TARTU TEOLOOGIA AKADEEMIA

Ethel Toomingas

Kogemusnustamise kui hingehoiut vajadused ja vimalused

SA TK Lastekliiniku nitel

Lput

Juhendaja: MA (sotsioloogia) Rein Murakas

Tartu, 2013

Summary Peer-counseling as a method of pastoral-counseling its needs and availabilities on the

example of the Foundation of the University of Tartu's Children's Clinic.

Keywords: peer-counseling, pastoral-counseling, premature birth, traumatic crisis, peer-

counseling in children's clinic, mother's emotional state after childbirth.

The rate of premature births in the world, including Estonia, is around 5-7%. Families

emotional managing plays a crucial role in infant's health stability condition and well-being.

Doctors follow the medical record, but often they lack resources for sufficient counseling to

create confidence in the families, well needed to cope with the everyday routines. This

bachelor thesis is based on interviews and surveys carried out on the mothers of deeply

prematurely born infants with the collaboration of the Foundation of the Children's Clinic of

the University of Tartu.. The goal of the survey was to find necessity and possibilities for

conducting peer-counseling of mothers with prematurely born babies. In the first chapter the

evolution of peer-counseling as a specific kind of counseling is described along with its

practice in Estonia and abroad. Also an overview is given which factors cause an emotional

crisis for a patient in hospital treatment. A person who is undergoing a traumatic crisis does

not seek help herself but needs special attention in the form of peer-counselor initiative. Only

the counselor who has gone through the same kind of a trauma is able to overcome the barrier

created by the crisis. The second chapter introduces the methodology used in the thesis and

the third one describes the findings of the survey. It can be concluded that the range of

emotions which mothers are going through after a premature childbirth is very broad and is

followed by an exceptional condition within the family that is in dire need of support and

counseling from outside the family.

The post-birth need for immediate support, information and counseling is exceptionally high,

especially when the infant has more serious developmental conditions or the mother has a

weak backing network and lack of emotional support. The fourth chapter reasons about the

necessities and possibilities of peer-counseling in consideration of the outcomes of the survey

and points out that the need for peer-counseling exists at the personal, health care

institutional, local governmental and state level. The personal working in obstetric clinics

should acknowledge the potential vulnerabilities of mothers and acquire a certain skills,

needed for handling a patient who is about to give a premature birth. It is essential to intensify

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the collaboration between medicine and pastoral-counseling, especially the concrete form of

the latter the peer-counseling.

The author hopes that this thesis would help to improve the development of peer-counseling

and the inclusion of it into a regular service in Estonia.

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SisukordSummary.....................................................................................................................................2 Sissejuhatus ................................................................................................................................6 I Uuringu taust ............................................................................................................................9

1.1. Kogemusnustamise miste ja funktsioonid ...................................................................9 1.2. Hingehoid ja kogemusnustamine ................................................................................11 1.3. Kogemusnustamise ajaloost ........................................................................................13

1.3.1. Nustamine sltuvusprobleemidega inimestele .....................................................13 1.3.2. Pshilise erivajadusega inimeste ja nende lhedaste sotsiaalse kaasatuse suurendamine tugi- ja eneseabigruppide abil - DUO projekt EPR-s.............................14 1.3.3. Tallinna Puuetega Inimeste Koja kogemusnustamine puuetega laste vanematele..........................................................................................................................................14

1.4. Kriisi vallandavad tegurid haiglas .................................................................................15 1.5. Kriiside mtestamine.....................................................................................................17 1.6. Enneaegsete laste ravi- ja toetusssteem Euroopa riikides ...........................................18 1.7. Kogemusnustamine SA Tartu likooli Kliinikumi Lastekliinikus .............................18

II Uuringu probleemipstitus ja metoodika..............................................................................21 2.1. Uuringu eesmrk ...........................................................................................................21 2.2. Uuringu probleemipstitus ............................................................................................21 2.3. Uurimismetoodika .........................................................................................................22 2.4. Uuritava kontingendi kirjeldus ja valimi moodustumine ..............................................22 2.5. Uurimist eetilised aspektid ........................................................................................23

III Anals................................................................................................................................24 3.1. Enneaegsete laste emade snnitusjrgne emotsionaalne seisund ..................................24 3.2. Enneaegsete laste vanemate toetuse-, info- ja nustamisvajadus..................................28

3.2.1. Toetuse olulisus ......................................................................................................28 3.2.2. Toetuse, info ja nustamise saamise allikad...........................................................30 3.2.3. Hilisema nustamise saamine.................................................................................32

3.3. Vimalused enneaegsete laste emade probleemide lahendamiseks vi leevendamiseks..............................................................................................................................................37

IV Arutelu.................................................................................................................................40 Kokkuvte ................................................................................................................................46 Kasutatud kirjandus ..................................................................................................................48 Lisa1. Uuringu ksimustik .......................................................................................................52

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JoonisedJoonis 1. Tunded enneaegse lapse emaks saamise jrgselt (%). ..............................................25 Joonis 2. Snnitusjrgse depressiooni tase Edinburghi snnitusjrgse depressiooni skaala (EPDS) alusel (kumulatiivne %). .............................................................................................27 Joonis 3. Snnitusjrgse toetuse saamise olulisus (%). ............................................................28 Joonis 4. Hilisema toetuse saamise olulisus (%). .....................................................................30 Joonis 5. Snnitusjrgse toetava suhtumise allikad (%)...........................................................30 Joonis 6. Abi saamine kodustelt lastehaiglast lahkumise jrgselt (%). ....................................32 Joonis 7. Hilisema nustamise saamine (%). ...........................................................................33 Joonis 8. Hilisema nustamise saamise allikad (%). ................................................................34 Joonis 9. Info saamise allikad lastehaiglast lahkumise jrgselt (%).........................................35 Joonis 10. Suhtlemine teiste enneaegsete laste emadega haiglas (%). .....................................36 Joonis 11. Suhtlemine teiste enneaegsete laste emadega haiglast lahkumise jrgselt (%).......37 Joonis 12. Vimalikud allikad lapse enneaegsusega seotud probleemide osas abi saamiseks (%). ...........................................................................................................................................38 Joonis 13. Enneaegsete laste vanematele meldud hingu vajalikkus (%)..............................38

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Kandke ksteise koormaid, nnda te tidate Kristuse seadust (Gl 6:2).

Sissejuhatus

Iga lapse snd on eriline ning lapsevanema jaoks thtis. Vastsndinud lapsel on eriline vgi,

mis knetab kigi sdameid. Tal on meelevald tmmata oma orbiidile mberseisjate phimad

tunded: huvi ja armastus, hoolimine ja kaastunne ning saada ilma mingi sunnita oma

vanemate elu keskpunktiks. Sama olulised on ka kik lapsevanemad oma mtete, tunnete,

tugevuste ja nrkustega. Aga vahel juhtub, et laps snnib enneaegsena vi mne haigusega.

Enneaegsena snnib maailmas ja ka Eestis 5-7% lastest. Seejuures vga vikesi enneaegseid

(snnikaal alla 1500g; sndinud enne 32. rasedusndalat) on umbes 1% kikidest sndidest.

Enneaegsete laste tervisehirete ja haiguste phjused o