| Abstract | Hrvatski branitelji su osobe koje su organizirano sudjelovale u obrani neovisnosti, teritorijalne cjelovitosti i suvereniteta Republike Hrvatske (RH). Domovinski rat ostavio je trajne posljedice na hrvatske branitelje tako da se i poslije rata organiziraju braniteljske udruge kako bi Vladi RH mogli predlagati mjere za poboljšanje svog statusa. Branitelji spadaju u zdravstveno rizičnu skupinu gdje dosadašnja istraživanje pokazuju da umiru ranije od ostale populacije, i to najčešće od kardiovaskularnih i malignih bolesti, a veliki broj ih počini samoubojstvo. Stoga je Vlada RH usvojila 1999. godine Nacionalni program psihosocijalne i zdravstvene pomoći sudionicima i stradalnicima Domovinskog rata s dugoročnim ciljem podizanja kvalitete življenja i njihove reintegracije. Nakon toga diljem Hrvatske osnivaju se Centri za psihosocijalnu pomoć i regionalni centri za psihotraumu kako bi pružali psihosocijalnu i zdravstvenu pomoć sudionicima i stradalnicima iz Domovinskog rata. Tako je i 2015. godine Ministarstvo branitelja i Ministarstvo zdravstva donijelo odluku da sve kliničke ustanove u RH u svojim ustanovama imenuju koordinatora za branitelje da bi se braniteljima i članovima njihovih obitelji pomoglo u ostvarivanju zdravstvene zaštite i ubrzalo proces dijagnosticiranja i liječenja bolesti. Iste godine imenovali su i četiri veteranske bolnice u Ogulinu, Kninu, Zaboku i Vukovaru koje bi trebale zbrinjavati branitelje na bolničku skrb. Također su se počeli provoditi i sistematski pregledi za branitelje u čije provođenje su direktno bili uključeni koordinatori za branitelje u zdravstvenim ustanovama. Funkciju koordinatora za branitelje najčešće obnašaju visokoeducirane medicinske sestre. One imaju ključnu ulogu u očuvanju zdravlja hrvatskih branitelja. Njihova suradnja s drugim profesijama unutar zdravstvenog sustava, socijalne službe i same društvene zajednice jasno doprinose tome.
Uspješni programi koordinacije zdravstvene skrbi su imperativ kako bi se pomoglo hrvatskim braniteljima u ispunjavanju cilja pružanja visokokvalitetnog, pravovremenog pristupa skrbi za veterane i kako bi se smanjila mogućnost nepovoljnih ishoda za korisnike. Braniteljima je najpotrebnija učinkovita koordinacija skrbi tijekom osjetljivih razdoblja tranzicije. Tijekom pružanja zdravstvenih pregleda visokoeducirana medicinska sestra ima neizostavnu ulogu u cjelokupnom procesu od naručivanja branitelja na pregled do koordiniranja tijekom njegova boravka u zdravstvenoj ustanovi do provođenja edukacije ili naručivanja na daljnju rehabilitaciju.
U ovom diplomskom radu prikazat ću analizu upućenih zahtjeva od hrvatskih branitelje na dijagnostičko terapijske postupke u Kliničku Bolnicu Dubrava (KB Dubrava) i koje je koordinator za branitelje odradio. Podaci su prikupljeni iz medicinske dokumentacije iz Bolničkog informacijskog sustava KB Dubrava, a Etičko povjerenstvo KB Dubrava za to je dalo svoju suglasnost.
Analiza medicinske dokumentacije obuhvatila je period od 2019. do 2022. godine, s time da je u 2020. godini zaprimljeno manje zahtjeva zbog pandemije bolesti COVID-19 i pozicije KB Dubrava koja je u tom periodu postala Primarni respiracijsko-intenzivistički centar za zbrinjavanje bolesnika oboljelih od bolesti COVID-19. Tada su se zahtjevi branitelja dobiveni u tom periodu odrađivali u dislociranim ambulantama KB Dubrava koje su bile formirane u Domovima zdravlja Grada Zagreba i drugim bolnicama u Zagrebu.
Od 2019. godine do rujna 2022. godine sveukupno 2 143 branitelja zatražilo je pomoć koordinatora i uz njegovu intervenciju učinjeno je 3 147 dijagnostičko terapijskih postupaka. Najviše zahtjeva pristiglo je 2019. godine kada je najveći broj i odrađen. Također, potvrđeno je da su pomoć većinom tražili branitelji (muški spol) dok su braniteljice (ženski spol) bile u znatno manjem postotku, što je i razumljivo s obzirom na njihov manji broj u Registru branitelja.
Za branitelje s najvišim i najsloženijim potrebama skrbi, pomoć kroz zdravstveni sustav pokazuje se vrlo uspješna u njihovu zadovoljavanju potreba tijekom pružanja zdravstvenih usluga pri čemu branitelji navode da vjeruju zdravstvenim radnicima koji brinu o njima i kako ih se tijekom pregleda poštuje, a što kod njih dovodi do većeg zadovoljstva pruženom uslugom i vjerom u zdravstveni sustav i zdravstvene djelatnike. |
| Abstract (english) | Croatian veterans are persons who organized and participated in the defense of the independence, territorial integrity and sovereignty of the Republic of Croatia. The Homeland War left lasting consequences on Croatian veterans, so even after the war they organized into veterans' associations so that they could propose measures to improve their status to the Government of the Republic of Croatia. Veterans belong to the health-risk group, where previous research shows that they die earlier than the rest of the population, most often from cardiovascular and malignant diseases, and a large number of them commit suicide. Therefore, in 1999, the Government of the Republic of Croatia adopted the National Program of psychosocial and health assistance to participants and victims of the Homeland War with the long-term goal of improving the quality of life and their reintegration. After that, centers for psychosocial assistance and regional centers for psychotrauma were established throughout Croatia to provide psychosocial and medical assistance to participants and victims of the Homeland War. Thus, in 2015, the Ministry of Veterans Affairs and the Ministry of Health made a decision that all clinical institutions in the Republic of Croatia appoint a coordinator for veterans in their institutions in order to help veterans and their family members obtain health care and speed up the process of diagnosing and treating diseases. In the same year, they appointed four veterans' hospitals in Ogulin, Knin, Zabok and Vukovar, which should provide hospital care for veterans. Also, systematic examinations for veterans began to be carried out, in the implementation of which coordinators for veterans in health institutions were directly involved. The function of coordinator for veterans is most often carried out by nurses, and thus they are given a key role in preserving the health of Croatian veterans. Her cooperation with other professions within the health system, social services and the community itself clearly contribute to this.
Successful health care coordination programs are imperative to help Croatian veterans meet the goal of providing high-quality, timely access to care for veterans and to reduce the potential for adverse outcomes for beneficiaries. Veterans need effective care coordination most during sensitive periods of transition. During the provision of health examinations, the nurse plays an indispensable role in the entire process, from ordering a veteran for an examination to coordinating during his stay in a health facility to conducting education or ordering further rehabilitation.
In this diploma thesis, I will present an analysis of requests from Croatian veterans for diagnostic and therapeutic procedures at KB Dubrava, which the coordinator for veterans made. The data was collected from medical documentation from the Hospital Information System of KB Dubrava, and the Ethical Commission of KB Dubrava gave its consent.
The analysis of medical documentation covered the period from 2019 to 2022, with fewer requests received in 2020 due to the COVID-19 pandemic and the position of KB Dubrava, which became a Covid hospital during that period. At that time, the requests of veterans received during that period were processed in the dislocated clinics of KB Dubrava, which were formed in the Health Centers of the City of Zagreb and other hospitals in Zagreb.
The analysis showed that from 2019 to September 2022, a total of 2,143 veterans requested the help of the coordinator and that with his intervention, 3,147 diagnostic and therapeutic procedures were performed. It was established that in 2019 the most requests were received and that the largest number of them were processed then, it was also confirmed that mostly veterans (male gender) sought help, while female veterans (female gender) were in a significantly smaller percentage, which is understandable considering their smaller number in the Register of Veterans.
For veterans with the highest and most complex care needs, assistance through the health care system has been shown to be very successful in meeting their needs during the provision of health care services, with veterans reporting that they trust the health care professionals who care for them and that they are respected during examinations, leading to greater satisfaction with the service provided and faith in the healthcare system and healthcare workers. |
