Aspects of a nurse's job. Abstract legal aspects of the nursing service

When a patient enters a medical institution, a medical worker is obliged to show human attention to the patient in addition to purely professional interest. To acquaint him with the structure of the department, explain the rules of the treatment regimen, give all the necessary information. The professionally high quality of the work of the medical institution is evidenced not only by the cleanliness of the floors and the silence in the wards, but by the atmosphere of friendliness, the human interest of the staff in each patient, the absence of tension in the relationship between members of the medical team. Ward placement of patients often creates an additional problem. If the patient is to be placed in a multi-bed ward, then the nurse is obliged to introduce him to the patients there, to find out his desire for a preferred neighborhood, since a special team is created in the ward. It can be harmonious, or it can be characterized by tension in relationships - egrotogeny (unfavorable influence of patients on each other). In the latter case, a medical psychologist should be involved in the grouping of patients. For recovering patients who do not need bed rest, the department should provide for leisure activities: walks, a library, a rest room and a psychotherapy room. If, despite the observance of all the rules of “psychological safety” in the department, the patient shows emotional stress, fear, anxiety, depression, it is necessary to immediately involve a medical psychologist in working with him. His visit to the patient is preferably carried out in a special room, in the ward the patient will feel embarrassed and will not give all the necessary information about himself.
The ability to listen is a prerequisite for professional communication with the patient. The consequences of the inability to listen are diverse: it is the patient's dissatisfaction with the doctor and the nurse, an increase in his emotional instability, which can transform into open, overt or displaced (on others) aggression. A patient who is not listened to may not follow medical instructions. In addition, in the future, when communicating with such a patient, the medical worker will experience anxiety and frustration due to the fact that the patient will emotionally reject any medical staff, and this, in turn, will lead to a tension in the medical worker's need for recognition, and will affect his professional self-esteem.
Listening skills are simple and effective. Sometimes it is enough just to sit silently next to the patient. A good listener listens with "the whole body." Sometimes it is very important to just look the patient in the eyes. There is a skill
rbally e joining, which consists in paraphrasing what was said by another person. Empathic attachment is an intuitive ability to empathize or a rational ability to share with the patient and experience his emotion with him: “I understand your anger, I would also be angry if I were you.” The ability to summarize is the formulation of a summary, when the most important thoughts expressed by the patient in a conversation are summarized in two or three sentences. You also need to be able to ask "open" questions that cannot be answered with a one-word "yes" or "no".
Non-verbal listening skills are also useful when working with a patient. The posture, understanding gesture, psychological distance are important here. In any case, when working with patients, one should avoid authoritarian communication, a tendency to impose one's point of view on the patient, the result of such communication is a deepening misunderstanding and resistance of the patient.
The art of communication requires an adequate self-assessment of one's own behavior. Few medical professionals can boast of knowing how they are perceived by patients, other members of the team. Many sisters can perfectly assess their professional medical knowledge, technical skills in performing various manipulations, but few have adequate knowledge of their own personality and can say what is the psychological style of their work with patients, what is the medicine or poison for the patient themselves.
To develop the ability to communicate with the patient and a psychotherapeutic approach to him, any medical worker needs to have information about his professional type of behavior. This knowledge can be obtained in personal growth groups, special behavior trainings. By attending a training group, a medical worker realizes and works out his own psychological problems, learns to correct non-adaptive forms of his behavior. Heads of nursing services and departments of medical institutions should see the need to create such a group for staff so that the team embarks on the path of self-improvement and development. I. Hardy (1973) provides a brief overview of the sisters' activities to help them see themselves "with the eyes of the patient", to understand the peculiarities of their communication capabilities.
Routiner sister (robot). For its activities, the most characteristic is the mechanical performance of its duties. These sisters are thorough, scrupulous, well technically qualified, and carefully carry out all the orders of the doctor. However, acting strictly according to the instructions, they do not put psychological content into their work, such nurses work like an automaton, they perceive the patient as a necessary addition to the instructions for his care. Their relationship with patients is devoid of emotional sympathy and empathy. They do everything, losing sight of one thing - the patient himself. It is such a sister who is able to wake up a sleeping patient in order to give him sleeping pills at the appointed time.
Grenadier sister. This type of sister is well represented in popular comedies. Patients already recognize her from a distance by her gait or loud voice, quickly trying to put their bedside tables and beds in order. This sister is resolute, uncompromising, persistent, instantly reacting to the slightest violation of "discipline". With a lack of culture, education, a low level of intellectual development, such an inflexible "strong-willed" sister can be rude and even aggressive with patients. In favorable cases, if she is smart, educated, a sister with such a determined character can become a good teacher of young colleagues.
Maternal type sister ("mother" and "sister"). She transfers her warm family relationships to work with patients or compensates for the absence of such in her work. Working with the sick, caring for them is an essential condition of life for her. She has a high level of empathy and empathy.
Sister expert. This sister is a narrow specialist. Due to the high need for professional recognition, he shows special curiosity in a certain area of professional activity and is proud of his importance in his field, where sometimes he even “overshadows” the doctor. Often these are qualified nurses of an X-ray or clinical laboratory, a physiotherapy room. Young doctors do not hesitate to turn to them for professional advice. Sometimes people of this type become fans of their narrow activities, excluding all other interests from their field of vision, not being interested in anything but work.
"Nervous sister". This type of unprofessional sister behavior should not occur in medical institution and testifies to poor-quality professional selection of personnel, to flaws in the work of the administration. Emotionally unstable, quick-tempered, irritable, she constantly gives neurotic reactions, is inclined to discuss personal problems and can be a serious hindrance in the work of a medical institution. A “nervous sister” is either a pathological person or a person suffering from a neurosis. Such people themselves often need serious psychotherapeutic or psycho-correctional assistance and are professionally unsuitable for working with patients.
A sister playing a learned role. This person has not yet formed a professional identity. Her behavior is distinguished by unnaturalness, pretense. She, as it were, plays a learned role, striving for the realization of a certain ideal. Unnaturalness in communication prevents her from establishing contacts with people, therefore, such a nurse must herself undergo a course of correction of the non-adaptive form of her professional behavior, clearly define her professional goals, and develop an adequate style of communication with the patient.

What is the structure of a psychiatric hospital?

The usual department of a psychiatric hospital consists of two halves: restless and calm, or sanatorium. On the restless half are patients in an acute state with psychomotor agitation or stupor, abnormal behavior, hallucinations and delusions. In this state, patients pose a danger to themselves and others and therefore need round-the-clock supervision. Some of them are placed in the observation ward, where there is a permanent post, consisting of an orderly (nurse) and a nurse. The calm (sanatorium) half of patients are transferred during the recovery period, when they are already able to serve themselves and do not pose a danger to themselves and others.

The doors of the psychiatric ward are permanently locked with a special lock, the keys to which are available only to doctors and medical personnel. The windows have bars, screens or safety glass. Windows can only be opened if there is a grill, and the windows should be located out of reach of patients.

What are the basic requirements for paramedical personnel?

Bright cosmetics and jewelry should be avoided, especially beads and earrings. The nurse in the department wears a gown and a cap or scarf. There are several sisters in the department at the same time, who perform different functions. Exist general rules which are mandatory for all medical personnel, regardless of their duties. First of all, a patient, friendly and attentive attitude towards patients is necessary, even in those cases when they show aggressive tendencies. At the same time, the nurse must be vigilant and constantly remember that the actions of the mentally ill are unexpected and, as a result, sometimes lead to tragic consequences. It is necessary to ensure that all doors remain closed, and the keys do not fall into the hands of patients and their relatives. Patients often try to open doors with the help of spoon handles, wood chips, wire. Therefore, the nurse periodically checks the contents of the pockets of patients, their bedside tables, beds. In addition, all doors of the department must be in the field of view of the staff.

The nurse must ensure that scissors, blades and other cutting and stabbing objects are not left unattended in the department.

How are the duties of nurses in a psychiatric hospital distributed?

The duties of the sisters in the department are distributed as follows: procedural, insulin (see "Insulinotherapy"), chlorpromazine and guard sisters.

The duties of the procedural nurse include the fulfillment of therapeutic appointments, the receipt and storage of medicines, and the call of consultants.

An insulin nurse conducts insulin therapy, one of the treatments for schizophrenia.

What is the responsibility of the aminosine nurse of the hospital?

Aminazine sister distributes psychotropic drugs. Distribution is carried out in a special room equipped with a fume hood, in which already opened boxes of medicines are stored, medicines are prepared for distribution to patients, and injection syringes are filled. Before dispensing medicines, especially before filling syringes, the nurse puts on a rubber apron, another gown over it, and a gauze mask. After the distribution is over, the nurse removes the top coat, apron and mask and stores it in a special closet. Syringes and utensils are washed with rubber gloves. At the end of the work, the chlorpromazine cabinet is thoroughly ventilated. It is desirable to distribute medicines and injections of psychotropic drugs only within a special chlorpromazine room. Patients should not enter it in the absence of a sister. Do not turn away from the medicine tray when dispensing them, or allow patients to take their own pills. It is necessary to check whether the patient has swallowed the medicine. To do this, you should ask him to open his mouth and raise his tongue or check the oral cavity with a spatula. Medicines accumulated by the sick can be used for the purpose of suicide. The sister should ensure that patients do not collect gauze and bandages in cases where compresses and bandages are applied to them. Bandages can also be used for suicide attempts.

What are the responsibilities of a hospital nurse?

The duties of the guard sister include round-the-clock supervision and care of the sick. She monitors the implementation of the daily routine, the duration of night sleep and afternoon rest, medical work, food intake, and sanitary and hygienic measures.

How are patients cared for and monitored in a psychiatric hospital?

Once a week, patients take a bath and change bed linen. Particular attention is paid to debilitated patients, as well as patients with suicidal tendencies. Every day, under the supervision of staff, patients are taken for a walk in the garden, enclosed by a fence with a well-locked gate, near which there is a post. The nurse is obliged to know the number of patients taken for a walk, and to pay Special attention those who are prone to escape and have suicidal thoughts. Every day, relatives give parcels to the sick and come to Oy*-Dania on the set days and hours. The nurse checks everything that is given to the sick. She has no right, bypassing the doctor, to send notes, to allow visits and telephone times. the thieves. In transfers and on dates, patients should not be given cutting and stabbing objects, products in glass jars, stimulating drinks, matches, cigarettes.

The sister keeps all products in a special closet and gives out to patients as needed. The sister enters her observations of the sick into the guard journal, which is transmitted by shift. The journal reflects changes in the condition of patients, features of their behavior and "statements. In children's and senile departments, the work of medical personnel has features associated with the age of patients. In these cases, care and feeding of the patient are of primary importance.

Today, the demand for the profession of a nurse (nurse) is high. It will be difficult for any doctor to cope with the treatment of a patient on his own without a professional assistant who specializes in nursing and has a secondary medical education. The high professionalism of a nurse is the most important factor in the friendly, collegial relationship between a nurse and a doctor. Familiarity, the non-official nature of the relationship between a doctor and a nurse in the performance of their professional duties, is condemned by medical ethics. If a nurse has doubts about the appropriateness of the doctor's medical recommendations, she should tactfully discuss this situation first with the doctor himself, and if there is still doubt, then with the higher management. A nurse today can independently monitor, treat (keep nursing records of the disease) certain groups of patients (for example, in hospices), and call a doctor only for consultation. Created and operated public organizations nurses considering the problems of nursing in the health care system, increasing the prestige of the profession, involving members of the Organization in scientific research in the field of nursing, holding conferences, seminars on topical issues in nursing, protecting the legal rights of nurses, etc. [ eleven ].

To become a nurse, you should get a secondary medical education after graduating from a school or college. Throughout the practice, it is important to constantly improve your skills and increase the level of knowledge and qualifications. To do this, you must attend nursing courses, seminars, conferences. Having worked in this specialty for at least three years, you can get the second category, after five years of experience - the first, after eight years - the highest.

The place of work determines the scope of duties of a nurse.

· Patronage nurses work in dispensaries (anti-tuberculosis, psycho-neurological, dermatological and venereal), in children's and antenatal clinics. All these nurses healing procedures carried out at home.

· Children's nurses. They can be found in children's clinics and hospitals, kindergartens, orphanages.

· Nurses in the physiotherapy room. Medical procedures are carried out using various special devices: electrophoresis, ultrasound, UHF devices, etc.

District nurses. Help the local doctor to receive patients. Receive test results, pictures from laboratories. Make sure that the doctor always has all the necessary sterile instruments for examining the patient. They bring outpatient cards from the registry.

· The procedural nurse makes injections (including intravenous), takes blood from a vein, puts droppers. All these are very difficult procedures - they require high qualifications and impeccable skills. Especially if the procedural nurse works in a hospital where severe patients can also lie.

· Ward nurse - distributes medicines, puts compresses, banks, enemas, makes injections. It also measures temperature, pressure and reports to the attending physician about the well-being of each patient. And if necessary, the nurse provides emergency care(for example, fainting or bleeding). The health of each patient depends on the work of the ward nurse. Especially if it's a seriously ill patient. In good hospitals, ward nurses (with the help of junior nurses and nurses) take care of weak patients: they feed, wash, change clothes, make sure that there are no bedsores.

A ward nurse has no right to be careless or forgetful. Unfortunately, the work of a ward nurse involves night shifts. This is bad for health.

· The operating room nurse assists the surgeon and is responsible for the constant readiness of the operating room. This is perhaps the most responsible nursing position. And the most favorite among those who at least had a little time to work on operations.

· The nurse prepares all the necessary instruments, dressings and sutures for the future operation, ensures their sterility, checks the serviceability of the equipment. And during the operation, he assists the doctor, supplies tools and materials. The success of the operation depends on the coherence of the actions of the doctor and the nurse. This work requires not only good knowledge and skills, but also reaction speed and a strong nervous system. As well as good health: like a surgeon, a nurse has to stand on her feet throughout the operation. If the patient needs dressings after the operation, they are also done by the operating room nurse.

For sterilization, instruments are taken to the sterilization department. The nurse working there is managed with special equipment: steam, ultraviolet chambers, autoclaves, etc.

· The head nurse supervises the work of all nurses in the department of the hospital or clinic. She draws up duty schedules, monitors the sanitary condition of the premises, is responsible for household and medical supplies, for the maintenance and safety of medical instruments and devices. In addition to their own medical duties, nurses have to keep records, the head nurse also monitors this. She also supervises the work of junior medical personnel (orderlies, nurses, nurses, etc.). To do this qualitatively, the head nurse must know the specifics of the department's work to the smallest detail.

· The junior nurse takes care of the sick: changes clothes, feeds, helps to move bedridden patients inside the hospital. Her duties are similar to those of a nurse, and her medical education is limited to short courses.

There are also massage nurses, diet nurses, etc. This is not a complete list of options for working as a nurse. Each has its own specifics. They are united by the fact that, although a nurse is considered a doctor's assistant, the main goal of a nurse's work is to help sick people. Such work brings moral satisfaction, especially if it is work in a hospital. But it is also very hard work, even if you love it very much. There is no time for smoke breaks and thoughtfulness in the middle of the working day. The most difficult are the departments in which operations are performed and where emergency patients arrive. These are surgery, traumatology, otolaryngology. The peculiarities of the profession of a nurse include the fact that many people in this specialty not only give injections and measure blood pressure, but also morally support the patient in difficult times. After all, even the strongest person, ill, becomes defenseless and vulnerable. And a kind word can work wonders.

The nurse should know the methods of disinfection, the rules for performing vaccinations, injections. She must understand medicines and their appointments and be able to perform various medical procedures. To master the profession of a nurse, good knowledge in the field of medicine and psychology is required, as well as in such subjects as biology, botany, anatomy, and chemistry. And this is understandable, because nurses, having the latest knowledge, can perform their work more efficiently and effectively, which will not only affect the well-being of patients, but also the satisfaction of nurses with their work.

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INTRODUCTION

LITERATURE

APPS

INTRODUCTION

The position and role of the nurse in the row medical workers is becoming more important these days. Further development of healthcare in Russian Federation largely depends on the optimal number, structure and professional level of medical and pharmaceutical personnel. The development of healthcare is one of the most important sections of the concept of long-term socio-economic development of the Russian Federation for the period up to 2020. The quality of life paradigm redefines the priorities of healthcare development in favor of prevention and development of the primary health care system, the introduction of systems for early diagnosis of diseases, as well as the development of technologies for remote monitoring of the health of patients based on modern information systems. Based on this, it is obvious that in the system of providing medical care to the population, the role of specialists with secondary medical education is sharply increasing, and the requirements for their professional competence are increasing. The ratio of the number of doctors and specialists with secondary medical education today is quite low and amounts to 1 to 2.22. Taking into account the goals of medical reforms, this is clearly not enough, since it causes an imbalance in the system of medical care, limits the possibilities for the development of aftercare services, patronage, rehabilitation, i.e. just complicates the solution of the priority tasks of the reform. By 2015, it is planned to bring this ratio up to 1:3-1:5, and by 2020 - up to 1:7-1:8. Work in medicine involves a model of professional activity in the "man-man" system. Great importance in such work has the ability to establish professional contacts with colleagues, patients and their relatives, management.

The purpose of the work: to identify the main psychological features work of nurses among medical workers.

Work tasks:

· characterize the work of nurses in conjunction with other medical workers;

to study the basic personal qualities necessary for the work of sisters;

identify the main occupational risk factors for medical workers

identify and analyze emotional burnout» in sisters as a consequence of the psychological factor of occupational risk;

consider possible ways prevention of "emotional burnout".

To train specialists, today a multi-level system for training medical staff with secondary medical education has been created, institutes of higher nursing education are being opened, and at present, postgraduate training of specialists in higher nursing education (internship, postgraduate study, etc.) is carried out in many higher medical educational institutions in our country. All this indicates an increasing need for qualified personnel, while the role of a nurse in the structure of mid-level health workers continues to be in the foreground for many reasons. First of all, it is direct contact both with patients on the one hand, and with attending physicians, consulting medical specialists on the other hand. The constant impact of increased psycho-emotional stress, one of the risk factors in the work of a nurse, currently leads to the phenomenon of "emotional burnout" in nurses. At the same time, they have an even greater risk of developing this type of deviation from the norm than many other medical workers.

Our study on the formation of the "burnout syndrome" included nurses working in the somatic service of outpatient and inpatient levels. First group: nurses- 26 people working in the outpatient service with a shift schedule during the day. The second group: nurses - 30 people working in inpatient departments, with round-the-clock work. Selection criteria for groups: age, gender, medical education.

Research methods: 1. anonymous survey of nurses

2. Evaluation of the locus of control according to D. Rotter.

3. Assessment of the psychological burden on nurses according to the method of V.V. Boyko "Diagnosis of the level of emotional burnout".

4. Statistical processing of the obtained results with the calculation of the mean, standard deviation and error of the mean, Student's test.

SUBJECT OF THE STUDY: nurses of the somatic service of the outpatient and inpatient link.

OBJECT: burnout syndrome for teachers and health workers working with children.

Taking into account the specifics of the topic and on the basis of the above tasks, this paper discusses the problems and directions for solving the burnout syndrome in nurses.

CHAPTER I. FEATURES OF THE PROFESSION A NURSE AMONG MEDICAL WORKERS

1.1 Characteristics of the professional activity of a nurse among medical workers

Today, the demand for the profession of a nurse (nurse) is high. It will be difficult for any doctor to independently cope with the treatment of a patient without a professional assistant who specializes in nursing and has a secondary medical education. The high professionalism of a nurse is the most important factor in the friendly, collegial relationship between a nurse and a doctor. Familiarity, the non-official nature of the relationship between a doctor and a nurse in the performance of their professional duties, is condemned by medical ethics. If a nurse has doubts about the appropriateness of the doctor's medical recommendations, she should tactfully discuss this situation first with the doctor himself, and if there is still doubt, then with the higher management. A nurse today can independently monitor, treat (keep nursing records of the disease) certain groups of patients (for example, in hospices), and call a doctor only for consultation. Public organizations of nurses are created and operate, considering the problems of nursing in the health care system, increasing the prestige of the profession, attracting members of the Organization to scientific research in the field of nursing, holding conferences, seminars on topical problems in nursing, protecting the legal rights of nurses, etc. d. [ eleven ].

The place of work determines the scope of duties of a nurse.

· Patronage nurses work in dispensaries (anti-tuberculosis, psycho-neurological, dermatological and venereal), in children's and antenatal clinics. Such nurses carry out all medical procedures at home.

· Children's nurses. They can be found in children's clinics and hospitals, kindergartens, orphanages.

· Nurses in the physiotherapy room. Medical procedures are carried out using various special devices: electrophoresis, ultrasound, UHF devices, etc.

· Ward nurse - distributes medicines, puts compresses, banks, enemas, makes injections. It also measures temperature, pressure and reports to the attending physician about the well-being of each patient. And if necessary, the nurse provides emergency care (for example, in case of fainting or bleeding). The health of each patient depends on the work of the ward nurse. Especially if it's a seriously ill patient. In good hospitals, ward nurses (with the help of junior nurses and nurses) take care of weak patients: they feed, wash, change clothes, make sure that there are no bedsores.

A ward nurse has no right to be careless or forgetful. Unfortunately, the work of a ward nurse involves night shifts. This is bad for health.

For sterilization, instruments are taken to the sterilization department. The nurse working there is managed with special equipment: steam, ultraviolet chambers, autoclaves, etc.

There are also massage nurses, diet nurses, etc. This is not a complete list of options for working as a nurse. Each has its own specifics. They are united by the fact that, although a nurse is considered a doctor's assistant, the main goal of a nurse's work is to help sick people. Such work brings moral satisfaction, especially if it is work in a hospital. But it is also very hard work, even if you love it very much. There is no time for smoke breaks and thoughtfulness in the middle of the working day.
The most difficult are the departments in which operations are performed and where emergency patients arrive. These are surgery, traumatology, otolaryngology. The peculiarities of the profession of a nurse include the fact that many people in this specialty not only give injections and measure blood pressure, but also morally support the patient in difficult times. After all, even the strongest person, ill, becomes defenseless and vulnerable. And a kind word can work wonders.

The nurse should know the methods of disinfection, the rules for performing vaccinations, injections. She is required to understand medicines and their prescriptions and be able to perform various medical procedures. To master the profession of a nurse, good knowledge in the field of medicine and psychology is required, as well as in such subjects as biology, botany, anatomy, and chemistry. And this is understandable, because nurses, having the latest knowledge, can perform their work more efficiently and effectively, which will not only affect the well-being of patients, but also the satisfaction of nurses with their work.

1.2 Profession history and personal qualities required to work as a nurse

nurse occupational risk

The first nurses appeared under the auspices of the church. And the word "sister" meant kinship not by blood, but by spirituality. Moral and ethical aspects have played a fundamental role in the activities of the sister of mercy at all times. Women, nuns or laywomen, devoted their whole lives to this high service. The Holy Scripture tells that even in the initial period of Christianity, people appeared, driven by love and compassion, who voluntarily devoted themselves to caring for the sick and wounded - brothers and, which is especially significant, sisters of mercy, whose names are found in the epistles of the Apostles. Among the disciples and followers of Jesus Christ were groups of women called the Community of Holy Wives, who accompanied the Savior and served on his behalf.

In the 11th century, communities of women and girls appeared in the Netherlands, Germany and other countries to care for the sick. In the XIII century, Countess Elisabeth of Thuringia, later canonized, built a hospital at her own expense, and also organized a shelter for foundlings and orphans, and she herself worked in it. In her honor, the Catholic community of Elizabethans was founded. In peacetime, sister nuns cared only for sick women, and in wartime, they also looked after wounded soldiers. They also cared for those with leprosy. In 1617 in France, the priest Vincent Paul organized the first community of sisters of mercy. He first proposed this name - "sister of mercy", "elder sister". The community consisted of widows and maidens who were not nuns and did not take any permanent vows. The community was headed by Louise de Marillac, who organized a special school for the training of sisters of mercy and nurses. Similar communities began to be created in France, the Netherlands, Poland and other countries.

In the middle of the XIX century. almost simultaneously in England and Russia, professional nurses appeared (that is, women who not only had a desire to serve their neighbor, but also possessed certain medical knowledge and skills). In Russia, the profession of a nurse appeared in 1863. Then an order was issued by the Minister of War on the introduction, in agreement with the Exaltation of the Cross community, of a permanent nursing care for the sick in military hospitals. The cornerstone of the philosophy of the nursing movement is the idea of the equal right to mercy of any person, regardless of his nationality, social status, religion, age, nature of the disease, etc.

The founder of the nursing profession, F. Nightingale, defined nursing as one of the oldest arts and one of the youngest sciences, which focuses on caring for patients. For the first time in history, she expressed her firm conviction that "... in its essence, nursing as a profession is different from medical practice and requires special knowledge that is different from medical knowledge." The Florence Nightingale Medal, established by the International Committee of the Red Cross and Red Crescent Societies, is the highest recognition for the professional service of a nurse. This award was awarded to many Russian nurses.

The moral and ethical foundations of the professional activity of a nurse are set out in a number of international and Russian documents. Thus, the Code of Ethics of the International Council of Nurses and the National Codes of Ethics for Nurses are in force in most developed countries. Russian nurses also have their own professional code of ethics, which was adopted in 1997 at the IV All-Russian Conference on Nursing. A nurse, paramedic, midwife (hereinafter referred to as a nurse) must respect the inalienable rights of every person to achieve the highest level of physical and mental health and to receive adequate medical care. The nurse is responsible for providing the patient with quality medical care that meets the principles of humanity, professional standards, and be morally responsible for their activities to the patient, colleagues and society.

Personal qualities required to work as a nurse. The former name of this profession is "sister of mercy". Mercy and sympathy for someone else's pain is one of the most important qualities of a nurse. This must be accompanied by care, accuracy and responsibility. Good coordination of movements is also important (this is especially important for operating rooms, procedural, ward nurses), good memory, and the desire for professional growth. Good health and endurance. Allergies to certain drugs can be an obstacle to work. For example, an operating room nurse cannot assist in operations if disinfectant vapors cause her to cough. Often the working day of a nurse is irregular, and night shifts and physical exercise can negatively affect the emotional and mental state of medical staff.

The main condition for the activity of a nurse is professional competence. To work as a nurse, it is necessary to strive to improve their knowledge, observe and maintain professional standards of activity determined by the Ministry of Health and social development Russian Federation. Continuous improvement of special knowledge and skills, raising one's cultural level is the first professional duty of a nurse. It must also be competent in relation to the moral and legal rights of the patient.

A nurse must be able to keep secret from third parties information entrusted to her or made known to her due to the performance of professional duties about the patient's health status, diagnosis, treatment, prognosis of his disease, as well as about the patient's personal life even after the patient dies. Respect the dying patient's right to humane treatment and a dignified death. The nurse must treat the deceased patient with respect. When processing the body, religious and cultural traditions should be taken into account.

1.3 Sister's tactics in the process of medical activity

Communication with the patient is an essential element of the treatment process. All this requires great tact, especially when it comes to clarifying the state of mind, mental trauma, which play a large role in the development of the disease. It should be noted that the prerequisite for the emergence of positive psychological relationships and trust between health workers and patients is the qualifications, experience and skill of the doctor and nurse. Narrow specialization carries with it a certain danger of a narrowed view of the patient. Medical psychology can help offset these negative aspects of specialization through a synthetic understanding of the patient's personality and body.

For the manifestation of trust in a health worker, the first impression that a patient has when meeting with him matters. At the same time, the actual facial expressions of a medical worker, his gestures, tone of voice, facial expressions arising from the previous situation and not intended for the patient, the use of slang speech turns, as well as his appearance are important for a person. For example, if a sick person sees a doctor or nurse as untidy, sleepy, then he may lose faith in them, often believing that a person who is not able to take care of himself cannot take care of others. Various behavioral and appearance Patients tend to forgive only providers they already know and trust.

A health worker gains the trust of patients if, as a person, he is harmonious, calm and confident, but not arrogant. Basically, in cases where his demeanor is persistent and resolute, accompanied by human participation and delicacy. Special requirements for the health worker are the need to be patient and self-controlled. He must always consider various possibilities for the development of the disease and not consider ingratitude, reluctance to be treated, or even a personal insult on the part of the patient if the patient's condition does not improve. There are situations when it is appropriate to show a sense of humor, however, without a hint of mockery, irony and cynicism. Such a principle as “laugh with the patient, but never at the patient” is known to many. However, some patients cannot stand humor even with good intentions and understand it as disrespect and humiliation of their dignity.

There are facts when people with unbalanced, uncertain and absent-minded manners gradually harmonized their behavior in relation to others. This was achieved both through our own efforts and with the help of other people. However, this requires certain psychological efforts, work on oneself, a certain critical attitude towards oneself, which for a health worker is and should be taken for granted.

It should be noted that the personal shortcomings of the health worker may lead the patient to believe that a doctor or nurse with such qualities will not be conscientious and reliable in the performance of their direct duties.

Thus, the professional activity of a nurse is a link in the process of work of medical workers. The nurse is the basis in solving the problems of treatment, aftercare, patronage, and rehabilitation services. Of great importance in such work is the ability to establish contacts, which imposes certain requirements on the personal qualities of the sister. From the moment of its inception to the present, the main qualities of nurses should be mercy and sympathy for someone else's pain, great tact in communication, both with patients and with colleagues.

CHAPTER II. aspects of the work of SISTER AMONG medical personnel

2.1 Occupational risk factors for healthcare workers in health care settings

One of the most important tasks for the successful work of medical workers is the definition, identification and elimination of various risk factors for medical personnel in medical institutions (HCF) . There are four groups of professional factors that adversely affect the health of staff:

I. Physical risk factors:

Physical interaction with the patient

exposure to high and low temperatures;

the action of various types of radiation;

violation of the rules for the operation of electrical equipment.

Physical interaction with the patient. In this case, all activities related to the transportation and movement of patients are implied. They are the main cause of injuries, back pain, and the development of osteochondrosis, primarily in nurses.

Exposure to high and low temperatures. Doctors and nurses working with liquid nitrogen, nurses working with paraffin in physiotherapy departments, in sterilization departments, pharmacists in the manufacture of medicines are subject to this factor. To avoid the adverse effects of high and low temperatures (burns and hypothermia) in connection with the performance of manipulations, the implementation of any nursing intervention strictly according to the algorithm of actions will allow.

Radiation action. High doses of radioactive exposure are fatal. Small doses lead to blood diseases, the occurrence of tumors, impaired reproductive function, and the development of cataracts. Sources of radiation in healthcare facilities are X-ray machines, scintigraphy devices, electron microscopes, etc. This factor affects primarily X-ray laboratory technicians and radiologists.

Violations of the rules for the operation of electrical equipment. In her work, the nurse often uses electrical appliances. Electric shock (electrical injury) is associated with improper operation of the equipment or its malfunction. When working with electrical appliances, you must follow the safety rules.

II. Chemical risk factors:

The risk of working in health care facilities for medical workers lies in the impact of different groups of toxic substances contained in disinfectants, detergents, medicines. This factor affects both nurses and doctors and nurses working in almost any branch of medicine. In nurses, the most common manifestation side effects toxic substances is occupational dermatitis - irritation and inflammation of the skin varying degrees gravity. Toxic and pharmaceuticals can affect the respiratory, digestive, hematopoietic, reproductive functions.

III. Biological risk factors:

Biological factors include the risk of contracting a nosocomial infection (HAI). Almost all medical workers working in almost any branch of medicine who are in direct contact with the patient and his secretions are subject to this factor. Prevention of occupational infection and ensuring the safety of medical staff is achieved by strict adherence to the anti-epidemic regime and disinfection measures in health facilities. This allows you to maintain the health of medical personnel, especially those working in emergency and infectious diseases departments, operating rooms, dressing rooms, manipulation rooms and laboratories, i.e. having a higher risk of infection as a result of direct contact with potentially infectious biological material (blood, plasma, urine, pus, etc.). Work in these functional rooms and departments requires individual anti-infection protection and compliance with safety regulations by personnel, mandatory disinfection of gloves, waste material, use of disposable instruments and underwear before their disposal, regularity and thoroughness of current and general cleaning.

IV. Psychological risk factors. This factor plays a particularly important role in the work of medical workers. If for a doctor psychologically the level of responsibility for the formation of the diagnosis and tactics of treating the patient has a greater psychological impact, then in the work of a nurse importance has an emotional safety mode. The work associated with caring for sick people requires a lot of physical and emotional stress. Psychological risk factors in the work of a nurse can lead to various types psychoemotional disorders.

Psycho-emotional stress. Psycho-emotional stress in a nurse is associated with a constant violation of the dynamic stereotype and systematic violations of daily biorhythms associated with work in different shifts (day-night). The work of a nurse is also associated with human suffering, death, colossal burdens on nervous system, high responsibility for the life and well-being of other people. By themselves, these factors already lead to physical and emotional strain. In addition, psychological risk factors include: fear of occupational infection, frequent situations associated with communication problems (worried patients, demanding relatives). There are a number of factors that increase overstrain: dissatisfaction with the results of work (lack of conditions for effective assistance, material interest) and excessive requirements for a nurse, the need to combine professional and family responsibilities.

Stress and nervous exhaustion. Constant stress leads to nervous exhaustion - loss of interest and lack of attention to the people with whom the nurse works. Nervous exhaustion is characterized by the following symptoms:

* physical exhaustion: frequent headaches, back pain, decreased performance, loss of appetite, sleep problems (drowsiness at work, insomnia at night);

* emotional overstrain: depression, feeling of helplessness, irritability, isolation;

* mental stress: negative attitude towards oneself, work, others, weakening of attention, forgetfulness, absent-mindedness.

Start implementing preventive measures nervous exhaustion needed as soon as possible. In order to prevent the negative impact of stressful situations, a nurse in her work should be based on the following principles:

1) a clear knowledge of their official duties;

2) planning your day; define goals and priorities using the characteristics "urgent" and "important";

3) understanding the importance and significance of their profession;

4) optimism, the ability to focus on the positive that was done during the day, considering only success as a result;

5) compliance healthy lifestyle life, proper rest, the ability to relax, "switch";

6) rational nutrition;

7) observance of the principles of medical ethics and deontology.

2.2 Identification and analysis of "emotional burnout" in sisters as a consequence of the psychological factor of occupational risk

Occupational stress is a multidimensional phenomenon, expressed in physiological and psychological reactions to a difficult work situation. The development of stress reactions is possible even in progressive, well-managed organizations, which is due not only to structural and organizational features, but also to the nature of the work, personal relationships of employees, and their interaction. In the course of a survey conducted in 15 countries of the European Union, 56% of workers noted the high pace of work, 60% - tight deadlines for its implementation, 40% - its monotony, more than a third did not have the opportunity to exert any influence on the order of tasks. Work-related stressors contribute to the development of health problems. Thus, 15% of workers complained of headache, 23% of neck and shoulder pain, 23% of fatigue, 28% of stress and 33% of back pain. Nearly one in 10 reported being subjected to intimidation tactics in the workplace.

Another phenomenon characteristic of many industries is mental violence, the cause of which is the deterioration of interpersonal relationships and organizational dysfunctions. The most common form of such violence is the abuse of power against people who are unable to defend themselves.

Social psychologist K. Maslac (1976) defined this condition as a burnout syndrome (BS), including the development of negative self-esteem, a negative attitude towards work, loss of understanding and empathy towards clients or patients. AT International classification diseases (ICD-X) SEB is classified under Z73 - "Stress associated with difficulties in maintaining a normal lifestyle." Among the professions in which SEB occurs most often (from 30 to 90% of employees), doctors, teachers, psychologists, social workers, rescuers, law enforcement officers. Almost 80% of psychiatrists, psychotherapists, psychiatrists-narcologists have signs of burnout syndrome of varying severity; 7.8% - a pronounced syndrome leading to psychosomatic and psychovegetative disorders. According to British researchers, among doctors general practice a high level of anxiety is found - in 41% of cases, clinically pronounced depression - in 26% of cases. In a study conducted in our country, 26% of therapists had a high level of anxiety, and 37% had subclinical depression. Signs of EBS are detected in 61.8% of dentists. Among the nurses of psychiatric departments, signs of EBS are found in 62.9%. 85% of social workers have some kind of burnout symptoms.

One of the first places on the risk of developing SES is the profession of a nurse. Her working day is the closest communication with people, mainly with the sick, who require vigilant care and attention. Facing negative emotions, the nurse involuntarily and involuntarily becomes involved in them, as a result of which she herself begins to experience increased emotional stress. Most of all, those who make unreasonably high demands on themselves are at risk of developing BS. A real doctor in their view is a model of professional invulnerability and perfection.

To assess the severity of emotional burnout, we conducted a study of two groups of nurses. The first group: nurses - 26 people working in the outpatient service with a shift schedule during the day. The second group: nurses - 30 people working in inpatient departments, with round-the-clock work. Selection criteria for groups: age, gender, medical education. In the future, we carried out a statistical analysis of the results.

Questioning. In order to obtain data on the demographic characteristics of nurses, a questionnaire was compiled (Appendix 1). The results of the survey are presented in table 1 and in fig. 1-2.

Table 1

Characteristics of the examined

The table shows that both groups were similar in terms of average age, work experience and marital status.

Fig.1 Characteristics of the examined by age.

But when comparing age indicators, it was found that younger specialists predominate in the polyclinic compared to the hospital (Fig. 1). Thus, there were 9 nurses under 25 years old in the polyclinic (34.6%), nurses aged 25-40 years 10 (38.4%), nurses aged 41-55 years 5 (19.2%) and over 55 years 2 (7.7%). There were 3 people (10.0%) in the hospital for nurses under 25 years old, 11 (36.7%) nurses aged 25-40 years old, 12 (40.0%) nurses aged 41-55 years old and over 55 years old 4 (13.3%).

Accordingly, the length of service also differed (Fig. 2). Having worked less than 5 years in a polyclinic, in a hospital

Fig. 2 Characteristics of the surveyed by length of service.

Thus, there were 4 nurses with work experience of up to 5 years in the polyclinic (15.4%), nurses with work experience of 5-10 years 6 (23.1%), nurses with work experience of 10-20 years 41-55 years 12 (46.2%) and with more than 20 years of work experience 3 (11.4%). In the hospital, there were 3 people (10.0%) of nurses with work experience of up to 5 years, 8 (26.7%) nurses with work experience of 5-10 years, 13 (43.3%) nurses with work experience of 10-20 years with more than 20 years of work experience 6 (20.0%).

In the survey, the locus of control was assessed in medical workers according to the method of J. Rotter. Locus of control is a concept that reflects the tendency of a person to attribute the causes of events to external or internal factors. The distribution of nurses by the level of locus of control is presented in Table 2.

table 2

The results of the study of the locus of control in nurses according to the method of J. Rotter

Table 2 shows that the majority of healthcare workers low level both general internality and internality in professional activities: it is expressed in 61.5% of nurses in the polyclinic and 66.7% of nurses in the hospital. This indicates the manifestation of their externality. They are characterized by outwardly directed protective behavior. Any situation is desirable to the external as externally stimulated, and in cases of success, one's abilities and capabilities are demonstrated. They are convinced that their failure is the result of bad luck, accidents, the negative influence of other people. Approval and support for such people is very necessary. However, one should not expect special gratitude for sympathy from them.

38.5% of polyclinic nurses and 33.7% of hospital nurses have a high level, which indicates the manifestation of internality. They have a broader time perspective, covering a significant number of events, facts, both future and past. At the same time, their behavior is aimed at consistently achieving success through the development of skills and deeper processing of information, setting ever-increasing in complexity tasks. The need for achievement, therefore, tends to increase, associated with an increase in the values of personal and reactive anxiety, which is a prerequisite for possibly greater frustration and less stress resistance in cases of serious failures. However, in general, in real, externally observed behavior, internals give the impression of quite self-confident people, especially since in life they often occupy a higher social position than externals. These people believe that everything they have achieved in life is the result of their work and merit.

We also studied the phenomenon of burnout among nurses. There are three main factors that play a significant role in the syndrome of emotional burnout - personal, role and organizational.

Personal factor. Studies have shown that such variables as age, marital status, work experience do not affect emotional burnout. But women develop emotional exhaustion to a greater extent than men, they have no connection between motivation and the development of the syndrome, in the presence of a connection with the significance of work as a motive for activity, satisfaction with professional growth. V. Boyko indicates the following personal factors that contribute to the development of the burnout syndrome: a tendency to emotional coldness, a tendency to intense experience of negative circumstances of professional activity, weak motivation for emotional return in professional activity.

role factor. A relationship has been established between role conflict, role uncertainty and emotional burnout. Working in a situation of distributed responsibility limits the development of the emotional burnout syndrome, and with fuzzy or unevenly distributed responsibility for one's professional actions, this factor increases sharply even with a significantly low workload. Those professional situations contribute to the development of emotional burnout, in which joint efforts are not coordinated, there is no integration of actions, there is competition, while a successful result depends on coordinated actions.

organizational factor. The development of the syndrome of emotional burnout is associated with the presence of intense psycho-emotional activity: intensive communication, reinforcing it with emotions, intensive perception, processing and interpretation of the information received and decision-making. Another factor in the development of emotional burnout is a destabilizing organization of activities and an unfavorable psychological atmosphere. This is a fuzzy organization and planning of work, insufficiency necessary funds, the presence of bureaucratic moments, many hours of work, which has difficult to measure content, the presence of conflicts both in the "head - subordinate" system and between colleagues.

Each component of "burnout" is diagnosed according to 4 signs that form the corresponding scales:

Burnout Components	Signs (scales)
"Voltage"	Experience of traumatic circumstances Self dissatisfaction - "trapped in a cage" Anxiety and depression
"Resistance"	Inappropriate selective emotional response Emotional and moral disorientation Expansion of the sphere of economy of emotions Reduction of professional duties
"Exhaustion"	Emotional deficit Emotional detachment Personal detachment (depersonalization) Psychosomatic and psychovegetative disorders

Using this technique, we interviewed 56 outpatient and inpatient nurses of the somatic service.

In the course of the study of the phenomenon of emotional burnout among nurses of a polyclinic and a hospital of a somatic service, the following results were obtained. Figure 3 shows data on the degree of formation of the stress phase in nurses of the polyclinic and hospital.

Fig.3 The degree of formation of the stress phase in nurses of the polyclinic and hospital.

An analysis of the symptoms of the tension phase showed that the symptom of emotional burnout "experiencing psychotraumatic circumstances" was formed in 93.3% of hospital nurses and 26.9% of polyclinic nurses (Table 3).

Table 3

The results of the study of emotional burnout among nurses in the stress phase

Phase/symptoms	Polyclinic	hospital

I. "Voltage": Phase not formed Phase in formation Formed phase
Experience of traumatic circumstances: an unresolved symptom developing symptom established symptom
Self dissatisfaction: *non-existent symptom developing symptom established symptom
"Caged in a cage": *non-existent symptom developing symptom established symptom
Anxiety and depression: an unresolved symptom developing symptom established symptom

Note: *p<0.05- разница статистически достоверна между показателем поликлиники и стациоанара

In the phase of tension, this symptom is manifested by an increasing awareness of the psycho-traumatic factors of professional activity, which are difficult or completely irremovable, irritation with them gradually grows, despair and indignation accumulate. The insolvability of the situation leads to the development of other phenomena of "burnout". In 6.7% of hospital nurses, this symptom is in the formation phase, and in 73.1% of outpatient clinic nurses, this symptom is not formed.

The syndrome of "dissatisfaction with oneself" was formed in 26.6% of hospital nurses and in 7.8% of polyclinic nurses. These medical workers are dissatisfied with themselves, with their chosen profession, position, and specific responsibilities. There is a mechanism of "emotional transfer" - the energy is directed not only and not so much outside, but towards oneself. Impressions from external factors of activity constantly injure a person and encourage her to experience psychotraumatic elements of professional activity again and again. In this scheme, the well-known internal factors that contribute to the emergence of emotional burnout are of particular importance: intensive internalization of duties, roles, circumstances of activity, increased conscientiousness and a sense of responsibility. In the initial stages of "burnout" they escalate tension, and in the subsequent ones they provoke psychological defense. In the majority of polyclinic nurses (73.1%) and in some hospital nurses, these symptoms are not formed (16.7%), in the formation phase this symptom is in 7.1% of polyclinic nurses and 56.7 of hospital nurses.

The symptom of "driven into a cage" was formed in 70.0% of nurses of the hospital and in 23.3% in the formative stage. It is significant that this symptom is not formed in 69.2% of the nurses of the polyclinic and in 30.8% in the formative stage. This symptom is a logical continuation of developing stress. That is, psychotraumatic circumstances affect health workers, and despite the fact that it is impossible to eliminate them, they experience a sense of hopelessness. This is a state of intellectual-emotional impasse, which is most typical of those working in a hospital around the clock.

Such a symptom of emotional burnout as "anxiety and depression" is formed in 60% of nurses of the hospital, in all nurses of the polyclinic (100% of nurses), this symptom is not formed. This syndrome is found in connection with professional activity in especially complicated circumstances, prompting emotional burnout as a means of psychological protection. The feeling of dissatisfaction with work and oneself is generated by powerful energy tensions in the form of experiencing situational or personal anxiety, disappointment in oneself, in one's chosen profession, in a particular position.

Figure 4 shows data on the degree of formation of the resistance phase in nurses of the polyclinic and hospital.

Fig. 4 The degree of formation of the phase of resistance in nurses of the polyclinic and hospital.

The phase of resistance is formed in the majority of health workers, let's consider the formation of its individual symptoms. The results of diagnosing the symptoms of the resistance phase are presented in Table 4.

Table 4

The results of the study of emotional burnout among nurses in the phase of resistance

Phase/symptoms	Polyclinic	hospital

I. "Resistance": Phase not formed *Phase in formation Formed phase
Inappropriate selective emotional response: an unresolved symptom developing symptom established symptom
Emotional and moral disorientation: an unresolved symptom developing symptom established symptom
Expanding the sphere of saving emotions: an unresolved symptom developing symptom established symptom
Reduction of professional duties: an unresolved symptom developing symptom *existing symptom

Note: *p<0.05- разница статистически достоверна между показателем поликлиники и стациоанара

The symptom of "inadequate emotional response" is the most pronounced in this phase, it is formed in 46.1% of polyclinic nurses and 73% of hospital nurses, in 46.1% of polyclinic nurses and 27% of nurses it is in the formative stage. The severity of this syndrome is an undoubted "sign of burnout", it shows that medical workers cease to grasp the difference between two fundamentally different phenomena: the economic manifestation of emotions and inadequate selective emotional response, demonstrating the latter.

The symptom of "emotional and moral disorientation" is expressed in 23.1% of polyclinic nurses and 36.7% of hospital nurses, while it is not formed in most medical workers. This symptom, as it were, deepens the inadequate reaction in relations with patients and colleagues. Consequently, some polyclinic nurses feel the need for self-justification. Without showing the proper emotional attitude to the subject, they defend their strategy. At the same time, judgments are heard: “this is not the case to worry about”, “such people do not deserve a good attitude”, “you can’t sympathize with such people”, “why should I worry about everyone”, this is more typical for hospital nurses.

The symptom of "expansion of the sphere of economy of emotions" was not formed in any of the nurses of the polyclinic and in 26.9% it was at the stage of formation, while among the nurses of the hospital this symptom was formed in 13.3% and in 36.7% it was at the stage formations. The formation of this symptom indicates that health workers get tired at work from contacts, conversations, answers to questions, and they no longer want to communicate even with their loved ones. And often it is the family who become the first "victim" of emotional burnout. In the service, specialists still communicate according to standards and duties, and houses are closed.

The symptom of "reduction of professional duties" was formed in 15.4% of polyclinic nurses and 86.7% of hospital nurses, in this sample, in 34.6% of polyclinic nurses and 13.3% of hospital nurses, this symptom is in the process of formation. Reduction is manifested in attempts to lighten or reduce responsibilities that require emotional costs - patients are deprived of attention.

Figure 5 shows data on the degree of formation of the exhaustion phase in nurses of the polyclinic and hospital.

Fig. 5 The degree of formation of the phase of exhaustion in nurses of the polyclinic and hospital.

The majority of polyclinic nurses have not developed the "exhaustion" phase, while inpatient nurses have. This phase is characterized by a more or less pronounced drop in the overall energy tone and a weakening of the nervous system. Emotional protection in the form of "burnout" becomes an integral attribute of the personality. From Table 5, we see that the symptom of "emotional deficit" is formed in 23.1% of polyclinic nurses and 80% of hospital nurses, in the majority of polyclinic nurses (50%) this symptom is not formed and in some hospital nurses (20.0%) in formation stage.

Table 5

The results of the study of emotional burnout in nurses in the phase of exhaustion

Phase/symptoms	Polyclinic	hospital

I. "Exhaustion": Phase not formed Phase in formation Formed phase
Emotional deficit: an unresolved symptom developing symptom *existing symptom
Emotional detachment: an unresolved symptom developing symptom established symptom
Personal detachment (depersonalization): *non-existent symptom developing symptom established symptom
Psychosomatic and psychovegetative disorders: *non-existent symptom developing symptom established symptom

Note: *p<0.05- разница статистически достоверна между показателем поликлиники и стациоанара

The symptom of "emotional detachment" was formed in 80% of the nurses of the hospital, in 11.5% of the nurses of the polyclinic and in 20% of the nurses of the hospital it was in the process of formation, in 88% of the nurses of the polyclinic the symptom was not formed. In the case of the formation of this symptom, the sisters completely exclude emotions from the sphere of professional activity. They care about almost nothing, almost nothing causes an emotional response - neither positive nor negative circumstances. Moreover, this is not an initial defect in the emotional sphere, not a sign of rigidity, but emotional protection acquired over the years of serving people. A person gradually learns to work like a robot, like a soulless automaton. In other spheres he lives full-blooded emotions.

The symptom of "personal detachment, or depersonalization" was formed in 43.3% of hospital nurses, in the majority of polyclinic nurses (65.4%) it, like the previous symptom, was not formed. This symptom manifests itself in a wide range of mentality and actions of a professional in the process of communication. First of all, there is a complete or partial loss of interest in a person - the subject of professional action. It is perceived as an inanimate object, as an object for manipulation - something has to be done with it. The object burdens with its problems, needs, its presence is unpleasant, the very fact of its existence. There is a depersonalized protective emotional-volitional anti-humanistic attitude. The personality claims that working with people is not interesting, does not give satisfaction, does not represent social value.

Aspects of a nurse's job. Abstract legal aspects of the nursing service

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