The discipline program “Fundamentals of Nursing. Section II

13. The concept of the nursing process, its purpose and ways to achieve it

Currently, the nursing process is the core of nursing education and creates the theoretical scientific basis for nursing care in Russia.

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

The nursing process is one of the basic and integral concepts of modern models of nursing.

Purpose nursing process is maintaining and restoring the patient’s independence in meeting the basic needs of the body.

Achieving the goal of the nursing process carried out by solving the following tasks:

1) creating a patient information database;

2) determining the patient's needs for nursing care;

3) designation of priorities in nursing care, their priority;

4) drawing up a care plan, mobilizing the necessary resources and implementing the plan, that is, providing nursing care directly and indirectly;

5) assessing the effectiveness of the patient care process and achieving the goals of care.

The nursing process brings a new understanding of the role nurse in practical healthcare, requiring from her not only technical training, but also the ability to creatively relate to patient care, the ability to individualize and systematize care. Specifically, it involves the use of scientific methods to determine the health needs of the patient, family or society, and on this basis the selection of those that can be most effectively met through nursing care.

The nursing process is a dynamic, cyclical process. Information obtained from assessing the results of care should form the basis for the necessary changes, subsequent interventions, and actions of the nurse.

14. Stages of the nursing process, their relationship and the content of each stage

I stage– nursing assessment or assessment of the situation to determine the patient's needs and the resources needed for nursing care.

II stage– nursing diagnosis, identification of patient problems or nursing diagnoses. Nursing diagnosis- this is the patient’s health status (current and potential), established as a result of a nursing examination and requiring intervention by the nurse.

Stage III– planning necessary assistance to the patient.

Planning refers to the process of forming goals (i.e., desired outcomes of care) and the nursing interventions necessary to achieve these goals.

IV stage– implementation (implementation of the nursing intervention (care) plan).

V stage– outcome assessment (summary assessment of nursing care). Evaluating the effectiveness of the care provided and adjusting it if necessary.

Documentation of the nursing process is carried out in the nursing record of monitoring the patient's health status, an integral part of which is the nursing care plan.

15. Principles of record keeping

1) clarity in the choice of words and in the entries themselves;

2) brief and unambiguous presentation of information;

3) coverage of all basic information;

4) use only generally accepted abbreviations.

Each entry must be preceded by a date and time, and the entry must be followed by the signature of the nurse writing the report.

1. Describe the patient's problems in his own words. This will help you discuss care issues with him and help him better understand the care plan.

2. Call goals what you want to achieve together with the patient. Be able to formulate goals, for example: the patient will have no (or reduced) unpleasant symptoms (indicate which ones), then indicate the period within which, in your opinion, a change in health status will occur.

3. Create individual patient care plans based on standard care plans. This will reduce plan writing time and define a scientific approach to nursing planning.

4. Keep the care plan in a place convenient for you, the patient and everyone involved in the nursing process, and then any member of the team (shift) can use it.

5. Mark the deadline (date, deadline, minutes) for the implementation of the plan, indicate that assistance was provided in accordance with the plan (do not duplicate entries, save time). Sign the specific section of the plan and enter it there Additional information, which was not planned, but was required. Correct the plan.

6. Involve the patient in keeping records related to self-care or, for example, taking into account the water balance of daily urine output.

7. Train everyone involved in care (relatives, support staff) to perform certain elements of care and record them.

The period of implementation of the nursing process is quite long, so the following problems related to documentation may arise:

1) the impossibility of abandoning old methods of record keeping;

2) duplication of documentation;

3) the care plan should not distract from the main thing - “providing assistance.” To avoid this, it is important to view documentation as a natural progression of the continuum of care;

4) documentation reflects the ideology of its developers and depends on the nursing model, therefore it is subject to change.

16. Methods of nursing interventions

Nursing care is planned on the basis of disruption to the patient's needs, and not on the basis of a medical diagnosis, i.e. disease.

Nursing interventions can also be ways to meet needs.

It is suggested to use the following methods:

1) provision of first aid;

2) fulfillment of medical prescriptions;

3) creation comfortable conditions for the patient in order to meet his basic needs;

4) providing psychological support and assistance to the patient and his family;

5) performing technical manipulations and procedures;

6) implementation of measures to prevent complications and promote health;

7) organizing training in conducting conversations and counseling the patient and his family members. Planning of necessary care is carried out on the basis of the classification of nursing actions according to the INCP (International Classification of Nursing Practice).

There are three types of nursing interventions:

1) dependent;

2) independent;

1) obtain a clear understanding of the patient before care planning begins;

2) try to determine what is normal for the patient, how he sees his normal state of health and what help he can provide himself;

3) identify the patient's unmet care needs;

4) establish effective communication with the patient and involve him in cooperation;

5) discuss care needs and expected care outcomes with the patient;

6) determine the patient’s degree of independence in care (independent, partially dependent, completely dependent, with the help of whom);

Transcript

1 basics of NURSING ALGORITHMS OF MANIPULATION TRAINING MANUAL FOR MEDICAL SCHOOLS AND COLLEGES Recommended by the State Educational Institution of Higher Professional Education “Moscow Medical Academy named after I.M. Sechenov" as a teaching aid for students of secondary vocational education institutions studying in the specialties "Nursing" and "General Medicine" in the discipline "Fundamentals of Nursing"

2 UDC (07) BBK 53.5 Registration 641 reviews from the Federal State Institution Federal Institute for Educational Development Team of authors: Shirokova N.V. teacher of nursing, Moscow Regional Medicine College 2. Ostrovskaya I. V. Associate Professor of the Department of Management nursing activities MMA I.M. Sechenov. Klyukova I.N. teacher of the fundamentals of nursing at the Lyubertsy Medical College. Morozova N. teacher of the fundamentals of nursing at the Mytishchi School of Medicine. Morozova G.I. teacher of the fundamentals of nursing at the Moscow Regional Medical College. Guseva I.A. teacher of the basics of nursing at Noginsk Medical University taught? 0-75 Fundamentals of nursing: Algorithms of manipulation: textbook / N.V. Shirokova and others - M.: GEOTAR-Media, p. ISBN The training manual contains algorithms for performing the necessary procedures for patient care and is designed to improve the quality of medical care provided. The manual has been developed in accordance with Federal law Russian Federation December 18, 2002 “On technical regulation”; provisions of the state standardization system of the Russian Federation (GOST R GOST R); general requirements for specialists in the field of nursing. Recommended for students and teachers of medical schools and colleges, students of advanced training departments in the specialties “Nursing”, “General Medicine” and medical workers. UDC "BBK53.5* The rights to this publication belong to LLC Publishing Group "GEOTAR-Media". Reproduction and distribution in any form of part or the whole publication cannot be carried out without the written permission of LLC Publishing Group "GEOTAR-Media". ISBN Team of authors, 2009 LLC Publishing Group "GEOTAR-Media", 2010 LLC Publishing Group "GEOTAR-Media", design, 2010

3 CONTENTS From the authors... 6 Chapter 1. Nursing examination... 7 Examination of the pulse on the radial artery... 7 Measuring body temperature in the axillary region (in a hospital setting)... 8 Measuring blood pressure... 10 Measuring the patient's height... 12 Weighing and determining body weight Chapter 2. Infection safety. Infection control Carrying out disinfection and pre-sterilization cleaning of medical devices in one stage manually...14 Chapter 3. Reception of the patient Treatment of a patient with lice...16 Chapter 4. Safe hospital environment. Therapeutic-protective regime Rotating the patient and placing him in the position on the right side...18 Transferring the patient from the supine position to the Sims position...20 Moving the patient with hemiplegia to the prone position...21 Placing the patient with hemiplegia in the Fowler position ...23 Placing the patient in a supine position...25 Chapter 5. Personal hygiene of the patient Changing bed linen in a transverse way...27 Changing bed linen in a longitudinal way Changing a shirt for a seriously ill patient Helping the patient use a bedpan or urinal Care of the external genitalia men... ".... :...32 Care of the external genitalia and perineum of women...34 Morning toilet of a seriously ill patient: washing Morning toilet of a seriously ill patient: toilet of the oral cavity...36 Application of medicinal effects on the oral mucosa ...38 Morning toilet of a seriously ill patient: toilet of the eyes...39 Morning toilet of a seriously ill patient: toilet of the nose Morning toilet of a seriously ill patient: toilet of the ears Chapter 6. Feeding the patient Feeding the patient in bed using a sippy cup Feeding the patient in bed using a spoon Feeding the patient through a nasogastric tube Caring for a nasogastric tube Feeding a patient through a gastrostomy tube Chapter 7. Methods of simple physiotherapy. Hirudotherapy Using mustard plasters Using a heating pad Using an ice pack Applying a warm compress Applying a cold compress... 56

4 Placement of cups Placement of leeches (hirudotherapy) Supply of humidified oxygen through a nasal catheter Chapter 8. Use of medications Instillation of oil drops into the nose Instillation into the nose vasoconstrictor drops Patient training in use pocket inhaler Introducing a suppository with a laxative effect to the patient. A set of medicine from an ampoule. Dilution of antibiotics. Performing an intradermal injection. Performing a subcutaneous injection. Performing an intramuscular injection. intravenous injection Filling the infusion system Carrying out the infusion Chapter 9. Enemas. Gas outlet pipe. Colostomy bag Cleansing enema Siphon enema Oil laxative enema Hypertonic laxative enema Medicinal microenema Drip enema Production vent pipe Algorithm of patient actions when replacing an adhesive (adhesive) colostomy bag Chapter 10. Catheterization Bladder Catheterization of a woman's bladder with a rubber catheter Catheterization of a man's bladder with a rubber catheter Placement and fixation of a permanent catheter...: Flushing the bladder Chapter 11. Punctures Participation of a nurse in performing a pleural puncture Participation of a nurse in performing a lumbar puncture Participation of a nurse in performing a sternal puncture Participation of a nurse in performing abdominal puncture Chapter 12. Laboratory and instrumental studies Guidelines “Rules and techniques for obtaining samples of clinical material for research in the clinical microbiology laboratory” Throat swab Nasal swab Collecting blood from a peripheral vein Taking blood from a vein into vacuum containers Collecting sputum for clinical analysis Collection of sputum for bacteriological examination Collection of sputum for Mycobacterium tuberculosis Collection of sputum for tumor cells(atypical) Collection of stool for scatological examination Collection of stool for bacteriological examination Collection of stool for examination on occult blood Stool collection to detect protozoa

5 5 Collection of stool for analysis for helminth eggs Collection of urine for general clinical analysis Collection of urine for sugar in daily quantity Urine collection for diastasis Urine collection according to Nechiporenko Urine collection according to Zimnitsky Preparing the patient for fibroesophagogastroduodenoscopy Chapter 13. Probe manipulations Gastric lavage with a thick probe Gastric lavage with a thin probe Taking gastric contents for examination secretory function stomach Duodenal intubation (fractional method) Chapter 14. Out-of-hospital cardiopulmonary resuscitation Cardiopulmonary resuscitation by one rescuer Cardiopulmonary resuscitation by two rescuers Chapter 15. Handling a tracheostomy tube Caring for a plastic tracheostomy tube with an indeflatable cuff Patient education tracheostomy tube care

6 CHAPTER 1 NURSING EXAMINATION STUDY OF PULSE ON THE RADIAL ARTERY Purpose: diagnostic. Indications: doctor's prescriptions, preventive examinations. Equipment: watch or stopwatch, temperature sheet, pen. I. Preparation for the procedure Establishing contact with the patient 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time 2. Explain to the patient the purpose and sequence of the procedure Psychological preparation of the patient 3. Obtain the patient's consent to the procedure Respect for the patient's rights 4. Prepare the necessary equipment Carrying out the procedure and documenting its results 5. Wash and dry hands P. Performing the procedure 1. Invite the patient to sit or lie down. In this case, the arms should be relaxed, the hand and forearm should not be suspended 2. Press the radial arteries on both hands of the patient at the base with fingers II, III, IV thumb(The first finger should be on the back of the hand), feel the pulsation and lightly squeeze the arteries. Ensuring the reliability of the result Determining the synchrony of the pulse. If the pulse is synchronous, then further research is carried out on one arm 3. Determine the pulse rhythm. If the pulse wave follows one after another at regular intervals, then the pulse is rhythmic, if not, it is arrhythmic. In case of severe arrhythmia, additional research to identify pulse deficiency The rhythm of the peripheral pulse should coincide with the rhythm of heart contractions. The difference between the number of heart beats per minute and the peripheral pulse rate at the same minute is called the pulse deficit

7 4. Determine the pulse rate per minute: take a watch or stopwatch and count the number of pulse beats within 30 seconds. Multiply the result by two (if the pulse is rhythmic) and get the pulse frequency. If the pulse is arrhythmic, then the number of pulse beats should be counted within 60 s. Heart rate depends on age, gender, physical activity. Ensuring accuracy of heart rate determination. Normal heart rate: from 2 to 5 years about 100 beats/min; from 5 to 10 years about 90 beats/min; adult men bpm; adult women bpm; pulse more than 80 beats/min, tachycardia; pulse less than 60 beats/min bradycardia 5. Determine the filling of the pulse: if the pulse wave is clear, then the pulse is full, if weak it is empty, if the pulse wave is very weakly palpable, then the pulse is thread-like Pulse filling depends on the volume of circulating blood and the magnitude of cardiac output 6. Determine pulse tension. To do this, you need to press the artery harder than before to radius. If the pulsation stops completely, the tension is weak, the pulse is soft; if the tension weakens moderately; if the pulsation does not weaken, the pulse is tense, hard. Ensuring the accuracy of determining the pulse voltage. It depends on the tone of the arterial vessels. The higher the blood pressure readings, the more intense the pulse 7. Inform the patient the result of the study The patient’s right to information III. End of procedure 1. Wash and dry hands 2. Make a note reflecting the results obtained and the patient's reaction Ensuring continuity of nursing care Note. To determine the pulse, you can use the temporal, carotid, subclavian, femoral arteries, and dorsal artery of the foot. MEASURING BODY TEMPERATURE IN THE AXILLAR REGION (IN A HOSPITAL CONDITION) Purpose: diagnostic. Indications: routine temperature measurement in the morning and evening, in patients with fever as prescribed by a doctor. Equipment: watch, medical maximum thermometer, pen, temperature sheet, towel or napkin, container with disinfectant solution. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully, clarify how to address him if the nurse sees the patient for the first time 2. If the patient does not know the purpose and sequence of the procedure, explain them to him Establishing contact with the patient Psychological preparation of the patient for the procedure 3. Obtain the patient’s consent to the procedure Respect for the patient’s rights

8 4. Wash and dry your hands Prevention nosocomial infection 5. Prepare the necessary equipment. Make sure that the thermometer is intact and that the reading on the scale does not exceed 35 C. Otherwise, shake the thermometer so that the mercury drops below 35 C. Ensuring patient safety and the reliability of the temperature measurement result P. Performing the procedure 1. Examine the axillary area, if necessary, wipe it dry with a napkin or ask the patient to do this. Attention! In the presence of hyperemia, local inflammatory processes, temperature measurement cannot be carried out. Ensuring the reliability of the result 2. Place the thermometer reservoir in the axillary area so that it is in close contact with the patient’s body on all sides (press shoulder to chest) Providing conditions for obtaining a reliable result 3. Leave the thermometer for at least 10 minutes. The patient should lie in bed or sit 4. Remove the thermometer. Assess the indicators by holding the thermometer horizontally at eye level Ensuring the reliability of the results Evaluating the measurement results 5. Inform the patient of the thermometry results Ensuring the patient's right to information III. End of the procedure 1. Shake the thermometer so that the mercury column drops into the reservoir. Preparing the thermometer for subsequent measurement of body temperature 2. Immerse the thermometer in a disinfectant solution 3. Wash and dry your hands 4. Make a note of the temperature readings on the temperature sheet. Report patients with fever to the doctor on duty Ensuring continuity of patient monitoring

9 MEASUREMENT OF BLOOD PRESSURE Purpose: diagnostic. Indications: doctor's prescription, preventive examinations. Equipment: tonometer, phonendoscope, alcohol, swab (napkin), pen, temperature sheet. I. Preparation for the procedure Establishing contact with the patient 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time 2. Explain to the patient the purpose and sequence of the procedure Psychological preparation for the manipulation 3. Obtain consent for the procedure Respect for the patient's rights 4. Warn the patient about the procedure 15 minutes before its start, if the study is being carried out in a planned manner Ensuring the reliability of the result 5. Prepare the necessary equipment Ensuring the effective implementation of the procedure 6. Wash and dry your hands 7. Connect the pressure gauge to the cuff and check the position of the pressure gauge needle relative to the zero mark of the scale Checking the serviceability and readiness of the device for work 8. Treat the phonendoscope membrane with alcohol P Performing the procedure 1. Sit or lay the patient down, ensuring the arm position in which the middle of the cuff is at the level of the heart. Place the cuff on the patient's bare shoulder 2-3 cm above the elbow (clothing should not compress the shoulder above the cuff); fasten the cuff so that 2 fingers are placed between it and the shoulder (or 1 finger in children and adults with small arms). Attention! You should not measure blood pressure on the arm on the side of the mastectomy, on the weak arm of a patient after a stroke, on a paralyzed arm. Elimination of possible unreliability of the results (every 5 cm of displacement of the middle of the cuff relative to the level of the heart leads to an overestimation or underestimation of blood pressure readings by 4 mm Hg) . Elimination of lymphostasis that occurs when air is pumped into the cuff and the vessels are compressed. Ensuring the reliability of the result 2. Invite the patient to place his hand correctly: in an extended position with the palm up (if the patient is sitting, ask to place a clenched fist of the free hand under the elbow) Ensuring maximum extension of the limb 3. Find the place of pulsation of the brachial artery in the area of the ulnar cavity and lightly press it to the skin in this place (without any effort) the phonendoscope membrane Ensuring the reliability of the result

10 4. Close the valve on the bulb by turning it to the right and pump air into the cuff under the control of a phonendoscope until the pressure in the cuff (according to the pressure gauge) exceeds 30 mm Hg. the level at which the pulsation disappeared 5. Turn the valve to the left and begin to release air from the cuff at a speed of 2-3 mm Hg/s, maintaining the position of the phonendoscope. At the same time, listen to the sounds on the brachial artery and monitor the indicators on the manometer scale. Eliminate discomfort associated with excessive compression of the artery. Ensuring the reliability of the result Ensuring the reliability of the result 6. When the first sounds (Korotkoff sounds) appear, “mark” the numbers on the pressure gauge scale and remember them; they correspond to the systolic pressure indicators. Ensuring the reliability of the result. The systolic pressure values should coincide with the pressure gauge readings at which pulsation disappeared during the process of pumping air into cuff 7. Continuing to release air, note the diastolic pressure readings corresponding to the weakening or complete disappearance of loud Korotkoff sounds. Continue auscultation until the pressure in the cuff decreases by mm Hg. relative to the last tone Ensuring the reliability of the result 8. Round the measurement data to 0 or 5, record the result as a fraction (in the numerator systolic pressure; the denominator is diastolic), for example 120/75 mm Hg. Release the air from the cuff completely. Repeat the procedure for measuring blood pressure two to three times with an interval of 2-3 minutes. Record the average values 9. Inform the patient the measurement result. Attention! In the interests of the patient, reliable data obtained during the study is not always reported. Ensuring reliable blood pressure measurement results. Ensuring the patient’s right to information III. End of the procedure 1. Treat the phonendoscope membrane with alcohol 2. Wash and dry your hands 3. Make a note reflecting the results obtained and the patient’s reaction Ensuring continuity of observation Note. At the patient’s first visit, you should measure the pressure on both arms, then only on one, noting which one. If persistent significant asymmetry is detected, all subsequent measurements should be carried out on the hand with higher values. Otherwise, measurements are carried out, as a rule, on the “non-working hand”.

11 MEASUREMENT OF PATIENT GROWTH Purpose: Assessment physical development. Indications: admission to hospital, preventive examinations. Equipment: stadiometer, pen, medical history. Problem: The patient cannot stand. I. Preparation for the procedure 1. Collect information about the patient. Kindly introduce yourself to him. Clarify how to contact him if the nurse sees the patient for the first time. Explain the upcoming procedure to the patient and obtain consent. Assess the patient's ability to participate in the Establishing contact with the patient procedure. Ensuring the patient’s psychological preparation for the upcoming procedure. Respect for the patient's rights 2. Prepare a stadiometer: place an oilcloth or disposable napkin under your feet. Invite the patient to take off his shoes and relax; women need to let their hair down. Ensuring the prevention of nosocomial infections. Ensuring reliable indicators II. Performing the procedure 1. Invite the patient to stand on the stadiometer platform with his back to the stand with the scale so that he touches it with three points (heels, buttocks and interscapular space) Ensuring reliable readings 2. Stand to the right or left of the patient Ensuring a safe hospital environment 3. Slightly tilt the patient’s head so that the upper edge of the external auditory canal and the lower edge of the orbit are located on the same line, parallel to the floor. Ensuring reliable indicators” 4. Lower the tablet onto the patient’s head, fix it, ask the patient to lower his head, then help him get off the stadiometer. Determine the indicators corresponding to the numbers located at the level of the bottom edge of the tablet. Providing conditions for obtaining results. Ensuring a protective regime 5. Communicate the received data to the patient Ensuring the patient's rights III. End of the procedure 1. Record the received data in the medical history Ensuring continuity of nursing care Note. If the patient cannot stand, the measurement is taken in a sitting position. I should offer the patient a chair. The fixation points will be the sacrum and interscapular space. And measure your height while sitting. Record the results.

12 WEIGHING AND DETERMINATION OF BODY WEIGHT Purpose: assessment of physical development, effectiveness of treatment and care. Indications: preventive examinations, diseases of the cardiovascular, respiratory, digestive, urinary and endocrine systems. Equipment: medical scales, pen, medical history. Problems: serious condition patient. I. Preparation for the procedure 1. Collect information about the patient. Politely introduce yourself to him. Ask how to address him if the nurse sees the patient for the first time. Explain the procedure and rules (on an empty stomach; in the same clothes, without shoes; after emptying the bladder and, if possible, bowel movements). Obtain patient consent for the procedure. Assess the possibility of his participation in it Establishing contact with the patient. Respect for the patient's rights 2. Prepare the scales: align, adjust, close the shutter. Place oilcloth or paper on the scale platform. reliable results. P. Performing the procedure 1. Ask the patient to take off his outer clothing, take off his shoes and carefully stand on the center of the scale platform. Open the shutter. Move the weights on the scales to the left until the level of the rocker matches the control level Ensuring reliable readings 2. Close the shutter Ensuring the safety of the scales 3. Help the patient get off the weight platform Ensuring protective regime 4. View the data. Remember that a large weight fixes tens of kilograms, and a small gram within a kilogram. Using the Ketele index body mass index, you can determine the correspondence of height to body weight. To do this, the weight must be divided by the squared height and compared with the indices below: 18 19.9 less than normal; 20 24.9 ideal body weight; 25 29.9 pre-obesity; over 30 obesity 5. Communicate data to the patient Ensuring patient rights III. End of the procedure 1. Remove the napkin from the site and throw it into the trash container. Wash and dry your hands Prevention of nosocomial infections 2. Record the findings in the medical history Ensuring continuity of nursing care Note. If it is not possible to weigh the patient at the moment, the manipulation can be postponed, since it is not vital. In intensive care units and hemodialysis, patients are weighed in bed using special scales.

13 CHAPTER 2 INFECTION SAFETY. INFECTION CONTROL DISINFECTION AND PRE-STERILIZATION CLEANING OF MEDICAL DEVICES IN ONE STAGE MANUAL Purpose: effective disinfection and removal of protein, fat, mechanical contaminants) drug residues to ensure the effectiveness of subsequent sterilization. Indications: contact of instruments and medical devices with biological > bones, wound surfaces and medications. Equipment: containers with tight-fitting lids, measuring cups or dispenser. syringes and needles, thick or “chain mail” gloves, medical instruments, trays, chemical compounds approved for use as detergents and disinfectants, cotton-gauze swabs, brushes, brushes, napkins. Conditions: presence of a ventilated room, strict adherence to guidelines (instructions regarding the timing of use of drugs and rules for working with each of them I. Preparation for the procedure 1. Put on protective clothing Preserving the health of personnel 2. Prepare equipment Efficiency of the procedure 3. Prepare a detergent and disinfectant complex, for example, based on amixan: add to a container with drinking water using a measuring container amixan at the rate of 30 ml per 1 liter of water. Stir P. Performing the procedure 1. Immerse the used instruments in the resulting 3% working solution: complex disassembled; having a locking part with open locks. Fill the internal channels of needles and tubular products with the resulting solution using a syringe. Make sure that the liquid level border rises above the instruments by more than 1 cm. Close the lid. Attention! Piercing and cutting instruments must be soaked in separate containers Ensuring a disinfection cleaning regime Ensuring the effectiveness of disinfection and cleaning. Environmental protection. Ensuring personnel safety 2. Maintain exposure of products for 15 minutes. Ensuring a disinfecting effect.

14 3. Remove the lid from the container and rinse each product in the solution using a sponge, brushes, napkin or cotton-gauze swab, channels using a syringe Removing contaminants from joints on instruments, from gaps, cavities, gaps 4. Raise the perforated tray with instruments over the container, allow the solution to drain. Place the tray with tools in the sink under running water and rinse each product for 5 minutes 5. Rinse each product with distilled water (channels using a syringe or electric suction) for 0.5 minutes Removing residues detergents from processed products Desalting the surface of products and preventing pyrogenic reactions 6. Dry the instruments with hot air in an air sterilizer at a temperature of 85 C until the moisture completely disappears Reducing the risk of contamination of products III. End of procedure 1. Remove gloves, wash hands with soap and running water Note. To carry out disinfection and pre-sterilization cleaning in one stage, you can use: alaminol, lysetol AF, veltolen, disinfectant, deconex dental, dulbak, septabic, septodor, septodor forte, virkon, peroximed, blanisol, anolytes from an ECHO installation, Vex-side, nika -exta M, lysofin and other approved products.

15 CHAPTER 3 RECEPTION OF A PATIENT TREATMENT OF A PATIENT WITH PEDICULOSIS Purpose: therapeutic and preventive. Indications: presence of pediculosis. Equipment: additional robe, headscarf, 2 waterproof aprons, gloves, oilcloth tires with warm water, anti-pediculosis agent, shampoo, 2 towels, comb (comb basin, cellophane drape, shower cap. I. Preparation for the procedure 1. Collect information about the patient before meeting him. Introduce yourself kindly and respectfully to him. Clarify how to address him, if the nurse sees the patient for the first time. Find out whether he is familiar with this manipulation; when, for what reason, how he underwent it Establishing contact with the patient 2. If the patient does not know the purpose and sequence of the upcoming procedure, explain them to him Psychological preparation for the manipulation 3. Obtain his consent Respect for the patient's rights 4. Prepare the necessary equipment Ensuring that the procedure is carried out effectively 5. Wash and dry your hands, put on an additional gown, apron, gloves Lay an oilcloth on the floor and place a chair on it 6. Help the patient put on an apron and sit (if condition allows) on chair, cover the patient's shoulders with a cellophane drape 7. Give the patient (if possible) a towel and ask him to close his eyes. If the patient is unable to hold a towel, an assistant will do this for him, who should also have an additional robe, scarf and gloves. Dilute the pediculocide in accordance with the instructions for use II. Performing the procedure 1. Wet the patient's hair with a small amount of water from a jug (water temperature C) Ensuring the safety of the infectious patient Preventing the fagot from getting into the patient's eyes. Ensuring the procedure and organizing the safety of the nurse and patient. Providing conditions for nag pediculocidal agent

16 2. Treat the patient’s hair evenly with the prepared anti-pediculocidal agent (t 27 C). Cover the patient's head with a cap for min (exposure depends on the product used) 3. Rinse the patient's hair with warm water, rinse it with a 6% solution of table vinegar (t 27 C). Divide hair into strands and comb each strand with a fine comb. Remove the towel covering your eyes. Dry and examine the patient's hair. Attention! If there are flat spots, the hair in armpits and the pubic area is shaved or treated with the same pediculocidal agent. Ensuring the quality of anti-pediculosis treatment. Quality control of the treatment. Ensuring quality treatment 4. Ask the patient how he is feeling Determine the patient's response to the procedure III. End of the procedure 1. Place the patient’s linen and clothing in a bag and send it to the disinfection chamber. Remove apron, robe, gloves, place in a bag for disinfestation. Wash and dry your hands 2. Make a note about head lice: on the title page in the right Ensuring continuity in the upper corner " Medical card inpatient” control and monitoring of the patient, put the letter “P” in red pencil 3. Fill out an emergency notification about the detection of an infectious disease and report to the branch of the Federal Government institution health care "Center for Hygiene and Epidemiology" (F. 058/U), register the patient's data in the "Recording Journal" infectious diseases» (F. 060/U) Compliance with nosocomial infection control requirements Note. If the hair is treated not with organophosphorus preparations, but with a soap-powder emulsion, the nits remain unharmed, so additional treatment is required with a 30% solution of table vinegar heated to 27 C (20 min). If head lice is detected in men, the hair can be cut short (with the patient's consent). The cut hair is collected in a bag and burned. Used instruments and care items, the room where the patient was treated, are disinfected with the same means.

17 TRANSFERING THE PATIENT FROM THE SUPINAL POSITION TO THE SIMPLE POSITION Purpose: to place the patient in a physiological position (done by one or two nurses; the patient can only help partially or cannot help at all). Indications: forced or passive position, change of position if there is a risk of developing bedsores or bedsores. Equipment: extra pillow, footrest or sandbag, bolsters, half a rubber ball. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time Establishing contact with the patient 2. Explain the purpose and sequence of the procedure Ensuring the patient’s psychological preparation for the procedure 3. Obtain the patient’s consent to perform the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5. Wash and dry your hands. If there is a risk of contact with biological fluid put on gloves II. Performing Procedure 1. Apply the bed brakes. Raise the bed to the maximum comfortable height for working with the patient 2. Lower the side rails (if any) on the left side of the patient. Move the head of the bed to a horizontal position (or remove pillows) 3. Ask the patient to cross his arms over his chest, move him closer to the left edge of the bed 4. Inform the patient that he can help the nurse in the following way: lay left leg under the right. If the patient himself is not capable of such actions, the nurse needs to clasp the back of the patient's foot with one hand and move it towards the pelvis, sliding it along the bed. At the same time, with the other hand, located in the popliteal cavity, the nurse lifts the patient’s leg up. Prevention of nosocomial infections. Ensuring the safety of the patient and the correct biomechanics of the nurse’s body. Ensuring access to the patient and his safety. Ensuring that the patient's body is properly erect Providing sufficient space for the patient to turn onto their side Ensuring the patient's active participation. Decline physical activity to the nurse 5. Raise the side rails. Stand to the right of the bed and lower the grab bars 6. Place the protector on the bed next to the patient. Stand as close to the bed as possible, bend one leg at the knee. Place your knee on the protector. The second leg is a support if the bed level is not adjustable Ensuring the safety of the patient Ensuring the correct biomechanics of the nurse's body. Ensuring nurse and patient safety

18 7. Place your left hand on the patient’s left shoulder and your right hand on his left thigh and move the patient to a side-lying position and partially on his stomach (only part of the patient’s abdomen is on the mattress) 8. Push the right “lower” shoulder back and release “ lower" arm from under the patient's body, placing it along the body. Place a pillow under the patient's head 9. Place a pillow under the bent “upper” arm at shoulder level. Place the relaxed hand on half of the ball 10. Place a pillow under the bent “upper” leg so that the leg is at hip level. Ensuring correct biomechanics of the nurse’s body. Reducing the risk of falls and skin friction when moving the patient towards the nurse Ensuring that the patient's body is straightened. Reduce lateral neck flexion Prevent shoulder internal rotation. Maintaining the necessary straightness of the body Preventing internal rotation of the hip and placing the “upper” leg on the “lower”. Prevention of hyperextension of the leg. Reducing the pressure of the mattress on the knee and ankle 11. Provide support for the lower foot at an angle of 90 Ensuring dorsiflexion of the foot. Preventing foot drop. Ensuring the prevention of bedsores 12. Make sure that the patient is lying comfortably, straighten the sheet. Raise the side rails. Lower the bed to its previous height III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry hands Ensuring patient safety 2. Record the procedure and the patient's response Ensuring continuity of nursing care MOVEMENT OF A PATIENT WITH HEMIPLEGIA INTO THE PRODUCT POSITION Purpose: to place the patient in a physiological position (performed by one or two nurses as directed by the doctor, the patient cannot help) . Indications: forced or passive position, change of position if there is a risk of developing bedsores or bedsores. Equipment: extra pillow, footrest or sandbag, bolsters, footrest, half a rubber ball, napkin. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time Establishing contact with the patient 2. Explain the purpose and sequence of the procedure Ensuring the patient’s psychological preparation for the upcoming procedure

19 3. Obtain the patient’s consent for the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5. Wash and dry hands. If there is a risk of contact with biological fluid, wear gloves P. Performing the procedure 1. Secure the bed brakes. Raise the bed to the height that is most comfortable for working with the patient 2. Lower the side rails of the bed (if any) on the side facing the paralyzed part of the patient’s body. Move the head of the bed to a horizontal position (or remove the pillows) 3. Cross the patient's arms over his chest. Move the patient towards the paralyzed side of the body Ensuring the safety of the patient and proper body mechanics of the nurse Ensuring access to the patient and his safety. Ensuring that the patient's body is properly straightened. Providing sufficient space to turn the patient onto his stomach. Prevention of injury to the paralyzed side 4. Place the patient's paralyzed leg on healthy decline physical stress on the nurse 5. Raise the side rails. Move to the other side of the bed and lower the rails 6. Place a thin pillow over the area where the patient's abdomen will be located. Ensuring the safety of the patient Preventing sagging of the abdomen. Reducing hyperextension of the lumbar vertebrae and tension in the lower back muscles 7. Straighten the elbow of the paralyzed arm. Press it along its entire length to the body. Place your healthy hand in. Eliminate the danger of your hand being crushed when moving the patient! on the stomach 8. Place the protector on the bed next to the patient. Stand as close to the bed as possible, bend one leg at the knee and place your knee on the protector. The second leg is a support if the bed level is not adjustable. Ensuring correct biomechanics of the nurse's body. Ensuring Nurse and Patient Safety 9. Place your left hand on the patient's "far" shoulder and your right hand on the patient's "far" thigh. Turn the patient on his stomach towards the nurse 10. Turn the patient's head to the side (towards the paralyzed side of the body). Place a thin pillow under the patient's head and neck 11. Bend the arm towards which the patient's head is facing at the elbow joint by 90. Place the relaxed hand on half of the ball covered with a napkin. Extend the other arm along the body. Ensuring the correct biomechanics of the sister’s body. Reducing the risk of falls and skin friction when moving the patient towards the nurse Reducing flexion and hyperextension of the cervical vertebrae of the neck muscles Preventing the risk of limiting the ability of the arm to perform external rotation around shoulder joint

20 12. Bend both knees of the patient and place a pillow under Preventing prolonged hyperextension of the knee joints. Prevention of the lower leg so that the fingers do not touch the bed for the development of bedsores on the toes 13. Provide support for the feet at an angle of 90. Ensure dorsiflexion of the foot 14. Make sure that the patient is lying comfortably, straighten the sheet. Raise the side rails. Lower the bed to its previous height III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry hands Ensuring patient safety 2. Record the procedure and the patient's response Ensuring continuity of nursing care POSITIONING A PATIENT WITH HEMIPLEGIA IN THE FOWLER POSITION Goal: Place the patient in a physiological position (performed by one nurse). Indications: feeding (eating independently), performing procedures requiring this provision; risk of developing bedsores and contractures. Equipment: set of pillows, bolsters, footrest, rubber ball halves (2 pieces), 2 napkins. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time 2. Explain to the patient the purpose and sequence of the procedure Establishing contact with the patient Ensuring the patient’s psychological preparation for the upcoming procedure 3. Obtaining the patient’s consent to perform the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5. Wash and dry your hands. If there is a risk of contact with biological fluid, wear gloves P. Performing the procedure 1. Secure the bed brakes. Raise the bed to the height that is most comfortable for working with the patient. Prevention of nosocomial infections. Ensuring the safety of the patient and the correct biomechanics of the nurse’s body. 2. Lower the side rails (if any) on the side where the nurse is. Ensuring access to the patient and his safety.

21 3. Make sure the patient is lying on his back in the middle of the bed. Remove pillows 4. Raise the head of the bed at an angle (or place three pillows) Position the patient in a position convenient for movement Ensuring the patient's comfort. Improving pulmonary ventilation Ensuring patient relaxation. 5. Sit the patient as high as possible. Place a small pillow under the head (if the headboard is raised) 6. Slightly lift the patient's chin up. Move the patient's upper limbs away from his body and place small pillows under the elbows and hands 7. Place the hands on halves of rubber balls covered with napkins. Place a thin pillow under the patient's lower back. Bend the patient’s legs at the knee and hip joints, placing a pillow or folded blanket under the lower third of the thigh 8. Place a bolster under the patient’s lower third of the lower leg so that the heels do not touch the mattress. Reducing the likelihood of the patient “falling over” to the paralyzed side of the body. Improving pulmonary ventilation, heart function, reducing intracranial pressure. Ensuring comfortable eating and liquids. Prevention of aspiration of food, liquids, and vomit. Prevention of neck muscle tension Reducing the load on cervical region spine. Prevention of flexion contracture of the muscles of the upper limb and overstretching of the capsules of the shoulder joint. Preservation of functional damage to the hands. Prevention of contracture of the joints of the hands. Reducing the load on the lumbar spine. Prevention of prolonged hyperextension of the knee joints and compression of the popliteal artery. Prevention of bedsores in the heel area. 9. Provide support for the feet at an angle of 90. Providing dorsal flexion of the foot. Prevention of foot drop. Maintaining muscle tone 10. Make sure that the patient is lying comfortably, straighten the sheet. Raise the side rails. Lower the bed to its previous height III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry hands Ensuring patient safety Preventing hospital-acquired infections 2. Record the procedure and the patient's response Ensuring continuity of nursing care.

22 PLACEMENT OF THE PATIENT IN A SUPRINE POSITION Purpose: to give the patient a physiological position (performed by one nurse). Indications: forced or passive position; risk of developing bedsores; hygiene procedures in bed. Equipment: extra pillow, bolsters, footrest, two rolled sheets, towel. Note: the procedure can be performed on either a functional or a regular bed. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time Establishing contact with the patient 2. Explain the purpose and sequence of the procedure Ensuring the patient’s psychological preparation for the upcoming procedure 3. Obtain the patient’s consent to perform the procedure Respecting the patient’s rights 4. Prepare equipment Ensuring the effectiveness of the procedure 5 Wash and dry your hands. If there is a risk of contact with biological fluid, wear gloves P. Performing the procedure 1. Secure the bed brakes. Raise the bed to the height that is most comfortable for working with the patient Ensuring the safety of the patient and the correct biomechanics of the nurse’s body 2. Lower the side rails (if any) on the side where the nurse is 3. Lower the head of the bed (remove excess pillows), giving the bed a horizontal position . Remove the blanket. Make sure that the patient is lying in the middle of the bed Ensuring access to the patient and his safety Ensuring the correct position of the patient 4. Give the patient the correct position: a) put a pillow under the head (or adjust the remaining one); b) place your arms along your body, palms down; c) place the lower limbs in line with hip joints 5. Place a small pillow under the upper shoulders and neck Ensuring the patient is positioned comfortably Ensuring proper distribution of the load on the upper body. Preventing tension in the neck muscles 6. Place small pillows under the forearms to facilitate the outflow of blood. Preventing swelling of the hand 7. Place a small towel rolled up under the lower back, without folds. Preventing hyperextension of the lumbar spine.

23 8. Place rolls of rolled sheets along the outer surface of the thighs from the area of the greater trochanter of the femur and further 9. Place a small pillow or roll under the lower leg in the area of its lower third. Preventing the hip from rotating outward. Preventing prolonged pressure of the mattress on the heels and forming pressure sores 10. Provide support to support the feet at an angle of 90 Ensuring dorsiflexion of the feet Preventing foot drop 11. Ensure that the patient is lying comfortably. Straighten the sheet and cover the patient with a blanket. Raise the side rails. Lower the bed to its previous height Ensuring patient safety III. End of procedure 1. Disinfect and dispose of gloves if they have been used. Wash and dry hands 2. Make a record of the procedure and the patient's response Ensuring continuity of nursing care

24 CHAPTER 5 PERSONAL HYGIENE OF THE PATIENT CHANGING BED LINEN BY THE CROSS-WAY METHOD Purpose: maintaining personal hygiene, preventing hospital-acquired infections (the procedure is performed by a nurse and an assistant, the patient is in bed). Indications: deficiency of self-care. Equipment: a set of clean linen, a bag for dirty linen, gloves, a container with a disinfectant solution. I. Preparation for the procedure 1. Collect information about the patient. Introduce yourself kindly and respectfully to him. Clarify how to contact him if the nurse sees the patient for the first time. Explain the sequence of the procedure to the patient and obtain his consent. Attention! If relatives or other members of the medical team are involved in the procedure, the extent of each intervention should be determined in advance 2. Prepare a set of clean linen. Roll up a clean sheet like a bandage (in the transverse direction) 3. Wash your hands, if possible contact with biological fluids, wear gloves II. Performing the procedure 1. Stand on both sides of the bed, lower the head of the bed. Establish contact with the patient. Ensuring the patient’s psychological preparation for the upcoming procedure. Respect for the patient's rights and hygienic comfort Ensuring the patient's safety and correct body biomechanics 2. The nurse place his hands under the patient's shoulders and head, slightly lift him up; Ensuring the effectiveness of the procedure; assistant remove the pillow from under the head 3. Lower the patient onto the bed. Change the pillowcase Ensuring a safe hospital environment 4. Remove the blanket from the patient, cover it with a small sheet Reducing discomfort in the patient without underwear 5. The nurse raises the patient's head and shoulders, the assistant rolls the dirty sheet from the side of the head to the middle of the bed. On the freed part, lay and spread a prepared and rolled up clean sheet for hygienic comfort.

25 6. Place a pillow at the head and lower the patient’s head and shoulders onto it 7. Raise the patient’s pelvis (ask the active patient to lean on his legs and rise above the bed), move the dirty sheet in the direction of the feet, then straighten the clean one, lower the patient onto it Ensuring physical comfort Ensuring the patient's comfort and infectious safety (the patient's active participation in care helps to increase self-esteem) 8. Place the dirty sheet in a laundry bag 9. Tuck the edges of a clean sheet under the mattress on all sides Ensuring comfort 10. Remove the duvet cover from the blanket, put on a clean one. Place the dirty duvet cover in the bag. Cover the patient. Tuck the blanket and hygienic comfort 11. Ensure that the patient feels comfortable Ensuring psychological comfort 12. Remove dirty linen from the room III. End of the procedure 1. Disinfect and further dispose of gloves if they have been used. Wash and dry your hands 2. Make a note about the change of linen in the documents Ensuring continuity of patient care CHANGING BED LINEN IN A LONGITUDINAL WAY Purpose: maintaining personal hygiene, preventing hospital-acquired infections (the procedure is performed by a nurse and an assistant, the patient is in bed). Indications: deficiency of self-care. Equipment: a set of clean linen, a bag for dirty linen, gloves, a container with a disinfectant solution. I. Preparation for the procedure 1. Introduce yourself kindly and respectfully to the patient. Clarify how to contact him if the nurse sees the patient for the first time. Explain to the patient the purpose and sequence of the upcoming procedure and obtain his consent. Assess the patient's ability to participate in the procedure. Attention! If relatives or other members of the medical team are involved in the procedure, the extent of each intervention should be determined in advance 2. Prepare a set of clean linen. Roll up half the sheet into a roll along its entire length Establishing contact with the patient. Psychological preparation of the patient for the upcoming procedure. Respect for patient rights. Ensuring careful procedure and hygienic comfort

26 3. Wash and dry your hands, if there is a risk of contact with biological fluid, wear gloves II. Performing the procedure 1. Stand on both sides of the bed, lower the head of the bed. Prevention of nosocomial infections. Ensuring the safety of the patient and correct body biomechanics 2. The nurse put his hands under the patient’s shoulders and head and slightly lift him, the assistant removes the pillow from under the head. Lower the patient onto the bed (without a pillow). Remove the pillowcase from the pillow and place it in the laundry bag. Put on a clean pillowcase Ensuring the procedure is effective 3. The nurse removes the blanket from the patient and covers him with a small sheet 4. The nurse turns the patient on his side, facing the edge of the bed, and holds him in this position. At the same time, monitor his condition. Reduce psychological discomfort. Provide the opportunity to change linen. Preventing the patient from falling 5. For the assistant to roll up the dirty sheet with the roller towards the back. Ensure the possibility of changing the patient’s linen and lay out a previously prepared and half-rolled clean sheet, covering the vacated part of the bed 6. For the assistant, turn the patient on his back, then carefully on the other side so that he is on the clean sheet. Keep the patient in a lateral position Ensure hygienic comfort. Preventing Patient Falls 7. The nurse rolls up the dirty sheet and places it in a laundry bag. Roll out a clean sheet and tuck its edges under the mattress 8. Turn the patient and lay him on his back. Place a pillow under your head and shoulders 9. Have your assistant remove the dirty duvet cover and put it in a dirty laundry bag. Wear a clean one. Cover the patient. Tuck the blanket and hygienic comfort Ensuring comfort in bed and hygienic comfort 10. Ensure that the patient feels comfortable Ensuring psychological comfort III. End of the procedure 1. Remove the bag with dirty laundry. Disinfect and further dispose of gloves if they have been used. Wash and dry your hands 2. Make a note about the change of linen Ensuring continuity of patient care

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Nursing process - one of the basic concepts of modern nursing grandfather. First introduced in the USA by Lydia Hall in 1955. The term “nursing process” emphasizes its connection with nursing care aimed at protecting “health” individuals, their families or community groups. It involves the use of scientific methods to determine the health needs of the patient (family or community) and on this basis the selection of those that can be most effectively met through nursing care" (WHO, 1995).

The nursing process is focused on the person as a unique, inimitable individual and on the family as the basis of the life of each person and society. This process includes a new understanding of the role of the nurse in health care, requiring from her not only good technical training, but also the ability to think logically, to work with the patient as an individual, and not as an object of “manipulative equipment.”

Definition. The nursing process is a dynamic process of managing a person’s adaptation to the environment and effectively meeting the physiological, psychological and social needs of a patient (family) or social group related to health, i.e. the provision of medical and social care by a nurse working as part of a multidisciplinary team specialists in the field of health and social sphere. This process involves mobilizing the necessary resources of the health care system and society as a whole. It includes methods for determining the needs, goals and objectives of interventions, their priority, and the type of nursing care. This process are planned and implemented with the active and interested cooperation of all participants in the process, it is ultimately aimed at achieving best quality the patient's life in specific conditions.

Tasks nursing process:

identification of violated needs and problems caused by them (existing and potential) both in a specific person and in his family, group of people or society;
identifying the capabilities of a person, family, group of people in satisfying their vital needs, i.e., the needs necessary to maintain the chosen social, family, professional roles, etc.;
establishing the reasons for the violation of needs and the occurrence of problems, reasons that reduce the capabilities of a person, family (group), society in realizing, restoring and maintaining their capabilities and solving health-related problems;
building and implementing a nursing care plan that will be accepted by all participants in the nursing process;
maintaining and restoring in an individual, family, or group of persons the greatest possible independence, autonomy in the implementation and satisfaction of vital needs, regardless of illness;
providing the patient, family, group of people (despite the persistence of health problems, the incurability of the disease, the inevitability of death) with a decent quality of life.

The need to implement the nursing process

in nursing education and practice

The nursing process is an approach to standardizing the activities of clinical nurses. Standardization of the work of nursing staff serves to improve the quality of nursing care, its assessment and control.

When performing the nursing process, it is necessary to adhere to the principle holistic approach to the patient as an individual, which is reflected in the principle of the domestic medical school: treating not the disease, but the patient in all its unity and diversity of connections with the environment (S. P. Botkin). In modern foreign literature, a holistic approach to personality in the unity of physical, mental and spiritual components is called holistic.

The principle of integrity that the nurse must use in her work is combined with the fundamental concept and principles of homeostasis.

Homeostasis(from the Greek homoios - similar and stasis - standing, immobility) - a type of dynamic balance characteristic of complex self-regulating systems, such as a living person, and consisting in maintaining the relative constancy of physiological indicators that are essential for the preservation of the system (health, human life).

The use of the nursing process as a scientifically based method is impossible without the nurse understanding and using the principles of integrity and homeostasis in her work. Knowing them allows her when working with healthy person, the patient, his family, identify those signs that indicate a loss of stability, balance, the threat of the disease, its relapse, changes in the family, its medical and social problems. The principles of integrity and homeostasis will help the nurse use evidence-based nursing practices that include overall plan medical care will ensure the preservation of stability or the return of the disturbed system to a state of stable equilibrium of both biological (human) and social (family) systems. The principles of the integrity of homeostasis have universal significance both in the study, observation and assessment of human health, and in the analysis external factors habitat, working and living conditions of a person, i.e. factors that can contribute to deterioration of health, development of disease and changes in lifestyle.

The method, called the "nursing process", is scientific basis organization of nursing, nursing education and practice.

Advantages methodology nursing process For nursing education and practice:

the safety of the conduct is guaranteed medical care, standards of nursing care are formed and implemented;
the principle of an individual and systematic approach to the provision of nursing care is implemented, the efforts of all participants in the process are coordinated and agreed upon;
the patient and his family actively participate in the planning and implementation of the nursing care program;
it becomes possible to use standards professional activity in a wide clinical practice, professional terminology and language of professional communication in training and practice;
in practice, the principle of continuity in the provision of medical care in the work of nurses and nursing services is implemented;
time and resources are effectively used to address the basic needs and problems of the patient, family and group of people;
the quality, timeliness of nursing care provided and the professionalism of the nurse are documented;
demonstrates the level of professional competence, responsibility and reliability of not only an individual nurse, but also the entire nursing service of a particular medical post, department, medical institution;
it becomes possible to analyze the work of each nurse, nursing service, generalize work experience, concretely evaluate new technologies of care, training programs and recommend them for wide practice;
the approach allows you to protect the professional interests of the nurse in cases of unfounded claims about the quality of her work, the level of her professional training and give an objective assessment in conflict situations;
the approach is scientifically based and universal.

Section 1. Introduction to the discipline “Fundamentals of Nursing”

1. State organizational structures dealing with nursing issues

Russia has a healthcare system with various forms property: state, municipal And private. It resolves issues of social policy and has three levels of management organization.

1. Ministry of Health of the Russian Federation, in which there are departments:

1) organization of medical care;

2) protection of maternal and child health;

3) scientific and educational medical institutions;

4) personnel, etc.;

2. Ministry of Health of the region (territory);

3. health department under the city administration.

The task of social policy is to achieve a level of health that will allow a person to live productively with the longest possible life expectancy.

The main priority areas of social policy in the field of healthcare:

1) development of laws to implement reforms;

2) protection of motherhood and childhood;

3) financing reform (health insurance, the use of funds from various funds to support and treat relevant categories of the population - pensioners, the unemployed, etc.);

4) compulsory health insurance;

5) reorganization of primary health care;

6) drug provision;

7) personnel training;

8) healthcare informatization.

The basic basis of the healthcare system should be the adoption of the laws of the Russian Federation “On State system healthcare”, “On the rights of the patient”, etc.

Already today, markets for medical services are being formed, medical and preventive institutions are being created with various forms of ownership, day-care hospitals, hospices, palliative medicine institutions, i.e., institutions where care is provided to the hopelessly ill and dying. In 1995 there were already 26 hospices in Russia, in 2000 there were already more than 100.

2. Main types of treatment and preventive institutions

There are two main types of treatment and prevention institutions: outpatient And stationary.

Outpatient facilities include:

1) outpatient clinics;

2) clinics;

3) medical units;

4) dispensaries;

5) consultations;

6) ambulance stations.

Inpatient institutions include:

1) hospitals;

2) clinics;

3) hospitals;

4) maternity hospitals;

5) sanatoriums;

6) hospices.

In order to improve the quality of medical and preventive work, since 1947, Russia has been merging clinics with outpatient clinics and hospitals. This organization of work helps to improve the qualifications of doctors, and thereby improve the quality of service to the population.

3. Structure and main functions of hospitals

There are general, republican, regional, regional, city, district, rural hospitals, which are often located in the center of the serviced area. Specialized hospitals (oncology, tuberculosis, etc.) are located depending on their profile, often on the outskirts or outside the city, in a green area. There are three main types of hospital construction:

2) centralized; 1) pavilion;

3) mixed.

With the pavilion system, small separate buildings are located on the hospital premises. The centralized type of construction is characterized by the fact that buildings are connected by covered above-ground or underground corridors. Most often in Russia, mixed-type hospitals were built, where the main non-infectious departments are located in one large building, and infectious diseases departments, outbuildings, and the like are located in several small buildings. The hospital site is divided into three zones:

1) buildings;

2) utility yard area;

3) protective green zone.

The medical and economic zones must have separate entrances.

The hospital consists of the following facilities:

1) a hospital with specialized departments and wards;

2) auxiliary departments (X-ray room, pathology department) and laboratory;

3) pharmacies;

4) clinics;

5) catering unit;

6) laundry;

7) administrative and other premises.

Hospitals are designed for ongoing treatment and care of patients with certain diseases, such as surgical, medical, infectious, psychotherapeutic, etc.

The hospital inpatient unit is the most important structural unit, where patients requiring modern, complex diagnostic methods and treatment are received, and treatment, care and other cultural and everyday services are provided.

The structure of a hospital of any profile includes wards for accommodating patients, utility rooms and WC, specialized rooms (procedural, treatment and diagnostic), as well as the resident's room, nursing room, and the office of the head of the department. The equipment and equipment of the wards corresponds to the profile of the department and sanitary standards. There are single and multi-bed wards. The ward has:

1) bed (regular and functional);

2) bedside tables;

3) tables or table;

4) chairs;

5) a wardrobe for the patient’s clothes;

6) refrigerator;

7) washbasin.

The beds are placed with the head end to the wall at a distance of 1 m between the beds for the convenience of transferring the patient from a gurney or stretcher to the bed and caring for him. Communication between the patient and the nurse's station is carried out using an intercom or light alarm. In specialized departments of the hospital, each bed is provided with a device for centralized oxygen supply and other medical equipment.

The lighting of the wards complies with sanitary standards (see SanPiN 5.). It is defined in daytime light coefficient, which is equal to the ratio of the window area to the floor area, respectively 1: 5–1: 6. In the evening, the chambers are illuminated with fluorescent lamps or incandescent lamps. In addition to general lighting, there is also individual lighting. At night, the wards are illuminated by a night lamp installed in a niche near the door at a height of 0.3 m from the floor (except for children's hospitals, where lamps are installed above the doorways).

Ventilation of the rooms is carried out using a supply and exhaust system of ducts, as well as transoms and vents at the rate of 25 m 3 of air per person per hour. Concentration carbon dioxide in the air environment of the room should not exceed 0.1%, relative humidity 30–45%.

The air temperature in the rooms of adults does not exceed 20 °C, for children – 22 °C.

The department has a distribution room and a canteen, providing simultaneous food intake for 50% of patients.

The department corridor must ensure the free movement of gurneys and stretchers. It serves as an additional air reservoir in the hospital and has natural and artificial lighting.

The sanitary unit consists of several separate rooms, specially equipped and designed to carry out:

1) personal hygiene of the patient (bathroom, washroom);

2) sorting dirty laundry;

3) storage of clean linen;

4) disinfection and storage of vessels and urinals;

5) storage of cleaning equipment and overalls for service personnel.

Infectious diseases departments of hospitals have boxes, semi-boxes, regular wards and consist of several separate sections that ensure the functioning of the department when quarantine is established in one of them.

Each department has, in accordance with the established procedure, an internal departmental routine that is mandatory for staff and patients, which ensures that patients comply with the medical and protective regime: sleep and rest, dietary nutrition, systematic observation and care, implementation of medical procedures, etc.

4. Contents of the activities of a paramedical worker

TO functional responsibilities hospital nurses include:

1) compliance with the medical and protective regime of the department;

2) timely implementation of medical prescriptions;

3) patient care;

4) assistance to the patient during examination by a doctor;

5) monitoring the general condition of patients;

6) provision of first aid;

7) compliance with the sanitary and anti-epidemic regime;

8) timely transmission of an emergency notification to the Center for State Sanitary and Epidemiological Surveillance (State Sanitary and Epidemiological Surveillance Center) about an infectious patient;

9) receiving medicines and ensuring their storage and accounting;

10) as well as management of junior medical staff of the department.

Nurses are required to systematically improve their qualifications, attend classes and conferences organized in the department and medical institution.

Community (family) nurse at a polyclinic working at a doctor's appointment, helps him, draws up various documentation, teaches patients how to prepare for various procedures, laboratory and instrumental studies. A clinic nurse works from home: carries out medical appointments, teaches relatives necessary elements care, gives recommendations on creating comfortable conditions for the patient in order to satisfy his vital physiological needs, provides psychological support to the patient and his family, carries out measures to prevent complications and improve the health of his patients.

Responsibilities of a paramedic quite wide, especially in the absence of a doctor. At a paramedic-midwife station (FAP), a paramedic independently performs inpatient, consultative, outpatient care, home care, sanitary and preventive work, prescribes medications from a pharmacy, etc. In a medical and preventive institution (MPI) - works under the guidance of a doctor .

Contents of the activities of a maternity hospital midwife and antenatal clinic depends on the specific characteristics of the job. She independently or together with a doctor delivers babies, provides medical and preventive care for pregnant women, mothers and newborns. She actively identifies gynecological patients, conducts psycho-prophylactic preparation of women for childbirth, monitors pregnant women, and ensures that pregnant women undergo all necessary tests. A midwife, like a clinic nurse, carries out a lot of patronage work and directly performs the duties of a nurse.

To perform their duties, a paramedic, nurse and midwife must have a certain amount of knowledge and practical skills, be responsible for the care process and show mercy. They improve their professional, psychological and spiritual qualities in order to provide the patient optimal care, meet the physiological needs of the patient and protect public health.

They participate in the work to eliminate infectious foci, carry out preventive vaccinations, and, together with a doctor, carry out sanitary supervision of children's institutions.

Paramedical workers with special training, can work in radiology; physiotherapy and other specialized departments and offices.

For assigning to themselves functions to which they do not have the right, paramedical workers are subject to disciplinary or criminal liability. 5. Philosophy of nursing

Philosophy (from Phil and Greek sophia “love and wisdom”, “love of wisdom”) is a form of human spiritual activity, which reflects issues of a holistic picture of the world, the position of man in the world, the relationship between man and the world as a result of this interactions. The need for a philosophical understanding of nursing arose because new terms increasingly appeared in professional nursing communication, which were clarified, developed, and discussed. They are still being discussed. There is a need for a new quality of nurse knowledge.

At the I All-Russian Scientific and Practical Conference on the Theory of Nursing, held July 27-August 14, 1993 in Golitsino, new terms and concepts were introduced into nursing. According to international agreement, the philosophy of nursing is based on four basic concepts, such as:

1) patient;

2) sister, nursing;

3) environment;

4) health.

Patient- a person who needs and receives nursing care.

Sister– specialist with vocational education who shares the philosophy of nursing

and eligible for nursing work.

Nursing- Part medical care care of the patient, his health, science and art aimed at solving existing and potential health problems in changing environmental conditions.

Environment– a set of natural, social, psychological and spiritual factors and indicators in which human life takes place.

Health– dynamic harmony of the individual with the environment, achieved through adaptation, a means of life.

Basic principles of nursing philosophy are respect for life, dignity, human rights.

The implementation of the principles of nursing philosophy depends on the interaction between the nurse and society.

These principles include the responsibility of the nurse to society, the patient, and the responsibility of society to the nurse. Society is obliged to recognize the important role of nursing in the healthcare system, regulate, and encourage it through the publication of legislative acts.

The essence of the modern model of nursing as a scientific theory is the substantiation of various approaches to the content and provision of nursing care.

The concept has entered the professional lexicon "nursing process", which is understood as systems approach to the provision of nursing care, focused on the needs of the patient.

Currently, the nursing process is the core of nursing education in Russia.

A theoretical scientific basis for nursing care is being created. Through the nursing process, the nurse must gain professional independence and independence, be not just an executor of the doctor’s will, but turn into a creative person who can understand and see in each patient a personality, his inner spiritual world. Russian healthcare is in dire need of nurses who master the modern philosophy of nursing, know human psychology, and are capable of teaching.

The essence of nursing philosophy is that it is the foundation professional life nurse, an expression of her worldview and forms the basis of her work and communication with the patient.

A sister who shares the accepted philosophy accepts the following: ethical responsibilities(whether we are doing it right or wrong):

1) tell the truth;

2) do good;

3) do no harm;

4) respect the obligations of others;

5) keep your word;

6) be loyal;

7) respect the patient’s right to independence.

According to the theory of nursing philosophy, the goals that a nurse strives for, i.e., the results of her activities, are called ethical values (ideals): professionalism, health, healthy environment, independence, human dignity, care (care).

The philosophy of nursing also reflects the personal qualities of a nurse that a good nurse should have - virtues that determine what is good and what is evil in people: knowledge, skill, compassion, patience, determination, mercy.

Ethical principles define the Code of Ethics for Nurses in each country, including

Russia, and are standards of behavior for nurses and a means of self-government for a professional nurse.

6. Nursing deontology

Nursing deontology– the science of duty to the patient and society, professional behavior of a medical worker, is part of nursing ethics.

Our compatriot A.P. Chekhov wrote: “The medical profession is a feat. It requires selflessness, purity of soul and purity of thoughts. Not everyone is capable of this."

A medical worker is entrusted with the most precious things - life, health, and well-being of people. He is responsible not only to the patient and his relatives, but also to the state as a whole. Unfortunately, even now there are cases of irresponsible attitude towards the patient, the desire to relieve oneself of responsibility for him, to find an excuse to shift responsibility to another, etc. All these phenomena are unacceptable. We must remember: the interests of the patient come first.

The nurse must have professional observation, allowing him to see, remember and evaluate in a nursing way the smallest changes in the physical, psychological state patient.

She must be able to control herself, learn to manage her emotions, and cultivate emotional stability.

The culture of behavior of a medical worker can be divided into two types:

1) internal culture. This is an attitude to work, adherence to discipline, careful handling of furnishings, friendliness, a sense of collegiality;

2) external culture: decency, good manners, culture of speech, appropriate appearance etc. The main qualities of a medical worker, and the qualities of his internal culture, are:

1) modesty– simplicity, artlessness, which testify to the beauty of a person, his strength;

2) justice– the highest virtue of a medical worker. Justice is the basis of his inner motivations. Cicero said that there are two principles of justice: “Harm no one and benefit society”;

3) honesty– must be consistent with all medical professional matters. It should become the basis of his daily thoughts and aspirations;

4) kindness- an integral quality of the internal culture of a good person.

A good person is, first of all, a person who treats the people around him favorably, understands both sorrows and joys, and in case of need, readily, at the call of his heart, without sparing himself, helps in word and deed.

The concept of “external culture of a medical worker” includes:

1) appearance. The main requirement for a medic’s clothing is cleanliness and simplicity, the absence of unnecessary jewelry and cosmetics, a snow-white robe, a cap and the availability of replaceable shoes. Clothing, facial expression, and demeanor reflect some aspects of the medical worker’s personality, the degree of his care and attention to the patient. “Doctors should keep themselves clean and have good clothes, for all this is pleasant for the sick” (Hippocrates).

Remember! The medical uniform does not need decoration. She herself adorns a person, symbolizes purity of thoughts, rigor in the performance of professional duties. The patient will not have confidence in a medical worker who has a gloomy look, a careless posture, and speaks as if he is doing a favor. The medical worker must behave simply, speak clearly, calmly, and with restraint;

2) speech culture. It is the second component of external culture. The speech of a medical worker should be clear, quiet, emotional, and polite. You cannot use diminutive epithets when addressing a patient: “granny”, “darling”, etc. You often hear people talking about a patient: “diabetic”, “ulcer sufferer”, “asthmatic”, etc. Sometimes the speech medical workers sprinkled with fashionable, slang words, primitive, the patient does not gain confidence in them. Such costs of the speech culture of medical workers seem to fence him off from the patient, push the patient’s personality, his individuality into the background, and cause a negative reaction in the patient.

Basic principles of nursing ethics and deontology as set out in Florence Nightingale's oath, the Code of Ethics of the International Council of Nurses and the Code of Ethics for Russian Nurses are:

1) humanity and mercy, love and care;

2) compassion;

3) goodwill;

4) selflessness;

5) hard work;

6) courtesy, etc.

7. Nursing, its goals and objectives

Nursing is an integral part of the health care system, an area of activity aimed at solving the problems of individual and community populations in changing environmental conditions. Today nursing is the science and art of patient care aimed at solving the patient's problems. Nursing as a science has its theories and methods, which are conceptual and used to meet the needs of the patient. As a science, nursing is based on knowledge tested in practice. Previously, nursing borrowed knowledge from medicine, psychology, sociology, and cultural studies. Now new sections are being added to them (theory and philosophy of nursing, management, leadership in nursing, marketing of nursing services, nursing pedagogy, communication in nursing), a unique, special structure of knowledge in the nursing field is created.

Art and a scientific approach are manifested in communication with patients and staff, in the ability to effectively build a nursing process. Being an art and a science, nursing today has the following objectives: tasks:

1) explain to the population the purpose and importance of nursing;

2) attract, develop and effectively use nursing potential to expand professional responsibilities and meet the needs of the population for nursing services;

3) develop in nurses a certain style of thinking in relation to people, health and the environment;

4) train nurses in the culture of communication with patients, their family members, and colleagues, taking into account the ethical, aesthetic and deontological aspects of behavior;

5) develop and implement new technologies of nursing care;

6) provide high level medical information;

7) create effective quality standards for nursing care;

8) conduct research work in the field of nursing.

It is known that the role and tasks of the nurse are determined by historical, social and cultural factors, as well as the general level of health of a particular society.

To fulfill the assigned tasks and establish nursing as a profession, you must have:

1) a scientifically based strategy for the development of nursing practice;

2) a common terminology as a tool for standardization professional language nurses.

Year of issue: 2007

Genre: Nursing

Format: PDF

Quality: OCR

Description: Nursing is an important part of the healthcare system. Currently, nursing personnel constitute the largest category of health care workers. The services they provide meet the population's needs for affordable medical care.
Russia is one of the few countries where nursing staff are traditionally considered only assistants and executors of the doctor’s will. Meanwhile, the role, functions and organizational forms of nursing activities are much broader. IN modern conditions Particular attention should be paid to such functions of paramedical workers as providing primary health care and carrying out disease prevention; training the population in basic hygiene; reducing the length of stay of patients in hospital; expansion of home care; increase in quantity rehabilitation activities; formation of branches with varying intensity treatment and care; rendering palliative care etc. The need for these types of activities is extremely great, especially now due to the deteriorating state of public health.
World practice shows that with the rational use of nursing personnel, the quality of medical care significantly improves, its accessibility and cost-effectiveness increase, and resources in healthcare are used effectively. Studies conducted in different countries reveal the universal nature of nursing care and emphasize the uniformity of needs for it. Nursing practice is characterized by accessibility, diversity of activities, and focus on the individual patient. Increasing the level of education of paramedical workers creates real opportunities to comply with the necessary medical technologies, ensure guarantees of the quality of treatment, diagnosis and care, accumulate and use knowledge about the needs of patients in nursing care.
Currently, nurses, paramedics, and midwives need modern knowledge in the field of philosophy and theory of nursing, communication in nursing, nursing pedagogy, psychology, and requirements for ensuring a safe hospital environment in medical institutions. They must be smart, perform nursing manipulations in strict accordance with modern requirements.
Having studied the course “Fundamentals of Nursing,” future specialists will be able to competently carry out the nursing process when providing care to patients with a variety of diseases. To carry out the nursing process, a nurse must possess theoretical foundations, practical skills, and be able to use patient care items.
In this regard, a feature of the textbook “Fundamentals of Nursing” is the combination of theoretical material with descriptions of practical manipulations. Test questions are provided at the end of the chapters, which allows students to self-study more effectively.
The authors hope that the textbook “Fundamentals of Nursing” will be indispensable in preparing qualified specialists nursing.

"Fundamentals of Nursing"

THEORETICAL FOUNDATIONS OF NURSING. NURSING PEDAGOGY

Nursing as a profession
History of the development of nursing in Russia
Philosophy and ethics of nursing
1. Features of nursing philosophy
2. Ethical Principles of Nursing
3. Tina nurses
Communication in Nursing
1. The essence of communication
2. Structure and level of communication
3. The influence of various factors on the communication process
4. Listening skills and the importance of feedback in the communication process
5. Recommendations for communicating with the patient
Nursing education
1. Teaching as a function of nursing
2. Objectives and areas of study in nursing
3. Conditions for effective learning
4. Principles of patient and family education

METHODOLOGY OF NURSING CARE

Human needs for health and illness
Conceptual models of nursing
1. Fundamentals and evolution of nursing models
2. Additive-complementary model V. Henderson
3. Model of nursing care N. Roper
4. Self-care deficit model by D. Orem
5. Model aimed at changing patient behavior (D. Johnson model)
6. Adaptation model K. Roy
7. Model aimed at promoting health (M. Allen model)
Nursing process
1. general characteristics nursing process
2. Nursing examination
3. Identifying Patient Problems
4. Planning nursing intervention
5. Implementation of the nursing intervention plan. Types of interventions
6. Assessing the effectiveness of care. Correction of the nursing intervention plan

SAFE HOSPITAL ENVIRONMENT

Infection control
Nosocomial infection
1. Sources of occurrence and routes of transmission of nosocomial infections
2. Prevention of hospital-acquired infections
3. Ensuring the safety of medical personnel
Disinfection
Organization of work of the central sterilization department
1. Central sterilization department. General characteristics of sterilization
2. Pre-sterilization cleaning
3. Sterilization methods
Medical and protective regime of medical and preventive institutions
Biomechanics and body position of the patient. Safe patient transport
1. Preparing to move the patient
2. Moving the patient in bed
3. Transporting the patient from bed to chair, from chair to wheelchair
4. Moving while swimming and walking
5. Rules for transporting patients
6. Patient position in bed
Risk factors in a health care facility
1. Risk factors for patients
2. Risk factors for nurses

MANIPULATION TECHNIQUES

Drug treatment
1. The procedure for receiving, storing, recording, writing off and distributing medicines
2. Administration of drugs
  1. Bullets and drug administration techniques
  2. Collecting syringes. Picking up medications
  3. Types of injections. Venipuncture
3. Treatment room equipment. Safety precautions
4. Complications drug therapy and nurse tactics. Anaphylactic shock
Patient personal hygiene
Methods of simple physiotherapy
Thermometry. Fever care
Nutrition and feeding of the patient
Enemas. Gas outlet pipe
Bladder catheterization
Ostomy care
Probe manipulations: gastric and duodenal intubation
Laboratory research methods
1. Stool examinations
2. Sputum examinations
3. Urine tests
4. Microflora research
Preparing the patient for instrumental methods research
1. X-ray studies
2. Endoscopic studies
3. Participation of the nurse in carrying out manipulations
Cardiopulmonary resuscitation outside the intensive care unit

NURSING CARE FOR A SERIOUSLY ILL PATIENT. PALLIATIVE CARE

Nursing care for seriously ill patients in the hospital and at home
Loss, Death and Grief
Palliative care