Psychological aspects of conducting a conversation (questioning) with a patient. Psychotherapeutic conversation What kind of conversation can be had with an infectious patient

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 her 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) is 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 doc. =1/2
M 4 =3200+600+800+800+750=6150g
V day =6150:6=1 liter
V times. =1000:6=170ml
V doc.day =1000:2=500ml

V document times =500:6=85ml
V gr.milk =170-85=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 in one of the sections of the city clinic is 1,700 people, of which 250 are undergoing medical examinations.

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 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 DPT

V 1 hemophilic infection

05/15/13 - V 2 DPT

V 2 IPV
V 2 hemophilic infection
01.07.13 - V 3 DPT
V 3 IPV
V 3 hemophilus influenzae infection

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 on 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 visible 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 the first pregnancy, first 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.
Ivan Ivanovich married, a son, Peter, was born into the family, he is two years old. He has asthma attacks at night. He has already been treated in a hospital several times, where he immediately feels better, as Petra’s mother notes.
Ivan Ivanovich smokes most often in the apartment; there is no balcony; his neighbors chase him from the landing.

Quests:
1. What are the risk factors for Ivan Ivanovich and his son Peter?
2. Compose a memo for Ivan Ivanovich “On the dangers of smoking.”

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. In the group he does not take part in games and asks to go home.

Objective: 2

Ivan Petrovich, male, 28 years old. 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. Passive smoking, active influence.

· 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 DPT

05/23/13 – V 2 DTP

V 2 IPV
V 2 hemophilic infection
07/08/13 – V 3 DPT
V 3 IPV
V 3 hemophilus influenzae infection

V 3 hepatitis B
01/08/14 – Mantoux

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 DTP

V 1 against Haemophilus influenzae

05/15/10 – V 2 DTP

V 2 IPV
V 2 hemophilic infection
01.07.10 – V 3 DTP
V 3 IPV
V 3 hemophilus influenzae infection

V 3 hepatitis B
01.01.11 – Mantoux

01/04/11 – against measles, rubella, epidemic. Mumps

01.07.11 –R 1 DTP
R 1 OPV
R 1 against Haemophilus influenzae

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 No. 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.

Collaboration is the interaction between the nurse, patient, and family to promote patient learning and development. A positive relationship between nurse and patient largely determines the outcome of care.

The nurse's tasks in establishing a supportive relationship with the patient:

1. Creating an atmosphere of trust.

2. Promoting the preservation and development of the patient’s abilities.

3. Promoting personal growth and development of the patient in the process of joint problem solving.

4. Formation in the patient of the ability to act as a physically and emotionally healthy person should.

The psychology of dealing with sick people is a general discipline that extends to the activities of both doctors and nurses, the essence of which is: knowledge in the field of communication and the center: the ability to approach the patient, find the key to his personality, the path to creating contact with him.

There are two main rules of communication:

1. The best conversationalist is not the one who knows how to speak well, but the one who knows how to listen well.

2. People tend to listen to others only after they have listened to them.

A nurse may be a poor listener not only because she is not interested or does not have enough time, but also because she may be absorbed in her thoughts and experiences. Therefore, it is important to learn to listen, “pushing” your problems aside for a while.

During the listening process, the nurse is also attentive to nonverbal communication signals that come from the patient.

The function of listening skills is quite important not only for collecting information about the patient. The opportunity to speak out in a situation of safety, which the nurse creates, in itself has a psychotherapeutic effect on the patient (i.e., acts as a unique way of nursing intervention).

During the conversation, an atmosphere of trust is formed between the nurse and the patient, which is very important for subsequent work with him. In the process of communication, not only does the nurse get to know the patient, but he also gets to know her better. American psychologist K. Rogers found that if a person in 40% of cases demonstrates the same reaction style in communication, a certain fixed set of communicative techniques, then his interlocutor has the right to think that this person always behaves this way. This is how myths about medical workers and nurses are born among patients, which leads to labeling them as “good-natured”, “strict”, “knowing about everything”, “understanding”, etc.

In order for a patient to listen to his sister, he himself must be listened to by her.

The nurse's speech culture presupposes the ability to:

1. Formulate your thoughts precisely

2. Formatting it grammatically correct

3. Present it in language accessible to the patient

4. Focus on the patient's reaction

When communicating with patients, the nurse should not overuse medical terminology, which is often incomprehensible to the patient and frightens him.

The nurse's speech should serve as an indicator of her interest in the fate of the patient, an indicator of her professional competence and culture.

In communication, not only words as such are important, but also thoughts and feelings conveyed by words.

American psychologists have calculated that verbal information in our communication makes up 1/6, and the language of postures, intonations, breathing and rhythm, i.e. non-verbal information - about 5/6. The verbal part usually takes up from 5% to 20% of the message, the rest is non-verbal communication.

In general, people are less able to consciously control nonverbal communication. Researchers have proven that oral speech is easier to control than facial and body language.

Information about the patient is conveyed by the nurse to the doctor in the form of a nursing primary psychological diagnosis, which should be considered as part of the nursing diagnosis.

A psychological diagnosis is a comprehensive assessment of the patient’s personality and his place in his immediate environment. This diagnosis indicates those needs that are significant for the patient, which for one reason or another are not satisfied, and indicates those areas of the patient’s life that cause increased emotional tension in him.

Image of a nurse.

A prerequisite for a patient's trust in a nurse is her qualifications. But it is only a tool, the effect of which depends on other personal qualities of the nurse. The patient should have the impression that the nurse wants to help him. The patient can attribute the indifferent voice, the unfriendly, gloomy expression on the nurse’s face personally.

A nurse is trustworthy if she is calm, confident, optimistic, conscientious, patient, but not arrogant or rude.

Image is a set of qualities that people associate with a certain personality. A nurse's image is a set of qualities that patients associate with a particular nurse. The image begins to work from the first moments of acquaintance.

An attractive image can only be built on the basis of the natural self-disclosure of one’s individuality. The art of imagery does not consist in falsehood, but in emphasizing one’s true advantages and not emphasizing shortcomings.

Stages of image building:

Stage 1 - awareness of your Self, your strengths and weaknesses (the image of the Self - for yourself);

Stage 2 - building your public identity (the image of I - for others, how I want to appear in the eyes of others), which should not be strikingly different from personal identity, otherwise you will not be able to hide the falsity in your behavior;

Stage 3 - self-presentation (broadcasting one’s public identity, “self-presentation”).

Appearance significantly influences the attribution of positive qualities. The formation of the image is also influenced by speech characteristics. The nonverbal component of communication (eye contact; proxemics - organization of space and time of communication; extra and paralinguistics - voice timbre, rate of speech, pauses; optical-kinetic sphere - facial expressions, pantomime) also carries a large information load.

Lack of attention from a physician to his appearance is unacceptable. The unity of content and form is a harmony worthy of admiration. A favorable or unfavorable effect on the treatment process is exerted not only by the impression made on the patient by the staff, but by the medical institution itself.

Establishing psychological contact with the patient, increasing his trust in medical personnel and in the medical institution are necessary so that the patient:

· began to do everything in his power to get better;

· Resign from the role of the patient as soon as possible;

· collaborated with the treating staff and followed the doctor’s orders.

The reason for the unfavorable development of the relationship between the nurse and the patient may be her failure to maintain the necessary psychological distance (for example, flirting or emotional identification with him, helpless sympathy).

A nurse's talkativeness can introduce elements of conflict not only into her relationship with the patient, but also into the relationships between patients.

Accepting gifts from a patient often leads to conscious or unconscious discrimination against those who have not received this, which reduces trust in it on the part of all patients.

However, sometimes, when dealing with a vulnerable patient, refusing a gift can cause a strong blow to his pride, demonstrating that he means nothing to you. It is believed that gratitude can be accepted if it is expressed in a civilized form and does not contradict the principles of humanism and spirituality, or current legislation.

Nurses need to be sensitive to their patients' cultural differences and be prepared to care for people from different races, cultures, and ethnicities.

Emotional identification. Empathy(from the English empathy - sympathy, empathy, the ability to put oneself in the place of another, penetration into the subjective world of another) - the ability of an individual to perceive the inner world of another accurately, while maintaining emotional and semantic shades. Empathy does not imply mandatory active intervention in order to provide effective help to another, nor does it imply an evaluative response. It brings people together in communication, bringing it to the level of trust and intimacy.

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).

A sympathetic interlocutor is always ready to express his compassion to the speaker and quickly agree with him. Techniques used: praise, verbal agreement, reassurance, sympathy, consolation. When using this type of listening, there is a danger in the emotional identification of the health worker; in this case, the health worker himself may need professional psychological help.

Empathic listening is the highest level of listening skill and involves empathy (the ability to understand the interlocutor not with the mind, but with the heart). In this case, there are no attempts to reveal the speaker’s unconscious feelings, since they can be traumatic. This is a type of unreflective listening that can be learned.

Non-reflective listening is listening without analysis, giving the interlocutor the opportunity to speak out. This is an active process on the part of the listener and requires the ability to remain silent attentively. Its purpose is to support the flow of the interlocutor's speech, trying to get him to speak out completely.

Rules for such a hearing:

1. Minimum responses (non-interference)

2. Be a kind of “sponge”, absorbing everything that the interlocutor says, without any selection or sorting

3. Constantly give signals to the interlocutor that he is being listened to and focused on what he is saying (replicas: yes, yes, head nods)

The costs of this type of listening: the patient may regard the nurse’s attention as complete agreement with the content of his story; for a long time he has to listen to sometimes empty chatter.

The nurse has to balance in communication with the patient between open and businesslike communication. Being an understanding listener is a good way to maintain this balance. The ability to listen creates an atmosphere of trust.

The ability to listen to your interlocutor is an important component of the psychological preparation of a nurse.

Transfer is the transfer to the medical worker of the patient’s emotional attitude towards people significant to him (father, mother, etc.).

The term first began to be used in psychoanalysis. Transfer varies:

· positive - transferring feelings of love, respect, trust, affection, etc.

· negative - transference of feelings of fear, hatred, disgust, etc.

In the process of nursing care, these feelings can spontaneously arise in the patient in the absence of objective reasons for this in her behavior. The patient himself does not understand why he “falls in love” with the nurse or begins to hate her without any external reason. So, a person who has suffered all his life from a lack of love and care may expect exactly these feelings from a nurse. He may begin to admire her, but if his expectations are not met, he may suddenly hate her. Novice nurses are at a loss when faced with strong manifestations on the part of patients of such emotions as love, sexual desire, or hatred, insatiable demands, aggression.

For example, a “disobedient” patient may behave towards the nurse as a stubborn, disobedient child towards his mother.

Strengthening transfer reactions is facilitated by:

1. Maintaining external passivity and neutrality by the nurse

2. She shows interest in the patient’s personal life

3. Her active listening to the patient

This is exactly how a nurse usually behaves, so there is a high probability that in her professional life she will encounter transference reactions from patients.

Countertransference is the transfer by a health worker of his emotions to the patient, a response to the patient’s transference. Countertransference destroys the nurse's usually benevolent-neutral position, causing internal imbalance in her, manifested in the form of anger towards the patient, irritation, fear of the patient, or special love for him. Countertransference intensifies when the nurse experiences stressful events and unresolved conflicts.

Communication with the patient in and out of the hospital. Patient care is based on a holistic approach to the person, taking into account the physiological, personal, social and spiritual needs of the patient and his family.

When a person encounters certain obstacles on the way to achieving life goals, he experiences a crisis. The nurse strives to reduce the patient's level of tension associated with the stressful situation in which he is, helps the patient adapt to his situation, and helps him find the strength to improve this situation. The patient has to be taught to cope with a crisis situation, because all life is accompanied by one or another challenge and one must be able to respond to them. In the process of overcoming a problem or a crisis situation, personality development occurs, a person becomes wiser.

Upon admission to the hospital, the patient often suffers from a change in environment. He can express his dissatisfaction openly or keep it to himself. The first type of patients creates special difficulties for other patients. There are patients who do not want to adapt to the demands of the hospital environment.

The patient's first reaction to the diagnosis may be as follows:

1. Real peace of mind

2. Apparent calm

5. Suicidal tendencies and even attempts

A person’s attitude towards illness is influenced by the level of education, culture, prejudices he adheres to, customs, and the behavior of others.

How the patient endures his illness is reflected in his behavior:

· a sick fighter does not close his eyes to trouble; he treats illness as an enemy that must be overcome; doing everything possible in the interests of recovery

· a capitulating patient becomes passive, helpless; they need to study all the time

· a patient who denies the fact of the disease does not want to hear anything about treatment or disease

Therapeutic environment- an environment that promotes self-respect and personal responsibility, and involves the patient in meaningful activities.

The relationships between patients have a significant impact on their well-being. Medical staff should cultivate camaraderie and empathy for each other in patients. He must also ensure that the patient’s individual regimen, which mobilizes his defenses, organically fits into the medical and protective regimen of the department.

The therapeutic and protective regime provides for the protection of the patient’s central nervous system from excessive external influences: creating conditions for maximum gentle treatment of the affected organs and systems; maintaining comfortable conditions for the body in new conditions of existence for it - in conditions of illness. Applying the principle of protective treatment and creating a healing environment in a medical institution is not so easy. In addition to material costs, it requires, first of all, constant education and self-education of all medical workers.

A healthy socio-psychological climate of a medical institution presupposes mutual trust among employees, the desire to conscientiously perform their work according to the principle of “no leniency”, constant exchange of information, monitoring the results of program implementation, the efficiency of the hospital administration and the style of its work.

The joint work of a doctor and a nurse on a team basis as professionals who respect and depend on each other increases the responsibility of the nurse and allows each professional to perform the functions for which he was trained. The basis for the success of teamwork is a relationship of cooperation and mutual assistance as opposed to conflict and confrontation.

Conditions for the formation of cooperative interdependence:

1. Freedom and openness of information exchange

2. Mutual support for the actions that the group has to do, conviction of their justification

3. Trust and friendliness between the parties

4. Effective feedback

Building a successful team is an art. For a team to succeed, it needs to be assembled and grown. It is important that people have the desire to cooperate and work together.

Communication with the patient's relatives. The illness of one of the family members imposes restrictions on the family, requires a special regime, changes in the usual way of life, forces changes in plans for the future, redistributes responsibilities, and causes a feeling of fear, uncertainty, and helplessness.

The psychology of relatives is determined by their personality, formed by their previous life, and their attitude towards the patient. The interest of most relatives is focused on promoting a speedy recovery. Often relatives are more concerned about the disease than the patient himself. They are concerned about all sorts of conversations, rumors, problematic information about the disease, medical personnel, and try to do something in favor of the patient.

Overprotective relatives often burden the medical staff with extensive questions and discussions about the patient’s condition and treatment. You need to be patient and remember that the relative is worried and also needs primary psychological help.

If a nurse notices that the condition of a patient in a hospital regularly worsens after visits from visitors, she should tell the attending physician about this, who can regulate the visits.

Both the patient and relatives have the right to information concerning each of them. However, the rights of one sometimes conflict with the rights of the other (for example, a patient wants to know what is happening to him, but does not want his relatives to know about some aspects of his illness). Sometimes relatives of the nurse want to clarify some information. The nurse needs to be very careful and not convey unnecessary information to either the patient or his relatives without coordinating her actions with the attending physician.

Communication management involves an impact on the communication process, which is selected from a variety of possible ones, taking into account the set goal, the state of the control object, and leads to the approach of the goal.

A person can consciously control his communication, influence his relationships with other people, and his attractiveness in the system of interpersonal relationships.

Three interrelated areas can be identified that require the nurse’s attention and her ability to manage the processes in them:

1. Directly professional work to implement the nursing process

2. Your internal mental processes and states included in interpersonal interaction with the patient

3. Emerging interpersonal relationships with the patient, level of trust established

All these areas are interconnected and affect the effectiveness of the nurse’s professional activities, because she works not only through nursing technologies, but also through her personality, through the relationships she creates between herself and the patient.

​​​​​​​​The main method of obtaining (and exchanging) information, the source and method of cognition and awareness of psychological phenomena based on verbal (verbal) communication between the psychotherapist and the patient.

Psychotherapeutic conversation, in accordance with the assigned tasks, performs various functions:

• communicative,
• diagnostic,
• informative and
• medicinal.

A psychotherapeutic conversation can be free in its content (like a confession) and structured by its specific tasks.

Psychotherapeutic conversation has a number of stages:

1. establishing contact,
2. collection of anamnestic information and diagnosis,
3. determining the dynamics of disease manifestations during treatment,
4. psychotherapeutic influences,
5. assessing the success of psychotherapy and
6. the result of the tasks posed and resolved in the conversation.

Already during the first conversation, complete emotional positive acceptance of the patient, attentive and patient listening to everything he says is important. If the patient expresses erroneous judgments, one should not demonstrate obvious disagreement or immediately refute them. The therapist remains sincere, but does not try to force the patient to immediately accept his point of view. The empathic approach of the psychotherapist allows the patient to feel freer, he has confidence in the doctor and a feeling that he is understood; the patient expresses his experiences, doubts and thoughts more freely, without fear of criticism and condemnation.

The psychotherapist is the most important source of information the patient needs, especially at the first stage of treatment. This information concerns the nature, causes and prognosis of the disease, treatment methods and prospects for recovery. It is very important for a psychotherapist to find out as early as possible all the features of the patient’s own “concept” of the disease, his idea of ​​its causes and impact on the life situation. Taking into account these data and the patient’s personality characteristics, the psychotherapist explains to the patient his understanding of the disease and discusses treatment methods with him. The effectiveness of the conversation may be reduced because the material presented to the patient is too complex for him to understand. The patient remembers only part of the content of the conversation and often interprets it incorrectly. Sometimes the way questions are posed to the patient is such that the question itself contains a suggested answer, or the patient provides only the information that the doctor directs him to with his direct questions, and as a result, significant areas of experience remain unclear. Psychotherapeutic conversation is a clinical method and at the same time has an experimental aspect. Throughout it, the psychotherapist makes certain assumptions for himself, and then checks them based on the analysis of the material received, influencing the patient and taking into account his reactions to the answers. It is important for a psychotherapist to achieve, through feedback, a consistent focus and mutual understanding on the issues under discussion.

The next element of the psychotherapeutic conversation is a discussion of the dynamics of the manifestations of the disease, correction of the patient’s inadequate “concept” of the disease, assistance in his understanding of the connection between psychogenic factors and manifestations of the disease, and increased motivation for active participation in psychotherapy. After the patient understands the connection between symptoms and psychological factors involved in the development of the disease, significant changes occur in the content of conversations. Their subject is no longer symptoms, but psychological problems, experiences and relationships of the individual. The characteristics of the patient’s relationship with the psychotherapist and his behavior during the psychotherapeutic conversation can become a psychotherapeutic “target” for modifying some specific maladaptive stereotypes of the patient’s communication with other people. An essential element of a psychotherapeutic conversation is a discussion with the patient of his efforts, difficulties and successes in gradually (in accordance with agreed upon tasks) changing previous, painful ways of experiencing and behavior.

The most general features (functions, structure, elements) of a psychotherapeutic conversation, regardless of the specific form of psychotherapy, were described above. There are, however, specific features of psychotherapeutic conversation with its different orientations, in particular psychoanalytic psychotherapy and client-centered psychotherapy as the most typical forms of “talk psychotherapy.” The originality of a psychotherapeutic conversation within the framework of psychoanalysis is determined by the psychoanalyst’s adherence to the rule of “emotional neutrality” (avoiding influence on the patient’s emotions, maintaining the position of “a mirror in front of the patient’s eyes”), the use of free associations when obtaining material for analysis, its interpretation, as well as the phenomena of resistance , transference and countertransference in the relationship between doctor and patient. The main task of a psychoanalyst is to identify experiences repressed into the unconscious and help the patient understand them, focusing attention on the unconscious, especially the sexual (and aggressive) and “infantile” in the content of the conversation.

In client-centered psychotherapy, a psychotherapeutic conversation takes place in an atmosphere of deeply personal contact while the psychotherapist observes special conditions (“Rogers’ triad”): unconditional positive acceptance, empathic understanding and congruence towards the patient. At the same time, during conversations, the patient is encouraged to increasingly freely express his experiences, their full awareness and inclusion in the concept of “I” with the aim of its constructive reorganization. A more complete expression of feelings by the psychotherapist himself and his personal involvement in the psychotherapeutic conversation are also essential.

The final stage of the psychotherapeutic conversation is summing up. It is important to accurately formulate what has been achieved and outline the next stage of treatment, specifying the patient’s participation.

The degree of adequacy of the psychotherapist’s self-perception influences the characteristics of his perception and assessment of the psychotherapeutic conversation as a whole. According to Sullivan H.S., the psychotherapist as a “participating observer” must be constantly aware of the impact of his behavior on the entire course of the psychotherapeutic conversation. To effectively manage a psychotherapeutic conversation, it is important for a psychotherapist not only to take into account his own communicative stereotypes and needs, but also to understand and control his feelings that arise in the process of communicating with the patient.

Correct communication with him is of great importance in psychological contact with the patient.

The nurse should not waste time talking with the patient. In conversations with the patient, the nurse gets to know his inner world and personal problems, strengths and weaknesses of character, hobbies and interests. Also, conversations with the patient make it possible to understand his psychological attitude towards recovery, his personality’s reaction to the disease. The better the nurse knows the patient's personality, the more effectively she will provide treatment and care. A proper conversation with a patient not only has a good psychotherapeutic effect, but also has an educational purpose. He corrects mistakes in the patient’s behavior and corrects his inadequate reactions to the disease. The conversation should not be intrusive and should take place exactly when the patient feels the need for it. Then this conversation will bring relief.

A conversation with the patient should calm him down, relieve anxiety and fear, and reduce mental stress. But we must remember that an inept word can turn into a weapon that destroys the patient, can deeply wound him or even worsen his somatic condition. But at the same time, a skillful word, spoken in time, unobtrusively and according to the needs of the patient, can become a miraculous healer. The nurse must be able to talk calmly and confidentially with the patient. It is important to own your voice, the ability to regulate its strength and shades.

When entering the room, you need to say hello, call the patient by name and patronymic, not forgetting to introduce yourself. Many patients pay attention, first of all, to the voice of the medical worker, to his intonation (patients are auditory learners). It will be important for them how they are spoken to, the timbre of the voice, its pleasant shades when collecting an anamnesis. Questions must be asked to the patient correctly, clearly and clearly so that they are easy to answer. When asking questions, you need to direct the patient to those problems that interest the medical professional.

The ability to listen to the patient is also very important. This ensures good mutual understanding during the conversation. When a patient tells a nurse about himself, about his problems, he should see her not as a passive, but as an active listener. He should feel that the nurse is interested, is closely following his thoughts, and understands him.

Nonverbal methods of communication

Non-verbal methods of communication include facial expressions and gestures. The facial expression (facial expressions) of a nurse when communicating with a patient is of great importance. A smile on your face always cheers you up, relieves tension, calms you down, and brings you closer together. A smile is always the key to success in communication.

A serious, calm expression on the face indicates an understanding of the patient’s problems and interest in them. When talking with a patient, there is no need to frown, show emotional displeasure, or impatience. A gloomy, dissatisfied, irritated facial expression repels the patient, does not allow him to open up, or even frightens him. Students need to remember that a frightened, timid, surprised facial expression will also not make the patient happy. Therefore, it is very important to control facial expressions and not show the patient your bad mood.

Gestures and pantomime (expressive body movements) also have a powerful effect on patients. If a nurse impatiently taps her foot on the floor or hastily glances at her watch while communicating with a patient, this has an unfavorable effect on the patient. He understands that the nurse does not have enough time for him and is in a hurry.

During communication and history taking, you can approvingly touch the back of the patient’s hand and lightly shake his hand. This will calm him down. Sometimes you can lightly touch the shoulder - this is also a calming, encouraging gesture.

When communicating or talking with a patient, it is best to sit opposite him so that he can see the facial expression and have eye contact.

Currently, there are many modern medical developments in the field of nutrition, which can be used to prolong the life of patients and significantly improve its quality. However, in practice this does not happen, because the patients themselves use them incorrectly. The magic key remains in the hands of the nutritionist, and those who desperately need it do not allow the doctor to get closer to the treasured door leading to their health.

In this issue, we will begin to examine psychological tools that will help the dietitian interact effectively with those for whom his valuable knowledge is intended. Let us give, as an example, several typical cases showing how information is distorted during interaction (in your practice, we believe, there are many of them).

1. Patient K., 45 years old, was hospitalized as an emergency with a diagnosis of acute myocardial infarction. For the first three days, the patient received full enteral nutrition (i.e., at all meals, instead of food, the patient received enteral formulas). After consultation with a nutritionist, the patient and relatives were given explanations about the possibility of expanding the diet and switching to specialized gentle diets including protein correction of the diet. However, the very next day violations begin. Relatives bring bags full of his favorite food, friends - fruits, vegetables, etc. In such a situation, close people have a desire to help the patient who finds himself in a difficult situation, to cheer him up. And the only thing, in their opinion, that they can do is try to bring into the ward all sorts of products that are contraindicated for him. The patient also believes that his usual food is something that can lift his mood. He is convinced, like many patients, that hospital food is tasteless food, and does not understand that this therapeutic food is one element of the treatment regimen. Why is there distortion of information? Don’t the people close to you and the patient himself want him to recover? The thing is that initially they misunderstood the recommendations, and therefore underestimated their significance.
2. Patient D., 32 years old, was discharged from the hospital after gastric resection due to ulcerative bleeding; the patient’s body mass index at discharge was 17.6. At the first appointment with the local doctor at the place of residence, the patient complains of excessive weakness, lethargy and malaise. Why did the patient have these particular complaints? The thing is that initially the attending physician did not have a conversation with the patient about the importance of maintaining a diet, and did not organize an additional consultation with a nutritionist who was supposed to correct the protein component of the diet.
3. The dietitian submits to the chief physician of the hospital the quarterly need for food products, including specialized ones, in accordance with the requirements of current legislation and food consumption standards per patient. In turn, the chief physician does not want to allocate funds in the amount indicated by the nutritionist, leaving the funding section for food purchases “on a residual basis.” In such a situation, the dietitian needs the ability to influence the decision of the chief physician.

Why do important information, valuable knowledge, modern effective treatment methods, including diet therapy, and legal documents disappear before reaching the recipient?

Let's look at the “logistics” of dietary recommendations:

1. Knowledge from the nutritionist is transferred directly to patients.
2. Knowledge from a nutritionist is transferred to patients through the attending physician.
3. The patient receives meals organized in the hospital; for this, the dietician gives recommendations to a number of specialists: the chef, the nutritional nurse, the barmaid, the head of clinical departments, attending physicians, economists, and hospital management. An additional complication is that the nutritionist is often not an authority on all listed employees and his knowledge is either distorted or not accepted by them.

It turns out that in order to organize an effective system of therapeutic nutrition, a dietitian needs to influence the opinions and decisions of people who are direct participants in the process of organizing and conducting therapeutic nutrition in a hospital, namely:

• catering workers;
• medical personnel of the departments, including attending physicians and heads of structural units;
• economists, accountants involved in organizing and conducting food accounting and procurement;
• hospital management (chief physician, deputy chief physician for medical work);
• patients.

Each of the listed participants in the process has their own opinion on the issue under consideration, which is not always similar to the opinion of a nutritionist.

For example, the issue of patient adherence to treatment is currently an acute issue - many of them refuse to accept the treatment regimen proposed by the doctor. Objections of this kind have appeared among patients relatively recently. Just 30 years ago this problem did not exist. However, since then, patients have become informed (often falsely informed), but this does not make them trust doctors any more. There are now many sources of information, and they strongly contradict each other due to the lack of one generally accepted means or approach. Patients' attitudes towards their rights have also changed.

All this leads to the fact that in the situation of communication between the doctor and the patient, mutual misunderstanding is exacerbated, doctors are unable to inspire trust, explain, and resolve the conflict.

It can be especially difficult to convince people from non-medical professions who think in completely different categories. For example, when planning food purchases, economists make calculations and strive to meet established budgets, instead of determining the actual need of patients for high-quality and effective nutritional therapy.

Communication Tools

Experience shows that psychological communication tools in the field of interpersonal contacts contribute to the following important results:

For patients:

• reducing the possibility of iatrogenicity, the likelihood of negative consequences due to misunderstanding of recommendations and following unprofessional recommendations due to mistrust of the doctor.

For doctors:

• increasing the effectiveness of treatment, patients’ responsibility for their actions and their adherence to treatment;
• reduction of professional stress;
• the opportunity to obtain information from the patient and give recommendations in the short time allotted for the appointment (for outpatient doctors).

In general, for a medical institution:

• improved treatment outcome;
• reducing the number of repeat requests;
• increased patient satisfaction with treatment, decreased number of complaints.

In this issue we will focus on the choice of psychological position for the interaction of a nutritionist with a patient. By making the right choice, you can increase the patient’s responsibility for treatment and ensure correct implementation of recommendations, ensuring conflict-free communication.

Test yourself

What type of influence do you usually use?

Let's take the first of the situations described above as an example. Here is a patient who ignores the recommendations of a nutritionist. You know that without following a diet, all efforts made for a quick recovery will be useless, therefore, the recovery period will be delayed. Various complications are also possible due to insufficient intake of essential nutritional components into the body, such as complete protein, vitamins, and microelements. Factors such as a chemically unbalanced diet and an increase in the volume of food intake will also lead to a re-deterioration of the patient’s condition. What will you do in this situation?

Select the answer option that is closest to you:

. A. You will persuade the patient. Listen to him, sympathize with him, and advise him to be patient.

. B. You will inform about what the diet is aimed at and what will happen if it is violated.

. C. Say that, in your opinion, he should follow a diet and if it is violated, punishment will come. For example, you will be forced to take action (discharge him from the hospital, indicate a violation of the regime on the sick leave certificate, etc.) or serious complications will occur in his condition (threat).

. D. You will take the violation of your diet with ease, sharing his joy from tasty, familiar food.

The choice of answer determines the psychological position you choose, which, in turn, directly determines the effectiveness of your interaction with the patient.

The psychological scenario determines whether the patient will become an assistant in treatment or will harm himself. Will become responsible or will not follow even simple recommendations. He realizes his role in the disease and treatment, or begins to blame others for all his troubles.

To influence effectively (to achieve the desired result with minimal effort and time), we recommend using the psychological model of transactional analysis, which is used to analyze human behavior. The author of the theory of transactional analysis is psychotherapist Eric Berne. In the early 1960s. he described the psychological positions that people take when interacting with others.

The main idea of ​​the transactional analysis scheme is this: in every person there are three components, three possible positions, which the author named in accordance with the roles that a person plays in life: Parent, Adult, Child. And just as in life, the Parent is the keeper of traditions, the Adult is an independently thinking and acting person, and the Child learns the world through play.

The scheme turned out to be so convenient and visual that in most approaches devoted to the interaction of people - at work and at home, in a psychotherapeutic group and when protecting from the influence of others - we are faced with ideas based on this scheme. Using this framework, we will analyze the following questions:

• compliance with the psychological position of the goal;
• psychological responsibility of the doctor and the patient;
• causes of conflicts and protection from manipulation.

Let's start with a description of the scheme and psychological positions.

Parent

He can be critical, tough, and judgmental. He looks for those to blame and does not tolerate objections. “You shouldn’t...”, “It’s your duty!”, “Your point of view is wrong...”, “Everyone always does this...” - he says with a condescending or accusing intonation. The parental position is also manifested in the use of interjections and particles, showing the unambiguity and rhetorical nature of statements: “-ka”, “well”, “whether”, “after all”. Compare phrases:

• “Do you want to feel good?” or “You want to feel good, right?”
• “Tell me, when did you take the medicine?” or “Tell me when?..”, “Tell me when?..”, “Well, when?..”

I don’t want to answer questions with particles “after all”, “-ka”, “well”, because the question becomes rhetorical, and it becomes rhetorical due to the fact that the Parent doesn’t actually ask anything, he knows everything in advance.

However, the Parent can also be soft, caring, then he helps, recognizes the other, shows care, encourages.

“Okay, well done,” “I understand you very well,” “Don’t worry,” he says warmly, reassuringly. In his speech there are many diminutive phrases: he calls the tablet a tablet, a pen - a little pen, those around him - Mashenka, Katenka, Vanechka, etc. This is how he takes care of the whole world around him. And outwardly he looks soft, worried. He has a smiling face and encouraging and calming gestures.

If a person is in the position of a Parent, then he is sure that he is right and does not separate his opinion from objective reality. He divides the whole world into those like him, Parents, and into everyone else - children, for whom the Parent takes responsibility.

Adult

Objective, neutral, open to other opinions. His typical sayings:

• “How will we proceed?”
• “How did this happen?” (Without hidden aggression.)
• “I am not aware of this point of view.”

An adult shares his opinion and the absolute truth, strives to find out objective facts, is ready to listen to another point of view and make an informed decision. He speaks calmly, specifically, confidently, neutrally, clearly and clearly. He holds himself straight, his face is turned to his partner, he looks attentively and intently, and he listens actively.

Child

He lives by emotions. “Great!”, “I want... I don’t want!!!” he blurts out with a stormy, capricious or surprised intonation. He laughs a lot and cries easily, emotions written all over his face. A person with a childish position does not care about the reactions of others; he is carefree, open, and self-directed. He can also be manipulative and demonstrative. And he never answers for anything.

About the book

Book by Eric Berne "Games People Play". London: Andre Deutsch, 1966; Penguin Books, 1968 (Bern. E. Games that people play. Translated from English by A. A. Gruzberg. M.: Progress, 1988) is a description of games discovered over several years of applying interaction analysis methods. This popular work has found recognition not only among the professionals for whom it was written, but also among a wide range of readers.

From the book by Eric Berne

Interaction analysis is a new way of seeing what people have done with each other over the centuries. Some critics have argued

that this is just another way of expressing the ideas of psychoanalysis. Of course, all doctors considered the same problems and the observations of psychotherapists have common features; however, the concepts of Parent, Adult and Child as real ego states have not been formulated by anyone before... The latest comparative data on interaction analysis and other types of treatment can be found in the book “Principles of Group Treatment” by Eric Berne. New York: Oxford University Press, 1966.

Source: Introduction to psychiatry and psychoanalysis for the uninitiated / Trans. from English A. I. Fedorova; terminological correction by V. Danchenko. — K.: PSYLIB, 2004 (Translation of the book “Layman’s Guide to Psychiatry and Psychoanalysis”).

How to proceed?

The key to efficiency is switching from one position to another. There is no bad or good position, there are adequate or inadequate goals. There are obvious correspondences - it is better to analyze information from the position of an Adult, communicate with friends over a cup of coffee - from the position of "Child - Child", give advice, order and patronize - from the Parent.

If you analyze the information from a child’s perspective, and, while discussing a weekend trip out of town over coffee, say phrases like “Taking into account the latest data received, it is advisable...”, the results will be, at a minimum, distorted.

But in the work of a doctor there are many non-obvious situations where an inadequate psychological position prevents the achievement of a goal. You and I will determine the best personal positions for each situation and learn how to manage the patient’s position. To do this, let's return to the question you answered earlier.

State of Self

The term "state of self" designates the various states of consciousness and patterns of behavior that correspond to this state, as they are seen in direct observation; the term allows one to avoid the use of such theoretical constructs as “impulse”, “civilization”, “super-ego”, etc. Structural analysis allows one to classify and accurately describe the states of the self.

Source: Bern E. Transactional analysis and psychotherapy. St. Petersburg, 1992. p. 19.

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Berne communication scheme

According to E. Berne, all three personality states (Adult, Parent, Child) are formed in the process of communication and a person acquires them regardless of his desire. The simplest communication process is the exchange of one transaction, it occurs according to a similar pattern: the “stimulus” of interlocutor No. 1 causes a “reaction” of interlocutor No. 2, who, in turn, sends a “stimulus” to interlocutor No. 1, that is, almost always a “stimulus” “one person becomes the impetus for the “reaction” of the second interlocutor. Further development of the conversation depends on the current state of the individual used

in transactions, as well as

in their combinations.

Source: Zelenkov M. Yu. Social conflictology, 2003.

Table 1. Pros and cons of various doctor positions for himself and the patient

Psychological gical position of the doctor	For the sick		For the doctor
	plus	minus	plus	minus
Criti- ical parent	Significantly, determine leniently, responsibly definitely	It is difficult for the patient to ask questions that concern him or express doubts	Speed ​​and definition laziness of influence	Required Difficulty of constant monitoring
Guardianship- parent	Comfortable, cozy	The ability to act independently is not developed Of course, without a doctor the patient feels helpless	Allows you to implement the pattern of guardianship, to feel indispensable silent	Constant emotions financial and time costs. There is a feeling of responsibility guilt for situations outside the zone of influence, possibly a feeling of guilt
Adult	Useful, practical, possible to discuss issues	Little emotional contact, there may be a lack of support, sometimes there is a feeling of detachment innocence	Achieving long- urgent goals, balance of responsibilities details	Weak emotional face-to-face contact with the patient
Child	Easy, interesting	The practical solution is not clear, there is no feeling of security and responsibility. the doctor's responsibility for what is happening	Mini- low stress	Loss of authority, impossible ability to achieve goals

Situation analysis

So, the patient says that it is impossible to eat tasteless hospital food and that he is not going to follow the therapeutic diet recommended by the doctor. The patient’s refusal may not be so obvious, but when communicating with the patient, the doctor understands that the patient will not follow his nutritional recommendations. Your options in this situation:

A. You will persuade the patient, you will sympathize with him.

B. Inform about the properties of the diet.

C. Threaten the patient.

D. You will take it easy to break your diet.

Answer option A

From the perspective of transactional analysis, this is the response of the caring Parent: the patient gets the opportunity to enjoy care and help. Convenient, but does not encourage the patient to take responsibility for his health and independently follow the instructions. The situation is established in which diet and treatment in general are needed by the doctor and he constantly persuades the patient to undergo treatment. This position can be the basis for manipulation by the doctor.

Answer option B

Adult's answer: provide all the necessary information, provide the right to make decisions and bear responsibility for them. It may seem that with this response the clinician is less likely to influence the participant. In fact, the patient’s adult position, updated in this case, forces him to carefully weigh all the arguments and make an adequate decision.

Answer option C

Response from a harsh, critical Parent. It is the most provocative and capable of causing resistance. Such a response will only work if the doctor really has sufficient power, administrative resources, authority, and the ability to inspire.

Answer option D

This is the response of a Child to a Child. He is very sweet, easy-going and charming. In addition, it develops and strengthens pleasant relationships. However, it does not lead to solving the doctor’s problems, which can later result in significant difficulties.

To test your psychological position in a real interaction with a patient, analyze the patient's response, which instantly responds in complementary roles. For example, if a patient demonstrates an unconscious childlike position, this means that the doctor is acting from a Parental position.

In order to consider the pros and cons that arise from various positions of the doctor for himself and the patient, we advise you to refer to the table. 1.

Now let's return to our goal - to increase the patient's responsibility for treatment and ensure that he correctly follows the recommendations.

The Adult is responsible for his (and specifically his) actions. And the child’s position is irresponsible; all the promises made by the Child have no force and are not fulfilled.

The boundaries of a doctor’s responsibility for a patient are quite blurred, and it often becomes global in nature. Therefore, the medical profession provokes professional deformation towards the predominance of the Parental position, which allows one to help and save. However, the Parental position is effective when the doctor works for the result in this particular situation and the situation is completely under his control.

But as soon as the patient’s own activity begins (independently taking medications, following recommendations, following a diet), it is necessary to achieve not the patient’s obedience at this particular moment in time, but his adequate independent actions. This means that the patient must not only perform actions, but accept them, realize them, and understand his responsibility. And this is an adult position.

An incorrect choice of position or an erroneous assessment of the patient’s psychological state can lead to tragic consequences. A frightened, exhausted person may be unable to understand the situation and accept responsibility. If the success of treatment depends on his actions, then the doctor needs to increase his awareness. However, if nothing depends on his actions (for example, an operation is currently pending during which the patient will be under anesthesia), an attempt at partner interaction can be a serious mistake.

But it can also be a serious mistake to try to implement Parent Scenarios in the absence of real power. Imagine that another, “stronger” Parent appears - neighbor Maria Ivanovna or a doctor at the clinic - and says: “What did they prescribe for you? Are you crazy?!” And our patient Child will easily succumb to this stronger influence. But the influence of an Adult is difficult to interrupt. If you have explained how proteins affect metabolism and why the amount of their consumption should not be below a certain level, then simply saying “if you want to lose weight, you can’t eat protein” will not change the patient’s opinion.

Flexibility in choosing a position will ensure adequate behavior in different situations. The Parent’s method of influence is an order, forceful pressure, the Adult’s method is persuasion, and the Child’s is emotional contagion. Therefore, it is better to begin contact with the expression of emotions - to be happy for the patient, sympathize with him, thank him. The easiest way to do this is from the “Child - Child” position. Other tasks are best performed from other positions: asking - from the position of “Child - Parent”, presenting arguments, conveying information, assigning responsibility and persuading for a long time more effectively from the position of “Adult - Adult”, ordering, making responsible decisions on your own, instructing, caring - adequately from a parental position.

What mistakes happen when choosing a psychological position?

• The chosen position is fundamentally unsuitable for the purpose. For example, you decide to clarify the situation, and you begin to act from the Parental position: “Well, what happened to you this time?” The patient’s reaction may be different (justification, counter-attack, withdrawal from contact), but you definitely will not receive information in response.
• Incorrect assessment of your capabilities and resources. For example, when choosing the position of a critical Parent, you need to understand that this is a forceful influence and it will not work if you do not have enough authority, power, status, knowledge, authority, communication abilities or any other type of strength. The most likely result will be covert or overt resistance. In the first case, you will encounter sabotage and failure to fulfill assignments; in the second, you will encounter objections and appeals to authorities.
• Getting stuck in one of the positions. Communication with a patient is multifaceted; just one role cannot meet all of his tasks. Therefore, some tasks will not be implemented. For example, no matter how constructive the Adult’s position is, it will not solve the problem of emotional support, which the patient needs in some cases. Even more dangerous—and common—is getting stuck in the Parent position. Because a vicious circle arises: responsibility - the parental position of the doctor - the childish position of the patient - his irresponsibility - the inability to achieve the goal. All this creates stress. It arises due to overload (being in the Parental position, we cannot say “I can’t”, “I don’t know”) and the feeling that circumstances are beyond our control.

The way out is to break the vicious circle, clearly define your area of ​​responsibility, and develop the responsibility of patients.

• First of all, learn to distinguish an Adult from a Child; The parent will appear later.
• Wait until the patient provides at least three examples or diagnostic illustrations before introducing the appropriate system of concepts.
• Subsequently, the diagnosis of the Parent or Child should be confirmed by specific historical material.
• Realize that the three Self-states should be taken literally, as if the patient contains three different people. The therapist must also acknowledge his or her own three self-states and their impact on therapy.
• It is necessary to proceed from the fact that each patient is characterized by the Adult self-state; the problem is in its feeding with psychic energy.
• A child is distinguished not by childishness, but by childishness. A child has potentially valuable qualities.
• The patient must experience the Child's Self-state, and not just remember his experiences (regression analysis).
• Pastime and games are not habits, attitudes or random events; they constitute a large part of the patient's activity.
• “The ideal would be to hit the bull's eye, an intervention that is acceptable and meaningful to all three aspects of the patient's personality, since they all hear what is said” (Berne, 1961, p. 237). The intervention is recognized by all three I-states.

A beginner will likely have some difficulty mastering the terminology, but this is a predictable part of learning any new system.