Assessing the need for combatants in rehabilitation assistance

Authors:

Bakhtina Irina Sergeevna, PhD in Medical sciences, Director of the Federal State-Financed Educational Institution of Continuing Professional Education “The Saint-Petersburg Center of Postgraduate Medical Education under the Federal Medical and Biological Agency of Russia”, 41 Lunacharskogo Ave., 194291 St. Petersburg, Russian Federation; e-mail: ibakhtina@yandex.ru; https://orcid.org/0000-0002-4046-0605.

| Bolotin Ivan Sergeyevich |, Doctor of Sociological Sciences, Professor; Federal State Budgetary Educational Institution of Higher Education «Moscow Aviation Institute (National Research University)», Volokolamskoe shosse, 4, Moscow, 125993, Russian Federation.
Zadorozhnyuk Ivan Evdokimovich, Doctor of Philosophy, Professor; Non-state educational institution «International Pedagogical Academy», 4th Roshinsky pr., 9A, Moscow, 115191, Russian Federation.

Kalinina Svetlana Alekseevna, PhD in Medical sciences, lecturer, Federal State-Financed Educational Institution of Continuing Professional Education “The Saint-Petersburg Center of Postgraduate Medical Education under the Federal Medical and Biological Agency of Russia”, 41 Lunacharskogo Ave., 194291 St. Petersburg, Russian Federation; e-mail: kalinina@spbcpo.ru; https://orcid.org/0000-0003-1033-5210.

Garderobova Larisa Vladimirovna, PhD in Medical sciences, Deputy director for scientific and methodological work of the Federal State-Financed Educational Institution of Continuing Professional Education “The Saint-Petersburg Center of Postgraduate Medical Education under the Federal Medical and Biological Agency of Russia”, 41 Lunacharskogo ave., 194291 St. Petersburg, Russian Federation; e-mail: lvg@spbcpo.ru; https://orcid.org/0000-0001-5191-8741.

Bolotina Dar’ya Ivanovna, PhD in culturology, academic secretary, Institute of Russian Heritage named after St. John of Shanghai and San Francisco, line 4th УО., 65 А, room 202-н, office 1, 199178 St. Petersburg, Russian Federation; e-mail: dibolotina@gmail.com.

Grishina Lyudmila Vladimirovna, head of Educational Center «Territory of security», Project «The Angel», 1st Luchevoy prosek, 7, building 3, Moscow, Russian Federation, mailing address: 107113 Moscow, Russian Federation; e-mail: angel4grishina@yandex.ru.

Annotation:

Introduction. The medical-social situation formed during the special military operation requires the professional medical community to be ready to carry out mass rehabilitation measures aimed at combatants and the affected civilian population. At the same time, modern holistic principles of organizing rehabilitation assistance should be implemented.

Aim. The aim of the study is to explore the needs of combatants in complex rehabilitation.

Materials and methods. This publication presents the results of the first stage of a comprehensive organizational and clinical nursing study, during which a survey was carried out on participants in local military conflicts and civilians affected by hostilities. The patient’s self-assessment was carried out by filling in a specially designed questionnaire. In a study of 77 units, 58% of men participated and 42% women; 50.0% (male) — 55.1% (female) were occupied by persons aged 28 — 47, 20.0% (male) — 31.1% (female) — 48 — 55 years; 6.9% (female) — 7.5% (male) — over 56; 22.5% (male) — 6.9% (female) — 18 — 27 years old. At the time of the study, 31.4% took part in combat action, 8.7% completed participation less than a month ago, 14.5% — from 1 to 12 months, 23.3% took part in combat action in the period 2014-2015, 17.7% participated in previous local military conflicts more than 10 years ago. Half of the respondents (49.5%) were militias, 32.5% were civilians, and 17.8% were military or police personnel during 1999 — 2009 years. Structural indicators and the frequency of occurrence of structural and functional disorders, restrictions on activity and participation in society were calculated.

Results. Participants in combat action who did not receive serious injuries did not undergo a medical examination (39.1%), others went to the doctor for traumatic brain injuries (31.8%), diseases of the cardiovascular system (40.6%), digestive systems (11.6%), diseases of the organs of hearing and vision (17.4% each); mental and behavioral disorders (8.7%). Structural disorders had 67.0%, functional disorders — 95.2%; scars from injuries (25.7%), fractures of limb bones (8.2%), disfigurement of facial features (5.5%), foreign bodies, fragments (5.8%), and chronic pain syndrome (12.0%), astheno-vegetative syndrome (10.4%); decrease in tolerance to physical (10.4%) and intellectual (5.6%) loads. Restrictions on activity and participation were noted by 64.8% of respondents, including restrictions on mobility (7.0%), self-care (7.0%), household (11.0%) and professional (10.2%) activity, communication (25, 1%). Also, 96.6% of respondents complained of changes in mentality and behavior, more often irritability (10.8%), anxiety (15.2%), asthenia (6.1%), sleep disorders (17.8%) and appetite (5 .0%), adaptation disorders (10.4%).

Discussion. The socio-hygienic portrait of a combatant, mainly in the status of a volunteer, represents a middleaged man or woman who is married, divorced (mostly men) or widowed (exclusively women). They sought inpatient medical care for moderate injuries, less often – to private practitioners or outpatient, and in the case of minor injuries or the absence of such, they did not undergo medical examinations and rehabilitation measures.

Conclusion. The majority of respondents who have taken part in hostilities experience moderate or mild functional impairment, activity and participation limitations, mainly associated with disorders of the autonomic nervous system and the consequences of PTSD, which requires the nurse to dynamically monitor key indicators, educate patients and their families methods of self-control and rehabilitation. It is necessary to include this topic in the program of additional professional education of nursing staff in the specialties “Nursing”, “Rehabilitation nursing” and “Medical and social assistance”.

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