According to the author of a number of scientific works and monographs on medicine, Yu.K. Subbotina, "medical ethics is a science that studies the moral side of the activities of medical workers, their moral relations and moral consciousness associated with the performance of professional duties."

Ethics is of paramount importance in the health care provider-patient relationship. An analogue of the well-known medical oath of Hippocrates for nurses became in the 19th century. the oath of Florence Nightingale.

The ethical code of a nurse in Russia is of particular importance in the history of domestic medicine and, in particular, nursing in the twentieth century. On the one hand, the overwhelming majority of medical workers have always remained faithful to duty and oath, and on the other, we should not forget that back in the 1920s. the official health officials of the Soviet Union regarded professional medical ethics as a "bourgeois relic". Moreover, these figures were firmly convinced that such a concept as "medical secrecy" was unacceptable for Soviet medicine and would soon die out. During the not always justified reforms, there was a prejudiced attitude towards the very concept of "nurse", which was to be replaced by the terms "doctor", "deputy doctor", "medical technician", etc.

Thus, the creation of the Ethical Code of a Nurse in Russia was a kind of repentance and hope for the return of moral and ethical health to our medical workers. This Code took into account new ideas that have emerged over the past several decades and which have influenced the professional ethics of the nurse. First of all, this Code reflected modern concepts of the patient's rights, which, in turn, determine the responsibilities of a medical professional.

The Ethical Code of a Nurse in Russia was drawn up on the basis of such documents as the WHO Charter (1946), the Ethical Code of Nurses of the International Council of Nurses (1973), the Code of Professional Ethics of a Psychiatrist adopted by the Russian Society of Psychiatrists in 1993, etc. According to these documents, nurses act not only as obedient executors of the doctor's instructions, but as representatives of an independent profession, possessing the skills of complex patient care and having the proper amount of knowledge in the field of psychology and psychotherapy. According to the founder of nursing F. Nightingale, "a sister must have a triple qualification: heart - for understanding patients, scientific - for understanding diseases, technical - for caring for the sick."

Almost any of us at least once in our life has asked for help in any medical institution, so it’s no secret that the impression of a hospital or clinic depends not only on the quality of the medical services provided, but also on how we met you. staff. The very first contact of the patient, in particular with the nurse, is of exceptional importance, since it determines the further relationship of the parties, the presence or absence of trust, the emergence of hostility, etc.

Deontology (translated from Greek - "must") - the science of morality and morality. Within its framework, issues such as responsibility for the life and health of patients, observance of medical confidentiality, relationships in the medical community, etc. are considered.

Both the appearance (neatness, hairstyle, facial expression) and the internal attitude of the nurse should evoke in the patient a sense of location, affection, and trust. A nurse in any case should not address a patient impersonally "sick", as this indicates her complete indifference. To establish a trusting relationship between a nurse and a patient, you need to make him feel that you care about his fate, and you sincerely want to help him. Only in such a situation can a degree of trust arise, at which a nurse can find out all the necessary information about the patient, his personality traits, his opinion about his own disease, hospital conditions, plans for the future. After all, it is this information obtained during direct contact that will give the nurse the opportunity to make an objective nursing diagnosis. However, the nurse needs to remember that it is unacceptable to cross the fine line between trust and familiarity, you should always reserve the leading role. A nurse must necessarily show sympathy for the patient, help establish sympathy between them, but at the same time, one should not identify with the patient. A prerequisite for establishing a relationship of trust is the patient's confidence in the confidentiality of conversations with the nurse.

Having information about the personality and character of the patient, his experiences, the nurse can tactfully explain to the patient not only his rights, but also some responsibilities, prepare him for the upcoming examinations and therapeutic procedures, telling about them in an accessible form. The patient's unwillingness to undergo certain types of examinations or medical procedures should not cause a negative attitude towards him on the part of the nurse. Nurses are required to be honest and truthful in communicating with the patient, but any conversations regarding the diagnosis or the characteristics of his disease should not go beyond the limits indicated by the doctor. The same rule must be observed during conversations with the patient's relatives.

The views of the doctor and nurse on some aspects of patient care can sometimes differ somewhat. Of course, there should be no fundamental disagreements, but nevertheless, it is necessary to discuss the problem with the doctor with the utmost tactfulness, since reaching full agreement greatly facilitates the work. It is not necessary to negotiate such disputable situations with third parties or immediately directly with the authorities, since this can provoke the development of an unhealthy environment within the work collective. Undoubtedly, a nurse has every right to defend her point of view, but at the same time she must be ready to admit and correct her own mistakes. High demands on yourself is one of the most important qualities of any professional, and a nurse is no exception.

The humanism of the profession of a medical worker creates the basis for protecting the personal dignity of a nurse, ensuring her immunity, the right to help in the performance of her professional duties.

In the system of relations "nurse - patient", the individual style of work of a nurse is of great importance. The main qualities that a good nurse should have are knowledge, skill, tenderness, gentleness, compassion, mercy, unlimited patience, responsibility and politeness. Unfortunately, at the present time, due attention is not paid to the definition and promotion of these important qualities. Huge workloads on a nurse in the course of her professional duties do not always allow her to show the necessary qualities to the proper degree. Ideally, the organization of work in a hospital should be such that knowledge, skills, competence and professional growth are expected and rewarded accordingly. Any person who decides to devote his life to medicine must understand that there are no and cannot be such circumstances that would justify any unethical act.

The ethical basis of the professional activity of a nurse is humanity and mercy. The most important tasks of the professional activity of a nurse are the complex all-round care of patients and the relief 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, is designed to promote the legal support of nursing, increase the prestige and authority of the nursing profession in society, and develop nursing in Russia.

To become a nurse, you must complete your secondary medical education through high school or college. Throughout the practice, it is important to constantly improve your skills and raise the level of knowledge and qualifications. To do this, you need to attend nursing courses, seminars, conferences. Having worked in this specialty for at least three years, you can get the second category, after five years of experience - the first, after seven years - the highest.

The place of work also determines the scope of the nurse's responsibilities.

• · Visiting nurses work in dispensaries (anti-tuberculosis, neuropsychiatric, dermatovenerologic), in children's and antenatal clinics. Such nurses carry out all medical procedures at home.
• · Children's nurses. They can be found in children's clinics and hospitals, in kindergartens, in children's homes.
• · Nurses in the physiotherapy room. Medical procedures are carried out using various special devices: electrophoresis, ultrasound, UHF devices, etc.
• · District nurses. Help the local doctor to receive patients. Analytical results and photographs are obtained from laboratories. Make sure that the doctor always has all the necessary sterile instruments for examining the patient. Outpatient cards are brought from the registry.
• · The procedural nurse gives injections (including intravenous ones), draws blood from a vein, puts on IVs. All these are very difficult procedures - they require high qualifications and impeccable skills. Especially if the procedure nurse works in a hospital, where serious patients can also lie.
• · The ward nurse - distributes medicines, puts compresses, cans, enemas, gives injections. She also measures temperature, pressure and reports to the attending physician about the well-being of each patient. And if necessary, the nurse provides emergency care (for example, for fainting or bleeding). The health of each patient depends on the work of the ward nurse. Especially if it is a serious patient. In good hospitals, ward nurses (with the help of junior nurses and nurses) take care of the weak patients: they feed, wash, change linen, and make sure that there are no bedsores.

The ward nurse has no right not to be negligent or forgetful. Unfortunately, the work of a ward nurse involves night shifts. This is bad for your health.

· The operating room nurse assists the surgeon and is responsible for ensuring that the operating room is always ready for work. This is perhaps the most responsible nursing position. And the most favorite among those who have at least a little time to work on operations.

The nurse prepares for the future operation all the necessary instruments, dressings and suture materials, ensures their sterility, and checks the serviceability of the equipment. And during the operation, he assists the doctor, gives the tools and materials. The success of the operation depends on the coordination of actions between the doctor and the nurse. This work requires not only good knowledge and skills, but also a speed of reaction and a strong nervous system. And also good health: like the surgeon, the nurse has to stand on his feet throughout the operation. If after the operation the patient needs dressings, they are also made by the operating nurse.

• · The nurse of the department of the CSO must have good theoretical training and practical skills in the use of modern means and methods of sterilization of medical devices, for which she undergoes regular training and advanced training in special training centers.
• · The head nurse supervises the work of the nurses of the department. She draws up duty schedules, monitors the sanitary condition of the premises, is responsible for economic and medical supplies, for the maintenance and safety of medical instruments and devices. In addition to the actual medical duties, the nurse has to keep records, the head nurse monitors this too. She also supervises the work of junior medical personnel (orderlies, nurses, nurses, etc.). To do this efficiently, the head nurse must know the specifics of the department's work to the smallest detail.
• · The assistant nurse takes care of the sick: changes clothes, feeds, helps to move the bedridden patients inside the hospital. Her duties are similar to those of a nurse, and her medical education is limited to short courses.

This is not a complete list of options for a nurse. Each has its own specificity. What they have in common is that, although a nurse is considered a doctor's assistant, the main purpose of a nurse's work is to help sick people. Such work brings moral satisfaction. There is no time for smoke breaks and thoughtfulness in the middle of the working day. The most difficult are the surgical departments in which operations are carried out and where emergency patients are admitted. The peculiarities of the nursing profession include the fact that many people of this specialty not only give injections and measure blood pressure, but also mentally support the patient in difficult times. After all, even the strongest person, being ill, becomes defenseless and vulnerable. A kind word can work miracles.

The nurse must know the methods of disinfection, the rules for performing vaccinations, injections. She is obliged to understand medicines and their prescriptions and be able to perform various medical procedures. To master the profession of a nurse, you need good knowledge in the field of medicine and psychology, as well as in subjects such as biology, botany, anatomy, chemistry, etc. work, which will not only affect the well-being of patients, but also the satisfaction of nurses with their work.

Denis Buchkin
Position: Teacher
Educational institution: SPb GBPOU "Medical College No. 2"
Locality: St. Petersburg
Material name: Article
Subject: Ethical and deontological aspects of the activity of a nurse of the resuscitation and intensive care unit
Date of publication: 07.04.2019
Section: secondary vocational

ETHICAL - DEONTOLOGICAL ASPECTS

ACTIVITIES OF THE MEDICAL NURSE OF THE DEPARTMENT

REANIMATION AND INTENSIVE THERAPY

INTRODUCTION

Medical

acquisition

independence of the patient in the treatment process, as it must combine

neatness, friendliness, mercy, diligence, and most importantly

education, intelligence, organizational skills, decency, creative

thinking and professional competence.

observance

ethical

is an

problem.

Relevance

compliance

everyday

practical

activities

nursing OAR (ICU) due to:

The specifics of the activities of nurses in the OAR (ICU);

Insufficient

ethical

legal

nursing, violation of the rights of patients;

The wrong choice of the limits of nursing care;

Complications and adverse outcomes;

Exposure

professional

emotional

Burnout of nurses;

Professional

harmfulness

lack of

legal

medical professionals.

The specifics of nursing activities:

extremeness

situations

necessity

quick

adopting

solutions and its implementation;

reduction or lack of psychological contact of the nurse with

sick;

using

invasiveness

diagnosis and treatment;

the presence of multiple organ failure in many patients;

necessity

cooperation

specialists

specialties;

iatrogenic lesions;

insufficient

personnel e,

material

technical

medication provision;

psycho-emotional

staff,

susceptibility

emotional burnout of nurses.

Choice of limits of nursing care.

An important part of any nursing intervention should

be rationalism. Every patient needs nursing action,

directed

liquidation

physical

suffering;

recovery

normal

emotional

states;

optimal

intensive

dying

called

comfortable

supportive care: thorough hygienic care, including treatment

oral cavity, adequate analgesia (regardless of the required doses), adequate

capabilities

probe),

psychological

(relatives, psychotherapist, tranquilizers, priest). Comfortable

supporting

predominantly

sister

medical supervision.

A nurse who has no insurance and is poorly guided in modern

legal

normatively

legal

remains

unprotected

patients,

relatives

insurance

companies.

Therefore, she must know and comply with the basic ethical and legal norms when

provision of anesthetic and resuscitation care.

DEFINITION OF CONCEPTS. WORK PRINCIPLES

analyze

the main

further

quality work with patients and medical staff.

Ethics is the science of morality, the principles that should

to be guided by people in their actions. The term was introduced by Aristotle,

philosophy

moral,

moral

behavior of people.

A Medical ethics is a set of ethical norms and principles

behavior

medical

workers

fulfillment

professional

responsibilities,

necessary

successful

the patient.

The basic principles of medical ethics are:

Respect for life;

Prohibition of harm to the patient;

Respect for the patient's personality;

Medical secrecy;

Respect for the profession.

Code of Professional Ethics for Nursing (adopted by the International

council of nurses).

Since many nurses are not familiar with him, one of the important

are:

Ethical Foundations of Nursing

Need

nurses

universal.

Nursing

implies respect for life, dignity and human rights. It is not

has restrictions on national or racial grounds, on the basis of

religion,

age,

political

social

provisions.

Nurses

render

medical

a separate

families and the community and coordinate with the work of others

Nurse and Patients

The main

a responsibility

nurse

needs

Rendering

nurse

trying

an atmosphere of respect for patients, customs and spiritual

beliefs

patients.

Nurse

received

confidentially

information and shares it with great care.

1.2DEONTOLOGY

Principles

medical

staff

practical

activities are considered by medical deontology.

Medical deontology is the principles of behavior of medical personnel,

directed

the maximum

the rise

efficiency

elimination

consequences

defective

medical

medical

deontology

reflects

specific

standards that are binding on doctors and nurses.

Deontology

identified

to act in this or that situation and how to act it is impossible.

The main

medical

deontology.

Problems

relationships

sick,

middle

medical

employee

the patient, around which the issues of the doctor's relationship also revolve

(middle

medical

employee)

surrounding

sick

(relatives, friends, acquaintances, etc.) doctors with each other and other

medical and paramedical personnel (i.e. relationships within

medical

medical

workers

separate

groups of society. In other words, modern medical practice -

a complex system in which doctors and patients can be in the most

different forms of social interaction.

A patient who entrusts his health to a nurse wants and

must be confident not only in professional skills, but also

following

moral

moral

principles.

A nurse must be decent and honest, sensitive and kind,

compassionate and sympathetic.

Moral and ethical basis, etalon and standard of behavior

medical

is an

"Ethical

medical

(Attachment 1).

1.3 BIOETHICS

The challenge of modern medicine is to make life

a long and happy person, without disease and suffering.

However, on the path of goodness and progress, people often become obsessed with

thirst for power, profit and solely their own interests. This and

cause

emergence

medical

bioethics, which views medicine in the context of human rights.

Bioethics is a modern model of biomedical ethics. Main

the principle is “respect for human rights and dignity”. Philosophical knowledge in

interaction

scientific,

technical

technological,

informational and genetic achievements of modern medicine.

All measures are aimed at preserving and maintaining the patient's life.

Medical

bioethics

fulfills

a medical worker as a person, allowing the doctor to do more than

according to existing laws, but also according to their own conscience when performing

professional duty.

Modern

medical

bioethics

collides

many

conflicting

artificial

fertilization,

cloning, sexology, euthanasia (Article 45 of the Federal Law of November 21, 2011 No. 323-FZOb

the basics of protecting the health of citizens in the Russian Federation. Medical

employees

prohibited

implementation

euthanasia,

acceleration

the patient's request for his death by any action (inaction) or

means,

termination

artificial

activities

maintenance of the patient's life.). In these cases, the so-called

conflict rights.

For example, the fetus's right to live and the woman's right to interrupt

pregnancy

Artificial

interrupt

pregnancy.

on my own

motherhood.

Artificial termination of pregnancy is carried out at the request of the woman

with informed voluntary consent.).

Also one of the factors affecting the possible limitation

medical

employee

is an

religious and cultural

formed

consciousness

the patient.

Without knowledge of cultural characteristics, competent rendering is impossible

medical

multi-denominational

Rendering

medical

religious and cultural

features

individual

lead

negative

consequences.

It should be especially noted that when providing medical care in

emergency

situations

conditions

massive

disasters

(special

transnational)

necessary

exercise the utmost care

rendering

medical

explain

relatives

necessity

medical

interference

the feasibility of such treatment. When providing medical

territory

foreign

states

desirable

is an

presence of local doctors who are familiar with the culture

providing medical care to the population.

Compliance with professional secrecy concerns not only doctors, but also

nurses.

Information

appeal

medical

the state of health of a citizen, the diagnosis of his illness and other information,

obtained during his examination and treatment, constitute a medical secret;

citizen

confirmed

guarantee

confidentiality

information transmitted to them - these provisions are enshrined in Part 1 of Art. 61 Fundamentals

legislation

Russian

Federation

health

(Federal Law of November 21, 2011 No. 323-FZO on the Fundamentals of Health Protection

Russian

Federation

allowed

disclosure of information constituting a medical secret by persons who

known

training,

execution

professional,

official and other duties (part 2 of the Fundamentals).

NURSE STATUTES

A nurse is the first assistant in treating a patient. Exactly and

it is your duty to carry out medical appointments on time.

Mindfulness

suffering

sick

facilitates

well-being. Treat the patient the way you would like to

treated you, immediately respond to every new complaint

patient, not the slightest change in his health.

behavior

state

sick

causes

concern for his condition, report it to your doctor immediately.

The word heals, the word hurts. Be restrained in conversations with the patient.

Polite, attentive. Only tell him about his health that

conviction, does not harm the psyche of the patient.

the most important

sick.

In every possible way

protect the medical and protective regime in the department.

workers - half the success.

Be neat and tidy, fit and dressed in uniform, sick

it will be nice to get help from your hands.

Prevention is the basis of medicine, explain to patients on a daily basis

hygiene rules and disease prevention measures.

attentive

relatives

the necessary requirements so that, according to their intended purpose, they do not cause

harm to the patient, by word or by illegal drugs.

10.To consciously participate in the treatment of patients, you need to know a lot,

constantly improve their medical knowledge.

11.The expertly performed medical manipulation eliminates unnecessary

disease, and sometimes from danger. Learn to be fluent in medical

technique.

12 protect

property,

medicines,

tools,

you are using.

Reasonable economy allows you to provide assistance by the same means.

SPECIFIC FEATURES OF A MEDICAL NURSE

RESCUE AND INTENSIVE CARE DEPARTMENTS

Medical

correctness

relationship

between all members of the team, regardless of ranks and titles. Respectful

appeal

colleagues,

medical

emphasizes the purity and high meaning of the profession. Especially strictly this

the principle should be adhered to if communication takes place in the presence

patient (see Appendix 1).

Pay attention to:

Appearance:

observance

the use of cosmetics should be moderate, should not come out harsh

smells of perfume, tobacco, etc.);

enough

completely cover the clothes, the sleeves of the robe should cover the sleeves

It is necessary to wear easily washable clothes under the robe, it is better

from natural cotton fabrics;

Hair should be tucked under a hat;

Shoes should be easy to clean, disinfectable

and allowing you to move silently.

Nurse-Doctor Relationship:

Roughness, disrespectful attitude in communication are unacceptable;

To execute

medical

destination

timely,

professionally;

inform

sudden

changes

the patient's condition;

If in doubt in the process of performing medical

appointments in a tactful manner, find out all the nuances with a doctor in the absence

sick.

Relationship between nurses:

Rude and disrespectful attitude towards colleagues is unacceptable;

Remarks should be made tactfully and in the absence of the patient;

Experienced nurses should share their experiences with young people;

In difficult situations, they must help each other.

Nurse-Nurse Relationship:

Observe mutual respect;

Control tactfully, unobtrusively the activities of the younger

medical staff;

Roughness, familiarity, arrogance are unacceptable;

permissible

remarks

presence

visitors.

Nurse's Attitude to Patients:

There are several models for the relationship between health workers and

patients (Robert Wich, 1992).

Paternalistic

latin

characterized by the fact that the medical staff treats patients in the same way as

parents treat their children. In doing so, they take most of the

responsibility for yourself.

Engineering - the model is characterized by the fact that it is revealed and

some functions are restored and breakdowns in the body are eliminated

the patient. The interpersonal aspect is almost entirely ignored here.

Collegiate

characterized by

mutual

trust

nursing staff

patients.

Anxious

the nurse becomes “friends” of the patient.

Contractual

looks like

legally

formalized

the patient.

presupposes

consistent respect for the rights of the patient.

In addition, the nurse's attitude towards patients should always be

friendly,

unacceptable

remarks,

consider

individual

psychological

features,

listen,

experiences

the patient.

heavy

painful

procedures

nurse

clarify

accessible

value,

necessity

successful

psycho-emotional

voltage.

The relationship of a nurse with relatives and friends of the patient:

It is necessary to maintain restraint, calmness and tact;

caring

seriously ill

clarify

the correctness of the procedures and manipulations;

Conversation only within the limits of their competence (does not have the right

talk about the symptoms, about the prognosis of the disease, but should direct to

to the attending physician);

Respond

calmly,

leisurely,

proper care of seriously ill patients.

Clinical etiquette in ICU (adherence to traditional external

behavior

medical

staff

medicine

critical

conditions) increases the effectiveness of resuscitation care.

finding

patient

unconscious

condition

remember implicit memory: an unpleasant conversation can be imprinted

in implicit memory and manifest, later, in the most unexpected

medical

legal

responsibility for those actions that, according to regulatory documents

are included in their responsibilities and competence. With the development of life-threatening

the patient of the consequences of intensive care the culprit is the medical

personnel are brought to administrative and criminal liability in

in accordance with the Criminal Code of the Russian Federation.

Among 16 nurses of OAR-I, GB # 15 was carried out

a questionnaire of 8 questions (Appendix 2).

Work experience:

Under 3 years - 4 (32%)

3-5 years - 6 (24%)

5-10 years - 2 (8%)

10-20 years - 4 (36%)

12 (75%) respondents are satisfied with their work.

To the question "what difficulties arise when communicating with the patient" 2

nurse

noted

difficulties

patient

arise, and the majority answered 14 (88%) that difficulties arise if

the patient is aggressive and was admitted to the department drunk.

respondents

normal, 5 (32%) nurses feel significant overload, and 2 (12%)

found it difficult to answer.

16 (100%) nurses in their professional activities always

guided by

principles

professional

medical

deontology.

10 (63%) of the surveyed nurses never had a moment

professional deformation, and 6 (37%) sometimes had conflict

situations.

When asked how do you deal with stress, nurses

listen to music - 4 (25%), training - 1 (6%), read - 3 (19%), the rest 8

To develop the implementation of medical ethics and deontology, 13 (82%)

of respondents suggest holding seminars and conferences, 2 (12%) -

booklets

periodic

leading

specialists from different countries - 1 (6%).

CONCLUSION

Based on the above, in daily activities

An ICU nurse needs the following components:

Individual approach to each patient, address by name

and patronymic, detailed informing the patient about the rules of admission

medicines, purposes and tasks of manipulations.

Thorough identification of ICU patients' problems.

Rapidity

definition

process

adopting

timely

adopting

clarity

action

the patient's life.

Simplicity of presentation when communicating with the patient.

Compliance

medical

deontology

the implementation of nursing care for patients.

Respectful attitude and willingness to help. An important

the role is played by the appearance, facial expression, speech of the nurse.

Attentiveness and interest in the patient's problems.

Ability to cope with stress, conflict situations for

prevention of occupational deformities in nurses.

ethical and deontological

principles

medical

staff

conditions

are

full-fledged

quality

rendering

specialized

help. Nursing and nursing staff are indispensable

component of health care institutions.

Professional skill of a nurse who will find

kind words, will be able to calm the patient, divert his attention from the disease,

The work of nurses is very important and makes a special contribution on the way

to the recovery of patients.

BIBLIOGRAPHY

Anesthesiology

resuscitation: leadership

anesthetists / [Alexandrovich Yu.S. and etc.] ; ed. Yu.S. Half bus. -

M.: SIMK, 2016 .-- 784 p.

A.I. Levshankov, A.G. Klimov Nursing in anesthesiology and

resuscitation... Modern aspects: textbook. allowance. - 2nd edition,

revised and add. / ed. prof. A.I. Levshankova. - SPb .: SpetsLit,

Bioethics: teaching aid/ E.A. Nagornov, D.A. Izutkin,

I.I. Kobylin, A.A. Mordvinov; ed. A.V. Grekhova. - N. Novgorod:

Nizhny Novgorod State Medical Academy, 2014.

Ezova, S.A. Professional communication: new nuances and aspects:

scientific and practical manual/ S.A. Ezova. - M .: Libereya-Bibinform,

In addition to the moral responsibility of a nurse, which is presented in the Nursing Code of Ethics, there are other types of responsibility. If, while performing her professional duties, a nurse commits offenses, then in accordance with the current legislation of the Russian Federation, she bears administrative, civil, property and criminal liability.

Inadequate performance of their professional duties can lead to liability. The following criteria are used to assess the quality of a nurse's work.

Criteria for assessing the quality of a nurse's work:

1) the absence of complications after performing medical procedures;

2) absence of complaints from the management and complaints from patients and their relatives;

3) timely and high-quality performance of professional duties;

4) lack of comments during scheduled and emergency inspections;

5) the presence of communicative connections with colleagues and clients.

In accordance with the Labor Code of the Russian Federation, a nurse is responsible for compliance with the terms of the employment contract. So, for going to work in a state of alcoholic or drug intoxication, an employee is subject to dismissal on the same day. When disclosing official or commercial secrets, as well as information about the patient, the employer may terminate the employment contract.

Poor performance of professional duties can lead to administrative and disciplinary responsibility of the nurse. In accordance with Art. 135 of the Labor Code, the management of a medical institution can impose a disciplinary sanction on employees (reprimand, severe reprimand, transfer to a less paid job, demotion for up to three months) or dismiss. When imposing a disciplinary sanction, the severity of the offense, the circumstances in which it was committed, as well as the employee's attitude to work duties prior to the commission of the offense are taken into account.

A nurse may be dismissed by the management of a medical institution for inconsistency with the position held (violation of the technology for performing manipulations, non-compliance with the sanitary and anti-epidemic regime).

In the event of a crime, a nurse can be prosecuted. A crime is an unlawful act or omission committed intentionally or accidentally (through negligence). In most cases, professional medical crimes are not intentional. Most often they are associated with unforeseen or underestimation of the possible consequences when performing any professional actions (Article 9 of the Criminal Code of the Russian Federation). If any actions or, conversely, inaction are regarded as criminal, then they lead to criminal liability.

The current Criminal Code of the Russian Federation does not provide for special articles on the responsibility of health workers. Criminal liability for medical workers comes in accordance with the articles of the Criminal Code on careless murder, careless grievous bodily injury, exposing another person to the danger of HIV infection, criminal abortion, substitution or abduction of a child, failure to provide assistance to a patient (Chapter 3 of the Criminal Code of the Russian Federation). All these crimes are characterized as crimes against life, health, freedom and dignity of the individual. So, let us consider the main cases of criminal liability.

Murder by negligence can occur when potent and poisonous drugs are mistakenly administered to the patient, the dose is incorrectly calculated, and in other similar cases. If a seriously ill patient is left without constant supervision of a nurse, which leads to death, this is also considered negligent homicide. In cases where inattention to the patient leads to a deterioration in his health, the nurse also bears legal responsibility.

A crime is the creation of a threat of infection or infection with HIV, which may be associated with active actions (for example, the use of non-sterile instruments) or inaction (violation of the sanitary and anti-epidemic regime). Regardless of whether HIV has occurred or not, the crime is considered committed.

Such a crime as substitution of a child can only be committed intentionally. In this case, the perpetrator is aware of his actions and has some motive. The person who made the substitution of the child is also prosecuted.

There is also criminal liability for failure to provide assistance to a patient (Article 128 of the Criminal Code of the Russian Federation). Failure to provide assistance to a patient is inaction, that is, it means that the health worker did not take any action to save the person or alleviate his condition. However, there are a number of circumstances in which failure to provide assistance to a patient does not lead to criminal liability. These include natural disasters, lack of funds for first aid, illness of a medical worker, the presence of several seriously ill patients at the same time, provided that assistance was provided to one of them.

Art. 221 of the Criminal Code of the Russian Federation provides for criminal liability for illegal medicine. The crime is associated with the diagnosis, the performance of medical manipulations, the appointment of treatment by a person without appropriate education. Responsibility for a crime occurs regardless of the presence or absence of harmful consequences. If, as a result of illegal treatment, harm was caused to the patient's health, then there is responsibility for the crime directed against the person.

When establishing responsibility for illegal medicine, it is necessary to identify the fact of receiving remuneration (money, valuables, products) for the illegal provision of medical services. Illegal medicine refers to the medical activity of a health worker who does not have the right to it (there is no diploma of relevant education, certificate or license to carry out specific activities). In the event that a medical professional wants to conduct private medical activities, in addition to the above documents, you must obtain permission from the local administration. In addition, private medical practice is coordinated with professional medical associations.

In everyday practice, nurses are often asked to give injections. Nurses should be aware that performing medical procedures at home is also an illegal activity. Moreover, it can lead to serious consequences. If a patient develops a severe allergic reaction (anaphylactic shock) during or after the administration of the drug, then at home the nurse will not be able to provide first aid in full, which can lead to the death of the patient.

Throughout the practice, it is important to constantly improve your skills and raise the level of knowledge and qualifications. To do this, you need to attend nursing courses, seminars, conferences. Having worked in this specialty for at least three years, you can get the second category, after five years of experience - the first, after eight years - the highest.

The place of work also determines the scope of the nurse's responsibilities:

· Visiting nurses work in dispensaries (anti-tuberculosis, neuropsychiatric, dermatovenerologic), in children's and antenatal clinics. Such nurses carry out all medical procedures at home.

· Children's nurses... They can be found in children's clinics and hospitals, in kindergartens, in children's homes.

· Physiotherapy Nurses... Medical procedures are carried out using various special devices: electrophoresis, ultrasound, UHF devices, etc.

· District nurses... Help the local doctor to receive patients. Analytical results and photographs are obtained from laboratories. Make sure that the doctor always has all the necessary sterile instruments for examining the patient. Outpatient cards are brought from the registry.

· Procedural Nurse makes injections (including intravenous ones), draws blood from a vein, puts in droppers. All these are very difficult procedures - they require high qualifications and impeccable skills. Especially if the procedure nurse works in a hospital, where serious patients can also lie.

· Charge nurse- distributes medicines, puts compresses, cans, enemas, gives injections. She also measures temperature, pressure and reports to the attending physician about the well-being of each patient. And if necessary, the nurse provides emergency care (for example, for fainting or bleeding). The health of each patient depends on the work of the ward nurse. Especially if it is a seriously ill patient. In good hospitals, ward nurses (with the help of junior nurses and nurses) take care of weak patients: they feed, wash, change clothes, and make sure that there are no bedsores.

The ward nurse has no right not to be negligent or forgetful. Unfortunately, the work of a ward nurse involves night shifts. This is bad for your health.

· Operating room nurse assists the surgeon and is responsible for ensuring that the operating room is always ready for work. This is perhaps the most responsible nursing position. And the most favorite among those who have at least a little time to work on operations.

The nurse prepares for the future operation all the necessary instruments, dressings and suture materials, ensures their sterility, and checks the serviceability of the equipment. And during the operation, he assists the doctor, gives the tools and materials. The success of the operation depends on the coordination of actions between the doctor and the nurse. This work requires not only good knowledge and skills, but also a speed of reaction and a strong nervous system. And also good health: like the surgeon, the nurse has to stand on his feet throughout the operation. If the patient needs dressings after surgery, they are also done by the operating room nurse.

· For sterilization the instruments are taken to the sterilization department. The nurse working there is controlled with special equipment: steam, ultraviolet chambers, autoclaves, etc.

· Head nurse supervises the work of all nurses in a hospital or polyclinic department. She draws up duty schedules, monitors the sanitary condition of the premises, is responsible for economic and medical supplies, for the maintenance and safety of medical instruments and devices. In addition to the actual medical duties, nurses have to keep records, the head nurse monitors this too. She also supervises the work of junior medical personnel (orderlies, nurses, nurses, etc.). To do this efficiently, the head nurse must know the specifics of the department's work to the smallest detail.

· Assistant nurse caring for patients: changing clothes, feeding, helping to move bedridden patients inside the hospital. Her duties are similar to those of a nurse, and her medical education is limited to short courses.

There are also massage nurses, diet nurses, etc. This is not a complete list of options for a nurse. Each has its own specificity. What they have in common is that, although a nurse is considered a physician's assistant, the main purpose of a nurse's work is to help patients. Such work brings moral satisfaction, especially if it is work in a hospital. But it is also very hard work, even if you love it very much. There is no time for smoke breaks and thoughtfulness in the middle of the working day.

The most difficult are the departments in which operations are carried out and where emergency patients are admitted. These are surgery, traumatology, otolaryngology. The peculiarities of the nursing profession include the fact that many people of this specialty not only give injections and measure blood pressure, but also morally support the patient in difficult times. After all, even the strongest person, being ill, becomes defenseless and vulnerable. A kind word can work miracles.

The nurse must know the methods of disinfection, the rules for performing vaccinations, injections. She is obliged to understand medicines and their prescriptions and be able to perform various medical procedures. To master the profession of a nurse, you need good knowledge in the field of medicine and psychology, as well as in subjects such as biology, botany, anatomy, chemistry. And this is understandable, because nurses, possessing the latest knowledge, can perform their work more efficiently and efficiently, which will not only affect the well-being of patients, but also the satisfaction of nurses with their work.

Nursing quality

Nursing quality- a set of characteristics that confirm the compliance of the provided medical care with the existing needs of the patient (population), his expectations, the modern level of medical science and technology. The modern experience of nursing medical care to the population shows that nursing care is an integral part of the treatment process.

Compliance of expectations with the perception of the consumer of services determines the level of satisfaction of patients, relatives, society with nursing services.

The main criteria for the quality of nursing care are:

Accessibility - the ability to receive the necessary medical assistance and care regardless of economic, social and other barriers;

Continuity and continuity - the patient receives the necessary medical care without delay or interruption;

Safety - minimizing the risk of possible complications, side effects of treatment;

Effectiveness - the effectiveness of nursing interventions that improve patient health.

Have you ever wondered why women in this profession are called sisters? And this word stuck for the reason that the first nurses appeared thanks to the church. So in this case “sister” is not a related, but a spiritual concept. There was a time when they were not called nurses, but sisters of mercy. And it was right. During the Crimean campaign, kind-hearted women looked after the wounded, tried to be relatives to them, and not only nurture the soldiers, but also morally support them. Sacrificial and noble, the profession of a nurse still presupposes compassion and mercy towards the sick.

If you want to get a profession that is always and everywhere in demand, study to be a nurse. Any doctor needs a competent assistant who understands diseases and can even suggest treatment tactics.
Can you imagine at least one polyclinic or hospital without nurses, on whom the order in the department or in the office depends, as well as the strict fulfillment of all doctor's prescriptions and almost everything that a medical institution lives on? That's right: it's impossible. In addition, any sick person experiences relief not only from the procedures, but also from simple attention and kind words. And this is always on the part of nurses. How can we do without them?
You yourself probably noticed that patients have much more to deal with nurses than with doctors. Therefore, women who have devoted themselves to this profession are distinguished by their special resistance to stress, the ability to maintain good relations, and the ability to calm down a sick person.

First of all - about the workplace of nurses. These are operating rooms, treatment rooms, dental and other specialized clinics, doctor's offices in polyclinics and inpatient departments of hospitals.
Now pay attention to how wide the range of responsibilities of a nurse is.

1. She writes out prescriptions, referrals and certificates - in this way, she follows the instructions of the doctor.
2. Makes injections, vaccinations, infusions, measures temperature and pressure.
3. Knows the names, doses and forms of release of drugs prescribed by a doctor.
4. Assists surgeons during surgery, changes dressings, prepares the necessary surgical instruments.
5. While patients are within the walls of the hospital, the nurse must monitor their mental health, personal hygiene and nutrition.
6. She must master the basics of first aid.
7. Its functions include the skillful use of special equipment.

This is not a complete list of duties of a paramedical worker.
You will be a good nurse if you have the best human qualities. You know how to sympathize with people, you are sociable, observant, balanced, hardy. You are attentive and caring towards a weak and sick person. You have a sense of responsibility.
A nurse is an important figure in any hospital. Often, it depends on her work how high the qualifications of the hospital or clinic are.
And most importantly, work should bring you joy. Probably only such women become wonderful nurses, merciful and skillful.

Where can you get the nursing profession?

Of course, you know that with such an abundance of responsibilities, professional education is essential. You can get it at a specialized medical college (school).
But if after a while after graduating from this educational institution you feel that you are capable of more, you have the opportunity to satisfy your ambitions. In some medical schools, nurses can pursue higher education. It all depends on your dedication. If you can fulfill this maxi program, you will get the opportunity to work in a large clinic as a nursing organizer, head or head nurse, head of the nursing department, teach at a medical school.

Can a nurse make a career? Well, dizzying career growth is hardly worth counting on, but there are some options.
A nurse has several career options. For example, working in one position, improve their qualifications. This is rewarded with a pay rise.
If the administration appreciates your experience, your ability to get along with people, you can get the position of a senior nurse of a department or even an entire medical institution.
Well, and, finally, continued education at the medical institute. After graduating from a university, you will become either a doctor or a qualified nursing specialist.

The pros and cons of such work

If you don't love the profession, nothing will work. Even if you are very attracted to the profession of a nurse, and you feel a vocation and a willingness to give all your strength to your favorite work, weigh all the pros and cons. "

• Choosing this profession, you must be prepared for some difficulties. And above all to the fact that you have to devote yourself entirely to work. No matter what happens in your family, no matter how hard it is after the night shift, you are required to be in a good mood and willing to support the patient with a smile.
• Any medical appointment is a law for you. You must know everything that happens in the department or doctor's office. Any conflict situation with patients is your fault. You should have foreseen it and not allowed it. That is, a nurse is a universal specialist: a physician, a psychologist, and an organizer.
• The nurse should always be neat and collected. After all, you must admit, a nurse is also a living person, but she is not allowed to mix up appointments, diagnoses, analyzes, medicines. Sometimes the health and even the life of a person depends on this.
• A nurse's work schedule will not suit every woman. Think also to you: will you be able to withstand the intense night shifts, the atmosphere of constant emergency work? This is fraught with physical and emotional stress.
• The nurse, like all healthcare professionals, is at risk. Providing help to the patient, she can catch a dangerous disease.

This entire list of "cons" of the nursing profession is not given in order to scare you or turn you away from your chosen profession. Maybe you dreamed about her since childhood. But, entering a medical school, you should be guided not only by romantic ideas, but also by the real state of affairs.
You know, they say that an unloved profession is akin to an unloved husband. Think about it, really weigh your options, so that disappointment does not ruin your life and harm your patients.

How is a nurse paid?

Unfortunately, not very good. In different regions, employers offer different salaries to nurses. It looks something like this:

• RUB 28,000 - the average salary of a nurse in Moscow;
• RUB 20,000 - in St. Petersburg;
• RUB 15,000 - in Novosibirsk;
• RUB 17,000 - In Ekaterinburg;
• RUB 14,000 - In Nizhniy Novgorod.

Do you remember the famous saying about what happiness is? This is when you happily go to work in the morning and return home in the evening with the same joy. If you nevertheless come to the profession of a nurse, may you have just such a fate.