Psihoogia Actului Medical

Psihologia
actului chirurgical
Atat asupra bolnavului, cat si a
medicului, impactul psihologic al bolii
chirurgicale este crescut.
Sentimentul responsabilitatii la
chirurg nu dispare odata cu sfarsitul
operatiei.
Acest sentiment este accentuat, sau
apare ca raspuns si la suprainvestirea
medicului de catre pacient;
Trasaturi cu implicatii
psihologice ale
acului chirurgical sunt:
a) Este o relatie transanta, lipsita cel mai
adesea de echivocuri, bolnavul avand perspectiva
unei vindecari rapide si, de regula, definitive;
b) Este dominat totusi de riscuri, uneori

majore - amenintand integritatea si, uneori, viata
bolnavului;
c) Incarcatura emotionala este maxima si se refera
nu numai la pacient ci si la chirurgul care opereza, acestuia
nefiindu-i indiferent un eventual esec al interventiei (inclusiv
efectele secundare sau complicatiile postoperatorii);
psihologice ale
d) Intreaga desfasurare a actului chirurgical
poarta pecetea unui dramatism generat, in primul rand,
de riscul chirurgical perceput de bolnav, si in al 2-lea
rand de numeroasele surprize ce pot apare in dinamica
actului operator;
e) Bolnavul poate avea senzatii si sentimente

generate de ideea de ,,prejudiciu corporal” in cadrul unor
exereze interesand segmente sau organe ale propriului corp;
psihologice ale
f) Anxietatea, care este o dominanta in plan psihologic

a bolnavului, este extrema si ea domina bolnavul aproape
pe tot parcursul actului chirurgical, incepand cu
momentul internarii, continuand cu pregătirea
preoperatorie (ganduri despre riscul operator) sau cu
momentul anesteziei (griji referitoare la posibilitatea de
,,a nu se mai trezi’’), amplificandu-se, paradoxal- dupa
reusita interventiei chirurgicale (,,ganduri negre’’ despre
posibilele sechele sau complicatii, ca si despre viitoarea
sa reinsertie socio-profesionala).
CAUZELE ANXIETATII PERIOPERATORII :
• internarea in clinica: separarea de familie si de prieteni

• mediu strain, zgomote si mirosuri (mai intense decat in
alte servicii)
• ingrijiri de rutina
• griji cu privire la recuperarea sanatatii si a capacitatii de
efort in familie, profesie
• teama de necunoscut, iminenta contactului cu acesta
• pierderea stapanirii de sine in relatiile cu cei din jur,
constiinta neajutorarii, comunicarea dificila cu lumea
exterioara, desfasurarea neobisnuita a zilelor de spital
• relatarile unor pacienti despre nereusitele sau sechelele
operatiilor ori accidentele anesteziei
• relatarile din presa despre esecurile sau greselile intra-si
postoperatorii.
TEMERI CU PRIVIRE LA:
1. rezultatul interventiei chirurgicale (daca isi va mai reveni la 9. sentimentul unui abandon total
vechile capacitati) 10. teama excesiva de complicatiile anesteziei (ex. alergice)
2. eventualele ,,surprize’’ negative intraoperatorii (ex. cancer) 11. grija fata de momentul trezirii
3. urmarile operatiei (griji cu privire la recuperarea sanatatii si 12. neplaceri cauzate de perfuzii, injectii, masca
a capacitatii de efort in familie, profesie, pierderea conditiei 13. teama de a nu se comite indiscretii asupra intimitatilor sale
fizice) 14. experiente anterioare neplacute
4. ingrijiri adiacente ( sonde, perfuzii, cateterizare, etc.) 15. momentul trezirii din anestezie si al evaluarii imediate a
5. vesti proaste inaintea operatiei rezultatelor operaţiei
6. anestezie 16. griji cu privire la recuperarea sanatatii si a capacitatii de
7. teama de moarte efort
8. senzatia stranie de ,,pseudomoarte’’, datorita pierderii 17. pierderea conditiei fizice.
cunostintei in cursul anesteziei
Patrunderea in lumea spitalului,
nefamiliara, rece, confruntarea cu
suferintele, eventual decesul altor bolnavi,
ruperea puntilor de legatura cu mediul
inconjurator sunt de asemenea factori ce
ridica serioase probleme psihologice.
Momentul postoperator este cel
care, prin durata lui relativ sporita si prin
anumiti factori obiectivi sau subiectivi, are o
importanta deosebita in plan psihologic.
In perioada postoperatorie precoce
disconfortul este mixt: fizic, prin dureri,
varsaturi, meteorism, impotenta functionala,
dar si posibil psihic (numai ideea – cazul
psihozelor post-partum- sau chiar prezenta
mutilarii, sechelelor, infirmitaţii - ca de ex.
in amputatiile de necesitate).
In această perioada, de multe ori,
ritmul progresului starii de sanatate, al
recuperarii este neconcordant cu al asteptarilor
bolnavului.
Acest lucru este perceput dureros de
persoanele vulnerabile la frustrare.
In perioada postoperatorie precoce, pacientul
este confruntat eventual si cu esecul interventiei
terapeutice, cu rezultate disproportionat de mici sau chiar
dramatice, raportate la expectatiile medicului sau ale
pacientului (ex. descoperirea intraoperatorie a unui cancer
inoperabil).
Tot acum, bolnavul este mai susceptibil la stresul
psihic iatrogen (disconfortul ,,minim’’ in alte situatii este
amplificat, pregatirea psihologica a pacientului se
centreaza cel mai adesea pe acceptarea si desfasurarea
momentului operator, si mai putin sau deloc pe perioada
postoperatorie).
In perioada postoperatorie tardiva se pot manifesta
doua tendinte cu sens contrar; pe de-o parte, recidiva/recaderea
(corelata cu suprasolicitarea anterioara de catre pacient a
interventiei chirurgicale) erodeaza puternic fundamentul
increderii in medic: ,,Daca nu chirurgia, atunci ce?’’; pe de alta
parte, in aceasta perioada se rup adesea legaturile cu terapeutul
(de regula, ele se mentin doar scurt timp dupa operatie, iar
problemele aparute tardiv sunt gestionate adesea de medicii de
medicina generala sau internisti, pana devin critice).
Desigur, in cadrul factorilor de prognostic prost in
plan psihologic, se pot include in aceasta perioada si
complicatiile generate de insasi interventia chirurgicala
(granulom de fir, eventratii, evisceratii, etc.).
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Psihologia

b) Este dominat totusi de riscuri, uneori

e) Bolnavul poate avea senzatii si sentimente

f) Anxietatea, care este o dominanta in plan psihologic

• internarea in clinica: separarea de familie si de prieteni

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