Subjects studied at the medical college are nursing. Academic year disciplines studied by semester Department of Nursing I year I semester
Various factors influence the definition of nursing. This is, first of all, the economic, social and geographical position of the country, the existing health care system and the level of its development, the structure of nursing personnel with a clearly defined! functional responsibilities, the attitude of medical personnel and society towards nursing, and finally, the personal worldview of the person who defines sowing science. It is not surprising that the definitions of nursing given by the physician, nurse, patient, family, administration, insurance and legislative bodies will differ from each other.
Participants in the All-Russian Scientific and Practical Conference on the Theories of Nursing (Galitsino, 1992) gave the following definition of this science: “Nursing is part of medical health care, science and art, aimed at solving existing and potential health problems in changing environmental conditions.” environment."
The SW Expert Committee back in the 60s defined nursing as “the practice of human relationships,” and the nurse “must be able to recognize the needs of patients arising in connection with illness, considering patients as individual human beings.”
The definition given by the American nurse and teacher Virginia Henderson in 1961, which later received international recognition, is considered a classic: “Assisting a person, sick or healthy, in carrying out those actions related to his health, recovery or peace of mind.”
deaths that he would undertake himself, possessing the necessary strength, knowledge and will. And this is done in such a way that he regains independence as quickly as possible.”
Another definition was given by American nurses in 1984: “A nurse is a person who nourishes, nurtures and protects; prepared to care for the weak."
But nursing was first defined by the legendary Florence Nightingale in her famous Notes on Nursing in 1859, defining it as “the act of using the patient’s environment to promote his recovery. At the same time, the nurse’s task is to create conditions for the patient under which nature would exert its healing effect. She believed that nursing and nursing were two important areas of nursing. At the same time, caring for the healthy is “maintaining a person’s condition in which the disease does not occur,” and caring for the sick is “helping a person suffering from an illness to live the most fulfilling and satisfying life.” She was the first to note that “at its core, nursing as a profession differs from medical practice and requires special knowledge that is different from medical knowledge,” and in addition to this, “organization, practical and scientific training.”
What is the difference between nursing as a profession and the work of a doctor? Medical practice, all the knowledge and practical actions of a doctor are aimed at identifying and treating a specific disease in a specific person. Most medical activities, be it treatment, teaching or research, are aimed at various aspects of the pathological conditions of specific diseases.
But the disease poses a number of questions and problems for the patient, his family, and the team in which he works or studies. For example, doctors saved the life of a victim after a severe traumatic brain injury, but were unable to preserve the patient’s vision due to the severity of the injury and damage to the optic nerves. The patient and his family have many problems that they are unable to solve without the help of medical and social services, without the help of society. In this case, the nurse will help solve an important part of the patient’s problems.
Consequently, nursing is focused more on the person or group of people (family, team, society) than on the disease. It is aimed at solving the problems and needs of people, their families and society as a whole that have arisen and may arise in connection with changes in health.
Thus, nursing is a profession in its own right, with sufficient potential to become on par with medical practice. From here it is clear that the functions of a nurse are much broader, including simply following the doctor’s instructions. She has primary responsibilities for patient care, disease prevention, health maintenance, rehabilitation and relief of suffering. She must be an excellent leader (at any level), with the makings of a leader, manager, teacher and psychologist. The need for a nurse has no restrictions on political or social grounds, nationality, race, religion, age or gender.
At a meeting of national representatives of the International Council of Sisters (New Zealand, 1987), the following formulation of nursing was given: “Nursing is an integral part of the health care system and includes activities to promote health, prevent disease, provide psychosocial assistance and care to people with physical and mental illnesses, as well as the disabled of all age groups. Such assistance is provided by nurses both in medical and in any other institutions, as well as at home, wherever there is a need for it.”
To meet modern requirements, a nurse must know, in addition to health standards and the basics of nursing care, the psychological characteristics of patient behavior. She must not only become familiar with the symptoms and syndromes of the disease, determine the possible causes of its occurrence, but also develop a comprehensive individual patient care program
entom, including medical advisory assistance, nursing supervision, as well as the organization of social and psychological assistance. In her work, a nurse is based on the principle that medical care is the right of every person, and not a privilege.
Society places high demands on morality and ethical issues. The nurse, together with the doctor, participates in the testing and testing of new drugs, in the development of new research methods, and participates in artificial insemination, abortion, sterilization, and life extension. Who is she, an obedient helper or an active participant? How to determine the extent of her responsibility, agreement or disagreement with the doctor’s actions?
With significant positive changes in medicine, the dangers to which a person is exposed when entering the sphere of medical actions simultaneously increase. With the rapid growth of the population and the prevalence of poverty among the inhabitants of our planet, the principles of providing medical care become relevant: efficiency - equality - safety. This is another reason for the high demands placed on the medical profession.
str Thus, the mission of nursing is to meet the needs of patients for highly qualified and specialized medical care.
In this case, the main goals of nursing are:
- explaining to the population and administration of medical institutions the importance and priority of nursing at the present time;
- attraction, development and effective use of nursing potential by expanding professional
- provision and conduct of the educational process for the preparation of highly qualified nurses and ) nursing managers, as well as post- | diploma training of middle and higher nursing specialists;
- development of a certain style among nurses | for thinking.
- development and expansion of organizational and managerial reserves for working with personnel;
- consolidation of professional and departmental efforts to provide medical services to the population;
- carrying out work to ensure advanced training and professional skills of personnel;
- development and implementation of new technologies in the field of nursing care;
- implementation of advisory nursing care;
- providing a high level of medical information;
- conducting sanitary education and prevention-| chesical work;
- conducting research work in the field of nursing;
- creating quality improvement standards that would guide nursing care and help measure performance outcomes.
»» No. 1 1995 Our author Galina Perfilyeva is a WHO expert, dean of the first faculty of higher nursing education in Russia, created on her initiative 4 years ago at the Moscow Medical Academy named after I.M. Sechenov. In June of this year, the first graduates of the VSO faculty defended their diplomas and defended their dissertation by its dean. For this scientific work, the result of 10 years of work on a new concept of nursing service, the author, bypassing the candidate's degree, was immediately awarded the degree of Doctor of Medical Sciences. "Nursing" cordially congratulates Dr. Perfilyeva and wishes her further success in her difficult career.
It is as difficult to give a definite answer to this question today as it was a hundred years ago, when Florence Nightingale, the first researcher and founder of modern nursing, revolutionized public consciousness and views on the role and place of the nurse in protecting public health. There are many definitions of nursing, each of which was influenced by the characteristics of the historical era and national culture, the level of socio-economic development of society, the demographic situation, the population's needs for medical care, the state of the health care system and the availability of its personnel, as well as the ideas and views of the person formulating this concept.
The first definition of nursing was given by Florence Nightingale in her famous “Notes on Nursing” (1859). Emphasizing cleanliness, fresh air, silence, and proper nutrition, she characterized nursing as “the action of using the patient’s environment to promote his recovery.” The most important task of the sister, according to Nightingale, was to create conditions for the patient under which nature itself would exert its healing effect. Nightingale called nursing an art, but she was convinced that this art required "organization, practical and scientific training."
Having first identified two areas in nursing - caring for the sick and caring for healthy people, she defined caring for the healthy as “maintaining a person’s condition in which illness does not occur,” and nursing as “helping a person suffering from an illness to live as fully as possible.” a life that brings satisfaction." Nightingale expressed the firm belief that “nursing as a profession is fundamentally different from medical practice and requires special, distinct knowledge.” For the first time in history, she applied scientific methods to solve nursing problems. The first schools created on its model in Europe, and then in America, were autonomous and secular. The nurses themselves taught there, paying special attention to the formation of special nursing knowledge, skills and values. Professional values were understood as respect for the patient’s personality, his honor, dignity and freedom, showing attention, love and care, maintaining confidentiality, as well as observing professional duty. It is no coincidence that the motto of the first honorary international sisterhood was the words: Love, Courage, Honor.
But after Nightingale’s death, forces began to develop in society that opposed her views and ideals. The rapid development of capitalist market relations in the first quarter of this century in a number of Western countries, including the United States, not least affected the healthcare system. The development of medicine, as a profitable medical business in the West, has provided conditions for rapid technological progress and the creation of a complex system for the provision of medical services. In the process of forming the health care system in scientific, organizational and political terms, doctors and hospital administrations began to consider nurses only as a source of cheap labor that contributed to the achievement of economic goals.
Most nursing schools in the USA and Europe came under the control of hospitals, and doctors and hospital administrators began to provide theoretical and practical training in them. The nurses were only required to unquestioningly follow the doctor’s orders; their role increasingly began to be perceived as auxiliary.
However, despite the prevailing social conditions, nursing leaders from among the first graduates of Florence Nightingale's schools steadfastly followed the ideals of their outstanding mentor, striving to develop a body of specialized knowledge that forms the basis of professional nursing practice. They were actively involved in the development of independent nursing practice in hospitals, homes, and institutions where there was a need for such care on the part of individuals, families and community groups.
Nursing practice began to gradually transform into an independent professional activity based on theoretical knowledge, practical experience, scientific judgment and critical thinking. Interest in the development of scientific research in the field of nursing was partly due to the wide possibilities of using their results in alternative supportive health care services created after the Second World War in a number of Western countries. These, first of all, included nursing homes, in which professional nurses monitored and provided comprehensive care to the elderly, chronically ill and disabled people who did not need intensive therapeutic measures, i.e. in medical interventions. Nurses have taken responsibility for providing these patients with the required level of care and maintaining their optimal quality of life and well-being. The organization of nursing homes and units, as well as home care and nursing services for mothers and children from low-income communities, ensured greater access to health care for the population in the face of rampant price increases in the hospital health care sector.
The vast majority (about eighty percent) of the nurses continued to work in hospitals. However, the use of modern medical equipment and advanced technologies required a new level of knowledge from nurses. There was no doubt that the quality of nursing care is entirely determined by the level of professional education.
Students and followers of Florence Nightingale advocated for nursing education to take its rightful place in colleges and universities. The first university nursing training programs appeared in the United States at the end of the last century, but their number increased significantly in higher education institutions in America and Europe after the Second World War. Soon new theories and models of nursing began to appear, and after them even scientific schools with their own authorities. Thus, the famous nursing theorist Virginia Hendensen, defining the relationship between the nurse and the patient, noted that “the unique task of the nurse in the process of caring for individuals, sick or healthy, is to assess the patient’s attitude towards his state of health and help him in carrying out those actions to strengthen and restore health that he could perform himself if he had enough strength, will and knowledge for this.” According to another researcher, Dorothea Orem, "the main purpose of the nurse's activity should be to support the patient's ability to take care of himself."
In professional nursing communication, new terms increasingly appeared, such as “nursing process”, “nursing diagnosis”, etc. They were given a place in new formulations of nursing. For example, in 1980, the American Nursing Association defined the task of nursing as “the ability to make a nursing diagnosis and adjust the patient's response to illness.” Let us clarify that a nursing diagnosis differs from a medical diagnosis in that it determines not the disease, but the patient’s response to the disease. Evolving nursing knowledge required further discussion, testing, application and dissemination.
In 1952, the first international scientific journal on nursing, Nursing Research, was published. Currently, about two hundred professional nursing magazines are published in America alone. By 1960, doctoral programs in nursing began to appear. By the end of the seventies, the number of nurses with a doctorate degree in the United States reached 2000. In 1973, the National Academy of Nursing Sciences was created in America, and in 1985, the US Congress passed legislation that created the National Center for Nursing Research within the National Institutes of Health.
However, such favorable conditions for the development of nursing were not everywhere. Neglect of the nursing profession and misuse of nursing personnel in many countries have hampered the development of not only nursing care, but also health care in general. In the words of the eminent researcher and promoter of nursing in Europe, Dorothy Hall, "Many of the problems facing national health services today could have been avoided if nursing had developed at the same rate as medical science over the past forty years." “The reluctance to recognize,” she writes, “that the nurse occupies an equal position in relation to the doctor, has led to the fact that nursing care has not received the same development as medical practice, which has deprived both sick and healthy people of the opportunity to benefit from a variety of accessible, cost-effective nursing services."
However, nurses in all countries of the world are increasingly expressing their desire to make a professional contribution to the creation of a qualitatively new level of medical care for the population. In the context of global and regional, social and economic, political and national transformations, they see their role in society differently, sometimes acting not only as a medical worker, but also as an educator, teacher, and patient advocate. At a meeting of national representatives of the International Council of Sisters, held in New Zealand in 1987, the following formulation was unanimously adopted: “Nursing is an integral part of the health care system and includes activities to promote health, prevent disease, provide psycho-social assistance and care to individuals ", with physical and mental illnesses, as well as disabled people of all age groups. Such assistance is provided by nurses both in medical and any other institutions, as well as at home, wherever there is a need for it."
I would like to believe that our Russian sisters are awakening a sense of professional self-awareness, that we are becoming equal participants in the transformation of the national healthcare system and members of the international nursing community. The future of nursing in Russia is in our hands; it depends on each of us, on each nursing team. And let the new professional magazine “Nursing” become a kind and wise assistant and advisor in all our endeavors.
Definition of nursing. There are many definitions of nursing, the formulation of which was influenced by various factors, including the characteristics of the historical era, the level of socio-economic development of society, the geographical location of the country, the level of development of the health care system, the characteristics of the responsibilities of nursing personnel, the attitude of medical personnel and society towards nursing, the characteristics of the national cultures, demographic situations, health care needs of the population, as well as the perceptions and personal worldview of the person defining nursing science. But despite these factors, nursing must comply with modern professional standards and have a legislative basis.
At the Congress of Nursing Professionals of the World Health Organization (WHO), held in Hannover in 1944, the following definition was given: nursing is an art and a science; it embraces the entire body, mind, and spiritual realm of the patient, promotes spiritual, mental, and physical health through teaching and example, emphasizes health as well as care for the sick, and includes care for the social and spiritual realm of the patient as well as and about the physical, and provides medical care to the family, society and the individual.
One of the “timeless” definitions of nursing, which later received international recognition, was given in 1961 by the American nurse W. Henderson, an outstanding teacher, educator, researcher and lecturer. She wrote that the unique function of a nurse is to assist a person, sick or healthy, in carrying out those actions related to his health, recovery or peaceful death that he would take himself, possessing the necessary strength, knowledge and will. And this is done in such a way that he regains independence as quickly as possible.
The first definition of nursing was given by the legendary Florence Nightingale (1820-1910) in Notes on Nursing, published in 1859, defining it as the act of using the patient's environment to promote his recovery. The task was to create conditions for the patient under which nature would exert its healing effect. F. Nightingale believed that caring for the sick and the healthy are two important areas of nursing. At the same time, caring for the healthy is maintaining a person in such a state in which the disease does not occur, and caring for the sick is helping the person suffering from the disease to live the most fulfilling and satisfying life. By observing and collecting information about the patient, F. Nightingale established a connection between the patient’s health status and environmental factors. F. Nightingale's concept of the environment as a core component of nursing care, as well as calls to relieve nurses of the need to know everything about how the disease progresses, can be seen as an attempt to distinguish between nursing and medical practice. She was the first to note that nursing as a profession differs from medical practice and requires special, different from medical knowledge, organization, practical and scientific training. F. Nightingale's theories have allowed many nurses to understand the essence of nursing and use the basic principles in practice, research and professional training. Her ideas, views, and beliefs have received wide recognition and dissemination in many countries of the world. Modern researchers consider the work of F. Nightingale as the first theory of the conceptual model of nursing.
Florence Nightingale was born on May 12, 1820 into an aristocratic English family, of Italian origin (Florence). She received a fairly comprehensive education, which was then only received by men. Contemporaries of F. Nightingale noted that she was a talented person and could realize her abilities in a wide variety of areas of activity, but her choice was medicine.
Florence Nightingale at the age of 20 decided to become a sister of mercy, but the women of her circle could not think about the profession of a sister, and only at the age of 33 did she realize her dream and become one. While working in a hospital, she realized that a school was needed to train nurses.
F. Nightingale was educated in Germany at the nursing school founded by F. Flender in 1836.
Florence's desire to serve in the hospital was categorically opposed by the entire family. At that time, degenerate women worked in hospitals and were not hired for any other work. The hospital was a place where patients got worse, not better.
In 1851, despite the protest of her family, Florence went to Germany to a community of deaconesses, which had its own hospital and school for training in caring for the sick. Having passed her exams brilliantly, the girl returned home, and in 1853 she went to Paris to get acquainted with monastic hospitals and undergo training with sister nuns.
After returning home, Miss Nightingale was asked to take over the management of the nursing facility. This infuriated the Nightingale family, and Florence was forced to leave the family and go to England.
At the age of 33, Florence took the position of superintendent in an institution for the care of sick women from high society in London, where she fully demonstrated her organizational abilities and professional care skills.
In October 1854, during the Crimean War, Florence, along with 38 assistants, went to field hospitals, first in Scutari (Turkey), and then in Crimea. The sisters of mercy saw a terrible picture: the hospital was overcrowded, lice-ridden wounded and sick were lying in the corridors on straw among sewage, rats were running on the floor, there was a shortage of the most necessary things - medicines, linen, food and fuel.
The appearance of women in the hospital was greeted by doctors with hostility. At first they were even forbidden to enter the wards and were assigned the dirtiest work and the most hopeless patients. However, Florence was able to prove that the wounded need constant competent care after medical interventions. Consistently implementing the principles of sanitation and care for the wounded, she achieved amazing results. F. Nightingale organized the work of the hospital in such a way that the mortality rate in it decreased from 49 to 2%. It was she who increased the number of wards in hospitals in order to eliminate overcrowding of the wounded, and organized kitchens and laundries. Florence believed that the job of the sisters of mercy was to save the wounded not only physically, but also spiritually: to take care of their leisure time, organize reading rooms and help establish correspondence with relatives. At night, she walked around the wounded with a lamp in her hand, for which she was nicknamed the Lady with the Lamp.
Upon returning to England in 1856, F. Nightingale was tasked with reorganizing the army medical service. With the support of the Minister of War, Florence ensured that hospitals were equipped with ventilation and sewage systems; hospital staff were required to undergo the necessary training; Strict statistical processing of all information was carried out in hospitals. A military medical school was organized, and awareness-raising work was carried out in the army about the importance of disease prevention. In her book “Notes on Hospitals,” Miss Nightingale showed the connection between sanitary science and the organization of hospital business. She resolutely opposed the “corridor system” of keeping patients, defending the need to introduce a pavilion system.
It was F. Nightingale who created the training system for paramedical and junior medical personnel in the UK.
The school created by F. Nightingale became a model for training managerial and pedagogical levels of nursing personnel. She insisted that nursing schools be taught by professional nurses and that hospitals be run by specially trained registered nurses. F. Nightingale believed that nursing as a profession differs from medical practice and requires special knowledge, different from medical knowledge.
In the course of her career, F. Nightingale wrote a number of works that provided invaluable service for the development of nursing care. Doctors of that time valued the book “How to Care for the Sick” very highly, considering it an outstanding teaching aid. Having studied the social and economic conditions of life in India, F. Nightingale published a number of articles in which she expressed the idea that prevention is better than cure. In “Introductory Notes on a Stay in an Institution” (1871), Miss Nightingale concluded that childbirth was safer at home, since in a hospital there was a high risk of cross-infections.
Miss Florence spent her entire life defending the equal rights of all people to care and treatment during illness and to die with dignity. The British government appreciated her contribution to the development of medical care and awarded her the Royal Red Cross in 1883. In 1907, F. Nightingale was awarded one of the highest British Orders of Merit.
During the Crimean War, which Russia waged with England, France, Italy and Turkey for two years, Florence Nightingale, along with 38 sisters, worked in Scutari, Turkey in a barracks where there were 2,300 wounded and sick. By nursing them, she achieved a reduction in mortality from 42 to 2%.
After the Crimean War, F. Nightingale, with her own money, in 1856 erected a large white marble cross on a high mountain near Balaklava in Crimea in memory of the fallen soldiers, doctors and sisters.
On June 26, 1860, the Nightingale Probation School for Sisters of Charity was opened at St. Thomas's Hospital in London. At the end of her sisters took an oath to F. Nightingale.
I, solemnly before God and in the presence of this assembly, pledge:
To spend my life in purity and serve my profession faithfully. I will abstain from everything that causes harm and death and will not take or knowingly give harmful medicine. I will do everything in my power to support and elevate the standard of my profession, and I promise to keep confidential all personal matters within my care and the family circumstances of patients that come to my knowledge during the course of my practice. With fidelity, I will strive to assist the physician in his work and devote myself to the welfare of those who have entrusted themselves to my care.
In her “Notes on Care,” F. Nightingale defined nursing, showed its difference from medicine, and she created a model of nursing, i.e., a theory that was taught in the first nursing schools in Europe and America.
The name F. Nightingale became a symbol of mercy.
F. Nightingale died on August 13, 1910.
In 1912, the League of the International Red Cross and Red Crescent established the Florence Nightingale Medal, still the most honorable and highest award for nurses throughout the world. 
Every 2 years, the International Committee of the Red Cross awards 50 medals in her name on her birthday (May 12). This is the highest award for nurses and Red Cross activists. The regulations about this medal say that it is given “not to crown a career, but in order to mark outstanding actions and recognize exclusively the moral qualities of the recipients.”
In 1907, in the USA, for the first time in the world, Columbia University nurse A. Nutting received the academic title of professor of nursing. It was from this event, with the active participation of the university departments, that a new period of development and scientific substantiation of nursing began. In her work, A. Nutting noted that nursing is associated with getting rid of suffering, caring for the sick and protecting people’s health. Most people do not have the opportunity to receive treatment in a hospital, so they need care at home. And every nurse needs to remember that no two patients are exactly alike or no two patients have exactly the same needs. Therefore, there cannot be the same care for two different people.
Gradually, nursing practice transformed into an independent professional activity based on theoretical knowledge, practical experience, scientific judgment and clinical thinking. Nursing did not compete with medical activities; it predominantly occupied those niches that did not represent the areas of interest of doctors, but required professional nursing participation. These, first of all, included nursing homes, where observation and care were provided for the elderly, patients with chronic diseases and the disabled. Nurses have taken responsibility for providing this patient population with the level of care they require and maintaining their optimal quality of life and well-being. The organization of homes and nursing departments, as well as home care and the creation of advisory services for mothers and children from low-income groups, ensured greater accessibility of medical care for the population, which earned recognition from government circles and the public.
According to D. Oram, nursing is caring for another for his benefit. However, what is special about it in comparison with medical activity, which is also consistent with the principles of benevolence towards the patient? The doctor seeks to benefit the patient by actively influencing his illness. These effects most often consist of the prescription of therapeutic agents or are limited in time to certain technology, procedures, etc. In the intervals between these episodes or after them, the patient may experience a feeling of unwellness and discomfort, but the doctor, as a rule, does not deal with these problems. Due to the fact that the patient’s problems arise regardless of the nature of his disease (surgical, therapeutic, oncological, etc.), nursing specializations arise in surgery, pediatrics, rehabilitation, gerontology, etc.
As the role of the nurse has changed, leading experts in the field have sought to cement the status of nursing as a profession. In 1945, a group of experts developed criteria for nursing, using D. Flexner's criteria for defining a profession prepared by the commission on standardization in medical schools in 1915. These criteria included not only the application of specialized knowledge acquired in educational institutions, but also autonomy in policy development and control of professional activities. The American Nurses Association was involved in the development of nursing as a profession, developing and clarifying policies, standards and norms governing professional activities. The Code of Nursing (1950, 1976 and 1985) provides standards of professional ethics. Nursing sets out social policy (1981 and 1995), defining the social context of nursing, the nature and scope of this activity, and practical specialization. The Standards of Nursing Practice (1973 and 1991) describe the functions that a nurse should perform.
In the 1960s The Yale University School of Nursing put forward a new interpretation of nursing. It was proposed to view nursing as a process, not an end result, as an interaction, not a content, as a relationship between two concrete individuals, and not as a connection between an abstract nurse and a patient. The process was based on a systematic approach to providing patient-centered nursing care. At the same time, the WHO Commission of Experts defined nursing as the practice of human relationships. The nurse, according to this definition, must be able to recognize the needs of patients arising from the disease, considering patients as individuals.
In Russia, until recently, no attempts were made to give a clear definition of nursing. The traditional idea of a nurse, formed in the past, only as an auxiliary technical assistant to a doctor, working according to his instructions and under his supervision, has not undergone significant changes, which has led to a significant lag in the sphere of public health nursing activities from the level of development of science, modern medical technologies and negatively affected the quality of nursing care to the population, the status of the nurse and the prestige of the profession.
The concept of “nursing” relatively recently entered the professional language of Russian doctors. This concept was first officially introduced in 1988. In the nomenclature of education of specialties in the field of healthcare, the place of the specialty “Nurse” was taken by the specialty “Nursing”. In this regard, a new academic discipline “Fundamentals of Nursing” was included in the basic training of nurses.
For the first time, G.M. Perfilyeva compared nursing in Russia and abroad in 1994-1995. She believes that nursing is a critical component of the health care system, with significant human resources and real potential to meet the population's needs for accessible and acceptable health care. Currently, nursing leaders take it as an axiom that it has separated from medicine as a special field of professional activity and is based on its own science. The high professional culture of this group is evidenced by multi-level nursing education, scientific research in the field of nursing sciences, and the title of Doctor of Science among many foreign nurses. All identified indicators of nursing in developed countries allow us to confidently speak about the formed institutional culture of nursing.
What is the difference between nursing as a profession and the work of a doctor? All knowledge and practical actions of a doctor are aimed at identifying and treating a specific disease in a specific person. Most medical activities, be it treatment, teaching or research, are aimed at various aspects of the pathological conditions of specific diseases. Nursing is focused more on the person or group of people (family, team, society) than on the disease. It is aimed at solving the problems and needs of people, their families and society as a whole that have arisen and may arise in connection with changes in health.
Thus, nursing is a profession in its own right, with sufficient potential to become as important as medicine. The functions of a nurse are much broader than simply following the doctor’s instructions. She is entrusted with the main responsibilities for caring for patients: disease prevention, health maintenance, rehabilitation and alleviation of suffering. A sister must be an excellent leader (at any level), with the makings of a leader, manager, teacher and psychologist.
At a meeting of national representatives of the International Council of Nurses, held in New Zealand in 1987, the following definition of nursing was unanimously adopted: nursing is an integral part of the health system and includes activities for the promotion of health, the prevention of disease, the provision of psychosocial care and nursing persons with physical and mental illnesses, as well as disabled people of all age groups. Such assistance is provided by nurses both in medical and any other institutions, as well as at home, wherever there is a need for it.
Nurse's mission. The nurse's mission is to help individuals, families, and groups achieve physical, mental, and social health within the context of their environment.
Recently, the view on the functions of a nurse has changed. If earlier the emphasis was on caring for sick people, now nursing staff, together with other specialists, see the main task in maintaining health, preventing diseases, and ensuring maximum independence of a person in accordance with his individual capabilities. In developed countries, it is considered preferable to care for and treat patients in the conditions of municipal (outpatient) medicine.
Functions of a nurse. The functions of a nurse are defined by the WHO Regional Office for Nursing for Europe, and this is evidenced by the international project of the WHO Regional Office for Europe - LEMON. This project provides for cooperation between different countries (including Russia) in the framework of nursing and midwifery issues, provides information about the needs, achievements and potential projects in countries that are members of the international community.
The first function is to provide nursing care, for example preventive measures, nursing interventions related to rehabilitation, psychological support for the person or his family. This function is most effective if carried out as part of the nursing process. Nursing care includes:
assessing the needs of the person and his family;
identifying needs that can be most effectively met through nursing intervention;
identification of priority health problems that can be addressed through nursing intervention;
planning and implementing necessary nursing care; involving the patient and, if necessary, members of his family and friends in care;
use of accepted professional standards.
The second function is training patients and nursing staff- includes:
assessment of a person’s knowledge and skills related to maintaining and restoring health;
preparing and providing the necessary information at the appropriate level;
assisting other nurses, patients and other staff in acquiring new knowledge and skills.
The third function - the nurse's performance of a dependent and independent role as part of a team of medical workers serving the patient - is just beginning to be introduced in Russia. However, without it, nursing will not be able to take its proper place in the health care system. A component of this function is collaboration with the patient, his family, and health care providers in planning and organizing patient care.
The fourth function is the development of nursing practice through research activities- is also just beginning to be implemented.
Main goals nursing are:
explaining to the population and the administration of a medical institution (HCI) the importance and priority of nursing at the present time;
development and effective use of nursing potential by expanding professional responsibilities and providing nursing services that best meet the needs of the population;
provision and conduct of the educational process for the training of highly qualified nurses and nursing managers, as well as postgraduate training of mid-level and senior nursing specialists;
development of a certain style of thinking among nurses.
Nursing solves the following problems:
1) development and expansion of organizational and managerial reserves for working with personnel;
2) consolidation of professional and departmental efforts to provide medical services to the population;
3) carrying out work to ensure advanced training and professional skills of personnel;
4) development and implementation of new technologies in the field of nursing care;
5) implementation of advisory nursing care;
6) providing a high level of medical information:
7) conducting sanitary education and preventive work;
8) conducting research work in the field of nursing;
9) creation of quality standards for nursing care.
The priority development of nursing will provide a qualitatively new level of medical care to the population through the effective use of nurses, expanding their professional responsibilities and providing nursing services that best meet the needs of the population.
Thus, nursing practice strategy must respond to the changing needs of the health care system; have a scientific basis; be socially acceptable; ensure universal accessibility of medical care (especially to those groups of the population that have the greatest need for it); provide assistance within the walls of a medical institution, at home and at the family level; guarantee high quality care.
Control questions
1. Name the basic requirements for nursing.
2. Who first gave a scientific definition of nursing?
3. How has the role of the nurse changed?
4. What approaches exist to the interpretation of the term “nursing”?
5. How does nursing as a profession differ from the work of a doctor?
6. Name the main functions of a nurse.
7. What are the main goals of nursing?
8. What problems does nursing solve?
9. Formulate a strategy for nursing practice.
CHAPTER II.
HISTORY OF NURSING DEVELOPMENT IN RUSSIA
2.1. FEMALE CARE IN Rus' until the 18th century
The history of serving the sick and wounded in Russia dates back to the early centuries of Christianity.
Female nursing has existed at all times and in all countries of the world.
Women performed hygienic measures and created comfortable conditions for the sick, often relatives.
In Rus', charitable medical care appeared in the 11th century, when almshouses and shelter cells began to be created at monasteries. Thus, in 1070, an almshouse (shelter, house) was opened in the Kiev-Pechersk Monastery in the name of St. Stephen for the residence of the poor, the weak, the lame, the blind and the lepers.
The same institution was opened in 1091 by Bishop Efim of Pereyaslavl. The monks looked after the crippled and sick. After the adoption of Christianity, hospital wards began to be created at the monasteries. The place where pain lays a person on his face began to be called hospitals.
In monasteries, sisters cared for the sick selflessly. Women were not involved in large numbers to care for the sick.
Some monasteries were called hospital monasteries, for example the monastery of Fyodor the Studite in Moscow.
In Rus', already in the 10th century, Princess Olga organized a hospital where care was entrusted to women.
There is very little information about women's medical activities in Rus'. However, it is known that already in the 11th century. The first domestic medical treatise was created called “Ointments,” the author of which was the granddaughter of Prince Vladimir Monomakh, Evpraksiya Mstislavovna, who deeply studied traditional medicine and covered in her work issues of physiology, hygiene, propaedeutics and the prevention of certain diseases. In sources of the 14th century. the names of the peasant girl Fevronia, Fedosia Morozova and many others who were involved in caring for the sick are mentioned. In the Novgorod chronicles, among the names of city doctors, Natalitsa Klementyevskaya, the doctor’s wife, who treated Novgorodians in the second half of the 16th century, was listed. In Muscovite Rus', women's participation in the fate of the sick was also manifested in charitable activities.
In the 16th century, the “Hundred-Glavy Cathedral” issued a decree on the organization of men’s and women’s almshouses with the employment of women.
In the 17th century, during the Time of Troubles, the first hospital was created on the territory of the Trinity-Sergius Monastery - in 1612.
In 1618, the first (in the modern sense) hospital arose at the Trinity Monastery. In 1650, a hospital appeared on the territory of St. Andrew's Monastery. There is no reliable data, but it is possible that women's care was used in these hospitals.
In the 17th century many Russian monasteries grew rich, which made it possible to build almshouses and small houses for the sick. Patriarch Nikon provided great assistance in creating such cells, almshouses and houses. With his help, almshouses were founded in the Moscow Znamensky Monastery, the Granatny Yard at the Nikitsky Gate, and the New Jerusalem Monastery. In “A Tale on Shelters,” he proposed creating a charity society, whose members would visit the homes of the poor and unfortunate and do charity work.
With the accession of the Romanov dynasty to the throne, in addition to the tsar and the highest church hierarchs, representatives of noble families began to engage in charity. One of these pioneers was the court nobleman F.M. Rtishchev, who in 1650, on the territory of the St. Andrew's Monastery, opened a shelter for the poor sick, beggars and drunks, where healers and even a doctor treated. (A doctor was a specialist with a university education; at that time these were exclusively foreigners. Doctors had a monastic education, which did not provide extensive medical knowledge.)
Related information.
The definition of nursing, as well as the activity of a nurse itself, has gone through a certain path of evolutionary development and has undergone significant changes.
It is difficult to choose one definition of nursing, revealing the versatility of this concept and interpret it unambiguously in different countries. There are many definitions, each influenced by different factors, including features of the historical era, the level of socio-economic development of society, the geographical location of the country, the existing healthcare system and the level of its development, features of the structure of nursing personnel with clearly defined functional responsibilities, the attitude of medical personnel and society towards nursing, features of national culture, demographic situations , the health care needs of the population, as well as the ideas and personal worldview of the person defining nursing science. It is not surprising that the definitions of nursing given by the doctor, nurse, patient, his relatives, administration, insurance and legislative bodies, and representatives of other professions will differ from each other.
There are over one hundred definitions of nursing, indicating that there is no definition that exhausts the concept.
The first scientific definition of nursing was given by Florence Nightingale in Notes on Nursing (1859). She believed that nursing was "the act of using the patient's environment to promote his recovery". The task was to create the best conditions for the patient under which nature would exert its healing effect. By “the best conditions,” F. Nightingale meant cleanliness, fresh air, and proper nutrition. She believed that nursing and nursing were two important areas of nursing. At the same time, caring for the healthy is “maintaining a person’s condition in which the disease does not occur,” and caring for the sick is “helping a person suffering from an illness to live the most fulfilling and satisfying life.”
The definition given by the American nurse and teacher Virginia Henderson in 1961, which later received international recognition, is considered a classic: “The unique task of the nurse is to assist a person, sick or healthy, in the implementation of those actions related to his health, recovery or peaceful death , which he would have undertaken himself, possessing the necessary strength, knowledge and will. And this is done in such a way that he regains independence as quickly as possible.” The sister takes the initiative, she controls the implementation of this work, she is the mistress here. In addition, she helps the patient follow all the prescriptions prescribed by the doctor. She is a member of the health care team and helps others (as they help her) plan and implement a complete program of action - whether it is improving health, recovering from illness or supporting the dying. A sister is “the legs of the legless, the eyes of the blind, the support of a child, the source of knowledge and confidence for a young mother, the mouth of those who are too weak or self-absorbed to speak.”
Back in the 1960s, the WHO Expert Committee defined nursing as “the practice of human relationships,” and the nurse “must be able to recognize the needs of patients arising from illness, considering patients as individual human beings.”
At a meeting of national representatives of the International Council of Nurses, held in 1987 in New Zealand, the following formulation was adopted: “Nursing is an integral part of the health care system and includes activities to promote health, prevent disease, provide psychosocial assistance and care to people with physical and mental illnesses, as well as the disabled of all age groups. Such assistance is provided by nurses both in medical and any other institutions, as well as at home, wherever there is a need for it.”
A very laconic and at the same time meaningful definition of nursing was given by the participants of the All-Russian Scientific and Practical Conference on Theories of Nursing (Galitsino, 1992): “Nursing is part of medical health care, science and art, aimed at solving existing and potential problems with health in changing environmental conditions."
With significant positive changes in medicine, the dangers to which a person is exposed when entering the sphere of medical actions simultaneously increase. With rapid population growth and the prevalence of poverty among the inhabitants of our planet, the principles of providing medical care become relevant: efficiency - equality, safety. This is another reason for the high demands placed on the nursing profession. Thus, the mission of nursing is to meet the needs of patients for highly qualified and specialized medical care.
Wherein The main goals of nursing are:
explaining to the population and administration of medical institutions the importance and priority of nursing at the present time;
Attracting, developing and effectively using nursing potential by expanding professional responsibilities and providing nursing services that best meet the needs of the population;
Providing and conducting an educational process for the training of highly qualified nurses and nursing managers, as well as conducting postgraduate training of mid-level and senior nursing specialists
Developing a certain style of thinking among nurses.
Nursing solves the following problems:
development and expansion of organizational and managerial reserves for working with personnel;
Consolidating professional and departmental efforts to provide medical care to the population;
Carrying out work to ensure advanced training and professional skills of personnel;
Development and implementation of new technologies in the field of nursing care;
Providing advisory nursing care;
Providing a high level of medical information;
Conducting sanitary education and preventive work;
Conducting research work in the field of nursing;
Creating quality improvement standards that guide nursing care and help measure performance outcomes.
There is a well-known saying: “Medicine represents the trunk of a tree, and its specialties are individual branches. But when a branch reaches the size of a whole tree, it acquires the right to independent significance.” This branch is nursing, which is separated from the medical education system into a separate science. From a dependent subsection of medicine, nursing is developing into an independent science.
Ministry of Health of the Republic of Belarus
Educational institution
"Mozyr State Medical College"
Lectures
theoretical studies
By academic discipline
"Nursing and manipulative technology"
Specialty 2-79 01 31 “Nursing”
NAMES OF SECTIONS, TOPICS IN THE CURRICULUM.
Section 1. History of the development of nursing.
Topic: “Introduction. Goals and objectives of nursing. History of the development of nursing"
The essence of nursing.
The nursing profession is very difficult. Those who choose it are subject to at least four types of requirements: professional competence, physical endurance, integrity and constant improvement of skills and knowledge.
Professional competence is necessary for successful work. Constant improvement of skills and knowledge provides the opportunity to communicate with representatives of other professions. Integrity is required of a nurse because she receives confidential information from both the patient and his family, deals with a variety of drugs, evaluates the work of other nurses, and participates in making decisions that are difficult from an ethical point of view.
What is nursing? What is the profession of a nurse?
One of the “timeless” definitions of the nursing profession was given by Virginia Henderson, an outstanding teacher, educator, researcher and lecturer: “A nurse is the legs of the legless, the eyes of the blind, the support of a child, the source of knowledge and confidence for a young mother, the mouth of those who are too weak or self-absorbed to speak.”
The concept of “nursing” has relatively recently entered the professional lexicon. We are becoming increasingly accustomed to the concept of “patient care” or “nursing activities.” The concept of “nursing” in our country was introduced in 1988, when a new academic discipline arose in the range of educational specialties - the fundamentals of nursing. However, there is no precise definition of the concept of “nursing”. This is due to a number of factors: the geographical location of the country, the environment, the number of nurses and their responsibilities in the area.
How is the concept of “nursing” defined abroad? After all, its English synonym “Nursing” comes from the verb “tonurse” (from the Latin nutrix - to feed), translated as “to look after” (for), care for, encourage, look after, feed, protect, educate and provide therapeutic care in case of ill health " Nursing involves the purposeful care of a person for the purpose of healing, relieving suffering and promoting health. The essence of nursing is to help individuals, families or groups to identify, achieve and develop their physical, mental and social potential and maintain it at appropriate levels in the contexts in which they live and work. Nursing also includes planning and providing assistance during illness, providing rehabilitation (recovery after illness).
Nursing is an integral part of the health care system, being a multifaceted health discipline. Nursing has medical and social significance, as it is intended to support, strengthen and protect the health of the population, provide assistance to the suffering and rehabilitate patients.
Over the years, under the influence of the changing needs of the population, determined by the historical, cultural, ethnographic, political, socio-economic characteristics of society, the demographic situation, the state of the health care system, the goals and objectives of nursing, as well as the role and functions of nursing personnel, have undergone certain changes. Gradually they became more diverse and responsible. Far in the past is the idea of a nurse as a worker who only carries out doctor’s orders. The modern level of development of nursing requires the nurse to be able to independently assess the patient’s condition and needs, conduct proper monitoring of him, and make informed decisions associated with a certain responsibility, when the success of treatment largely depends on her professional competence. World famous nurse Florence Nightingale in 1859 in her book “Notes on Nursing” she gave its first definition. She wrote that nursing staff do not need to know everything about the disease process. In her understanding, nursing care includes the ability to properly use fresh air, light, warmth, cleanliness, peace, and an appropriate diet with the least expenditure of the patient’s vitality.
The philosophy of nursing is part of the general philosophy and defines:
the basic ethical responsibilities of professionals serving people and society;
the goals that the professional strives for;
moral character – virtues and skills expected of practitioners.
The need for nursing care is universal; it is necessary for a person from birth to death. When providing care to a patient, a nurse should strive to create an atmosphere of respect for his spiritual interests, customs and beliefs. The nurse maintains confidentiality and protects the information received in the interests of the patient, if this information does not contradict his health and the health of members of society.
According to the Code of Conduct for Nurses developed by the International Council of Nurses, the fundamental responsibility of nurses has four main aspects: promoting health, preventing disease, restoring health, and alleviating suffering. In addition, this code defines the responsibility of nurses to society and colleagues.
In 2003, the Belarusian Association of Nurses adopted the “Code of Ethics for Nurses of the Republic of Belarus”. The ethical principles and norms that make up its content specify moral guidelines in professional nursing activities.
Being an art and a science, nursing currently has the following objectives:
provide effective training of highly qualified nurses and promote their qualifications;
train nurses in the culture of communication with patients, their family members, and colleagues, taking into account ethical and deontological aspects of behavior;
conduct research work in the field of nursing;
provide a high level of medical information;
develop a certain style of thinking among nurses.
Art and science are evident in the work of both the performing nurse and the nurse manager. High professionalism and competence, the ability to respect and sympathize with the patient, and finally, a creative approach to nursing activities reflect both science and art in the work of the performing nurse. In the activities of a nurse manager, art and a scientific approach are manifested in communication with staff and patients, in the ability to effectively build a nursing process, and correctly organize the professional growth of employees. Often, nurses also act as educators. In this case, the nurse must have teaching abilities, the ability to professionally present nursing science to students, be distinguished by a culture of communication and high creative potential.
Patient care is a necessary and essential part of treatment. The term “care” refers to a whole range of therapeutic, preventive, sanitary and epidemiological measures aimed at alleviating the patient’s suffering, speeding his recovery and preventing complications. With some diseases (myocardial infarction, stroke, etc.), the physical activity of patients and their ability to self-care may be limited to one degree or another. Some patients cannot wash themselves without assistance, change their body position in bed, eat food, etc. Toilet of the skin, oral cavity, proper feeding, timely change of linen, provision of emergency care in critical conditions (fever, fainting, attack of pain in the heart area), implementation of a number of sanitary and epidemiological measures aimed at maintaining proper cleanliness in a medical institution and preventing the occurrence and spread of infectious diseases - all this is included in the concept of “patient care” or “nursing process”.
Patient care is divided into general and special. General care includes those activities that any patient needs, regardless of the nature of his illness (injections, feeding, dispensing medications, cleaning the room, etc.). Special care includes those measures that are applied only to patients of a certain group: surgical (dressings, immobilization), urological (washing the bladder, washing drainage tubes, etc.), therapeutic (assisting the doctor with abdominal and pleural puncture) etc.
Patient care is the direct responsibility of the nurse. Only certain manipulations of general care can be performed by junior nurses (cleaning the premises, supplying a bedpan or urinal, sanitary treatment of the patient), but even in these cases the nurse is responsible for the correct execution of them.
History of the development of nursing.
Self-improvement and improvement in the profession is impossible without the experience of previous generations. A good knowledge of the past is necessary for a better understanding of the challenges of the present. Therefore, we will first focus on the history of the emergence of the nursing profession.
Society at all times has highly valued and values health and well-being, because healthy people are able to create and protect their loved ones. People who can alleviate suffering or heal have always played an important role, especially during wars and epidemics. There was a connection between health, healing and religion; religious figures of antiquity - priests, priestesses - were considered endowed with healing powers. For treatment, medications prepared according to the necessary prescriptions, various procedures, prayers and rituals were used. Even in ancient times, women often devoted their lives to caring for the elderly, sick and disabled.
Organized care for the sick and wounded began during the reign of Peter I. In 1715. he issued a decree that dealt with the use of women's labor to care for sick children. Somewhat later, by decree of Peter I, a “medical board” was created (an office that, for work in hospitals in 1728, introduced a staff unit for women to care for the sick and wounded). But after the death of Peter I, all his endeavors were interrupted for almost 100 years. Only towards the end of the 18th century. Women's labor in caring for the sick began to be used in civilian hospitals (Pavlovsk Hospital).
The next step in the development of nursing is the emergence of a service for “compassionate widows”. In 1807 Shelters for poor widows were opened in Moscow and St. Petersburg. In January 1814 in one of these shelters at the Mariinsky Hospital, 24 widows expressed a desire to devote themselves to caring for the sick. In January 1818 An institute of “compassionate widows” was established in Moscow. A great contribution to the training of personnel was made by the chief physician of the Mariinsky Hospital, Oppel, who published the textbook Guide and rules on how to care for the sick, for the benefit of everyone involved in this matter, and otherwise for compassionate widows who have especially dedicated themselves to this title...” It emphasized: “Without proper care, even the most skillful doctor can do little, or even nothing, in restoring health or averting death.”
Residents of widows' houses and their unmarried daughters could join the service of "compassionate widows" after long tests of virtues. Oppel's book contained the requirements that were presented to the subjects. They had to have sobriety of mind, loyalty, philanthropy, conscientiousness, patience, silence, neatness, and lack of disgust. If their mentors were convinced of these qualities, then special training for compassionate widows began.
A new stage in the development of women's medical care is the emergence of compassionate communities in Russia. The first community of sisters of mercy was organized in 1844. in St. Petersburg, later (1873) it became known as the Holy Trinity community. There was a community supported by charitable organizations. It accepted widows and girls aged 20 to 40 years. Sisters of mercy were required to be on duty with patients in apartments, in hospitals and to assist the doctor in receiving patients served by the community. Thus, female labor began to be used in hospitals and clinics, but women were not yet involved in helping the wounded.
In 1854 (during the Crimean War) the Holy Cross community of sisters of mercy was created in St. Petersburg to care for the sick and wounded. The charter of the Holy Cross community was drawn up by N.I. Pirogov. The main goal of the community was to train sisters of mercy to care for the sick and wounded in the military hospitals of Crimea, where there was an urgent need for medical personnel.
Women who joined the community underwent an internship for 2-3 months and then were sent to the front. Many Russian women provided assistance to the wounded on the battlefield in difficult combat conditions. Among them are Dasha Sevastopolskaya, Ekaterina Bakunina, Ekaterina Khitrova, Varvara Shchedrina and others. N.I. Pirogov characterized the sisters of mercy this way: “Our sister of mercy should not be an Orthodox nun. She must be a simple, God-respecting woman with a practical mind and a good technical education, and at the same time she must certainly retain a sensitive heart.” Here is a description of the conditions in which the sisters of mercy provided assistance to the sick and wounded in Crimean hospitals.
The situation in Crimean hospitals was extremely difficult. Autumn came, it rained, the roads became difficult to pass. In the hospitals, the cloth tents became cool and damp. Sisters of mercy in military boots, stomping in the mud, walked around the soaking wet tents, sometimes on their knees, making bandages, handing out tea to warm the wet patients lying on mats or simply on the ground. Typhus, cholera, scurvy, and fever were reported. In such cases, the sisters provided all possible assistance. All these women were different, but they were united by their love for the Fatherland and the desire to serve their people.
The life and work of the English sister of mercy Florence Nightingale received international recognition. She was born in Florence in 1823 and received a good upbringing. Since childhood, she was characterized by a heightened sense of compassion for all the sick and unfortunate. At the age of 31, by the time of her voluntary trip to the Crimea for the war (1855), she had already visited all the hospitals in London and many in Europe. In the difficult conditions of the war, Nightingale, leading a detachment of volunteer “nurses,” managed to organize care for the wounded and ensure their supply of food, clothing, and books.
“Where the disease is in its strongest development, where the hand of death approaches its victim, there you can meet this incomparable woman. Her gentle presence has a comforting effect on the patient, even in his last struggle with death,” newspapers of that time wrote.
While caring for the sick during widespread epidemics, Florence Nightingale fell ill with a fever, but upon recovery, despite the entreaties of her friends to return home, she remained at the hospital. She made a great contribution to the education of women who wanted to devote themselves to caring for the sick. In her work “How to Care for the Sick,” she developed many ideas on sanitation and hygiene of medical institutions, practice and treatment of diseases, and reflected issues of medical deontology.
In 1860 Florence Nightingale founded the first school of the Sisters of Charity in England at St. Thomas's Hospital. She first noted that there are two important areas in nursing: caring for healthy patients and caring for sick patients. Health care was defined as “the maintenance of a healthy person in a state of being free from disease.” Nursing was revealed by her as “the ability to help a person suffering from an illness to live,” not just to survive, but to live as full and satisfying a life as possible. She insisted that preventing a disease is easier than curing it. This point of view was the predecessor of the theories of microbiologists and psychologists. Florence Nightingale pioneered the use of scientific methods and statistical research in health care, combining problem solving with preventative methods such as cleanliness, healthy eating, attention to the emotional state of patients, and appropriate education of nurses.
In gratitude for his outstanding services in the development of nursing in 1912. The British government established the International Foundation and the Florence Nightingale Medal.
In Florence, Nightingale’s homeland, in an ancient temple next to the tombs of Dante and Michelangelo, in a deep niche there is a statue of a woman with a lamp. At its foot are carved the words: “She was an example of service to people and a prototype of international charity, the bearer of which later became the Red Cross.”
Every year, on May 12, Florence Nightingale's birthday, the best nurses in the world are awarded. In Belarus, six nurses were awarded this high award: Maria Afanasyevna Goryachuk, Gomel (1983), Sofya Adamovna Kuntsevich, Minsk (1981), Sofya Vasilyevna Belukhova, Gomel (1975), Ekaterina Efimovna Sirenko, Baranovichi (1971), Evgenia Maksimovna Shevchenko, Skidel (1967), Zinaida Mikhailovna Tusnolobova-Marchenko, Polotsk (1957). On the reverse side of the medal is engraved the inscription: “For true mercy and care for people, arousing the admiration of all mankind.”
After the Crimean War, numerous new communities of sisters of mercy began to emerge in Russia, and they became more widely involved in caring for the wounded in hospitals. In 1867 The Society for the Care of Wounded and Sick Soldiers was organized, renamed in 1879. to the Russian Red Cross Society. One of the tasks of this society was to train sisters of mercy. In 1868, the St. George community arose in St. Petersburg, one of the leaders of which was the outstanding doctor S.P. Botkin. Other Red Cross communities also emerged (in St. Petersburg, Moscow, Kharkov, Tiflis, etc.).
In addition to Red Cross communities, sisters of mercy were trained by monastic communities, as well as in courses at hospitals. In 1894 The Cross Movement community was transferred to the jurisdiction of the Russian Red Cross Society. With her heroic work she won the right to care for the sick and wounded in the Crimean War; Russian sisters of mercy later took part in the Russian-Turkish War (1877-1878), the Russian-Japanese War (1904-1905), and the First World War (1918-1920). . Women's work in medicine takes its rightful place in the treatment and care of the wounded and sick. High moral qualities and service, sometimes sacrificial, to suffering people became characteristic of Russian sisters of mercy. Generations of nurses were and are being educated on them. N.I. Pirogov’s associate S.P. did a lot to ensure women’s medical education. Botkin. On the initiative of S.P. Botkin and M.A. Sechenova, the first Russian woman surgeon, in 1872. The Committee for the Care of the Sisters of Mercy was created and a search for funds began to establish a shelter for elderly nurses.
By the end of 1912 under the jurisdiction of the Red Cross Society there were 109 communities with 3,442 sisters of mercy. In accordance with the charter, only persons of the Christian faith were accepted into the community. The sisters did not receive payment for their work, but were provided with housing, food, and clothing from the community.
Second half of the 19th century. characterized by the intensive opening of educational institutions for the training of paramedical personnel in Belarus. These were midwives, paramedics, dentists, and schools for training sisters of mercy.
In January 1865 The first secondary medical educational institution in Belarus was opened - the Mogilev Midwifery School. The initiator of its creation, N.M. Mandelstam, was one of the most prominent figures in medicine in the Mogilev province of that time. In October 1876 A midwifery school for 20 people was opened in Grodno.
In addition, on the territory of Belarus there were schools at hospitals of the Order of Public Charity: a special school of sisters of mercy in Minsk (1890-1902) and a paramedic school in Vitebsk (1872-1875).
Medical schools were also opened by some public organizations. Thus, in Minsk, in December 1902, one-year training courses for sisters of mercy were opened at the Community of Sisters of Mercy of the Red Cross. From 1904 to 1910, a ten-month school of midwives operated in Minsk at the maternity shelter of the Minsk branch of the Russian Society for the Protection of Women.
Private medical schools played a significant role in the training of paramedical personnel. In 1907 and 1908 The first two dental schools in Belarus were opened in Minsk. In 1909 they merged into one school, the training in which lasted two and a half years.
The development of medical schools was accompanied by a number of changes. In 1869 The Vitebsk province joined the shareholding of the Mogilev midwifery school, so the school officially acquired inter-provincial significance.
At that time, medical school charters varied widely regarding terms of study and programs. Only in 1872 The government established a standard charter for paramedic and midwifery schools.
The nursing courses covered Latin, physiology, surgery and desmurgy, hygiene, anatomy, internal medicine, nursing and primary care, pharmacology and formulation. Every day, theoretical classes lasted 2 hours; the rest of the time, students were taught how to care for patients in hospitals and at home.
In a private school, to obtain the title of a second-class midwife, it was necessary to study for 1 year, for a first-class midwife - 2 years, and for a paramedic - 3 years. The school followed the approved curriculum for paramedic schools.
Thus, in Belarus at the end of the 19th and beginning of the 20th centuries. There were several types of educational institutions in which paramedical personnel were trained. Extensive training of sisters of mercy began after the October Revolution. Unfortunately, one of the first measures to improve the training of nurses was not only the liquidation of communities of sisters of mercy, but also the abolition of the name of such a profession. Now the sisters of mercy began to be called nurses. In the first years after the end of the Civil War, the destroyed network of medical institutions was restored very slowly, so the problem of medical personnel at that time was one of the most important and most acute in healthcare.
The system of secondary medical education changed several times in the 20-40s. In October 1922 The Main Directorate for Professional Education held the I All-Russian Conference on Secondary Medical Education, which determined the system for training secondary medical personnel and the types of secondary medical educational institutions in Belarus.
In 1936-1937 In Belarus, the secondary medical school was restructured on a unified basis. The number of schools increased from 6 in 1932. to 33 in 1937
After the annexation of Western Belarus in 1939. Medical schools were opened in Grodno, Slonim, Baranovichi, and Pinsk. By 1940 There were 35 secondary medical schools in the republic: 4 paramedic-midwife schools, 2 paramedic schools, 3 pharmaceutical schools, 23 for nurses, 2 for medical laboratory assistants and 1 dental school. At the same time, nursing staff were trained at courses. By the beginning of the Great Patriotic War, there were 15,293 paramedical workers in Belarus.
Medical workers showed heroism and dedication during the Great Patriotic War: 72.3% of the wounded and 90% of the sick were returned to duty - this is the result of their work. There were 500 thousand paramedical workers in the active army. In the period from 1941 to 1945. The Red Cross organization trained 300 thousand nurses, 500 thousand. sanitary workers and 300 thousand nurses. Providing assistance to the wounded on the battlefield was equated with a feat of arms. Countless such feats were performed by nurses during the Great Patriotic War.
In the first months of the war, our troops were forced to retreat under the pressure of superior enemy forces, suffering heavy losses. Military doctors and the staff of a few hospitals have a huge burden and responsibility. People worked, forgetting about rest, until exhaustion. From the very first days of the war, 1000 doctors, paramedics, and nurses came to the military registration and enlistment offices with a request to send them to the active army, to the front. During the war, almost half of the medical service was represented by women. Working on an equal basis with men, taking on the same dangers and hardships, our women were not inferior to them in bravery and courage. Among the 44 doctors - Heroes of the Soviet Union - 17 are women. There are no words that could convey all the nobility of what female doctors did during the war, just as there are no words that sufficiently convey the depth of gratitude that the soldiers felt for their nurses. Among them are I.N. Levchenko (in the battle for Crimea she carried 28 soldiers and officers out of burning tanks), V.S. Kashcheeva. The feat of the young nurse Zinaida Tusnolobova-Marchenko, a native of Polotsk, deserves special attention. At the beginning of the war, she voluntarily took nursing courses and, after completing them, was appointed as a sanitary instructor for a rifle company. Over three days of fighting, Zinaida provided assistance to 40 wounded soldiers and commanders. She was awarded the Order of the Red Star and was soon given the rank of sergeant major of a medical company. During the fighting, Tusnolobova-Marchenko carried 123 wounded soldiers and commanders out of the fire.
Winter 1943 The roads of war brought Zina to the Kursk region. In one of the battles, while providing assistance to a wounded commander, she herself was seriously wounded in both legs by explosive bullets. The girl lay bleeding for about a day in the February frost. Only the next day the scouts found her and sent her to the hospital. To save her life, Zinaida had to have her arms and legs amputated. It seemed that such a misfortune would break her spirit, but life went on.
The youth of one of the factories in Sverdlovsk produced 5 tanks beyond the plan and wrote on the towers: “For Zina Tusnolobova.” Fellow soldiers avenged her. In 1957 she was awarded the title of Hero of the Soviet Union, and the International Committee of the Red Cross awarded her the Florence Nightingale Medal.
The high awards that were awarded to the best military doctors were recognition of the great merits of the entire medical staff, recognition of the high heroism shown by doctors on the battlefields.
Marshal K.K. Rokosovsky wrote in his memoirs: “Truly our doctors were heroic workers. They did everything to quickly put the wounded on their feet and give them the opportunity to return to duty. My deepest bow to them for their care and kindness.”
During the war, the healthcare system of Belarus suffered enormous damage. The network of medical institutions was destroyed by 80%, almost all medical schools were destroyed along with their equipment.
With the beginning of the liberation of Belarus from the German invaders, medical institutions began to be restored. In March 1944 Medical schools began to function in Mogilev, Mozyr, and Gomel. By December 1944 22 secondary medical institutions were restored in Belarus. Medical schools did not have enough premises, there was a lack of educational literature and teaching aids.
In 1954-1955. Medical schools in Belarus were transformed into medical schools.
Designation of priorities in nursing care, their priority;
Drawing up a care plan, mobilizing the necessary resources and implementing the plan, i.e. providing nursing care directly and indirectly;
Evaluate the effectiveness of the patient care process and the achievement of the goals of care.
The nursing process brings a new understanding of the role of the nurse in practical healthcare, requiring from her not only technical training, but also the ability to creatively relate to patient care, the ability to individualize and systematize care. Specifically, it involves the use of scientific methods to determine the health needs of the patient, family or society, and on this basis the selection of those that can be most effectively met through nursing care.
Nurse based on collected information identifies violated needs patient or his family and in connection with this should identify problems for proper care. This means that the nurse, within the limits of her competence, helps the patient in obtaining what is “missing” and decides how to help the patient correct and restore impaired needs.
JV is a cyclical process, its organizational structure provides five consecutive stages, each of which is closely interconnected with the other four.
Participation of the patient or family members is a prerequisite for SP. The degree of patient participation depends on several factors:
nurse-patient relationship;
patient's attitude towards health;
level of knowledge, culture;
awareness of the need for care.
The joint venture is dynamic, since any of its stages can be reviewed and changed after the ongoing assessment. Documentation of all stages of the joint venture is a prerequisite.
The need to introduce the nursing process into nursing education and nursing practice arose in connection with the understanding of the shortcomings of general patient care by nurses and the development of nursing in the world. These include, first of all, a bureaucratic approach to nursing care, based on medical diagnosis, when the nurse knows what the doctor has prescribed for the patient and strictly carries out those orders without much consideration for the patient's psychological, social and spiritual needs for care. To take these factors into account, the nurse, as a specialist, will need not intuitive, but additional knowledge in the field of modern philosophy, nursing methodology, human psychology, and the ability to teach and research. This knowledge will ensure increased professional growth of nurses, improve the quality of care, provide a systematic approach to nursing care, and restore the lost professional values of nurses.
The nurse should knowstages of the nursing process , their relationship and the content of each stage.
The five stages of the nursing process, their relationship and the content of each stage.
First stage : examination of the patient or assessment of the situation – the process of collecting information about the patient’s health status and confirming its accuracy.
The purpose of the examination is to collect, substantiate and link the obtained data about the patient to create an information base about him.
1. Subjective data the nurse identifies verbal(manner of speaking, adequacy of answers to questions, logical construction of phrases) and non-verbal(eye contact, facial expressions, gestures, body position) levels.
The main role in the survey belongs to questioning. The completeness of the information will depend on the nurse’s ability to position the patient for the necessary conversation.
Subjective information is the patient's perceptions of his state of health.
The nurse begins the subjective examination with passport data about the patient, then identifies him:
1) complaints - what made a person seek medical help;
2) anamnesis of life, illness - the history of the occurrence of a particular health problem; the nurse asks the patient in detail about the satisfaction of a person’s basic life needs;
3) sociological data (relationships in the family, team, financial status, environment in which the patient lives and works);
4) intellectual data (speech, memory, assessment of communication abilities);
5) data about culture (ethnic, cultural values);
6) data on spiritual development (spiritual values, attitude towards religion, habits, beliefs and customs).
The source of information is:
the patient himself (the most reliable source);
family members, relatives;
medical staff;
colleagues, friends;
medical documentation.
psychological data (individual character traits, behavior, mood, self-esteem, ability to make decisions).
physical data - examination of the patient, assessment of morphological and functional features using palpation, percussion, and auscultation techniques.
laboratory and instrumental (X-ray, endoscopy, ultrasound) methods.
This means that the first stage (collection of information) determines the direction of nursing care.
IIstage – nursing diagnosis is the identification of real and potential patient problems that must be resolved or eliminated by the nurse based on his/her professional competence.
A patient problem is a patient's response to an illness or health condition ( that is, the nurse makes conclusions, which become problems-subjects of nursing care).
A nursing problem is a thoughtful conclusion based on an analysis of information obtained during the examination. That is, the doctor makes his diagnosis based on the pathological process, and the nurse determines the problem based on the patient’s reaction to the disease or health condition.
This means that the nurse, conducting an examination, analyzes the data, identifies impaired needs and determines the patient’s problems.
An example of possible disrupted needs of a young girl: after surgery for appendectomy, a 23-year-old patient experiences difficulty in maintaining personal hygiene.
Stage goals:
1) identification of problems arising in the patient;
2) identification of factors contributing to or causing the development of these problems;
3) identifying the patient’s strengths that would help prevent or resolve his problems;
The patient himself is often aware of the presence of problems and the need for help, but there are problems that he is not aware of and which can only be identified by a nurse.
Classification of patient problems
Depending on the time of appearance:
Potential (probable) – those that do not exist today but may develop over time (eg, communication deficits, pressure ulcers, constipation in an immobile patient, or risk of dehydration due to persistent vomiting).
According to the nature of the patient’s reaction to the disease and his condition:
2) psychological(anxiety about the upcoming operation, depression due to the loss of a loved one);
3) spiritual– problems of the highest level associated with changes in values, the search for the meaning of life, turning to religion (loneliness, loss of the meaning of life, the need to turn to God);
4) social(conflict situation at work, in the family, loss of ability to work, financial difficulties due to disability).
Subjective and objective:
Objective– are associated with the use of medical knowledge, may not be recognized or ignored by the patient, are diagnosed more often by a health care worker (often potential – high risk of developing bedsores, suffocation).
In most cases, a patient may have several health problems, so the nurse must consider them based on their significance.
Priority of problems:
Primary– require urgent measures, are life-threatening (shortness of breath, suffocation, disturbance of consciousness), those problems that are mainly resolved by a doctor or medical team.
Intermediate- do not require emergency measures, are not life-threatening - these are mainly the problems that a nurse will deal with (loss of appetite due to illness, lack of knowledge about one’s health, urinary incontinence in an elderly person).
Secondary– are not directly related to the disease and prognosis (for example, intestinal dysfunction in a patient with bronchitis or a lack of knowledge about healthy eating in a patient with a broken leg).
The plan should be understandable to all specialists, practical, easy to use, and easy to adjust.
During planning
1) determine goals and expected results;
2) choose measures to care for patients;
3) draw up a care plan.
There are two types of goals by time of determination:
short-term– goals that are achievable in 1-2 weeks. Goals are determined, as a rule, in the acute phase of the disease in a hospital (for example, reducing pain in the area of a postoperative wound, reducing appetite in a patient with acute gastritis);
long-term– goals that are achievable over a longer period of time – more than two weeks. They are usually aimed at preventing relapses of the disease, complications, their prevention, rehabilitation and social adaptation. If they are not determined, then, in fact, the patient is deprived of systematic nursing care upon discharge.
1) activities - actions;
2) criterion – date, time, distance;
3) conditions – assistant, assistant.
For example, the nurse should teach the patient within two days put to myself warming compress:
actions – apply a compress;
time criterion - during two days;
condition - with the help of a nurse.
Target – it is the expected outcome, what the nurse and patient want to achieve regarding a particular problem. Formation of goals requires the active participation of the patient. The goal and expected result should not interfere with treatment provided by other specialists. In our case, the patient must learn to apply a compress to himself.
Requirements for setting goals:
1) must be focused on the patient;
2) must be real and achievable;
3) must be delivered in such a way that they can be assessed.
The patient's problem is the basis for planning nursing care.
Example:
|
Problem |
Target |
|
The patient does not understand the dangers of smoking |
The patient understands the dangers of smoking |
|
The patient is unaware of the possible complications of his disease |
The patient is aware of the possible complications of his disease |
|
Patient forgets to take medications regularly at home |
The patient regularly takes medications prescribed by the doctor at home |
|
The patient does not know the principles of rational nutrition |
The patient knows the principles of rational nutrition |
|
The patient cannot eat on his own |
The patient takes food in a timely manner with the help of a nurse or relatives |
|
The patient experiences discomfort when performing physiological functions in an unusual position |
The patient does not experience discomfort and accepts help from a nurse or relatives |
|
The patient does not understand the need for bed rest |
The patient understands and complies with bed rest |
|
The patient experiences discomfort due to disruption of the usual biological rhythm (sleep deficiency) |
The patient sleeps at least 8 hours a day |
|
The patient is unable to perform self-care due to high fever |
The patient performs self-care with the help of a nurse or relatives |
|
The patient has difficulty performing personal hygiene in bed due to his serious condition |
The patient receives assistance from a nurse or relatives in performing personal hygiene in bed |
IIIstage – planning necessary assistance to the patient. Planning refers to the process of forming goals (i.e., desired outcomes of care) and the nursing interventions necessary to achieve these goals.
IVstage – implementation of the plan(implementation of the nursing intervention (care) plan).
Stage 4 goal– providing appropriate care for the victim, training and counseling. The nurse must remember that all nursing interventions are based on:
on knowing the goal;
individual approach, safety;
ensuring confidentiality and respect for the individual;
encouraging the patient to become independent.
temporal– designed for a short period of time when there is a shortage of self-care;
constant– requires assistance throughout life (limb amputation, spinal injury);
rehabilitative– the process is long, sometimes throughout life (physical therapy, massage, gymnastics);
educational– the process of training relatives and the patient himself.
1) dependent;
2) independent;
3) interdependent.
Dependent Interventions
These are the actions of a nurse that are performed upon request or under the supervision of a physician. For example, antibiotic injections every 4 hours, changing bandages, gastric lavage.
Independent interventions
These are actions carried out by the nurse on his own initiative, autonomously, without direct demands from the doctor. The following examples may serve as illustrations:
1) assisting the patient in self-care;
2) monitoring the patient’s response to treatment and care, as well as his adaptation in a health care facility;
3) education and counseling of the patient and his family;
4) organization of the patient’s leisure time.
Interdependent interventions
This is a collaboration with your doctor or other health care professional, such as a physiotherapist, nutritionist or exercise instructor, where the actions of both parties are important to achieve the final result.
Vstage – evaluation of results(summative assessment of nursing care). Evaluating the effectiveness of the care provided and adjusting it if necessary.
The 5th stage of the joint venture includes:
1) assessment of the patient’s response to care:
improvement (desire to communicate, improved mood, appetite, easier breathing);
deterioration (insomnia, depression, diarrhea);
previous condition (weakness, difficulty walking, aggression);
3) the opinion of the patient or his family (improved condition, worsened, no change);
4) assessment of actions by the nurse manager (achievement of the goal, correction of the care plan).
The concept of “diagnosis” applied only to the medical profession. And now most researchers agree that nursing diagnosis
- this is the patient’s health condition, established as a result of a nursing examination and requiring intervention from the outside nurses.
A medical diagnosis differs from a nursing diagnosis in that a medical diagnosis defines a disease, and nursing diagnosis aims to identify reactions of the body in connection with the disease.
The medical diagnosis may remain unchanged throughout the illness, nursing – may change every day.
A medical diagnosis presupposes treatment within the framework of medical practice, and sister– nursing intervention within her competence.
There are standards of nursing practice.
Standard- this is a sample, norm, standard, a unified and mandatory model, taken as the initial one for comparing other similar objects and actions with it.
Standards allow us to objectively assess the quality of work. Standards are more necessary for young specialists and hospital administration, since they are a tool for management activities; thanks to standards, the time for providing assistance and care is reduced, the quality of care provided is improved, and the work of a nurse is objectively assessed.
Mandatory conditions for the application of standards:
The choice of standard should be appropriate to the clinical situation;
The level of assistance must correspond to the qualifications of the personnel and the capabilities of the healthcare facility;
The nurse is responsible for knowing and understanding the standard as a whole;
The standard can be changed taking into account the specifics of the patient’s condition, his individual characteristics and transformed into an individual care plan;
Care, according to the standard, must be provided in the shortest possible time and in the minimum sufficient volume;
It is necessary to ensure timely calling of a doctor and organization of consultation.
All conceptual models of nursing (D. OremRoy, Henderson, etc.) include four aspects of nursing:
1. Patient
2. Nursing
3. Environment
4. Health
These aspects of nursing are divided into 3 classes:
1. Survival needs
2. Intimacy needs
3. Freedom needs
A need is a conscious psychological or physiological deficiency of something, reflected in the perception of a person, which he experiences throughout his life.
American psychophysiologist A. Maslow, Russian origin, in 1956 identified 14 basic human needs:
2. There is stage I needs survival.
4. Highlight
5. Sleep, rest
6. Be clean
7. Dress and undress II level of needs that provide own
safety from natural elements, diseases, stress.
8. Maintain temperature
9. Be healthy
10.Avoid danger
11.Move
12. Communicate III stage to be understood and accepted, respected: to have support in
life, belonging to society, family.
13.Achievement successIVstep has vital values in work, life, family,
desire for beauty and order.
14.Play, study, work - Stage V: the top of Maslow’s pyramid, which states
that man is a rational being, the development of personality.
This theory of human needs is popular all over the world and forms the basis of nursing diagnosis. It has the characteristics of each need and methods for assessing the level of their satisfaction.
Domestic scientists Simonov and Ershov are the authors need-information theory, which explains the causes and driving forces of human behavior.
The essence of the theory is that needs are stimulated by the conditions of existence of the organism in a constantly changing environment.
The transition of needs into actions and actions is accompanied by emotions. Emotions are an indicator of needs.
Simonov and Ershov divided all needs into 3 groups:
Group I – vital(the need to live and provide for one’s life).
Group II – social(the need to occupy a certain place in society).
III group – educational(the need to know the external and internal world).
Section 2. Medical ethics and deontology in the practice of nurses. Moral and legal responsibility of medical workers.
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