Aspects of a nurse's job. Psychological aspects of the professional activity of a medical worker
Buchkin Denis Alexandrovich
Job title: Teacher
Educational institution: St. Petersburg GBPOU "Medical College No. 2"
Locality: St. Petersburg
Material name: Article
Topic: Ethical and deontological aspects of the activity of a nurse in the intensive care unit and intensive care
Publication date: 07.04.2019
Chapter: secondary vocational
ETHICAL AND DEONTOLOGICAL ASPECTS
ACTIVITIES OF THE NURSE OF THE DEPARTMENT
REANIMATION AND INTENSIVE CARE
INTRODUCTION
Medical
acquisition
independence of the patient in the course of treatment, as it must combine in
neatness, friendliness, mercy, diligence, and most importantly
education, intelligence, organizational skills, decency, creativity
thinking and professional competence.
compliance
ethical
is
problem.
Relevance
compliance
everyday
practical
activities
nurses OAR (ICU) is due to:
The specifics of the activities of nurses in the OAR (ICU);
insufficient
ethical
legal
nursing activity, violation of the rights of patients;
Wrong choice of limits nursing care;
Complications and adverse outcomes;
Exposure
professional
emotional
"burnout" of nurses;
professional
harmfulness
absence
legal
The specifics of the activities of nurses:
extremeness
situations
need
fast
acceptance
solutions and their implementation;
reduction or lack of psychological contact of the nurse with
sick;
usage
invasiveness
diagnostics and treatment;
the presence of multiple organ failure in many patients;
need
cooperation
specialists
specialties;
iatrogenic lesions;
not enough
personnel e,
material
technical
medical provision;
psycho-emotional
staff,
exposure
emotional "burnout" of nurses.
Choosing the limits of nursing care.
An important part of any nursing intervention should be
be rational. Every patient needs nursing action,
directed
liquidation
physical
suffering;
recovery
normal
emotional
states;
optimal
intensive
dying
called
comfortable
supportive care: meticulous hygiene care, including treatment
oral cavity, adequate analgesia (regardless of required doses), adequate
capabilities
probe),
psychological
(relatives, psychotherapist, tranquilizers, priest). Comfortable
supportive
predominantly
sister
doctor's control.
A nurse without insurance and poorly oriented in modern
legal
regulatory
legal
remains
unprotected
patients
relatives
insurance
companies.
Therefore, she must know and comply with the basic ethical and legal norms when
providing anesthetic and resuscitation care.
DEFINITION OF CONCEPTS. WORK PRINCIPLES
let's analyze
main
further
quality work with patients and medical staff.
Ethics is the science of morality, the principles by which
guide people in their actions. The term was introduced by Aristotle
philosophy
moral,
moral
people's behavior.
A Medical ethics is a set of ethical norms and principles
behavior
medical
workers
implementation
professional
responsibilities,
necessary
successful
patient.
The main principles of medical ethics are:
respect for life;
Prohibition on causing harm to the patient;
Respect for the personality of the patient;
Medical secrecy;
Respect for the profession.
Code of Professional Ethics for Nurses (adopted by the International
council of nurses).
Since many nurses are not familiar with it, one of the important
are:
Ethical Foundations of Nursing
Need
nurses
universal.
Nursing
implies respect for life, dignity and human rights. It doesn't
has restrictions on national or racial grounds, on grounds of
religion,
age,
political
social
provisions.
nurses
render
medical
separate
families and the community and coordinate their activities with the work of others
Nurse and patients
main
a responsibility
nurse
needs
Rendering
nurse
tries
atmosphere of respect for patients, customs and spiritual
beliefs
patients.
Nurse
received
confidentially
information and share it with great care.
1.2DEONTOLOGY
Principles
medical
personnel
practical
activities are considered by medical deontology.
Medical deontology is the principles of behavior of medical staff,
directed
maximum
promotion
efficiency
elimination
consequences
defective
medical
medical
deontology
reflects
specific
standards for doctors and nurses.
Deontology
identified
what to do in a given situation and what not to do.
Main
medical
deontology.
Problems
relationships
sick,
middle
medical
worker
patient, around which revolve also issues of the relationship of the doctor
(medium
medical
employee)
surrounding
sick
(relatives, relatives, acquaintances, etc.) doctors with each other and other
medical and paramedical personnel (i.e. relationships within
medical
medical
workers
separate
groups of society. In other words, modern medical practice is
a complex system in which doctors and patients can be in the most
various forms of social interaction.
A patient who trusts his health to a nurse wants and
must be confident not only in professional skills, but also
following
moral
moral
principles.
A nurse should be decent and honest, sensitive and kind,
merciful and responsive.
Moral basis, standard and standard of behavior
medical
is
"Ethical
medical
(Attachment 1).
1.3 BIOETHICS
A task modern medicine is to make life
a person long and happy, without illness and suffering.
However, people who are obsessed with
thirst for power, profit and exclusively their own interests. This and
cause
occurrence
medical
bioethics, which considers medicine in the context of human rights.
Bioethics is a modern model of biomedical ethics. Basic
principle - "respect for human rights and dignity". Philosophical knowledge in
interaction
scientific,
technical
technological,
informational and genetic achievements of modern medicine.
All measures are aimed at preserving and maintaining the life of the patient.
Medical
bioethics
performs
medical worker as a person, allowing the physician to act not only
according to existing laws, but also according to their own conscience when performing
professional debt.
Modern
medical
bioethics
faces
many
controversial
artificial
fertilization,
cloning, sexology, euthanasia (Article 45 of the Federal Law of November 21, 2011 No. 323-FZOB
fundamentals of protecting the health of citizens in Russian Federation. Medical
employees
prohibited
implementation
euthanasia,
acceleration
the patient's request for his death by any action (inaction) or
means,
termination
artificial
activities
keeping the patient alive). In these cases, the so-called
rights conflict.
For example, the fetus's right to life and the woman's right to abortion
pregnancy
artificial
interrupt
pregnancy.
on one's own
motherhood.
Artificial termination of pregnancy is carried out at the request of a woman
with informed voluntary consent).
Also, one of the factors affecting the possible limitation
medical
worker
is
religious and cultural
formed
consciousness
patient.
Without knowledge cultural characteristics, it is impossible to correctly render
medical
multi-confessional
Rendering
medical
religious and cultural
features
individual
lead
negative
consequences.
It should be especially noted that when medical care in
emergency
situations
conditions
massive
disasters
(especially
transnational)
necessary
take the utmost care
rendering
medical
explain
relatives
need
medical
intervention
the feasibility of such treatment. When providing medical
territory
foreign
states
desirable
is
the presence of local doctors familiar with cultural peculiarities
providing medical care to the population.
Compliance with professional secrecy concerns not only doctors, but also
nurses.
Information
appeals
medical
the state of health of a citizen, the diagnosis of his disease and other information,
obtained during his examination and treatment constitute a medical secret;
citizen
confirmed
guarantee
privacy
information transmitted to them - these provisions are enshrined in Part 1 of Art. 61 Basics
legislation
Russian
Federations
health
(Federal Law No. 323-FZO dated November 21, 2011 On the Fundamentals of Health Protection
Russian
Federations
allowed
disclosure of information constituting a medical secret by persons who
known
learning,
performance
professional,
official and other duties (part 2 of the Fundamentals).
CHARTER NURSES
The nurse is the first assistant in the treatment of the patient. Precisely and
It is your duty to fulfill medical appointments on time.
Attentiveness
suffering
sick
facilitates
well-being. Treat the patient the way you would like to
treated you, respond immediately to each new complaint
sick, not slightest change his well-being.
behavior
condition
sick
causes
concern about his condition, immediately report this to the doctor.
The word heals, the word hurts. Be restrained in conversations with the patient.
Polite, attentive. About his health tell him only what
belief, does not harm the psyche of the patient.
the most important
sick.
in every possible way
protect the medical and protective regime in the department.
workers - half the success.
Be clean and tidy, fit and dressed in a uniform that is sick
It will be nice to get help from you.
Prevention is the basis of medicine, explain to the sick every day
hygiene rules and disease prevention measures.
attentive
relatives
necessary requirements so that, for their intended purpose, they do not cause
harm to the sick, word or illegal drugs.
10. In order to consciously participate in the treatment of patients, you need to know a lot,
constantly improve their medical knowledge.
11. Masterfully performed medical manipulation eliminates unnecessary
disease, and sometimes danger. Learn to be good at medicine
technique.
12. Protect
property,
medicines,
tools,
you use.
Reasonable savings allow the same means to provide assistance.
FEATURES OF THE ACTIVITY OF A NURSE
REANIMATION AND INTENSIVE CARE DEPARTMENTS
Medical
correctness
relations
between all members of the team, regardless of rank and title. respectful
appeal
colleagues
medical
emphasizes the purity and high meaning of the profession. Especially strictly this
principle should be adhered to if communication takes place in the presence of
patient (see Appendix 1).
You should pay attention to:
Appearance:
compliance
the use of cosmetics should be moderate, there should not be sharp
smells of perfume, tobacco, etc.);
enough
completely cover the clothes, the sleeves of the bathrobe should cover the sleeves
Under the bathrobe, you need to wear easy-washable clothes, it is better
from cotton natural fabrics;
Hair must be tucked under a cap;
Shoes should be easy to wash and disinfect.
and allowing you to move silently.
Nurse-Physician Relationship:
Rudeness, disrespectful attitude in communication are unacceptable;
Execute
medical
destination
in a timely manner,
professionally;
inform
sudden
changes
the patient's condition;
If there are doubts in the process of performing medical
appointments in a tactful manner to find out all the nuances with the doctor in the absence
sick.
Relationship between nurses
Rudeness and disrespectful attitude towards colleagues is unacceptable;
Remarks should be made tactfully and in the absence of the patient;
Experienced nurses should share their experience with the young;
In difficult situations, we must help each other.
The relationship of the nurse with the junior medical staff:
Maintain mutual respect;
Control tactfully, unobtrusively the activities of a junior
medical staff;
Rudeness, familiarity, arrogance are unacceptable;
admissible
remarks
presence
visitors.
Nurse's attitude towards patients:
There are several models of relationships between health workers and
patients (Robert Wich, 1992).
paternalistic
Latin
is characterized by the fact that the medical staff treats patients in the same way as
parents treat their children. However, they take most of
responsibility for yourself.
Engineering - the model is characterized by the fact that
some functions are restored and breakdowns in the body are eliminated
patient. The interpersonal aspect is almost entirely ignored here.
Collegiate
characterized
mutual
trust
medical staff
patients.
striving
nurses become "friends" of the patient.
Contract
looks
legally
issued
patient.
suggests
consistent respect for the rights of the patient.
In addition, the attitude of a nurse towards patients should always be
benevolent,
unacceptable
remarks,
take account of
individual
psychological
peculiarities,
listen,
experiences
patient.
heavy
painful
procedures
nurse
clarify
affordable
meaning,
need
successful
psycho-emotional
voltage.
The relationship of the nurse with relatives and friends of the patient:
It is necessary to maintain restraint, calmness and tact;
caring
seriously ill
clarify
the correctness of the procedures and manipulations;
Talk only within their competence (does not have the right
talk about the symptoms, about the prognosis of the disease, but should direct to
treating physician);
Reply
calmly,
slowly
proper care of the seriously ill.
Clinical etiquette in the ICU (observance of traditional external
behavior
medical
personnel
medicine
critical
conditions) increases the effectiveness of resuscitation care.
finding
patient
unconscious
able
be aware of implicit memory: an unpleasant conversation can be imprinted
in implicit memory and manifest itself, later, in the most unexpected
medical
legal
responsibility for those actions that, according to regulatory documents
fall within their responsibilities and competences. With the development of life-threatening
patient of the consequences of intensive care, the medical
personnel are subject to administrative and criminal liability in
in accordance with the Criminal Code of the Russian Federation.
Among 16 nurses of OAR-I GB No. 15,
survey of 8 questions (Appendix 2).
Work experience:
Up to 3 years - 4 (32%)
3-5 years - 6 (24%)
5-10 years - 2 (8%)
10-20 years old - 4 (36%)
12 (75%) respondents are satisfied with their work.
To the question "what difficulties arise when communicating with the patient" 2
nurse
noted
difficulties
patient
arise, and the majority answered 14 (88%) that difficulties arise if
the patient is aggressive and was admitted to the department in a state of intoxication.
respondents
normal, 5 (32%) nurses feel significant overload, and 2 (12%)
found it difficult to answer.
16 (100%) nurses in their professional activities always
guided
principles
professional
medical
deontology.
10 (63%) of the interviewed nurses never had moments
professional deformation, and 6 (37%) sometimes had conflict
situations.
To the question “how do you cope with stress”, nurses
listen to music - 4 (25%), training - 1 (6%), read - 3 (19%), the rest have 8
To develop the implementation of medical ethics and deontology, 13 (82%)
respondents suggest holding seminars and conferences, 2 (12%) -
booklets
periodical
leading
specialists from different countries - 1 (6%).
CONCLUSION
Based on the foregoing, in daily activities
The ICU nurse needs the following components:
Individual approach to each patient, address by name
and patronymic, detailed informing the patient about the rules of admission
drugs, goals and objectives of manipulations.
Careful identification of problems in ICU patients.
Rapidity
definition
process
acceptance
timely
acceptance
clarity
action
patient's life.
Simplicity of presentation when communicating with the patient.
Compliance
medical
deontology
implementation nursing care for the patients.
Respectful attitude and willingness to help. important
play a role - appearance, Facial Expression, Nurse Speech.
Attentiveness and interest in the problems of the patient.
Ability to deal with stress and conflict situations
prevention of occupational deformities in nurses.
ethical-deontological
principles
medical
personnel
conditions
are
full-fledged
quality
rendering
specialized
help. Middle and junior medical staff is indispensable
component of health care institutions.
The professional skills of a nurse who will find
kind words, will be able to calm the patient, divert his attention from the disease,
The work of nurses is very important and has a special contribution to
to the recovery of patients.
BIBLIOGRAPHY
Anesthesiology
resuscitation: management
anesthetists / [Aleksandrovich Yu.S. and etc.] ; ed. Yu.S. Half. -
M. : SIMK, 2016. - 784 p.
A. I. Levshankov, A. G. Klimov Nursing in anesthesiology and
resuscitation. Modern aspects: textbook. allowance. - 2nd Edition,
revised and additional / ed. prof. A. I. Levshankova. - St. Petersburg: SpetsLit,
Bioethics: teaching aid / E.A. Nagornov, D.A. Izutkin,
I.I. Kobylin, A.A. Mordvinov; ed. A.V. Grekhov. - N.Novgorod:
Nizhny State Medical Academy, 2014.
Ezova, S.A. Professional communication: new nuances and aspects:
scientific and practical guide/ S.A. Ezov. - M.: Liberea-Bibinform,
In addition to the moral responsibility of a nurse, which is presented in the Nurse's Code of Ethics, there are other types of responsibility. If during the performance of her professional duties a nurse commits offenses, then in accordance with the current legislation of the Russian Federation, she bears administrative, civil, property and criminal liability.
Improper performance of their professional duties may lead to liability. The following criteria are used to assess the quality of a nurse's work.
Criteria for assessing the quality of the work of a nurse:
1) no complications after the execution medical manipulations;
2) the absence of complaints from management and complaints from patients and their relatives;
3) timely and high-quality performance of professional duties;
4) absence of comments during scheduled and emergency inspections;
5) the presence of communication links with colleagues and clients.
In accordance with the Labor Code of the Russian Federation, the nurse is responsible for compliance with the terms of the employment contract. So, for going to work in a state of alcoholic or drug intoxication, the employee is subject to dismissal on the same day. When disclosing official or commercial secrets, as well as information about the patient, the employer may terminate the employment contract.
Poor quality of performance of professional duties can lead to administrative and disciplinary liability of a nurse. In accordance with Art. 135 Labor Code manual medical institution may impose a disciplinary sanction on employees (reprimand, severe reprimand, transfer to a less paid job, demotion for up to three months) or dismiss. When imposing a disciplinary sanction, the severity of the misconduct, the circumstances in which it was committed, as well as the attitude of the employee to work duties before the misconduct were taken into account.
A nurse may be dismissed by the management of a medical institution for inconsistency with the position held (violation of the technology for performing manipulations, non-compliance with the sanitary and anti-epidemic regime).
If a crime is committed, a nurse can be held criminally liable. A crime is an unlawful act or omission committed intentionally or accidentally (through negligence). In most cases, crimes in professional medical activity are not intentional. Most often they are associated with unforesight or underestimation. possible consequences when performing any professional actions (Article 9 of the Criminal Code of the Russian Federation). If any actions or, conversely, inaction are regarded as criminal, then they lead to criminal liability.
The current Criminal Code of the Russian Federation does not provide for special articles on the responsibility of health workers. Criminal liability for medical workers comes in accordance with the articles of the Criminal Code on reckless murder, reckless grievous bodily injury, exposing another person to the risk of HIV infection, criminal abortion, substitution or abduction of a child, failure to provide assistance to a patient (Chapter 3 of the Criminal Code of the Russian Federation). All these crimes are characterized as crimes against the life, health, freedom and dignity of the individual. So, let's look at the main cases of criminal liability.
Negligent homicide can occur when a patient is erroneously injected with potent and poisonous drugs, the dose is incorrectly calculated, and in other similar cases. If a seriously ill patient is left without the constant supervision of a nurse, resulting in death, this is also considered negligent homicide. In cases where a careless attitude towards a patient leads to a deterioration in his health, the nurse also bears legal responsibility.
It is a crime to create a threat of infection or infection with HIV, which may be associated with active actions(for example, using non-sterile instruments) or inaction (violation of the sanitary and anti-epidemic regime). Regardless of whether HIV infection has occurred or not, the crime is considered committed.
Such a crime as child substitution can only be committed intentionally. In this case, the perpetrator is aware of his actions and has some motive. The person who has committed the substitution of the child is also subject to criminal liability.
There is also criminal liability for failure to provide assistance to the patient (Article 128 of the Criminal Code of the Russian Federation). Failure to provide assistance to the patient consists in inaction, that is, it means that the health worker did not take any action to save the person or alleviate his condition. However, there are a number of circumstances in which failure to provide assistance to the patient does not lead to criminal liability. These include natural disasters, lack of funds for first aid, illness of a medical worker, the presence of several seriously ill patients at the same time, provided that assistance was provided to one of them.
Art. 221 of the Criminal Code of the Russian Federation provides for criminal liability for illegal medical treatment. The crime is associated with making a diagnosis, performing medical manipulations, prescribing treatment by a person without an appropriate education. Responsibility for a crime occurs regardless of the presence or absence of harmful consequences. If, as a result of illegal medical treatment, harm was caused to the health of the patient, then liability also arises for a crime directed against a person.
When establishing liability for illegal medical treatment, it is necessary to identify the fact of receiving remuneration (money, valuables, products) for illegal provision medical services. Illegal doctoring includes the medical activity of a health worker who does not have the right to it (there is no diploma of the relevant education, certificate or license to carry out specific types of activity). In the event that a medical professional wishes to conduct a private medical activity, in addition to the above documents, you need to obtain permission from the local administration. In addition, private medical practice is coordinated with professional medical associations.
AT daily practice nurses are often asked to give injections. Nurses should be aware that performing medical procedures at home is also an illegal activity. In addition, it can lead to serious consequences. If the patient develops a severe allergic reaction (anaphylactic shock), then at home the nurse will not be able to provide first aid in full, which can lead to the death of the patient.
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. On the professional high quality of work medical institution 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 eye. 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 have already recognized 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 behavior of a sister should not be found in a medical institution and indicates a poor-quality professional selection of personnel, 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.
The nurse strictly follows the doctor's orders. She also needs to address the psychological, social and spiritual needs of the patient. For this, a nurse, as a specialist, needs not intuitive, but additional knowledge in the field of nursing methodology, modern philosophy, and human psychology. The nurse must possess pedagogical knowledge and possess research skills. This knowledge will provide an increase in the professional growth of nurses, improve the quality of medical care, provide a systematic approach to nursing care, and restore the lost professional values of nurses.
But the implementation of the nursing process will require specific changes, not only professional, but also organizational. For such changes to occur, it is very important to recognize the need for these changes in the legislation. Today, the implementation of the nursing process is one of the goals of the development of nursing in Russia.
Nursing process is a method of evidence-based and practical actions of a nurse to provide care to patients.
The purpose of this method is to ensure an acceptable quality of life in illness by providing the maximum possible physical, psychosocial and spiritual comfort for the patient, taking into account his culture and spiritual values. Nursing currently consists of five stages:
Stage 1 - nursing examination
Stage 2 - Nursing problem of the patient
Stage 3 - Nursing care planning for the patient
Stage 4 - Implementation of the nursing care plan for the patient
Stage 5 - Evaluation of the effectiveness of nursing interventions
The first step in the nursing process is the nursing examination.
At this stage, the nurse collects data on the patient's health status and fills out the inpatient nursing card. In the process of communicating with the patient, it is very important for the nurse to establish warm, trusting relationships necessary for cooperation in the fight against the disease.
The second stage of the nursing process is the patient's nursing problem.
The concept of the patient's nursing problem was first officially recognized and legally enshrined in 1973 in the United States. The list of nursing problems approved by the American Nurses Association currently includes 114 main items, including hyperthermia, pain, stress, social isolation, lack of self-hygiene, anxiety, decreased physical activity, and more.
A patient's nursing problem is a patient's health condition, established as a result of a nursing examination, and requiring intervention from the sister. This is a symptomatic or syndromic diagnosis, in many cases based on the patient's complaints. The main methods of this stage are observation and conversation. Nursing problem determines the scope and nature of care for the patient and his environment. The nurse does not consider the disease, but the patient's response to the disease.
Nursing problems can be classified as physiological, psychological and spiritual, social. In addition to this classification, all nursing problems are divided into existing / present - problems that bother the patient at the moment (for example, pain, shortness of breath, swelling).
Since the patient always has a few real problems, the nurse must define a system of priorities, classifying them as primary, secondary, and intermediate. Priorities - this is a sequence of the most important problems of the patient, allocated to establish the order of nursing interventions, there should not be many of them - no more than 2-3.
The primary priorities include those problems of the patient, which, if left untreated, can have a detrimental effect on the patient. Intermediate priorities are non-extreme and non-life-threatening needs of the patient.
Secondary priorities are the needs of the patient that are not directly related to the disease or prognosis (for example, in a patient with a spinal injury, the primary problem is pain, the intermediate is limitation of mobility, the secondary is anxiety).
Priority selection criteria:
1. all emergency conditions, for example, sharp pain in the heart, the risk of developing pulmonary hemorrhage;
2. The most painful problems for the patient at the moment, what worries the most is the most painful and important for him now. For example, a patient with heart disease, suffering from attacks of retrosternal pain, headaches, swelling, shortness of breath, may point to shortness of breath as his main suffering. In this case, "dyspnea" will be a priority nursing problem.
Potential - these are problems that do not yet exist, but may appear over time (for example, the risk of complications - the transition to chronic form, sepsis, chronic renal failure); problems, the solution of which leads to the resolution of a number of other problems. For example, reducing the fear of an upcoming operation improves the patient's sleep, appetite, and mood.
The next task of the second stage of the nursing process is the formulation of the patient's problems - determining the patient's response to the disease and his condition. Nursing problems patients can change every day and even during the day as the body's response to illness changes.
Having established both types of problems, the nurse determines the factors that contribute to or cause the development of these problems, also reveals the strengths of the patient, which he can counter the problems.
The third step in the nursing process is care planning.
After examining, establishing a diagnosis and determining the patient's primary problems, the nurse formulates the goals of care, expected results and terms, as well as methods, methods, techniques, i.e. nursing actions that are necessary to achieve the goals. Necessary by proper care eliminate all complicating conditions of the disease so that it takes its natural course.
During planning for each priority issue goals and a care plan are formulated. There are two types of goals: short-term and long-term. Short-term goals must be achieved within a short time(usually 1-2 weeks). Long-term goals are achieved over a longer period of time, aimed at preventing recurrence of diseases, complications, their prevention, rehabilitation and social adaptation, the acquisition of medical knowledge.
Each goal has 3 components:
1. action;
2. criteria: date, time, distance;
3. condition: with the help of someone/something.
After formulating the goals, the nurse draws up the actual patient care plan, which is a detailed listing of the special actions of the nurse necessary to achieve the goals of care.
Goal Setting Requirements:
1. goals must be achievable;
2. it is necessary to set specific deadlines for achieving each goal;
3. the goals of nursing care should be within the nursing competencies.
After formulating goals and drawing up a care plan, the nurse must coordinate with the patient, enlist his support, approval and consent. By acting in this way, the nurse orients the patient towards success, proving the achievability of goals and jointly determining ways to achieve them.
The fourth stage is the implementation of the care plan.
This stage includes the measures taken by the nurse for the prevention of diseases, examination, treatment, rehabilitation of patients.
1. independent - provides for actions carried out by a nurse on her own initiative, guided by her own considerations, without a direct request from the doctor or instructions from other specialists (for example, measuring body temperature, blood pressure, pulse rate, etc.);
2. dependent - performed on the basis of written doctor's prescriptions (for example, injections, instrumental and laboratory research etc.);
3. interdependent - joint activities of a nurse with a doctor and other specialists (for example, preparing a patient for any examination).
Carrying out the fourth stage of the nursing process, the nurse performs the necessary manipulations to achieve the intended goals.
The fifth step in the nursing process is evaluation.
The purpose of the fifth stage is to assess the patient's response to nursing care, analyze the quality of care provided, evaluate the results and summarize.
The following factors serve as sources and criteria for evaluating nursing care:
1. assessment of the degree of achievement of the goals of nursing care;
2. assessment of the patient's response to nursing interventions, to medical staff, treatment, satisfaction with the fact of being in the hospital, wishes;
3. assessment of the effectiveness of the impact of nursing care on the patient's condition; active search and evaluation of new patient problems.
If necessary, the nursing action plan is reviewed, interrupted or modified. When the intended goals are not being achieved, the assessment provides an opportunity to see the factors that hinder their achievement. If the end result of the nursing process results in failure, then nursing process repeated sequentially to find the error and change the plan of nursing interventions.
A systematic evaluation process requires the nurse to think analytically when comparing expected results with achieved results. If the goals are achieved, the problem is solved, then the nurse certifies this by making an appropriate entry in the nursing history of the disease, signs and puts down the date .
The essence of nursing is caring for a person and how the sister provides this care. This work should be based not on intuition, but on a thoughtful and formed approach, designed to meet the needs and solve the problems of the patient. In other words, the model must be the basis.
A model is a model according to which something should be done. The nursing model is a direction towards achieving a goal.
The value of nursing models for the development of the nursing specialty is very great, it helps to take a different look at the functions of a nurse. If earlier she only cared for seriously ill patients, now the nursing staff, together with other specialists, sees the main task in maintaining health, preventing diseases, and ensuring maximum independence of a person in accordance with his individual capabilities.
Acting in this manner, the new concept will replace the long-established hierarchical and bureaucratic organization of nursing with a professional model. A highly qualified nurse practitioner must have the knowledge and skills and confidence to plan, implement and evaluate care that meets the needs of the individual patient. At the same time, she places special emphasis on the unique contribution of nursing care to recovery and restoration of health.
The development of existing nursing models was influenced by research and discoveries in the field of physiology, sociology, and psychology.
Each model differently reflects the understanding of the essence of the patient as an object of nursing activity, the goal of care, a set of nursing interventions and evaluation of the results of nursing care (Appendix No. 4).
Have you ever wondered why women in this profession are called sisters? And this word took root for the reason that the first nurses appeared thanks to the church. So in this case, "sister" is not a related, but a spiritual concept. There was a time when they were called not nurses, but sisters of mercy. And it was fair. During the Crimean campaign, kind-hearted women looked after the wounded, tried to be their relatives, and not only nurse the soldiers, but also morally support them. Sacrificial and noble, the profession of a nurse even now involves compassion and mercy towards the sick.
If you want to get a profession that is always and everywhere in demand, study to be a nurse. Any doctor needs a competent assistant who understands diseases and can even suggest treatment tactics.
Can you imagine at least one polyclinic or hospital without nurses, on whom the order in the department or in the office depends, as well as the precise execution of all doctor's prescriptions and practically everything that the medical institution lives by? That's right: it's impossible. In addition, any sick person is relieved not only from the procedures, but also from simple attention and kind words. And this is always the part of nurses. How can you do without them?
You've probably noticed yourself that patients have a lot more to deal with nurses than doctors. Therefore, women who have devoted themselves to this profession are distinguished by their special resistance to stress, the ability to maintain good relations, and the ability to calm a sick person.
First of all - about the workplace of nurses. These are operating rooms, treatment rooms, dental and other specialized clinics, doctor's offices in polyclinics and inpatient departments of hospitals.
Now pay attention to how wide the range of duties of a nurse is.
- She writes out prescriptions, referrals and certificates - thus following the instructions of the doctor.
- Makes injections, vaccinations, infusions, measures temperature and pressure.
- Knows the names, doses and forms of release medicines prescribed by the doctor.
- Helps surgeons during surgery, changes dressings, prepares the necessary surgical instruments.
- While patients are in the walls of a medical institution, the nurse must monitor their mental state, personal hygiene and nutrition.
- She must be proficient in first aid.
- Its functions also include the skillful use of special equipment.
This is by no means a complete list of the duties of a paramedical worker.
You will be a good nurse if you have the best human qualities. You know how to sympathize with people, you are sociable, observant, balanced, hardy. You are attentive and caring towards a weak and sick person. You have a sense of responsibility.
A nurse is an important figure in any medical institution. Often it depends on her work how high the qualification of a hospital or clinic is.
And most importantly, work should bring you joy. Probably, only such women become excellent nurses, merciful and skillful.
Where can you get a job as a nurse?
Of course, you know that with such an abundance of responsibilities professional education just necessary. You can get it at a specialized medical college (school).
But if after some time after graduating from this educational institution you feel that you are capable of more, you have the opportunity to satisfy your ambitions. In some medical institutes, nurses can receive higher education. It all depends on your intent. If you can complete this maxi-program, you will get the opportunity to work in a large clinic as a nursing service organizer, head or head nurse, head of the nursing department, and teach at a medical school.
Can a nurse make a career? Well, you can hardly expect a dizzying career growth, but there are some options.
Nursing has several career options. For example, working in the same position, improve skills. This is rewarded with a pay rise.
If the administration appreciates your experience, your ability to get along with people, you can get the position of the head nurse of the department or even the entire medical institution.
Well, and, finally, - the continuation of education in medical institute. After receiving a university degree, you will become either a doctor or a qualified nursing specialist.
"Pros" and "cons" of such work
If you do not love the profession, nothing will work. Even if you are very attracted to the profession of a nurse, and you feel a vocation in yourself and a willingness to give all your strength to your favorite business, weigh the pros and cons.
- When choosing this profession, you should be prepared for some difficulties. And above all, to the fact that you have to devote yourself entirely to work. Whatever happens in your family, no matter how hard it is after the night shift, you need a good mood and a willingness to support the patient with a smile.
- Any medical appointment for you - the law. You must know everything that happens in the department or doctor's office. Any conflict situation with patients is your fault. You should have foreseen it and prevented it. That is, a nurse is a universal specialist: a physician, a psychologist, and an organizer.
- A nurse should always be neat, collected. After all, you must admit, a nurse is also a living person, but she is not allowed to confuse appointments, diagnoses, tests, medicines. From this sometimes depends on the health and even life of a person.
- The work schedule of a nurse will suit not every woman. Think about it: will you be able to withstand the tense night shifts, the situation of constant rush? This is fraught with physical and emotional overload.
- The nurse, like all medical workers, is at risk. Helping the sick, she can pick up a dangerous disease.
This whole list of "cons" of the profession of a nurse is not given in order to scare you or turn you away from your chosen profession. Maybe you dreamed about her since childhood. But, entering a medical school, you should be guided not only by romantic ideas, but also by the real state of affairs.
You know, they say that an unloved profession is akin to an unloved husband. So think about it, really weigh your options so that disappointment does not ruin your life and harm your patients.
How are nurses paid?
Unfortunately not very good. In different regions, employers offer nurses different salaries. It looks something like this:
- 28 000 rub. - the average salary of a nurse in Moscow;
- 20 000 rub. - in St. Petersburg;
- 15 000 rub. - in Novosibirsk;
- 17 000 rub. - In Ekaterinburg;
- 14 000 rub. - In Nizhniy Novgorod.
Do you remember the famous saying about what happiness is? This is when you happily go to work in the morning and return home with the same joy in the evening. If you still come to the profession of a nurse, may you have just such a fate.
