VISOKA ŠOLA ZA ZDRAVSTVENE VEDE SLOVENJ GRADEC Diplomsko delo visokošolskega strokovnega študijskega programa prve stopnje ZDRAVSTVENA NEGA IZPOSTAVLJENOST IN OBVLADOVANJE STRESA PRI REŠEVALCIH ZAPOSLENIH V NUJNI MEDICINSKI POMOČI Mentor: pred. Uroš Zafošnik, dipl. zn., univ. dipl. soc. del. Somentor: viš. pred. mag. Boris Miha Kaučič Slovenj Gradec, junij 2013 Kandidat: Bojan Kovačič POVZETEK Teoretična izhodišča: Reševalci zaposleni v nujni medicinski pomoči (NMP) so zaradi narave svojega dela izpostavljeni različnim stresnim situacijam. Dolgotrajno delovanje stresa negativno vpliva na zdravje zaposlenih in je eden glavnih povzročiteljev različnih bolezni. Z raziskavo smo želeli identificirati najpogostejše stresorje na delovnem mestu reševalca in spoznati načine, s katerimi zaposleni obvladujejo stres na delovnem mestu in izven njega. Metode: Uporabili smo kvantitativno metodo dela. Za zbiranje podatkov smo kot instrument uporabili anketni vprašalnik, ki smo ga oblikovali na podlagi pregleda literature. Uporabili smo neslučajnostni, namenski vzorec. Raziskava je potekala med reševalci v štirih centrih NMP (v Ljubljani, Mariboru, Murski Soboti in Kranju). Od 60 razdeljenih anketnih vprašalnikov, je bilo vrnjenih 56 vprašalnikov, kar predstavlja 93% realizacijo vzorca. Podatki so bili analizirani s statističnim programom SPSS 20.0. Cronbah alfa koeficient je znašal 0,903. Rezultati: Stres je prisoten na delovnem mestu reševalca v NMP, saj je 21 (37,5%) anketiranih reševalcev navedlo, da so stresu najpogosteje izpostavljeni enkrat do dvakrat na mesec. Kot najpogostejše vrste stresorjev, glede na podane scenarije primerov in stopnjo intenzivnosti, ki delujejo nanje na njihovem delovnem mestu, so reševalci izpostavili scenarij reanimacije otroka (PV=4,5), incident z uporabljeno iglo narkomana (PV=4,5) in hudo poškodbo svojca, ki je brez zavesti (PV=4,4). Za učinkovito obvladovanje stresa na svojem delovnem mestu je 40 (71,4%) reševalcev navedlo pogovor s sodelavcem in umik v miren prostor, kjer lahko v miru analizirajo stresno situacijo, kateri so bili izpostavljeni. Razprava: Reševalci zaposleni v različnih centrih NMP po Sloveniji so pri svojem delu izpostavljeni stresu. Ključnega pomena je, da ga zaposleni in nadrejeni pravočasno prepoznajo in ustrezno odreagirajo. V nasprotnem primeru lahko pride do izgorelosti zaposlenih in posledično do nastanka različnih bolezni. Zdravstveni zavodi imajo pomembno vlogo pri preprečevanju oz. zmanjšanju stresa, tako da svojim zaposlenim z različnimi dejavnostmi, kot tudi s strokovno pomočjo, omogočijo omiliti stres, ki ga doživljajo na svojem delovnem mestu. Ključne besede: reševalec, nujna medicinska pomoč, stres, obvladovanje stresa. SUMMARY Theoretical background: Paramedics working in the emergency medical care (EMC) settings are subjected to various stressful situations due to the nature of their work. Longterm effects of stress negatively influence the health of employees and are one of the major causes of different illnesses. This study was performed to identify the most common stressors at workplace of paramedics and to identify ways to manage stress at and outside of work. Method: We used a quantitative method of work. A survey was used for data collection which was designed on the basis of a literature review. We applied a predicted, intentional sample. The study included paramedics from four EMC centres in Slovenia (Ljubljana, Maribor, Murska Sobota, and Kranj). Out of 60 survey questionnaires sent out to EMCs, 56 were returned, which represents 93% realisation of the sample. The data was analysed using the statistical program SPSS 20.0. The Cronbach's alpha coefficient was 0,903. Results: Stress is a part of an EMC paramedic's workplace. Twenty-one (37,5%) of the surveyed paramedics stated to be exposed to stress once or twice per month. As the most common stressors, according to the given case scenarios and the level of intensity, they proclaimed cases of paediatric resuscitation (MV=4,5), an incident with a used needle of a drug abuse patient (MV=4,5), and a severely injured, unconscious family member (MV=4,5). As efficient management of workplace stress, 40 (71,4%) paramedics proclaimed talking to a co-worker and retrieval to a calm place where they can peacefully analyse the stressful situation they were exposed to. Discussion: Paramedics working in different EMC centres in Slovenia are exposed to stress at work. It is of utmost importance that employees and the superiors recognise it and react accordingly. Otherwise, a burnout syndrome and consequently various illnesses may arise. Healthcare centres have an important role in preventing and decreasing work-related stress by offering employees various activities and professional help. Keywords: paramedic, emergency medical care, stress, stress management KAZALO 1 UVOD ...................................................................................................................................1 2 NUJNA MEDICINSKA POMOČ V SLOVENIJI ...................................................................3 2.1 Definicija nujne medicinske pomoči ...................................................................................3 2.2 Organiziranost in delovanje nujne medicinske pomoči v Sloveniji ....................................3 2.2.1 Sestava ekipe za izvajanje NMP ....................................................................................4 2.2.2 Mreža službe nujne medicinske pomoči .........................................................................4 2.3 Vloga reševalca v nujni medicinski pomoči .......................................................................6 3 STRES ..................................................................................................................................8 3.1 Definicije stresa ..................................................................................................................8 3.2 Vrste stresa ........................................................................................................................9 3.3 Znaki oziroma simptomi stresa ........................................................................................10 3.4 Sindrom izgorelosti (Burnout sindrom) .............................................................................11 3.4.1 Stopnje izgorevanja ......................................................................................................12 3.4.2 Ukrepi za preprečitev izgorevanja ................................................................................13 3.5 Soočanje s stresom .........................................................................................................14 3.5.1 Relaksacijske tehnike ...................................................................................................15 3.6 Stres na delovnem mestu reševalca v NMP ....................................................................16 3.7 Načini obvladovanja stresa reševalca v NMP ..................................................................17 3.7.1 Tehnike za zmanjševanje stresa na delovnem mestu reševalca .................................19 4 RAZISKOVALNI DEL .........................................................................................................20 4.1 Namen in cilji raziskave ...................................................................................................20 4.2 Raziskovalna vprašanja ...................................................................................................20 4.3 Raziskovalna metodologija ..............................................................................................20 4.3.1 Raziskovalna metoda ....................................................................................................20 4.3.2 Opis instrumentarija ......................................................................................................20 4.3.3 Opis vzorca ...................................................................................................................21 4.3.4 Postopek zbiranja in obdelave podatkov ......................................................................22 4.4 Rezultati ...........................................................................................................................22 4.5 Razprava ..........................................................................................................................31 5 ZAKLJUČEK.......................................................................................................................35 6 LITERATURA IN VIRI ........................................................................................................39 PRILOGA