Yenidoganda Invaziv Girisimler

.: PREFACE
Ön Söz
Preface
Prof. Dr. Nilgün KÜLTÜRSAY
Ege Üniversitesi Tıp Fakültesi, Neonatoloji BD, İzmir
Article Language: TR
Yenidoğanda Simüle Uygulamalı Aciller ve İnvaziv Girişimler Eğitimi

Yenidoğan dönemi hayata başlangıcın risklerini taşır ve az sayıda da olsa bebeklerin bir kısmı yoğun müdahaleler gerektiren sorunlarla doğabilirler. Antenatal tanının gelişmesine rağmen doğumsal anomali, erken doğum gibi nedenlerle doğum odasında ve yoğun bakımda yaşadıkları ağır sorunlar nedeniyle bu bebekler özel bir bakım gerektirirler.

Neonatoloji Bilimi geliştikçe yenidoğan yoğun bakımında büyük ilerlemeler olmuş ve en riskli en küçük bebekler bile yaşama şansı bulmuştur. Bu süreçte bebeklere en az invaziv girişimle en uygun müdahaleleri yapmak amaçlansa da, invaziv girişimler de sıklıkla kaçınılmaz olmaktadır. Bu girişimlerde ve tüm yoğun bakım sürecinde hekim-hemşire ekip çalışması çok büyük önem taşır. Son yıllarda ülkemizde yenidoğan yoğun bakım ünitesi sayısı ve burada görev yapan hemşire ve doktor sayıları çok artmıştır. Bu ünitelerde görev alan arkadaşlarımızın bilgi ve becerilerinin geliştirilmesi ve güncellenmesi de bilginin çok hızlı yenilendiği günümüzde çok önem kazanmıştır.

Bu becerilerin kazanılması amacıyla son yıllarda bazı Tıp Fakültelerinde ve mezuniyet sonrası hizmet içi eğitimde gerçek hayatı taklit eden acil senaryolar üzerinde çalışılmaya ve yapay zekâlı mankenler kullanılmaya başlanmıştır. Ancak hâlâ bu programlar Pediatri alanında dünyada bile nadirdir ve en duyarlı grup olan yenidoğanlar için ülkemizde çok yeni olarak Ege Üniversitesi tarafından geliştirilmiştir. Ege Üniversitesi Neonatoloji Bilim Dalı öğretim üyeleri ve sorumlu hemşirelerinden oluşan gönüllü bir ekiple 2014 yılından itibaren başlattığımız Egeneosim programı, arkadaşlarımızın özverili çalışmaları ile şu ana kadar ülkemizde çok değişik bölgelerde 35 kez gerçekleştirilmiştir. Şu ana kadar ülkemizde 460 hemşire, 450 doktor arkadaşımız bu programa katılmıştır. Ayrıca Azerbaycan'da istek üzerine yapılan kursta, yoğun katılım talebi olduğundan dolayı kurs daha ağırlıklı olarak teorik eğitim olarak tasarlanmıştır ve toplam 400 doktor ve hemşire katılmıştır. Bunun dışında kendi ülkelerinde bu eğitimi uygulamak isteyen çeşitli ülkelerden yurtdışı eğiticilerine yapılan kursa da toplamda 24 kişi katılmıştır. Böylece kurs uluslararası bir öncülük yapmış ve ülkemize de önemli bir prestij sağlamıştır. Kursumuz EgeNeoSim, 25/07/2016 tarihinde Türk Patent Enstitüsü'nden 'Marka Tescil Belgesi' almıştır.

EgeNeoSim Kursu 2 gün olarak uygulanmaktadır. Kursa başvuruda bölgedeki ünitelerden hekim ve hemşire ekibi olarak birer kişi, yer müsaitliği halinde ikişer kişi alınmaktadır. Çünkü kursun temel amaçlarından biri ekip çalışmasını güçlendirmektir. Yenidoğan yoğun bakımında ekip çalışmasının önemi ve girişimlerde hatanın minimalize edilmesi için ekip görev dağılımın yapılması, kontrol listelerinin kullanımı teorik olarak anlatılmakta ve uygulamalar da bu şekilde yapılmaktadır.

İlk günde tanışma ve öntest ardından ilgili teorik dersler anlatılmaktadır. Her dersin ardından da katılımcılar farklı beceri istasyonlarında, maket bebekler ve gerekli malzemelerle eğitici tarafından gösterilen, pratik noktaları tekrar anlatılan uygulamaları herbiri bağımsız olarak yaparlar. Kursun 2. gününde ise katılımcı doktor ve hemşireler kendi ekip arkadaşıyla önceden planlanmış 6 farklı senaryodan birine katılır. Bu senaryolar doğum odası ve yoğun bakım acillerini içerir. Katılımcılar eğitici öğretim üyemiz tarafından günlük yaşamda karşılaşılana uygun şekilde detaylandırılan kurgulanmış senaryoya göre manken bebeğe müdahalelerde bulunurlar. Anlatılan dersler ve yapılan pratikler doğrultusunda doğru zamanda doğru müdahale yapılması beklenir. Akıllı mankenler üzerindeki bu çalışmalarda müdahalenin başarısı veya başarısızlığı mankenin yakın görüntüsü ve vital bulgu izlemleri ekrana yansıtılarak tüm katılımcılara detayıyla gösterilir. Senaryonun ardından senaryoda görev alan ve gözlemci gruplar yaklaşım ve girişimlerde yapılan hatalar ve doğru uygulamalar hakkındaki özdeğerlendirme ve görüşlerini bildirir ve ardından bağımsız gözlem yapan eğitici tarafından son değerlendirme ve bilgilendirmeler yapılır.

Kursun etkinliğini ölçmek için yapılan kurs öncesi ve kurs tamamlandıktan sonra, hemşire ve doktorlar için ayrı ayrı hazırlanmış ön-test ve son-test uygulamasında doktor sorularındaki başarı %60,3'ten %89,2'ye yükselmiştir, hemşire sorularındaki başarı %54,78'den %81,47'ye yükselmiştir. Kurs beklentilerinin karşılanması ve kurs memnuniyeti 10 puan üzerinden ortalama 9,36 puan bulunmuştur.

Kursun ardından 1. ve 6. aylarında telefon edilerek, kurs memnuniyetleri yeniden sorulan katılımcıların günlük pratiklerine katkısı, memnuniyet oranları, böyle formatta başka kurslara da katılmak isteyip istemedikleri sorularına verilen yanıtlar %93,5-97,5 arasında olarak olumlu bulunmuştur.

Bu kurs formatıyla term ve preterm bebeklerde en sık görülen sorunlar tartışılarak ve katılımcıların hızlı karara verme ve manken üzerinde invaziv girişim becerileri ilerletilmiş olmaktadır. Ülkemizde bu özgün uygulamamız geniş yankı bulmuş ve çok olumlu geri bildirimler almıştır. Ayrıca yurtdışına da deneyimlerimiz yansımıştır. Ancak doğal olarak bu model eğitimin başarısı eğitim kurumlarındaki standart eğitimle ve ekiplerin günlük pratikte kazanacakları deneyimle pekiştiğinde artmaktadır.

Türkiye Klinikleri'nin bu çalışmasında da yenidoğanda invaziv girişimlerin uygun şekilde planlanması ve hatasız uygulanması için konu ile ilgili teorik bilgiler pekiştirilecek, pratik noktalar ve ekip çalışmasının önemi vurgulanacaktır.

Prof. Dr. Nilgün KÜLTÜRSAY
Editör
Simulative Education for Neonatal Invasive Procedures and Neonatal Emergencies

Neonatal period carries the risks related to the beginning of life and some low number of neonates may be born with problems necessitating intensive interventions. Despite the advances in the antenatal care, these infants may need special care at the delivery room or in the intensive care unit for the severe conditions such as congenital abnormalities and preterm delivery.

Neonatal intensive care has advanced together with the developments in Neonatology and even the tiniest and the highest risk infants have gained the chance to survive. Invasive procedures however become inevitable although the best interventions with noninvasive ways are aimed during their hospitalization period. The team approach of doctors and nurses carries a great importance throughout these processes.

Recently the number of doctors and nurses who work in the intensive care units have increased in our country. The development and update of these health care workers' knowledge and skills have gained a real importance in today's era that scientific knowledge is being renovated so quickly. Recently these educations are started to be given on mannequins of artificial intelligent both in medical schools and in postgraduate educative programs and emergency scenarios are used to simulate the real life. However these programs are still very rare in the field of Pediatrics and only recently have been established for the most vulnerable group of neonates by EgeUniversity in our country. We have started EgeNeosim program as a group of volunteered faculty members and nurses in 2014 and implemented this program 35 times in several parts of Turkey so far. At the moment 460 nurses and 450 doctors who work in neonatal care have joined to this educative program. Another theoretical EgeNeoSim course have been implemented in Azerbaijan for 400 doctors and nurses. The pioneering 24 doctors and academic staff from different countries who want to take this course as a model have also been trained in a separate course in İstanbul. Therefore this course has been an international pioneer and gained a prestige for our country. Our 'EgeNeosim' course has been registered in Turkish Patent Institute in 07.25.2016.

EgeNeoSim is applied as a two day course. One doctor and nurse from each center are accepted as the supporting of the team approach is one of the main aims of the program. The importance of team work in delivery room and neonatal intensive care to minimize the risk of mistakes, the work distribution of the team and control list checks are theoretically taught and all practical applications are performed as teams.

After the acquaintance and pretest (with nicknames of the participants); theoretical lessons followed by practical sessions are applied. The trainees separetely practice in different stations on maquette dolls under the guidance and supervision of an instructor. The participant doctors and nurses actively play role as a team at one of the 6 scenarios and follow the other scenarios on the second day of the course. These scenarios are about the emergency situations in the delivery room and in neonatal intensive unit. The participants make the necessary interventions on the intelligent mannequine in accordance with the fictioned and detailed scenario of daily life situations and emergencies. The whole process is driven and/or modified by the instructor professor. The success or failure of the interventions are shown to all participants with the real time videorecordings and vital signs of the mannequine on the big screen. After the completion of the scenario, the team makes a self evaluation and the observant participants also talk about the good parts and errors of the interventions. Another instructor who also follows and records all the applications gives a last brief and information about the process at the end.

At the end of the day an evaluation paper and posttest is given to participants, and after the evaluation of the papers, the quiz questions are discussed and pretest ' posttest evaluation of the each participant and the whole group are given.

In order to evaluate the efficiency of the course doctors and nurses have been evaluated with their separate tests. As a whole group for the 35 courses the success rate increased from 60.3% to 89.2% for doctors and from 54.78% to 81.47% for nurses. The participants give 9.36 out of 10 for their satisfaction and fulfillment of the course. One and also 6 months after the course the participants were given a phone call and were asked about the positive effect on their daily practice, course fulfillment and if they want to join a similar course and the answere were positive in 93.5-97.5%.

The most frequent emergency situations are discussed and the participants have the chance to practice invasive interventions on mannequines and gain the quick decision skills in this course format. Our original EgeNeoSim program have received very good feedbacks from neonatologists and pediatricians in our country and our experience have reflected to other countries too. However naturally the success of this model program increases with the standart education of pediatrics in educational institutions, and the daily life practice and experience.

At this study of Türkiye Klinikleri the theoretical knowledge about the planning and implementation of invasive procedures on neonates are consolidated and also the practical points and the importance of team work are emphasised.

Prof. Dr. Nilgün KÜLTÜRSAY
Editor

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