Nursing process method development. Nursing Process

The nursing process consists of five main steps. FIRST STAGE - examination of the patient in order to collect information about the state of health. The purpose of the survey is to collect, substantiate and interconnect the information received about the patient in order to create an information database about him, about his condition at the time of seeking help. The main role in the survey belongs to the questioning. The collected data are recorded in the nursing history of the disease in a certain form. Nursing medical history is a legal protocol-document of an independent, professional activity of a nurse within her competence. STAGE SECOND - identifying the patient's problems and formulating a nursing diagnosis. The patient's problems are divided into: basic or real, concomitant and potential. The main problems are the problems that bother the patient at the moment. Potential problems are those that do not yet exist, but may appear over time. Associated problems are not extreme or life-threatening needs and are not directly related to disease or prognosis. Thus, the task of nursing diagnostics is to establish all current or possible future deviations from a comfortable, harmonious state, to establish what is most burdensome for the patient at the moment, is the main thing for him, and try to correct these deviations within his competence. The nurse does not consider the disease, but the patient's response to the disease and his condition. This reaction can be: physiological, psychological, social, spiritual. THIRD STAGE - nursing care planning. Care Plan Setting Goals: Patient Participation Nursing Standards 1. Short term and family practice 2. Long term FOURTH STAGE – Implementation of the nursing intervention plan. Nursing interventions Categories: Patient's need Methods of care: for help: 1. Independent 1. Temporary 1. Achievement of therapeutic 2. Dependent 2. Permanent goals 3. Interdependent 3. Rehabilitative 2. Maintenance of daily life needs, etc. FIFTH STAGE - assessment of the effectiveness of the nursing process. Efficiency of the nursing process Evaluation of actions Patient's opinion Evaluation of the actions of the nurse nurse or his family by the head (senior and main (personally) nurses) Evaluation of the entire nursing process is carried out if the patient is discharged, if he was transferred to another medical institution, if the patient died or in case of prolonged illness. The implementation and implementation of the nursing process in health care facilities will help solve the following tasks: Improve the quality and reduce the time of the treatment process without attracting additional funds; Reduce the need for medical personnel by creating "nursing departments, homes, hospis" with a minimum number of doctors; Increase the role of the nurse in the treatment process, which is important to achieve a higher social status of the nurse in society; The introduction of multilevel nursing education will make it possible to provide the treatment process with personnel with a differentiated level of training.

In the first half of the 50s. 20th century In the United States, the concept of "nursing process" first appeared. In 1955, the journal Public Health News published an article by Lydia Hall entitled "The Quality of Nursing Care", in which the researcher gave her description of the nursing process. The interpretation proposed by her did not meet with the general approval of nurses, and its new interpretations began to appear more and more often in the specialized literature.

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Objectives of the Nursing Process

1. Ensuring an acceptable quality of life for the patient, depending on his condition.
2. Prevention, relief, minimization of the patient's problems.
3. Assistance to the patient and his family about maladjustment associated with illness or injury.
4. Support or restore the patient's independence in meeting basic needs or in ensuring a peaceful death.

The Benefit of Using the Nursing Process

1. Individuality, taking into account the clinical, personal and social needs of the patient.
2. Opportunity for widespread use of nursing care standards.
3. Participation of the patient and his family in the planning and provision of care.

Stages of the Nursing Process

Nursing examination

Establishing the patient's disturbed needs (nursing diagnosis)

At this stage, the nurse identifies the real and potential problems of the patient, which she must eliminate by virtue of her professional competence. Real problems are those problems that the patient is currently experiencing. Potential - those that do not yet exist, but may arise over time. Having established both types of problems, the nurse determines the factors contributing to or causing the development of these problems. In other countries, this stage is called nursing diagnosis, which cannot be justified in Russia, since the doctor is in charge of diagnosis and treatment.

Nursing care planning

At the third stage of the nursing process, the nurse draws up a nursing care plan with motivation for her actions. At the same time, the nurse should be guided by the standards of nursing practice, which are designed to work in a typical situation, and not with an individual patient. The nurse is required to be able to apply the standard flexibly in a real situation. She has the right to reasonably supplement the action plan.

Implementation of the nursing diagnosis plan

The purpose of the nurse at this stage is to provide appropriate patient care, training and counseling on the necessary issues. The nurse must remember that all nursing interventions are based on:

1. Knowing the purpose.
2. On an individual approach and security.
3. Respect for the individual.
4. Encourage the patient to be independent.

There are three categories of nursing intervention. The choice of category is determined by the needs of patients. doctor's instructions and under his supervision. Independent nursing intervention involves actions carried out by a nurse on her own initiative, guided by her own considerations, without a direct request from the doctor. For example, teaching the patient hygiene skills, organizing the patient's leisure time, etc. Interdependent nursing intervention involves the joint activities of the sister with the doctor, as well as with other specialists. Dependent nursing intervention, such as following doctor's orders. In all types of interaction, the sister's responsibility is exceptionally great.

Efficiency evaluation and correction

This stage includes the patient's reactions to the intervention, the patient's opinion, the achievement of goals, the quality of care provided in accordance with the standards.

The nursing process consists of five steps. Each stage of the process is an essential step in solving the main problem - the treatment of the patient - and is closely interconnected with the other four stages.
The first stage: examination of the patient - the current process of collecting and processing data on the patient's health status (Fig. 1).

In "Notes on leaving" Florence Nightingale in 1859 | wrote; “The most important practical lesson that can! best given to nurses is to teach them what to watch for, how to watch, what symptoms indicate deterioration, what signs are! significant, which can be predicted, what signs indicate insufficient care, what is expressed in insufficient care. How relevant these words sound | these days!
The purpose of the survey is to collect, substantiate and interconnect! collect the information received about the patient in order to "create an information database about him, about his condition at the time of seeking help. The main role in the examination belongs to questioning. How skillfully * the nurse can arrange the patient for the necessary conversation, the information it receives will be so complete.
Survey data can be subjective or objective. The source of information is, first of all, the patient himself, who sets out his own assumptions about his state of health, this information is subjective. Only himself na | The patient can provide this kind of information. Subjective! ] data includes feelings and emotions expressed verbally and non-verbally.
Objective information - data that is received! as a result of observations and examinations conducted by a nurse. These include; anamnesis, sociological data (relationships, sources, environment in which the patient lives and works), developmental data (if it is a child), cultural information (scientific and cultural values), information about spiritual development! vitii (spiritual values, faith, etc.), psychological! data (individual character traits, self-esteem and ability to make decisions).
The source of information can be not only on-| sufferer, but also members of his family, work colleagues, friends, passers-by, etc. They give information; I tion and in the case when the victim is a child, a mentally ill person, a person in an unconscious state "or etc.
An important source of objective information are: data of the patient's physical examination (palpation, percussion, auscultation), measurement of blood pressure, pulse, respiratory rate; laboratory data.
The most objective and reliable are the observations and data of the nurse, obtained by her in the course of a personal conversation with the victim, after his physical examination and analysis of the available laboratory data. During the collection of information, the nurse establishes a “healing” relationship with the patient:

• determines the expectations of the patient and his relatives from the medical institution (from doctors, nurses);
• carefully acquaints the patient with the stages of treatment;
• begins to develop in the patient an adequate self-assessment of his condition;
• receives information that requires additional verification (information about infectious contact, previous diseases, operations performed, etc.);
• establishes and clarifies the attitude of the patient and his family to the disease, the relationship "patient - family".

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of the patient and the formulation of the nursing diagnosis (Fig. 2). It should be noted that the purpose of this stage is complex and diverse.
It consists, firstly, in identifying problems,! arising in the patient as a kind of response reaction! bodily functions. The patient's problems are divided into cv-1 current and potential. Existing problems -1 are problems that the patient is currently experiencing. For example: a 50-year-old patient with a spinal injury is under observation. Victim-1 is on strict bed rest. Problems | of the patient that are currently bothering him - pain, stress, limited mobility, lack) of self-care and communication Potential problems are those that do not yet exist, but may appear over time.In our patient, potential problems are pressure sores, pneumonia, decreased muscle tone, irregular bowel movements, (constipation, fissures, hemorrhoids).
Secondly, in establishing the contributing factors! or causing these problems. Thirdly, in identifying the strengths of the patient, which would contribute to the prevention or resolution of his problems. |
Since the patient in most cases has several health problems, the nurse cannot start to solve them all at the same time. Therefore, in order to successfully resolve the patient's problems, the nurse must consider them taking into account priorities.
Priorities are classified as primary, intermediate and secondary. Patient problems that, if left untreated, could have a detrimental effect on the patient, have primary priority. Intermediate priority patient problems include non-extreme and non-life-threatening needs of the patient. Secondary priority issues are patient needs that are not directly related to disease or prognosis (Gordon, 1987).
Let's go back to our example and consider it in terms of priorities. Of the existing problems, the first thing a nurse should pay attention to is pain, stress - the primary problems, arranged in order of importance. Forced position, restriction of movements, lack of self-care and communication are intermediate problems.
Of the potential problems, the primary ones are the likelihood of pressure sores and irregular bowel movements. Intermediate - pneumonia, decreased tone of the mouse. For each identified problem, the nurse outlines a plan of action for herself, not disregarding potential problems, as they can turn into obvious ones.
The next task of the second stage is the formulation of a nursing diagnosis.
(From the history of the emergence of nursing diagnosis: in 1973, the first scientific conference on the problem of classification of nursing diagnoses was held in the United States. Its objectives were to determine the functions of a nurse in the diagnostic process and develop a classification system for nursing diagnoses. In the same year, nursing diagnosis was included in the Standards of Nursing Practice published by the American Nursing Association (AAM).The North American Association for Nursing Diagnosis (NANAD) was founded in 1982. The purpose of this association was to "develop, improve, maintain a taxonomy, terminology of nursing diagnosis for general use by professional nurses "(Kim, McFarland, McLane, 1984). For the first time, the classification of nursing diagnoses was proposed in 1986 (McLane), in 1991 it was supplemented. The total list of nursing

diagnoses includes 114 main items, including: hyperthermia, pain, stress, social self-isolation, insufficient self-hygiene, lack of hygiene skills and sanitary conditions, anxiety, reduced physical activity, reduced individual ability to adapt and overcome stress reactions, excessive nutrition that exceeds the needs of the body , high risk of infection, etc.).
Currently, there are many definitions of nursing diagnosis. These definitions arose as a result of the recognition of nursing diagnosis as part of the professional activity of a nurse. In 1982, a new definition appeared in the textbook on nursing by the authors Carlson, Kraft and Maklere: "Nursing diagnosis is a patient's health condition (current or potential), established as a result of a nursing examination and requiring intervention from the nurse."
It should be recognized that there is verbosity and inaccuracy in the diagnostic language in nursing diagnosis, and this, of course, limits its use by nurses. At the same time, without a unified classification and nomenclature of nursing diagnoses, nurses will not be able to use nursing diagnosis in practice and communicate with each other in a professional language that is understandable to everyone.
It should be noted that, unlike a medical diagnosis, a nursing diagnosis is aimed at identifying the body's responses to a disease (pain, hyperthermia, weakness, anxiety, etc.). A medical diagnosis does not change unless a medical error has been made, but a nursing diagnosis can change every day, and even throughout the day, as the body's response to disease changes. In addition, the nursing diagnosis may be the same for different medical diagnoses. For example, a nursing diagnosis of "fear of death" may be in a patient with acute myocardial infarction, in a patient with a neoplasm of the breast, in a teenager whose mother has died, etc.
Thus, the task of nursing diagnostics is to establish all current or possible future deviations from a comfortable, harmonious state, to establish what is most burdensome for the patient at the moment, is the main thing for him, and try to correct these deviations within his competence.
The nurse does not consider the disease, but the patient's response to the disease and their condition. This reaction can be: physiological, psychological, social, spiritual. For example, in bronchial asthma, the following nursing diagnoses are likely: ineffective airway clearance, high risk of suffocation, reduced gas exchange, despair and hopelessness associated with a long-term chronic illness, lack of self-hygiene, a sense of fear.
Please note that there can be several nursing diagnoses for one disease at once. The doctor stops an attack of bronchial asthma, establishes its causes, prescribes treatment, and teaching the patient to live with a chronic disease is the task of a nurse.
Nursing diagnosis can refer not only to the patient, but also to his family, the team in which he works or studies, and even to the state. Since the realization of the need for movement in a person who has lost his legs, or self-care in a patient who is left without arms, in some cases cannot be realized by the family. To provide the victims with wheelchairs, special buses, lifts to railway cars, etc., special state programs are needed, that is, state assistance. Therefore, in the nursing diagnosis of "social isolation of the patient" both family members and the state can be guilty.
After the examination, diagnosis and determination of the patient's primary problems, the nurse formulates the goals of care, expected results and terms, as well as methods, methods, techniques, i.e. nursing actions that are necessary to achieve the goals. She moves on to the third stage of the nursing process - nursing care planning (Fig. 3).
The care plan coordinates the work of the nursing team, nursing care, ensures its continuity, helps to maintain links with other specialists and services. A written plan for patient care reduces the risk of incompetent care. This is not only a legal document of the quality of nursing care, but also

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A document that identifies economic costs as it specifies the materials and equipment i required to provide nursing care. This "allows you to determine the need for those resources that are used most often and effectively in a particular medical department and institution. The plan necessarily provides for the participation of the patient and his family in the care process. It includes criteria for evaluating care and expected results.
Setting goals for nursing care is important for the following reasons. It provides direction in the conduct of individual nursing care, nursing activities and is used to determine the degree of effectiveness of these activities. Setting goals for care must meet certain requirements: goals and objectives must be realistic and achievable, must have specific deadlines for achieving each task (the principle of “measurability”). It should be noted that in setting care goals, as well as in their implementation, the patient (where possible), his family, as well as other specialists are involved.
Each goal and expected result should be given time for evaluation. Its duration depends on the nature of the problem, the etiology of the disease, the general condition of the patient and the established treatment. There are two types of goals: short-term and long-term. Briefly-(

urgent - are goals that must be completed in a short period of time, usually 1-2 weeks. They are placed, as a rule, in the acute phase of the disease. These are targets for urgent nursing care.
Long-term - are goals that are achieved over a longer period of time (more than two weeks). OII are usually aimed at preventing recurrence of diseases, complications, their prevention, rehabilitation and social adaptation, and acquiring knowledge about health. The fulfillment of these goals most often falls on the period after the discharge of the patient. It must be remembered that if long-term goals or objectives are not defined, then the patient does not have, and in fact is deprived of, planned nursing care at discharge.
During the formulation of goals, it is necessary to take into account: action (performance), criterion (date, time, distance, expected result) and conditions (with the help of what or by whom). For example: a nurse must teach a patient to inject himself with insulin for two days. Action - to inject; time criterion - within two days; condition - with the help of a nurse. To successfully achieve the goals, it is necessary to motivate the patient and create a favorable environment for their achievement.
In particular, an approximate individual care plan for our victim might look like this:

• solution of existing problems; administer an anesthetic, relieve the patient's stress with the help of a conversation, give a sedative, teach the patient to serve himself as much as possible, that is, help him adapt to the forced state, talk more often, talk with the patient;
• solving potential problems: strengthen skin care measures to prevent pressure ulcers, establish a diet with a predominance of foods rich in fiber, dishes with a reduced content of salt and spices, conduct regular bowel movements, exercise with the patient, massage the muscles of the limbs, exercise with the patient breathing exercises, to teach family members how to care for the victim;
• identification of possible consequences: the patient must be involved in the planning process.

The preparation of a care plan requires the existence of standards of nursing practice, that is, the implementation of the minimum quality level of service that provides professional care for the patient. It should be noted that the development of nursing practice standards, as well as criteria for evaluating the effectiveness of nursing care, nursing medical history, nursing diagnoses for Russian healthcare is a new, but extremely important matter.
After defining the goals and objectives of care, the nurse draws up the actual care plan for the patient - a written care guide. The patient care plan is a detailed listing of the nurse's special actions needed to achieve nursing care, which is recorded in the nursing record.
Summing up the content of the third stage of the nursing process - planning, the nurse should clearly present the answers to the following questions:

• what is the purpose of care?
• Who do I work with, what is the patient as a person (character, culture, interests, etc.)?
• what is the patient's environment (family, relatives), their attitude towards the patient, their ability to provide assistance, their attitude to medicine (in particular, to the activities of nurses) and to the medical institution in which the victim is being treated?
• What are the tasks of the nurse in achieving the goals and objectives of patient care?
• what are the directions, ways and methods of achieving goals and objectives?
• what are the possible consequences?

Independent nursing intervention refers to actions carried out by a nurse on her own initiative, guided by her own considerations, without a direct request from the doctor or instructions from other specialists. For example: training the patient in self-care skills, relaxing massage, advice to the patient about his health, organizing the patient's leisure time, teaching family members how to care for the sick, etc.
Dependent nursing intervention is carried out on the basis of written prescriptions of a doctor and under his supervision. The nurse is responsible for the work performed. Here she acts as a sister performer. For example: preparing the patient for a diagnostic examination, performing injections, physiotherapy, etc.
According to modern requirements, the nurse should not automatically follow the instructions of the doctor (dependent intervention). IN THE CONDITIONS of guaranteeing the quality of medical care, its safety for the patient, the nurse should be able to determine whether this prescription is necessary for the patient, whether the dose of the drug is correctly selected, whether it does not exceed the maximum single or daily dose, whether
contraindications, is this drug compatible | remedy with others, whether the route of administration is chosen correctly. I The fact is that the doctor may get tired, he may lose attention, finally, due to a number of objective or | subjective reasons, he can make a mistake. Therefore, in the interests of the safety of medical care for [the patient, the nurse must know and be able to clarify the need for certain prescriptions, the correct dosage of medicines, etc. It must be remembered that a nurse who performs an incorrect or unnecessary prescription is professionally incompetent and is just as responsible for the consequences of the error as the one who made the appointment.
Interdependent nursing intervention involves the joint activities of a nurse with a doctor and other specialists (physiotherapist, nutritionist, exercise therapy instructor, social care workers). The responsibility of the nurse is equally great for all types of intervention.
The nurse carries out the planned plan, applying several methods of care: assistance related to daily life needs, care for achieving therapeutic goals, care for achieving surgical goals, care for facilitating the achievement of health care goals (creating a favorable environment, stimulating and motivating the patient) etc. Each of the methods includes theoretical and clinical skills. The patient's need for help can be temporary, permanent and rehabilitating. Temporary assistance is designed for a short period of time when there is a shortage of self-care. For example, with dislocations, minor surgical interventions, etc. The patient needs constant help throughout his life - with amputation of limbs, with complicated injuries of the spine and pelvic bones, etc. Rehabilitating care is a long process, an example of this is exercise therapy, massage, breathing exercises, I conversation with the patient.
Among the methods for implementing patient care activities, a conversation with the patient and advice that a nurse can give in a necessary situation play an important role. Advice is emotional, intellectual and psychological help that helps

the sufferer to prepare for present or future changes arising from stress, which is always present in any disease and facilitates interpersonal relationships between the patient, family, and medical personnel. Patients in need of advice include those who need to adapt to a healthy lifestyle - stop smoking, lose weight, increase their degree of mobility, etc.
Carrying out the fourth stage of the nursing process, the nurse carries out two strategic directions:

• monitoring and monitoring the patient's response to doctor's appointments with fixing the results in the nursing history of the disease;

• observation and control of the patient's response to the performance of nursing actions related to the nursing diagnosis and recording the results in the nursing history of the disease.

The nurse must certify this by making an appropriate entry in the nursing record, date and signature.
At this stage, the patient's opinion about the nursing activities carried out is important. The assessment of the entire nursing process is carried out if the patient is discharged, if he was transferred to another medical institution, if he died, or in case of long-term follow-up.
If necessary, the nursing action plan is reviewed, interrupted or modified. When the intended goals are not being achieved, the assessment provides an opportunity to see the factors that hinder their achievement. If the end result of the nursing process results in failure, then the nursing process is repeated sequentially to find the error and change the nursing intervention plan.
Thus, the evaluation of the results of nursing intervention enables the nurse to establish the strengths and weaknesses in her professional activities.
It may seem that the nursing process and the nursing diagnosis are formalism, “sticky papers”. But the fact is that behind all this is a patient who is right
In a new state, effective, high-quality and safe medical care, including nursing, must be guaranteed. The conditions of insurance medicine imply, first of all, the high quality of medical care, when the measure of responsibility of each participant in this care must be determined: doctor, nurse and patient. Under these conditions, rewards for success and penalties for mistakes are assessed morally, administratively, legally, and economically. Therefore, every action of a nurse, every stage of the nursing process is recorded in the nursing history of the disease - a document reflecting the qualifications of the nurse, the level of her thinking, and therefore the level and quality of the care she provides.
Undoubtedly, and world experience testifies to this, the introduction of the nursing process into the work of medical institutions will ensure the further growth and development of nursing as a science, and will allow nursing in our country to take shape as an independent profession.

The purpose of this method is to ensure an acceptable quality of life in illness by providing the maximum possible physical, psychosocial and spiritual comfort for the patient, taking into account his culture and spiritual values.

Currently, the nursing process is one of the main concepts of modern models of nursing and includes five stages:
Stage 1 - Nursing examination
Stage 2 - Nursing diagnostics
Stage 3 - Planning
Stage 4 - Implementation of the care plan
Stage 5 - Evaluation

The duties of the nurse, which includes both the implementation of the interventions prescribed by the doctor and her independent actions, are clearly defined by law. All manipulations performed are reflected in the nursing documentation.

The essence of the nursing process is:
specification of the patient's problems,
definition and further implementation of the nurse's action plan in connection with the identified problems and
evaluating the results of nursing intervention.

Today in Russia, the need to introduce the nursing process in healthcare institutions remains open. Therefore, the educational and methodological center for scientific research in nursing at the FVSO MMA named after. THEM. Sechenov together with the St. Petersburg regional branch of the all-Russian public organization "Association of Nurses of Russia" conducted a study to clarify the attitude of medical workers to the nursing process and the possibility of its implementation in practical healthcare. The study was conducted by the method of questioning.

Of the 451 respondents, 208 (46.1%) are nurses, of which 176 (84.4%) respondents work in Moscow and the Moscow Region, and 32 (15.6%) in St. Petersburg. 57 (12.7%) of the respondents are nursing managers; 129 (28.6%) are doctors; 5 (1.1%) - teachers of higher and secondary medical educational institutions; 37 (8.2%) - students; 15 (3.3%) are other healthcare professionals, 13 (86.7%) of which work in Moscow and the Moscow Region, and 2 (13.3%) work in St. Petersburg.

To the question “Do you have an idea about the nursing process?” the main part of all respondents (64.5%) answered that they had a complete understanding, and only 1.6% of the survey participants answered that they had no idea about the nursing process.

Further analysis of the survey results showed that the majority of respondents (65.0%) believe that the nursing process organizes the activities of nurses, but it is needed, according to 72.7% of respondents, primarily to improve the quality of patient care.

According to 65.6% of respondents, the most important stage of the nursing process is the 4th stage - the implementation of the plan.

When asked who should evaluate the activities of a nurse, more than half of all respondents (55.0%) named a senior nurse. However, 41.7% of all respondents believe that a doctor should evaluate the activities of a nurse. This is exactly what the bulk of the surveyed doctors (69.8%) think. More than half of the group of nurses (55.3%) and the main part of the group of nursing managers (70.2%), on the contrary, believe that the senior nurse should evaluate the performance of a nurse. Also, a lot of attention in the group of nursing managers is paid to the assessment of the patient and the nurse herself (43.9% and 42.1%, respectively).

When asked about the degree of implementation of the nursing process in their institution, 37.5% of respondents indicated that the nursing process was partially implemented; 27.9% - implemented enough; 30.6% of respondents noted that the nursing process has not been introduced in any form in their medical organization.

When clarifying the possibility and necessity of introducing the nursing process for the further development of nursing in Russia, it was found that 32.4% of respondents consider the introduction necessary, 30.8% - possible, 28.6% - mandatory. Some respondents (two nurses and one nursing manager) believe that the introduction of the nursing process is harmful to the development of nursing in the Russian Federation.

Thus, based on the preliminary results of the study, the following conclusions can be drawn:
the main part of the respondents has an idea about the nursing process and participates in its implementation in their healthcare institutions;
the introduction of the nursing process is an integral element of the quality of nursing care;
the majority of respondents recognize the feasibility of introducing a nursing process.

The first step in the nursing process is the nursing examination.

At this stage, the nurse collects data on the patient's health status and fills out the inpatient nursing card.

The purpose of the examination of the patient is to collect, substantiate and interconnect the information received about the patient in order to create an information database about him and his condition at the time of seeking help.

Survey data can be subjective or objective.

Sources of subjective information are:
the patient himself, who states his own assumptions about his state of health;
family and friends of the patient.

Sources of objective information:
physical examination of the patient by organs and systems;
acquaintance with the medical history of the disease.

For a general assessment of the patient's condition, the nurse should determine the following indicators:
the general condition of the patient;
position of the patient in bed;
the state of consciousness of the patient;
anthropometric data.

The second stage of the nursing process - nursing diagnostics

The concept of nursing diagnosis (nursing problem) was first officially recognized and legislated in 1973 in the United States. The list of nursing problems approved by the American Nurses Association currently includes 114 main items, including hyperthermia, pain, stress, social isolation, lack of self-hygiene, anxiety, decreased physical activity, etc.

Nursing diagnosis is a patient's health condition established as a result of a nursing examination and requiring intervention by a nurse. This is a symptomatic or syndromic diagnosis, in many cases based on the patient's complaints.

The main methods of nursing diagnosis are observation and conversation. Nursing problem determines the scope and nature of care for the patient and his environment. The nurse does not consider the disease, but the external reaction of the patient to the disease. There is a difference between medical and nursing diagnosis. Medical diagnosis focuses on recognizing pathological conditions, while nursing diagnosis is based on describing the reactions of patients to health problems.

Nursing problems can be classified as physiological, psychological and spiritual, social.

In addition to this classification, all nursing problems are divided into:
existing - problems that bother the patient at the moment (for example, pain, shortness of breath, swelling);
potential problems are those that do not yet exist but may develop over time (eg risk of pressure ulcers in an immobile patient, risk of dehydration with vomiting and frequent loose stools).

Having established both types of problems, the nurse determines the factors that contribute to or cause the development of these problems, also reveals the strengths of the patient, which he can counter the problems.

Since the patient always has several problems, the nurse must establish a system of priorities, classifying them as primary, secondary and intermediate. Priorities - this is a sequence of the most important problems of the patient, allocated to establish the order of nursing interventions, there should not be many of them - no more than 2-3.

The primary priorities include those problems of the patient, which, if left untreated, can have a detrimental effect on the patient.
Intermediate priorities are non-extreme and non-life-threatening needs of the patient.
Secondary priorities are the needs of the patient that are not directly related to the disease or prognosis (for example, in a patient with a spinal injury, the primary problem is pain, the intermediate is limitation of mobility, the secondary is anxiety).
Priority selection criteria:
All emergency conditions, for example, acute pain in the heart, the risk of developing pulmonary hemorrhage.
The most painful problems for the patient at the moment, what worries the most, is the most painful and main thing for him now. For example, a patient with heart disease, suffering from attacks of retrosternal pain, headaches, swelling, shortness of breath, may point to shortness of breath as his main suffering. In this case, "dyspnea" will be a priority nursing problem.
Problems that can lead to various complications and deterioration of the patient's condition. For example, the risk of pressure ulcers in an immobile patient.
Problems, the solution of which leads to the solution of a number of other problems. For example, reducing the fear of an upcoming operation improves the patient's sleep, appetite, and mood.

The next task of the second stage of the nursing process is the formulation of a nursing diagnosis - determining the patient's response to the disease and his condition.

Unlike medical diagnosis, which is aimed at identifying a specific disease or the nature of the pathological process, nursing diagnosis can change every day and even during the day as the body's response to the disease changes.

The third step in the nursing process is care planning.

After examining, establishing a diagnosis and determining the patient's primary problems, the nurse formulates the goals of care, expected results and terms, as well as methods, methods, techniques, i.e. nursing actions that are necessary to achieve the goals. It is necessary, through proper care, to eliminate all complicating conditions for the disease to take its natural course.

During planning, goals and a care plan are formulated for each priority problem. There are two types of goals: short-term and long-term.

Short-term goals should be achieved in a short time (usually 1-2 weeks).

Long-term goals are achieved over a longer period of time, aimed at preventing recurrence of diseases, complications, their prevention, rehabilitation and social adaptation, and the acquisition of medical knowledge.

Each goal has 3 components:
action;
criteria: date, time, distance;
condition: with the help of someone / something.

After formulating the goals, the nurse draws up the actual patient care plan, which is a detailed listing of the special actions of the nurse necessary to achieve the goals of care.

Goal Setting Requirements:
Goals must be realistic.
It is necessary to set specific deadlines for achieving each goal.
The goals of nursing care should be within the scope of nursing, not medical competence.
Formulated in terms of the patient, not the nurse.

After formulating goals and drawing up a care plan, the nurse must coordinate with the patient, enlist his support, approval and consent. By acting in this way, the nurse orients the patient towards success, proving the achievability of goals and jointly determining ways to achieve them.

The fourth stage is the implementation of the care plan.

This stage includes the measures taken by the nurse for the prevention of diseases, examination, treatment, rehabilitation of patients.

There are three categories of nursing intervention: independent, dependent, interdependent. The choice of category is determined by the needs of patients.

Independent - provides for actions carried out by a nurse on her own initiative, guided by her own considerations, without a direct request from the doctor or instructions from other specialists (for example, measuring body temperature, blood pressure, pulse rate, etc.).

Dependent - performed on the basis of written prescriptions of a doctor and under his supervision (for example, injections, instrumental and laboratory tests, etc.).

Interdependent - joint activities of a nurse with a doctor and other specialists (for example, the actions of an operating nurse during surgical interventions).

The patient's need for help can be temporary, permanent and rehabilitating.

Temporary assistance is designed for a short period of time when there is a lack of self-care - for dislocations, minor surgical interventions, etc.

The patient needs constant help throughout his life - with amputation of limbs, with complicated injuries of the spine and pelvic bones, etc.

Rehabilitative care is a long process, for example, exercise therapy, massage, breathing exercises, conversation with the patient.

Carrying out the fourth stage of the nursing process, the nurse solves two strategic tasks:
observation and control of the patient's reaction to the doctor's appointments with the fixation of the results obtained in the nursing history (card) of the disease;
observation and control of the patient's reaction to the performance of nursing actions related to the establishment of a nursing diagnosis and registration of the data obtained in the nursing history (card) of the disease.

The fifth step in the nursing process is evaluation.

The purpose of the fifth stage is to assess the patient's response to nursing care, analyze the quality of care provided, evaluate the results and summarize.

The following factors serve as sources and criteria for evaluating nursing care:
assessment of the degree of achievement of the goals of nursing care;
assessment of the patient's response to nursing interventions, to medical staff, treatment, satisfaction with the fact of being in the hospital, wishes;
assessment of the effectiveness of the impact of nursing care on the patient's condition; active search and evaluation of new patient problems.

If necessary, the nursing action plan is reviewed, interrupted or modified. When the intended goals are not being achieved, the assessment provides an opportunity to see the factors that hinder their achievement. If the end result of the nursing process results in failure, then the nursing process is repeated sequentially to find the error and change the nursing intervention plan.

A systematic evaluation process requires the nurse to think analytically when comparing expected results with achieved results. If the goals are achieved, the problem is solved, then the nurse certifies this by making an appropriate entry in the nursing history of the disease, signs and puts down the date.

ANNOTATION

This paper highlights the topic "Nursing process in the work of district nurses with peptic ulcer".

The work consists of three chapters and a conclusion.

In the introduction, the relevance of the choice of topic, purpose and task is substantiated.

The first chapter gives a clinical description of peptic ulcer of the stomach and duodenum.

The second chapter discusses the nursing process as a new type of activity of nursing staff and the impact of the nursing process on the quality of life of patients.

The third chapter presents the characteristics of the examined patients, describes the methods of their study and the conclusions obtained as a result of the work. The role of nurses in the restoration of disturbed needs in patients with peptic ulcer is also considered.

In conclusion, practical recommendations are formulated.

INTRODUCTION
“Young people, and even teenagers, are increasingly among the victims of peptic ulcer. The results of the prevention and treatment of this disease do not satisfy either doctors or patients. The social cost of the disease is still too high. Naturally, therefore, the study of the causes of the disease and its exacerbations, ways of prevention, the search for methods of treating patients are among the urgent tasks and not only of medical science.

E.I.Zaitseva.

The relevance of the topic lies in the fact that peptic ulcer disease occupies a leading place among diseases of the digestive system. Patients with peptic ulcer prevail in the structure of hospitalized gastroenterological patients, as well as those who often use a sick leave. This indicates that this pathology is becoming not only a medical, but also a major social problem.

Reducing the number of relapses and achieving long-term remission is the most important task of clinical medicine. According to various authors, the frequency of recurrence of the disease reaches 40-90%. This is undoubtedly also due to the fact that insufficient attention is paid to the diagnosis and rational treatment of this pathology during remission.

Many people do not know the risk factors for peptic ulcer disease, they cannot recognize the first signs of the disease in themselves, therefore, they do not seek medical help on time, they cannot avoid complications, they do not know how to provide first aid for gastrointestinal bleeding.

The introduction of the nursing process into the activities of nurses in outpatient clinics is dictated by the need to improve the level of patient care, bringing it into line with modern requirements.

Peptic ulcer disease is the most frequent and widespread disease that district doctors and nurses of our polyclinic face in their daily work.

Peptic ulcer is not the last place in the number of patients in the clinic.

Peptic ulcer of the stomach and duodenum causes suffering to many patients, therefore I believe that district nurses under the guidance of a district therapist can and should carry out extensive preventive measures to prevent and reduce the incidence, medical examination and provide qualified medical care.

MPPU "Polyclinic No. 2" serves the population of Popovka-Kiselevka microdistricts in the amount of 62,830 people.

Geographically, the population is divided into 32 areas, including the assigned area.

The land plot where I work has a population of 1934 people. One of the aspects of my work as a district nurse is preventive measures, the purpose of which is to preserve and improve the health of the population.

Work on medical examination is one of the types of preventive work. Its goal is to improve the health of the population, reduce morbidity, and increase life expectancy.

In total, the dispensary group consists of 189 people.

Diseases of the digestive system - 74 people, including peptic ulcer - 29 people. From this it follows that 39% of diseases among the "D" group are diseases of the digestive system, and peptic ulcer accounts for 39% of diseases of the digestive system.

STATISTICAL DATA ON ULCER DISEASE

at site No. 30 of polyclinic No. 2

The structure of dispensary groups in section No. 30 of polyclinic No. 2.

The structure of the morbidity of the digestive organs of site No. 30 of polyclinic No. 2.

Given all of the above, I believe that this problem is of great social and economic importance.

The nursing process, as a universal nursing technology, can and should be used by district nurses in their work to timely identify and eliminate the actual risk of peptic ulcer disease, which will reduce the incidence rate and reduce the number of complications, and therefore improve the quality of life of patients.

This work aims to study the problems of a patient with peptic ulcer and determine the main activities of nurses in an outpatient setting.

Tasks:

to study modern literature on peptic ulcer disease;

to investigate the statistical data on peptic ulcer in the area;

substantiate the need for prevention of peptic ulcer at the outpatient stage;

identify patient problems through questionnaires;

to develop for patients a memo on nutrition in case of peptic ulcer.

The work was carried out on the basis of MLPU polyclinic No. 2.

CHAPTER 1
THE CONCEPT OF ESSENCE AND AVAILABILITY

Peptic ulcer

Prevention and treatment of diseases in modern society is a complex of socio-economic and medical measures aimed at maintaining and strengthening people's health by increasing the compensatory-adaptive abilities of the body, eliminating the causes and conditions that cause the recurrence of the disease. Interest in the problem of peptic ulcer of the stomach and duodenum is due not only to the wide spread of this pathology of the digestive system, but also to the lack of sufficiently reliable methods of treatment that minimize the possible recurrence of the disease.

Statistics show that peptic ulcer is the most common disease of the digestive system and among the adult population is an average of 7-10%. Duodenal ulcers are 4 times more common than gastric ulcers. Among patients with duodenal ulcers, men significantly predominate over women, while among patients with gastric ulcers, the ratio of men and women is approximately the same.

Mostly people of working age get sick.

According to medical statistics, half of the adult population of the country suffers from gastritis and peptic ulcer. Every year, about 6,000 people die in Russia from complications of peptic ulcer disease and inadequate therapy.

With improper behavior (smoking, alcohol abuse, neglect of diet), peptic ulcer is difficult, gives complications, and sometimes leads to disability.

Peptic ulcer is a chronically recurrent disease that is prone to progression with the involvement of other organs of the digestive system in the pathological process with the development of complications that threaten the life of the patient.

CLASSIFICATION

There is no generally accepted classification of peptic ulcer disease. From the point of view of nosological isolation, peptic ulcer and symptomatic gastroduodenal ulcers, as well as peptic ulcer associated and not associated with HP, are distinguished.

Depending on the localization, there are:

stomach ulcers;

duodenal ulcers;

Combination of gastric and duodenal ulcers.

According to the number of ulcerative lesions, they distinguish:

Solitary ulcers;

Multiple ulcers.

Depending on the size of the ulcer:

Small ulcers;

Ulcers of medium size;

Large ulcers;

Giant ulcers.

Contribute to the development of the disease and its exacerbation:

prolonged and often recurring neuro-emotional overstrain (stress);

genetic predisposition, including a persistent increase in the acidity of gastric juice of a constitutional nature;

pre-ulcerative condition: the presence of chronic gastritis, duodenitis, functional disorders of the stomach and duodenum of the hypersthenic type;

violation of the diet;

smoking;

the use of strong alcoholic beverages, certain medications (aspirin, butadione, indomethacin).

Over the past 10 years there have been revolutionary changes in views on the nature of peptic ulcer. The bacterium Helicobacter pylori (H.P.) was discovered, which is currently considered to be the causative agent of chronic gastritis and plays an important role in the pathogenesis of peptic ulcer and gastric cancer.

Epidemiological evidence suggests that 100% of duodenal ulcers and more than 80% of gastric ulcers are associated with the presence of H.R.

Local mechanisms of ulceration include a decrease in the protective mucous barrier, slowing down and irregularity in the evacuation of the contents of the stomach.

With this disease, patients often experience abdominal pain, nausea and vomiting. As a rule, peptic ulcer of the stomach and duodenum is accompanied by a violation of the liver, gallbladder and pancreas, as well as a violation of the activity of the large intestine, which is expressed by increased or delayed stools.

Along with this, an exacerbation of peptic ulcer is often accompanied by weight loss, heartburn, belching (sometimes a rotten egg), a feeling of fullness and rapid saturation with a relatively small amount of food.

Complications of peptic ulcer include:

bleeding;

perforation and penetration of the ulcer;

development of perivisceritis (adhesions);

the formation of cicatricial-ulcerative stenosis of the pylorus;

ulcer malignancy.

CHAPTER 2

CONCEPT OF THE NURSING PROCESS

In connection with the introduction of family and insurance medicine in Russian health care, a new concept for the development of health care, which, in particular, provides for the redistribution of part of the volume of care and the expensive inpatient sector to the outpatient sector, primary health care is becoming the main link in the provision of medical care to the population. A special role of nursing staff in the provision of primary health care with an emphasis on core work is the use of modern prevention technologies, including the formation of medical activity of the population.

The role of nursing personnel in the health education of the population in such important areas as the formation of a healthy lifestyle and disease prevention is growing.

F. Nightingale also singled out one of the areas of care - this is caring for healthy people and the most important task of nurses was "maintaining a person in such a state in which the disease does not occur", that is, for the first time, emphasis was placed on the need for nurses to participate in disease prevention and conservation public health.

W. Henderson noted that “the unique task of nurses in the process of caring for individuals, sick or healthy, is to assess the patient's attitude to the state of his health and help him in the implementation of those actions to strengthen and restore health that he could I would do it myself if I had enough strength, will and knowledge for this.

Therefore, the nurse must know and be able to apply the nursing process as an evidence-based method for solving patient problems.

To carry out the nursing process, a nurse must have the necessary level of theoretical knowledge, have the skills of professional communication and patient education, and perform nursing manipulations using modern technologies.

The nursing process is a scientific method of organizing and executing systematic patient care, focused on meeting the needs of a person related to health.

The nursing process includes a discussion with the patient and (or) his relatives of all possible problems (the patient does not suspect the presence of some of them), assistance in solving them within the nursing competence.

The purpose of the nursing process is to prevent, alleviate, reduce or minimize the problems that a patient has.

The nursing process consists of 5 steps:

nursing examination (collection of information about the patient);

nursing diagnostics (determination of needs);

goal setting and care planning;

implementation of the care plan;

assessment and correction of care, if necessary.

All stages are mandatory recorded in the documentation for the implementation of the nursing process.

Stage I - nursing examination. The nurse must be clear about the uniqueness of each of her patients in order to realize such a requirement for professional care as the individuality of the nursing care provided.

Taking into account the realities of Russian practical health care, it is proposed to provide nursing care within the framework of 10 fundamental human needs (see Appendix 1).

Any disease, including peptic ulcer, leads to a violation of the satisfaction of one or more needs, which causes the patient a feeling of discomfort.

Since the ultimate goal of the nurse's work is the comfort of her patients, she is obliged to find out, using a special technique of nursing examination, the violation of the satisfaction of which needs causes discomfort.

To do this, she asks the patient, performs a physical examination of his organs and systems, studies his lifestyle, identifies risk factors for this disease, gets acquainted with the medical history, talks with doctors and relatives, studies medical and special literature on disease prevention and patient care .

After carefully analyzing all the information collected, the nurse proceeds to stage II - nursing diagnostics. Nursing diagnosis always reflects the lack of self-care that the patient has, and is aimed at accommodating and overcoming it. Nursing diagnosis can change daily and even throughout the day as the body's response to illness changes. Nursing diagnoses can be physiological, psychological, spiritual, social, as well as present and potential.

At the end of the second stage, the nurse identifies priority problems, that is, those problems whose solution is most important at the moment.

At stage III, the sister sets goals and draws up an individual plan for nursing interventions. When drawing up a care plan, a nurse can be guided by the standards of nursing practice, which lists activities that provide quality nursing care for a given nursing problem.

At the end of the third stage, the sister necessarily coordinates her actions with the patient and his family and writes them down in the nursing history.

The fourth stage is the implementation of nursing interventions. Not necessarily the sister does everything herself, she entrusts part of the work to other persons - junior medical staff, relatives, the patient himself. However, she takes responsibility for the quality of the activities performed.

There are 3 types of nursing interventions:

Dependent intervention - performed under the supervision of a doctor and prescribed by a doctor;

Independent intervention - the action of a nurse at her own discretion, that is, helping the patient in self-care, monitoring the patient, advice on organizing leisure activities, etc.

Mutual Intervention – Collaboration with physicians and other professionals.

The task of stage V is to determine the effectiveness of nursing intervention and its correction, if necessary.

Evaluation is carried out by the sister continuously, individually. If the problem is resolved, the nurse should reasonably certify in the nursing history. If the goals were not achieved, the reasons for the failure should be clarified and the necessary adjustments made to the nursing care plan. In search of a mistake, it is necessary to analyze all the sister's actions step by step again.

Thus, the nursing process is an unusually flexible, lively and dynamic process that provides a constant search for errors in care and systematic, timely adjustments to the nursing care plan.

The nursing process is applicable in any area of ​​nursing, including preventive work.

CHAPTER 3

NURSING PROCESS AS A METHOD FOR SOLVING PROBLEMS IN ULCER DISEASE.

The job of community nurses is to help individuals, families, and groups of people identify and achieve physical, mental, and social health in the environment in which they live and work. This requires certain functions from nurses that contribute to the strengthening and preservation of health, as well as the prevention of its deviations. The position of a nurse includes the planning and implementation of care during the period of illness and during the period of rehabilitation, influencing not only the physical, but also the psychological and social aspects of a person's life that make up his whole.

The nurse involves the patient, his family members in self-care, helping him to maintain independence and independence. The participation of a nurse in preventive, medical, diagnostic and rehabilitation care not only in a polyclinic, but also, which is extremely important, at home for patients, makes it possible to ensure greater accessibility of medical and social care within their competence.

Peptic ulcer is a chronic disease that lasts for months, then for years, calming down, then flaring up again. More often improvement occurs in winter and summer, and deterioration - in spring and autumn. This disease affects people at the most active, creative age, often causing temporary and sometimes permanent disability. Therefore, the competent systematic work of nurses is an important link in the prevention and treatment of peptic ulcer.

It is very important for a sister to know the patient's psychology, his environment - relatives, family, since the nurse is a guest in the patient's house and a lot of ethical issues can arise when providing assistance.

Knowing the risk factors for peptic ulcer disease allows for the prevention of this disease, reduce the frequency of exacerbations. Each person has a different idea of ​​health and illness, and the nurse must be prepared to interact with any individual. Understanding by the patient of all factors influencing the development of the disease, changing his attitude to his own health can be the goal of nursing intervention in the prevention of peptic ulcer.

For the study, patients were taken, consisting of a dispensary for peptic ulcer disease. All patients underwent a general clinical examination, which included the collection of anamnestic data and physical examination data.

To study the "quality of life" of patients, a survey was conducted using the SF-36 general health questionnaire and the Shmishek psychological test. All test questions of questionnaires on "quality of life" are divided into groups according to the categories that form the concept of "general quality of life". In most questionnaires, there are five such categories:

general subjective perception of one's health;

mental condition;

the physical state;

social functioning;

role functioning.

After analyzing the results, we can conclude that in patients with peptic ulcer there is a decrease in all categories of "quality of life", and, to the greatest extent - the psychological state, role functioning and especially the physical state.

1. Of the physiological problems in patients, the most common are:

pain (100%);

heartburn (90%);

nausea (50%);

vomiting (20%);

constipation (80%).

2. Of the psychological problems in patients, the most common are:

lack of knowledge about the characteristics of nutrition and lifestyle in case of their illness (80%);

depression, apathy of patients associated with a lack of knowledge about the disease (65%);

anxiety about the outcome of the disease (70%);

fear of diagnostic tests (50%).

Thus, it becomes obvious that the indicator of "quality of life" is an objective criterion during the ulcer process, allowing individualization of treatment and care.

Most often, patients do not have a real idea about their own health, and the nurse can influence the patient, convince him to lead a healthy lifestyle, avoid risk factors that can lead to illness.

The nurse during the first conversation with the patient should outline the range of problems, discuss and outline a plan for further work. The task of the nurse is to make the patient an active fighter for the maintenance and restoration of their own health. At the same time, she must act in such a way that the goals of her activity are internally accepted by the patient.

The nurse acts as the organizer of the conditions for maintaining and restoring the health of the patient, his consultant and the direct executor of everything that is needed to achieve the goal. The result of this joint activity of the nurse and the patient will depend on the level of mutual understanding in everything.

The medical department analyzes all the data received about the patient, taking into account the patient's own comments on each problem, forms together with the patient his problems on the risk factors for peptic ulcer disease, outlines goals and nursing interventions. The goal of nursing intervention is to improve the well-being of the patient.

At the first stage of the nursing process, a nursing examination of the patient is carried out. For the organization and implementation of high-quality individual care, the nurse collects information about the patient.

When collecting information, the following data sources should be used:

questioning the patient;

interviewing family members and others;

familiarization with the outpatient card of the patient;

physical examination of the patient.

The essence of this information is how the patient satisfies the 10 basic vital needs, since the goal of care is to create conditions for the satisfaction of these needs.

Most often, patients suffering from peptic ulcer present with the following complaints:

abdominal pain,

nausea,

vomit,

heartburn,

burp,

spastic constipation,

sleep disturbance,

increased irritability.

The nurse also asks for the following information:

Family history (genetic predisposition);

The presence of chronic diseases (chronic gastritis, duodenitis);

Environmental data (stressful situations, the nature of the patient's work);

The presence of bad habits (smoking, drinking strong alcoholic beverages);

The use of certain medications (acetylsalicylic acid, butadione, indomethacin);

Data on the patient's diet (malnutrition).

At the second stage of the nursing process, nursing diagnoses are made. The purpose of diagnostics is to catch all real and potential deviations from the patient's comfortable state.

Analyzing the information received about the patient, the nurse identifies needs, the satisfaction of which is impaired.

In a patient with peptic ulcer, there are violations of the satisfaction of needs:

in adequate nutrition;

in physiological functions;

in normal sleep;

in maintaining personal hygiene;

in safety.

The nurse then identifies the patient's problems. The most frequent are:

lack of knowledge about the characteristics of nutrition (abuse of salty, spicy foods, violation of the diet);

improper alternation of work and rest;

excessive alcohol consumption;

smoking (20 cigarettes per day);

inability to overcome stress;

ignorance of risk factors for peptic ulcer disease;

lack of understanding of the need to change lifestyle;

anxiety about the outcome of the disease;

ignorance of the complications of peptic ulcer;

lack of knowledge about peptic ulcer;

lack of understanding of the need for regular intake of prescribed medications.

At stage III, the sister begins planning nursing activities. The nurse develops an individual nursing intervention plan. But be sure, when discussing the situation with the patient and possible ways to correct it, the nurse must take into account a very important point: the patient has the right to agree or refuse the proposed care after receiving the necessary information. This means that he must be informed about everything that happened to him, what will be done to him, about what he will have to do himself, and what his relatives, and give consent to this. It is desirable that the patient's consent be recorded in the nursing document.

The sister solves all the problems that she poses and with which the patient agrees, in order of their importance, starting with the most important and going down in order. Goals are set for each problem.

Stage 4 - implementation of nursing interventions.

At this stage, the nurse educates the patient, constantly inspires, encourages and reassures him. As nursing interventions are performed, the nurse records all her actions to solve this problem in the nursing history.

At the fifth stage of the nursing process, the nurse evaluates the effectiveness of the nursing intervention and the degree of achievement of the goal and, if necessary, makes adjustments.

At the end, the nurse tells the patient the result of the assessment: he must know how successfully he coped with the task.

CONCLUSION

The quality of work of paramedical personnel is an indicator of the state of health care in our country as a whole. The concept of the development of nursing, of course, should have provided for the reorganization of the work of nurses. Nurses should use advanced technologies in the process of providing medical services.

In this regard, the advantages of introducing the nursing process into nursing practice are obvious, since the nursing process provides:

a systematic approach to the organization of nursing disease prevention;

individual approach and taking into account all the personal characteristics of the patient;

active participation of the patient and his family in planning and ensuring disease prevention;

the possibility of using standards in the professional activities of a nurse;

efficient use of the nurse's time and resources focused on the patient's core work;

increasing the competence, independence, creative activity of a nurse;

universality of the method.

It is the nursing process that can ensure the further growth and development of nursing and improve the quality of life of patients.

Having studied the modern literature on peptic ulcer and examined the statistical data, we can conclude that patients with peptic ulcer have a lot of physiological and psychological problems.

It is the nurse who should help a person in a difficult situation for him, mobilize his will, find the right way to solve problems, should give people peace and hope.

I, as a district nurse, faced with this problem in my daily work, developed recommendations for district nurses on organizing the nursing process for peptic ulcer disease and a memo for patients on therapeutic nutrition (see appendices 2, 3, 4).

BIBLIOGRAPHY

Reference manual "Clinic, classification and etiopathogenetic principles of anti-relapse treatment of patients with peptic ulcer", Smolensk, 1997.

Journal "Nursing", No. 2, 2000, pp. 32-33

Journal "Nursing", No. 3, 1999, p. 30

Newspaper "Pharmacy for you", No. 21, pp. 2-3

"Educational and methodological manual on the basics of nursing" under the general editorship of A.I. Shpirn, Moscow, 2003.

Medical examination report, section No. 30 for 2003.

APPS

Appendix 1.

Fundamental human needs

Normal breathing.

Adequate food and drink.

Physiological departures.

Motion.

Dream.

Personal hygiene and change of clothes.

Maintain normal body temperature.

Security.

Communication.

Rest and work.

Appendix 2

An example of planning nursing activities.
Lack of knowledge about peptic ulcer disease and the impact of harmful factors

on the patient's health.

Goal: The patient will learn the risk factors for the disease and learn how to avoid them.

Plan:

1. The nurse will ensure enough time to discuss the problem with the patient daily.

2. The nurse will talk with relatives about the need for psychological support.

3. The nurse will tell the patient about the harmful effects of alcohol, nicotine and certain drugs (aspirin, analgin).

4. If there are bad habits, the nurse will think over and discuss with the patient ways to get rid of them (for example, visiting special groups).

6. The nurse will talk with the patient and relatives about the nature of the diet:

a) eat 5-6 times a day, in small portions, chewing thoroughly;

b) avoid the use of products that have a pronounced irritant effect on the mucous membrane of the stomach and duodenum (acute, salty, fatty);

c) include in the diet protein foods, foods rich in vitamins and minerals, foods containing dietary fiber.

7. The nurse will explain to the patient the need for dispensary observation: 2 times a year.

8. The nurse will introduce the patient to a person adapted to the risk factors for peptic ulcer disease.

Appendix 3
Nursing planning example

The patient is unaware of the complications of peptic ulcer

Objective: The patient will demonstrate knowledge of complications and their consequences.

Plan:

1. The nurse will ensure enough time to discuss problems with the patient.

2. The nurse will tell the patient about signs of bleeding (vomiting, drop in blood pressure, cold and clammy skin, tarry stools, restlessness) and perforation (sudden sharp pain in the abdomen).

3. The nurse will convince the patient of the importance of a timely visit to the doctor.

4. The nurse will teach the patient the necessary rules of conduct in case of peptic ulcer and will convince them of the need to comply with them:

a) the rules of drug therapy;

b) elimination of bad habits (smoking, alcohol).

5. The nurse will talk to the patient about the dangers of self-treatment (using soda).

Appendix 4
Memo to a patient with peptic ulcer on the organization of therapeutic nutrition

Diet: take food 5-6 times a day in small portions, in a warm form (t = 40-50 ° C), chewing thoroughly.

Exclude: spicy, salty, canned, smoked, fatty, fried.

Featured Products
Products not recommended
Wheat bread from premium flour and 1c yesterday's baking, crackers Rye bread, fresh, muffin
Lean meat (steamed, boiled) Fatty and sinewy meats (lamb, goose, duck), fried, stewed
Low-fat fish (perch, hake, cod, bream) boiled and steamed Fatty fish (sturgeon, salmon, salmon), salted, smoked, fried, canned stew
Soft-boiled eggs, steam scrambled eggs and scrambled eggs (2 eggs per day) Fried scrambled eggs, scrambled eggs, hard-boiled eggs, raw egg white
Whole milk, cream, day-old kefir, non-acidic cottage cheese, sour cream, non-spicy grated cheese Dairy products with high acidity, spicy, salty cheeses
Butter unsalted butter, refined vegetable oil Margarine, fat, unrefined vegetable oil
Cereals: semolina, rice, buckwheat, oatmeal. Semi-viscous cereals, finely chopped boiled pasta Millet, pearl barley, barley, legumes, crumbly cereals, whole pasta
Potatoes, carrots, beets, cauliflower, boiled and pureed White cabbage, turnips, sorrel, onions, pickled cucumbers, pickled and pickled vegetables, mushrooms
Ripe and sweet berries and fruits, marshmallows, jelly Sour, unripe fruits and berries, chocolate, halva, ice cream
Weak tea, coffee with milk, juices from fruits and berries, boiled rose hips Carbonated drinks, kvass, black coffee, juices of sour berries and fruits

Abstract………………………………………………………… ….2

Introduction………………………………………………………… …3

Chapter 1

peptic ulcer disease…………………………………………………….7

Chapter 2. The concept of the nursing process…………………… ..10

Chapter 3

with peptic ulcer…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Conclusion………………………………………………………….20

Applications……………………………………………………… …22

References………………………………………………27

Primary prevention is the main direction of primary health care for the population

N.I. Gurvich, O.N. Knyagina, V.A. Minchenko, E.E. Shalnova
Bureau of Medical Statistics of the Department of Health of the Administration of the Nizhny Novgorod Region,
Center for State Sanitary and Epidemiological Surveillance of the Nizhny Novgorod Region
[email protected]

In the concept of state policy in the field of health promotion and prevention of diseases of the population for 2000 - 2010. a significant place is given to strengthening preventive activities aimed not only at eliminating the causes of diseases, reducing the impact of adverse factors and protecting against diseases, but also at developing the potential of public health.

In this regard, much attention is paid to the development and improvement of primary health care, which, as stated in the concept, "should take its place in changing the lifestyle of every person and family, the population as a whole." In the healthcare system, primary health care (PHC) is provided by the coordinated interaction of the district (family) service, which deals with this work at the individual level, and the medical prevention service, which operates mainly at the population level.

On the territory of the Nizhny Novgorod region, in accordance with the order of the Ministry of Health of the Russian Federation No. 295 of 06.10.97 "On improving the activities of health authorities in the field of hygienic education and education of the population of the Russian Federation", in 1998 a specialized network of structural units of the medical prevention service was created.

In pursuance of the order of the Department of Health of the Administration of the Nizhny Novgorod Region No. 7A dated May 12, 1998 "On measures to develop the medical prevention service", a department of medical prevention was organized in the structure of the Bureau of Medical Statistics, which has the status of a regional Center for Medical Prevention (OCMP). The structure of the medical prevention service of the Nizhny Novgorod region also included the Center for Medical Prevention in Dzerzhinsk, 2 departments (in the cities of Arzamas and Ardatov); over the two years of its existence, 50 offices have been reorganized, functioning as part of the health care facilities of the districts of the Nizhny Novgorod region. As of the beginning of 2000, 24 doctors and 54 paramedical workers work in the medical prevention service. However, in 7 districts of the region and health care facilities of regional subordination, rates are not allocated, the work is assigned to responsible persons.

OCMP, being at the level of the Nizhny Novgorod region the head institution of the medical prevention service, coordinates, organizes and controls the work of departments, medical prevention rooms of medical institutions in the areas of hygienic education and upbringing, disease prevention, formation and strengthening of public health, as well as the implementation of cultural and health-improving measures that contribute to increasing efficiency and achieving active longevity of the population.

The OCMP provides unified methodological guidance for the activities of medical prevention structures, interaction with institutions and healthcare professionals of the Nizhny Novgorod region at all levels on medical prevention - regional Centers for State Sanitary and Epidemiological Surveillance, Prevention and Control of AIDS, Family Planning, clinical hospitals, etc.), attracts the teaching staff of the Novosibirsk State Medical Academy, the chief specialists of the Department of Health of the Administration of the Nizhny Novgorod Region and the city of Nizhny Novgorod to the work on hygienic education and education of the population. Together with specialists from specialized services, the OCMP analyzes the cause-and-effect relationships between the health of the population, its lifestyle and sanitary culture, the level of medical care, and the environmental situation in the region; based on the results of the analysis determines priorities in the promotion of medical, preventive and hygiene knowledge among the population. Such for the medical prevention service of the Nizhny Novgorod region, as well as in Russia as a whole, are the prevention of diseases of the circulatory system, respiratory organs, nervous system, oncological and infectious diseases (including socially significant ones, such as HIV / AIDS infection, tuberculosis, diseases, sexually transmitted), maternal and child health, promotion of adolescent health, prevention of unnatural causes of death, as well as promotion of healthy lifestyles and the fight against bad habits

In order to ensure a unified policy of primary prevention of diseases, preservation and promotion of health, the OCMP participates in the development and implementation of regional programs and regulatory documents on the protection and promotion of public health, prevention of diseases and injuries; in the work of interdepartmental coordinating councils, collegiums and submits for consideration by the Department of Health, the Center for State Sanitary and Epidemiological Surveillance, the Department of Education and Science and other interested departments issues of hygienic education and sanitary culture of the population.

Consistently orienting the health care institutions of the region to priority preventive activities, the OCMP provides organizational, methodological and advisory assistance to units of the medical prevention service, specialized institutions and medical personnel of medical institutions on supervised problems of disease prevention and hygiene education; prepares and publishes for specialists and the public methodological, informational and other printed materials on various sections of disease prevention, injury, medical rehabilitation and the formation of a healthy lifestyle; sends them to the Central District Hospital of the Nizhny Novgorod Region and the health care facilities of the city of Nizhny Novgorod and the city of Dzerzhinsk. In total for 1998-1999. about 40 varieties of methodological materials, leaflets and booklets were issued.

To ensure effective primary health care for the population, the OCMP trains specialists in the prevention of non-communicable diseases and hygiene education to work with the population - in 1998, a certification course was organized and conducted for paramedical workers of the medical prevention service in the Nizhny Novgorod region and the city of Nizhny Novgorod in the line of the Criminal Procedure Code of paramedical workers in the specialty "hygienic education", in 1999-2000. - separate seminars and practical classes on medical and preventive topics with nurses and paramedics who improve their qualifications in the specialty "General Medicine" and "Nursing" - 252 people were trained; seminars, conferences and meetings on the exchange of experience on diverse topics, for example, such as: "Actual issues of improving the medical prevention service in health care facilities of the Nizhny Novgorod region", "Organization of preventive work in children's clinics", "Issues of prevention of drug addiction, HIV / AIDS infection in hygienic education of the population", "Actual problems of family health" and others.

Work with the population by medical workers of the Nizhny Novgorod region and the city of Nizhny Novgorod is carried out mainly by affordable and low-cost methods and means (due to the lack of targeted funding for the medical prevention service) in the form of lectures, conversations, conferences, seminars, evenings of questions and answers, " round tables", preparation of sanitary bulletins. According to the reports of the Central District Hospital of the Nizhny Novgorod region, medical facilities of regional subordination and the city of Nizhny Novgorod for 1999. 68455 lectures, 698162 conversations were read, 1624 promotional and recreational events were held.

An important section of the work is interaction with the media, organization of television and radio programs
etc.................

Nursing process is a method of evidence-based and practical actions of a nurse to provide care to patients.

The purpose of this method is to ensure an acceptable quality of life in illness by providing the maximum possible physical, psychosocial and spiritual comfort for the patient, taking into account his culture and spiritual values.

Currently, the nursing process is one of the main concepts of modern models of nursing and includes five stages:

Stage 1 - Nursing examination

Stage 2 - Nursing diagnostics

Stage 3 - Planning

Stage 4 - Implementation of the care plan

Stage 5 - Evaluation

The duties of the nurse, which includes both the implementation of the interventions prescribed by the doctor and her independent actions, are clearly defined by law. All manipulations performed are reflected in the nursing documentation.

The essence of the nursing process is:

specification of the patient's problems,

definition and further implementation of the nurse's action plan in connection with the identified problems and

evaluating the results of nursing intervention.

Today in Russia, the need to introduce the nursing process in healthcare institutions remains open. Therefore, the educational and methodological center for scientific research in nursing at the FVSO MMA named after. THEM. Sechenov together with the St. Petersburg regional branch of the all-Russian public organization "Association of Nurses of Russia" conducted a study to clarify the attitude of medical workers to the nursing process and the possibility of its implementation in practical healthcare. The study was conducted by the method of questioning.

Of the 451 respondents, 208 (46.1%) are nurses, of which 176 (84.4%) respondents work in Moscow and the Moscow Region, and 32 (15.6%) in St. Petersburg. 57 (12.7%) of the respondents are nursing managers; 129 (28.6%) are doctors; 5 (1.1%) - teachers of higher and secondary medical educational institutions; 37 (8.2%) - students; 15 (3.3%) are other healthcare professionals, 13 (86.7%) of which work in Moscow and the Moscow Region, and 2 (13.3%) work in St. Petersburg.

To the question “Do you have an idea about the nursing process?” the main part of all respondents (64.5%) answered that they had a complete understanding, and only 1.6% of the survey participants answered that they had no idea about the nursing process.

Further analysis of the survey results showed that the majority of respondents (65.0%) believe that the nursing process organizes the activities of nurses, but it is needed, according to 72.7% of respondents, primarily to improve the quality of patient care.

According to 65.6% of respondents, the most important stage of the nursing process is the 4th stage - the implementation of the plan.

When asked who should evaluate the activities of a nurse, more than half of all respondents (55.0%) named a senior nurse. However, 41.7% of all respondents believe that a doctor should evaluate the activities of a nurse. This is exactly what the bulk of the surveyed doctors (69.8%) think. More than half of the group of nurses (55.3%) and the main part of the group of nursing managers (70.2%), on the contrary, believe that the senior nurse should evaluate the performance of a nurse. Also, a lot of attention in the group of nursing managers is paid to the assessment of the patient and the nurse herself (43.9% and 42.1%, respectively).

When asked about the degree of implementation of the nursing process in their institution, 37.5% of respondents indicated that the nursing process was partially implemented; 27.9% - implemented enough; 30.6% of respondents noted that the nursing process has not been introduced in any form in their medical organization.

When clarifying the possibility and necessity of introducing the nursing process for the further development of nursing in Russia, it was found that 32.4% of respondents consider the introduction necessary, 30.8% - possible, 28.6% - mandatory. Some respondents (two nurses and one nursing manager) believe that the introduction of the nursing process is harmful to the development of nursing in the Russian Federation.

Thus, based on the preliminary results of the study, the following conclusions can be drawn:

the main part of the respondents has an idea about the nursing process and participates in its implementation in their healthcare institutions;

the introduction of the nursing process is an integral element of the quality of nursing care;

the majority of respondents recognize the feasibility of introducing a nursing process.

The first step in the nursing process is the nursing examination.

At this stage, the nurse collects data on the patient's health status and fills out the inpatient nursing card.

The purpose of the examination of the patient is to collect, substantiate and interconnect the information received about the patient in order to create an information database about him and his condition at the time of seeking help.

Survey data can be subjective or objective.

Sources of subjective information are:

the patient himself, who states his own assumptions about his state of health;

family and friends of the patient.

Sources of objective information:

physical examination of the patient by organs and systems;

acquaintance with the medical history of the disease.

For a general assessment of the patient's condition, the nurse should determine the following indicators:

the general condition of the patient;

position of the patient in bed;

the state of consciousness of the patient;

anthropometric data.

The second stage of the nursing process - nursing diagnostics

The concept of nursing diagnosis (nursing problem) was first officially recognized and legislated in 1973 in the United States. The list of nursing problems approved by the American Nurses Association currently includes 114 main items, including hyperthermia, pain, stress, social isolation, lack of self-hygiene, anxiety, decreased physical activity, etc.

Nursing diagnosis is a patient's health condition established as a result of a nursing examination and requiring intervention by a nurse. This is a symptomatic or syndromic diagnosis, in many cases based on the patient's complaints.

The main methods of nursing diagnosis are observation and conversation. Nursing problem determines the scope and nature of care for the patient and his environment. The nurse does not consider the disease, but the external reaction of the patient to the disease. There is a difference between medical and nursing diagnosis. Medical diagnosis focuses on recognizing pathological conditions, while nursing diagnosis is based on describing the reactions of patients to health problems.

Nursing problems can be classified as physiological, psychological and spiritual, social.

In addition to this classification, all nursing problems are divided into:

existing - problems that bother the patient at the moment (for example, pain, shortness of breath, swelling);

potential problems are those that do not yet exist but may develop over time (eg risk of pressure ulcers in an immobile patient, risk of dehydration with vomiting and frequent loose stools).

Having established both types of problems, the nurse determines the factors that contribute to or cause the development of these problems, also reveals the strengths of the patient, which he can counter the problems.

Since the patient always has several problems, the nurse must establish a system of priorities, classifying them as primary, secondary and intermediate. Priorities - this is a sequence of the most important problems of the patient, allocated to establish the order of nursing interventions, there should not be many of them - no more than 2-3.

The primary priorities include those problems of the patient, which, if left untreated, can have a detrimental effect on the patient.

Intermediate priorities are non-extreme and non-life-threatening needs of the patient.

Secondary priorities are the needs of the patient that are not directly related to the disease or prognosis (for example, in a patient with a spinal injury, the primary problem is pain, the intermediate is limitation of mobility, the secondary is anxiety).

Priority selection criteria:

All emergency conditions, for example, acute pain in the heart, the risk of developing pulmonary hemorrhage.

The most painful problems for the patient at the moment, what worries the most, is the most painful and main thing for him now. For example, a patient with heart disease, suffering from attacks of retrosternal pain, headaches, swelling, shortness of breath, may point to shortness of breath as his main suffering. In this case, "dyspnea" will be a priority nursing problem.

Problems that can lead to various complications and deterioration of the patient's condition. For example, the risk of pressure ulcers in an immobile patient.

Problems, the solution of which leads to the solution of a number of other problems. For example, reducing the fear of an upcoming operation improves the patient's sleep, appetite, and mood.

The next task of the second stage of the nursing process is the formulation of a nursing diagnosis - determining the patient's response to the disease and his condition.

Unlike medical diagnosis, which is aimed at identifying a specific disease or the nature of the pathological process, nursing diagnosis can change every day and even during the day as the body's response to the disease changes.

The third step in the nursing process is care planning.

After examining, establishing a diagnosis and determining the patient's primary problems, the nurse formulates the goals of care, expected results and terms, as well as methods, methods, techniques, i.e. nursing actions that are necessary to achieve the goals. It is necessary, through proper care, to eliminate all complicating conditions for the disease to take its natural course.

During planning, goals and a care plan are formulated for each priority problem. There are two types of goals: short-term and long-term.

Short-term goals should be achieved in a short time (usually 1-2 weeks).

Long-term goals are achieved over a longer period of time, aimed at preventing recurrence of diseases, complications, their prevention, rehabilitation and social adaptation, and the acquisition of medical knowledge.

Each goal has 3 components:

action;

criteria: date, time, distance;

condition: with the help of someone / something.

After formulating the goals, the nurse draws up the actual patient care plan, which is a detailed listing of the special actions of the nurse necessary to achieve the goals of care.

Goal Setting Requirements:

Goals must be realistic.

It is necessary to set specific deadlines for achieving each goal.

The goals of nursing care should be within the scope of nursing, not medical competence.

Formulated in terms of the patient, not the nurse.

After formulating goals and drawing up a care plan, the nurse must coordinate with the patient, enlist his support, approval and consent. By acting in this way, the nurse orients the patient towards success, proving the achievability of goals and jointly determining ways to achieve them.

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