The nurse records the patient's and family's assessments of the plan of intervention and makes necessary changes to the plan based on the family's belief that the expected results can be achieved. She summarizes the work done by family members.

Having familiarized ourselves with several models out of many existing ones, we see that a single model does not exist today.

Nurse practitioners in many countries use several models simultaneously, with the choice of model depending on the patient's inability to meet certain needs.

Understanding the models that have already been developed helps to select those that are suitable for a particular patient.

The nursing care model helps focus the nurse's attention when assessing the patient, making a diagnosis, and planning nursing interventions.

Domrachev E.O. Lecture.

LECTURE No. 5.

Topic: "Nursing process: concepts and terms."

The concept of nursing process was born in the USA in the mid-50s. Currently, it has been widely developed in modern American, and since the 80s - in Western European models of nursing.

The nursing process is a scientific method of organizing and delivering nursing care, a systematic way of identifying the patient and nurse situation and the problems that arise in that situation, in order to implement a plan of care that is acceptable to both parties. The nursing process is a dynamic, cyclical process.

The goal of the nursing process is to maintain and restore the patient's independence in meeting the basic needs of the body, which requires an integrated (holistic) approach to the patient's personality.

FIRST STAGE - INFORMATION COLLECTION

SECOND STAGE - NURSING DIAGNOSIS

The concept of a nursing diagnosis, or nursing problem, first appeared in the United States in the mid-50s. and was legislated in 1973. Currently, the list of nursing problems approved by the American Nurses Association includes 114 units.

The International Council of Nursing (ICN) developed in 1999 the International Classification of Nursing Practice (ICNP) is a professional information tool necessary to standardize the language of nurses, create a unified information field, document nursing practice, record and evaluate its results, and train staff.

In the ICFTU, a nursing diagnosis is understood as a nurse's professional judgment about a phenomenon related to health or a social process that represents the object of nursing intervention.

A nursing diagnosis is a description of the nature of the patient's existing or potential response to the disruption of meeting vital needs due to illness or injury, in many cases these are patient complaints.

Nursing diagnosis should be distinguished from medical diagnosis:

A medical diagnosis defines a disease, while a nursing diagnosis is aimed at identifying the body’s reactions to its condition;

The doctor's diagnosis may remain unchanged throughout the illness. Nursing diagnosis may change daily or even throughout the day;

A medical diagnosis involves treatment within the scope of medical practice, and a nursing diagnosis involves nursing interventions within the scope of her competence and practice.

The medical diagnosis is associated with the emerging patho-physiological changes in the body. Nursing - often associated with the patient's ideas about the state of his health.

Nursing diagnoses cover all areas of a patient's life. There are physiological, psychological, social and spiritual diagnoses.

There may be several nursing diagnoses, 5-6, but most often only one medical diagnosis.

There are obvious (real), potential and priority nursing diagnoses.

Sample bank of patient problems or nursing diagnoses

1. Feelings of anxiety associated with... (indicate the reason).

2. Insufficient nutrition that does not meet the needs of the body.

3 Excessive nutrition, exceeding the body's needs.

4. Reduced protective functions of the body due to...

5. Lack of sanitary conditions (living, work...).

6. Lack of knowledge and skills to implement... (for example, hygiene measures).

7. Fatigue (general weakness).

STAGE THIRD - CARE PLANNING

During planning, GOALS and a CARE PLAN are formulated SEPARATELY FOR EACH PROBLEM. Requirements for setting goals:

1) Goals must be realistic and achievable. You cannot set a goal: the patient will lose 10 kg in 3 days.

2) It is necessary to set deadlines for achieving the goal. There are 2 types of goals based on timing:

a) short-term (less than one week);

b) long-term (weeks, months, often after discharge).

3) Goals must be within nursing competence.

Incorrect: “The patient will not have a cough at the time of discharge,” since this is the physician's area of ​​expertise.

Correct: “The patient will demonstrate knowledge of cough discipline by the time of discharge.”

4) The goal should be stated in terms of the patient, not the nurse.

Incorrect: The nurse will teach the client techniques for self-administration of insulin. Correct: The patient will demonstrate the ability to self-inject insulin technically correctly within a week.

The nurse then creates a plan of care for the patient, which is a written manual that is a detailed listing of the nurse's actions necessary to achieve nursing goals.

The nurse carefully considers the situation over a blank sheet of paper, trying to answer the questions in detail, point by point - what can she do for the patient regarding this problem? How can I make his situation easier?

When drawing up a care plan, the nurse can be guided by the STANDARD of nursing intervention, which is understood as a list of evidence-based activities that provide quality care for the patient for a specific problem.

For example, review the sample STANDARD for nursing interventions for constipated bowel movements. Nursing problem: stool with a tendency to constipation.

Goals: Short-term - the patient will have a bowel movement at least once every two days.

Long-term - the patient will demonstrate knowledge of ways to combat constipation by the time of discharge.

Nature of nursing intervention:

1) provide a fermented milk plant diet (cottage cheese, vegetables, black bread, fruits, greens) - diet No. 3.

2) ensure sufficient fluid intake (fermented milk products, juices, sulfate mineral waters) up to 2 liters per day.

3) try to develop in the patient a conditioned reflex to defecate at a certain time of day (in the morning, 15-20 minutes after drinking a glass of cold water on an empty stomach).

4) ensure sufficient physical activity for the patient.

5) ensure the intake of laxatives and cleansing enemas as prescribed by the doctor.

6) record daily stool frequency in medical records.

7) teach the patient about dietary habits for constipation.

The standard is created to help the nurse, it is a reference book, but the standard cannot provide for all clinical situations, so it cannot be applied thoughtlessly and blindly. Peter I also warned: “Do not hold on to the rules like a blind man to a fence.”

For example, including a large amount of vegetables and fruits and black bread in the diet cannot be recommended for a constipated patient with inflammatory bowel disease; a lot of fluid, performing cleansing enemas with a volume of 1.5-2 liters - for a patient with constipation due to edema; expansion of motor activity - for a patient with constipation and spinal injury.

STAGE FOUR - IMPLEMENTING THE CARE PLAN

Everything that the nurse has planned to do on paper, she must now put into practice - independently or with outside help.

Nursing actions involve 3 types of nursing interventions:

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, guided by his own considerations, 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 health care facilities,

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.

FIFTH STAGE - ASSESSMENT OF THE EFFECTIVENESS OF CARE

The effectiveness and quality of patient care is assessed by the nurse regularly, at certain intervals. For example, for the problem “risk of pressure ulcers,” the nurse will assess every two hours, changing the patient's position.

Key aspects of the assessment:

Assessing progress towards achieving goals to measure quality of care;

Studying the patient’s response to medical staff, treatment and the very fact of being in the hospital.

The assessment process requires the nurse to think analytically when comparing desired results with achieved ones. If the goals are achieved and the problem is resolved, the nurse signs and dates the documentation. For example:

Goal: The patient will be able to measure his or her own blood pressure by September 5.

Assessment: the patient measured blood pressure and assessed the results correctly on 5.09. Goal achieved; nurse's signature.

Thus, the nursing process is a flexible, living and dynamic process that provides constant search for care and systematic adjustments to the nursing care plan. At the center of the nursing process is the patient as a unique individual who actively collaborates with the staff.

Once again, I would like to especially draw attention to the fact that the nurse does not consider the disease, but the patient’s reaction to the disease and his condition. This reaction can be physiological, psychological, social and spiritual.

For example, a doctor stops an attack of bronchial asthma, determines its causes and prescribes treatment, but teaching a patient to live with a chronic disease is the task of a nurse. And today the words of F. Nightingale remain relevant: “To train sisters means to teach how to help a sick person live.”

WHAT DOES IMPLEMENTATION OF THE NURSING PROCESS IN PRACTICAL HEALTH CARE GIVE?

1) systematic, thoughtful and planned nursing care;

2) individuality, taking into account the specific clinical and social situation of the patient;

3) scientific nature, the possibility of using standards of nursing practice;

4) active participation of the patient and his family in the planning and implementation of care;

5) effective use of the nurse’s time and resources;

6)increasing the sister’s competence, independence, creative activity, and the prestige of the profession as a whole.

The nursing process method is applicable to any area of ​​nursing practice and can be used not only in relation to an individual patient, but also to groups of patients, their families, and society as a whole.

Domrachev E.O. Lecture.

LECTURE No. 6.

Topic: "1st stage of the nursing process"

The first stage of the nursing process is a subjective and objective examination, i.e. an assessment of the person’s health status.

The subjective method is a conversation with the patient (identification of complaints, lifestyle, risk factors, etc.) with a source of information, perhaps. patient, relatives and honey. documentation (patient's medical record or extract from medical history), honey. staff, special medical literature.

The examination methods are: subjective, objective and additional methods of examining the patient to determine the patient's care needs.

1. Collection of necessary information:

a) subjective data: general information about the patient; complaints currently - physiological, psychological, social, spiritual; the patient's feelings; reactions related to adaptive capabilities; information about unmet needs associated with changes in health status;

b) objective data. These include: height, body weight, facial expression, state of consciousness, position of the patient in bed, condition of the skin, patient’s body temperature, breathing, pulse, blood pressure, natural bowel movements;

c) assessment of the psychosocial situation in which the patient is:

Socio-economic data are assessed, risk factors are determined, environmental data affecting the patient’s health, his lifestyle (culture, hobbies, hobbies, religion, bad habits, national characteristics), marital status, working conditions, financial situation;

The observed behavior and dynamics of the emotional sphere are described.

2. The purpose of analyzing the collected information is to determine the priority (according to the degree of threat to life) impaired needs or problems of the patient, the degree of independence of the patient in care.

Why can’t a nurse use the data of a medical examination, that is, get all the information she needs to organize care from the medical history of the disease? A nursing examination is independent and cannot be replaced by a doctor’s, since the doctor and the nurse pursue different goals in their work.

The doctor’s task is to establish the correct diagnosis and prescribe treatment. The nurse’s task is to provide the patient with maximum comfort and, within the limits of his nursing competence, to try to alleviate his condition. Therefore, what is important for the nurse is not so much the causes of health problems (infection, tumors, allergies), but rather the external manifestations of the disease as a result of impaired body functions and the main cause of discomfort. Such external manifestations may be, for example: shortness of breath, cough with sputum, swelling, etc.

Since the nurse and the doctor have different goals, therefore, the information they collect when examining a patient should be different.

An objective examination is an examination of the patient, i.e., observation of how the patient satisfies his 14 vital needs.

Additional examination includes data from laboratory tests and instrumental studies. What does an objective examination consist of?

1. Patient's condition

2. Consciousness, facial expression

3.Position in bed, movement of joints

4. Condition of the skin and mucous membranes

5.Lymph nodes

6. Condition of the musculoskeletal system

7. Condition of the respiratory system

8.Gastrointestinal tract

9. Urinary system

10.Cardiovascular system

12. Nervous system

13. Reproductive system

14. Body temperature, respiratory rate, pulse. A/D, height, body weight

Modern honey the nurse must have the skills to conduct a general examination, palpation of the lymph nodes, abdomen, thyroid gland, auscultation of the lungs and heart, abdomen, percussion of the lungs, and examine the mammary glands and genital organs.

Conduct anthropometry: i.e. measuring height, body weight, head circumference. breasts

1Patient's condition; mild, moderate, severe, critical. agonal.

2 Consciousness - clear, confused, unconscious. coma, no reaction to verbal and painful stimuli.

3The patient’s position is active, forced (when he sits or lies in a certain way), passive.

4 Condition of the skin and mucous membranes - pale, cyanotic, hyperemic, marbling of the skin, cold, hot, dry, wet, normal.

5 Condition of the musculoskeletal system - without pathology - correctly developed, disharmony of the skeletal system (bone curvature)

6 The condition of the lymph nodes is not palpable, small, large up to 1 cm, etc.

7 State of the respiratory system - normal type of breathing, shallow breathing, deep breathing, rapid breathing, pathological. The frequency of respiratory movements in a newborn is from 36-42-45, transitional age from 30-24, adults 16-18 movements.

During auscultation, several types of breathing are heard:

1.puerial 1 from birth to 2 years of age

2. vesicular - normal breathing

3.hard - increased breathing sound, with acute respiratory infections, etc.

4. weakened - decrease in breathing sound.

3 types of breathing: chest, abdominal, mixed.

When examining the cardiovascular system, med. The nurse examines the pulse, measures A/D, and conducts auscultation of the heart.

When auscultating the heart, the rhythm, heart shadows and the presence or absence of pathological noises are heard.

The pulse is the vibration of the arterial wall caused by the release of blood into the arterial system. Most often determined on the radial artery, carotid artery. The pulse can be arterial, venous, or capellar.

The nurse determines the pulse at the wrist joint, temporal artery, popliteal artery, carotid artery, posterior tibial artery, and artery above the foot.

Arterial pulse - central and peripheral.

Central - carotid artery, abdominal aorta.

Pulse indicators: rhythm, frequency, tension (hard, soft), filling (satisfactory, full, thread-like)

A/D - the force with which the blood exerts pressure on the walls of blood vessels depends on the magnitude of cardiac output and the tone of the arterial wall. A/D depends on age and health status. In a young child 80/40-60/40 mmHg, in an adult (12-13; 30-40 years old) 120/60-70

Hypotension - decreased A/D (hypotension)

Hypertension - increased A/D (hypertension)

9. Gastrointestinal tract - examination of the tongue, palpation of the abdomen, regularity of bowel movements.

10.urinary system - frequency of urination, pain, presence of edema.

Water balance is the correspondence of the liquid drunk and excreted by a person per day (1.5-2 liters); edema can be hidden or obvious.

11.Endocrine system - palpation of the thyroid gland (enlargement, pain)

12. Nervous system - smooth reflexes (reflex to light), pain reflexes.

13. Reproductive system - type female, male, development correct or not.

Based on subjective and objective examinations, violations of need satisfaction are identified.

For example: a 40-year-old patient complains of headache, drowsiness, and weakness. From the analysis it was found out: these symptoms have been tormenting the patient for 3 months, he is overworked at work, is very tired, smokes, works as an economist.

From examination: moderate condition, conscious, active position, clean skin, hyperemia-blush, parietal tissue is overdeveloped. Lymph nodes are small. On auscultation, breathing is vesicular. A/D160/100, heart rate 88. The abdomen is soft. Appetite is reduced. Genital organs are developed according to the male type. Disturbed needs: sleep. eat, relax, work. Risk factors are physical inactivity, smoking. Further planning, etc.

3.Data registration: examination data is documented and recorded in the inpatient's nursing record. Where is it recorded:

Date and time of patient admission

Date and time of patient's discharge.

Department No. ward No.

Type of transportation: on a gurney, can walk

Blood group, Rh factor

Side effects of drugs

Year of birth

Place of residence

Place of work (position)

Gender and disability group

Directed by

Sent to the hospital due to epidemiological indicators, hours after the onset of the disease

Medical diagnosis

5 assessment of nursing intervention

Afterwards, the nursing process data is registered

Data registration is carried out in order to:

1 Record all patient data

3 To make it easier to adjust your care plan.

4 To reflect the dynamics of the patient’s condition.

5To make it easier to evaluate the effectiveness of nursing interventions.

Throughout the entire care, the nurse reflects the dynamics of the patient’s subjective and objective state in an observation diary.

Conclusion: We got acquainted with stage 1 - an objective examination. Conducting an examination of an objective patient to identify his violated needs.

Domrachev E.O. Lecture.

LECTURE No. 7.

Topic: "Infection control and prevention of nosocomial infections."

The problem of hospital-acquired infections (HAIs) is one of the most pressing health problems both in Russia and abroad. In the United States of America, European and Asian countries, work on the prevention of nosocomial infections is called infection control; in our country the term “epidemiological surveillance” has been adopted.

The infection control program is a 2-stage program and is implemented by two organizational structures: the commission for the prevention of hospital-acquired infections and the hospital epidemiologist (assistant epidemiologist).

Surveillance of hospital-acquired infections includes identifying nosocomial infections, investigating these cases, identifying causes and mechanisms of infection, identifying pathogens, and developing hospital-based interventions to reduce and prevent hospital-acquired infections.

US hospitals have infection control departments. The staff is staffed by epidemiologists and nurses who have been trained in infection control at special courses. Nurses are hired into the department if they have at least 10 years of work experience, then they are assigned to the most experienced nurse in the infection control department, and only after completing an internship does an employee of the department have the right to work independently.

The work is based on the principle of supervising departments (1 employee per 250 beds), collecting information and analyzing cases of nosocomial infections.

The data obtained as a result of this analysis is brought to the attention of the department staff and discussed with them.

In our country, this work began to be systematically carried out after the publication of Order No. 220 of the Ministry of Health “On measures to develop and improve the infectious disease service in the Russian Federation” in 1993. Before this, the work of epidemiological surveillance was assigned to the epidemiologist of the sanitary and epidemiological service. The appearance of epidemiologists in hospitals over time will certainly lead to a decrease in the level of nosocomial infections. Success can only be achieved by establishing a trusting relationship between infection control professionals and department staff. A significant role in this cooperation is given to paramedics, whose work determines the incidence of nosocomial infections in medical institutions.

According to the expert assessment of specialists, nosocomial infections are transmitted to 7-8% of patients.

The fight against nosocomial infections is a set of measures aimed at breaking the chain of transmission of infection from one patient or health worker to another.

The transmission routes for nosocomial infections are varied, but most often the infection spreads through medical instruments and equipment that are difficult to disinfect. Endoscopes are the most difficult to clean.

It is important to ensure the quality of instrument processing at all stages - from cleaning to disinfection and sterilization. Purification makes it possible to reduce the contamination of microorganisms by 10,000* times, i.e. by 99.99%. Therefore, the key to handling tools and equipment is to thoroughly clean them.

Nosocomial infection is any disease of microbial origin that affects a patient as a result of admission to the hospital or seeking medical care, as well as the disease of a hospital employee as a result of his work in this institution, regardless of the appearance of symptoms of the disease during his stay in the hospital or after discharge.

VBI IN RUSSIA

OFFICIAL DATA - 52-60 THOUSAND. SICK

ESTIMATED DATA - 2.5 MILLION.

INCIDENCE OF HAI IN NEWBORNS IN RUSSIA

OFFICIAL REGISTRATION DATA -1.0-1.4%

SAMPLE STUDIES - 10-15%

DAMAGE CAUSED BY HAI IN RUSSIA

INCREASE IN BED DAY BY 6.3 DAYS

COST OF 1 BED DAY WITH VBI ~ 2 THOUSAND RUBLES.

ECONOMIC DAMAGE -2.5 BILLION. RUB PER YEAR

SOCIO-ECONOMIC DAMAGE FROM HAI IN THE USA

2 million patients suffer from nosocomial infections per year

88,000 patients die from nosocomial infections

Economic damage: $4.6 billion.

Nosocomial infections occur in 5-12% of patients admitted to medical institutions:

In patients infected in hospitals;

In patients infected while receiving outpatient care;

In healthcare workers who became infected while providing care to patients in hospitals and clinics.

What unites all three types of infections is the place of infection - the medical institution.

Nosocomial infections are a collective concept that includes various diseases. The definition of nosocomial infection proposed by the WHO Regional Office for Europe in 1979 is: “Nosocomial infection is any clinically recognizable infectious disease that affects a patient as a result of his admission to hospital or seeking medical care, or an infectious disease of a hospital employee as a result of his work in that institution outside depending on the onset of symptoms before or during hospital stay."

This category of infections has its own epidemiological features that distinguish it from the so-called classical infections. In particular, medical personnel play a crucial role in the emergence and spread of nosocomial infections.

In the structure of nosocomial infections detected in health care facilities, purulent-septic infections (PSI) occupy a leading place, accounting for up to 75-80%. Most often, GSIs are recorded in surgical patients, especially in the departments of emergency and abdominal surgery, traumatology and urology. The main risk factors for the occurrence of GSI are: an increase in the number of carriers among employees, the formation of hospital strains, an increase in contamination of the air, the environment and the hands of personnel, diagnostic and therapeutic manipulations, non-compliance with the rules for placing patients and caring for them.

Another large group is intestinal infections. They make up 7-12% of the total. Among them, salmonellosis predominates. Salmonellosis is recorded in weakened patients in surgical and intensive care units who have undergone major operations or have severe somatic pathology. The isolated Salmonella strains are characterized by high antibiotic resistance and resistance to external influences. The leading routes of transmission in health care facilities are household contact and airborne dust.

A significant role is played by blood-contact viral hepatitis B, C, D, accounting for 6-7%. Patients who undergo extensive surgical interventions followed by blood transfusions, hemodialysis, and infusion therapy are most at risk of the disease. In 7-24% of patients, markers of these infections are detected in the blood. The risk category represents personnel whose duties include performing surgical procedures or working with blood. Surveys reveal that carriers of markers of viral hepatitis are from 15 to 62% of the personnel working in these departments.

Other infections in healthcare facilities account for up to 5-6% of the total incidence. Such infections include influenza and other acute respiratory viral infections, diphtheria, and tuberculosis.

The problem of preventing nosocomial infections is multifaceted and very difficult to solve. The design of the healthcare facility building must comply with scientific achievements, the healthcare facility must have modern equipment, and the anti-epidemic regime must be strictly observed at all stages of medical care. Three important requirements must be met in health care facilities:

Minimizing the possibility of infection;

Exclusion of nosocomial infections;

Preventing the spread of infection outside the health care facility.

In matters of preventing nosocomial infections in hospitals, nursing staff are assigned the role of organizer, responsible executor, and controller. Daily, thorough and strict compliance with the requirements of the sanitary-hygienic and anti-epidemic regime forms the basis of the list of measures for the prevention of nosocomial infections. The importance of the role of the head nurse of the department should be emphasized. This is a nursing staff who have worked in their specialty for a long time, have organizational skills, and are well versed in security issues.

Each of the areas of prevention of nosocomial infections provides for a number of targeted sanitary-hygienic and anti-epidemic measures aimed at preventing one of the routes of transmission of infection within the hospital.

BASIC MEASURES FOR CONTROL AND PREVENTION OF HAI

Reducing the scale of hospitalization of patients.

Expanding home health care.

Organization of day hospitals.

Examination of patients during planned operations at the prehospital level.

Careful adherence to the anti-epidemic regime.

Timely isolation of patients with nosocomial infections.

Reduced length of hospitalization (early discharge).

Suppression of the transmission mechanism during medical procedures:

Reduction of invasive procedures;

Use of procedure algorithms;

Expansion of the central service network;

Measures to disrupt natural transmission mechanisms:

Use of modern effective disinfectants;

Use of immunocorrectors for risk groups (bifidumbacterin, etc.).

Medical personnel training.

Development of a program for the prevention of nosocomial infections in each health care facility.

MEASURES FOR PROTECTING MEDICAL PERSONNEL.

Specific prevention (vaccinations, hemorrhagic fever, diphtheria, tetanus).

Prevention of infections during invasive procedures.

Suppression of the natural transmission mechanism (contact-household, airborne).

Emergency prevention in emergency situations (HIV, cholera, plague, HF).

When caring for a sick person, it is necessary to comply with the sanitary and anti-epidemic regime (SER) and remember that if you do not comply with the SER, you can become infected with an infectious disease from the patient or infect him.

GOALS AND PLANNING OF NURSING INTERVENTIONS.

ASSESSMENT OF THE EFFECTIVENESS OF MEETING THE BASIC VITAL NEEDS OF THE PATIENT AND FORMULATION OF NURSING PROBLEMS.

STAGE OF THE NURSING PROCESS

2.1. DETECTING VIOLATIONS OF VITAL NEEDS: breathe, eat, drink, excrete, move, maintain body position in space, maintain normal body temperature, sleep, rest, dress, undress. Be clean, avoid danger, communicate, have life values ​​(material), work (play, study), be healthy.

2.2. IDENTIFYING PATIENT'S NURSING PROBLEMS.

2.2.1. Identifying the patient's real problems.

2.2.2. Identification of the patient’s priority problems: 1st order priorities, 2nd order priorities, etc.

2.2.3. Identifying potential patient problems.

III. STAGE 3 OF THE NURSING PROCESS - DEFINITION

3.1. Determining the goal of nursing interventions according to each identified patient problem:

§ short-term

§ long-term

3.2. Planning nursing interventions for each patient's identified problem and goals.

IY. IMPLEMENTATION OF NURSING INTERVENTION PLAN.

A detailed description of all the actions of the nurse. In this section, the student must describe the algorithms of the nurse’s actions according to the plan of nursing interventions with a detailed description of the organization and conduct of all activities, including conversations, lectures and recommendations.

While completing this stage of the nursing process, the student must answer the following questions:

§ how to prepare a patient for prescribed laboratory and instrumental tests? What to tell the patient about these studies, how to prepare for them;

§ how to carry out certain nursing manipulations?

§ how to organize and implement each point of the nursing intervention plan.

§ What will the student tell the patient and his relatives about this disease?

Assess changes in the patient's problem and the result obtained as a result of nursing interventions.

Table 1.

Nursing process map

Table 2.

Nursing care for therapeutic illness.

Having carried out nursing care for a therapeutic disease, the student must evaluate changes in the subjective and objective status, as well as laboratory and instrumental examinations, according to all stages of collecting information about the patient: complaints, examination, palpation, percussion and auscultation. Also changes in disruption of patient needs and patient problems.

The student must sign at the end of the nursing history.

EXAMPLE OF WRITING A NURSING HISTORY OF ILLNESS.

COLLECTING INFORMATION ABOUT THE PATIENT.

1.1. GENERAL INFORMATION (passport part).

· Full name: Ivanov Sergey Petrovich

· Age – 60 years

· Gender - male

· Nationality - Russian

· Education - secondary

· Place of registration – Kirov, st. Lenina, 2, apt. 5.

· Place of residence - Kirov, st. Lenina, 2, apt. 5.

· Place of work - pensioner

· Profession (position) driver

· Who referred the patient to the local doctor.

· Drug intolerance - no

· Date of admission 01/01/08.

· Date of discharge - 01/30/08.

Diagnosis upon admission: chronic bronchitis, II degree DN.

Clinical diagnosis: COPD: chronic obstructive mixed bronchitis (bronchitis and emphysematous variant), moderate severity, exacerbation phase, II degree DN. Chronic cor pulmonale, compensation stage, CHF 0. Polycythemia.

Basic:

§ Cough with viscous sputum up to 30 ml per day,

§ Shortness of breath with little physical exertion.

General: weakness, fatigue, inability to perform normal physical activity, work, independently, or walk without the help of relatives.

HISTORY OF THE PRESENT DISEASE

He considers himself sick for more than 20 years, when for the first time after prolonged smoking he coughed in the morning. I didn’t attach any importance to this. He didn’t see a doctor, didn’t get treatment, and didn’t listen to his wife’s advice to stop smoking. After 6 years, shortness of breath began, which appeared with significant physical activity: fast walking on a flat surface for 300 meters. He continued to smoke. I started catching colds often due to working outside. He believes that due to colds and frequent acute bronchitis, his condition worsened. The cough intensified in the morning and persisted throughout the day, and the amount of sputum increased. Despite this, the patient continued to smoke up to 2 packs a day. The shortness of breath increased over the next 2 years, and last year it began to appear at rest.

The patient consulted a therapist and was examined: an X-ray of the lungs from 2007 showed a significant expansion of the roots of the lungs and an increase in the airiness of the lung tissue. A general analysis of sputum showed: quantity 30 ml, gray, odorless, viscous, up to 5 leukocytes in the field of view, no red blood cells detected, no atypical cells. When examining FVD: vital capacity - 3.4 l at a norm of 5.0 EF ext 1 ˝ - 2.2 l (significantly reduced).

In 2007, the patient was treated in the pulmonology department. Northern City Clinical Hospital twice. He doesn’t know what he was treated for, and he can’t produce documents. According to the patient, he does not receive hormones.

The last exacerbation was on January 1, 2008; after walking about 1 km, the cough and shortness of breath intensified. The respiratory rate was up to 30 per minute and lasted for more than 3 hours. The patient took 2 tablets of theophedrine, 2 inhalations of salbutamol, however, the condition did not improve. An ambulance was called and the patient was taken to the hospital.

LIFE HISTORY

Born in the Kirov region, he grew up and developed according to his age.

He served in the army for 2 years in tank forces.

Living conditions are good, he lives in a comfortable apartment with his wife and son, eats well: weekly meat, fruits, vegetables.

He worked as a heavy vehicle driver for 40 years.

Among the diseases he has suffered, he notes frequent acute respiratory diseases; in 1990, he suffered a fracture of 2 ribs on the right (5 and 6) due to a fall.

Heredity is not burdened.

Allergy history is clear.

Denies blood transfusions.

Bad habits: smoked from the age of 17 at 1-1.5 packs a day, for the last 2 years up to 2 packs a day. Drinks alcoholic drinks moderately.

Psychological status: notes a feeling of anxiety about the future due to increased cough and shortness of breath.

Spiritual status: non-believer. He rests passively, does not play sports, is passionate about reading fiction, and prefers historical novels.

INSPECTION, PALPATION, PERCUSSION, AUSCULTATION

Moderate condition. Consciousness is clear.

Position active. Posture is slouched.

Anthropometric data: weight 70 kg, height 180 cm.

Quetelet index = weight/height 2 (in m) = 21.6.

The face is puffy. The hair is gray.

Acrocyanosis of the earlobes. The skin is cyanotic.

The subcutaneous fat layer is poorly developed.

Lymph nodes are not enlarged. There is no swelling in the legs.

On examination, the chest is emphysematous: the anterior - posterior size approaches the lateral one. The supraclavicular and subclavian fossae bulge, the ribs have a horizontal direction, and the epigastric angle is acute. The Louis angle is pronounced.

Auxiliary muscles are involved in the act of breathing, respiratory rate is 24 per minute. Breathing is deep.

Percussion tone over symmetrical areas of the lungs is box-like.

Breathing is weakened and vesicular. The exhalation is whistling, prolonged, and dry, scattered wheezing is heard over the entire surface of the lungs.

Borders of the heart: right 2 cm outward from the right edge of the sternum. The upper and left borders of the heart are not changed. Heart sounds are muffled, rhythmic, an accent of the 2nd tone is heard above the pulmonary artery (2nd intercostal space on the left). Above the xiphoid process, 1 sound is weakened, and a decreasing systolic murmur is heard. Blood pressure 125/80mm Hg. Pulse 90 per minute.

The liver is not enlarged. The abdomen is soft and painless. There is no swelling.

LABORATORY AND INSTRUMENTAL EXAMINATION METHODS:

General blood test: erythrocytes – 5.5 x 10 12 /l, Hb-170 g/l, leukocytes 9.5 x 10 9 /l, ESR 24 mm per hour. Conclusion: Plethora syndrome, leukocytosis, increased ESR.

General analysis of sputum: viscous, serous, 2-5 leukocytes in the field of view, no red blood cells.

X-ray of the chest: the roots of the lungs are expanded, the pulmonary fields of increased transparency.

FEV: FEV 1 / FVC) x 100% = 57% Tiffno test is significantly reduced, which corresponds to a severe degree of DN.

ECG: Deviation of the heart axis to the right. The amplitude of the P wave = 3 mm, the P wave is pointed. In lead I there is a deep S wave. In leads V 1 -V 2 there is a high R wave. Conclusion: P-pulmonale.

Ultrasound examination of the heart: the pressure in the pulmonary artery is 30 mm - increased, which indicates the formation of chronic pulmonary heart.

Functional drug tests: the test is assessed as negative, because FEV 1 did not change after the use of m-anticholinergic.

Bronchoscopic examination

Study of blood gas composition: P a O 2 = 56 mm Hg. Art. or SaO 2= 89%

II. STAGE 2 OF THE NURSING PROCESS

Assessing the effectiveness of nursing care

This stage is based on the study of the dynamic reactions of patients to the nurse's interventions. The sources and criteria for assessing nursing care are the following factors: assessment of the patient's response to nursing interventions; the following factors serve to assess the degree to which the goals of nursing care have been achieved: assessment of the patient’s response to nursing interventions; assessing the degree to which nursing care goals have been achieved; assessing the effectiveness of nursing care on the patient’s condition; active search and assessment of new patient problems.

An important role in the reliability of assessing the results of nursing care is played by the comparison and analysis of the results obtained.

Organization of nursing process in patients with surgical diseases (practical part)

Patients are often admitted to the surgical department on a gurney in serious condition. Nursing staff, providing care to seriously ill patients, are exposed to physical stress.

Moving a patient in bed, placing a bedpan, moving stretchers, gurneys, and sometimes heavy equipment can ultimately lead to damage to the spine.

The nurse is exposed to the greatest physical stress when moving the patient from the stretcher to the bed. In this regard, you should never perform this manipulation alone. Before moving a patient anywhere, ask a few questions to make sure they can help you.

The patient must know the entire course of the upcoming manipulation.

One of the most important tasks of patient care is the creation and provision of a therapeutic and protective regime in the department. This regimen is based on eliminating or limiting the impact of various adverse environmental factors on the patient’s body. Creating and ensuring such a regime is the responsibility of all medical personnel of the department.

In all surgical work, compliance with the golden rule of asepsis is required, which is formulated as follows: everything that comes into contact with the wound must be free of bacteria, i.e. sterile.

The problem of nosocomial infection in a hospital.

Nursing staff should be aware of the problem of nosocomial infections, their impact on the course of the disease and mortality.

The most susceptible to nosocomial infections are patients in surgical departments. The greatest risk of developing a nosocomial infection is observed in a patient suffering from a severe chronic disease, staying in hospital for a long time and having direct contact with various employees of the medical institution.

Post-injection complications such as infiltration and abscess are not uncommon. Moreover, the causes of abscesses are:

• 1 syringes and needles contaminated (infected) by nursing staff.
• 2 contaminated (infected) medicinal solutions (infection occurs when a needle is inserted through a contaminated bottle stopper).
• 3 violation of the rules for cleaning the hands of staff and the patient’s skin in the area of ​​the injection site.
• 4 insufficient needle length for intramuscular injection.

Due to the fact that the hands of personnel are very often a carrier of infection, it is very important to be able to wash your hands and treat this with due responsibility.

Patients with surgical diseases are concerned about pain, stress, dyspeptic disorders, bowel dysfunction, reduced self-care abilities and lack of communication. The constant presence of a nurse next to the patient leads to the fact that the nurse becomes the main link between the patient and the outside world. The nurse sees what patients and their families are going through and brings compassionate understanding to the patient's care.

The main task of a nurse is to relieve the patient’s pain and suffering, to help in recovery, and in restoring normal functioning.

The ability to perform basic elements of self-care in a patient with surgical pathology is severely limited. The nurse's timely attention to the patient's implementation of the necessary elements of treatment and self-care becomes the first step towards rehabilitation.

In the process of care, it is important to remember not only about a person’s basic needs for drinking, eating, sleeping, etc., but also about the needs of a particular patient - his habits, interests, the rhythm of his life before the onset of the disease. The nursing process allows you to competently, skillfully and professionally solve both real and potential problems of the patient related to his health.

The components of the nursing process are nursing assessment, making a nursing diagnosis (identifying needs and identifying problems), planning care to address identified needs and problems), implementing a nursing intervention plan, and evaluating the results obtained.

The purpose of the patient examination is to collect, evaluate and summarize the information obtained. The main role in the survey belongs to questioning. The source of information is primarily the patient himself, who sets forth his own assumptions about the state of his health. Sources of information can also be members of the patient’s family, colleagues, and friends.

As soon as the nurse has begun to analyze the data obtained during the examination, the next stage of the nursing process begins - making a nursing diagnosis (identifying the patient's problems).

Unlike medical diagnosis, nursing diagnosis is aimed at identifying the body’s reactions to the disease (pain, hyperthermia, weakness, anxiety, etc.). Nursing diagnosis may change daily and even throughout the day as the body's response to illness changes. Nursing diagnosis involves nursing treatment within the nurse's competence.

For example, a 36-year-old patient with gastric ulcer is under observation. At this time, he is worried about pain, stress, nausea, weakness, poor appetite and sleep, and lack of communication. Potential problems are those that do not yet exist, but may appear over time. In our patient, who is on strict bed rest, potential problems include irritability, weight loss, decreased muscle tone, and irregular bowel movements (constipation).

To successfully resolve the patient's problems, the nurse needs to divide them into existing and potential.

Of the existing problems, the first thing the nurse should pay attention to is pain and stress - the primary problems. Nausea, loss of appetite, poor sleep, lack of communication are secondary problems.

Of the potential problems, the primary ones, i.e. those that you need to pay attention to first are the likelihood of weight loss and irregular bowel movements. Secondary problems are irritability, decreased muscle tone.

For each problem, the nurse notes an action plan.

• 1. Solving existing problems: administer an anesthetic, give antacids, relieve stress with the help of conversation, sedatives, teach the patient how to care for himself as much as possible, i.e. help him adapt to the condition, talk with the patient more often.
• 2. Solving potential problems: establish a gentle diet, carry out regular bowel movements, engage in physical therapy with the patient, massage the muscles of the back and limbs, train family members to care for the sick.

The patient's need for assistance may be temporary or permanent. There may be a need for rehabilitation. Temporary assistance is designed for a short time when there is a limitation in self-care during exacerbations of diseases, after surgical interventions, etc. The patient needs constant assistance throughout his life - after reconstructive surgical interventions on the esophagus, stomach and intestines, etc.

An important role in caring for patients with surgical diseases is played by the conversation and advice that a nurse can give in a particular situation. Emotional, intellectual and psychological support helps the patient prepare for present or future changes that arise due to stress, which is always present during an exacerbation of the disease. So, nursing care is needed to help the patient solve emerging health problems, prevent deterioration of the condition and the emergence of new health problems.

At the fifth stage of the nursing process, the achievement of the set goal is assessed,

result of preliminary activities (determination of criteria and frequency of assessment

results), as well as nursing activities. Assessment of the effectiveness of nursing care consists of:

From determining the patient's condition at the current moment;

Assessments of goal achievement;

Determining aspects that influence the achievement of goals;

changes as necessary to the nursing diagnosis, goal and/or plan

nursing care.

Nursing care at this level must be assessed by both parties: both the medical

nurse and patient.

Stage I of the nursing process is collecting information.

(SUBJECTIVE AND OBJECTIVE EXAMINATION)

Nursing process is a method of organizing and providing nursing care. The essence

nursing is about caring for a sick person and how a nurse

provides this care. Regardless of the form, the nursing care plan must

provide for continuity of the nursing process. In addition to the nursing plan

The documentation contains the patient's biographical information and the results of the nursing assessment of his condition.

When taking notes, you should present information concisely, clearly and unambiguously, using

only common abbreviations.

At the first contact with the patient, the nurse begins to collect information. IN

as soon as possible after a person enters the health care system

An initial assessment of the situation and its documentation is carried out. Ideally this initial

the assessment includes a detailed medical history. Where possible, the patient is asked

express your own judgment and talk about existing needs. Then

the information received is analyzed and used as the basis for determining needs

person in care. Gathering information is very important. Wrong information leads to wrong actions. Insufficient information is accompanied by inadequate

actions.

Patient communication strategy

Subjective examination:

 You must be sure that your conversation will take place in a quiet, informal environment without distraction and without interruption.

 To establish a trusting relationship with the patient, the nurse must introduce herself, stating her name, position and state the purpose of the conversation.

 Call the patient by name and patronymic, and by “you”. Be friendly, helpful and caring.

 Use exclusively positive intonation of your voice. Be calm and unhurried. Do not show annoyance or irritation.

 Speak clearly, slowly, distinctly. Use terminology that the patient understands. If you doubt that he understands you, ask what he means by this or that concept. Encourage your patient to ask questions.

 Allow the patient to finish the sentence, even if he is excessively verbose. If a question needs to be repeated, rephrase it for better understanding.

 Do not start the conversation with personal, sensitive questions.

To formulate a report on the patient's problems and complete a nursing history

illness with a nursing process map according to which you will work. Ask: "What

brought you to our medical institution?” Listen carefully to his opinion about your

condition, as he assesses it. Does he consider himself seriously ill, slightly ill, how focused is he on his problems, what results does he expect from his stay in this medical institution (he hopes to get well, does not expect his condition to improve and his problems to be solved, he thinks that his condition will remain unchanged).

Then ask, “What is bothering you?”

The patient's complaints are determined at the moment, he is given the opportunity

Express your feelings yourself. The student then asks questions to

systematize and detail complaints. If the patient is in pain, you should

find out:

 Localization;

 Irradiation;

 Time of appearance;

 Character (aching, stabbing, pressing);

 Duration (constant, paroxysmal);59

 Causes that cause or increase pain (movement, eating);

 Associated phenomena (weakness, nausea).

Particular attention should be paid to the “Medical History” section. Need to check with

how long does he consider himself sick (the first signs of the disease). You should pay attention to the patient’s condition immediately before the illness, whether there were any mental injuries, overwork, hypothermia, or eating errors.

Onset of the disease: when and how the first manifestations appeared, their nature.

In the chronic course of the disease, it is necessary to find out how it progressed during this time, how it manifested itself, whether there were exacerbations, their frequency, and the duration of remissions.

Conducted research (list which).

Treatment and its effectiveness (groups of drugs, effect of use).

Answers to the questions in the Medical History section should be written down in the nursing

medical history is short, clear, to the point.

Questions about sexual life and gynecological history should be asked tactfully, without attracting the attention of the patient’s environment.

When determining an allergy history, it should be noted which specific medications, foods, and household substances the patient cannot tolerate.

When identifying spiritual status, you should not express your opinion about

moral values ​​of the patient.

In the social status of the patient, attention is paid to the health of his close relatives

(parents, brothers, sisters), focusing on the pathology that is important for

disease of this patient.

Objective examination.

Measure blood pressure, body temperature, examine pulse, respiratory rate, and determine the condition of the skin. For an objective examination, the sister uses her vision, hearing, touch, and smell.

An additional source of information can be laboratory and

instrumental research.

When examining a patient, you need to find out:

 the state of his health, taking into account each of the 14 fundamental needs,

 what this person considers normal for himself in connection with each indicated

need;

 what this person does or what help he needs to satisfy each

needs;

 how and to what extent, the person’s current state of health or his social

needs prevent him from providing self-care or assistance at home;

 what potential difficulties or problems can be foreseen in connection with the change

his health;

 a person’s ability to self-care, what help his friends can provide to a person and

relatives;

 medical diagnosis, principles of treatment and prognosis;

 previous illnesses and social problems.

The results obtained during the nursing examination are recorded in

nursing medical history.

Physical status information may reflect normal manifestations

life activity, as well as changes associated with a certain stage of development

(e.g. infant, adult, elderly person) and changes caused by

disease.

Information about the state of mind allows you to assess emotional health and

changes in behavior due to illness.

Information about social health allows you to assess the patient’s capabilities

carry out self-care at home.

Stage II of the nursing process - nursing diagnosis.

After the initial assessment of the patient's condition and recording the information received, the nurse

summarizes, analyzes the results obtained and draws certain conclusions. They are 60

become those problems, i.e. nursing diagnoses that are the subject

nursing care.

You should highlight the nursing diagnoses:

1. Real ones, those that occur in the patient today, will be present tomorrow and in the future

throughout the entire period of nursing care in the hospital.

2. Potential - problems that may arise for the patient in the process of caring for

it or be caused by an underlying disease.

Nursing diagnoses are recorded in the nursing record after section

"Nursing analysis of laboratory and instrumental data." Then you begin to work on the nursing process map. Fill in the fields highlighted in it. Special

Pay attention to planning patient care and its implementation.

Stage III of the nursing process - planning nursing interventions

patient-centered goals and establishing strategies to achieve goals. In

planning time, priorities are set, goals are determined, expected

results and a nursing care plan is formed. In addition to communicating with the patient and his

As a family, the sister consults with colleagues and studies relevant literature. After

establishing specific medical diagnoses, the nurse determines priorities in

according to the severity of the diagnosis. Prioritization is a method in which the patient and nurse work together to make diagnoses based on the patient's wants, needs, and safety. Because the patient has multiple diagnoses, the nurse cannot begin caring for all of them simultaneously once they are identified.

The nurse selects priority diagnoses depending on the urgency, nature

prescribed treatment, interactions between diagnoses. Priorities are classified as primary, intermediate and secondary. Nursing diagnoses that could result in the patient's death if not treated immediately are given priority.

Intermediate priority nursing diagnoses include non-extreme and

non-life-threatening needs of the patient. Secondary priority nursing diagnoses:

patient needs that are not directly related to the disease or its prognosis.

There are two types of goals allocated for patients: short-term (less than one

weeks); long-term (weeks, months, often after discharge).

Short-term goals are those that must be achieved in a short period

time, usually less than a week.

Long-term goals are those that can be achieved over a longer period of time.

a period of time over weeks and months.

These goals can be determined when the patient is discharged and when he returns home.

They are aimed at prevention, rehabilitation, and acquisition of knowledge about health. If long-term goals are not highlighted, it deprives the patient and nurse of

Plan for continued nursing care upon discharge. The expected result is a special step-by-step concept that leads to achieving goals and determining the cause of the disease for diagnosis. The result is a change in the patient's behavior in response to nursing care. The result refers to changes in the patient’s condition in terms of physiology, social, emotional and spiritual state. Expected outcomes are derived from short-term and long-term patient-centered goals and are based on nursing diagnoses.

IY stage of the nursing process - implementation of the care plan. After formulating goals

the nurse draws up a patient care plan, i.e. a written care guide,

which is a detailed list of special actions of the nurse,

necessary to achieve nursing goals. The care plan coordinates nursing care,

ensures continuation of care and lists outcome measures by which

care is assessed.

Y stage of the nursing process - assessing the effectiveness of care. Systematic

the assessment process requires the nurse to think analytically when comparing what is expected

results with those achieved. When the pursuit of a goal fails, the nurse must identify the reason, for which the entire nursing process is repeated from the beginning in search of the mistake made.

For example:

Target: The patient will be administering insulin to himself by 05/07/99

Grade: 7.05.99 The patient prepared the dose correctly and injected himself with insulin

The function coincided with all the criteria for the target setting, the goal was achieved.

Nurse's signature.

The patient care plan should reflect the principles of care, i.e. the main activities for

patient care aimed at solving the patient’s problem. Record them in the “Nature of nursing intervention” column.

In the column “Implementation of the nursing care plan” you write what exactly you did,

implementing a patient care plan, listing all your actions.

You must evaluate your results in accordance with your goals.

Short term goals- daily or hourly (in emergency situations), long-term

Within the time limits specified in the corresponding column.

Since you will supervise the patient for 3-5 days during the training practice, in the column

“Assessment” You should have 3-5 entries indicating whether the patient's care is making progress or not. If the goals of care are achieved, you record in this column, put the date and your signature. If, despite all your care, the goals are not achieved, then it is necessary to find out the reasons for the failure and repeat the nursing process from stage 1.

After working on the nursing process map, you begin to work with the “Dynamic Patient Assessment Sheet”, making the appropriate marks in its columns. Weight, daily diuresis, pulse, blood pressure, number of respiratory movements are marked with numbers. The remaining columns are “+” and “-”

Then you start working with the medication sheet. You write into it from

list of medical prescriptions, all medications received by the patient, indicate their pharmacological action, indications, side effects, dose, for which you use reference and additional literature.

Assessment of the success of nursing care is carried out in accordance with the goals set. This may be an assessment of the patient’s degree of independence, the ability of relatives to communicate effectively with him. Achieving the goal of effective communication means that the nursing staff and family members of the patient understand both verbal and nonverbal information, respond correctly to the patient's various requests and can anticipate them.

8.10. NEED FOR WORK AND REST

It is well known that a person spends one third of his life in sleep, most of it in work and the rest of the time in rest. Work and rest are complementary concepts that are equally important aspects of life. The term “work” in the generally accepted sense means the main activity of a person during the day for the sake of earning money to ensure a certain standard of living. Since work is a vital necessity, it is often talked about with a negative connotation, although it often determines the meaning and sometimes the purpose of life, allows you to communicate with people, and increases family and social status.

Working from home (not to be confused with housework) has both its advantages (savings on transportation costs, clothes and shoes wear out less, no strict schedule) and disadvantages (lack of communication).

Even when people work for money, money is not the only argument for which a person works. Thus, most of the nursing staff, receiving a small salary, work out of the need to help people; journalists need to realize themselves through publications in the media, i.e. When choosing a particular profession, people see it not only as a source of income. It is important to remember that a woman who raises children and does not receive a salary for it also works.

Any work (paid or free) is a meaningful, useful pastime. Rest is what a person does during non-working hours: games, sports, music, travel, walks, etc. The purpose of relaxation is to have fun. Often the concepts of “work” and “leisure” are intertwined. For most people, sport is recreation, but for athletes it is work. There are many examples when work for some is relaxation for others and vice versa.

As a rule, a person achieves success in a profession in adulthood (40-50 years), while for athletes this peak occurs at 20-30 years, for politicians and managers it occurs more often after 50 years. During these same periods, a person has maximum opportunities for relaxation. In old age, it is better to do your usual work and provide yourself with the usual type of rest.

The goals that an adult sets for himself when choosing this or that type of recreation are different: some consider being in the fresh air to be a vacation, others consider maintaining physical fitness, others consider thrills (mountain climbing, slalom, etc.), others consider communication, fifth - aesthetic development and education (literature, museums, theater, music, etc.). The main purpose of relaxation is to have fun and prevent boredom.

Theoretically, a person retiring has more time to relax. However, given the small size of pension benefits, people very often work while they have the strength and opportunity. When people stop working, many have certain problems:

Loss (change) of social status and role in society, family;

Loss of communication;

Loss of earnings;

Loss of meaning in life.

Thus, the dynamics of work and leisure change at different stages of life: starting school - finishing school - starting work - changing jobs - promotion - retirement.

It should be remembered that work in adulthood and rest in childhood are important components in life and disruption of their balance is harmful to health. Work brings a person money, which often gives him independence. Often the independence of mature people is of a financial nature, which allows them to choose one or another type of recreation, although this choice does not always promote health.

Naturally, frailty and deteriorating health in old age increase dependence on other people or devices (cane, glasses, hearing aids, etc.) both during work and during leisure, although some people of retirement age consider themselves more independent, than before.

People with physical disabilities (congenital diseases or injuries), learning disabilities, mental illness or sensory impairments are dependent on their choice of work and leisure activities throughout their lives. The choice of one type of activity or another is influenced by many factors, primarily physical characteristics and health. For example, the profession of a nurse requires the applicant to be in good physical shape and health, although in some departments of health care facilities nursing work is quite monotonous and sedentary.

Diseases that lead to deterioration of physical health (obesity, diseases of the respiratory system, blood vessels and heart, musculoskeletal system, diabetes) often do not allow a person to engage in certain types of activities and recreation.

The choice of type of work and rest is also influenced by psychological factors. Playful forms of learning in childhood and the productive work of adults contribute to the intellectual, emotional and general development of the individual, which is an important factor in allowing a person to choose a profession. Temperament and character (patience, irritability, sociability, desire for loneliness, self-discipline) influence the choice of work and leisure. Thus, indiscipline leads to the creation of dangerous situations in the workplace that pose a threat to health. A nurse who does not observe safety precautions when working with electrical equipment, correct body biomechanics when moving a patient or lifting heavy objects, universal precautions when working with biological fluids of the body or infected care items, endangers not only herself, but also patients, colleagues and others people, including your family members.

Many people primarily focus on physical safety in the slogan “Keep your workplace safe,” but you should also think about reducing the real and potential risk of emotional stress. In nursing, as in many health care professions, emotional stress is an occupational hazard because most people working in the health care system frequently see pain, death, and empathize with those who are suffering. They are close to patients who are depressed, doomed, and are often present when the patient dies. Diseases such as diabetes, coronary heart disease, peptic ulcers, headaches and depression often occur due to stress.

Lack of work has equally important psychological consequences, both for the person himself and for his family. People who have lost their jobs are more likely to suffer from insomnia, depression, and experience anger and worthlessness. The unemployed are more likely to commit suicide, and they are more likely to suffer from somatic and mental illnesses. The fear of being fired creates serious psychological problems for a person (especially a man). For some, leaving a job is tantamount to an early death.

Nursing staff, when conducting an initial (current) assessment of the patient's condition, must take into account the impact of work on health. It is necessary to clarify the conditions in which the person works:

Is safety provided at the workplace (safety glasses, gloves, clothing), do others smoke;

Is the noise level controlled (increased noise levels lead to stress, irritability, fatigue, decreased attention, injuries, increased blood pressure, stroke. If the noise level is 90 dB or more, a person should be provided with headphones);

Is a comfortable temperature provided, etc.

The literature describes the so-called sick building syndrome, a long stay in which due to exposure to noise, heat, cold, high air humidity, and electromagnetic radiation causes headaches, fatigue, decreased attention, tearing, runny nose, and sore throat.

The influence of unfavorable environmental conditions on women and men of reproductive age leads to serious consequences. Women experience infertility, spontaneous abortions, stillbirths, the birth of children with birth defects, and cancer. Men may develop infertility, impotence, and their children may develop cancer.

Initial assessment

The nurse can obtain data on the satisfaction of the need for work and rest when conducting a nursing assessment, using her erudition and knowledge. You should find out:

What type of activity does the patient engage in, what type of recreation does he prefer;

Length of working day and rest;

Where does a person work and by whom?

What factors influence a person at work and leisure;

What does a person know about the impact of his work and leisure conditions on health;

How does a person feel about his work and rest?

Are there problems at work and during leisure and how does he cope with them?

What problems with work and leisure exist at the moment and what problems may arise.

Answers to these questions can be obtained simultaneously during an initial assessment of meeting the patient's needs for movement and maintaining a safe environment, since all these needs are closely interconnected.

Patient problems

Solving problems arising from unmet labor needs may be beyond the competence of nursing staff. In this case, the nurse involves competent specialists in solving this problem or gives advice on where to turn for help.

It should be remembered that a new job, dismissal, retirement play an important role in a person’s life. People with such problems will be happy to receive psychological and emotional support from anyone, especially from a nurse.

All problems arising within this need should be grouped as follows:

Changes in the state of independence;

Changes in work and leisure activities associated with drug and alcohol use, unemployment;

Changes in the environment and usual activities due to stay in a medical institution.

Independence in activities related to work and leisure is highly desirable for any adult. Those who cannot maintain it feel disadvantaged because they become dependent on the family or the state.

The reasons that force addiction are associated with physical or mental illness, dysfunction of the sensory organs. Physical illnesses, depending on the nature and degree of damage to organs and systems, lead to the fact that performing usual work is often unrealistic, and only passive rest is possible. This is especially true for patients with diseases and injuries leading to disability due to impaired mobility.

The degree of dependence of patients is different; they require different adaptations to new working conditions and types of recreation. For example, people who worked outdoors before becoming ill, and athletes experience significant difficulties in adapting to conditions of sedentary work and passive rest. At the same time, people who previously engaged in sedentary work adapt more easily to new conditions of work and rest. Sports competitions for the disabled, including even the Paralympic Games, allow people accustomed to an active lifestyle to realize their need for one form or another of recreation.

Loss (decrease) in the function of the senses often leads to difficulties in communication, which also affects the choice of work and type of leisure. Decreased vision (blindness) creates problems associated with the need to change jobs. Special courses provide an opportunity to master the skills of reading literature published using a special Braille font. Radio, telephone, tape recorder, computer (touch typing) and mastering new professions allow these people to maintain some degree of independence both at work and at leisure.

With hearing loss, even at the very beginning, a person learns to read lips in order to maintain the same work and leisure habits for a while. If the work of a person who has lost his hearing is not associated with intensive communication and does not jeopardize his safety, the use of a hearing aid makes it possible to maintain a certain independence in work and leisure (theater, cinema, TV, travel, etc.). The speech disorders described above can also create problems in the area of ​​independent choice of work and leisure, especially in cases where oral speech is a necessary condition of work.

Loss of independence at work and at leisure due to chronic diseases that lead to disability often changes the patient's habits. Drug use, for example, for the purpose of pain relief, often forces a person to leave work and a previously favorite form of recreation.

“Experiments” with drugs often begin during free time from study and work. Teenagers want to experience a feeling of excitement, emotional uplift, and more vivid sensations than usual. Sometimes, after the first use of a drug, addiction appears, creating physical, psychological, social and legal problems.

Unemployment, like drugs, changes a person’s usual way of life. Loss (absence) of work entails various problems: excess free time, idleness, inability to have a full (active) rest due to financial difficulties. If this period is prolonged, a person may lose motivation to find a job that brings pleasure. Apathy and depression force a person to sleep a lot in order to escape from reality. All this leads to deterioration of health, and more mental than physical. Such a person is restless and preoccupied, quickly loses self-confidence and self-esteem, and suffers from sleep disorders. All this predisposes to mental disorders.

Families of the unemployed are also at risk: they are more likely to experience divorce, child abuse, abortion, malnutrition of newborns, and high infant mortality.

Once these problems are identified, the nurse is unlikely to be able to resolve them on their own. However, understanding the problem and its connection with the health disorder should generate sympathy for both the patient and his family members.

Changes in the environment and daily activities also create problems with work and rest. Of course, a medical institution for a patient is not a place where they work and relax. Problems are often associated with the fact that patients are usually bored by monotony, and are often forced (sometimes there is no reason for this) to be indoors all the time. Thus, if a nurse plans to help a person cope with the discomfort caused by a change in the environment, she should, taking into account the nature of the work and the person’s usual type of rest, plan activities that replace the usual ones: reading books, magazines, television and radio programs, physical exercise, walks around the territory of the medical institution, etc.

Changes in daily routine often cause anxiety in a person. The lifestyle of an adult is usually determined by his work, or rather, the ratio of time spent on work and rest. In many departments of a hospital there are good reasons for a rigid daily routine; for most patients this gives a feeling of calm. It should be remembered that every person experiences anxiety in the face of the unknown, so the nurse must inform the newly admitted patient about the degree of rigidity of the daily routine.

Patients experience serious problems due to their inability to make independent decisions regarding their own treatment. Sometimes the staff of a medical institution deprives a person of this opportunity, forgetting that in this case the person loses his self-esteem. For example, if adult patients are required to stay in bed during the daytime rest, especially male managers and women who are accustomed to being the head of the family resist having young nurses make decisions for them and experience discomfort in such situations. Thus, the staff often causes unnecessary distress to a person, sometimes harmful to his health. This disrupts the patient's normal role in daily life and does a disservice to subsequent reinstatement in professional activities. If possible (the patient’s health does not deteriorate, the interests of other patients are not violated), the person can be allowed to continue his work activity. Some patients may need to be told why they should not work while in a health care facility. There will definitely be patients who will be happy with temporary idleness.

Visiting patients with loved ones, acquaintances and friends most often helps to alleviate the feeling of loneliness and abandonment. F. Nightingale wrote in “Notes on Care” that each other’s company is ideal for small children and the sick. Of course, it is necessary to manage such communication so that none of the participants are harmed, which is quite possible. If there is concern that the air in the room where the patient is is harmful to a small child, then it is also harmful to the patient. Of course, this needs to be corrected in the interests of both. But the very sight of a baby cheers up a sick person if they don’t spend too long together.

Visiting the sick, both children and adults, is very important. Staying outside the family (in a medical institution) traumatizes the patient. However, family members are not always the ones the patient really wants to see. In some cases, the patient needs to be protected from a large number of (or unwanted) visitors. Visiting days and hours in a health care facility can be stressful for both visitors and patients and, conversely, can serve as a means to minimize the discomfort caused by the absence of a person from the family.

There are patients who cannot be visited for one reason or another. In these cases, you need to arrange communication by phone (if possible) or by mail.

For a lonely or elderly patient who is not being visited, a nurse can help by simply taking the time to talk to him or her when the person expresses a desire to communicate.