Cultura HPH promozione della salute mentale in oncologia pediatrica

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1 Cultura HPH promozione della salute mentale in oncologia pediatrica Oncologia ed Ematologia Pediatrica Prof. A. Pession U.O. Pediatria M.Masi Gli standard HPH e il sistema di qualità Seminario regionale della Rete HPH Regione Emilia-Romagna e Dorella Scarponi

2 Ospedale Paziente pediatrico oncologico Complessità età patologia contesto

3 Esperienza del dolore aspetti somatici mentali sociali culturali Analisi della domanda

4 Trattamento farmacologico e trattamento non farmacologico del dolore oncologico pediatrico da procedure

5 Efficacia del trattamento non farmacologico PATIENT'S GROUP ,7 3,21 1,58 1,54 S.D. M. 0 CONTROL PATIENT GROUP SPERIMENTAL PATIENT GROUP SPERIMENTAL GROUP WITH PLAYTHERAPY ,6 1,5 1,26 3 1,58 1,46 2 1,26 1 1,77 2,18 2,04 2,39 2,64 1,81 0 PATIENT FATHER MOTHER NURSE PHISICIA OBSERVATOR S.D. M. CONTROL GROUP WITHOUT PLAYTHERAPY ,54 1,53 1,27 1,4 1,53 1, ,21 3,08 3,04 3,25 3,16 3,2 1 0 PATIENT FATHER MOTHER NURSE PHISICIA OBSERVATOR S.D. M. Free hospital model applied to paediatric onchoematology. Play therapy as a nopharmachological support for painful procedures. D.Scarponi, E. Marri, S. Baroncini, S.Liverani, A. Pession

6 Standardizzazione del trattamento non farmacologico

7 An educational project for the family Il coinvolgimento della famiglia e la prevenzione psicologica Information Psychodiagnosis Psychotherapy Emotional Communication in Pediatric Oncology: sibling in care. D.Scarponi, A.Pession

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9 Education- changing- autonomy the acquisition of new possibility to approach the reality Patients Play therapy in hospital: The play therapy is the ideal space, in the hospital, where the children in difficulty usually place personages, experiences and means regarding fear, indecision, suffering. In particular way the play, inside the therapeutic relationship, becomes occasion of encouragement to find places, in the reality and the imagination, where it is possible to tell frightful stories. In the same times it is possible to find another sense, with a different end, thanks to the tie with another person: it is possible to change perspective, to look at the events adding new hope elements. The specific therapeutic factors of the play setting for the childhood age allow, through the transfert and the interpretation, a new reading of himself and the events.

10 Parents, always very worried that the pain suffered by their child is not sufficiently evaluated, generally act as anxiety amplifiers, that is they tend to describe their child s pain as the maximum pain. In this case, helped in containing their child s pain, through play-therapy for the child and conversations for them, they managed to minimize the effect of resonance box that their own anxiety induces to the painful perception of their child. Similar benefits have been observed in the operators that have effected the painful manoeuvre; whenever they can carry out these painful manoeuvres on less anxious children, they face this experience with more relaxation, being even able to experiment it as a further occasion of comprehension and vicinity with the children. The results of project underline the importance of educational and support interventions for oncological patients undergoing procedures, with special attention to the use of psychotherapy for patients and their parents, as an important step to the self government of the family in front of emotional pain.

11 Approcci integrati PAIN FREE HOSPITAL. AN INTEGRATED APPROACH TO THE ONCOLOGICAL PAEDIATRIC PAIN D. Scarponi, I.Puglisi, A. Pession, S.Baroncini

12 Le associazioni di volontariato

13 Percezione del dolore PAINFUL PERCEPTION 4 3,5 3 2,7 2 2,1 painful perception (range 0-4) 1 1,3 0 playtherapy and sedation (65 patients) playtherapy w ithout sedation (60 patients) sedation w ithout playtherapy (51 patients) no playtherapy and no sedation (71 patients)

14 REPORT DI RIESAME DELLA DIREZIONE DI DIREZIONE/UFFICIO DI STAFF/UNITA OPERATIVA UO- Pediatria Masi R01/PA01 Rev. 1 Pag. 1/25 Data di applicazion e: 28/02/2005 OBIETTIVI Risultato ottenuto consuntivo anno 2006 Valore di riferimento anno 2007 Risultato ottenuto consuntivo anno 2007 Risultato atteso I semestre 2007 Risultato ottenuto I semestre 2006 (se disponibile) Risultato ottenuto I semestre 2007 Note OSPEDALE SENZA DOLORE Applicazione di procedure diagnostiche in sedazione 1.N interventi in sedazione Asp.midollarePunt.lombare medicata, punt.lombare esplorativa Controllo non farmacologico del dolore Applicazione piano 5 1.Attività di controllo non farmacologico del dolore N interventi di giocoterapia individuale e di gruppo 390 >90% 380/ % >

15 21,80% TOTALI 12,57% DICEMBRE 23,28% NOVEMBRE 14,38% OTTOBRE 13,92% SETTEMBRE 24,83% AGOSTO 11,33% LUGLIO 16,92% GIUGNO 16,87% MAGGIO 50,00% APRILE 33,66% MARZO 50,66% FEBBRAIO 43,00% GENNAIO % PRE- MANOV RA sul tot. MAN.DOLOROSE TOTALE GIOCOTERAPIA GRUPPO GIOCOTERAPIA IND. ANNO 2007

16 Il gradimento del servizio

17 Psychological Performances Satisfaction from nov 2007 to april % 9% 3% 27% 19 % 3% 30% play/playtherapy/interview (n=20) playtherapy/interview and no play (n=2) playtherapy (n=7) none (n=2) play/playtherapy (n=22) play (n=14) interview (n=7)