Theoretical foundations of nursing. Program of the discipline “Fundamentals of Nursing

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

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

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

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

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

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

1) creating a patient information database;

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

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

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

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

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

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

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

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

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

Stage III– planning necessary assistance to the patient.

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

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

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

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

15. Principles of record keeping

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

2) brief and unambiguous presentation of information;

3) coverage of all basic information;

4) use only generally accepted abbreviations.

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

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

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

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

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

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

6. Involve the patient in keeping records related to self-care or e.g. water balance daily diuresis.

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

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

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

2) duplication of documentation;

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

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

16. Methods of nursing interventions

Nursing care is planned on the basis of failure to meet the patient's needs, rather than on the basis medical diagnosis, i.e. diseases.

Nursing interventions can also be ways to meet needs.

It is suggested to use the following methods:

1) provision of first aid;

2) fulfillment of medical prescriptions;

3) creating comfortable conditions for the patient in order to satisfy his basic needs;

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

5) performing technical manipulations and procedures;

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

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

There are three types of nursing interventions:

1) dependent;

2) independent;

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

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

3) identify the patient's unmet care needs;

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

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

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

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Introduction.

I.Founder of modern nursing.

II. Our compatriots in the history of nursing.

III. The concept of the nursing process.

Conclusion.

Introduction

The modern concept of nursing, aimed at strengthening the status of the nurse, was adopted in Russia in 1993 at the international conference “New nurses for a new Russia. A notable recent event was the II All-Russian Congress of Medical Workers in October 2004, at which health care reform was discussed. More than 1,100 delegates and guests took part in its work.

Today, the topic “Modern ideas in the development of nursing” is very relevant, since we are faced with very serious tasks, the implementation of which will radically change the existing situation in nursing, as an integral part of organizational health care technology, aimed at solving the problems of individual and public health in today's complex and rapidly changing conditions.

Today, nursing is an art, a science, it requires understanding, application of special knowledge and skills.

Nursing is "the act of using the patient's environment to promote his recovery." Nursing is based on knowledge and technology created on the basis of the humanities and natural sciences: biology, medicine, psychology, sociology, and others.

The nurse accepts responsibility and acts with appropriate authority while directly performing professional duties. She is responsible for the medical services she provides. She has the right to independently evaluate and decide whether she needs further education in management, teaching, clinical work and research and to take steps to meet these needs.

Nursing involves the planning and delivery of care during illness and rehabilitation and considers the impact of various aspects of a person's life on health, illness, disability and death.

Founder of modern sisterhoodncivil affairs

Florence Nightingale, the first researcher and founder of modern nursing, revolutionized public consciousness and views on the role and place of the nurse in protecting public health. There are many definitions of nursing, each of which was influenced by the characteristics of the historical era and national culture, the level of socio-economic development of society, the demographic situation, the population's needs for medical care, the state of the health care system and the availability of its personnel, as well as the ideas and views of the person formulating this concept.

The first definition of nursing was given by Florence Nightingale in her famous “Notes on Nursing” (1859). Attaching particular importance to cleanliness, fresh air, silence, proper nutrition, she characterized nursing as “the act of using the patient’s environment to promote his recovery.” The most important task of the sister, according to Nightingale, was to create conditions for the patient under which nature itself would exert its healing effect. Nightingale called nursing an art, but she was convinced that this art required "organization, practical and scientific training."

Having for the first time identified two areas in nursing - caring for the sick and caring for healthy people, she defined caring for the healthy as “maintaining a person’s condition in which illness does not occur,” while nursing as “helping a person suffering from an illness to live the best possible life.” full life, bringing satisfaction." Nightingale expressed the firm belief that "at its core, nursing as a profession is different from medical practice and requires special, distinct knowledge." For the first time in history, she applied scientific methods to solving nursing problems. The first schools , created according to its model in Europe, and then in America, were autonomous and secular. Teaching in them was conducted by the nurses themselves, paying special attention to the formation of special nursing knowledge, skills and values. Professional values ​​meant respect for the patient’s personality, his honor, dignity and freedom, showing attention, love and care, maintaining confidentiality, as well as observing professional duty.It is no coincidence that the motto of the first honorary international sisterhood was the words: Love, Courage, Honor.

But after Nightingale’s death, forces began to develop in society that opposed her views and ideals. Rapid development in the first quarter of this century in a number of Western countries, including in the USA, capitalist market relations have not least affected the healthcare system. The development of medicine, as a profitable medical business in the West, provided the conditions for rapid technological progress and the creation of a complex system of providing medical services. In the process of forming the health care system in scientific, organizational and political terms, doctors and hospital administrations began to consider nurses only as a source of cheap labor that contributed to the achievement of economic goals.

Most nursing schools in the USA and Europe came under the control of hospitals, and doctors and hospital administrators began to provide theoretical and practical training in them. The nurses were only required to unquestioningly follow the doctor’s orders; their role increasingly began to be perceived as auxiliary.

However, despite the prevailing social conditions, nursing leaders from among the first graduates of Florence Nightingale's schools steadfastly followed the ideals of their outstanding mentor, striving to develop a body of specialized knowledge that forms the basis of professional nursing practice. They were actively involved in the development of independent nursing practice in hospitals, homes, and institutions where there was a need for such care on the part of individuals, families and community groups.

Nursing practice began to gradually transform into an independent professional activity based on theoretical knowledge, practical experience, scientific judgment and critical thinking. Interest in development scientific research in the field of nursing was partly due to the wide possibilities of using their results in the alternative supportive health services created after the Second World War in a number of Western countries. These, first of all, included nursing homes, in which professional nurses monitored and provided comprehensive care to the elderly, chronically ill and disabled people who did not need intensive therapeutic measures, i.e. in medical interventions. Nurses have taken responsibility for providing these patients with the required level of care and maintaining their optimal quality of life and well-being. The organization of nursing homes and units, as well as home care and nursing services for mothers and children from low-income communities, ensured greater access to health care for the population in the face of rampant price increases in the hospital health care sector.

The vast majority (about eighty percent) of the nurses continued to work in hospitals. However, the use of modern medical equipment and advanced technologies required a new level of knowledge from nurses. There was no doubt that the quality of nursing care is entirely determined by the level of professional education.

Students and followers of Florence Nightingale advocated for nursing education to take its rightful place in colleges and universities. The first university nursing training programs appeared in the United States at the end of the last century, but their number increased significantly in higher education institutions in America and Europe after the Second World War. Soon new theories and models of nursing began to appear, and after them even scientific schools with their authorities. Thus, the famous nursing theorist Virginia Hendensen, defining the relationship between the nurse and the patient, noted that “the unique task of the nurse in the process of caring for individuals, sick or healthy, is to assess the patient’s attitude towards his state of health and help him in carrying out those actions to strengthen and restore health that he could perform himself if he had enough strength, will and knowledge for this.” According to another researcher, Dorothea Orem, "the main purpose of the nurse's activity should be to support the patient's ability to take care of himself."

In professional nursing communication, new terms increasingly appeared, such as “nursing process”, “nursing diagnosis”, etc. They were given a place in new formulations of nursing. For example, in 1980, the American Nursing Association defined the task of nursing as “the ability to make a nursing diagnosis and adjust the patient's response to illness.” Let us clarify that a nursing diagnosis differs from a medical diagnosis in that it determines not the disease, but the patient’s response to the disease. Evolving nursing knowledge required further discussion, testing, application and dissemination.

In 1952, the first international scientific journal on nursing, Nursing Research, was published. Currently, about two hundred professional nursing magazines are published in America alone. By 1960, doctoral programs in nursing began to appear. By the end of the seventies, the number of nurses with a doctorate degree in the United States reached 2000. In 1973, the National Academy of Nursing Sciences was created in America, and in 1985, the US Congress passed legislation that created the National Center for Nursing Research within the National Institutes of Health.

However, such favorable conditions for the development of nursing were not everywhere. Neglect of the nursing profession and misuse of nursing personnel in many countries have hampered the development of not only nursing care, but also health care in general. In the words of the eminent researcher and promoter of nursing in Europe, Dorothy Hall, “Many of the problems facing national health services today could have been avoided if nursing had developed at the same rate over the past forty years.” medical science". "The reluctance to admit," she writes, "that the nurse occupies an equal position in relation to the doctor, has led to the fact that nursing care has not received such development as medical practice, depriving both sick and healthy people of the opportunity to benefit from diverse, accessible, cost-effective nursing services.”

However, nurses in all countries of the world are increasingly expressing their desire to make a professional contribution to the creation of a qualitatively new level of medical care for the population. In the context of global and regional, social and economic, political and national transformations, they see their role in society differently, sometimes acting not only as a medical worker, but also as an educator, teacher, and patient advocate. At a meeting of national representatives of the International Council of Sisters, held in New Zealand in 1987, the following wording was unanimously adopted: “Nursing is an integral part of the health care system and includes activities to promote health, prevent disease, provide psychosocial assistance and care to people with physical and mental illness, as well as disabled people of all age groups. Such assistance is provided by nurses both in medical and any other institutions, as well as at home, wherever there is a need for it.”

I would like to believe that our Russian sisters are awakening a sense of professional self-awareness, that we are becoming equal participants in the transformation of the national healthcare system and members of the international nursing community. The future of nursing in Russia is in our hands; it depends on each of us, on each nursing team. And let the new professional magazine “Nursing” become a kind and wise assistant and advisor in all our endeavors.

Our compatriots in the history of sistersncivil affairs.

There is probably no person who does not know who nurses are. Many will remember that until 1917, nurses were called sisters of mercy or merciful sisters. Someone, perhaps, will remember that the sisters of mercy first appeared in Russia during the Crimean War of 1854-1855 in besieged Sevastopol, and will even argue that their appearance is connected with the name of the great Russian surgeon Nikolai Ivanovich Pirogov. But this will not be an entirely correct statement, because the institute of sisters of mercy owes its appearance not so much to Pirogov as to one remarkable woman, once very famous, but now, unfortunately, very rarely remembered - Grand Duchess Elena Pavlovna. It would seem that God gave this woman everything she needed for happiness: beauty, intelligence, a home - a beautiful palace, delight and veneration of outstanding people of her time, and finally, a large family - a husband and five daughters. But this happiness did not last long: in 1832, one-year-old daughter Alexandra died, and in 1836, two-year-old Anna died; in 1845, nineteen-year-old Elizabeth died, and a year later, the eldest daughter Maria, who was only 21 years old. In 1849, Mikhail Pavlovich died, and Grand Duchess widowed at the age of 43. After this, Elena Pavlovna completely devoted herself to social and charitable activities.

Back in 1828, Empress Maria Feodorovna bequeathed to her the management of the Mariinsky and Midwifery Institutes, and since then, the problems of medicine have been constantly in her field of vision. She, however, was accused of patronage and patronage mainly of German doctors, but it is unlikely that such reproaches were fair if we remember her participation in the fate of the outstanding Russian doctor Nikolai Ivanovich Pirogov...

In 1856, at the request of the same Elena Pavlovna, a medal was minted to reward especially distinguished sisters of the Holy Cross community. At the same time, Empress Alexandra Feodorovna, the widow of Nicholas I, established a similar medal. Elena Pavlovna died on January 3 (15), 1873. In the same year, it was decided to implement one of her latest plans - to build an institute for advanced training of doctors in St. Petersburg.

Concept of nursingm process.

The nursing process is one of the basic concepts of modern nursing models. In accordance with the requirements of the State educational standard in nursing, the nursing process is a method of organizing and performing nursing care for a patient, aimed at meeting the physical, psychological, social needs of a person, family, and society.

The nursing process requires from the nurse not only good technical training, but also a creative attitude towards patient care, the ability to work with the patient as an individual, and not as an object of manipulation. The constant presence of the nurse and her contact with the patient make the nurse the main link between the patient and the outside world.

The nursing process consists of five oWithnew stages.

1. Nursing examination. Collection of information about the patient’s health status, which can be subjective and objective. The subjective method is physiological, psychological, social data about the patient; relevant environmental data. The source of information is a survey of the patient, his physical examination, study of medical documentation data, conversation with the doctor, and the patient’s relatives. Objective method is a physical examination of the patient, including assessment and description of various parameters (appearance, state of consciousness, position in bed, degree of dependence on external factors, color and humidity skin and mucous membranes, the presence of edema). The examination also includes measuring the patient's height, determining his body weight, measuring temperature, counting and estimating the number breathing movements, pulse, measurement and assessment of blood pressure.

The end result of this stage of the nursing process is the documentation of the information received and the creation of a nursing medical history, which is a legal protocol - a document of the independent professional activity of the nurse.

2. Identifying the patient's problems and formulating a nursing diagnosis. The patient's problems are divided into existing and potential. Existing problems are those problems that are currently bothering the patient. Potential - those that do not yet exist, but may arise over time. Having established both types of problems, the nurse determines the factors that contribute to or cause the development of these problems, and also identifies strengths the patient, which he can confront the problems.

Since a patient always has several problems, the nurse must establish a system of priorities. Priorities are classified as primary and secondary. Primary priority is given to problems that are likely to have the greatest impact harmful influence on the patient.

The second stage ends with the establishment of a nursing diagnosis. There is a difference between medical and nursing diagnosis. Medical diagnosis focuses on recognizing pathological conditions, while nursing diagnosis is based on describing patients' reactions to health problems. The American Nurses Association, for example, identifies the following as the main health problems: limited self-care, disruption of the normal functioning of the body, psychological and communication disorders, problems associated with life cycles. As nursing diagnoses, they use, for example, phrases such as “deficiency of hygiene skills and sanitary conditions”, “decreased individual ability to overcome stressful situations", "worry", etc.

3. Determining the goals of nursing care and planning nursing activities. The nursing care plan must include operational and tactical goals aimed at achieving specific long-term or short-term results.

When forming goals, it is necessary to take into account the action (execution), criterion (date, time, distance, expected result) and conditions (with the help of what and by whom). For example, “the goal is that the patient, with the help of a nurse, should get out of bed by January 5.” Action - get out of bed, criterion January 5, condition - help from a nurse.

After determining nursing goals and objectives, the nurse develops a written nursing care manual that details the nurse's specific nursing actions to be recorded in the nursing record.

4. Implementation of planned actions. This stage includes the measures that the nurse takes to prevent diseases, examine, treat, and rehabilitate patients. There are three categories of nursing interventions. The choice of category is determined by the needs of the patients.

Dependent nursing intervention is carried out on the basis of physician orders and under his supervision. Independent nursing intervention involves actions carried out by the nurse on his own initiative, guided by his own considerations, without direct demands 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 nurse with the doctor, as well as with other specialists. In all types of interactions, the sister's responsibility is exceptionally great.

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

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

Conclusion.

The goal of the nursing process is to maintain and restore the patient's independence and meet the basic needs of the body.

In conclusion, we can conclude that modern performance about the development of nursing in society is to help individuals, families and groups to develop their physical, mental and social potential and maintain it at an appropriate level, regardless of changing living and working conditions.

This requires the nurse to work to promote and maintain health, as well as to prevent diseases.

List of used literature

1. S. A. Mukhina, I. I. Tarkovskaya “Theoretical foundations of nursing” part I - II 1996, Moscow

2. V. M. Kuznetsov “Nursing in surgery”, Rostov-on-Don, Phoenix, 2000.

3. Standards of practical activity of nurses in Russia volume I - II

4. S. I. Dvoinikoova, L. A. Karaseva “Organization of the nursing process in patients with surgical diseases” Med. Help 1996 No. 3 P. 17-19.

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moral and ethical standards, rules and principles of professional nursing behavior

ethical foundations of modern medical legislation

patient and nurse rights

concept of medical secrecy

oath F. Nightingale

Code of Ethics of the International Council of Nurses

Ethical Code of Russian Nurses

concept and functions of communication

types, styles and means of communication

factors that promote or hinder effective communication

The student must be able to:

identify ethical errors in the professional activities of nurses

organize therapeutic communication with the patient.

Basic concepts and terms

Bioethics– norms, principles, rules of conduct.

Dispensary– a specialized institution for providing medical and preventive care to groups of patients of a certain profile.

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

Medical ethics– the science of moral principles in the work of a nurse.

Communication- these are all methods of behavior that a person uses consciously or unconsciously to influence another, not only through oral or written speech, but also through facial expressions, gestures, and symbols.

Verbal communication (verbal, speech)– the process of transferring information during communication from one person to another.

Non-verbal (wordless) communication– communication using facial expressions, gestures, posture and posture instead of words.

Patronage– systematic, active monitoring of the patient.

Patient– a person who needs and receives nursing care.

Environment– a set of natural, social, psychological and spiritual factors and indicators that are affected by human activity.

Sister– a specialist with professional education who shares the philosophy of nursing and has the right to practice nursing.

Nursing deontology– the science of nurse behavior in specific situations in health care facilities and outside it.

Nursing- part of medical health care, specific, professional activity, science and art aimed at solving existing and potential health problems in the face of environmental change.

Philosophy of Nursing– a belief system between the nurse, the patient, society and the environment.

Phobia– fear of a particular disease.

Purpose of Nursing– help a person meet his personal needs.

Code of Ethics for Nurses are ethical principles formulated by representatives of the nursing profession.

Iatrogenesis- painful conditions caused by the activities of a health worker.

Florence Nightingale's Oath

“Before God and before the congregation, I solemnly promise to lead a life of purity and honorably discharge my professional duties.

I will abstain from everything that is poisonous and harmful and will never knowingly use or prescribe drugs that may cause harm.

I will do everything in my power to maintain and improve the level of my profession.

I will keep confidential all personal information that comes into my possession while working with patients and their families.

I will faithfully assist the physician in his work and devote myself to tireless concern for the well-being of all those entrusted to my care.”

International Council of Nurses Code

1. Ethical Foundations of Nursing

The nurse has 4 main responsibilities:

maintain health,

prevent diseases,

restore health,

alleviate suffering.

Nursing involves respect for life, dignity and human rights. Nursing has no restrictions on nationality, gender, age, religious and political beliefs.

2. Nurse and patients:

the nurse is responsible to those who need help,

the nurse creates an atmosphere of respect for the patient,

The nurse stores the information received.

3. Nurse and practice:

the nurse has personal responsibility for the assigned work,

the nurse performs work at the highest level,

the nurse makes informed decisions when taking on assignments,

the nurse behaves in such a way as not to undermine confidence in the profession.

4. The nurse and society.

The nurse, like other citizens, is responsible for implementing and supporting measures aimed at meeting public needs in the field of health care.

5. Nurse and staff:

The nurse must maintain relationships and collaboration with other health care professionals,

The nurse takes necessary measures for patient safety if there is a threat from employees and other people.

6. Nurse and her profession

The nurse plays a major role in translating SP into practice.

The nurse takes an active part in the development of professional knowledge.

The nurse participates in the development and provision of social and economic conditions of work.

CODE OF ETHICS OF NURSE RUSSIA

Taking into account the most important role in modern society of the most widespread of medical professions - the profession of a nurse; taking into account the traditionally great importance of ethics in medicine and healthcare; Guided by the documents on medical ethics of the International Council of Nurses and the World Health Organization, the Association of Russian Nurses adopts this Code of Ethics.

PARTI. GENERAL PROVISIONS

The ethical basis of the professional activity of a nurse is humanity and mercy. The most important tasks of a nurse’s professional activity are: comprehensive comprehensive care for patients and alleviation of their suffering; health restoration and rehabilitation; promoting health and preventing disease.

The Code of Ethics provides clear moral guidelines for the professional activity of a nurse and is designed to promote consolidation, increase the prestige and authority of the nursing profession in society, and the development of nursing in Russia.

Fundamentals of Nursing

Illness and physical suffering often give rise to increased irritability in the patient, a feeling of anxiety and dissatisfaction, sometimes even hopelessness, and dissatisfaction with people around him. Medical personnel must be able to protect the patient from the influence of negative factors and distract him from excessive concentration on his painful condition.

During hospitalization in a hospital, it is necessary to decide on the methods of transporting the patient. If you can move independently, there is no need to use a stretcher or gurney. After admission to emergency department held sanitization. Subsequently, it is repeated every 7 days with a change of linen. Depending on the condition, the patient is prescribed a specific mode– strict bed, in which one is not even allowed to sit; bed, when you can move in bed without leaving it; semi-bed, allowing movement around the premises; general, not significantly limiting the patient’s motor activity. The less limited physical activity, the more the patient’s ability to self-care is preserved. However, this does not relieve nursing staff from the need for appropriate care, providing the diet and diet recommended by the doctor, monitoring the condition and fulfilling medical prescriptions.

The temperature in hospital premises should be constant (within 18–20 °C), and the relative humidity should be 30–60%. The premises must be well ventilated daily. There should be daylight in the room, which affects the mood and condition of the patient. Light intensity decreases only in certain diseases of the eyes and nervous system.

Rooms must be cleaned at least twice a day. Window frames, doors, furniture are wiped with a damp rag, the floor is washed or wiped with a brush wrapped in a damp rag. It is better to remove carpets, curtains and other objects where dust can accumulate from the room or frequently shake it out or clean it with a vacuum cleaner. The volume of radios and televisions must be reduced, and conversations should not be loud.

Body care: if the patient is on bed rest, he is wiped daily with a sponge or towel moistened with warm water or some kind of disinfectant solution (camphor alcohol, table vinegar, etc.). Before wiping, an oilcloth is placed. The skin is wiped sequentially, special attention is paid to the treatment of folds behind the ears, under the mammary glands in women, in the gluteal-femoral folds, armpits, interdigital spaces of the legs, and perineum. After wet wiping, the skin is wiped dry. If there are no contraindications, patients wash in the shower or take a hygienic bath. Hygienic baths are contraindicated when hemorrhagic syndromes, severe general exhaustion, myocardial infarction, acute cardiovascular failure, cerebrovascular accident. The bathtub must first be washed and treated with a disinfectant solution. After use, washcloths and brushes are dipped in a disinfectant solution, for example solutions of 0.5% clarified bleach or 2% chloramine, and then boiled. The temperature of the bath water should be warm (about 38 °C). The patient is helped to carefully immerse himself in the water; leaving him alone in the bath is not recommended. If necessary, the patient is helped to wash. Washing in the shower is easier for patients. The temperature in the bathroom should be comfortable and drafts should be avoided. Patients with urinary and fecal incontinence, as well as those on bed rest, must be washed at least twice a day with warm water or a weak solution of potassium permanganate from an Esmarch mug with a rubber tube and a clamp or a jug. Additionally, you must have a vessel, oilcloth, forceps, and cotton swabs. For diaper rash in groin areas The skin is lubricated with sunflower oil, Vaseline, and baby cream. If there are wet surfaces, use talc or baby powder. Areas of skin redness, especially in bedridden patients, are wiped with camphor alcohol, lemon pulp, a solution of brilliant green, and irradiated with quartz. To prevent incipient bedsores, the patient is placed on a rubber circle covered with a cotton bedding. In this case, the sacrum should be above the center of the circle. For fecal and urinary incontinence, a rubber bed is used instead of a circle. It is very important to ensure that the patient does not remain in one position for a long time. It needs to be turned. Underwear in such patients should be changed at least once a week, and for urinary and fecal incontinence - several times a day after appropriate washing.

Needs attention hair care. It is advisable for men to have their hair cut short. Each patient should have an individual comb. Bedridden patients wash their hair in bed at least once a week. If hair lice are detected, appropriate sanitary treatment is carried out using insecticides. If your hair is short, it is better to cut it and burn it. If pubic lice are detected, the pubic hair is covered with a generous amount of soap suds and shaved off. The skin is washed with warm water and sublimate vinegar (1:300) is rubbed in or treated with ointments: sulfur 33% or mercury sulfur 5-10%. After a few hours, the pubic area is washed with soap. Nails are trimmed with small scissors. After use, scissors are wiped with alcohol, a 3% carbolic acid solution or a 0.5% chloramine solution.

Eye care It usually comes down to washing them when the secretions stick together the eyelashes and form crusts on the eyelids. Rinsing is carried out with sterile gauze swabs moistened with a warm solution of boric acid 3%, in the direction from the outer corner of the eye to the inner. Bedridden patients need to clean the nasal passages with a cotton swab moistened with petroleum jelly or glycerin.

Oral care: in severely ill patients, after each meal, the oral cavity is treated with a cotton ball moistened with a weak solution of potassium permanganate, boric acid, soda or boiled water, food debris is removed from the oral mucosa and teeth. After this, the patient rinses his mouth. It is better to treat the oral cavity in a sitting or semi-sitting position. The neck and chest are covered with oilcloth, and a tray or basin is placed under the chin. Bad breath is reduced by rinsing with a 2% soda solution. Removable dentures are removed at night and washed with soap.

Physiological functions: For bedridden patients, a bedpan and a urine bag are used. Before use, the vessel is rinsed with warm water and a small amount of water is left in it. After completing the physiological functions, the perineal area is cared for, the vessel is washed, disinfected, for example, with a 3% chloramine solution or bleach and rinsed. In men, a urinal is more often used, which is located between the slightly spread thighs with a pipe towards the penis. The urine is poured out, and the urine bag is washed and disinfected. To remove the ammonia odor, the urinal is periodically washed with a weak solution of hydrochloric acid.

Patient nutrition: it is necessary to follow a strict diet. In this case, attention should be paid to setting the table or bedside table. For certain diseases, a corresponding treatment table is prescribed:

Table zero - first days postoperative period during interventions on the stomach and intestines, semi-consciousness due to impaired cerebral circulation, traumatic brain injuries, and feverish conditions.

Table No. 1 – gastric ulcer and duodenum in the stage of fading exacerbation and in remission; chronic gastritis with preserved and increased secretion in the stage of fading exacerbation; acute gastritis in the subsiding stage.

Table No. 1a – exacerbation of gastric and duodenal ulcers in the first 10–14 days, acute gastritis in the first days of the disease, exacerbation of chronic gastritis with preserved and increased secretion in the first days of the disease.

Table No. 1b – exacerbation of gastric and duodenal ulcers in the next 10–14 days, acute gastritis in the subsequent days of the disease, exacerbation of chronic gastritis with preserved and increased secretion in the next 10–14 days of the disease.

Table No. 2 – acute gastritis, enteritis and colitis during the recovery period, chronic gastritis with secretory insufficiency, enteritis, colitis during remission without concomitant diseases of the liver, biliary tract, pancreas.

Table No. 2a – the diseases are the same as with table No. 2, characterized by limiting table salt to 8-10 g.

Table No. 3 – chronic diseases intestines, accompanied by persistent constipation during periods of mild exacerbation and remission, as well as accompanied by damage to the stomach, liver, bile ducts, and pancreas.

Table No. 4 – acute and chronic intestinal diseases during the period of profuse diarrhea and severe dyspeptic disorders, condition after intestinal surgery.

Table No. 4a – chronic enterocolitis with a predominance of fermentation processes in the intestines. Compared to table No. 4, carbohydrates and protein foods are more limited.

Table No. 4b – acute and chronic intestinal diseases during exacerbation, as well as when they are combined with damage to the stomach, liver, biliary tract, pancreas.

Table No. 4b – acute diseases intestines during the recovery period, transition to general diet, chronic intestinal diseases in remission.

Table No. 5 – chronic hepatitis of a progressive and benign course with signs of mild functional liver failure, chronic cholecystitis, cholelithiasis, acute hepatitis during the recovery period (when switching to a general diet).

Table No. 5a – the diseases are the same as with table No. 5, characterized by restriction of table salt and fat.

Table No. 5 (sparing) – postcholecystectomy syndrome with concomitant duodenitis, exacerbation of chronic gastritis, hepatitis.

Table No. 5g – condition after cholecystectomy with the presence of bile stagnation syndrome and hypomotor dyskinesia of the biliary tract.

Table No. 5p – acute pancreatitis in the stage of sharp exacerbation (energy value 1300–1800 kcal).

Table No. 5p - acute pancreatitis in the stage of subsiding of acute phenomena and reduction of pain (energy value 2300–2500 kcal).

Table No. 6 – gout, uric acid diathesis.

Table No. 7 (low protein) – acute nephritis (after sodium-free days), exacerbation of chronic nephritis with edematous syndrome.

Table No. 8 – varying degrees obesity.

Table No. 9 – diabetes(as a trial diet, with the exception of pre- and post-comatose states).

Table No. 9a – diabetes mellitus (in overweight patients).

Table No. 9b – diabetes mellitus (in patients receiving insulin).

Table No. 10 – heart defects, cardiosclerosis, hypertension I and II degrees with mild pronounced signs circulatory failure.

Table No. 10a – diseases of the cardiovascular system, accompanied by circulatory failure of II and III degrees.

Table No. 10c (anti-atherosclerotic) – atherosclerosis of coronary, cerebral and peripheral vessels, atherosclerosis of the aorta, atherosclerotic cardiosclerosis.

Table No. 10i – myocardial infarction.

Table No. 11 – pulmonary tuberculosis, the period of recovery after a serious long-term illness (with exhaustion, anemia, etc.).

Table No. 12 – diseases of the nervous system.

Table No. 13 – acute infectious diseases, a condition after extensive illnesses (but not in the gastrointestinal tract).

Table No. 14 – phosphaturia.

Table No. 15 is a common table, prescribed for diseases that do not require dieting.

The nurse monitors the patient's condition. She must report any changes in his condition to the doctor. Elderly and elderly patients require special attention old age. Many of their diseases occur atypically, without a pronounced temperature reaction, with the addition severe complications. This group of patients is characterized by increased irritability, which requires special attention and patience on the part of nurses. Prescribed drugs must be given within strictly prescribed periods and all prescribed procedures must be followed.

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