri aziis 28 qveynis
kvlevebSi, raodenobrivi da xarisxobrivi meTodebis gamoyenebiT
naTeli gaxda, rom arsebobs mniSvnelovani gansxvaveba sxvadasxva qveyanaSi paliatiuri mzrunvelobis misawvdomobaSi da aseve
mniSvnelovani msgavseba im interessa da energiaSi, rac paliatiuri mzrunvelobis samsaxurebis daarsebas eTmoba (Clark &
Wright 2002).
15. poloneTsa da ruseTs gaaCniaT paliatiuri mzrunvelobis samsaxurebis yvelaze didi raodenoba; zogierT yofil sabWoTa
respublikas saerTod ar gaaCnia msgavsi samsaxurebi. aRmosavleT
evropaSi, binaze movla aris paliatiuri mzrunvelobis yvelaze
gavrcelebuli forma, rasac mosdevs stacionaruli paliatiuri
mzrunveloba; aRmoCnda, rom gacilebiT iSviaTia saavadmyofos
gundi, dRis movlis centri, moxucebulTa saxlis gundebi. kvlevis Sedegad ganisazRvra xuTi e.w. `Suqura~ (sabaziso centri)
oTx qveyanaSi (rumineTi, ungreTi, poloneTi (2) da ruseTi); es
centrebi istoriulad Zalian mniSvnelovani iyo paliatiuri
mzrunvelobis ganviTarebisaTvis da dResac jer kidev asruleben eqspertizis centris rols.
16. kvlevis Sedegad ganisazRvra aRmosavleT evropis qveynebisaTvis
saerTo ramodenime mniSvnelovani problema:
- politikis oficialuri aRiarebis, dafinansebisa da sicocxlisunarianobis nakleboba;
- opioidebis arasakmarisi misawvdomoba;
- samuSao Zalis dasaqmeba;
- samedicino da saeqTno aRWurvilobis nakleboba;
- kvlevis arasakmarisi SesaZleblobebi;
- negatiuri kulturuli stereotipebi.
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17. `palium~ kvlevam, romelic dafinansebuli iqna evro komisiis
mier, ganixila aRmosavleT evropis qveynebis paliatiuri mzrunvelobis koncefciebi da masTan dakavSirebuli moqmedebis gzebi.
(Ten Have & Jansenns 2002)
18. holandiaSi, 70-ian wlebSi paliatiuri mzrunvelobis specifikuri proeqtebis dawyebis pioneri gaxda roterdamis moxucebulTa
saxli (msgavsad `Suqurisa~). zemoTaRniSnuli kvlevis mixedviT,
holandiaSi paliatiuri mzrunvelobis udides nawils binaze
movla warmoadgenda, romelsac axorcielebdnen moxucebulTa
saxlisa da Cveulebrivi momvlelebi. hospisebi paliatiuri
mzrunvelobis mcired nawils Seadgendnen ; arsebobs gansxvaveba
`dabali~ da `maRali~ zrunvis hospisebs Soris: pirveli umetesad imarTeba moxaliseebis mier, xolo ukanasknelSi ki metia
profesionalTa wvlili.
19. 1998 wels saxelmwifos mier miRebuli iqna gadawyvetileba paliatiuri mzrunvelobis ganviTarebis centrebis akademiur samedicino centrebSi CarTvis programis sasargeblod. holandiaSi
politika mimarTulia hospisebis profesionalur jandacvis
sistemaSi integrirebaze. aseTi ganviTarebis Sedegs warmoadgens
samedicino saswavleblebis gazrdili interesis maCvenebeli
niSnebi: kvalifikaciis amaRlebis treningebisa da uwyveti samedicino ganaTlebis programebi. moxucebulTa saxlebma daiwyes
paliatiuri mzrunvelobis ganyofilebebis gaxsna sakuTar
Senobebsa da maT teritoriaze mdebare sxva specifikur
SenobebSi.
20. tradiciulad, keTdeba ra aqcenti binaze movlis formaze,
holandiaSi yuradReba maxvildeba zogadi praqtikis eqimebis
treningebsa da daxmarebaze, rasac sxva SedegebTan erTad mTel
qveyanaSi mobiluri sakonsultacio gundebis qselis SeqmnasTan
mivyavarT. 2000 wlidan moqmedebs volontiorTa daxmarebis saxelmwifo programa, romelic ZiriTadad koordinaciasa da treningebs exeba.
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21. `palium~ kvlevam gamoavlina, rom belgiaSi saxelmwifom gamosca ramodenime samefo brZaneba, sadac sxva sakiTxebTan erTad
miTiTebulia, rom yovel saavadmyofosa Tu moxucebulTa saxls
unda hyavdes paliatiuri mzrunvelobis multiprofesiuri
gundi; aseve miTiTebulia is profesiebi, romelic am jgufebSi
unda iqnas warmodgenili. meore mxriv, akeTebdnen ra aqcents
paliatiuri mzrunvelobis jandacvis saerTo sistemaSi integrirebaze da binaze movlis samsaxurebis ganviTarebaze, profesionaluri organizaciebi TanamSromlobdnen regionalur da erovnul mTavrobebTan.
22. SvedeTSi, specializirebuli paliatiuri mzrunvelobis ganviTareba daiwyo 1977 wels qveynis samxreTSi binaze dafuZnebuli
hospisis programidan; Semdgom aTwleulSi es modeli gavrcelda mTel qveyanaSi. 1979 wels SvedeTis mTavrobam Tavis angariSSi
araorazrovnad uaryo momakvdavi adamianebisaTvis gancalkevebuli dawesebulebebis arseboba (Fürst 2000)
23. germaniaSi, paliatiuri mzunvelobis organizeba daiwyo germanuli sazogadoebis sensibilizaciis periodidan, 1983 wels, pirveli paliatiuri palatis daarsebiT, rasac moyva sxvadasxva hospisebisa da saxelmwifo iniciativebi paliatiuri mzrunvelobis
12 dawesebulebis daarsebis Sesaxeb.
24. espaneTSi, `palium~ kvlevis mixedviT, iseve rogorc sxva
qveynebSi paliatiuri mzunvelobis ganviTareba ar dawyebula
Zireuli hospisuri moZraobidan. procesi inicirebuli iqna jandacvis saxelmwifo sistemis mier; pirveli centrebi ganlagebuli iyo specializirebul saavadmyofoebSi. 2000 wels paliatiuri mzrunvelobis saxelmwifo gegmaSi moxseniebulia paliatiuri mzrunvelobis 241 dawesebuleba. maTgan naxevars binaze movlis samsaxuri Seadgens, romelic yovelwliurad 23000 pacients uwevs mzrunvelobas. Tumca, arian ra qveyanaSi araTanabrad
ganawilebuli, aRniSnuli dawesebulebebi srulad ver akmayofileben mosaxleobis saWiroebebs.
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25. gaerTianebuli samefo specifikuri paliatiuri mzrunvelobis
samsaxurebis akvnad aris miCneuli. kvlevis ingliseli monawileebi aRniSnaven, rom Zlieri britanuli hospisuri moZraoba
yovelTvis rCeboda jandacvis erovnuli sistemis gareT, rac amcirebda mis SesaZleblobas èqadaga~ misi midgomebi sistemis
SigniT. paliatiuri medicina mravali wlis manZilze iyo
aRiarebuli medicinis erT-erT dargad da amdenad misi akademiuri statusi sakmaod myaria. Tumca qveyanaSi paliatiuri mzrunvelobis dafinanseba umetesad jer kidev kerZo seqtoris mier
xdeba.
26. italiaSi paliatiuri mzrunvelobis ganviTareba daiwyo 70-iani
wlebidan, rasac mTel qveyanaSi hospisebis didi raodenobiT
daarseba moyva; bolo periodSi italiis mTavrobam paliatiur
mzrunvelobas gansakuTrebuli adgili miakuTvna jandacvis saxelmwifo gegmaSi.
27. 1999 wlis bolosaTvis, `palium~ proeqtis monawile Svidi qveynis mier warmodgenili iqna Semdegi suraTi:
belgia germania italia
mosaxleoba
(milionebSi)
niderespaneTi SvedeTi
landebi
10.1
81.9
57.4
15.6
40
1
64
3
16
1
49
50
0
2
23
55
1
0
34
binaze movla
45
582
88
dRis movlis
centri
2
9
0
stacionaruli
hospisi
stacionaruli
ganyofileba
saavadmyofo
da moxucebulTa
saxlis gundebi
gaerTiane
buli
samefo
8.8
57.1
{ 69
{ 219
45
41
336
286
75
67
355
0
0
13
248
28. SveicariaSi, jandacvis organizebaze sxvadasxva olqSi sxvadasxva aqcenti keTdeba. Sveicariis frangulenovani olqebis mTav28
CM(2003)130
roba CarTulia paliatiur mzrunvelobaSi, xolo germanulenovan da italiurenovan olqebSi, paliatiuri mzrunveloba kerZo
iniciativad aris miCneuli. 2000 wlisaTvis qveyanas gaaCnia 9
stacionaruli ganyofileba, 6 hospisi, 6 binaze movlis da 5 saavadmyofos mobiluri gundebi (2 maTgani sauniversiteto klinikaSi). medicinisa da paliatiuri mzrunvelobis sazogadoebis
2000 wlis angariSis Tanaxmad, paliatiuri mzrunvelobis swavleba samedicino da saeqTno saswavleblebSi Zalian gansxvavebulia; paliatiuri mzrunvelobis swavlebas sul eTmoba 8 saaTi;
ar tardeba gamocda, ganaTleba Zalian cvalebadia.
29. Sveicariis zemoTxsnebul angariSSi miTiTebulia ramodenime specifikuri barieri. maTgan pirvelia qveynis federaluri struqtura, romelic uaryofiT gavlenas axdens paliatiuri mzrunvelobis ganviTarebaze mimarTul aqtivobebsa da maT koordinaciaze; meore bariers warmoadgens specializaciis ar arseboba im
motiviT, rom, TiTqosda `Cven yvelam viciT ra aris paliatiuri
mzrunveloba~. mesame barieria biujetis SezRudvebi, romelic
aferxebs jandacvis iseTi axali sferos ganviTarebas, rogoricaa paliatiuri mzrunveloba.
30. binaze movlis specifikuri sakiTxebi:
- tradiciulad mraval regionSi Seicvala ojaxis struqtura;
- bevri xandazmuli adamiani cxovrobs marto da ver iqneba
ojaxis daxmarebis imedad;
- seriozulad daavadebulTa 50% upiratesobas aniWebs saxlSi
darCenas
- xSirad mTavar winaaRmdegobas warmoadgens finansuri resursebis nakleboba
31. angariSSi miTiTebulia ramodenime SemaSfoTebeli momenti: warmatebis sawyisi periodis Semdeg, SeicariaSi moxda paliatiuri
moZraobis blokireba. darCa ra ramodenime `pioneris~ pirad
iniciativad, dargma Semdgomi ganviTareba ver ganicada. Tumca,
zogierT olqSi (gansakuTrebiT vaudSi) paliatiuri mzrunveloba viTardeba yvela profesionalis konsensusis safuZvelze, rac
CM(2003)130
29
rTuli, magram gadamwyvetia. aseve SeSfoTebas iwvevs sazogadoebis jer kidev arasakmarisi informireba, rac ara mxolod
SveicariisaTvisaa damaxasiaTebeli.
32. ungreTSi, bolo wlebSi paliatiuri mzrunveloba mniSvnelovnad
ganviTarda. 1997 wels SemuSavda janmrTelobis dacvis kanoni,
romelic moicavda ra paliatiuri mzrunvelobis detalurad
damuSavebul rekomendaciebs, oficialurad aZlevda pacientebs
simptomebis marTvisa da naTesavebis wreSi cxovrebis uflebas;
kanonSi aRniSnulia, rom SesaZleblobis SemTxvevaSi, SeTavazebuli unda iqnas binaze movla, xolo naTesavebisa da ojaxis wevrebis mxardaWera da sulieri daxmareba misawvdomi unda iyos
yvelasaTvis.
33. jandacvis saministrosa da hospis-paliatiuri asociaciis mier
momzadda da gavrcelda profesionaluri saxelmZRvanelo, romlis sruli versia arcTu didi xnis win daibeWda.
34. 2001 wlis seqtemberSi, daiwyo hospisis eqTnebisa da koordinatorTa erTwliani saswavlo programa. 2001 wlisaTvis qveynis
gankargulebaSi iyo 4 hospisi (sul 55 sawolze); 14 binaze movlis gundi; 2 dRis movlis centri; 2 mobiluri gundi
(budapeStSi); ganyofilebebi 5 moxucebulTa saxlSi.
35. umaRles samedicino saswvleblebis studentebis programaSi 10
saaTi daTmobili aqvs tkivilisa da simptomebis marTvas,
daaxloebiT 30 saaTi fsiqo-socialur sakiTxebs. saeqTno saswavleblebSi arsebobs kvalifikaciis amaRlebis 80 saaTiani trening kursi; aseve kvalifikaciis amaRlebis trening kursi
eqimebisaTvis.
36. avstriaSi, 3 wlis win jandacvis politikis mier ganxiluli
iqna paliatiuri mzrunveloba da SemuSavebuli iqna gegma, sadac
miTiTebulia paliatiuri sawolebis saWiro raodenoba, romelTa
3/4-i misawvdomi iqneba 2005 wlisaTvis.
30
CM(2003)130
37. avstriaSi paliatiuri mzrunveloba ar aris aRiarebuli specialobad da specifikur kvalifikaciad. sul arsebobs 8
hospisi/ganyofileba, mTlianad 100 sawolze (2001).
38. 1998 wlidan paliatiuri mzrunvelobis sakiTxebze treningi warmoadgens eqTnebis saswavlo programis (kurikulumis) nawils.
xolo 2002 wlidan is gaxda eqimTa saswavlo programis nawili;
specialistTa trening programebSi, mciredi, Tumca mzardi
yuradReba eqceva paliatiur mzrunvelobas.
39. SeSfoTebis mizezs warmoadgens stacionaruli da binaze movlis
gundebis dafinanseba, ramdenadac jer kidev didia damokidebuleba SedarebiT arastabilur damxmare dafinansebaze.
gansazRvrebebi da ZiriTadi
principebi
40. rogorc aRniSnulia rekomendaciaSi, dokumentebSi gamoyenebulia
1991 - 2002 wlebSi paliatiur mzrunvelobasTan dakavSirebiT
janmo-s (jandacvis msoflio organizacia) mier mowodebuli da
paliatiuri mzrunvelobis sferos mier farTod mxardaWerili
gansazRvrebebi da aRwerilobebi.
41. gansazRvrebebisa da principebis ganxilvamde mniSvnelovania
aRvniSnoT, rom paliatiuri mzrunveloba ar unda iqnas miCneuli
jandacvis sxva sferoebisa da formebisagan Zireulad gansxvavebul sferod. aseTi Zireuli gansxvaveba ara marto gaarTulebs,
aramed SeuZlebelsac gaxdis mis jandacvis saerTo sistemaSi
integrirebas. paliatiuri mzrunvelobis bevri sakvanZo sakiTxi
aseve exeba kuraciul medicinasac. meore mxriv, akeTebs ra
aqcents zogierT iseT arasaTanadod Sefasebul elementze,
rogoricaa sulieri problemebi, paliatiuri mzrunvelobis
ganviTarebam SesaZloa dadebiTi gavlena iqonios jandacvis sxva
dargebzec.
CM(2003)130
31
gansazRvrebebi
42. paliatiuri mzrunvelobis gansazRvreba viTardeboda wlebis
manZilze, ramdenadac Tavad dargi viTardeboda sxvadasxva
qveyanaSi. paliatiuri mzrunveloba ganisazRvreba ara
organosTan, asakTan, daavadebis tipsa an paTologiasTan
mimarTebaSi, aramed SesaZlo prognozis Sefasebis, yoveli pacientisa da misi ojaxis wevrebis specifikuri saWiroebebis
gaTvaliswinebiT. tradiciulad, paliatiuri mzrunveloba
saWirod iTvleboda mxolod im momentSi, rodesac sikvdili gardauvali xdeboda. dRes miCneulia, rom paliatiur mzrunvelobas
gacilebiT metis SeTavazeba SeuZlia progresirebadi daavadebis
mimdinareobis adreul etapze.
43. termini paliatiuri mzrunveloba warmoiSva laTinuri `paliumi`-sagan, rac niSnavs `niRabs~, `mantias~. aseTi etimologia
miuTiTebs, rom paliatiuri mzrunveloba ZiriTadad warmoadgens
ukurnebeli daavadebis efeqtis SeniRbvas an `mantiiT maT dacvas, vinc siciveSi darCa~, maSin, rodesac SeuZlebelia daxmareba kuraciuli medicinis saSualebiT.
44. paliatiuri mzrunveloba moicavs yvela saxis paliatiur
Carevas, rac gulisxmobs daavadebis marTvaze mimarTul
Terapiebs: rogoricaa qirurgia, radioTerapia, qimioTerapia,
hormonaluri manipulaciebi da a.S. yvela aseTi Carevis saboloo
amocanas warmoadgens pacientis maqsimaluri reabilitacia da
sicocxlis saukeTeso xarisxis miRweva. amdenad, sasicocxlo
mniSvneloba aqvs paliatiuri mzrunvelobis programebis srul
integrirebas saavadmyofoebsa da saTemo dawesebulebebSi arsebul jandacvis programebSi. Sesabamisi mkurnalobis gansaxorcieleblad, individualurad, xSiri intervalebiT unda Catardes
mzrunvelobis rogorc simptomuri, aseve daavadebis marTvaze
mimarTuli RonisZiebebis Sedegebis Sefaseba, raTa SemuSavebuli
iqnas mkurnalobis optimaluri sqema.
32
CM(2003)130
45. msoflio jandacvis organizacia iZleva paliatiuri mzrunvelobis Semdeg gansazRvrebas: `paliatiuri mzrunveloba aris srulyofili, efeqturi mzrunveloba pacientze maSin, rodesac daavadeba aRar eqvemdebareba mkurnalobas. umTavresi xdeba tkivilisa da sxva simptomebis, fsiqologiuri, socialuri da sulieri problemebis kontroli. paliatiuri mzrunvelobis mizania
pacientebisa da maTi ojaxis wevrebis sicocxlis xarisxis gaumjobeseba~. (janmo 1990 w.)
46. aseTi gansazRvreba misaRebia, ramdenadac akeTebs ra aqcents adamianis mdgomareobis mravalaspeqtovan bunebaze, igi orientirebulia pacientze da sicocxlis xarisxis gaumjobesebas ganixilavs mTavar amocanad. zogierTi qronikuli mdgomareobis gankurnebis SeuZleblobis gamo termini `kuraciuli~-s gamoyeneba
gaumarTlebelia, Tumca mravali aTwleulis ganmavlobaSi igi
sicocxlis molodins ukavSirdeba.
47. situacia ganmarta doilma, rodesac dawera, rom `paliatiuri~
mzrunveloba fokusirebulia sicocxlis im ukanasknel wlebsa
Tu Tveebze, rodesac sikvdili ufro mosalodnelia vidre
SesaZlebeli.
48. janmos bolo periodis gansazRvrebebSi meti aqcenti keTdeba
tanjvis prevenciaze:
`paliatiuri mzrunveloba aris midgoma, romelic simptomTa
prevenciiTa da tanjvis SemsubuqebiT, adreuli aRmoCenis, Sefasebis,
tkivilis an sxva fizikuri, fsiqologiuri da sulieri problemebis mkurnalobis gziT aumjobesebs ukurnebeli seniT Sepyrobili
pacientebisa da maTi ojaxis wevrebs sicocxlis xarisxs.~
paliatiuri mzrunvelobis principebi
uaxlesi gansazRvrebis danarTis saxiT, janmo-m SeimuSava ZiriTadi
principebi, romlis mixedviTac paliatiuri mzrunveloba:
-
uzrunvelyofs tkivilisa da sxva simptomebis Semsubuqebas;
CM(2003)130
33
-
-
-
ganamtkicebs sicocxles da ganixilavs sikvdils normalur
procesad;
miznad ar isaxavs sikvdilis daCqarebas an gadavadebas;
axdens pacientze mzrunvelobis fsiqologiuri da sulieri
aspeqtebis integrirebas;
gvTavazobs pacientis daxmarebisa da gardacvalebamde aqtiuri cxovrebis wesis SenarCunebis sistemas;
gvTavazobs ojaxebisaTvis pacientis avadmyofobis periodSi
Seguebisa da gardacvalebiT gamowveuli mZime danakargis
dros daxmarebis sistemas;
pacientebisa da maTi ojaxebis saWiroebaTa dakmayofilebisaTvis, maT Soris mZime danakargis Sedegad saWiro konsultaciebis CaTvliT, gamoiyenebs gundur midgomas;
aumjobesebs sicocxlis xarisxs da SesaZlo dadebiT gavlenas axdens avadmyofobis mimdinareobaze.
misaRebia avadmyofobis adreul etapze sicocxlis gaxangrZlivebaze mimarTul sxva iseT TerapiebTan kavSirSi, rogoricaa qimioTerapia, sxivuri Terapia; moicavs klinikuri
garTulebebis ukeT gaazrebisa da marTvisaTvis saWiro kvlevas.
50. sasurvelia aRniSnuli ZiriTadi principebis Semdgomi dakonkreteba.
34
paliatiuri mzrunveloba did mniSvnelobas aniWebs tkivilisa
da sxva simptomebis marTvis optimaluri donis miRwevasa da
SenarCunebas. es moiTxovs yoveli pacientis detalur Sefasebas,
rac moicavs avadmyofobis anamnezs, fizikalur gasinjvas da
Sesabamis gamokvlevas. pacientebisaTvis misawvdomi unda iyos
yvela saWiro medikamenti, maT Soris opioidebis farTo speqtri,
rogorc es formulirebaSia mocemuli. moTxovnis SemTxvevaSi
aseve misawvdomi unda iyos daavadebis marTvaze mimarTuli
Terapiebi, romelTac aseve SeuZliaT sasargeblo simptomuri
sargeblobis motana.
CM(2003)130
paliatiuri mzrunveloba ganamtkicebs sicocxles da ganixilavs
sikvdils normalur procesad. es ZiriTadi principi mimarTulia
paliatiuri mzrunvelobasadmi damokidebulebis sirTuleebis
gaazrebaze. ZiriTadad, erTi ram, rasac yvela viziarebT aris
is, rom sikvdili gardauvalia. pacientebi, romelTac paliatiuri mzrunveloba esaWiroebaT, ar unda CaiTvalon `medicinis
marcxad~. paliatiuri mzrunveloba eZiebs gzebs, raTa gaamxnevos
pacientebi da uzrunvelyos sasargeblo, aqtiuri cxovrebis
wesis SenarCuneba gardacvalebamde.
paliatiuri mzrunveloba miznad ar isaxavs sikvdilis daCqarebas an gadavadebas. paliatiuri mzrunveloba ar aris da ar unda
iyos mimarTuli sicocxlis droze adre dasrulebaze. aseve
mniSvnelovania, rom Tanamedrove samedicino praqtikaSi arsebuli teqnologiebi ar gamoiyenebodes sococxlis arabunebrivi
gziT gagrZelebisaTvis. eqimebi ar unda iyvnen iZulebulni
ganagrZon mkurnaloba maSin, rodesac igi aSkarad usargeblo da
pacientisaTvis zedmetad mZimea. paliatiuri mzrunvelobis amocanas warmoadgens pacientisaTvis sicocxlis saukeTeso xarisxis uzrunvelyofa. im momentisaTvis, rodesac avadmyofobis procesi uaxlovdeba bunebriv bolos, pacients saSualeba unda hqondes miiRos srulyofili fizikuri, emociuri da sulieri daxmareba. gansakuTrebuli yuradReba eTmoba im faqts, rom paliatiuri mzrunvelobis arcerTi ganmarteba ar moicavs eftanazias da
eqimis daxmarebiT ganxorcielebul suicids. aRniSnulis gamo am
sakiTxze komiteti ar SeCerebula. ix. Tavi VIII
paliatiuri mzrunveloba aerTianebs pacientze zrunvis fsiqologiur da sulier aspeqtebs. ra Tqma unda sasicocxlo
mniSvneloba aqvs fizikuri movlis maRal xarisxs, magram
TavisTavad es sakmarisi ar aris. adamianis pirovneba ar unda
davakninoT martiv biologiur yofamde.
paliatiuri mzrunveloba gvTavazobs mxardaWeris sistemas,
romelic daexmareba pacients sicocxlis bolomde SeinarCunos
CM(2003)130
35
maqsimalurad aqtiuri cxovrebis wesi. amasTan mimarTebaSi
mniSvnelovania imis aRniSvna, rom miznebsa da prioritetebs
gansazRvravs Tavad pacienti. jandacvis profesionalebis rols
ki warmoadgens pacientebisaTvis daxmarebis gaweva maTi miznebis
miRwevaSi. naTelia, rom garkveuli drois Semdeg yoveli pacientis prioriteti SeiZleba sakmaod dramatulad Seicvalos. jandacvis profesionalebs unda esmodeT aseTi cvlilebebi da
Sesabamisad reagirebdnen maTze.
36
paliatiuri mzrunveloba exmareba ojaxs pacientis avadmyofobasa da gardacvalebasTan SeguebaSi. paliatiur mzrunvelobaSi
ojaxi aseve warmoadgens mzrunvelobis obieqts. ojaxis wevrebs
SesaZloa gauCndeT garkveuli sirTuleebi, risi gamovlenis Semdeg maT daxmareba unda gaewioT. mZime danakargis SemsubuqebisaTvis, daxmareba ar unda daiwyos mxolod pacientis gardacvalebis momentidan ix. Tavi VIII.
paliatiuri mzrunveloba saWiroebs koordinirebul gundur
muSaobas. aRniSnuli dasturdeba imiTac, rom arcerT pirovnebasa da arcerT disciplinas ar ZaluZs adekvaturi pasuxi gasces
yvela im rTul sakiTxs, romelic Cveulebriv paliatiuri mzrunvelobis periodSi wamoiWreba. da Tumca xSirad eqimisa da
eqTnis SemadgenlobiT momuSave ZiriTad gunds SeuZlia aucilebeli mzrunvelobis uzrunvelyofa, xSir SemTxvevaSi saWiro
xdeba medicinis da masTan dakavSirebuli sxvadasxva specialistis monawileoba. aseTi gundis SeTanxmebuli muSaobisaTvis
aucilebelia miznebis, amocanebis ganawileba da aseve komunikaciis efeqturi da swrafi saSualebebis arseboba. ix. Tavi VIII.
paliatiuri mzrunveloba miznad isaxavs sicocxlis xarisxis
gaumjobesebas. bolo wlebSi `sicocxlis xarisxi~-s sakiTxi mravali kvlevis sagani gaxda. mniSvnelovania vaRiaroT, rom igi ar
warmoadgens mxolod fizikuri komfortisa da funqcionirebis
sazoms, aramed aris is `raRac~, risi ganmartebac mxolod
TiToeul pacients SeuZlia da rac, SesaZloa mniSvnelovnad
Seicvalos droTa ganmavlobaSi.
CM(2003)130
paliatiuri mzrunveloba misaRebia daavadebis adreul periodSic, daavadebis marTvasa da sicocxlis gamaxangrZlivebel sxva
TerapiebTan kavSirSi. istoriulad, paliatiuri mzrunveloba
asocirdeboda sasikvdilod ganwirul onko pacientebze mzrunvelobasTan. aRiarebulia, rom paliatiur mzrunvelobas gacilebiT metis SeTavazeba SeuZlia pacientebisa da maTi ojaxis
wevrebisaTvis daavadebis adreul etapebze, Tundac im momentidan, rodesac daavadeba ukurnebeli xdeba da misi progresirebis
SeCereba SeuZlebelia. yovelive aRniSnuli moiTxovs, rom paliatiuri mzrunveloba integrirebuli iqnas jandacvis samsaxurebis speqtrSi saavadmyofoebsa da Temze dafuZnebul dawesebulebebSi.
51. rogorc zemoTmoyvanili gansazRvrebebidan xdeba naTeli, paliatiuri mzrunveloba ar Semoifargleba romelime konkretuli
daavadebiT. efuZneba ra SesaZlo prognozsa da konkretul
saWiroebebs, igi potenciurad misaRebia yvela asakis pacientisaTvis.
52. terminaluri mzrunveloba aris paliatiuri mzrunvelobis kontiniumi da aRwers pacientis mdgomareobis marTvas maSin, rodesac sikvdili gardauvali xdeba da ramodenime saaTSi an dReSia
mosalodneli. araswori da umarTebuloa am terminis gamoyeneba
paliatiuri mzrunvelobis yvela elementis aRwerisaTvis.
53. paliatiuri medicina aris adekvaturi samedicino mzrunveloba
daavadebis aqtiuri, progresirebadi, Sorswasuli formis mqone
pacientze, romlis prognozi SezRudulia da mzrunvelobis
mTavar fokuss sicocxlis xarisxi warmoadgens. paliatiuri
medicina moicavs ojaxis interesebis gaTvaliswinebas pacientis
gardacvalebamde da Semdgom.
CM(2003)130
37
paliatiuri mzrunvelobis midgoma. jandacvis yvela profesionali
unda icnobdes paliatiuri mzrunvelobis umTavres principebs da
saTanadod iyenebdes maT.
zogadi paliatiuri mzrunveloba. aRiarebulia, rom jandacvis
zogierTma profesionalma, romelic eqskluziurad ar aris
CarTuli praqtikul paliatiur mzrunvelobaSi, unda gaiaros
damatebiTi treningi da kvalifikaciis amaRlebis kursi paliatiuri mzrunvelobis sferoSi. termini `zogadi paliatiuri mzrunveloba~ gamoiyeneba aseTi personalis saqmianobis aRwerisaTvis.
specializebuli paliatiuri mzrunveloba. specializebuli paliatiuri mzrunvelobis samsaxurebis ZiriTadi saqmianoba Semoifargleba paliatiuri mzrunvelobis uzrunvelyofiT. aseTi samsaxurebi Cveulebriv CarTuli arian gansakuTrebulad rTuli
saWiroebebisa da moTxovnebis mqone pacientebze mzrunvelobaSi.
amdenad, maTTvis saWiroa ganaTlebis ufro maRali xarisxi,
profesionalTa Stati da resursebi.
38
CM(2003)130
54. maSinac ki, rodesac e.w. aqtiuri, daavadebis marTvaze mimarTuli
mkurnaloba aRar aris efeqturi, paliatiuri mzrunveloba
SeiZleba iyos mzrunvelobis Zalian aqtiuri, intensiuri Terapiis eqvivalenturi forma, Tumca gansxvavebuli imisagan, rasac
vxvdebiT reanimaciul ganyofilebaSi. Cveulebriv, xSiria aqtiuri Careva iseT SemTxvevaSi, rogoricaa hiperkalcemiis mkurnaloba, tkivilis sxivuri Terapia, zurgis tvinis kompresiis
sisxldenis kupireba, sawyis stadiaze zeda Rru venis obstruqciis qimioTerapia, qirurgiuli Careva motexilobebis an
nawlavTa gauvalobis dros. aseve aqtiur moqmedebas moiTxovs im
pacientebTan da maT ojaxebTan muSaoba, romlebic progresirebad, danakargTan dakavSirebul Zlier da zogjer yovlismomcvel
tanjvas ganicdian. reabilitacia, zogadad miCneulia aqtiuri
paliatiuri mzrunvelobis erT-erT mniSvnelovan formad. (Doyle,
Hanks and , MacDonald 1998)
55. paliatiuri mzrunveloba aris ara mxolod aqtiuri, aramed proaqtiuric: misi mizania winaswar gaTvalos, SesaZleblobis SemTxvevaSi Seaferxos, magram yovelTvis mxedvelobaSi miiRos daavadebis procesSi wamoWrili SesaZlo axali problemebi.
56. ZiriTadi principebi, romelic paliatiuri mzrunvelobis samsaxurebis qvakuTxeds warmoadgens, fokusirebulia pacientebisa da
maTi ojaxebisaTvis sicocxlis saukeTeso xarisxis miRwevaze.
aRniSnuli moicavs: simptomebis kontrolze mkacr yuradRebas;
globalur midgomas, romelic iTvaliswinebs pirovnebis ganvlil cxovrebas da dRevandel mdgomareobas; momakvdavsa da
masTan dakavSirebul pirebze mzrunvelobas; pacientebTan, momvlelebsa da profesional kolegebTan mimarTebaSi Ria komunikacias.
57. irlandiaSi, jandacvis departamentma 1996 wels gamosca kibosTan
brZolis strategia. aRniSnul dokumentSi gamoikveTa ganviTarebadi paliatiuri mzrunvelobis samsaxurebis mier misaRebi
principebi:
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-
-
-
pacientebs unda SeeZloT gamoxaton sakuTari arCevani
imasTan dakavSirebiT, Tu sad miiReben mzrunvelobas da gaatareben sicocxlis ukanasknel periods.
samsaxurebi unda iyos Sesabamisad moqnili da imgvarad integrirebuli, rom advili iyos pacientis erTi dawesebulebidan
meoreSi gadayvana, misi klinikuri mdgomareobisa da piradi
arCevanis gaTvaliswinebiT.
saboloo mizans unda warmoadgendes yvela pacientisaTvis
specializebuli paliatiuri mzrunvelobis samsaxurebis
misawvdomoba yvelgan, sadac es saWiroa.
58. paliatiuri mzrunveloba aris sfero, sadac mravali eTikuri
sakiTxi wamoiWreba. maTi umetesoba medicinis sxva sferoebisaTvis damaxasiaTebeli sakiTxebis analogiuria. Tumca, zogierTi
sakiTxi, mag. sicocxlis bolo periodi, paliatiuri mzrunvelobis mniSnelovnad gamokveTil sakiTxs warmoadgens.
59. paliatiur mzrunvelobaSi arsebuli eTikuri principebis gaazreba emyareba im faqtis aRiarebas, rom ukurnebeli an terminaluri pacienti ar aris `biologiuri narCeni~, romelic mxolod
gautkivarebas saWiroebs; rom ukve aRarafris gakeTeba SeiZleba
da misi cxovrebis gaxangrZlivebas mniSvneloba aRar aqvs.
piriqiT, yoveli pacienti warmoadgens pirovnebas, romelic
saTanado urTierTobebis SemTxvevaSi, bolomde inarCunebs cxovrebiseuli zrdisa da miRwevebis aRqmis unars.
60. profesionalebi unda aRiarebdnen medicinis SezRudul SesaZleblobebs da Tavs ikavebdnen gadametebuli mkurnalobisagan.
mniSvnelovania kiTxvis qveS davayenoT iluzia, rom arsebobs
tkivilisa da tanjvis Semsubuqebis mxolod erTi gza: tkivilis
Sesusteba. aseve unda gvaxsovdes, rom ar SeiZleba `totaluri~
tkivilis (sikvdilis SiSi, daSorebis wuxili, martooba, realobis aRqmis sakiTxebi, SegrZneba imisa, rom xdebi zedmeti tvirTi
sxvebisaTvis) srulfasovani marTva mxolod samkurnalwamlo
saSualebebiT. aqedan gamomdinare, tkivilis dros analgetikebis
40
CM(2003)130
moqmedebis efeqturoba damokidebulia mkurnalobaSi pacientisaTvis mniSvnelovani fsiqologiuri momentebis CarTvaze.
61. biuCemfisa da Cildresis (Beauchamp and Childress 1994) mier
gansazRvruli Semdegi oTxi principis dacvisas, (damoukideblobis pativiscema, keTilganwyoba, àr avno~ da samarTlianoba)
iseve rogorc medicinis sxva sferoebSi, eqimebma da sxva mzrunvelebma, pacientTan da maT momvlelebTan erTad priorotetebisa da miznebis SeTanxmebiT, unda gamoavlinon pativiscema pacientis damoukideblobisadmi. ar unda iqnas ugulvebelyofili
pacientis ufleba, flobdes misTvis saintereso informacias, an
uari ganacxados mkurnalobaze.
62. mzrunvelebma unda daicvan balansi mkurnalobis upiratesobebsa
da sirTuleebs Soris (keTilganwyoba) da Seafason yoveli klinikuri gadawyvetilebis upiratesobis Tanmdevi riski (àr avno~)
imisaTvis, rom Tavidan iqnas acilebuli fuWi mkurnaloba, romelic ar emsaxureba arc daavadebis prevenciasa da mkurnalobas
da arc reabilitaciasa da tkivilis Semsubuqebas. aseve Tavidan
unda iqnas acilebuli is Carevebi, romlic Tumca iZleva garkveul Sedegebs, magram mTlianobaSi damRupvelia pacientis
janmrTelobisaTvis.
63. miuxedavad aRniSnulisa, paliatiuri mzrunvelobis sferoSi
SeiZleba arasakmarisi iyos samedicino eTikis zogad wesebze
damyarebuli is midgoma, romelic xasiaTdeba zemoaRniSnuli
oTxi principiT. bolo periodSi Camoyalibebuli midgomebi,
rogoricaa mzrunvelobis eTika (Tronto 1993) da zneobriobis
eTika (MacIntyre 1995) paliatiuri mzrunvelobisaTvis gansakuTrebiT Sesaferisad gvesaxeba. mzrunvelobis eTika aqcents
akeTebs adamianis mowyvlad da damokidebulebiT bunebaze. amdenad is amtkicebs, rom eTika exeba ara mxolod gadawyvetilebis
miRebas, aramed urTierTobebis xarisxis iseT maCveneblebs,
rogoricaa: uwyvetoba, gulaxdiloba, ndoba da saimedooba.
64. zneobriobis eTika akritikebs gadawyvetilebebze eTikur fokuCM(2003)130
41
sirebas pirovnebis Sexedulebebidan gamomdinare; igi yuradRebas
amaxvilebs xangrZlivi droiT zneobrivi moqmedebis mniSvnelobaze.
65. daavadebis Sorswasuli formis mqone da momakvdav pacientebs
aqvT samedicino daxmarebisa da pirovnuli daxmarebis miRebis
iseTive uflebebi, rogorc sxva pacientebs (mag. axlo naTesavis
sawolTan yofna). maT aseve aqvT ufleba miiRon an uaryon informacia da/an sadiagnostiko procedurebi, iseve rogorc mkurnaloba. mkurnalobaze uaris ufleba garantirebuli unda iqnas,
gansakuTrebiT maSin, rodesac samedicino CareviT SeuZlebelia
sikvdilis Tavidan acileba. mkurnalobaze uarma aranairad ar
unda moaxdinos gavlena paliatiuri mzrunvelobis xarisxze.
yvelaze mniSvnelovania, rom paliatiuri mzrunveloba pacientebs aZlevs tkivilis da tanjvis efeqturi Semsubuqebisa da
adamianuri Rirsebis SenarCunebis uflebas.
66. magaliTad mogvyavs paliatiuri mzrunvelobis is eTikuri principebi, romelic formulirebulia ungreTis hospisisa da paliatiuri mzrunvelobis asociaciis mier (Hegedüs 2000):
1.
paliatiuri mzrunvelobis gundis wevrebi pativs scemen pacientis damoukideblobas, aTanxmeben prioritetebsa da miznebs
pacientsa da mis momvlelebTan, ganixilaven mkurnalobis
alternatiul gzebs da erToblivad adgenen mzrunvelobis
gegmebs; ar umalaven pacientebs maTTvis saintereso informacias; akmayofileben mkurnalobis mimdinareobis Sesaxeb
informaciis miRebis saWiroebas da pativs scemen pacientis
survils uaris Tqvas mkurnalobaze.
2. paliatiuri mzrunvelobis gundis wevrebma unda awon-dawonon
mkurnalobis upiratesobebi da sirTuleebi (keTilganwyoba),
Seafason yoveli klinikuri gadawyvetilebis upiratesobis
Tanmdevi riski (àr avno~); gaacnobieron pacientis ufleba,
yvela SesaZlo resursis gamoyenebiT miiRos mzrunveloba
umaRlesi standartebiT; miiRon gadawyvetileba resursebis
CarTvisa da gadanawilebis Sesaxeb.
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3.
momakvdavi pacientis umTavresi uflebebia: samedicino daxmarebis ufleba, adamianuri Rirsebis ufleba, personaluri daxmarebis ufleba, tkivilisa da sxva simptomebis Semsubuqebis
ufleba, informirebulobis, TviT-gamorkvevisa da mkurnalobaze uaris Tqmis uflebebi.
4.
pacientebs ufleba aqvT miiRon detaluri informacia Semdeg
sakiTxebze: janmrTelobis mdgomareoba da samedicino
Sefaseba; SeTavazebuli gamokvlevebi da Careva; gamokvlevebisa da Carevis rogorc ganxorcielebis, aseve ganuxocieleblobis SemTxvevaSi potenciuri upiratesobebi da riskebi;
gamokvlevebisa da Carevebis savaraudo TariRi. pacients
ufleba aqvs miiRos gadawyvetileba: gamokvlevebsa da
Carevebze; alternatiul procedurebsa da meTodebze; mkurnalobasa da mosalodnel Sedegebze.
5.
pacientebs ufleba aqvT monawileoba miiRon gamokvlevebsa da
mkurnalobaze gavlenis mqone gadawyvetilebebis miRebaSi.
informirebuli Taxmobis miReba aris nebismieri samedicino
Carevis winapiroba.
6.
mkurnalobaze uaris Tqmis ufleba: Tu pacienti itanjeba
ukurnebeli avadmyofobiT, romelic Tanamedrove etapze
medicinaSi arsebuli codnis gamoyenebiT, Sesabamisi mkurnalobis SemTxvevaSic ki, mokle periodSi iwvevs sikvdils,
sicocxlis gamaxangrZlivebel da damxmare Carevebze uaris
TqmiT SeiZleba avadmyofobas mieces bunebrivi gziT mimdinareobis saSualeba. qmedunarian pirovnebas SeuZlia oficialurad (mag. ànderZi sicocxlis Sesaxeb~) ganacxados uari
sicocxlis gamaxangrZlivebel da damxmare Carevebze ukurnebeli daavadebis, TviTmovlis unaris dakargvisa da iseTi tkivilis arsebobis SemTxvevaSi, romelic mkurnalobas ar eqvemdebareba. pacenti uflebamosilia daasaxelos pirovneba, romelic misi qmeduunarobis SemTxvevaSi gamoiyenebs am uflebas.
ganacxadi SeiZleba gakeTdes nebismier dros. mkurnalobaze
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uaris Tqmis SemTxvevaSi pacientebs srulad unarCundebaT
tkivilisa da tanjvis Semsubuqebis ufleba.
7.
yovel qmedebasa da gadawyvetilebaze unda Sedges werilobiTi dokumenti.
d aw es eb u l eb eb i d a s am s axu reb i
dawesebulebebi
67. paliatiuri mzrunveloba SeiZleba ganxorcieldes sxvadasxva
dawesebulebaSi:
a.
b.
g.
d.
e.
saxli
kerZo klinika
moxucebulTa saxli
saavadmyofo
hospisi
68. paliatiuri mzrunveloba umetesad xorcieldeba saxlis
pirobebSi. maSinac ki, rodesac pacientebi institucionalur
dawesebulebaSi gardaicvlebian, isini paliatiuri mzrunvelobis
udides periods saxlSi atareben. paliatiuri mzrunvelobis
samsaxurebisaTvis mniSvnelovani Sedegebi aqvs qvemoT ganxilul
aspeqtebs.
69. ori aTeuli wlis win, gaerTianebuli samefodan miRebulma
angariSebma gavlena iqonia paliatiuri mzrunvelobis samsaxurebis ganviTarebaze. aRniSnul angariSebSi gansazRvruli iqna
paliatiuri mzrunvelobis Semdegi principebi:
paliatiuri mzrunvelobis umTavres princips warmoadgens
pacientisaTvis mzrunvelobis misawvdomoba nebismier dros misi
saWiroebebisa da arCevanis Sesabamis dawesebulebaSi. praqtikulad,
paliatiuri mzrunveloba nebismier garemoSi misawvdomi unda iyos
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CM(2003)130
yvela pacientisaTvis. rogorc es aRwerilia gansazRvrebebis TavSi,
paliatiuri mzrunvelobis mTavari principebis gacnoba jandacvis
yvela profesionalis pasuxismgeblobas warmoadgens. am miznis
misaRwevad aucilebeli iqneba paliatiuri mzrunvelobis samedicino da masTan dakavSirebuli profesionalebis momzadebis saswavlo
programebSi CarTva. aseve, jandacvis profesionalebs unda qondeT
saSualeba uwyveti profesiuli ganaTlebis programebis meSveobiT
aimaRlon kvalifikacia da SeiZinon saWiro unar-Cvevebi. ase rom, Tu
pacienti jandacvis profesionals mimarTavs konsultaciisaTvis
saavadmyofoSi, zogadi praqtikis qirurgiul ganyofilebaSi, kerZo
klinikaSi an sxva dawesebulebaSi, igi darwmunebuli unda iyos, rom
miiRebs misi mdgomareobis Sesabamis paliatiur mzrunvelobas.
70. aseve aRiarebulia, rom mzrunvelobis zogierTi dawesebulebebi,
romlebic eqskluziurad paliatiuri mzrunvelobis sferos ar
emsaxurebian, miizidaven im pacientebis did nawils, visac paliatiuri mzrunveloba esaWiroeba. amasTan dakavSirebiT cxadia,
rom paliatiur mzrunvelobaSi kvalifikaciis gacilebiT maRali
moTxovnileba eqnebaT zogierT kerZo klinikebs, moxucebulTa
movlis dawesebulebebsa da onkologiasTan dakavSirebul samsaxurebs. aRniSnul dawesebulebebSi momuSave Tundac zogierT
profesionals unda qondes SesaZlebloba gaiaros treningi da
miiRos damatebiTi gamocdileba paliatiur mzrunvelobaSi. aseve
mosalodnelia, rom isini daamyareben mWidro profesionalur
kavSirebs specializebuli paliatiuri mzrunvelobis specialistebTan. aseTi diferencirebis mTavari mizania pacientebis
specifikuri saWiroebis Sesabamisi eqspertizis doniT uzrunvelyofa.
samsaxurebi
71. paliatiuri mzrunvelobis araspecializebul da specializebul
samsaxurebs Soris gansxvaveba praqtikul xasiaTs atarebs. araspecializebuli an zogadsamedicino samsaxurebi paliatiur
mzrunvelobas uzrunvelyofen mis ZiriTad saqmianobad aRiarebis
CM(2003)130
45
gareSe. aseTi samsaxurebia: saubno saeqTno samsaxuri, zogadi
praqtikosebi, binaze movlis gundebi, zogadi Terapiuli palatebi da moxucebulTa saxlebi.
72. paliatiuri mzrunvelobis uzrunvelyofa umetesad xdeba, da
savaraudod ase iqneba yovelTvis, araspecializebuli samsaxurebis mier. xSir SemTxvevaSi araspecialisti profesionalebi
uzrunvelyofen mzrunvelobas specialistebis Carevis gareSe;
bevr sxva SemTxvevaSi araspecializebuli mzrunvelobis konteqstSi SeiZleba saWiro gaxdes specialistis CarTva. Tumca, mcirea im SemTxvevaTa ricxvi, rodesac mzrunveloba mTlianad specialistis mier unda ganxorcieldes.
73. araspecializebuli samsaxurebi aseve moicavs mxolod garkveul
SemTxvevebSi CarTul iseT momsaxurebasac, rogoricaa
qimioTerapia, sxivuri Terapia da qirurgiuli Careva. aRniSnul
samsaxurebs zogjer aqvT pacientTa rigi, rac gansakuTrebiT
damRupvelia paliatiuri mzrunvelobis pacientebisaTvis, ramdenadac Zalze mcirea is sasicocxlo periodi, rodesac mkurnalobas garkveuli Sedegebi moaqvs. amdenad, paliatiuri pacientebisaTvis daxmarebis misawvdomobis uzrunvelyofisaTvis
SemoTavazebuli iqna e.w. `paliatiuri avtobusis sagzao xazi~-s
koncefcia.
74. bolo wlebis ganmavlobaSi paliatiuri mzrunvelobis koncefcias meti yuradReba daeTmo saqmianobis iseT specifikur sferoSi,
rogoricaa intensiuri Terapiis ganyofileba.
75. araspecialists SeuZlia SeiZinos sakmarisi gamocdileba paliatiuri mzrunvelobis SedarebiT martiv sakiTxebSi, magram paliatiuri pacientebis SezRuduli raodenobis gamo (mag. holandiaSi, zogadi praqtikosebi weliwadSi saSualod 2-6 paliatiur
pacients xvdebian), ar xdeba paliatiur mzrunvelobaSi rTuli
SemTxvevebis marTvis gamocdilebis SeZena. im SemTxvevaSi, Tu
pacienti araspecialist profesionalTa zrunvis obieqtad rCeba,
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CM(2003)130
specialistTa daxmarebis karg SesaZleblobas iZleva xelmisawvdom sakonsultacio samsaxurebTan urTierToba.
76. specializebulia samsaxurebi, romlTa saqmianoba mTlianad
paliatiur mzrunvelobas eZRvneba da romelTa gundebi specialurad arian momzadebulni mzrunvelobis am sferosaTvis. aseTi
samsaxurebi ar ikaveben mzrunvelobis im adgils, sadac momsaxurebas pirveli rigis profesionalebi ewevian (binaze movla,
saavadmyofo, sareabilitacio dawesebulebebi), Tumca yoveli
konkretuli situaciis sirTulisa da saWiroebebis Sesabamisad
daxmarebas uweven maT. aseTi samsaxurebis arsebobis pirobebSi,
pacientebs SesaZlebloba unda qondeT aucileblobis
SemTxvevaSi miiRon daxmareba nebismier dros, yovelgvari dagvianebis gareSe.
77. yvelaze gavrcelebul samsaxurebs warmoadgens secializebuli
stacionaruli ganyofilebebi, saavadmyofoebis paliatiuri
mzrunvelobis gundebi, binaze movlis gundebi, dRis movlis
dawesebulebebi, binaze hospitalizeba, poliklinikebi.
78. arsebobs mciredi pozitiuri mtkicebuleba, Tu ra saxis paliatiur mzrunvelobas aniWeben upiratesobas pacientebi.
mimoxilvaSi, vilkinsoni da sxvebi aRniSnaven zogad
saavadmyofoebTan SedarebiT specializebuli momsaxurebis upiratesobis tendencias, rogorc saavadmyofoebSi, aseve TemebSi.
(Wilkinson et.al 1999) aRniSnuli Sedegebis interpretacia garkveul sifrTxiles moiTxovs.
79. araspecialuri samsaxurebi moicavs:
- araformalur mzrunvelebs;
- volontiorebs (?);
- ubnis eqTnebs;
- arapaliatiuri mzrunvelobis specialistebs;
80. specialur paliatiur samsaxurebs warmoadgenen is samsaxurebi, romelTa mTavari saqmianoba paliatiuri mzrunvelobaa. maT
CM(2003)130
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esaWiroebaT maRali profesiuli unar-Cvevebis mqone personali
da pacientebisa da personalis Sesabamisi Sefardeba. aseTi samsaxurebi misawvdomi unda iyos yvela samkurnalo dawesebulebaSi; maT unda SeeZloT daxmarebis gaweva pacientisaTvis yvelgan, sadac ar unda iyos igi: saxlSi, saavadmyofoSi, kerZo
klinikaSi, dRis movlis centrebSi, poliklinikebsa da paliatiuri mzrunvelobis specialur centrebSi. aseve mniSvnelovani
roli eniWebaT specializebul paliatiuri mzrunvelobis samsaxurebs jandacvis im profesionalTa daxmarebaSi, vinc Tavad
axorcielebs paliatiur mzrunvelobas saavadmyofoebsa da
saTemo doneze. saWiroebis SemTxvevaSi, jandacvis yvela
profesionalisaTvis misawvdomi unda iyos paliatiuri mzrunvelobis gundis rCevebi da daxmareba.
81. specialuri paliatiuri mzrunvelobis umTavresi maxasiaTeblebi
aRwerili iqna gaerTianebulo samefos hospisis erovnuli
sabWosa da specialuri paliatiuri mzrunvelobis samsaxuris
mier da mxardaWerili iqna irlandiis paliatiuri mzrunvelobis erovnul sakonsultacio komitetis mier, rac Camoyalibebulia Semdegi saxiT:
-
-
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48
multiprofesionaluri, erTiani gunduri midgomiTa da
Sesabamisi unarCvevebis gamoyenebiT fizikuri, fsiqologiuri,
socialuri da sulieri daxmarebis aRmoCena;
multiprofesionaluri gundis profesionalTa jgufis erTi
lideri mainc unda warmoadgendes paliatiur mzrunvelobaSi
momzadebul da aRiarebul specialists;
pacientebi da maTi ojaxebi iReben daxmarebas da CarTuli
arian administrirebis procesSi;
pacientebs eZlevaT saSualeba airCion, Tu sad urCevniaT
mzrunvelobis miReba da sad surT sikvdili;
mzrunvelebi da ojaxebi iReben daxmarebas pacientis avadmyofobis periodSi da misi gardacvalebis Semdgom.
pacientebis dasaxmareblad, sadac ar unda imyofebodnen isini,
pirveladi jandacvis profesionalebs, saavadmyofoebisa da
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binaze movlis samsaxurebs Soris arsebobs TanamSromloba da
partnioroba;
aRiarebulia da dafasebulia volontiorTa wvlili;
paliatiur samsaxurebs rogorc pirdapir, aseve arapirdapir
eniWeba aRiarebuli akademiuri saganmanaTleblo da kvalifikaciis amaRlebis uzrunvelyofis roli.
SemuSavebulia ganaTlebis standartebi da uzrunvelyofilia
treningebi;
arsebobs mkurnalobisa da misi Sedegebis kvlevisa da klinikuri Sefasebis programebi;
arsebobs paliatiuri mzrunvelobis sferoSi sruli an arasruli droiT momuSave personalis saWiroebebis Sesabamisi
damxmare saSualebebi.
specialuri paliatiuri mzrunvelobis samsaxuris saStato moTxovnebi
82. aRiarebulia, rom paliatiuri mzrunveloba evropis qveynebSi
ganviTarebis sxvadasxva safexurze imyofeba. mTeli rigi faqtorebi, maT Soris ekonomikuri, gansazRvraven Statebis dakompleqtebis masStabsa da xelmisawvdomobas. Tumca, paliatiuri mzrunvelobis yvela samsaxurs unda yavdes Sesabamisi ganaTlebisa da
kvalifikaciis eqimebisa da eqTnebis Stati.
83. gaerTianebul samefoSi, paliatiuri mzrunvelobis samsaxurebisa da hospisis erovnuli sabWos rekomendaciiT, gaTvaliswinebulia Semdegi Statebis arseboba, iqneba es sruli droiT,
nawilobrivi an regularuli sesiebisaTvis:
-
fizikuri Terapevti;
okupaciuri Terapevti;
socialuri muSaki;
pacientebis, ojaxis wevrebisa da momvlelebis fsiqo-socialuri saWiroebebis mcodne, specialurad momzadebuli Stati;
axloblis gardacvalebiT gamowveuli
mZime danakargis
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SemTxvevaSi momsaxurebisaTvis momzadebuli Stati;
sulieri mzrunvelobis koordinatori;
enisa da metyvelebis Terapevti;
dietologi/samkurnalo kvebis specialisti;
damxmare Terapevti;
volontiori koordinatori;
ganaTlebis personali;
biblioTekari;
administraciuli, samdivno da zogadi damxmare Stati.
84. paliatiuri mzrunvelobis yvela samsaxurs rodi aqvs
SesaZlebloba daakmayofilos zemoTmoyvanili rekomendaciebi.
politika
85. specialuri paliatiuri mzrunvelobis samsaxurebi unda uzrunvelyofdnen momsaxurebis farTo speqtrs sxvadasxva dawesebulebaSi. samsaxurebis struqtura unda iZleodes mzrunvelobis erTi dawesebulebidan meoreSi pacientebis gadayvanis
SesaZleblobas, maTi saWiroebebisa da arCevanis gaTvaliswinebiT.
am ukanasknels miekuTvneba paliatiur mzrunvelobaSi specializebuli sxvadasxva dawesebulebebi, romlebic ar arian izolirebuli, aramed funqcionireben rogorc koordinirebuli, integrirebuli da mWidrod dakavSirebuli erTeulebi.
paliatiuri mzrunvelobis stacionaruli ganyofilebebi
86. aRniSnul dawesebulebaSi sawolebi gankuTvnilia paliatiuri
momsaxurebis miznebisaTvis. aseTi ganyofileba moiTxovs maRalkvalificiur, interdisciplinur gunds da gankuTvnilia SedarebiT ufro rTuli fizikuri, fsiqo-socialuri da/an sulieri saWiroebebis mqone pacientebisa da maTi ojaxebisaTvis. aRniSnuli
dawesebulebebi mWidrod unda iyvnen integrirebuli saavadmyofoebsa da Temze dafuZnebul samsaxurebTan. xSirad isini ganlagebuli arian zogadi profilis saavadmyofoebis bazaze.
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saavadmyofos bazaze arsebuli paliatiuri mzrunvelobis gundi
87. aRniSnuli termini aRwers situacias, rodesac specialuri
paliatiuri mzrunvelobis gundi funqcionirebs zogadi profilis saavadmyofoSi sakonsultacio da damxmare doneze.
Temze dafuZnebuli paliatiuri mzrunvelobis gundi
88. bevr pacients SesaZloa survili qondes mzrunveloba miiRos
sakuTar saxlSi, an im dawesebulebaSi, romelic misTvis saxlad
iqca, mag: moxucebulTa saxli, patronaJi sacxovrebeli adgilis
mixedviT da sxv. ewvevian ra aseT dawesebulebebs, specialuri
paliatiuri mzrunvelobis gundebi personals aZleven rCevebs
samuSaoTa warmarTvis Sesaxeb. konkretuli rTuli problemis
gadasaWrelad SeiZleba saWiro gaxdes zogierTi pacientis
gadayvana specialuri paliatiuri mzrunvelobis ganyofilebaSi.
aseT SemTxvevaSi maT eZlevaT ukan dabrunebis saSualeba.
dRis movlis dawesebulebebi
89. dRis movla SeiZleba xorcieldebodes stacionarebsa da aseve
kerZo klinikebSi, sadac pacientebi SeiZleba modiodnen kviraSi
erTi an ramodenime dRiT. maTTvis SeTavazebuli momsaxureba
SeiZleba iyos samedicino xasiaTis (sisxlis gadasxma, tkivilisa da simptomebis marTvis Sefaseba da sxv.) socialuri xasiaTis
(Sxapis, abazanis miReba), sareabilitacio (fizioTerapia/ okupaciuri Terapia). sarelaqsacio (masaJi) an garTobiTi xasiaTis
(xelovneba da xelosnoba). aseve, aseTi saxis dawesebulebebi momvlelebs droebiTi gamonTavisuflebisa da Sesvenebis saSualebas
aZleven.
dRis stacionarebi
90. dRis stacionaris tipis dawesebulebebi paliatiuri mzrunvelobis programis Rirebul elements warmoagenen.
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51
[Wilkinson EK § COL. pacientTa da momvlelTa arCevani da kmayofi-
leba paliatiuri mzrunvelobis specialuri modelebiT: literaturis meToduri mimoxilva. paliatiuri medicina 1999; 13:197-216]
91. specialur dRis stacionarebs Cveulebriv 10 - 15 sawoli
gaaCniaT da iReben pacientebs, romelTa tanjvis done (fizikuri/fsiqocosialuri/socialuri) droebiT an gardacvalebamde,
specializebul interdisciplinur paliatiur mzrunvelobas
moiTxovs. maT aseve eniWebaT saswavlo da kvleviTi funqcia.
aRniSnuli dawesebulebebi SeiZleba ganTavsdnen rogorc damoukideblad, aseve saavadmyofoSi, rac sxvadasxva specialistis
daxmarebis wvlilisa da xelmisawvdomi samedicino teqnologiebis gamoyenebis saSualebas zrdis. damoukideblad arsebobis
SemTxvevaSi, sasurvelia mWidro kavSirebis damyareba Sesabamisi
teqnologiebiT aRWurvil saavadmyofosTan.
92. specialuri stacionaruli ganyofilebis datvirTvis done nebismier dros unda uzrunvelyofdes pacientebis Seuferxebel
miRebas, gansakuTrebiT im pacientebisa, romelTac binaze mzrunveloba ukve miRebuli aqvT. bolo dromde, onkologiuri pacientebis paliatiuri mzrunvelobisaTvis saWiro sawolTa raodenoba Sefasebuli iyo rogorc 50 sawoli yovel milion mosaxleze.
Tumca, es monacemi, romelSic gaTvaliswinebuli ar aris arc
araonkologiuri pacientebis saWiroebebi da arc evropis mosaxleobis siberiT gamowveuli qronikul daavadebaTa mzardi gavrceleba, SesaZloa sanaxevrodac ar akmayofilebdes realur
saWiroebas. zogadad rom visaubroT, sawolTa raodenoba yovel
mocmul regionSi damokidebulia demografiul da socialurekonomikur konteqstze da sxva specialuri paliatiuri samsaxurebis misawvdomobaze (droebiTi movlis centri, binaze hospitalizireba da sxv.)
93. saavadmyofos paliatiuri mzrunvelobis gundebi, romelic
Cveulebriv Sedgeba paliatiur mzrunvelobaSi specializebuli
erTi eqimisa da erTi eqTnisagan mainc, magram xSirad aerTianebs
sxvadasxva specialists (socialuri muSaki, fsiqologi,
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mRvdeli, da a.S.), romlebic moqmedeben rogorc konsultantebi
mzrunvelobaSi monawile personalis, hospitalizirebuli pacientisa da misi naTesavebis moTxovnis safuZvelze. isini mWidrod
TanamSromloben sxvadasxva specialistebTan (eqimi, onkologebi,
sxivuri Terapevtebi da sxv), jandacvis sxva iseT profesionalebTan, rogoricaa socialuri muSaki, fsiqologi da aseve
mRvdeli. paliatiuri mzrunvelobis gundebi aseve asruleben
saganmanaTleblo funqcias.
94. binaze movlis gundebis funqciebi da moqmedebis meTodebi saavadmyofos gundis muSaobis msgavsia. pirvelad mzrunvelobaSi
monawile personalis Txovnis safuZvelze isini exmarebian
saxlebSi, kerZo klinikebsa da sxva saTemo dawesebulebebSi
mcxovreb pacientebs.
95. kvlevebSi aRwerilia mravali organizaciuli, fuqcionaluri da
finansuri winaaRmdegoba, rasac izolirebulad arsebuli saavadmyofo da binaze movlis gundebi xvdebian. umTavresia, aRniSnuli
gundebi funqcionirebdnen stacionarul ganyofilebSi, an ukidures SemTxvevaSi mWidrod iyvnen dakavSirebuli maTTan. aseve
uzrunvelyofili unda iqnas gundisaTis daxmarebisa da uwyveti
ganaTlebis miReba. aseTi saxis formalur Tu araformalur
kavSirebs mivyavarT pacientebze mzrunvelobis uwyvetobisaken.
96. dRis stacionarebi saxlSi myof pacientebs sTavazoben kviraSi
erT an ramdenime dRian mzrunvelobas. aseTi tipis dawesebulebebi ufro metad gavrcelebulia gaerTianebul samefoSi. arsebuli monacemebi gviCveneben did gansxvavebas maT funqciebsa da
moqmedebis meTodebs Soris. dRis stacionaris mizans SeiZleba
warmoadgendes: simptomTa Sefaseba; mkurnalobis sxvadasxva
formebis marTva keTilmosurne garemoSi; droebiTi Svebis
SeTavazeba pacientebis, naTesavebisa da mzrunvelobis pirveladi
gundebisaTvis, rac iZleva pacientis binaze datovebis da hospitalizebis Tavidan acilebis SesaZleblobas; fsiqologiuri daxmarebis uzrunvelyofa; pacientebisa da maTi naTesavebis sicocxlis xarisxis gaumjobesebaze mimarTuli damxmare midgomebis
gamoyeneba (art Terapia da sxv.)
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97. zogierT qveyanaSi, mag. safrangeTsa da fineTSi, samsaxurebi
`binaze hospitalizeba~ da `saavadmyofo binaze~ moicaven samedicino da saeqTno mzrunvelobis farTo speqtris uzrunvelyofas
binaze myofi im pacientebisaTvis, romlebic sxva SemTxvevaSi
hospitalizebuli unda yofiliyvnen. aseTi momsaxureba moicavs
saavadmyofosTvis damaxasiaTebel ufro srulyofil mzrunvelobas, vidre amas Cveulebriv binaze movlis gundebis momzadeba
uzrunvelyofs. arsebobs sxvadasxva organizaciuli modelebi,
dawyebuli binaze arsebuli resursebis gaumjobesebiT, damTavrebuli yvela saWiroebisaTvis specialuri gundis momsaxurebis uzrunvelyofiT.
98. dRis stacionarebi umetesad ganlagebulia saswrafo daxmarebis
klinikebSi. konsultaciebi ZiriTadad xorcieldeba klinikis mobiluri gundis mier, romelic uzrunvelyofs specialur konsultaciebs binaze myofi im pacientebisaTvis, romelTac SeuZliaT klinikaSi misvla.
99. satelefono daxmarebis xazi profesionalebs sTavazobs rCevebs
paliatiuri pacientebis movlis sakiTxebze da xels uwyobs specializebuli paliatiuri mzrunvelobis iseTi samsaxurebis
xelmisawvdomobas, rogoricaa mobiluri gundebi an stacionaruli ganyofilebebi. im oficialuri kavSirebis saSualebiT, romelic mas gaaCnia sxva profesionalebTan da volontiorebTan, is
aseve sTavazobs yovel spcifikur situaciasTan dakavSirebul
rCevebsa da daxmarebas. aseTi saxis damxmare satelefono xazebi Cveulebriv erTi regionis farglebSi arsebuli sxvadasxva
specializebuli samsaxuris TanamSromlobis Sedegs warmoadgens.
100. regionSi mzrunvelobis uzrunvelyofis xarisxi damokidebulia
ara marto TiToeuli samsaxuris mier SemoTavazebuli mzrunvelobis xarisxze, aramed samsaxurebs Soris arsebul TanamSromlobasa da specializebul dawesebulebebsa da pirvelad mzrunvelebs Soris arsebul koordinaciaze. koordinirebuli regionuli qselis saxiT samsaxurebis organizeba aumjobesebs palia54
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tiuri mzrunvelobis misawvdomobas da amaRlebs mzrunvelobis
xarisxsa da uwyvetobas. (Elsey and McIntyre 1996; Mitchell and Price
2001; Schroder and Seely 1998)
101. aseTi qselis muSaoba moiTxovs makoordinirebel organos an pirovnebas (aRniSnuli funqcia SeiZleba Sesrulebuli iqnas qselSi CarTuli sxvadasxva samsaxurebis warmomadgenel profesionalTa interdisciplinuri gundis, an stacionaruli ganyofilebis mier), pacientebisaTvis saWiro sxvadasxva donis mzrunvelobisaTvis Sesabamisi dawesebulebebis speqtrs (stacionaruli ganyofilebebi, droebiTi sawolebi, binaze hospitalizeba,
dRis stacionarebi, xangrZlivi mkurnalobis saavamdyofoebi,
saswrafo daxmarebis klinikebi), da damakavSirebel samsaxurebs
(mobiluri klinikebi da binaze movlis gundebi) (Zalot 1989).
aseTi saxis qseli sxvadasxva miznebs emsaxureba: axdens ra
mzrunvelobis koordinacias, mas aseve SeuZlia Seafasos misi
Sedegebi (Caataros auditi) da moaxdinos swavlebisa da kvlevis
koordinacia.
102 Seuferxeblad momuSave qselis Semadgeneli nawilebia:
-
miznebisa da xarisxis standartebis erToblivi dasaxva;
mzrunvelobis yvela doneze sayovelTaod cnobili, misawvdomobisa da tanjvis Semsubuqebis kriteriumebis gamoyeneba;
Sefasebis farTod aRiarebuli meTodebis gamoyeneba;
farTod aRiarebuli, SesaZleblobis SemTxvevaSi klinikur
kvlevaze dafuZnebuli Terapiuli strategiebis danergva.
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politika da organizeba
103. evrosabWos mravali wevri qveynis mier bolo aTwleulebSi SemuSavda paliatiuri mzrunvelobis, rogorc jandacvis sistemis
Semadgeneli nawilis, ganviTarebisa da ganxorcielebis yovlismomcveli erovnuli gegmebi.
104. magaliTisaTvis da ara misi, rogorc srulyofili variantis
SeTavazebis saxiT, gvinda movixsenioT sami aseTi saxelmwifo.
105. espaneTma SeimuSava paliatiuri mzrunvelobis gegma, romelic
miRebuli iqna jandacvis erovnuli sistemis interregionuli
sabWos mier The Plan Nacional de Cuidados Paliativos; Bases Para Su
Desarollo (18 December 2000). gegma iTvaliswinebs upiratesad
sazogadoebriv dafinansebaze myofi, saWiroebebze mimarTuli
paliatiuri mzrunvelobis SeTavazebas; jandacvis saxvadasxva
dones Soris koordinirebis xelSewyobas; Tanasworobis uzrunvelyofas, xarisxis, efeqturobisa da qmediTobis gaumjobesebas;
ufro zustad, gegmis mizania xeli Seuwyos sxvadasxva seqtorebs (ara jandacvis sferos) Soris interdisciplinur da koordinirebul muSaobas; yuradRebis gamaxvilebas paliatiuri
mzrunvelobis iseT yvelaze gavrcelebul formaze, rogoricaa
binaze movla; gaidlainebisa da standartebis SemuSavebas; profesionalebisa da ojaxis wevrebis ganaTlebis xelSewyobas.
ganaTlebasTan mimarTebaSi gegma ganasxvavebs sawyis, Sualedur
da umaRlesi ganaTlebis kompetenturobas. espanuri gegma aseve
moicavs misi Sefasebis mkafio aRwerilobas.
106. ungreTSi, jandacvis 1997 wlis kanoni moicavs paliatiuri
mzrunvelobis detalurad SemuSavebul rekomendaciebs, romelic
oficialurad aniWebs pacientebs simptomebis marTvisa da axloblebis garemocvaSi cxovrebis uflebas. SesaZleblobis SemTxvevaSi SeTavazebuli unda iqnas binaze movla; kanonSi mkafiod aris
aRwerili naTesavebis daxmarebis, ojaxisa da naTesavebis sulieri mxardaWeris sakiTxebi. ungreTis jandacvis saministrom da
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hospis-paliatiurma asociaciam dabeWda da gaavrcela profesionaluri saxelmZRvaneloebi (gaidlaini).
107. 1999 wels, irlandiaSi, janmrTelobisa da bavSvTa saministrom
daaarsa paliatiuri mzrunvelobis erovnuli sakonsultacio
komiteti, romelmac gamoaqveyna paliatiuri mzrunvelobis politikis aspeqtebis ganmazogadebeli rekomendacia, romelic
aseve exeba finansirebasa da saorganizacio sakiTxebs. aRniSnul
rekomendaciaSi paliatiuri mzrunveloba saxelmwifo dafinansebis calke sferod iqna gamoyofili. (National Advisory Committee
on Palliative Care 2001)
108. erovnul da regionul politikasTan dakavSirebuli dokumentebis umravlesobaSi didi yuradReba eqceva sazogadoebriv azrs,
saxelmwifos, profesiuli jgufebisa da arasamTavrobo organizaciebis rols sikvdilisa da gardacvalebis adekvaturi gagebis popularizaciisa da inkurabeluri daavadebis Sorswasuli
formis mqone pacientebze mzrunelobaSi. aseTi politikis
magaliTad evropis gareT SeiZleba CaiTvalos amerikuli proeqti `sikvdili amerikaSi~, romelic dafinansebuli iqna sorosis
fondis mier, sadac sikvdilisa da gardacvalebis Tema dadga samoqalaqo ganxilvis dRis wesrigSi iseTi sxvadasxva saSualebis
gamoyenebiT, rogoricaa sazogadoebrivi debatebi da Teatraluri warmodgenebi.
109. paliatiuri mzrunvelobis erovnuli da regionuli politikis
safuZvels pacientis saWiroebaTa codna warmoadgens. imisaTvis,
rom ganaviTaron da monitoringi gauwion paliatiuri mzrunvelobis erovnul strategiebs, qveynebs esaWiroebaT ZiriTad
monacemTa uwyveti Segroveba, monacemTa minimaluri nakrebi (mmn),
romelic mag. moicavs epidemiologiur, paliatiuri mzrunvelobis samsaxurebiT sargeblobis jgufebad dayofil detalur
monacemebs, aseve monacemebs sxvadasxva regionSi paliatiuri
mzrunvelobis samsaxurebis misawvdomobis Sesaxeb. mmn nawilobriv damokidebulia sxvadasxva qveynis specifikur sainformacio
saWiroebaze.
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110. zogierTi qveynis mier Catarebuli iqna saWiroebaTa Sefasebis
Seswavla. holandiis magaliTze, Catarebuli iqna saxelmwifos
mier dafinansebuli kvleva, romlis farglebSic ganxorcielda
Sorswasuli daavadebis mqone pacientTa mwvave da etapobrivi
saWiroebebis gansazRvris mcdeloba; aRniSnulis safuZvelze,
daarsda mzrunvelobisaTvis aucilebeli tipisa da xarisxis dawesebulebebi. mniSvnelovania e.w. monacemTa minimaluri nakrebis
gansazRvris is gamocdileba, romelic gvaZlevs saWiroebaTa
Sefasebis Catarebisa da monitoringisaTvis saWiro minimalur
monacemebs. (paliatiuri mzrunvelobis erovnuli sakonsultacio komiteti, 2001 w)
111. miuxedavad imisa, rom mwiria informacia sazogadoebis araprivilegirebuli wevrebisaTvis paliatiuri mzrunvelobis misawvdomobis Sesaxeb, komitetSi arsebobs mosazreba, rom usaxlkaro
adamianebs, SemecnebiTi SezRudvis mqone pirebsa da ltolvilebs
SesaZloa SeeqmnaT sirTuleebi am kuTxiT. arsebobs monacemebi,
rom eTnikuri umciresobebis warmomadgenlebi arasamkarisad
iReben paliatiur mzrunvelobas. es SesaZloa gamowveuli iyos
aRniSnuli kategoriis pacientebis Taviseburi damokidebulebiT
`sicocxlis bolos mzrunvelobisadmi~, rac maTi kulturis
moTxovnebiT aris ganpirobebuli.
112. inkurabeluri da sicocxlisaTvis saSiSi davadebis mqone
bavSvebi gansakuTrebulad saWiroeben paliatiur mzrunvelobas,
rac yvelaze xSirad saxlis pirobebSi xorcieldeba; Tumca arsebobs imis SemaSfoTebeli monacemebi, rom bavSvebisaTvis paliatiuri mzrunveloba arasakmarisadaa misawvdomi (Clark 2002;
Mabrouk 2001). bavSvebs esaWiroebaT pedagogiuri profilis treningze momzadebuli personalis (gansakuTrebiT eqTnebis) mier
ganxorcielebuli specialuri momsaxureba, rasac Tan unda
erTvodes binaze movla, romelic daexmareba bavSvebsa da maTi
ojaxis wevrebs.
113. bevr qveyanaSi, paliatiuri mzrunveloba sazogadoebisaTvis
ucnobia an SezRudulia iseTi negatiuri gagebis gamo, rogori58
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caa fatalizmi. aman SesaZloa gamoiwvios sazogadoebrivi yuradRebis nakleboba, rac TavisTavad gamoiwvevs mag. moxaliseTa
organizaciebSi gawevrianebis arasakmaris interess. sazogadoebrivi interesis naklebobam aseve SeiZleba gamoiwvios sikvdilisa da gardacvalebis Semdgomi marginalizacia.
114. arsebobs monacemebi, romlis mixedviTac, paliatiuri mzrunvelobis misawvdomoba damokidebulia daavadebaze (onko pacientebs
aqvT meti misawvdomoba), da aseve socialur-ekonomikur faqtorebze. ufro metic, zogierT qveyanaSi, intensiuri terminaluri
mzrunvelobis misawvdomoba Semoifargleba mxolod im
pacientebiT, romelTa limitirebuli sasicocxlo prognozi
daaxloebiT 3 Tves Seadgens. aseTi SezRudvebi TiTqmis yovelTvis iwvevs did problemebs maSin, rodesac pacientebi sawyis
prognozze gacilebiT didxans cocxloben da maRali xarisxis
paliatiur mzrunvelobas saWiroeben.
115. farmakologiuri Careva warmoadgens simptomebis kontrolis safuZvels. adekvaturi samedicino mkurnalobis SemTxvevaSi
gacilebiT advilia tanjvis iseTi aspeqtebis Semsubuqeba, rogoricaa mZime daavadebiTa da gardacvalebiT gamowveuli socialuri cvlilebebi, sulieri saWiroebebi. Tumca, zogierT qveyanaSi
SesaZloa arsebobdes materialur-teqnikuri uzrunvelyofisa da
efeqturobis problemebi adgilobrivi jandacvis ganyofilebebis
doneze. aseve erovnul da adgilobriv doneze unda iqnas ganxiluli Sesabamisi farmakologiuri mkurnalobisaTvis saWiro
finansuri mxardaWeris sakiTxi
116. narkotikuli tkivilgamayuCeblebis arasakmarisi misawvdomoba
gansakuTrebul SeSfoTebas iwvevs maSin, rodesac es ganpirobebulia sakanonmdeblo SezRudvebiT, rogorc sxvadasxva opioidebis gamoyenebis, aseve maTi dozebis sxvadasxvaobis reJimebis
mixedviT. morfini aris yvelaze xSirad gamoyenebadi opioidi.
kiboTi gamowveuli tkivili yvelze mgrZnobiarea opioidebze,
magram sxva analgezuri medikamentebis efeqti damokidebulia
maT dozirebaze, rac niSnavs, rom ar arsebobs standartuli
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doza yvelasaTvis, igi SeiZleba icvlebodes dReSi aTidan ramodenime aTas mg-mde. (Foley 1995; Folley 1996) misawvdomi unda iyos
sxvadasxva opioidTa gamoyeneba, ramdenadac efeqturobisa da
gverdiTi movlenebis mimarT individualuri damokidebulebis
pirobebSi SesaZloa saWiro gaxdes erTi medikamentis meoreTi
Secvla. (Indelicato and Portenoy 2002)
117. tkivilis marTvisaTvis opioidebis adekvaturad gamoyenebis
SemTxvevaSi ar arsebobs wamalze damokidebulebis mavne Cvevis
Camoyalibebis problema. janmo-sa da evropis paliatiuri asociaciis mier (EAPC) gamocemuli iqna tkivilis marTvisa da mkurnalobis saxelmZRvanelo (gaidlaini) (Hanks et al. 2001; World
Health Organization. 1990)
118. federalur, erovnul da regionul gegmebSi gansakuTrebuli
yuradReba unda mieqces pacientebis iseT umciresobaTa kategoriebs, rogoricaa institucionalizebuli SezRuduli SesaZleblobis mqone pirebi, bavSvebi, patimrebi da sxv. maTTvis nebismier dros da ara aucileblobis SemTxvevaSi uzrunvelyofili
unda iyos sxvadasxva specialuri dawesebulebebis misawvdomoba,
sadac isini miiReben maTi specifikuri saWiroebebis Sesabamis
mzrunvelobas.
x a r i s x i s g a u m jo b e s e b a d a k v l e v a
xarisxis gaumjobeseba
119. zogadad, paliatiur mzrunvelobaSi momsaxurebis xarisxis gaumjobeseba ar gansxvavdeba jandacvaSi xarisxis gaumjobesebisagan,
rogorc es aRwerilia evrosabWos rekomendaciebSi R(97) 17 da
mis danarTebSi.
120. Tumca paliatiuri mzrunvelobis zogierTi specifikuri ganzomileba (pacientis arCevanis umTavresoba; ojaxi, rogorc mzrunvelobis erTeuli; sulieri da egzistencialuri sakiTxebis
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mniSvneloba da ara profesionalTa monawileoba) ganapirobebs
paliatiuri mzrunvelobis xarisxis gaumjobesebisa da marTvis
aspeqtebis specifikurobas (ix. Tavi 1)
121. mTlianobaSi, samedicino dargSi erT-erT mTavar inovacias mtkicebulebaze damyarebuli klinikuri gaidlainebis SemuSaveba warmoadgens. paliatiuri mzrunvelobis gaidlaini mravali qveynis
mier iqna SemuSavebuli. Tumca, paliatiuri mzrunvelobis aRiarebuli Carevebis SedarebiT susti mtkicebulebiTi baza
saerTo saxelmZRvanelo meTodikis SemuSavebis mTavar winaaRmdegobas warmoadgenda. sabednierod, mtkicebulebaze damyarebuli gaidlainebis popularizaciis yvelaze mniSvnelovan saerTSoriso organizacias, koxreinis TanamSromlobas (Cochrane
Collaboration) gaaCnia paliatiuri medicinis seqcia.
122.mzrunvelobis xarisxis uwyveti gaumjobeseba SeiZleba ganisazRvros, rogorc SeTavazebuli momsaxurebis Sefasebisa da gaumjobesebis sistematiuri procesi.
123. paliatiur mzrunvelobaze specialzirebul bevr dawesebulebaSi jer kidev SezRudulia mzrunvelobis xarisxis Sefasebis
procedurebi. amis gamo am sferoSi literatura arasrul monacemebs gvTavazobs.
124. arsebobs xarisxis Sefasebis araadekvaturobis mravali mizezi.
sxva sakiTxebTan erTad, xarisxis SefasebisaTvis saWiroa meTodologiuri unar-Cvevebi da logariTmuli resursebi, rac miuwvdomelia mcire dawesebulebebisTvis. Sefasebis procedurebis
ganxorcieleba moiTxovs xarisxis standartebis gansazRvras,
paliatiuri mzrunvelobis konteqstSi Sefasebis iseTi modelebis gamoyenebas, rogoricaa multidisciplinuri auditi da
Sedegebis sazomi Sesabamisi saSualebebi.
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Photo: Jacob Forsell, Sweden
125. Catarebuli Sefaseba SesaZloa moicavdes im demografiul, administraciul da diagnostikur monacemebs, romelic uzrunvelyofs standartul informacias im pacientebis Sesaxeb, romelTac
mzrunveloba utardebaT. isini SeiZleba warmoadgendnen ufro
rTul sazom erTeulebs, romelTa gamoyenebiT xdeba xarisxis
ganzomilebaTa Sefaseba. amJamad misawvdomTagan zogierTi SemuSavebuli da dadasturebuli iqna specialurad paliatiuri
mzrunvelobis sferoSi, mag. damxmare gundis Sefasebis ganrigi
(Support Team Assesement Schedule) edmontonis simptomTa Sefasebis sistema (Edmonton Symptom Assesement System) an paliatiuri mzrunvelobis SedegTa Skala (Palliative Care Outcome Scale).
Mag (Bruera et.al.1991; earn and Higginson 1999; Higginson and
McCarthy 1993)
126. aRniSnuli sazomi erTeulebi sasargebloa ara marto xarisxis
Sefasebis procesisaTvis, aramed yoveldRiuri klinikuri praqtikisaTvis. aseT SemTxvevaSi axali saSualebebis gamoyenebas
jobia arsebuli da Sefasebuli xerxebis gamoyeneba.
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127. mniSvnelovania xarisxis standartebis SemuSaveba da maTi gavrceleba paliatiur mzrunvelobaSi specializebul yvela dawesebulebaSi. mravali samsaxurisa da klinikuri Sefasebis auditi
damokidebulia aRniSnuli standartebis arsebobaze, romelTa
Sesabamisad SesaZlebelia praqtikis Sefaseba. standarti aris
mzrunvelobis specifikur sferoSi arsebuli `kargi praqtikis~
identificireba.
128. standartebi SeiZleba SemuSavdes saxelmwifo da regionul/adgilobriv doneze. saxelmwifo done uzrunvelyofs ganviTrebisa da monitoringis mkafio strategias, izogeba dro da
energia. regionuli/adgilobrivi done iZleva erovnuli standartebis regionisa Tu dawesebulebisaTvis specifikur maxasiaTebelebTan mimarTebaSi adaptaciis saSualebas. saukeTeso midgomas warmoadgens am ori momentis kombinacia.
129. xarisxis standartebis wardgenas, misi maqsimaluri dasabuTebisa da iuridiuli Zalis uzrunvelyofisaTvis, win unda uswrebdes rac SeiZleba farTo konsultaciebi sakiTxze momuSave yvela partniorTan. zogierTma qveyanam SeimuSava standartebi,
romelic SeiZleba gamoyenebuli iqnas ganxilvis safuZvlad maTTvis, visac igi jer ar gaaCnia.
130. rogorc es miTiTebulia higinsonisa da sxvebis naSromSi, auditis teqnika paliatiuri mzrunvelobis sferoSi, kerZod specialuri multidisiplinuri gundebisaTis Sefasebis gansakuTrebuli meTods warmoadgens.
131. pacientsa da mis axloblebze orientirebuli es meTodi iZleva
momsaxurebis rogorc klinikuri, aseve araklinikuri aspeqtebis
Sefasebis saSualebas. mis mizans warmoadgens ara marto xarisxis gaumjobesebis mudmivi kontroli, aramed analizis procesSi
CarTuli profesionalebis momzadebac.
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63
kvleva paliatiur mzrunvelobaSi
132. ramdenadac kvlevis mTavar mizans warmoadgens (an unda warmoadgendes) pacientze mzrunvelobis xarisxis gaumjobeseba, calke
Tavis miZRvnis nacvlad, aRniSnul sakiTxs xarisxTan mimarTebaSi
ganvixilavT.
133. adreul wlebSi, kvleva paliatiuri medicinisa da mzrunvelobis
ganviTarebis umTavres da prioritetul nawils warmoadgenda.
paliatiuri medicina iseve unda iyos damyarebuli mtkicebulebebze, rogorc medicinis sxva sferoebi.
134. kvlevis Sedegebis safuZvelze mniSvnelovani progresi iqna miRweuli tkivilisa da simptomebis marTvis sferoSi. kvleva aseve
swrafad viTardeba medicinisa da jandacvis samsaxurebis sxva
sferoebSi, Tumca mimdinare da momavali problemebi jer kidev
saWiroeben Semdgom Seswavlas. paliatiuri mzrunvelobis praqtikis umetesi nawili dafuZnebulia epizodur da/an istoriul
faqtebze da ara mecnierul meTodebsa da mtkicebulebebze. miuxedavad imisa, rom komitetis mizans ar warmoadgens mkurnalobaSi SemoqmedebiTi midgomisa da aratradiciuli meTodebis
gamoyenebis mniSvnelobis daknineba, igi miiCnevs, rom saWiroa
masStaburi kvlevebis Catareba, raTa moxdes realurad sasargeblos usargeblosagan gamorCeva.
135. paliatiur mzrunvelobaSi kvlevis SedarebiTi simwire SeiZleba
aixsnas mravali faqtoriT, maT Soris imiTac, rom SezRudulia
kvleviTi muSaoba am jgufis pacientebSi. Cven unda ganvixiloT
paliatiuri mzrunvelobis kvlevasTan dakavSirebuli lojistikuri, demografiuli, akademiuri faqtorebi da specifikuri
eTikuri problemebi.
136. pacientebis SerCeva da aRniSnul kvlevaSi maTi CarTva sakmaod
rTulia paliatiuri mzrunvelobis realuri bunebidan gamomdinare. ramdenadac kvleva tardeba hospisebsa da stacionarul
ganyofilebebSi, maTi mcire moculoba aferxebs kvlevas. ufro
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metic, pacientebi, romelTa mdgomareobis stabiluroba kvlevaSi
monawileobis
miRebis
saSualebas
iZleva,
aRniSnul
dawesebulebebSi mxolod mcire droiT rCebian, xolo is pacientebi, romelTa mdgomareoba moiTxovs ufro xangrZlivi droiT
iq darCenas, imdenad mZimea, rom bevr maTgans ar SeuZlia im
damatebiTi tvirTis atana, rac kvlevas axlavs Tan. yovelive
aRniSnulis Sedegad, mxolod zogierT pacients SeuZlia miiRos
monawileoba Sesabamisi kvlevis CatarebaSi drois saWiro
monakveTSi.
137. zemoTaRniSnulTan erTad, arsebobs specifikuri klinikuri faqtorebi, romlebic kidev ufro arTuleben kvlevas am sferoSi.
pacientebi umTavresad asakovani adamianebi arian, romelTa mdgomareoba garTulebulia ramodenime organos dazianebiT, rasac
Tan axlavs Tanmdevi simptomebi. daavadeba aris progresirebadi,
simptomebi ki swrafad cvalebadi, gansakuTrebiT terminalur
stadiaSi; sasicocxlo vada SezRudulia da mravali medikamentis gamoyeneba Cveulebriv movlenas warmoadgens.
138. aRniSnuli sxvadasxva faqtorebi moiTxoven kvlevis srulyofil
meTodologias, romlis sqema maqsimalurad iqneba miznebze morgebuli. sqema SeiZleba iyos rogorc xarisxobrivi, aseve raodenobrivi. paliatiur mzrunvelobaSi fsiqosocialuri da emociuri sakiTxebis mniSvnelobidan gamomdinare, umetesad misaRebia
xarisxobrivi midgoma. sabednierod kvlevis xarisxobrivi
meTodebi samedicino mecnierebaSi sul ufro metad aRiarebuli
xdeba. Tumca, meTodologiuri codna ar aris sakmarisi aseTi
seriozuli problemis gadaWrisaTvis.
139. bevr qveyanaSi paliatiuri medicina da mzrunveloba ar aris
gamoyofili calke disciplinad, aramed miCneulia mkurnalobis
filosofiad, sadac aqcenti keTdeba adamianis pirovnebaze. mcirea kavSirebi akademiur organizaciebTan, dabalia am organizaciebis mier paliatiuri mzrunvelobis, iseve rogorc jandacvis
sxva sferoebis prioritetulobis aRiareba. swored am mizezis
gamo erovnuli kvleviTi fondebis umetesoba paliatiur mzrunCM(2003)130
65
velobas an ar miiCnevs kvlevis cakle sferod, an ar aRiarebs
mis prioritetulobas da Sesabamisad naklebadmisawvdoms xdis
dafinansebas.
140. paliatiur medicinaSi kvlevis Semaferxebel sxva SesaZlo barierebs warmoadgens: Sefasebis erTiani meTodikebis nakleboba da
aseTi meTodikebis arasakmarisad gamoyeneba. paliatiuri medicinis arazusti gansazRvreba; yuradRebis nakleboba farmakologiuri kompaniebis mxridan, garda misi iseTi zogierTi momgebiani
seqtorebisa, rogoricaa analgezia; koordinaciis nakleboba
paliatiuri mzrunvelobis kvlevis sferoSi momuSave centrebs
Soris.
141. Catarebuli iqna kvleva terminaluri pacientebis gamokiTxvis
eTikur sakiTxebTan dakavSirebiT, gansakuTrebiT pacientTa im
jgufis mimarT, romelTac ar aqvT SesaZlebloba miiRon monawileoba gadawyvetilebis miRebaSi (SemecnebiTi darRvevebis
maRali maCvenebeli) da/an ganacxadon Tavisufali da informirebuli Tanxmoba. (damokidebuleba im dawesebulebaze, sadac isini
mzrunvelobas iReben, grZnobebisa da madlierebis Sesaxeb).
(Grande and Todd 2000; Hardy 1997; Kaasa and De Conno 2001). Tumca,
umetesoba aRniSnul problemebs ar ganixilavs mxolod paliatiuri medicinis problemad da miiCnevs, rom isini medicinis
sxva sferoebSic gvxvdeba. (heriatria, intensiuri mkurnaloba da
sxv) Sedegad, ar arsebobs paliatiuri pacientebis calke kategoriad gamoyofis aucilebloba da maT mimarT helsinkis
aRiarebuli eTikuri kodeqsisagan gansxvavebuli eTikuri normebis gamoyeneba. (Crigger 2000). paliatiuri mzrunvelobis sferoSi
kvlevebi unda Seesabamebodes klinikuri kvlevis sferoSi
miRebul yvela eTikur normebs da aRiarebuli unda iqnas regionuli da instituciuri eTikuri komitetis mier.
142. gansakuTrebuli yuradReba unda mieqces kvleviTi proeqtis im
riskebisa da upiratesobebis Sefasebas, romelic SeiZleba gansxvavdebodes daavadebis progresirebis sxvadasxva stadiaze.
mzrunvelobis amocanebi icvleba terminalur stadiaze, rodesac
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sicocxlis gaxangrZlivebasTan SedarebiT upiratesoba sicocxlis xarisxs eniWeba. aseT SemTxvevaSi gansakuTrebuli mniSvneloba aqvs iseTi faqtorebis gaTvaliswinebas, romelTac umetesad ar aqvT biologiuri safuZveli, mag. rogoricaa pacientebisaTvis daniSnulebis modificireba.
143. miuxedvad evropis paliatiuri medicinis asociaciis (EAPC)
mcdelobisa, xeli Seuwyos TanamSromlobas, jer kidev arsebobs
TanamSromlobis nakleboba evropis qveynebSi paliatiuri mzrunvelobis kvlevis sferoSi momuSave profesionalTa Soris.
profesionalTa da volontiorTa
ganaTleba da treningebi
144. paliatiuri mzrunvelobis ganviTarebisaTvis udidesi mniSvneloba eniWeba profesionalTa da sazogadoebis ganaTlebas. bevr
qveyanaSi gansazRvrulia ganaTlebis sami done: sawyisi done, romelic unda miiRos jandacvis yvela profesionalma; Sualeduri
done, romelic unda miiRos paliatiur medicinaSi specifikuri
kvalifikaciis miRebis msurvelma profesionalma (paliatiuri
medicinis eqspertis statusis miRebis gareSe) da umaRlesi done
maTTvis, visac surs gaxdes paliatiuri mediciis specialisti.
145. sabaziso sauniversiteto kursi profesionalebisaTvis aris is
pirveli periodi, rodesac studentebi Seiswavlian paliatiur
mzrunvelobas. bevrma profesiulma organizaciam, rogoricaa
gaerTianebuli samefos eqimTa samefo koleji, evropis paliatiuri mzrunvelobis asociacia, SeimuSava saswavlo programebi
(kurikulumi). miuxedavad simwirisa, eqimTa sabazo sauniversiteto gamocdileba naTlad miuTiTebs, rom gamarTlebulia studentebisaTvis paliatiuri mzrunvelobis aspeqtebis sawvleba.
naklebad aris cnobili informacia saeqTno da sxva arasamedicino profesiebis studentebisaTvis sabaziso saswavlo programebis efeqturobisa da ganxorcielebadobis Sesaxeb.
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67
146. paliatiuri mzrunvelobis saswavlo programebSi mniSvnelovani
adgili ukavia im eTikur dilemebs, romelTa gadawyveta uwevT
rogorc profesional, aseve araprofesional momvlelebs. aseT
programebSi gansakuTrebuli yuradReba eqceva studentTa mier
pirovnuli Rirebulebebis gacnobierebas, mag. sicocxlis
dasrulebasTan dakavSirebul sakiTxebTan da im gavlenasTan
mimarTebaSi, rasac igi axdens mzrunvelobaze. aRniSnul
sakiTxebTan dakavSirebiT gansakuTrebiT misasalmebelia gulaxdiloba.
147. ganaTlebasTan dakavSirebul mniSvnelovan fsiqologiur aspeqtebs warmoadgens usiamovno ambis miwodeba, iseTi fsiqologiuri darRvevebis diagnozireba da mkurnaloba, rogoricaa wuxili, depresia da SfoTva. aseve saswavlo programis mniSvnelovan
nawils warmoadgens pacientis SemecnebiT unarSi cvlilebis
aRiareba. igive exeba pacientisa da misi ojaxis daxmarebis
saWiroebas.
148. ganaTlebis mniSvnelovan sakiTxs warmoadgens iseTi socialuri
aspeqtebi, rogoricaa pacientisa da misi ojaxis sacxovrebeli
pirobebi, socialuri da praqtikuli daxmarebis arseboba an
ararseboba.
149. paliatiur mzrunvelobaSi ganaTlebis yvelaze mniSvnelovan
tipiur sakiTxebs sulieri da kulturuli aspeqtebi warmoadgens. studentebma unda iswavlon pacientebisaTvis sicocxlis
bolo periodSi am sakiTxebis mniSvneloba, gaigon maTi
saWiroebebi da gauwion adekvaturi daxmareba.
150. aRiarebs ra dadgenil moTxovnebs, gunduri muSaobis SesaZleblobebsa da SezRudvebs, saswavlo programis organizaciuli
aspeqtebi ukavSirdeba jandacvis sistemisa da arsebuli paliatiuri samsaxurebis Sesaxeb codnas. sauniversiteto saswavlo
programa moicavs yvela zemoTCamoTvlil aspeqts. maTi umravlesoba SeiZleba CarTuli iqnas samedicino saswavleblebis sxva
mimdinare programebSi.
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CM(2003)130
151. mraval qveyanaSi paliatiuri medicina CarTulia uwyveti samedicino ganaTlebis (usg) programis sawyis doneze. zogierTi erovnuli asociaciebi uzrunvelyofen an mxars uWeren zogadi praqtikis eqimebis ganaTlebis aseT kursebs.
152. usg programebis garda zogierTma qveyanam ganaviTara ufro
maRali donis ganaTleba, magram mxolod araspecialistebisaTvis
(Sualeduri done). aseT magaliTs warmoadgens uelsis universitetis mier SemuSavebuli paliatiuri mzrunvelobis distanciuri saswavlo kursi da holandiis zogad praqtikosTa kolejis
mier SemuSavebuli eqspert zogad praqtikosTa satreningo
kursi. aseTi saxis kursebis mizania monawileebs saSualeba misces gaxdnen paliatiuri mzrunvelobis eqspertebi da amavdroulad saqmianoba ganagrZon ZiriTadi specialobiT. umaRlesi donis
sauniversiteto ganaTlebis kidev erTi magaliTia belgiaSi,
Libre de Bruxelles –is universitetis mier aRiarebuli Sida-sauniversiteto diplomi. aqcenti keTdeba mzrunvelobis uwyvetobaze, mkurnalobasa da paliatiur mzrunvelobas Soris dogmaturi sazRvrebis gavlebis gareSe.
153. ufro maRal doneze, arsebobs paliatiuri mzrunvelobis saswavlo programebi, romlebic ZiriTadad SemuSavebulia evropis im
qveynebSi, sadac paliatiuri mzrunveloba damoukidebel specialobad aris aRiarebuli.
komunikacia
154. kargi sakomunikacio unar-Cvevebi paliatiuri mzrunvelobis umTavresi nawilia da ar aris specifikurad damaxasiaTebeli paliatiuri mzrunvelobisaTvis. Civili arasaTanado mzrunvelobis
Sesaxeb ufro xSirad gamowveulia araefeqturi komunikaciiT da
ara mkurnalobis dabali doniT. komunikacia moicavs ufro mets,
vidre ubralod informaciis miwodeba. es aris procesi,
romelSic CarTulia mravali adamiani da romlis amocanebi moicavs informaciis gacvlas, urTierTgagebasa da daxmarebas,
CM(2003)130
69
rTuli da zogjer mtkivneuli sakiTxebis ganxilvas da am sakiTxebiT gamowveuli emociuri stresis ganawilebas. sxvaTa wuxilis gaziareba aseve moicavs dros, pasuxismgeblobasa da gulwrfel survils. nawilobriv, es exeba pasuxis gacemas, ufro metad
ki tkivilis Semsubuqebasa da pirovnebis gverdiT yofnas maSin,
rodesac pasuxi ar arsebobs. komunikacia ar aris `damatebiTi
momsaxureba~, igi jandacvis sasicocxlo, ganuyofel da aucilebel komponents warmoadgens. tradiciulad, bevri sauniversiteto kursi ar moicavs komunikaciis sakiTxebs. dReisaTvis
aRiarebulia am deficitis arseboba da kurikulumebis umetesobaSi yuradReba maxvildeba komunikaciis sakiTxebze.
155. komunikacia ar moicavs mxolod jandacvis profsionalsa da
pacients. is moicavs komunikacias jandacvis profesionalsa da
ojaxs, pacientTa da maT ojaxebs (an pacientisaTvis mniSvnelovan
axloblebs) Soris da kominikacias jandacvis profesionalebs
Soris sxvadasxva dawesebulebaSi. yvela am mxares Soris efeqturi da swrafi komunikaciis fasilitacia moiTxovs Semdeg
elementebs:
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70
jandacvis yvela profesionalis ganaTlebasa da treningebs
komunikaciis unar-Cvevebis sakiTxebze;
hospisebi da klinikebi unda uzrunvelyofdnen pacientebisa
da maTi ojaxebis piradi SexvedrebisaTvis Sesaferis farTs;
jandacvis profesionalebs unda qondeT yovelkvireuli ganrigi pacientebTan da maT ojaxis wevrebTan, aseve jandacvis
sxva profesionalebTan SexvedrebisaTvis.
jandacvis profesionalebisaTvis misawvdomi unda iyos
Tanamedrove teqnologiebi.
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Photo: Maciej Kluziak, Poland
komunikacia pacientebsa da jandacvis profesionalebs Soris
156. avadmyofobis tipiuri procesis ganmavlobaSi pacients jandacvis mraval profesionalTan uxdeba Sexvedra. yoveli aseTi
Sexvedra iZleva komunikaciis SesaZleblobas. komunikaciis nawili xdeba metyvelebiT, umetesi nawili ki araverbaluria. zogadad, pacientebi moiTxoven gulaxdil, misawvdom da Tanmimdevrul informacias maTi daavadebisa da SesaZlo garTulebebis
Sesaxeb. arcTu iSviaTad, jandacvis profesionalebi da ojaxis
wevrebi pacientisaTvis imedis SenarCunebis mizniT mas araswor
informacias awvdian. aseTi `keTili ganzraxvis strategiam~
SesaZloa gamoiwvios sirTuleebi, ramdenadac daavadeba progresirebs. cudi axali ambavi yovelTvis cudi ambavia, Tumca misi
miwodebis meTodebi da is, Tu ramdenad grZnobs pacienti
mxardaWerasa da gagebas, mniSvnelovnad ganapirobebs mis
Seguebas axal realobasTan.
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157. ufro metic, arsebobs mkafio emociuri, fsiqologiuri SezRudvebi, Tu ra doziT SeiZleba iqnas miwodebuli SemaSfoTebeli
informacia erTi saubris dros: cudi ambis gagebiT miRebuli
emociuri dartymis gamo, Semdgomi informacia Cveulebriv veRar
aRiqmeba. amitom informaciis danawevreba, pacientisa da misi
ojaxisaTvis cudi ambis gasaazreblad drois micema, umTavres
momentad aris aRiarebuli. dadasturebulia cudi axali ambis
gamxelis arsebuli safexureobrivi etiketis (mag. Buckman in 3)
efeqturoba.
158. rogorc wesi, pacientebs daavadebis, mkurnalobisa da prognozis
Sesaxeb aseTi saxis informacia unda miewodos mgrZnobiare,
TanadgomiTi da gulaxdili formiT. pacientis damoukideblobasa da RirsebasTan mimarTebaSi sasicocxlo mniSvneloba aqvs
misTvis aucilebeli informaciis miwodebas, raTa man SeZlos
informirebuli arCevanis gakeTeba. aRniSnul procesze SeiZleba
garkveuli gavlenaiqonios kulturulma garemom im gagebiT, rom
zogierTma pacientma, aniWebs ra informaciis sisrules nakleb
mniSvnelobas, SesaZloa mniSvnelovani gadawyvetilebis miReba
sxvas miandos.
159. paliatiur mzrunvelobaSi komunikacias gansakuTrebiT SemecnebiTi darRvevebi arTulebs. amdenad SemecnebiTi darRvevebis
SesaZlo cvalebadobis mxedvelobaSi miReba da misi xarisxis
Sefaseba metad mniSvnelovania.
komunikacia pacientsa da ojaxis wevrebs Soris
160. paliatiuri mzrunvelobis dawesebulebebSi pacientebi da maTi
ojaxis wevrebi xSirad stresis qveS imyofebian. arcTu iSviaTad,
mxareebs Soris komunikacia Zalian mcirea, Tuki is saerTod
arsebobs. aseT SemTxvevebSi xSiria gaugebrobisa da wyenis momentebi. pirovnebas SeiZleba miaCndes, rom mzrunvelobis tvirTi
arasamarTliania. SesaZloa amotivtivdes Zveli jibri da Suri,
ramac situaciaze kontrolis dakargva gamoiwvios.
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161. jandacvis profesionalebs ekisrebaT aseTi fenomenis gamovlenisa da sapasuxo reaqciis gamoxatvis movaleoba. ukidures SemTxvevaSi maT unda moaxdinon informaciis gaziarebis faqtis
modelireba, raTa pirovnebebs SeeZloT iyvnen gulaxdilni
TavisTavTan da sxvebTan sakuTar grZnobebsa da emocebTan
mimarTebaSi. erT saojaxo Sexvedras SeuZlia Secvalos da
gadaarCinos iseTi situaciac ki, romelic sxva SemTxvevaSi swrafad gadaizrdeboda sibrazis, simwarisa da wyenis nazavSi.
162. yuradReba unda daeTmos bavSvebisa da mozardTa gansakuTrebul
saWiroebebs. mWidro ojaxur situaciebSi, bavSvebi xSirad gariyuli arian procesidan Tumca keTili ganzraxviT, magram araswori mcdelobiT `daicvan~ isini. iseve rogorc ufrosebs, bavSvebs
sWirdebaT, rom maTi esmodeT, ugebdnen da qondeT SesaZlebloba
CarTuli iyvnen mimdinare procesebSi.
komunikacia jandacvis profesionalebs Soris
163. erT pacientze mzrunvelobaSi SesaZloa sxvadsaxva sferosa da
dawesebulebaSi momuSave jandacvis profesionalebi monawileobdnen. Sesabamisad, aucilebelia informaciis swrafi da adekvaturi gacvla. drois simciris garda komunikaciis problemas
warmoadgens movaleobaTa ganawileba, mzrunvelobis sxvadasxva
filosofiisa da barierebis arseboba. iseve rogorc ojaxSi,
saqme ar exeba mxolod informaciis gacvlas. aucilebelia
sxvaTa Sexedulebebis gaziareba, gansakuTrebiT maSin, rodesac
mkurnalobis strategiebis Sesaxeb gansxvavebuli mosazrebebi
arsebobs. aseT SemTxvevebSi, urTierTgagebis, poziciis Sejerebisa da pacientisaTvis saukeTeso servisis SeTavazebis SesaZleblobas faqtTan dakavSirebuli azrTa gacvla iZleva. rekomendebulia azrTa Ria urTierTgacvla gareSe fasilitatoris monawileobiT. Semdgomi informaciisaTvis ix. Semdegi Tavi.
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gundebi, gunduri muSaoba da dagegmva
164. daavadebis Sorswasuli formis mqone pacientebisa da maTi ojaxis wevrebis xSirad garTulebuli problemebis gaTvaliswinebiT
zogadi da specializebuli mzrunveloba umetes SemTxvevaSi
unda xorcieldebodes interdisciplinuri gundis mier, romlis
mizania mzrunvelobis uzrunvelyofa interdisciplinuri, gunduri midgomiT, fizikuri, fsiqologiuri, socialuri da sulieri mxardaWerisa da Sesabamisi unar-Cvevebis SejerebiT. es ar
aris mxolod paliatiuri mzrunvelobisaTvis damaxasiaTebeli
specifikuri sakiTxi: kompleqsuri mzrunvelobis yvela forma,
rogorc mwvave, aseve qronikul SemTxvevebSi, moiTxovs multidisciplinur gundur muSaobas. Tumca paliatiur mzrunvelobaSi
gundur muSaobas ramodenime gansakuTrebuli maxasiaTebeli aqvs:
araprofesionalTa, moxaliseTa (volontiorTa) da ojaxis wevrebis CarTva; momvlelebze zrunvis saWiroeba; sulieri da emociuri sakiTxebis mniSvneloba. (Cummings 1998) miuxedavad imisa,
rom mtkicebuleba jer kidev arasrulia, arsebobs maCveneblebi,
romlebic paliatiur mzrunvelobaSi pacientisaTvis gunduri
muSaobis upiratesobas adastureben.
165. gundis moculoba moqnilia da SesaZloa icvlebodes pacientis
saWiroebebidan gamomdinare. ase mag. gundis minimaluri SemadgenlobaSi Sedian ojaxis eqimi da ubnis eqTani, magram Cveulebriv,
gundSi aseve Sedian socialuri muSakebi, fsiqologebi da moxaliseebi (volontiorebi). udavoa, rom yvela aRniSnul profesionalsa da volontiorebs SesaZlebloba unda qondeT monawileoba miiRon gadawyvetilebis miRebis procesSi. Tumca jer kidev
sakamaToa sakiTxi, iTvlebian Tu ara ojaxis wevrebi gundis wevrebad. is faqti, rom ojaxis wevrebi umetes SemTxvevaSi
xangrZlivad arian CarTuli mzrunvelobaSi, amis sasrgeblod
metyvelebs, xolo is, rom isini aseve warmoadgenen `zrunvis
obieqts~, sapirispiros amtkicebs.
166. xSirad keTdeba gansxvaveba interdisciplinur da multidisciplinur gundebs Soris. pirveli nakleb mniSvnelobas aniWebs
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profesiul gansaxvavebulobas, vidre ukanaskneli _ ZiriTadad
mzrunvelobas uzrunvelyofs mTeli gundi, ise rom davalebebi
yovelTvis ar aris ganawilebuli profesiebis mixedviT. interdisciplinur gundSi lideroba damokidebulia arsebul amocanaze da ara profesiul ierarqiaze, rogorc es multidisciplinuri gundis dros xdeba. zogierTi avtori mkafio upiratesobas
aniWebs interdisciplinur gunds. komitets am sakiTxTan
dakavSirebiT ar gaaCnia erTiani rekomendacia da miaCnia, rom
gundis tipis Sesaxeb gadawyvetileba miRebuli unda iqnas adgilobrivi situaciisa da gadasawyveti problemis safuZvelze.
167. miuxedavad imisa, rom ar Catarebula aranairi kvleva eqimis
xelmZRvanelobiT momuSave da sxva gundebs Soris gansxvavebis
gamosavlenad, komitets miaCnia, rom specialuri gundis erT
wevrs mainc unda qondes gavlili treningi da iyos paliatiuri
mzrunvelobis aRiarebuli specialisti.
168. aRiarebulia ra pacientebisaTvis gundis sxvadasxva wevris mier
erTi da igive informaciis miwodebis aucilebelebloba, komunikacia gunduri muSaobis mniSvnelovan aspeqtis warmoadgens. gundebi SeimuSaveben komunikaciis gamWvirvale arxebs ise, rom
uzrunvelyofili iqnas gundis yvela wevris mier mzrunvelobis
procesSi wvlilis Setanis SesaZlebloba da am procesis mimdinareobis Sesaxeb maTi drouli informireba.
mzrunvelobis dagegmva da winaswari direqtivebi
169. paliatiuri mzrunvelobis xarisxi mniSvnelovnad umjobesdeba
maSin, rodesac misi winaswari dagegmva xdeba. (Cummings 1998)
mzrunvelobis gegmaSi miTiTebulia ara marto mniSvnelovani da
mosalodneli simptomebi, aramed arsebuli da SesaZlo fsiqologiuri da sulieri problemebi. Tu es keTdeba sistematiurad
da uwyvetad, SesaZlebelia arasasurveli krizisisa da saavadmyofoSi gadayvanis Tavidan acileba.
170. mzrunvelobis winaswari dagegmva Cveulebriv moicavs winaswar
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direqtivebs sicocxlis bolo periodTan dakavSirebul samedicino xasiaTis gadawyvetilebebTan: usargeblo mkurnalobis
Sewyveta, sicocxlis xangrZlivobis Semamcirebeli tkivilisa da
simptomTa marTva, sicocxlis bolos tkivilgayuCeba; pacientis
mier sakiTxis wamoWris SemTxvevaSi, eqimebi mzad unda iyvnen ganmarton TavianTi mosazrebebi eqimis daxmarebiT gardacvalebis
Sesaxeb (daxmareba TviTmkvlelobaSi, eftanazia). detaluri ganxilvisa da sakiTxTan dakavSirebiT evropis sabWos rekomendaciebisaTvis, mkiTxveli unda gaecnos evropis sabWos 1999 wlis 21
maisis #8421 dokuments adamianis uflebebis, terminaluri da
momakvdavi pacientebis Rirsebis dacvis Sesaxeb.
171. warmodgenili memorandumis konteqstSi sakmarisia xazi gaesvas,
rom miuxedavad eqimebs Soris amgvari gadawyvetilebis eTikuri
Sefasebis sxvadasxvaobisa, arsebobs erTi saerTo mosazreba, rom
profesional mzrunvelebs unda SeeZloT pacientTan Ria dialogis warmoeba. (Quill 1996) aseTi gaxsnili dialogi zogierT
SemTxvevaSi Tavidan agvacilebs eqimis daxmarebiT sikvdilis
moTxovnas. mniSvnelovania eqims miRebuli qondes Sesaferisi
ganaTleba sicocxlis bolos pacientze mzrunvelobis eTikur
dilemebTan dakavSirebiT, raTa man SeZlos gaiazros da
Sesaferisi wesiT pacientsa da misi ojaxis wevrebTan ganixilos
kargad Camoyalibebuli mosazreba. eTikuri dilemebi gansakuTrebiT maSin warmoiSveba, rodesac pacients jiutad surs sikvdili, Tumca paliatiuri mzrunvelobis SesaZleblobebi jer kidev
ar aris amowuruli. ufro xSirad ki dilemebi aRmocendeba maSin, rodesac paliatiuri mzrunveloba, mag. morfinis maRali dozebiT tkivilis marTva, iwvevs an SesaZloa gamoiwvios sicocxlis xangrZlivobis Semcirebis (an gangrZobis) efeqti.
172. marTvis gegmebis SemuSavebasa da monitoringSi pacientisa da
misi ojaxis wevrebis CarTvas aSkara eTikuri upiratesoba aqvs.
garda amisa arsebobs mtkicebulebebi, rom aRniSnuls dadebiTi
wvlili Seaqvs mzrunvelobis xarisxis gaumjobesebaSi.
173. profesionalebi da araprofesionalebi paliatiur mzrunvelobas
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sxvadasxva TanafardobiT afaseben rogorc sasargeblosa da
aucilebels. arc is aris gasakviri, rom literaturaSi
gansakuTrebuli yuradReba eqceva iseT Temas, rogoricaa `mzrunveloba mzrunvelebze~. Tumca okupaciuri janmrTelobis
TvalsazrisiT ar arsebobs Camoyalibebuli mtkicebuleba, Tu
mzrunvelobis romeli modelia saukeTeso. eWvgareSea, rom
mzrunvelebi raime formiT unda iRebdnen yuradRebas. mzrunvelTa gadaRlis Tavidan asacileblad maTi mZime tvirTis sakiTxi
sistematiurad unda iqnas ganxiluli gundis Sekrebaze. aRniSnuli exeba ara marto ojaxis wevrebs, aramed maTac, visTvisac
mzrunveloba aris profesionaluri da sistematiuri saqmianoba.
ojaxis daxmarebisa da krizisuli situaciebis Tavidan asacileblad sasargeblo iqneba ojaxuri Sexvedrebi pacientisa da
erTi-ori profesionali mzrunvelis monawileobiT.
174. qamingsi aRwers gunduri muSaobis mniSvnelovan, Tumca xSirad
miviwyebul aspeqtebs: (Cummings 1998) gundebs, gansakuTrebiT ki
paliatiuri mzrunvelobis gundebs gaaCniaT iseTive sasicocxlo
cikli, rogorc yvela individs: pirveli faza - idealisturi
enTuziazmi, romelsac TanamSromloba da qarizmatuli lideroba axasiaTebs; meore faza - marTvis komponentebis gaZliereba,
sadac iniciatorebi awydebian gundSi sakuTari adgilis
gaazrebasTan dakavSirebul sirTuleebs da mesame faza - rodesac arsebobs idealizmisa da pragmatizmis kombinacia.
volontiorebi
175. warmodgenil memorandumSi sasargeblo iqneboda gansakuTrebuli
yuradRebis gamaxvileba volontiorebze, mzrunvelTa im kategoriaze, romelic garkveulwilad specifikuria paliatiuri
mzrunvelobisaTvis. volontiorebs paliatiur mzrunvelobaSi
mniSvnelovani, Tumca xSir SemTxvevaSi arasaTanadod dafasebuli
roli eniWebaT. maT SeuZliaT pacients SesTavazon `mosmenis mzadyofna~. ar gaaCniaT ra profesionaluri movaleobebi, isini Tavs
srulad uZRvnian pacientebs, romelTac xSirad esaWiroebaT
CM(2003)130
77
sakuTari tanjvis vinmesTvis gaziareba. mesame piris arseboba,
(romlis ndobac advilia) pacients saSualebas aZlevs Tavi
SeigrZnos da aRiqvas sxvebTan Tanabar pirobebSi myof, jer kidev
sazogadoebis wevrad.
176. volontiorTa sxva mniSvnelovani amocana SeiZleba iyos ojaxis
wevrebis droebiT gamoTavisufleba avadmyofze mzrunvelobisagan (rac xSirad amcirebs maTSi danaSaulis grZnobas), maTi emociebis gaziareba, xolo pacientis gardacvalebis SemTxvevaSi
maTi daxmareba da sazrunavis Semsubuqeba.
177. SeuZliaT ra damxmare pirebis CarTva mzrunvelobis procesSi,
volontiorebs mniSvnelovani funqcia eniWebaT profesionali
mzrunvelebisaTvis. isini profesionalebs saSualebas aZleven
gamonaxon dro sxva saqmianobisaTvisac. profesional mzrunvelebs volontiorebis daxmarebiT aseve SeuZliaT pacientisagan
axali informaciis miReba.
178. saimedo partniorobisaTvis unda xdebodes volontiorebis momzadeba, monitoringi da asociaciis mier maTi damtkiceba. ar aris
sakmarisi mxolod daxmarebis survili, mniSvnelovania guldasmiT SerCeuli personalis momzadeba.
179. volontiori damxmareebi qmnian koordinatoris pasuxisxmgeblobiT momuSave gunds, romelic mzrunvelebsa da volontior
damxmareTa Soris damakavSirebeli rgolis fuqcias asrulebs.
maTze zedamxedveloba warmoebs damxmare jgufis konteqstSi.
180. volontiorTa asociaciebi uzrunvelyofen saavadmyofoebSi
volontiorTa saWiro struqturis Camoyalibebas. aseve didia
maTi mniSvneloba binaze movlis pirobebSi volontiorTa daxmarebis organizebisaTvis.
181. interdisciplinur gundSi, volontiorebi ar ikaveben sxvis
adgils; SeaqvT ra sakuTari gansakuTrebuli wvlili gundis
muSaobaSi, isini avseben sxvaTa muSaobas da ar iWrebian maT
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funqciebSi. mkafiod unda iyos gansazRvruli maTi roli da amocanebi. jandacvis am araprofesionalTa gverdiT profesionali
mzrunvelebi da administratorebi Tavs maqsimalurad komfortulad unda grZnobdnen.
182. belgiaSi, 1991 wlis samefo dadgenilebiT nebadarTuli iqna paliatiuri mzrunvelobis asociaciebisa da am sferoSi momuSave
sxvadasxva organizaciebis finansuri daxmareba.
183. im asakSi, rodesac sikvdilis Temas tabu edeba, profesional
mzrunvelebTan erTad gansakuTrebuli simboluri mniSvneloba
eniWeba volontior damxmareebs. maTi pirovnuli movaleobebis
garda, isini momakvdavi adamianis garemo sazogadoebas warmoadgenen.
mZime danakargi
184. daxmareba axloblis gardacvalebiT gamowveuli mZime danakargis
SemTxvevaSi, specialur literaturaSi paliatiuri mzrunvelobis programebis erT-erT mTavr sakiTxad aris miCneuli. rogorc
samsaxuri, igi misawvdomi unda iyos yvela im dawesebulebaSi,
sadac paliatiuri mzrunveloba xorcieldeba: specialuri paliatiuri mzrunvelobis dawesebulebebi, klinikebi da saTemo saavadmyofoebi, binaze movlis pirobebSi. amas ori mizezi aqvs.
erTis mxriv, mZime danakargis SegrZneba Cveulebriv pacientis
gardacvalebamde gacilebiT adre iwyeba, radgan daavadebis paliatiuri faza pacientisa da misi ojaxis wevrebisaTvis danakargis mzard SegrZnebas warmoadgens. meores mxriv, paliatiuri
mzrunvelobis profesionalebi ojaxs ganixilaven rogorc
`mzrunvelobis
obieqts~,
ris
logikur
aucilebel
gagrZelebasac warmoadgens ojaxTan urTierToba pacientis gardacvalebis Semdgom. (Doyle, Hanks and MacDonald 1998)
185. mZime danakargis SemTxvevaSi damxmare samsaxuris mizania mxari
CM(2003)130
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dauWiros pacientebsa da maTi ojaxis wevrebs, raTa gaumklavdnen avadmyofobisa da gardacvalebis periodSi axloblis
dakargviT gamowveul mraval problemas. aseTi samsaxurebi unda
efuZnebodnen mraval faqtors, maT Soris: individualur
Sefasebas, mwuxarebis siZlieres, problemasTan gamklavebis
unars da TiToeuli ojaxis specifikur saWiroebebs. mZime danakargis SemTxvevaSi daxmarebis efeqturoba dadasturebulia profesionaluri samsaxurebisa da profesionalTa mxardaWeriT
ganxorcielebuli volontioruli samsaxurebis muSaobaze Catarebul mraval kvlevaSi. aRniSnuli kvlevebis analizis safuZvelze parqisi akeTebs daskvnas, rom mZime danakargis SemTxvevaSi
damxmare samsaxurebs SeuZliaT danakargiT gamowveuli fsiqiatriuli da fsiqosomaturi darRvevebis riskis Semcireba.
(Parkes 1980)
186. mwuxarebis da mZime danakargis sakiTxebze zrunva paliatiuri
mzrunvelobis mTeli procesis ganmavlobaSi uwyvetad unda xorcieldebodes. ojaxis wevri Tavs gacilebiT advilad arTmevs
mwuxarebas, Tu igi grZnobs, rom misTvis axlobeli adamiani
iRebs karg mzrunvelobas, aqvs SesaZlebloba gamoxatos sakuTari wuxili da miiRos daxmareba. Sesabamisad, maT, visac seriozuli eWvi SeaqvT mzrunvelobis srulyofilebaSi, mwuxarebis
gamoxatvis ufro garTulebuli da xanrgZlivi reaqcia axasiaTebT.
187. ojaxis mxardaWera moicavs avadmyofobisa da mZime danakargiT
gamowveul periodebSi daxmarebas. faqtiurad, daxmarebis es ori
forma mWidrod aris dakavSirebuli erTmaneTTan: axlobeli adamianis gardacvalebamde yovelive gancdili, pirovnebas momavalSi
mwuxarebasTan gamklavebaSi exmareba. axloblis dakargvisaTvis
mzadeba ukve aris mwuxarebis procesis nawili. daxmarebis gaweva SeiZleba xdebodes axloblis gadacvalebamde, gardacvalebis
procesSi da mis Semdgom. es aris erTiani, sruli procesi da
SeiZleba grZeldebodes ramodenime saaTi an Tve. profesional
mzrunvelebs sxvadasxva gziT SeuZliaT daxmarebis aRmoCena: maT
SeuZliaT daexmaron ojaxis wevrebs sakuTari grZobebis ufri
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mkafiod gansazRvrasa da gamoxatvaSi. (ambivalenturoba, danaSaulis SegrZneba, frustracia da a.S.) amgvari moqmedebiT gunds
SeuZlia gadauWreli an konfliqturi situaciebis ganmuxtva.
mzrunvelobis gundebi aseve mniSvnelovan rols asruleben gardacvlilis survilebTan dakavSirebuli formaluri mxareebisa
da dakrZalvis sakiTxebis organizebaSi.
188. axloblis gardacvalebis Semdgomi periodis winaswari gaazreba
da misTvis mzadeba, mZime danakargis procesis winaTgrZnobad
SeiZleba iqnas miCneuli.
189. emociebis moTokva kidev ufro arTulebs mwuxarebas, maTi daufaravi gamoxatva ki am process aadvilebs. amisaTvis ki mTavaria
Sesabamisi droisa da adgilis SeTavazeba.
190. mwuxarebis procesSi axloblebisaTvis didi mniSvneloba aqvs im
garemos, romelsac mas Seuqmnis gundi da romelic gahyveba
momavalSi. mZime danakargi xSirad axloblebSi sicarielis
SegrZnebas tovebs. adamiani Tavs martosulad, izolirebulad
grZnobs da ar SeuZlia axal situaciasTan Segueba. ojaxis wevrebisa da megobrebis daxmareba arasakmarisia; socialur struqturebs daxmarebis aRmoCena ar ZaluZT. paliatiuri samsaxuris
mier SemoTavazebul specialur samsaxurs SeuZlia Seavsos es
bzari mzrunvelobis axali formebiT: xsovnisadmi miZRvnili
ceremonia, korespodenciis warmoeba, satelefono daxmareba,
individualuri saubrebi da damxmare jgufebi. mZime danakargis
SemTxvevaSi, damxmare samsaxuri gansakuTrebiT yuradRebiT unda
iyos bavSvebisa da mozardebis mimarT, romelTac mwuxarebis
ufrosebisagan gansxvavebuli aRqma da Segueba axasiaTebT. aseve
mniSvneloba eniWeba kulturul gansxvavebulobas.
191. mZime danakargis SemTxvevaSi damxmare samsaxurebis muSaobis
efeqturobis damadasturebeli meToduri mtkicebuleba arasakmarisia. aRniSnuli samsaxurebis marTvasa da koordinacias axdenen Sesaferisi rangisa da kvalifikaciis mqone profesionalebi.
specialurad momzadebuli volontiorebi, romelTac miRebuli
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aqvT codna mZime danakargis SemTxvevaSi daxmarebis sakiTxebSi,
aseve muSaoben profesionalTa xelmZRvanelobiT.
mZime danakargis SemTxvevaSi damxmarebis done
192. mZime danakargis SemTxvevaSi daxmarebis sami done SeiZleba
gamoiyos (Worden 1999)
pirveli done - mZime danakargis SemTxvevaSi ZiriTadi daxmareba,
romelsac profesionalTa xelmZRvanelobiT axorcieleben maRal
doneze momzadebuli personali da volontiorebi. es ar aris konsultireba, Tumca momzadebuli volontiorebi aseve gamoiyeneben
Sesabamis sakonsultacio unar-Cvevebsac. aRniSnuli gansakuTrebiT
Rirebulia maTTvis, vinc moklebulia socialur daxmarebas da Tavs
daxmarebis potenciuri wyaroebidan izolirebulad grZnobs. daxmarebis aRniSnuli done akmayofilebs maT umravlesobas, visac mZime
danakargis SemTxvevaSi daxmareba esaWiroeba.
meore done - sakonsultacio daxmareba, romelsac secialur paliatiur samsaxurebTan an TemTan arsebuli Sesabamisi kvalifikaciis
mqone personali axorcielebs. aseTi konsultaciebi gansakuTrebiT
mniSvnelovania maTTvis, visi mdgomareobac garTulebulia damatebiTi stresiTa da mwuxarebasTan gamklavebis araadekvaturi damokidebulebiT.
mesame done - moicavs ufro intensiur fsiqoTerapias, rodesac
saWiro xdeba specialistisaTvis mimarTva. aseTi saWiroeba SeiZleba
aRmocendes im situaciebSi, rodesac danakargi disfunqciuri qcevis
Rrma Sreebs an ufro Rrma emocionalur kriziss iwvevs.
193. zemoTaRniSnuli samive done gulisxmobs riskis Sefasebas,
romelic gamoiyeneba pirovnebasTan an ojaxTan saubris dros,
yovel konkretul SemTxvevaSi mzrunvelobis yvelaze Sesaferisi
donis gansazRvrisaTvis.
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Photo: Mihai Eröss, Romania
ganmartebiTi leqsikoni:
zrunva mzrunvelebze - paliatiuri mzrunvelobis aqtivoba, romelic ukavSirdeba momakvdavi pirovnebis movlasTan dakavSirebul
sirTuleebsa da barierebs. aseve moicavs daxmarebas mZime danakargis (axloblis dakargviT gamowveuli) SemTxvevaSi.
mzrunvelobis gegma - paliatiuri mzrunvelobis gundis mier pacientisa da misi ojaxis wevrebis monawileobiT Sedgenili da regularulad ganaxlebadi dokumenti, sadac aRniSnulia pacientisa da
misi ojaxis saWiroebebi da arCevani, mdgomareobis prognozireba,
procesSi CarTul profesionalTa da araprofesionalTa amocanebi;
mzrunvelobis gegma aris winmswrebi da mimarTulia krizisuli
situaciebis prevenciaze.
CM(2003)130
83
dRis mzrunvelobis dawesebulebebi - Cveulebriv funqcionireben
specialuri paliatiuri mzrunvelobis stacionarebis bazaze, sadac
pacientebi Tavsdebian kviraSi erTi an ramodenime dRiT. SeTavazebuli momsaxureba SeiZleba iyos sxvadasxva xasiaTis: samedicino
(sisxlis gadasxma, tkivilisa da simptomTa marTva, a.S.), socialuri
(Sxapi/abazana), sareabilitacio (fizio/okupaciuri Terapia), gantvirTviTi (masaJi) an damxmare (yuradRebis gadamtani: xelovneba,
xelsaqme). aRniSnuli momsaxurebis mizans aseve warmoadgens ZiriTadi momvlelisaTvis mcire drois gamoTavisufleba.
ojaxi - paliatiuri mzrunvelobis konteqstSi, ojaxi moicavs pacientze mzrunvelobaSi monawile yvela axlobels. xSirad ojaxi
ganixileba rogorc `mzrunvelobis erTeuli~. SesaZloa es mosazreba ar iyos zedmiwevniT gamarTlebuli, (pacienti yovelTvis aris da
unda rCebodes yuradRebis centrSi) Tumca igi xazs usvavs ojaxis
rogorc mzrunvelis, aseve zrunvis obieqtis mniSvnelobas.
fuWi aqtivoba - warmoadgens yvelaze xSir sakamaTo sakiTxs prevenciis, diagnostikisa da mkurnalobis im samedicino CarevebTan
mimarTebaSi, romelTac aranairi sargebloba ar moaqvT pacientisaTvis. is ukavSirdeba “acharnement thërapeutique” (Terapiuli mZvinvareba) frangul gagebas, romelic ZiriTadad gamoiyeneba kuraciuli an
sicocxlis gamaxangrZlivebeli mkurnalobis dros.
hospisuri mzrunveloba - ar arsebobs pospisuri mzrunvelobis
erTi, yvelasaTvis misaRebi ganmarteba. Tavdapirvelad, koncefcia
mimarTuli iyo jandacvis zogadi sistemisagan gansxvavebuli mzrunvelobis formaze, sadac samuSaos udidesi nawili sruldeboda
volontiorTa mier da aqcenti keTdeboda komfortsa da sulierebaze. dResdReobiT, mraval qveyanaSi pospisuri mzrunveloba paliatiuri mzrunvelobis sinonims warmoadgens.
hospisi - SeiZleba niSnavdes dawesebulebas an binaze movlis samsaxurs. zogjer gansxvaveba keTdeba maRali da dabali mzrunvelobis donis hospisebs Soris.
84
CM(2003)130
mzrunvelobis individualuri gegma - ix. `mzrunvelobis gegma~
interdisciplinuri - gunduri muSaoba, rodesac mzrunvelobas
uzrunvelyofs erTiani, mTliani gundi. multidisciplinuri gundis
muSaobis stilisagan gansxvavebiT, sazRvrebi disciplinebsa da maT
kompetenciebs Soris naklebad mniSvnelovnad aris miCneuli.
multidisciplinuri - gundSi erTze meti profesiis warmomadgenlebis arseboba. multidisciplinuri gundi SeiZleba Sedgebodes
eqimebis, eqTnebisa da jandacvis sxvadasxva sferos muSakebisagan;
igi SeiZleba muSaobdes interdisciplinuri an multidisciplinuri
stiliT.
paliatiuri mzrunvelobis erovnuli/regionuli gegma - politikis
SemmuSaveblebis, profesionalTa da pacienTa mier SemuSavebuli strategia, romlis mizansa da ZiriTad ideas paliatiuri mzrunvelobis masStaburobis, Tanasworobisa da xarisxis (efeqturobisa da
dakmayofilebis) uzrunvelyofa warmoadgens. racionaluri gegmis
saerTo elementebi moicavs Semdeg aspeqtebs: Sefasebis saWiroeba;
mkafio miznebis gansazRvra; specifikuri momsaxurebis ganxorcieleba; ZiriTadi/tradiciuli momsaxureba (upiratesad Sorswasuli daavadebis mqone pacientTa mzrunvelobaze mimarTuli da Temze dafuZnebuli); ganaTleba da treningi; opioidTa misawvdomobis popularizacia; specifikuri sakanonmdeblo baza; standartebis SemuSaveba da
Sedegebis sistematiuri Sefaseba.
paliatiuri mzrunveloba - arsebobs paliatiuri mzrunvelobis
ramodenime ganmarteba. warmodgenil rekomendaciebsa da ganmartebiT
memorandumSi gamoyenebulia janmo-s mier 1990 wels formulirebuli da 2002 wels koreqtirebuli ganmarteba: Sorswasuli, progresirebadi daavadebis mqone pacientebze aqtiuri, srulyofili zrunva. umTavresi xdeba tkivilisa da sxva simptomebis, fsiqologiuri,
socialuri da sulieri problemebis kontroli. paliatiuri mzrunvelobis mizania pacientebisa da maTi ojaxis wevrebis sicocxlis
xarisxis gaumjobeseba.
CM(2003)130
85
paliatiuri medicina - warmoadgens specifikur samedicino mzrunvelobas aqtiuri, progresirebadi da Sorswasuli daavadebis mqone im
pacientebze, romelTa sasicocxlo prognozi SezRudulia da mzrunvelobis aqcenti keTdeba sicocxlis xarisxze.
sicocxlis xarisxi - paliatiuri mzrunvelobis umTavres mizans
sicocxlis optimaluri xarisxi warmoadgens, Tumca am koncefcias
efemeruli xasiaTi aqvs da Sorswasuli daavadebis mqone pacientebSi misi gazomva rTulia. daavadebis modificirebaze mimarTul
mkurnalobaSi SemuSavebuli ganzomilebebi paliatiur medicinasTan
mimarTebaSi ver gamoiyeneba, gansakuTrebiT, rodesac saqme sicocxlis bolos sulierebis sakiTxebisadmi yuradRebas exeba. paliatiuri mzrunvelobisaTvis misaRebia pacientTa prioritetebze damyarebuli sicocxlis xarisxis Sefaseba.
reabilitacia - Sorswasuli daavadebis mqone pacientebSi funqciuri mdgomareobis maqsimaluri gaumjobeseba, raTa maT SesaZlebloba
qondeT SeinarCunon aqtiuroba da sicocxlis optimaluri xarisxi.
aRniSnulma SesaZloa fizio da okupaciuri Terapevtebis muSaoba
moiTxovos.
droebiTi mzrunveloba - mzrunvelobis forma, romelic ojaxis wevrebs aZlevs pacientis movlisagan droebiTi Sesvenebis saSualebas:
aRniSnuli SeiZleba saWiro gaxdes sxvadasxva SemTxvevaSi, mag. dasvenebis dReebsa da Svebulebis dros, mkurnalobis saWiroebis dros
da a.S. droebiTi
mzrunveloba SeiZleba xorcieldebodes
saavadmyofoebSi, moxucebulTa saxlebSi an hospisebSi. zogjer
droebiTi, dRis mzrunvelobis da samedicino procedurebisaTvis
hospitalizaciis formebs Soris sazRvrebi mkafio ar aris.
specializebuli paliatiuri mzrunvelobis samsaxurebi - samsaxurebi, romelTa mTavar specializacias
warmoadgens paliatiuri
mzrunveloba, romelsac Sesabamisi ganaTlebisa da gamocdilebis
mqone paliatiuri mzrunvelobis profesionalebis xelmZRvanelobiT
uzrunvelyofs interdisciplinuri gundi.
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CM(2003)130
sulieri mzrunveloba - aqcents akeTebs cxovrebis arsze, im egzistencialur da religiur sakiTxebze, romlebic xSirad uCndeba
pacientebsa da ojaxis wevrebs. igi exeba rogorc morwmune, aseve
ara religiur pacientebsa da maTi ojaxis wevrebs, rogorc gardacvalebamde, ase gardacvalebis Semdgom.
terminaluri zrunva - paliatiuri mzrunvelobis kontiniumi. Cveulebriv mimarTulia pacientTa mdgomareobis marTvaze sicocxlis
bolo saaTebsa an dReebSi.
volontiorebi - mzrunvelebi, romelnic sakuTari drois nawils
uangarod uTmoben maTTvis ucnob pacientebze mzrunvelobas.
Cveulebriv maT ganaTlebasa da muSaobas koordinacias uweven
volontioruli organizaciebi. jandacvis profesionalebi aseve
SesaZloa iyvnen volontiorebi.
CM(2003)130
87
88
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evropis sabWos angariSi paliatiuri mzrunvelobis
organizebis Sesaxeb
2003 wlis 12 noembers ministrTa komitetis mier oficialurad iqna miRebuli
evropis sabWos paliatiuri mzrunvelobis organizebis eqspertTa komitetis
angariSi, romelic mravali qveynis monawileTa mWidro TanamSromlobis Sedegs
warmoadgens. TandarTul memorandumTan erTad saboloo saxiT warmodgenili
rekomendaciebi gansazRvraven wevr saxelmwifoebSi paliatiuri mzrunvelobis
uzrunvelyofis standartebs.
konkretulad, wevri saxelmwifoebi SeTanxmdnen SeimuSaon paliatiuri
mzrunvelobis SeTanxmebuli da yovlismomcveli erovnuli politikisaTvis aucilebeli moqmedebis, sakanonmdeblo da sxva zomebi. angariSSi paliatiuri mzrunveloba jandacvis samsaxurebis sasicocxlo Semadgenel nawilad aris
aRiarebuli. nebismier pirovnebas, romelsac paliatiuri mzrunveloba esaWiroeba,
unda SeeZlos miiRos igi yvelanairi biurokratiuli Seferxebis gareSe im
dawesebulebaSi, romelic maqsimalurad Seesabameba mis individualur
saWiroebebsa da arCevans. angariSSi xazgasmiT aris aRniSnuli ganaTlebis, treningebisa da kvlevis struqturuli programebis saWiroeba.
warmodgenili angariSis miRebis gadawyvetileba, warmoadgens wevri saxelmwifoebis mzadyofnas ganaviTaron maqsimalurad maRali standartebis paliatiuri
mzrunveloba. mis warmatebas gansazRvravs is, Tu ramdenad ganvaviTarebT da
davnergavT 45 wevr qveyanaSi paliatiuri mzrunvelobis im programebs, romelTac
realurad SeuZliaT yoveli individualuri pacientisa da ojaxis wevrebis
saWiroebaTa dakmayofileba,
angariSis miRebisas, wevri qveynebi SeTanxmdnen mxari dauWiron paliatiuri
mzrunvelobis saerTaSoriso saagentoebis qselur muSaobas da xeli Seuwyon warmodgenili rekomendaciebis aqtiur, mizanmimarTul gavrcelebas. amasTan
dakavSirebiT, aRmosavleT evropis paliatiuri mzrunvelobis aRmosavleTis
(EAPS –East) sakoordinacio centrma, sxva mraval erovnul organizaciasTan
erTad miiRo gadawyvetileba 2004 wlis oqtomberSi rac SeiZleba met qveyanaSi
gauwios popularizacia angariSis ZiriTad principebs. rogorc evropelebi, evropis sabWos rekomendaciebis popularizaciiT Cven SevZlebT erTad SevcvaloT
mdgomareoba Cvens qveynebSi da partnioruli muSaobiT xedva gadavaqcioT realobad. Cven da Tqven SegviZlia SevcvaloT msoflio!
stokholmi, agvisto 2004
karl jon fursti silvia sauteri
(EAPS –East) aRmosavleT evropis paliatiuri mzrunvelobis
aRmosavleTis sakoordinacio centri
Stockholms Sjukhem Foundation
112 35 Stockholm, Sweden
www/ eapcest. org
CM(2003)130
91
dabeWdilia fond `Ria sazogadoeba saqarTvelo~-s finansuri
mxardaWeriT proeqt `saerTaSoriso standartebis danergva
saqarTveloSi paliatiuri mzrunvelobis sferoSi~-s farglebSi.
Published with financial assistance of Open Society Georgian Foundation
within the framework of the project "Introducing of International Standards
into Palliative Care Services in Georgia "
dabeWdilia S.p.s ètiketSi~, q. Tbilisi, 2005 w.
Printed by the Ltd. "Etiketi", Tbilisi, 2005

ministrTa komitetis rekomendacia REC (2003) 24 evropis

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