Caregivers in Chronic Mental Disorders and Psychiatric Nursing

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ÖN SÖZ
PREFACE
Prof. Dr. Döndü ÇUHADAR
Gaziantep Üniversitesi Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, Ruh Sağlığı ve Hastalıkları Hemşireliği AD, Gaziantep, Türkiye
Article Language: TR
Psikiyatri hemşireliği alanında doktora tezim kapsamında bipolar bozukluk tanılı hastalara psikoeğitim uygulaması yapmıştım. Bu süreçte eğitim günlerinde bazı hastalarıma gelirken anneleri eşlik ederdi. Anneler hastalarını bırakmadan önce kendileri gelinceye kadar hastalarını yalnız bırakmamamı söyler, eğitim bittiğinde de gelip hastalarını alırlardı. Annelerden bir tanesine bunun nedenini sorduğumda hastalığın akut döneminde yaşadıkları sorunları anlattı ve bundan dolayı yalnız başına dışarı gönderemediğini, başına tekrar kötü bir şey gelmesinden korktuğunu belirtti. Diğer anneler için de benzer gerekçeler söz konusuydu. Psikoeğitim oturumları bittikten bir yıl sonra annelerden bir tanesi teşekkür etmek için aradı, eğitimler sırasında birlikte geldiği oğlunun kendi kendine işe gittiğini, sorumluluklarını alabildiğini söyledi. Tezimin benim için unutamadığım en güzel etkisi de bu olmuştu, birinin yaşamına dokunabilmek. Editörlük ile ilgili teklif geldiğinde ilk aklıma gelen de bu nedenle bakım verenler oldu. Bu kitap, kronik ruhsal bozukluklara sahip bireylerin bakım sürecinde önemli ancak çoğu zaman göz ardı edilen bir grup olan bakım verenlerin yaşantılarına odaklanmaktadır. Kronik ruhsal hastalıklar, sadece bireyin değil, onunla birlikte yaşayan, destek olan ve bakım sorumluluğunu üstlenen aile bireylerinin de yaşam kalitesini derinden etkilemektedir. Bu süreçte bakım verenler; fiziksel, duygusal, sosyal ve ekonomik açılardan çeşitli zorluklarla karşı karşıya kalmaktadır.

Dünya genelinde yeti yitimine neden olan hastalıklar sıralamasında ilk 10 hastalıktan beşi ruhsal kökenli hastalıklardır. Ruhsal kökenli hastalıklar bireylerin ailevi, sosyal ve mesleki işlevsellik alanlarında ciddi sorunlara neden olmakta, bireylerin günlük yaşam becerileri de dahil birçok alanda sorun yaşamasına neden olmaktadır. Ruhsal hastalık nedeniyle damgalama, ruhsal hastalıkların nedenlerinin doğa üstü güçlere bağlı olduğu düşüncesinin yol açtığı sağlık kuruluşu dışındaki tedavi arayışları, ruh sağlığı hizmetlerine erişimdeki sınırlılıklar, tedaviye uyum sorunları, ruhsal hastalıkların kronikleşmesine ve yeti yitiminin artmasına neden olmaktadır. Kronik ruhsal bozukluklarda bakım bir ekip işidir. Hastane ortamı dışında hastanın bakımını üstlenen bakım verenler ki, genellikle bunlar aile bireyleridir, bu ekibin informal üyeleridir. Son yıllarda, ruhsal hastalıkla yaşayan bireyler için sağlık hizmetlerinin, kurumsal bakımdan toplum temelli bakıma geçmesiyle birlikte bakımda önemli değişiklikler olmuş, ruhsal hastalığı olan kişilerin bakımı kurumlardan ailelere kaymıştır ve aile üyeleri veya birlikte yaşanılan kişiler artık hastaya bakım sağlamak için önemli bir kaynak hâline gelmiştir. Ruh sağlığı, bireyin yalnızca kendisini değil, aynı zamanda yakın çevresini de derinden etkileyen bir süreçtir. Özellikle kronik ruhsal bozukluklarla yaşayan bireylerin bakımını üstlenen aile üyeleri, bu bakımın yükünün önemli bir kısmını üstlenirler. Kronik ruhsal hastalıklar, sadece bireyin değil, onunla birlikte yaşayan, destek olan ve bakım sorumluluğunu üstlenen aile bireylerinin de yaşam kalitesini derinden etkilemektedir. Çünkü bakım verenler, hastanın günlük yaşamını sürdürebilmesinde kritik bir rol üstlenirken, çoğu zaman kendi sağlık ve yaşam kalitelerini ikinci plana atmak zorunda kalmaktadır. Bu süreçte bakım verenler; fiziksel, duygusal, sosyal ve ekonomik açılardan çeşitli zorluklarla karşı karşıya kalmakta, aynı zamanda sistemsel destek eksiklikleriyle de mücadele etmektedir. Üstlenilen bakımın yükü arttıkça yalnızlık, tükenmişlik, suçluluk ve çaresizlik gibi duygular da yoğun olarak deneyimlenmektedir. Bakım verme, zor ve bakım verene ağır yükler getiren bir süreçtir. Bakımla iç içe geçebilir. Bakım veren hâline gelme seçilemez veya planlanamaz bir durumdur. Bu nedenle bu duruma uyum, durum ortaya çıktıktan sonra gerçekleşmektedir. Sunulan bakımın süresi ve yoğunluğundaki artış ile birlikte bakım iş, aile hayatı, sosyal yaşam gibi alanlardaki değişiklikler birleşince, bakım yükü daha da artmaktadır. Psikiyatri hemşireleri bakım yükünü azaltmak için; birey ve aileye bilgi ve eğitimler verme, stres yönetimini öğreterek baş etme stratejilerini geliştirme, psikoeğitim verme, damgalamayla mücadele, toplumsal destek sistemlerini örgütleme, psikososyal ve finansal destek kaynakları hakkında aileyi bilgilendirme, ilgili kurum, kuruluş ve derneklerle işbirliği yaparak danışmanlık yapma gibi hemşirelik uygulamalarını gerçekleştirir.

Ruhsal bozuklukların önde gelen klinik belirti/bulguları ve işlevsellik üzerindeki etkilerindeki farklılıklarla ilişkili olarak her bir ruhsal bozukluğun bakım veren üzerindeki etkileri ve bakım verenlerin sorumlulukları değişkenlik gösterebilir. Bu kitapta yer alan her bir bölümde tarihsel süreç içinde bakım verme rolündeki değişikliklerden birçok farklı ruhsal hastalıkta bakım verenlerin yaşadığı sorunlara ve psikiyatri hemşiresinin bu süreçteki sorumluluklarına yer verilmiştir. Bu kitabın kronik ruhsal hastalığa sahip bireylerin bakımında ve yaşam kalitesinin artırılmasında önemli bir role sahip olan bakım verenlerin yaşadıkları sorunlara ve çözüm önerilerine yönelik farkındalık kazandırmasını umut ediyoruz.

Son olarak; bir işin kalitesini ve etkinliğini artıran en önemli faktörlerden biri de, bakımda olduğu gibi ekip olarak çalışılmasıdır. Bu kitabın ortaya çıkması için oluşturulan ekipte yer almayı kabul eden, değerli vakitlerini ayıran, her bir bölüm yazarına çaba, emek ve katkılarından dolayı teşekkür ediyorum.

Prof. Dr. Döndü ÇUHADAR
Editör
Gaziantep Üniversitesi Sağlık Bilimleri Fakültesi, Hemşirelik Bölümü, Ruh Sağlığı ve Hastalıkları Hemşireliği AD, Gaziantep, Türkiye
I had conducted psychoeducation on patients diagnosed with bipolar disorder as part of my doctoral thesis in psychiatric nursing. During this process, some of my patients would be accompanied by their mothers during the training days. Before dropping off their patients, the mothers would tell me not to leave them alone until they arrived, and when the training was over, they would come and pick up their patients. When I asked one of the mothers why, she explained the problems she had experienced during the acute phase of the illness and stated that she could not send them out alone because she was afraid that something bad would happen to them again. Similar reasons were also present for the other mothers. One year after the psychoeducation sessions ended, one of the mothers called to thank me and said that her son, whom she had come with during the training, had gone to work on his own and was able to take responsibility. This was the best effect of my thesis for me, to be able to touch someone's life. When I received an offer to be an editor, the first thing that came to my mind was caregivers. This book focuses on the lives of caregivers, an important but often overlooked group in the care process of individuals with chronic mental disorders. Chronic mental illnesses deeply affect the quality of life not only of the individual but also of the family members who live with him/her, support him/her and assume the responsibility of his/her care. During this process, caregivers face various difficulties in terms of physical, emotional, social and economic aspects.

Five out of the top 10 diseases in the list of diseases that cause disability worldwide are diseases of mental origin. Diseases of mental origin cause serious problems in the areas of family, social and occupational functionality of individuals, and cause individuals to experience problems in many areas, including daily living skills. Stigmatization due to mental illness, seeking treatment outside of health institutions caused by the idea that the causes of mental illnesses are due to supernatural forces, limitations in accessing mental health services, and problems complying with treatment cause mental illnesses to become chronic and disability to increase. Care for chronic mental disorders is a team effort. Caregivers who undertake the care of the patient outside the hospital environment, who are usually family members, are informal members of this team. In recent years, there have been significant changes in care for individuals living with mental illness, with the transition from institutional care to community-based care, the care of people with mental illnesses has shifted from institutions to families, and family members or people they live with have now become important resources for providing care to the patient. Mental health is a process that deeply affects not only the individual himself/herself but also his/her immediate environment. Family members who take care of individuals living with chronic mental disorders, in particular, undertake a significant portion of the burden of this care. Chronic mental illnesses deeply affect the quality of life not only of the individual but also of the family members who live with them, support them and assume the responsibility of their care, because caregivers play a critical role in the patient's ability to continue their daily lives, while often having to put their own health and quality of life in the background. During this process, caregivers face various difficulties in terms of physical, emotional, social and economic aspects, and also struggle with a lack of systemic support. As the burden of the care undertaken increases, feelings such as loneliness, exhaustion, guilt and helplessness are experienced intensely. Caregiving is a difficult process that places heavy burdens on the caregiver. It can be intertwined with care. Becoming a caregiver is a situation that cannot be chosen or planned. Therefore, adaptation to this situation occurs after the situation arises. The care burden increases even more when the duration and intensity of the care provided is combined with changes in areas such as care, work, family life and social life. Psychiatric nurses implement nursing practices such as providing information and training to the individual and family, developing coping strategies by teaching stress management, providing psychoeducation, combating stigma, organizing social support systems, informing the family about psychosocial and financial support resources, and providing consultancy by cooperating with relevant institutions, organizations and associations in order to reduce the burden of care.

The effects of each mental disorder on the caregiver and the responsibilities of the caregivers may vary depending on the differences in the leading clinical signs/findings of mental disorders and their effects on functionality. Each chapter in this book includes changes in the role of caregiving throughout history, the problems experienced by caregivers in many different mental illnesses and the responsibilities of the psychiatric nurse in this process. We hope that this book will raise awareness of the problems experienced by caregivers, who play an important role in the care of individuals with chronic mental illnesses and in increasing their quality of life, and the solutions offered.

Finally, one of the most important factors that increases the quality and effectiveness of a job is working as a team, as in care. I would like to thank each chapter author who agreed to take part in the team formed to produce this book and who devoted their valuable time for their efforts, labor and contributions.

Prof. Dr. Döndü ÇUHADAR
Editor
Gaziantep University Faculty of Health Sciences, Department of Nursing, Division of Psychiatric Nursing, Gaziantep, Türkiye

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