Communication with patients of different age groups, patients in the hospital. Psychological aspects of conducting a conversation (questioning) with a patient What conversations can be conducted with patients
Getting to know the patient
The first impression makes a strong effect, remains for a long time and creates an opinion about you, so a warm greeting and a sweet smile would be a good start. Even if there is a lot of other things to do in the department or clinic, the patient should clearly feel a kind and sincere disposition.
1) look the patient in the face, smile, greet the patient warmly;
2) introduce yourself, give your name and position;
3) ask the patient's name;
4) explain the situation in the department and the role you will perform in the treatment process;
5) familiarize yourself with the department and the medical and protective regime;
6) escort the patient to the room, point the patient to his bed;
7) check if everything is in order on his bed, in the ward;
8) introduce the patient to his roommates.
Communication with a patient with visual impairment
Algorithm for communicating with a patient with visual impairment (accompaniment to an ultrasound examination)
1) explain in detail the purpose and progress of the study;
2) explain to the patient the preparation for the study;
3) make sure she understands you;
4) escort the patient to the ultrasound room;
5) provide the necessary assistance;
6) escort to the room.
Communication with a patient with hearing loss
Always approach from the front so the patient can see you. Use simple words in your conversation, speak loudly and clearly, but do not shout, so that the patient can watch your lips and facial expression. Pay careful attention to non-verbal expressions. Use touch as a means of encouraging the patient to communicate. Use picture cards, diagrams, or written messages. Write neatly and without mistakes.
1) reduce background noise (close the door, window, turn off the radio, TV, etc.);
2) before talking, approach so that the patient can see you;
3) invite him to use the device;
4) explain to the patient the necessary information in an accessible form;
5) make sure that the patient understands you;
6) write the information on a piece of paper.
| Question type | Advantage | Flaw |
| general How are you? How's your health? | Useful because they promote self-expression. A person can describe in his own words what is important to him | Difficulty controlling deviations from a question, achieving a specific goal, or limiting talkative interlocutors |
| specific What is your last name? What is your address? | Allows you to quickly collect specific information - accurate and unambiguous | Limited by the formulation of the question, focused only on the question |
| suggestive You will quit smoking, won't you? Will you be paying more attention to outdoor activities after discharge? | Pushes the respondent to an answer that corresponds to our opinion | Limits the self-expression of the respondent, can cause an angry reaction if perceived as threatening |
| trial Are you saying that your daughter will look after you? Have heart pains become more frequent in recent days? | Research a topic that the questioner considers important; answers may provide specific information. May take the responder by surprise | May be intimidating to the respondent and may cause an angry reaction |
| multiple Are you saying that your daughter will look after you? Does she have sufficient skills? How will she keep up with such intense work? | Can demonstrate interest and enthusiasm | Leads to confusion because the responder does not know which question to answer first. The answer cannot be rational |
Communication with the patient.
| Parameter name | Meaning |
| Article topic: | Communication with the patient. |
| Rubric (thematic category) | Psychology |
Topic No. 3.
- Specifics of communication between health worker and patient.
Any work with people is inextricably linked with the process and problems of communication; it permeates the professional activities of health workers at any level. The individual characteristics of the patient’s psyche in the conditions of therapeutic relationships and interactions come into contact with the psychological properties of the medical worker. The purpose of such contact is to provide assistance to the patient. Both the patient and the health worker have their own motives for interaction, and the medical staff has a role in ensuring conflict-free interaction.
Mid-level medical staff are in direct contact with the patient for a long time, and therefore can have both a positive and negative impact on the patient. The task of the medical staff is to avoid unnecessary negative psychological influences as much as possible and to contribute to the creation of a psychological climate that has a beneficial effect on the healing process.
The prerequisites for interaction between the patient and the health worker are formed based on a number of factors that determine the patient’s expectations:
1. preliminary information about the health worker
2. reputation of the medical institution
3. “roads” to honey. establishment
For effective and conflict-free interaction with patients, the presence of such a psychological parameter as communicative competence is extremely important.
Communicative competence – the ability to establish and maintain the necessary contacts with people, which implies achieving mutual understanding between communication partners, awareness of the situation and the subject of communication. It is also considered as a system of internal resources aimed at building effective communication in situations of interpersonal interaction. Incompetence in communication can disrupt the diagnostic and treatment process.
Characteristics of a healthcare worker that predispose them to successful communication with a patient:
Empathy
Acceptance (unconditional acceptance of the patient)
Authenticity or self-congruity (naturalness of behavior, consistency of feelings and their expression, sincerity).
The state of empathy is, along with an objective feeling of psychological contact between the health worker and the patient, one of the indicators that understanding communication has taken place.
Empathy (from the English empathy - feeling) is the ability to feel the emotional state of another person, accurately perceive the semantic shades of his inner world, the ability to look at circumstances through the eyes of the interlocutor. Empathy does not necessarily imply active intervention in order to provide effective help to another. It only implies entering the personal world of another, delicately staying in it without evaluating it. Empathy should be distinguished from emotional identification (likening, identifying oneself with another, with his emotional state) and from sympathy (concerns about the feelings of another). If a state of identification with the patient’s emotional state occurs, the health worker loses the ability to work professionally and needs psychological help.
The process of communicating with a patient begins with choosing the interaction distance; it should be such that the patient feels comfortable and safe. When changing the distance, especially when shortening it, it is advisable to explain your actions in order to avoid an increase in psychological tension and aggression. The patient, being in a situation of stress caused by the disease, needs a fixed territory that belongs only to him. Positive interaction depends not only on the territory, but also on the social status of patients and their age homogeneity.
Models of interaction between health care worker and patient.
Partnership- cooperation in matters of treatment, division of responsibility for the results of examination and treatment between the health worker and the patient.
Contract– cooperation based on mutual obligations, identified tasks, expected results. Used in paid healthcare settings.
In communication between a nurse and a patient, in the process of establishing a relationship with him, I. Hardy identifies three stages characteristic of inpatient treatment:
1. orientation - the patient and the nurse get to know each other.
2. expanded stage – cooperation with each other can take place.
3. the final stage - the stage of discharge, is associated with the loss of a sense of security in the patient.
General rules of communication with the patient.
1. Showing genuine interest in the patient.
2. understanding the patient’s merits and maximum approval - praise, emphasizing importance.
3. Understanding the meaning of his actions instead of sweeping criticism.
4. Friendliness, friendliness.
5. Addressing patients by name and patronymic, introducing yourself first, using a badger.
6. The ability to conduct a conversation in the circle of interests of the interlocutor.
7. The ability to listen carefully and give the patient the opportunity to “speak out”.
8. The ability to respect the opinion of the interlocutor, without persistently imposing one’s opinion.
9. The ability to point out to the patient his mistakes without causing offense.
10. The ability to correctly formulate questions and help the patient verbalize his condition.
11. Communicate with the patient as a healthcare professional would want to be treated if he was ill.
12. Use optimal non-verbal methods of communication - calm timbre of voice, smooth gestures, correct distance, signs of approval (patting, affectionate touching), etc.
- Communication with patients of different age groups, patients in the hospital.
The main conditions for the effectiveness of professional communication of a health worker are: demonstration of goodwill, tact, attention, interest, and professional competence.
It is necessary to know the peculiarities of the psychological reflection of their condition by patients of different ages and implement deontological communication tactics towards them accordingly.
For children preschool age typical :
Lack of awareness of the disease in general;
Inability to formulate complaints;
Strong emotional reactions to individual symptoms of the disease;
Perception of treatment and diagnostic procedures as frightening events;
Strengthening character defects, raising a child during illness;
Feelings of fear, melancholy, loneliness within the walls of a medical institution, away from parents.
Deontological tactics - emotional warm attitude, distraction from illness, organization of quiet games, reading, carrying out procedures with persuasion, professional treatment of relatives of a sick child.
For teenagers characteristic:
The predominance of the psychological dominant of age is the “claim to adulthood”;
Bravado as a form of self-defense with internal psychological vulnerability;
Disregard for the disease and risk factors.
Deontological tactics - communication taking into account age-related psychological characteristics, reliance on independence, and adulthood of a teenager.
When working with patients working age.
It is necessary, first of all, to know the patient’s personality and her individuality. Find out the attitude towards the disease, the medical staff, the position on the interaction of the patient with the medical staff.
Deontological tactics- orientation towards labor and social rehabilitation, selection of communication tactics based on VKB, correction of inadequate attitudes, psychotherapy for anxious and suspicious patients.
For patients elderly and senile age characteristic:
The psychological dominant of age is “departing life”, “approaching death”;
Feelings of melancholy, loneliness, increasing helplessness;
Age-related changes: decreased hearing, vision, memory, narrowing of interests, increased sensitivity, vulnerability, decreased ability to self-care;
Interpretation of the disease only through age, lack of motivation for treatment and recovery.
Deontological tactics - maintaining the patient’s sense of self-worth; an emphatically respectful, tactical, delicate attitude, without familiarity, commanding tone, or moralizing; orientation to physical activity; motivation for recovery.
Features of communication with a patient in a hospital
Illness or hospitalization unsettle a person in life, and he may feel offended by fate and unhappy. He is worried about illness, possible complications, prognosis, being forced to leave work, parting with home, unfamiliar or unfamiliar surroundings, on which he also becomes dependent. In severe cases, in cases of paralysis, severe pain, and strict bed rest, the dependence must be absolute.
The routine of a patient’s life in a hospital is determined by medical workers; the patient’s life in a hospital itself is based on their knowledge, skills, responsibility, and kindness. At the same time, the relationship that he develops with paramedical workers, primarily with nurses, who communicate with patients constantly, is especially significant for the patient.
Relationships with patients should be built on the basis of age, profession, general cultural level, character, mood, severity and characteristics of the disease. All measures for treating patients and caring for them should be carried out calmly, accurately, carefully, trying not to irritate them, without causing them pain, and in no way humiliating their human dignity. It is necessary to take into account the feeling of awkwardness and frustration usually characteristic of patients due to their helplessness and dependence.
The average health care worker must know what diagnosis has been made to the patient, why the doctor has prescribed certain medications, procedures, and laboratory tests. At the same time, you need to be careful when talking with the patient; the conversation should be soothing.
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Under no circumstances should you tell him anything that could upset or frighten him. It is unacceptable to say in the process of communicating with him that he looks bad today, that his eyes are “sunken in,” or that his tests are bad.
It must be remembered that with many diseases, patients experience certain characteristics of mental activity. Thus, with atherosclerosis of the cerebral vessels, a significant decrease in memory, absent-mindedness, faint-heartedness, tearfulness, touchiness, and egocentrism are possible. Patients with heart pathology often feel a sense of fear for their lives, are wary, and are highly emotional. With diseases of the liver and gall bladder, irritability, causticity, and anger are often noted. In acute infectious diseases and intrathecal hemorrhage, euphoria and underestimation of the severity of one’s condition are possible. With high internal pressure, the patient is usually lethargic, inactive, passive, apathetic, answers questions with delay, laconically, as if reluctantly, and often remains in some fixed position. Certain features of the mental state and behavioral reactions are characteristic of many endocrinological, oncological and other diseases, various forms of endogenous intoxication, poisoning.
The work of a nurse in children's departments has significant features, because... Staying in a hospital without a mother is a significant psychologically traumatic circumstance for children. Relationships between medical workers and relatives of sick children can be difficult. Brief communication with parents can sometimes only agitate a sick child who has partially adapted to hospital conditions.
When communicating with patients’ relatives, it is extremely important to be tactful, polite, and do everything possible to reassure them and convince them that everything necessary is being done for the patient. At the same time, sufficient firmness is necessary to prevent relatives from violating the regime established in the hospital.
A genuine culture of communication is also necessary within the healthcare team itself. Kindness in relationships with colleagues and mutual assistance are required to create an optimal psychological climate in a medical institution and to provide comprehensive medical care. At the same time, the discipline of team members and their observance of subordination are very important.
- Communication in complex conflict situations.
It is believed that complex interpersonal and conflict situations, incl. arising between health workers and patients are primarily due to difficulties in communication. Human communication can become a source of problems, failures, worries, a wall separating people. What people's relationships will be like depends on their psychological literacy.
Conflicts of interests (needs) are the source of conflicts, but the factors that provoke conflict are extremely diverse. These include the characterological characteristics of a person: reduced self-criticism, prejudice and envy, self-interest, selfishness, the desire to subordinate others to oneself; his mood, well-being, intelligence, knowledge and ignorance of human psychology, psychology of communication, etc.
As a result, everything that constitutes an interpersonal communication situation can act as a conflict factor, a barrier in communication, and create a difficult psychological situation.
The likelihood of conflicts increases when:
Incompatibility of characters and psychological types;
The presence of a choleric temperament;
The absence of three qualities: the ability to be critical of oneself, tolerance of others and trust in others.
Often the cause of conflict is the incorrect behavior of the participants in communication. In a conflict situation you cannot:
Critically evaluate your partner;
Attribute bad intentions to him;
Show signs of superiority;
Blame and attribute responsibility for the conflict only to the partner;
Ignore his interests;
See everything only from your position;
Exaggerate your merits;
Annoy, shout, attack;
Touch your partner’s “pain points”;
Blast your partner with a lot of complaints.
Conflicts between a health worker and a patient can be divided into realistic and unrealistic.
Realistic (subject) - caused by dissatisfaction of the requirements or expectations of communication participants, unfair distribution of responsibilities, advantages; such conflicts are aimed at achieving specific results, etc.
Often associated with a discrepancy between the patient's expectations and reality.
Unrealistic (pointless) - have the goal of openly expressing accumulated pointless emotions, grievances, hostility, when the conflict itself is the goal. For example, a biased attitude towards the medical service or towards an individual health worker.
Daniel Dena identified three levels of conflict; skirmishes, clashes and crises.
Under skirmishes refers to minor conflicts that resolve or disappear on their own and do not affect the relationship's ability to meet the needs of the participants. Example - after a remark was made, the patient was again late for the procedure.
Collision. A sign of conflict at this level is the prolonged repetition of the same arguments on the same issue; expanding the range of reasons causing quarrels; a decrease in the desire to cooperate with another, a decrease in faith in the good attitude of another person; irritation for several hours, days; the emergence of doubts about the correctness of one’s understanding of these relationships. An example is a situation in which you have to repeatedly correct a colleague’s mistakes, but he does not respond to comments and perceives them as the result of pickiness.
Crisis- a level of conflict that threatens the further continuation of the relationship. A sign of a conflict at this level is the decision to finally break off the relationship; fears that the other will break off the relationship unilaterally; feeling that the relationship is unhealthy, fear of an emotional breakdown if it continues; fear of physical violence.
Psychologists call the inability to find a way out of conflict situations a barrier to interpersonal communication.
Communication barriers - These are the many factors that cause or contribute to conflicts. Barriers to interpersonal communication include: barriers to communication skills, divergence of interests, goals, needs, methods of activity, semantic, linguistic barters, prejudices, prejudices, social cliches, attribution of alien intentions to the interlocutor, etc.
- Means of communication and their use for psychotherapeutic purposes.
The practical activities of a health worker are characterized by their own specific verbal communication.
A message that is simple, clear, credible, relevant, and delivered at the right time, taking into account the individual characteristics of the patient, is considered effective. Simplicity is understood as brevity, completeness of phrases, and clarity of words. The clarity criteria assume that after receiving a message, the patient can unambiguously answer the question regarding his further actions (what, how, how much, where, when, why). The criterion “trustworthy” is very important for effective communication; trust in a health worker is influenced by the attitude of other health workers towards him, the health worker’s knowledge of the issue being discussed, and respect for confidentiality. The criteria of “appropriateness of the message” and “good timing” can be combined into one - “appropriateness”, which involves paying attention to the patient while he is waiting for a medical visit, performing manipulations, procedures, etc. Taking into account the individual characteristics of the patient during his stay in a health care facility is extremely important as a criterion for the verbal adequacy of the transfer of information. It is this measure of simplicity, clarity, appropriateness, and trustworthiness for a particular patient. Verbal communication skills should also include the ability to listen, which requires discipline and requires effort.
S.V. Krivtsova and E.A. Mukhamatulin distinguishes between active, passive and empathic listening. By active they understand listening, in which the reflection of information comes to the fore, and by empathic listening, the reflection of feelings.
The health worker mainly comes into contact with weakened people who sometimes find it difficult to communicate using words, ᴛ.ᴇ. verbally. For this reason, they must have the skills to encode and decode nonverbal signals, which have their own specifics when organizing communication with the patient. At the same time, it is important to master professional body language. The importance of body language is due to the fact that patients not only experience pain or illness, but also may be anxious about their chances of recovery, worried about leaving home and household members, etc. In a word, patients need psychological support and a caring attitude towards themselves.
The use of non-verbal means of communication for psychotherapeutic purposes on the part of the health worker requires a readiness for eye contact, a smile and other positive forms of facial expressions, nodding when listening to the patient’s complaints, open gestures, tilting the body towards the patient, a short distance and direct orientation, as well as the active use of touch, expressing support (holding the hand, hugging the shoulders, gently pressing oneself, etc.), neat appearance, careful synchronization of the communication process with the patient and the use of encouraging interjections.
specialty "Nursing"
Communication with the patient. - concept and types. Classification and features of the category "Communication with the patient." 2017, 2018.
Any work with people is inextricably linked with the process and problems of communication; it permeates the professional activities of health workers at any level. The individual characteristics of the patient’s psyche in the conditions of therapeutic relationships and interactions come into contact with the psychological properties of the medical worker. The purpose of such contact is to provide assistance to the patient. Both the patient and the health worker have their own motives for interaction, and the medical staff has a role in ensuring conflict-free interaction.
Mid-level medical staff is in direct contact with the patient for a long time, and therefore can have both a positive and negative effect on the patient. The task of the medical staff- avoid unnecessary negative psychological influences as much as possible, contribute to the creation of a psychological climate that has a beneficial effect on the recovery process.
The prerequisites for interaction between the patient and the health worker are formed depending on a number of factors that determine the patient’s expectations:
1. preliminary information about the health worker
2. reputation of the medical institution
3. “roads” to honey. establishment
For effective and conflict-free interaction with patients, it is necessary to have such a psychological parameter as communicative competence.
- acceptance(unconditional acceptance of the patient)
Authenticity or self-congruity (naturalness of behavior, consistency of feelings and their expression, sincerity).
The state of empathy is, along with an objective feeling of psychological contact between the health worker and the patient, one of the indicators that understanding communication has taken place.
Empathy(from English empathy - feeling) is the ability to feel the emotional state of another person, accurately perceive the semantic shades of his inner world, the ability to look at circumstances through the eyes of the interlocutor. Empathy does not necessarily imply active intervention in order to provide effective help to another. It only implies entering the personal world of another, delicately staying in it without evaluating it. Empathy should be distinguished from emotional identification (likening, identifying oneself with another, with his emotional state) and from sympathy (feeling about the feelings of another). If a state of identification with the emotional state of the patient arises, the health worker loses the ability to work professionally and needs psychological help.
Communication process communication with a patient begins with choosing a distance of interaction; it should be such that the patient feels comfortable and safe. When changing the distance, especially when shortening it, it is advisable to explain your actions in order to avoid an increase in psychological tension and aggression. The patient, being in a situation of stress caused by the disease, needs a fixed territory that belongs only to him. Positive interaction depends not only on the territory, but also on the social status of patients and their age homogeneity.
Patient-provider interaction models
Partnership- cooperation in matters of treatment, division of responsibility for the results of examination and treatment between the health worker and the patient.
Contract- cooperation based on mutual obligations, identified tasks, expected results. Used in paid healthcare settings.
In the communication between a nurse and a patient, in the process of establishing a relationship with him, I. Hardy identifies three stages characteristic of inpatient treatment:
1. orientation - the patient and the nurse get to know each other.
2. expanded stage - cooperation with each other can take place.
3. the final stage - the stage of discharge, is associated with the loss of a sense of security in the patient.
General rules of communication with the patient.
1. Showing genuine interest in the patient.
2. understanding the patient’s merits and maximum approval - praise, emphasizing importance.
3. Understanding the meaning of his actions instead of sweeping criticism.
4. Friendliness, friendliness.
5. Addressing patients by name and patronymic, introducing yourself first, using a badger.
6. The ability to conduct a conversation in the circle of interests of the interlocutor.
7. The ability to listen carefully and give the patient the opportunity to “speak out.”
8. The ability to respect the opinion of the interlocutor, without persistently imposing one’s opinion.
9. The ability to point out to the patient his mistakes without causing offense.
10. The ability to correctly formulate questions and help the patient verbalize his condition.
11. Communicate with the patient as a healthcare professional would want to be treated if he was ill.
12. Use optimal non-verbal communication methods - calm timbre of voice, smooth gestures, correct distance, signs of approval (patting, affectionate touching), etc.
Communication with patients of different age groups, patients in the hospital
The main conditions for the effectiveness of a health worker’s professional communication are: demonstration of goodwill, tact, attention, interest, and professional competence.
It is necessary to know the features of the psychological reflection of their condition by patients of different ages and accordingly implement deontological communication tactics towards them.
For preschool children it is typical:
- lack of awareness of the disease in general;
- inability to formulate complaints;
- strong emotional reactions to individual symptoms of the disease;
- perception of therapeutic and diagnostic procedures as intimidating events;
- strengthening of character defects, raising a child during illness;
- a feeling of fear, melancholy, loneliness within the walls of a medical institution, away from parents.
Deontological tactics - emotional warm attitude, distraction from illness, organization of quiet games, reading, carrying out procedures with persuasion, professional treatment of relatives of a sick child.
Typically for teenagers:
- the predominance of the psychological dominant of age - “aspiration to adulthood”;
- bravado as a form of self-defense with internal psychological vulnerability;
- neglectful attitude towards the disease and risk factors.
Deontological tactics- communication taking into account age-related psychological characteristics, reliance on independence, and adulthood of a teenager.
When working with patients working age.
It is necessary, first of all, to know the patient’s personality and individuality. Find out the attitude towards the disease, the medical staff, the position on the interaction of the patient with the medical staff.
Deontological tactics- orientation towards labor and social rehabilitation, choice of communication tactics depending on the VKB, correction of inadequate attitudes, psychotherapy for anxious and suspicious patients.
For elderly and senile patients it is typical:
The psychological dominant of age is “departing life”, “approaching death”;
Feelings of melancholy, loneliness, increasing helplessness;
Age-related changes: decreased hearing, vision, memory, narrowing of interests, increased sensitivity, vulnerability, decreased ability to self-care;
Interpretation of the disease only through age, lack of motivation for treatment and recovery.
Deontological tactics - maintaining the patient’s sense of self-worth; an emphatically respectful, tactical, delicate attitude, without familiarity, commanding tone, or moralizing; orientation to physical activity; motivation for recovery.
Features of communication with a patient in a hospital
Illness and hospitalization knock a person out of the rut of life, and he may feel offended by fate and unhappy. He is worried about the illness, possible complications, prognosis, the forced need to leave work, parting with home, unfamiliar or unfamiliar surroundings, on which he also becomes dependent. In severe cases, in cases of paralysis, severe pain, and strict bed rest, the dependence can be absolute.
Patient's routine In a hospital, it is determined by medical workers; the very life of a patient in a hospital depends on their knowledge, skills, responsibility, and kindness. At the same time, the relationships that he develops with paramedical workers, primarily with nurses, who communicate with patients constantly, are especially significant for the patient.
Relationships with patients should be built depending on age, profession, general cultural level, character, mood, severity and characteristics of the disease. All measures for treating patients and caring for them should be carried out calmly, accurately, carefully, trying not to irritate them, without causing them pain, and in no way humiliating their human dignity. It is necessary to take into account the feeling of awkwardness and frustration usually characteristic of patients in connection with their helplessness and dependence.
The average health worker should know what diagnosis was made to the patient, why the doctor prescribed certain medications, procedures, laboratory tests. However, caution must be exercised when talking with the patient; the conversation should be soothing. Under no circumstances should you tell him anything that could upset or frighten him. It is unacceptable in the process of communicating with him to say that he looks bad today, that his eyes are “sunken in,” or that his tests are bad.
It must be remembered that with many diseases, patients experience certain peculiarities of mental activity. Thus, with atherosclerosis of the cerebral vessels, a significant decrease in memory, absent-mindedness, weakness, tearfulness, touchiness, and egocentrism are possible. Patients with heart pathology often feel a sense of fear for their lives, are wary, and are highly emotional. In diseases of the liver and gall bladder, irritability, causticity, and bitterness are often noted.
For acute infectious diseases, intrathecal hemorrhage, euphoria and underestimation of the severity of one’s condition are possible. With high internal pressure, the patient is usually lethargic, inactive, passive, apathetic, answers questions with delay, laconically, as if reluctantly, and often remains in some fixed position. Certain features of the mental state and behavioral reactions are characteristic of many endocrinological, oncological and other diseases, various forms of endogenous intoxication, poisoning.
The work of a nurse in children's departments has significant features, because... Staying in a hospital without a mother is a significant psychologically traumatic circumstance for children. Relationships between medical workers and relatives of sick children can be difficult. Brief communication with parents can sometimes only agitate a sick child who has partially adapted to hospital conditions.
When communicating with patients’ relatives, it is necessary to be tactful, polite, and do everything possible to reassure them and convince them that everything necessary is being done for the patient. At the same time, sufficient firmness is necessary to prevent relatives from violating the regime established in the hospital.
A genuine culture of communication is also necessary within the healthcare team itself. Goodwill in relationships with colleagues and mutual assistance are required to create an optimal psychological climate in a medical institution and to provide comprehensive medical care. At the same time, the discipline of team members and their observance of subordination are very important.
Communication in difficult conflict situations
Counts that complex interpersonal and conflict situations, including those arising between health workers and patients, are primarily caused by difficulties in communication. Human communication can become a source of problems, failures, worries, a wall separating people. What people's relationships will be like depends on their psychological literacy.
Conflicts of interests (needs) are the source of conflicts, but the factors that provoke conflict are extremely diverse. These may include the character-logical characteristics of a person: reduced self-criticism, prejudice and envy, self-interest, selfishness, the desire to subordinate others to oneself; his mood, well-being, intelligence, knowledge and ignorance of human psychology, psychology of communication, etc.
As a result, everything that constitutes an interpersonal communication situation can act as a conflict factor, a barrier to communication, and create a difficult psychological situation.
The likelihood of conflicts increases when:
Incompatibility of characters and psychological types;
The presence of a choleric temperament;
The absence of three qualities: the ability to be critical of oneself, tolerance of others and trust in others.
Often the cause of conflict is the incorrect behavior of the participants in communication. In a conflict situation you cannot:
Critically evaluate your partner;
Attribute bad intentions to him;
Show signs of superiority;
Blame and attribute responsibility for the conflict only to the partner;
Ignore his interests;
See everything only from your position;
Exaggerate your merits;
Annoy, shout, attack;
Touch your partner’s pain points;
Blast your partner with a lot of complaints.
Conflicts between health care worker and patient can be divided into realistic and unrealistic.
Realistic(subject) - caused by dissatisfaction with the requirements or expectations of communication participants, unfair distribution of responsibilities, advantages; such conflicts are aimed at achieving specific results, etc.
Often associated with a discrepancy between the patient's expectations and reality.
Unrealistic(pointless) - have the goal of openly expressing accumulated pointless emotions, grievances, hostility, when the conflict itself is the goal. For example, a biased attitude towards the medical service or towards an individual health worker.
Daniel Dena identified three levels of conflict; skirmishes, clashes and crises.
Under the skirmishes refers to minor conflicts that resolve or disappear on their own and do not affect the relationship's ability to meet the needs of the participants. Example - a patient, after making a remark, was again late for the procedure.
Collision. A sign of conflict at this level is the prolonged repetition of the same arguments on the same issue; expanding the range of reasons causing quarrels; a decrease in the desire to cooperate with another, a decrease in faith in the good attitude of another person; irritation for several hours, days; the emergence of doubts about the correctness of one’s understanding of these relationships. An example is a situation in which you have to repeatedly correct a colleague’s mistakes, but he does not respond to comments and perceives them as the result of pickiness.
Crisis- a level of conflict that threatens the further continuation of the relationship. A sign of a conflict at this level is the decision to finally break off the relationship; fears that the other will break off the relationship unilaterally; feeling that the relationship is unhealthy, fear of an emotional breakdown if it continues; fear of physical violence.
Psychologists call the inability to find a way out of conflict situations a barrier to interpersonal communication.
Communication barriers — These are the many factors that may cause or contribute to conflicts. Barriers to interpersonal communication can be: barriers to communication skills, divergence of interests, goals, needs, methods of activity, semantic, linguistic barters, prejudices, prejudices, social cliches, attribution of alien intentions to the interlocutor, etc.
Means of communication and their use for psychotherapeutic purposes
The practical activities of a health worker are characterized by their own specific verbal communication.
Considered effective a simple, clear, credible, relevant message, delivered at the right time, tailored to the individual patient. Simplicity is understood as brevity, completeness of phrases, and clarity of words. The clarity criteria assume that after receiving a message, the patient can unambiguously answer the question regarding his further actions (what, how, how much, where, when, why). The “trustworthy” criterion is very important for effective communication; trust in a health worker is influenced by the attitude of other health workers towards him, the health worker’s knowledge of the issue being discussed, and respect for confidentiality.
Criteria for “relevance of message” and “good timing” can be combined into one - “appropriateness”, which involves paying attention to the patient while he is waiting for a medical visit, performing manipulations, procedures, etc. Taking into account the individual characteristics of the patient during his stay in a health care facility is extremely important as a criterion for the verbal adequacy of the transfer of information. It is this measure of simplicity, clarity, appropriateness, and trustworthiness for a particular patient. Verbal communication skills should also include the ability to listen, which requires discipline and requires effort.
S.V. Krivtsova and E.A. Mukhamatulin distinguishes between active, passive and empathic listening. By active they understand listening, in which the reflection of information comes to the fore, and by empathic - the reflection of feelings.
The health worker mainly makes contact with weakened people who sometimes find it difficult to communicate using words, i.e. verbally. Therefore, they must have the skills to encode and decode nonverbal signals, which have their own specifics when organizing communication with the patient. In addition, it is important to have professional body language. The importance of body language is due to the fact that patients not only experience pain or illness, but also may be anxious about their chances of recovery, worried about leaving home and household members, etc. In a word, patients need psychological support and a caring attitude towards themselves.
Use of nonverbal means of communication for psychotherapeutic purposes, on the part of the health worker, it requires readiness for eye contact, smiling and other positive forms of facial expressions, nodding when listening to the patient’s complaints, open gestures, tilting the body towards the patient, short distance and direct orientation, as well as active use touches expressing support (holding hands, hugging shoulders, lightly pressing oneself, etc.), neat appearance, careful synchronization of the process of communication with the patient and the use of encouraging interjections.
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introduction
In the early 70s of the twentieth century. There has been an increase in interest in psychosomatic medicine in scientific research and clinical practice. The prevailing biomedical model, within which there was no place for the social, psychological, and behavioral, was replaced by a biopsychosocial model, which assumes the role of psychological, biological and social factors in the development, course and outcome of somatic and mental disorders.
Currently, in our country, the problem of changes in the psyche of chronically ill patients is becoming increasingly relevant. Due to the increase in life expectancy of patients with chronic renal failure during treatment with donor kidney allotransplantation, the importance of psychosomatic relationships in the context of transplant functioning increases.
In this thesis we identified three main tasks:
Analyze the scientific and theoretical foundations of this problem.
To analyze scientific methods for expecting psychological help for patients after donor kidney allotransplantation.
Conducting empirical research.
I. psychological conversation,
as a method of working with clients
Counseling can be considered as a special type of helping relationship, as a certain repertoire of possible influences, as a psychological process. In addition, counseling can be viewed in terms of its objectives or its relationship to psychotherapy, as well as from the point of view of the counselors.Some experts believe that “the presence of these factors is not only necessary, but sufficient for constructive change to occur in clients,” Rogers (45).
Many professionals are forced to use a specific repertoire of influences in addition to the helping relationship. Alternatives to interventions include counseling methods and assistance strategies. Consultants with repertoires of interventions must determine which interventions should be applied to different clients and what the likelihood of success is. The influence repertoires used by counselors reflect their theoretical orientation: for example, psychoanalytic counselors use psychoanalytic influences, specialists in the field of rational-emotive behavioral counseling use rational-emotive behavioral influences, and Gestalt consultants use Gestalt influences.
The main reasons for the fundamental connection between psychology and counseling are as follows. First, the goals of counseling have a consciousness-related aspect. To varying degrees, all counseling approaches focus on changing people's feelings, thoughts and actions so that people can live more effectively. Secondly, the counseling process is psychological. Counseling is not something static, it involves the exchange of thoughts between consultants and clients, as well as the passage of thought processes separately between consultants and clients. Much of the information gained in counseling appears in client development in the intervals between sessions, as well as during periods when clients try to help themselves after counseling ends. Thirdly, the fundamental theories from which the goals of counseling and the influences used in it “grow” are psychological. Many major counseling theorists, such as Rogers (45). Fourthly, specialists conducting psychological research have made a major contribution to the creation of counseling theories: in addition, the results of psychological research are used in assessing counseling processes and its results.
In counseling, much attention is paid to achieving a state of psychological comfort and maintaining mental health. Having described the characteristic qualities of people who fully realize their abilities (self-actualizers), Maslow (29) attempted to consider the goals of counseling in terms of their relation to development rather than to treatment. According to Maslow (29), complete self-actualization involves the realization of creativity, autonomy, social fulfillment, and the ability to focus on problem solving.
Consultants, regardless of their chosen theoretical direction, attach particular importance to increasing clients' personal responsibility for the course of their own lives. As Maslow (29) notes, “To choose development and growth over fear a dozen times a day is to take steps toward self-actualization a dozen times a day.”
Solving the main task of counseling - changing the personal model - can be carried out in various ways.
Some clients, after deeply studying the problem, are able to make the right decision themselves and begin to implement it, acting in the chosen direction. However, in the presence of a neurotic way of personality development, its inability to independently make decisions and choose directions for their implementation is manifested. This implies the inappropriate behavior of such a client. A conversation with a consultant, if it proceeds successfully, should serve as the impetus that will release the most pronounced intrapersonal tendency of such a client. Therefore, during the conversation, the consultant must repeatedly, in an indirect form, unobtrusively express his thoughts about the client’s problem. Some of these attempts will remain unsuccessful, but the client will definitely respond to some. As a result, the suggested idea will settle in the mind and begin to influence his mental process unnoticed by the client. This idea will begin to interact with a tendency already existing in the client's subconscious and will ultimately lead him to a solution. Thus, the consultant manages to achieve correction of intrapersonal tensions and greater integrity of the client’s “I”.
Sometimes it is preferable to consider together with the client all possible constructive options for solving his problem. The client’s subconscious will itself select the necessary and most acceptable option for him.
The main task of any consultation is to help the client make a decision, change independently, without coercion, without justification and the need to shift responsibility for this to someone else. The consultant can only help the client by “turning” him in the right direction. Clients retain the right to refuse a change if they are not internally ready for it, preferring to leave everything as it is. In reality, the client often lacks the desire to abandon the usual pattern of behavior. But knowledge alone is not enough for a change in the client’s personality to occur. It is also necessary to have the impact of an empathic connection that is established between the client and the consultant during the conversation. If such a connection is created, then the client knows that the consultant accepts him as he is, without judging him. As a result, he begins to trust the consultant more. The client identifies with the positive will of the consultant, while the client receives strength for a positive constructive manifestation of himself and his will. He gains the courage to live and solve his problems.
In the process of this work, it is important to establish and support all the positive aspects of the personality, using them to increase the individual’s self-esteem and strengthen his self-confidence. To do this, you should use psychotherapeutic techniques that the consultant knows and which he considers appropriate to use in working with this client. At the same time, you should try to identify the circle of friends and relatives of the person being consulted who could help him in the current situation.
If this can be done, then the activation of all possible resources necessary to achieve the goal is achieved, which is a prerequisite for the client’s advancement from the current to the desired state.
The main method used in the process of professional consultation is conversation.
There are several stages in a consultation conversation. This emphasis is rather verbal in nature - the stages do not have clear boundaries and in fact, during a conversation, the consultant can simultaneously realize the goals of several stages.
1.1. Clinical interviewing of patients
after kidney allotransplantation
One of the main goals of a clinical conversation is to assess the individual psychological characteristics of the patient, ranking the identified characteristics by quality, strength and severity, classifying them as psychological phenomena or psychopathological symptoms.
Clinical talk– obtaining information about the individual psychological properties of a person, psychological phenomena and psychopathological symptoms and syndromes, the internal picture of the patient’s illness and the structure of the client’s problem, as well as the method of psychological influence on a person, carried out directly on the basis of personal contact between the psychologist and the patient.
The conversation is aimed not only at the complaints actively presented by the person, but also at identifying the hidden motives of the patient’s behavior and helping him to understand the true (internal) reasons for the altered psychological state. Psychological support for the patient is also considered essential for the conversation.
Conversation features in clinical psychology are: diagnostic and therapeutic. They must be carried out in parallel, since only their combination can lead to the desired result for the psychologist - recovery and rehabilitation of the patient.
Patients often cannot accurately describe their condition and formulate complaints and problems. That is why the ability to listen to the presentation of a person’s problem is only part of the conversation, the second is the ability to tactfully help him formulate his problem, let him understand the origins of psychological discomfort - to crystallize the problem.
“Speech is given to a person in order to better understand himself,” wrote L. Vygotsky, and this understanding through verbalization in the process of a clinical conversation can be considered significant and fundamental.
Principles of Clinical Interview are: unambiguity, accuracy and accessibility of question formulations; adequacy, consistency (algorithmic); flexibility, impartiality of conversation; verifiability of the information received.
One of the important parameters of the conversation is the algorithmic nature of the questioning, based on the diagnostician’s knowledge in the field of compatibility of psychopathological symptoms and syndromes; endogenous, psychogenic and exogenous types of response; psychotic and non-psychotic levels of mental disorders.
The current situation in society allows us to talk about potentially or clearly existing conflicts in the sphere of communication.
Clinical conversation is no exception in this regard. Potential psychological difficulties when conducting a conversation are possible at different levels - yesterday they covered one area; today – the second; tomorrow – they may spread to a third. Without a trusting atmosphere and therapeutic empathy between a psychologist and a patient, a qualified conversation and a psychotherapeutic effect are impossible.
Jacques Lanant's theory (39) suggests that conversation is not simply a relationship between two people physically present at the session. This is also the relationship between cultures. That is, at least four people are involved in the counseling process, and what we took for a conversation between a psychologist and a patient may turn out to be a process of interaction between their cultural and historical roots (Fig. 1)
Empathy requires that we understand both the personal uniqueness and the “foreignness” (cultural-historical factor) of our patient. Historically, empathy has focused on personal uniqueness, and the second aspect has remained forgotten.
Figure 1.
Psychologists in the United States and Canada typically expect that all patients, regardless of their cultural background, will respond equally to the same treatment. Such therapy looks like this (Fig. 2).
Figure 2.
Ideally, both the psychologist and the patient are aware of and use the cultural-historical aspect. Empathy cannot be considered a necessary and sufficient condition if attention is not paid to the cultural aspect.
The model provides additional impetus for building a certain level of empathy. Sometimes the patient and psychologist believe that they are talking to each other, when in fact they are only passive observers of how two cultural attitudes interact.
The focus of a clinical psychologist working in a somatic clinic is the mental reactions of a person suffering from a particular disorder. It becomes significant to analyze both their clinical characteristics and diversity, and to assess the factors that contribute to the emergence in a particular person of a certain type of mental response to his own illness. The type of response to a somatic disease is associated, first of all, with the patient’s assessment of its severity. In this case, we can talk about the existence of the phenomenon of “objective severity of the disease” and “subjective severity of the disease” (Fig. 3).
Figure 3.
The terms objective and subjective are enclosed in quotation marks because it is practically impossible to quantify the severity of the disease, and it is impossible to create a quantified register of the severity of the disease.
The severity of the disease, subjectively assessed by the patient, turns out to be more significant in this context. In turn, the development of a subjective attitude towards a particular disease is influenced by several factors (Fig. 4)
Figure 4.
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Character |
Ticket No. 1 Task: 1 You are a nurse in a preventive room and are responsible for the work of the health school for patients with gastrointestinal diseases. 1. Conduct a lesson at a gastro school on the topic: rational nutrition. 2. Define the concepts of primary, secondary, tertiary prevention. Objective: 2 An 18-year-old girl, a student at a pedagogical college, came to the antenatal clinic with complaints of a delay in menstruation for 2 months, considers herself pregnant, does not want to give birth, because she had a quarrel with a young man, and her parents do not know anything. Exercise. Identify the patient's problems. Try to solve them. 1. The real problem is pregnancy and the reluctance to carry it to term Potential inflammatory diseases after abortion, bleeding, uterine perforation, infertility. Mental relations since the girl-future teacher understands the gravity of her act and will repent a lot of it. 2. refer the patient to a family planning center. Inform the nurse about the dangers of abortion, especially the first one Examine the place. Give the woman a special literature on this issue, advise her to resolve the issue of pregnancy with the young man and with the parents Invite to an appointment in 2 weeks Ticket No. 2 Task: 1 A 65-year-old patient made an appointment with a doctor. He has no complaints, but wants to get advice on organizing a balanced diet. 1.Consult on organizing a balanced diet. 2. Define the concept of “healthy lifestyle”. The main components of a healthy lifestyle. Objective: 2 Boy 2 years old EXERCISE Determine the child’s CPD group Solution: health group 1, since all indicators correspond to age, and according to one indicator it is even ahead of the epicrisis period. Ticket No. 3 Task: 1 You are a local nurse. A 25-year-old patient came to the appointment with a diagnosis of duodenal ulcer. A nursing examination revealed complaints of acute pain in the epigastric region, occurring 3-4 hours after eating, often at night, sour belching, heartburn, constipation, weight loss. Appetite preserved. From the anamnesis it was revealed that he considered himself sick for about a year, but did not contact a doctor. The work involves frequent nervous strains; he has been smoking 15 cigarettes a day for more than 5 years. 1. Determine your health group. Objective: 2 Make a menu for one day for an 8-month-old child, bottle-fed, birth weight 3200 g. M birth = 3200g M 8 months =3200+600+800+800+750+700+650+600+550=8650g Total volume – 1 liter Single-1000:5=200 ml 6 00 – 200ml NAN 10 00 – 10% milk rice porridge + 3-5g butter 14 00 – 150g zucchini. puree + 50g meat puree + 3-5g vegetable oil + 1/2 yolk 18 00 -50g cottage cheese + 150g kefir 22 00 – 200 ml NAN Between feedings 50 ml fruit juice Task: 1 Ivanova V., 51 years old, was undergoing outpatient treatment for influenza. Works as a teacher in a kindergarten. Smokes 1 pack of cigarettes per day. Has low body weight. Objective: 2 A nurse provides primary care to a newborn baby. Child from 1 normal pregnancy. Delivery on time. Apgar score 8-9 points. Weight 3300 g, length 51 cm. Attached to the breast immediately, suckling actively, a lot of BCG milk on the 4th day. The condition of other organs is without deviations. Tell us about the tasks and responsibilities of the nurse when conducting primary care of a newborn. SOLUTION: Problem 1 1-2 days after discharge, the first visit to the newborn occurs. Patronage(French patronage) - a form of work of health care facilities, the main goal of which is to carry out health and preventive measures at home, introduce rules of personal hygiene and improve sanitary and hygienic conditions in everyday life. Tasks of primary patronage: Assess the child's condition Assess lactation status Assess social and living conditions Teach how to care for a newborn: skin care, umbilical wound, newborn hygiene, nutrition Prevention of hypogalactia, During patronage, the medical worker is obliged to: 1. carefully examine the child, measure body temperature 2. evaluate the data obtained 3. check and critically evaluate the results of the mother’s compliance with the child care rules 4. write down in the child’s development history (form 112) the received data on the state of health and development, these recommendations Ticket No. 5 Task: 1 Petr Andreevich. 33 years old, registered as “D” since May 2012 with a diagnosis of gastric ulcer. Chronic cholecystitis. Chronic pancreatitis. The last exacerbation was in March 2013, he was hospitalized and discharged with improvement. Remission (scarring of the ulcer) has been achieved. Works as a driver on an intercity bus. He has been smoking 1.5 packs of cigarettes a day since he was 20 years old. 1. List the risk factors for the disease and measures to prevent diseases of the gastrointestinal tract. 2. Give the concept of health schools. Group and individual patient education in health schools. Objective: 2 A pregnant woman came to the antenatal clinic complaining of constipation. In 2 weeks I gained 800 grams. Upon examination, a diagnosis was made: pregnancy 38 weeks. Identify problems. Try to solve problems. What vital needs of a pregnant woman have changed? 1. The real problems are constipation, excessive weight gain (average weight gain of 300 g per week) Potential – development of gestosis of pregnancy 2. conduct a conversation on “pregnant women’s nutrition”, advise limiting liquid to 1000.0 g, salt to 3-4 g, to regulate intestinal function, use beets, carrots, sunflower oil, raisins, dried apricots. Since the pregnant woman has excessive weight gain, it is advisable to hospitalize her in the pregnancy pathology department. 3. the need to eat - it is necessary to follow a diet. The need to drink - the water-salt regime should be observed. Need to eliminate - constipation and frequent urination The need to breathe - shortness of breath at 38 weeks, high position of the uterine fundus under the diaphragm Ticket No. 6 Task: 1 Worker K., working the second shift at the end of the working day, feeling unwell, went to the plant’s health center. The medical assistant at the health center, having made a preliminary diagnosis: Hypertensive crisis, provided pre-medical care and referred the patient for further examination and treatment to the clinic. 1. Does the health center paramedic have the right in this case to issue a certificate of incapacity for work? 2. Define the concepts of health, illness, pre-illness. Objective: 2 Create a menu for a 4 month old child. The child is on mixed feeding. The volume of supplementary feeding is ½ of the total volume. Birth weight 3200 g. M birth =3200g V document times =500:6=85ml 6h. – mother’s breast 85 ml +85 ml NAN mixture 9:30 – mother’s breast 85 ml +85 ml NAN mixture 13 00 – mother’s breast 85 ml +85 ml NAN mixture 16 30- mother's breast 85 ml +85 ml NAN mixture 20 00 - mother's breast 85 ml + 85 ml NAN mixture 23 30- mother's breast 85 ml +85 ml NAN mixture Ticket No. 7 Task: 1 Patient Shishkin. P., 32 years old, agronomist, diagnosed with: Bronchial asthma, atopic form (allergy to pollen of field grasses and cereals), remission phase, mild course. Vasomotor rhinitis, remission 2. Medical prevention centers: tasks, structure, organization of work. Objective: 2 Girl 6 years old, weight 21 kg, body length 110 cm, chest circumference 56 cm. Girl, 6 years old OG=58cm(75%) FR: harmonious, normosomatic type Ticket No. 8 Task: 1 You are a nurse in a preventive clinic. 1. Conduct a class at a hypertensive health school. On the topic: what is arterial hypertension. Make a lesson plan. 2. Give the concept of medical examination of the population, goals, objectives, and the role of the nurse in medical examination. Objective: 2 The mother is 18 years old and is caring for a newborn child. I'm concerned that I don't know how to care for my baby's skin. Teach the mother how to care for her baby's skin every day. Prepare: Sterile vegetable oil 1% solution of brilliant green 3% hydrogen peroxide solution Beaker with boiled water Sterile cotton balls, flagella, cotton swabs Container for discarding used material HP eye treatment 1.Moisten 2 cotton balls with boiled water 36-37 degrees 2. Treat both eyes with separate balls (from the outer corner of the eye to the inner) Facial treatment 1.Moisten a cotton ball in boiled water 36-37 0 C 2. Turn the child’s face in the direction from the center to the periphery 3. Dry your face with dry cotton balls from the center to the periphery Treatment of natural skin folds 1.Moisten a large cotton ball with sterile vegetable oil 2.Treat the natural folds of the skin in the following order: BTE Axillary Elbows Radiocarpal Palmar Popliteal Ankle Gluteal Ticket No. 9 Task: 1 The number of residents at one of the sites of the city clinic is 1,700 people, of which 250 are undergoing medical examination. 1. Determine the indicator of dispensary observation coverage of the entire population of the site. 2. Main tasks and types of work ability examination. Objective: 2 A nurse provides patronage to a newborn child: Upon examination of the child, it was revealed that the umbilical wound is covered with a crust. The umbilical ring is not hyperemic, the baby’s skin is clean, the feeding regimen is set to 6-8 times a day. Feeding on demand. The mother does not know how to treat the umbilical wound. Give advice on caring for the umbilical wound. Disturbed need to be clean. The reason is the mother's lack of knowledge. Algorithm for treating the umbilical wound Equipment: 1. Liquid soap with dispenser 2. Skin antiseptic 3. Disposable sterile gloves 4. Clean disposable apron 5. Disposable paper napkins 6. Individual styling with eraser. material (one tweezers, 5-6 cotton balls, 3-4 cotton swabs) 7. 3% hydrogen peroxide solution 8. 0.5% solution of chlorhexidine alcohol or 1% solution of brilliant green 9. Disposable sterile diaper EXECUTION: 1. Clean your hands using the hygienic method 2. Place all equipment on a pre-disinfected table 3. Treat the changing table with a disinfectant solution and cover it with a wiped diaper 4. Wash your hands, put on an apron, treat your hands with skin. antiseptic, wear sanitary gloves 5. Treat the last wound with 3% hydrogen peroxide solution and dry it 6. Then 1% solution of brilliant green or 0.5% solution of chlorhexidine alcohol 7. After we take off the gloves, throw them into a container, then take off the apron and treat our hands with a skin antiseptic. Ticket No. 10 Task: 1 Ilya I., 13 years old, has been registered as “D” since May 2010 with a diagnosis of VSD of the vagotonic type. Chronic erosive gastritis, chronic duodenitis. The last exacerbation in March 2012, he was in the hospital and discharged with improvement. Remission achieved. Anti-relapse therapy was carried out in the rehabilitation treatment department for a year. 1. Determine your health group. 2. The role of the nurse in education and the formation of a healthy lifestyle, in the fight against alcoholism and drug addiction Objective: 2 The child is 5 months old. body weight 7100, length 65 cm, the girl distinguishes loved ones from strangers, recognizes her mother’s voice, distinguishes between strict and gentle intonation of speech, clearly takes a toy from the hands of an adult and holds it, lies on her stomach, leaning on her forearm. Doesn't roll over from back to stomach. Stands upright with support under his arms, walks, eats semi-thick food from a spoon. Conclusion: CPD group II (lag by 1 epicrisis period for 2 indicators) Ticket No. 11 Task: 1 You are a nurse in a preventive room and are responsible for the work of the health school for patients with hypertension. 1.Make a plan for the topics of this school. Conduct a lesson on the topic: Correct measurement of blood pressure. 2. Give the concept of the incidence of non-communicable diseases in the population: indicators, levels, preventive measures. Training plan for patients of this group at the School of Arterial Hypertension. Lesson 1. What do you need to know about arterial hypertension? Lesson 2. Healthy eating. What does a patient need to know about nutrition for arterial hypertension? Lesson 3. Obesity and arterial hypertension. Lesson 4. Physical activity and health. Lesson 5. Smoking and health (lesson for smokers) Lesson 6. Stress and health. Lesson 7. Drug treatment of arterial hypertension. How to increase adherence to treatment? Explain how to measure blood pressure correctly Objective: 2 The nurse is providing patronage to a newborn baby, a child from the second full-term pregnancy, weight 3350, length 51 cm. Apgar score 9 points, actively sucking, skin with a moderate icteric color, pink mucous membranes. According to the mother, icteric discoloration of the skin appeared on the third day of life. Give advice on care Condition: physiological jaundice of the newborn. Care: From 5-6 days it gradually decreases and disappears. Sometimes a suspension of carbolene (activated carbon) in a 5% glucose solution is prescribed, which is an adsorbent and removes bilirubin from the gastrointestinal tract, phototherapy, phenobarbital. Ticket No. 12 Task: 1 While caring for a 2.5-month-old child, the nurse noticed that the child was lethargic and held his head for a short time. With support under the armpits, the child does not rest on the entire foot; the child is awake in diapers. Parents do not provide massage or gymnastics. Identify violated needs. Give advice on the child’s physical development The basic vital need to move has changed. That. the priority problem is insufficient physical activity. It is necessary to have a conversation with parents, where it is necessary to tell: Basic motor skills at 3 months of age. are: long-term holding of the head in an upright position, as well as lying on the stomach; turning the child from the stomach to the back; satisfactory support on the legs (symmetrical, with straightened legs, support on the entire foot) Physical exercise has a beneficial effect on all body functions and increases resistance to pathogenic agents. Create a set of physical exercises: The room must be ventilated at least 4 times a day, the temperature in the room is 22 degrees. While awake, the child should be dressed in rompers and a blouse to stimulate active movements Gymnastics is carried out no earlier than 40 minutes. after feeding Gymnastics is performed on a table Initially, complex No. 1 is required, when the result is achieved at the age of 3 months. Master complex No. 2 (give parents instructions on how to conduct gymnastics and massage) Disturbed needs: to be healthy, to play Massage (set No. 1): 1.Massage should be carried out 30-40 minutes after meals or 20-30 minutes before meals with warm, clean, dry hands. 2.Hand massage - stroking in the direction from hand to shoulder 4-6 times 3. Foot massage - stroking in the direction from the foot to the groin area 4-6 times 4.Laying the baby on his stomach. 5. Back massage - stroking, with the back of the palm in the direction from the buttocks to the shoulders and in the opposite direction 4-6 times. 6. Reflex extension of the spine. When holding the thumb and forefinger along the paravertebral line from bottom to top, reflex extension of the spine occurs 1 time. 7. Abdominal massage - circular stroking with the palm in a clockwise direction 6-8 times. 8.Laying the baby on his stomach. 9. Reflex crawling 1-2 times. 10. Foot massage - stroking is done with the thumbs on the back side in the direction from the toes to the ankle joints 4-6 times. 11. Reflex flexion and extension of the toes. When light pressure is applied to the skin of the sole near the toes, the child’s toes reflexively bend, and when pressure is applied to the skin of the sole in the heel area, they straighten. 12.Dancing 1-2 times. Objective: 2 A young woman came to the antenatal clinic for advice on how to keep a menstrual calendar and how to use it to protect herself. She has been sexually active for 6 months, is married, protects herself with condoms, but her husband does not want to protect herself with this method. Menstruation since the age of 13, established within a year, after 28-30 days, 5 days each, moderate, painless. During examination, no changes were found in the female genital organs. Exercise. Identify the woman's problems and solve them. 4. For a given menstrual cycle, the shortest (28) and longest (30 days) cycles are distinguished. The following calculation is carried out: 28-18=10 FROM the shortest menstrual cycle (28) subtract 18 30-11=19 From the longest - 11 Therefore, the period from 10 to 19 days of the menstrual cycle is fertile and requires protection. Before and after these days, a woman may not use protection. Ticket No. 13 Task: 1 The child is healthy, full-term, date of birth January 1, 2013. Make an individual schedule of preventive vaccinations from 0 months. up to 6 months 01/01/13 – V 1 hepatitis B 01/04/13 - V 1 BCG 02/01/13 - V 2 hepatitis B 01.04.13 - V 1 DTP V 1 hemophilic infection 05.15.13 - V 2 DTP V 2 IPV V 3 hepatitis B Objective: 2 A young woman came to the antenatal clinic for advice on how to keep a menstrual calendar and how to use it to protect herself. She has been sexually active for 3 months, is married, protects herself with condoms, but her husband does not want to protect herself with this method. Menstruation since the age of 12, established within a year, after 26-31 days, 3 days each, moderate, painless. During examination, no changes were found in the female genital organs. Assignment: Identify problems and solve them. Cordon off a woman's menstrual cycle. Teach how to keep a menstrual calendar. Calculate fertile days using the menstrual calendar. 1.the menstrual cycle is correct. 2. present problem - spouses are not sufficiently informed about contraceptive methods. Potential problem - quarrels in the family due to the lack of common opinion about contraceptive methods. Counseling should be given about contraceptive methods. And refer the patient to a family planning center. 3. The menstrual calendar is kept constantly, the patient must mark the days of menstruation and free days, so at least 3 months, from here it will be seen how many days menstruation occurs and after how long, only the correct menstrual cycle makes it possible to protect yourself with this method. 4. For a given menstrual cycle, the shortest (26) and longest (31 days) cycles are distinguished. The following calculation is carried out: 26-18=8 FROM the shortest menstrual cycle (28) subtract 18 31-11=20From the longest - 11 Therefore, the period from 8 to 20 days of the menstrual cycle is fertile and requires protection. Before and after these days, a woman may not use protection. Ticket No. 14 Task: 1 Create a menu for a 10 month old child. breastfed, birth weight 3300 M born. =3300g M 10 months =3300+600+800+800+750+700+650+600+550+500+450=9700g V day = 1 liter V times =1000:5=200ml 6 hours - breast milk 200 ml 10 hours – 10% buckwheat porridge 200 ml + ½ yolk, butter 3-5 g 14h – vegetable puree 150 g, vegetable oil 5 g, meat puree 50 g 18:00 – cottage cheese 50, kefir 150, cookies 5 g. 22h – breast milk 200 ml. Between feedings: fruit juices 70 ml/fruit purees 70 ml, crackers, cookies, bread -10g Objective: 2 When examining the pregnant woman during her next visit, it was determined that over the last week the patient had lost 400.0 g in weight; she noted that it became easier for her to breathe, the fundus of the uterus had dropped and was located midway between the navel and the xiphoid process. The presenting part is pressed against the entrance to the pelvis. Exercise. Determine the gestational age and the date of the upcoming birth based on the last menstruation and fetal movements What signs confirm the imminent delivery date and what are they called? What other signs do you know? Ticket No. 15 Task: 1 Ivanova R., 54 years old, was undergoing outpatient treatment for ARVI. Works for teachers. Smokes 2 packs of cigarettes a day. Has low body weight. 1.Identify measures for primary and secondary prevention. 2. The role of mass medical examinations in disease prevention: Objective: 2 The nurse was invited to the gerontology department with a conversation about “Personal hygiene of the elderly” 1. Make a plan for the conversation. Ticket No. 16 Task: 1 Newborn 3 days from I pregnancy, I term birth. Born with a weight of 3500, length 52 cm. Apgar score 9 points. He sucks actively; examination revealed an increase in t to 37.8, the skin is pink, and the lips are dry. No deviations from other organs. EXERCISE. Determine and justify the condition of the newborn. Create a child care plan. Objective: 2 Ivan Ivanovich, male, 27 years old. He has been smoking since he was 17 years old, currently two packs of cigarettes a day. Coughs constantly, but more in the morning. The temperature periodically rises and purulent sputum is released. Five years ago I was diagnosed with chronic bronchitis. Doctors recommended quitting smoking, but he did not heed their advice. Quests: 1. Appeal to I.I. 2. The influence of smoking on my son. About passive smoking. 3. How a bad habit of parents can affect their child in the future. 4. Tobacco smoking and its impact on human health Ticket No. 17 Task: 1 A child 3 years 6 months old was enrolled in kindergarten 10 days ago. The girl’s physical and neuropsychological development indicators correspond to the norm. According to the mother, negative changes in behavior are noted. The girl became capricious, agitated, sleeps poorly at night, and does not eat in kindergarten. At home during dinner he eats more food than usual. In the morning he is reluctant to go to kindergarten. Doesn't take part in games in the group and asks to go home. Objective: 2 Ivan Petrovich, 28-year-old man. He has been smoking since he was 15 years old, currently two packs of cigarettes a day. Coughs constantly, but more in the morning. The temperature periodically rises and purulent sputum is released. Five years ago I was diagnosed with chronic bronchitis. Doctors recommended quitting smoking, but he did not heed the advice. Ivan Petrovich got married and a son, Gena, was born into the family; he is three years old. He has asthma attacks at night. Doctors diagnosed him with bronchial asthma. The boy has already been treated in a hospital several times, where he immediately feels better, as Gena’s mother notes. Ivan Petrovich smokes most often in the apartment; there is no balcony; neighbors prohibit smoking on the landing. 1. What are the risk factors for Ivan Petrovich and his son Gena? 2.Draw up a plan and abstract of an individual conversation with Ivan Petrovich “About the dangers of smoking.” 1. Ivan Ivanovich’s risk factors are active smoking. His son Gena has passive smoking. 2.Plan for an individual conversation for I.I. “About the dangers of smoking”: 6. Appeal to I.I. 7. The influence of smoking on my son. About passive smoking. 8. How a bad habit of parents can affect their child in the future. 9. Tobacco smoking and its impact on human health 3. Theses of an individual conversation: · Your tobacco abuse can cause mental retardation, serious impairment of the child’s physical and mental development · Children living in smoky rooms suffer more often and much more severely from respiratory diseases. Your son already has bronchial asthma. This is your fault. Smoking is passive, the influence is active. · In children of smoking parents, the incidence of bronchitis and pneumonia increases, and the risk of serious illnesses increases. · Tobacco smoke, in addition, delays the sun's ultraviolet rays, which are important for the child, affects his metabolism, and destroys vitamin C, which he needs during growth · In families where children smoke, pneumonia and acute respiratory infections are more common, children are weakened · In families where there are no smokers, children are practically healthy Parents who smoke set a bad example for their children · Smoking is the main risk factor for the development of cancer and respiratory diseases · Smoking can cause atherosclerosis, stroke, myocardial infarction, and weakened immunity. Premature aging of the body also occurs and life expectancy is shortened. · The effect of nicotine on the nervous system is manifested by headache, dizziness, increased irritability and fatigue. The inhibitory effect of nicotine on the sexual function of men has been noted. · If you value your son, quit smoking immediately. Ticket No. 18 Task: 1 Make a plan for preventive vaccinations for a child from 0 to 1 year old, date of birth 01/8/2013. 01/08/13 – V 1 hepatitis B 01/11/13 – V 1 BCG 02/08/13 – V 2 hepatitis B 04/08/13 – V 1 DTP 05/23/13 – V 2 DTP V 2 IPV V 3 hepatitis B 01/11/14 – against measles, rubella, epidemic. Mumps Objective: 2 Maria Ivanovna, woman, 30 years old. Works as a janitor in a dormitory. She is obese, with a body weight of 120 kg, her height is 165 cm. She loves to eat: cakes, sweets, sandwiches with lard and ham, etc. Moves little. Lives on the first floor, next to the house. After work he goes to the store and watches TV series all day, lying on the sofa. And he eats something at the same time. She is not married. Her parents died and she lives alone. Work, food and TV are her whole life. The patient does not consider himself. · Identify the risk factors that Maria Ivanovna has. · Define BMI and explain its meaning. Risk factors: Systematic overeating Physical inactivity Obesity 2.BMI is important when determining indications for the need for treatment, including drugs for obesity. Body mass index is calculated using the formula: I=m: h 2 and measured in kg/m 2 Where m is body weight in kilograms h – height in meters BMI= 120:2.7=44.4 BMI should not be higher than 25, but your BMI is more than 44, which indicates severe obesity Ticket No. 19 Task: 1 Make a plan for preventive vaccinations for a child from 1 to 15 years old, date of birth 01/01/2010. 01.01.10 – V 1 hepatitis B 01/04/10 – V 1 BCG 01.02.10 – V 2 hepatitis B 01.04.10 – V 1 DPT V 1 against Haemophilus influenzae 05/15/10 – V 2 DPT V 2 IPV V 3 hepatitis B 01/04/11 – against measles, rubella, epidemic. Mumps 01.07.11 –R 1 DPT 01.09.11 – R 2 against polio 01/01/12 – Mantoux test 01/01/13 - Mantoux test 01.01.14 - Mantoux test 01.01.15 - Mantoux test 01/01/16 - Mantoux test 01/04/16 – R against measles, rubella, epidemic. mumps 01.01.17 – Mantoux, if negative 01/04/17 – BCG 01/01/18– Mantoux test 01/01/19– Mantoux test 01/01/20– Mantoux test 01/01/21– Mantoux test 01/01/22– Mantoux test 01.01.23 – Mantoux test 01/01/24 - Mantoux test, if negative. 01/04/24 – R 3 BCG R 3 against polio Objective: 2 Petr Ivanovich, male, 40 years old. Works as a janitor in a dormitory. He is obese, with a body weight of 120 kg and his height is 165 cm. He loves to eat: cakes, sweets, sandwiches with lard and ham, and so on. Moves little. Lives P.I. on the ground floor, works next to the house. After work, he goes to the store and watches action movies on TV all day, lying on the couch. And he eats and drinks something at the same time. Parents died. Divorced from his wife, no children, lives alone. Work, food and TV are his whole life. He does not consider himself sick. 1. Identify the risk factors that Pyotr Ivanovich has. 2. Make a memo about healthy lifestyle (healthy lifestyle) for Pyotr Ivanovich. 1.risk factors: Systematic overeating Physical inactivity Alcohol abuse Obesity 2.Memo: · You need to move. You should spend at least 3.5 hours a week on physical exercise, that is, 30 minutes a day. Walk more, take a walk in the park. · Regular physical activity trains the heart. A sign of a healthy heart and its economical operation is a low resting heart rate. · Physical activity must correspond to the level of fitness of the body. · Buy a pedometer and count the kilometers traveled per day. · Get a dog. You will involuntarily walk with her and move more. · Buy a scale. Control your weight. · Eat properly; your diet must include vegetables, fruits, whole grain products, lean poultry, and lean fish. · The amount of red meat, fatty foods, and sweets should be limited. · Limit your alcohol intake · Obesity is a risk factor for the development of cardiovascular diseases; the risk of developing certain types of cancer, diseases of the digestive system, respiratory system and joints, and type 2 diabetes increases. · Obesity significantly impairs quality of life; many obese patients suffer from pain and limited mobility · Visit your doctor. Get tested. Get more detailed recommendations on healthy lifestyle. · the main goal of your lifestyle should be to reduce body weight, thereby prolonging your life and its quality. Ticket number 20 Task: 1 A 3 month old child is being admitted. The mother complains that the baby is restless after feeding and there is no milk left in the breast. During control feeding, he sucked 90 ml of milk from the breast. Birth weight 3100. EXERCISE. Determine the child's condition. Create a menu for a 3 month old child. M 3 - 3100+600+800+800=5300g V c ut =5300:6=890g V times =890:6=150g 149-90=60g – amount of supplementary feeding Mixed feeding, supplementary feeding volume 1/3 6h -90 ml breast milk + 60 ml NAN 9:30 - 90 ml breast milk + 60 ml NAN 13:00 -90 ml breast milk + 60 ml NAN 16:30 -90 ml breast milk + 60 ml NAN 20:00 -90 ml breast milk + 60 ml NAN 23:30 -90 ml breast milk + 60 ml NAN Objective: 2 Zoya Petrovna, woman, 25 years old. Doesn't work, housewife. She has been smoking for seven years and smokes two packs of cigarettes a day. She got married three years ago. She is in her second month of pregnancy. Refuses to quit smoking. My husband has been smoking since he was 10 years old. Zoya Petrovna registered with the antenatal clinic for pregnancy. She does not understand the harm she is causing to her unborn child. Both spouses smoke in all areas of the house. Quests: · What risk factors can have a negative impact on the reproductive health of spouses? · Draw up a plan and abstract of an individual conversation for spouses “About the dangers of smoking.” 1.Risk factors, which can have a negative impact on the reproductive health of spouses over a long, ongoing period maternal and paternal smoking. Plan for an individual conversation for spouses “About the dangers of smoking.” 2.1. Address to spouses. 2.2. The influence of smoking on the fetus and the development of pregnancy. 2.3.How a bad habit of parents can affect their child in the future. 2.4.Tobacco smoking and its impact on human health 2.5. Conclusion: the need to quit smoking. Abstracts of an individual conversation for spouses “On the dangers of smoking.” · Smoking is incompatible with the normal course of pregnancy; it causes intrauterine growth retardation and the formation of severe malformations in the newborn. · Smoking during pregnancy can lead to miscarriage or premature birth, and can also lead to sudden baby death syndrome. · Your tobacco abuse can cause mental retardation and serious impairment of the child’s mental and physical development. · Smoking is a major risk factor for the development of cancer and respiratory diseases. · Smoking can cause atherosclerosis of blood vessels, myocardial infarction, stroke, weakened immunity, and also causes premature aging of the body, shortening life expectancy. · Quit smoking if you want to be healthy and have healthy offspring! Ticket No. 21 Task: 1 A newborn girl 4 days old from the first term birth with a weight of 3600, a length of 50 cm. She screamed immediately, the Apgar score was 8 points. During the morning toilet, the nurse noticed a slight enlargement of the mammary glands and bloody discharge from the vagina. The baby is active, sucks well EXERCISE Determine and justify the condition of the newborn. Create a newborn care plan State of sexual crisis. Care: 1. Diapers and diapers are only sterile. At home - iron on both sides 2.The first thin vest is worn with a wrap around the back, seams facing out 3. Wash girls only with boiled water 4. Avoid warm compresses Objective: 2 Ekaterina Stepanovna, woman, 23 years old. Not working, second year vocational school student. She has been smoking for nine years and smokes two packs of cigarettes a day. She got married three years ago. She is in her third month of pregnancy. Refuses to quit smoking. The husband does not interfere, since he himself has been smoking since he was 13 years old. Ekaterina Stepanovna registered with the antenatal clinic for pregnancy. She does not understand the harm she is causing to her unborn child. Both spouses smoke at home, in the kitchen. 1.What risk factors can have a negative impact on the reproductive health of spouses? 2. Make a memo for spouses “On the dangers of smoking during pregnancy.” 1.risk factors that can have a negative impact on the reproductive health of spouses: long-term, continuous smoking of the mother and father. More on the topic
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