. determination of the patient's condition at the current moment;
. assessment of the achievement of goals;
. identification of aspects influencing the achievement of goals;
. modification of the nursing diagnosis, goal and/or plan of care, if necessary.
In appreciation nursing care at this level, it is necessary to involve both the staff and the patient himself.
For quality performance final stage the nursing process needs to know which aspect is supposed to be evaluated; have sources of information (patient, medical staff, relatives) necessary for the assessment; clarify the evaluation criteria - the intended result that the nursing staff strives to achieve together with the patient.
Assessment aspects:
. patient responses to nursing care;
. obtaining results and summing up;
. registration of the discharge epicrisis;
. the quality of the assistance provided.
The words or behavior of the patient, data from an objective study, information received from roommates or relatives can be used as evaluation criteria. For example, with edema, weight and weight indicators can serve as evaluation criteria. water balance, when determining the level of pain - pulse, position in bed, behavior, verbal and non-verbal information and digital scales for assessing pain (if used).
If necessary, the nursing action plan is revised or interrupted. When the goal is partially or completely not achieved, the reasons for the failure should be analyzed, among which may be:
. lack of psychological contact between the staff and the patient;
. language problems in communication with the patient and relatives;
. incomplete or inaccurate information collected at the time of admission of the patient to the hospital or during the stay in it;
. erroneous interpretation of problems;
. unrealistic goals;
. wrong ways to achieve goals, lack of sufficient experience and professionalism in performing specific care activities;
. insufficient or excessive participation of the patient and relatives in the process of care;
. unwillingness to seek help from colleagues if necessary.
When preparing the patient for discharge, a discharge summary is drawn up. It provides for a reflection of all the care received by the patient during the stay in the health facility. Here are fixed:
. problems present in the patient on the day of admission;
. problems that have joined during the stay in the department;
. the patient's response to the care provided;
. problems with which the patient is discharged;
. the patient's own opinion about the quality of care provided. Nursing staff who will continue to care for the patient after discharge have the right to review the planned activities in order to quickly adapt the patient to home conditions.
In practice Russian healthcare the following definitions (concepts) of quality are most common medical care:
· A set of properties and characteristics of services that - determine their ability to meet specified or implied requirements;
The totality of the results of the prevention, diagnosis and treatment of diseases, determined by the established requirements based on achievements medical science and practices.
A number of scientists define other characteristics of the quality of medical care: adequacy, accessibility, continuity and continuity, efficiency, effectiveness, efficiency, safety, timeliness, ability to meet expectations and needs, stability of the process and results, continuous improvement and improvement.
Thus, medical assistance should be provided with the maximum possible effect(that is, its results should be as close as possible to scientifically predicted ones), while at the same time - have a minimum cost, be reasonable, legal, meet the expectations of the patient and investors and be distributed fairly.
The most important step in solving the problems of reforming nursing is to study the experience of other medical institutions in introducing a new concept of nursing, creating a friendly psychological microclimate in the team according to its perception, studying by heads of departments and senior nurses, the content and ways of reforming nursing.
Exclusively great importance to improve the quality of nursing care to the population has the definition and implementation of goals related to the performance of normal work duties. The definition of these goals should be based on the results of the work of health care facilities, materials for quality control of nursing care, and the requirements of higher health authorities.
Chief Nurses, in setting these goals, should focus on:
on improvement job descriptions middle and junior medical personnel and control over their unconditional implementation;
development and use of standards for the activities of middle and junior medical personnel and their control; implementation, seeking unification and uniformity in the implementation of the same nursing manipulation;
Improving the culture of behavior of nursing staff in servicing patients;
Compliance with the principles of infectious safety for patients and staff;
· economical use of material resources by nursing staff, rational use of the bed fund, improving the quality of nursing care in outpatient clinics.
Determining the goal in nursing management is important, as it allows you to plan work, both for the long term and for the near future. This gives management activity clarity, purposefulness and allows you to determine the stages in achieving the ultimate goal.
A plan is a document that determines the order and sequence of work of medical personnel. There are several types of planning, defined by time intervals and the content of goals, tasks and deadlines.
Based on the annual plan, draw up quarterly and monthly plans. They include those activities that, according to the annual plan, must be completed in the corresponding planning period. Quarterly and monthly plans are more detailed than annual plans.
Of particular importance for the organization of the work of the head nurse are daily plans. In the daily plan, by the hour (and, if necessary, by the minute), all the planned tasks for the coming day are scheduled. The plan for the next day is made in the evening. First of all, the results for the past day are summed up, and the unfulfilled, but remaining relevant cases are transferred to the following days. Taking into account the monthly plan and regulations, a work plan is drawn up for the next (and subsequent) day. It is advisable that the necessary reference data be indicated in the daily plan: last names, first names, patronymics, telephone numbers, addresses, and other persons who should be met, called, etc.; types of work to be performed (prepare documents, accept employees, etc.).
Organizational structure The nursing process includes five main stages: nursing examination, diagnosing the patient's condition, planning care, implementing a plan for the necessary nursing interventions and evaluating the results obtained with their correction if necessary.
Stage 1 - examination of the patient. To make professional decisions and solve patient problems nurse is guided in its actions by a scheme corresponding to the sequence of stages of the nursing process. At all stages, the prerequisites for the actions of a nurse should be professional competence, skills of observation, communication, analysis and interpretation of data, sufficient time and a confidential environment, confidentiality, consent and participation of the patient, if necessary, the participation of other medical professionals.
The purpose of the first stage is to obtain information to assess the patient's condition in the gynecological department or to collect and analyze objective and subjective data on the state of health. Nursing examination is based on the principles of a holistic approach to the patient's personality, taking into account not only physical, but also psychological, emotional, intellectual, social and spiritual needs. The quality of the survey conducted and the information obtained from it determines the success of the subsequent stages of the nursing process. The nurse receives subjective data about the patient's condition during the conversation, first of all, patients of the gynecological department share their own ideas about the state of health and related problems, subjective data depend on the emotions and feelings of the patient. The sister receives the necessary information from relatives, friends, colleagues of the patient, this happens in cases where the patient is disoriented or in an unconscious state, the nurse receives objective data about the patient's condition as a result of examination (palpation, percussion, auscultation), in determining blood pressure, heart rate, respiratory rate and study data laboratory research. The nurse enters this data into the nursing history of the disease.
Stage 2 - diagnosing the patient. Identification of needs and identification of problems. This stage is defined as the establishment of a nursing diagnosis, the purpose of this stage is to establish existing and potential problems arising in the patient as a kind of reaction of the body to his condition, including the disease. Identification of factors that contribute to or cause the development of these problems, as well as the strengths of the patient, which could help in the prevention or resolution of these problems. In fact, existing problems are called problems that the patient currently has. Potential (probable) are those problems that may arise over time, but in this moment They are not here. Nursing diagnoses in the gynecological department are the basis for building a plan for the provision of nursing care, and if a medical diagnosis is usually associated with pathophysiological changes that have occurred in the body, then a nursing diagnosis is often associated with the patient's ideas about his state of health.
Stage 3 - care planning. The purpose of this stage is to determine the expected results of nursing care for the patient and develop a plan for nursing interventions aimed at achieving them. In order to achieve this goal, certain requirements are imposed on it:
reachability;
Diagnostics (possibility to check achievement);
time limits (indicating the timing of achieving goals).
By type, short-term (up to 2 weeks) and long-term (more than 2 weeks) goals are distinguished. The structure of goals should reflect specific actions, the criterion of time (date, time) and the condition - with the help of whom or what the result will be achieved.
Stage 4 - implementation of the plan of nursing interventions. The objectives of this stage are the performance by the nurse of the gynecological department of actions in accordance with the plan of the doctor and their mandatory documentation. There are three types of nursing interventions. Independent interventions - actions that a nurse performs without a direct prescription from a doctor, guided by independent professional decisions. Dependent interventions are actions performed by a nurse on the basis of a written prescription from a physician or under his direct supervision. Mutual interventions are the actions of a nurse in cooperation with a doctor, relatives or other health or social workers.
The final stage of the nursing process is the evaluation of its effectiveness.
1. Evaluation of the actions of the nurse;
2. The opinion of the patient and / or his family;
3. Evaluation of the actions of a nurse by the head (senior and chief nurses).
The goals of the fifth stage are to evaluate the patient's response to nursing interventions, analyze the quality of care provided and evaluate the results obtained. The main criteria for the effectiveness of nursing care include progress in achieving goals, response to interventions, compliance with the expected result. Thus, the evaluation of the results nursing intervention enables the nurse to determine the strengths and weak sides in his professional activity. It may seem that the nursing process and nursing diagnosis are formalism and unnecessary paperwork, but behind all this is the patient, who must be guaranteed effective, high-quality and safe medical care, including nursing care, in the state. Undoubtedly, this is evidenced by world experience, the introduction of the nursing process into work medical institutions will ensure the further growth and development of nursing as a science and allow nursing in our country to take shape as an independent profession.
One of the most important problems in the management of nursing leaders is to ensure the high quality of nursing care. As WHO (World Health Organization) experts point out, when defining the objectives and content of activities to ensure the quality of medical care, one should focus on four components:
performance of professional functions by a medical worker;
· resource usage;
risk to the patient as a result of medical intervention;
Patient satisfaction with medical intervention.
All these components are directly related to the activities of nursing staff and heads of nursing services for patient care, since from the level vocational training nursing staff, the correct performance of nursing manipulations in appropriate conditions and the level of communication with patients depends on the assessment of the quality of medical care provided by nurses. Skillful organization of the nursing process helps to achieve this kind of qualification. One of challenging tasks in health care - the formation of nursing staff and its retention in the health care system. A high professional level, the quality of medical care can be maintained, provided a well-functioning training system, the availability of professional practice, control over medical events and the activities of staff. It is the chief nurse who is entrusted with the tasks of managing and fulfilling all of the above.
Nursing management is purposeful activity heads of nursing services of medical institutions (HCIs) and their departments, using various management mechanisms and communication channels to ensure well-coordinated, qualified work of nursing staff to provide patients with nursing care of the appropriate quantity and quality.
In accordance with Deming's concept of continuous quality improvement, the main task of the fifth stage of the nursing process is to assess the quality of the patient care plan and, if necessary, correct it (Fig. K.8). Grade
Evaluation of the effectiveness of the nursing process
The study of disease outcomes on residual problems, including using a set of questionnaires, scales, tests
and questionnaires
Internal audit system:
assessment of nursing care by the patient and his relatives;
Patient satisfaction with training in self-care techniques:
nurse's self-assessment of her actions in relation to
to this patient
External audit system - assessment of the actions of a nurse by the head of the center * 1 And experts
At
Filling in the final part of the nursing process map and other medical documentation
Overall evaluation of activities and, if necessary, adjustment of the plan
Rice. 8.8. Evaluation of results and correction of plans for nursing interventions
is carried out to determine the degree of achievement of the goals, therefore, it is first necessary to determine:
who will evaluate the desired outcomes of care;
the goals themselves;
the conditions under which these goals will be achieved;
the criteria used to evaluate the goal; >
the period of time in which the goals must be achieved. To assess the quality of nursing interventions and care, three elements must be considered: structure, process, and outcome.
Structural assessment involves an assessment of the prerequisites for patient care (diseases, injuries, environmental changes, etc.), physical: amenities, organization of the department or institution in which the patient is located, and resources (human, etc.).
Process evaluation means monitoring the performance of care, the behavior of the nurse in relation to the patient, his relatives and others. medical workers. Assessing the vacgg-
99
All activities for which the nurse is responsible.
When evaluating the result, the final state of the patient, the effectiveness of nursing care is determined. The end result of care is compared with the expected outcome to assess whether the patient's condition is in line with the intended goal.
The basis for determining the degree of implementation of the planned plan is the compliance of the criteria with the standards. Criteria examples nursing practice, for example, are regulation functions Bladder or bowel, pain, personal hygiene. If we take the criterion of "personal hygiene", the standard could be the following statement: "the patient is clean and reports that he feels comfortable."
The main evaluation method is an audit (from the Latin ais1shsh - listening). Previously, the concept of "audit" meant listening to facts and arguments in order to establish the truth. However, over time, it lost its broad meaning and began to mean checking financial accounts (documents).
Nursing audit involves comparing the practical activities of a nurse with a standard or algorithm for performing nursing manipulations. Traditionally, it is held centrally. Nursing audit includes checking the data recorded by nurses in the documentation. Its tasks are:
assessment of the work of a nurse;
determining the competence of a nurse;
identify ways to improve performance in the future, if necessary.
There are two evaluation methods - current and retrospective. The first is carried out in the process of providing care, the second - in the analysis of the performed nursing work.
Ongoing assessment is based on direct observation of care, interviews with the patient and his relatives, determination of the competency of the nurse, audit of current records in nursing documentation.
A retrospective evaluation can be carried out by organizing an interview with the patient, his questionnaire, a conference for staff, an audit of records in nursing records after the implementation of the care plan.
The competence of a nurse is determined by her ability to plan care based on an analysis of the situation. A competent nurse is able to prioritize and organize her work. The main, although not the only, criterion of competence is safety. The method of assessing competence is observation and questioning or a scale for scoring.
If the goal of nursing care is not achieved within the planned period, the reasons for the failure should be found out, the necessary adjustments should be made and a new plan for the nursing process should be drawn up, starting from the first stage.
test questions
Define the nursing process.
State the purpose of the nursing process.
List the steps in the nursing process and describe them.
What documents are required for the implementation of the nursing process?
What are the advantages of introducing the nursing process into practical healthcare.
Includes:
1) assessment of the patient's response to care:
Improvement (desire to communicate, improved mood, appetite, easier breathing),
Deterioration (insomnia, depression, diarrhea),
Previous condition (weakness, difficulty walking, aggression);
2) assessment of actions by the sister herself (result achieved, partially achieved, not achieved);
3) the opinion of the patient or his family (improvement, deterioration, no change);
4) assessment of actions by the nurse-leader (achievement of the goal, correction of the care plan).
If the goal is not achieved or partially achieved, the sister formulates a conclusion, for example, “the assistance plan needs to be reviewed”, “it is necessary to conduct an examination ...”. If the prioritization of actual and potential problems is incorrect, the nurse also needs to reconsider goals and priorities. Only after the necessary changes have been made, the sister proceeds with the revised plan of care and the nursing process resumes.
The Nursing Profession is Diversified functional duties. Fulfillment of medical appointments is one of the sections of the work, but not the main and only one in its activity.
Application of the nursing process in the work of a nurse
Clinical situation
Patient Petrova Olga Ivanovna, 18 years old, lives in Rostov-on-Don, Pushkinskaya street, 174, apt. 1. Entered the pulmonology department of the Regional clinical hospital at 10 h 20 min. Clinical diagnosis: acute small-focal pneumonia.
Complains of fever, dry mouth, cough, headache, general weakness, lack of appetite. Sleeps restlessly due to cough.
He considers himself ill within two weeks after suffering ARVI. A sharp deterioration marks the last 2 days and associates this with an untreated respiratory infection and hypothermia.
I got sick sometimes when I was a kid. colds treated on an outpatient basis. There were no operations or injuries. Allergic skin reactions happen on cosmetics. Heredity is not burdened, does not smoke, does not drink alcohol.
The patient makes contact with difficulty, talks with the nurse reluctantly, is depressed, anxious. It turned out that she is studying at a medical college and expresses fear for her future, she is worried that she may be on academic leave.
Lives in a 2-room isolated apartment with his parents; they are very attentive to their daughter.
Consciousness is clear, position is active. Skin clean, dry, hyperemic; tongue dry with white coating. Reduced nutrition, height 160 cm, weight 46 kg.
Body temperature 39.2 ° C, respiratory rate 22 per minute, pulse symmetrical on both arms, rhythmic, 80 beats per minute, satisfactory filling and tension, blood pressure 120/80 mm Hg.
Rib cage correct form, evenly participates in the act of breathing, with auscultation - scattered dry rales.
Heart sounds are rhythmic, muffled; the abdomen is soft, painless.
Implement SP when meeting the patient's need.
Conduct a subjective assessment of the satisfaction of the patient's basic needs.
| Subjective examination | Subjective examination data |
| Passport part | Petrova Olga Ivanovna, 18 years old, address Rostov-on-Don, Pushkinskaya street, 174, apt. 1. Place of study: RBMK |
| Reason for patient referral | fever, dry mouth, cough, headache, general weakness, lack of appetite, restless sleep due to cough |
| Anamnesis of life | As a child, she suffered from colds and was treated on an outpatient basis. The only child in the family, lives with loving parents in a 2-room isolated apartment. There were no operations or injuries. Notes allergic skin reactions to cosmetics. Heredity is not burdened. Has no bad habits. No contact with infectious patients |
| Medical history | considers himself ill within two weeks after suffering ARVI. A sharp deterioration marks the last 2 days and associates this with an untreated respiratory infection and hypothermia. The ability to self-service is preserved within the ward, but it is difficult to make contact, she is reluctant to talk with a nurse, depressed, anxious. Expresses fear for his future, worries that he may be on academic leave |
Conduct an objective examination of the satisfaction of the patient's basic needs.
| Objective examination | Physical examination data |
| Consciousness, behavior | clear, closed, makes contact with difficulty, talks with a nurse reluctantly |
| Mood | depressed, depressed |
| position in bed | active |
| Anthropometric data | height 160 cm, weight 46 kg |
| Body temperature | 39.2 and C |
| Skin | clean, hyperemic, dry tongue with white coating |
| musculoskeletal system | without features |
| Respiratory system | NPV 22 per minute |
| The cardiovascular system | pulse 80 beats per minute, satisfactory filling and tension, rhythmic, symmetrical on both arms, blood pressure 120/90 mm Hg. |
| Gastrointestinal tract | no appetite, tongue dry with white coating, abdomen soft, painless |
| urinary system | without features |
| Nervous system | sleeps restlessly due to cough, expresses fear for his future, worries about his college studies, which may be on academic leave |
Identify the patient's basic disturbed needs:
| | 3 | |
Evaluation of the success of nursing care is carried out in accordance with the goals. This may be an assessment of the degree of independence of the patient, the ability of relatives to communicate effectively with him. Achieving the goal of effective communication means that the nursing staff and family members of the patient understand both verbal and non-verbal information, correctly respond to various requests from him and can anticipate them.
8.10. NEED FOR WORK AND REST
It is well known that a person spends one third of his life in a dream, most of it - in work and the rest of the time - on vacation. Work and rest are complementary concepts that are equally important aspects life. The term "work" in the generally accepted sense means the main activity of a person during the day for the sake of earning money, which makes it possible to provide a certain standard of living. Since work is a vital necessity, it is often spoken of with a negative connotation, although it often determines the meaning and sometimes the purpose of life, allows you to communicate with people, and increases family and social status.
Working from home (not to be confused with housework) has both its advantages (savings in transportation costs, less wear and tear of clothes and shoes, no strict schedule) and disadvantages (no communication).
Even when people work for money, money is not the only argument for which a person works. So, most of the nursing staff, receiving a small wages, work out of the need to help people, journalists need to fulfill themselves through publications in the media, i.e. people, choosing this or that profession, see in it not only a source of income. It is important to remember that a woman who raises children and does not receive wages for this also works.
Any work (paid or free) is a meaningful useful pastime. Recreation is what a person does during non-working hours: games, sports, music, travel, walks, etc. The purpose of recreation is to have fun. Often the concepts of "work" and "leisure" are intertwined. For most people, sport is recreation, and for athletes it is work. There are many examples where work for some is rest for others and vice versa.
As a rule, a person achieves success in a profession in mature years(40-50 years), while for athletes this peak occurs at 20-30 years, for politicians, leaders occurs more often after 50 years. During these periods, a person has the maximum opportunities for relaxation. In old age, it is better to do the usual work and provide yourself with the usual kind of rest.
The goals that an adult sets for himself when choosing one or another type of recreation are different: some consider being outdoors a recreation, others consider maintaining physical fitness, others consider thrills (mountaineering, slalom, etc.), others consider communication, fifth - aesthetic development and education (literature, museums, theater, music, etc.). The main purpose of recreation is to have fun and prevent boredom.
Theoretically, a person who retires has more time to relax. However, given the small size of pensions, people very often work as long as they have the strength and opportunity. When people stop working, many people have certain problems:
Loss (change) of social status and role in society, family;
Loss of the ability to communicate;
Loss of earnings;
Loss of the meaning of life.
Thus, the dynamics of work and leisure change at different stages of life: the beginning of school - the end of school - the beginning of work - a change of job - promotion - retirement.
It should be remembered that work in adulthood and rest in childhood are important components in life and the imbalance of them is harmful to health. Work brings a person money, which often gives him independence. Often people's independence middle age is precisely of a financial nature, which allows you to choose one or another type of recreation, although this choice does not always contribute to health promotion.
Naturally, weakness and deterioration in health in old age increase dependence on other people or devices (canes, glasses, hearing aids, etc.) both during work and during leisure, although some people of retirement age consider themselves more independent, than before.
People suffering from physical disabilities (congenital diseases or injuries), unable to learn, with mental illness or impaired function of the sense organs are dependent on the choice of work and type of recreation throughout their lives. The choice of this or that type of activity is influenced by many factors, primarily physical data and health. For example, the profession of a nurse requires the applicant to be in good physical shape and health, although in some units of medical facilities, nursing work is quite monotonous and sedentary.
Diseases leading to deterioration physical health(obesity, diseases of the respiratory system, blood vessels and heart, musculoskeletal system, diabetes), often do not allow a person to engage in a certain type of activity and recreation.
The choice of the type of work and rest is influenced by psychological factors. Game forms of education in childhood and productive work of adults contribute to the intellectual, emotional and common development personality, which is an important factor that allows a person to choose a profession. Temperament and character (patience, irritability, sociability, desire for solitude, self-discipline) influence the choice of work and rest. Thus, indiscipline leads to the creation of hazardous situations in the workplace that pose a threat to health. A nurse who does not follow safety precautions when working with electrical equipment, the correct biomechanics of the body when moving a patient or lifting heavy objects, universal precautions when working with biological fluids organism or infected care items, endangers only himself, but also patients, colleagues and other people, including members of his family.
In the slogan "Observe safety in the workplace" many people first of all put the concept physical security, but you should also think about reducing the real and potential risk of emotional stress. AT nursing as in many medical professions, emotional stress- professional risk, since most people working in the healthcare system often see pain, death and empathize with those who suffer. They are next to patients who are depressed, doomed, often present at the death of a patient. Diseases such as diabetes, ischemic disease hearts, peptic ulcers, headache and depression, often occur against a background of stress.
Lack of work has equally important psychological consequences, both for the person himself and for his family. People who have lost their jobs are more likely to suffer from insomnia, depression, anger, their worthlessness. The unemployed are more likely to commit suicide, they are more likely to have somatic and mental illnesses. The fear of being fired creates for a person (especially for a man) serious psychological problems. For some, being fired from a job is tantamount to an early death.
Nursing staff, conducting an initial (current) assessment of the patient's condition, should take into account the impact of work on health. It is necessary to clarify the conditions in which a person works:
Is safety ensured at the workplace (safety glasses, gloves, clothing), do others smoke;
Is noise level controlled? elevated level noise leads to stress, irritability, fatigue, decreased attention, injuries, high blood pressure, stroke. At a noise level of 90 dB or more, a person must be provided with headphones);
Is the temperature at a comfortable level, etc.
The literature describes the so-called sick building syndrome, a long stay in which due to exposure to noise, heat, cold, high humidity, electromagnetic radiation causes headache, fatigue, decreased attention, tearing, runny nose, sore throat in people.
Impact of adverse conditions environment on women and men reproductive age leads to serious consequences. Women experience infertility, spontaneous abortions, stillbirths, the birth of children with birth defects, oncological diseases. Men can develop infertility, impotence, and their children can develop cancer.
Initial assessment
Data on satisfaction of the need for work and rest can be obtained by a nurse during a nursing assessment, using her erudition and knowledge. You should find out:
What type of activity the patient is engaged in, what type of rest he prefers;
The length of the working day and rest;
Where does the person work and by whom;
What factors affect a person at work and leisure;
What does a person know about the impact on health of the conditions of his work and rest;
How does a person relate to his work and leisure;
Are there problems at work and during leisure time and how does he cope with them;
What problems with work and leisure exist in this moment and what problems might arise.
Answers to these questions can be obtained at the same time when conducting an initial assessment of the satisfaction of the patient's needs for movement, maintaining a safe environment, since all these needs are closely related.
Patient problems
Solving problems that have arisen in connection with the dissatisfaction of the need for work may be beyond the competence of nursing staff. In this case, the nurse involves competent specialists in solving this problem or gives advice on where to go for help.
It should be remembered that new job, dismissal, retirement play an important role in a person's life. People with such problems will be happy to accept psychological and emotional support from anyone, especially from a nurse.
All problems that arise within this need should be grouped as follows:
Changes in the state of independence;
Changes in work and leisure associated with the use of drugs and alcohol, with unemployment;
Changes in environment and habitual activities due to being in medical institution.
Independence in activities related to work and leisure is highly desirable for any adult. Those who cannot keep it feel disadvantaged, because they become dependent on the family or the state.
Causes forcing addiction are associated with physical or mental illness, impaired function of the sense organs. Physical diseases, depending on the nature and degree of damage to organs and systems, lead to the fact that the performance of the usual work is often unrealistic, and only passive rest is possible. This is especially true for patients with diseases and injuries leading to disability due to impaired mobility.
The degree of dependence of patients is different, they require different adaptation to new working conditions and types of recreation. For example, people who worked outdoors before the disease, athletes experience significant difficulties in adapting to the conditions of sedentary work and passive rest. At the same time, people who were previously engaged in sedentary work are easier to adapt to new conditions of work and rest. Sports for the disabled, including even the Paralympic Games, allow people accustomed to active image life, to realize their need for a particular form of recreation.
Loss (decrease) of the function of the sense organs often leads to difficulties in communication, which also affects the choice of work and type of leisure. Reduced vision (blindness) creates problems associated with the need to change jobs. Special courses provide an opportunity to master the skills of reading literature published using a special Braille font. Radio, telephone, tape recorder, computer (blind typing) and mastering new professions allow these people to some extent maintain independence both at work and at leisure.
With hearing loss, even at the very beginning, a person learns to read lips in order to save previous job and leisure habits. If the work of the person who has lost his hearing does not involve intensive communication and does not jeopardize his safety, use hearing aid makes it possible to maintain a certain independence in work and leisure (theatre, cinema, television, travel, etc.). The speech disorders described above can also create problems in the area of independent choice of work and leisure, especially in cases where oral speech is a necessary condition for work.
Loss of independence in work and leisure due to chronic diseases leading to disability, often changes the habits of the patient. The use of drugs, for example, for the purpose of pain relief, often forces a person to leave work and a previously beloved form of recreation.
"Experiments" with drugs often begin in their free time from study and work. Adolescents want to experience a feeling of excitement, emotional uplift, more vivid sensations than usual. Sometimes, after the first use of a drug, addiction appears, creating physical, psychological, social and legal problems.
Unemployment, like drugs, changes a person's habitual way of life. The loss (absence) of work entails a variety of problems: an excess of free time, idleness, the impossibility of a full-fledged (active) rest due to financial difficulties. If this period is prolonged, a person may lose motivation to find a job that brings pleasure. Apathy and depression force a person to sleep a lot in order to escape from reality. All this leads to a deterioration in health, and more mental than physical. Such a person is restless and preoccupied, quickly loses faith in himself, self-esteem, suffers from sleep disorders. All this predisposes to mental disorders.
Families of the unemployed are also at risk: they are more likely to experience divorces, child abuse, abortions, hypotrophy of newborns, and high infant mortality.
Having identified these problems, the nurse is unlikely to be able to solve them on her own. However, the understanding of the problem and its connection with the disorder of health should cause sympathy for both the patient and his family members.
Changing environment and daily activities also creates problems with work and rest. Of course, a medical institution for a patient is not a place where they work and rest. Problems are often associated with the fact that usually patients are bored by monotony, monotony, often forced (sometimes there is no reason for this) to be in the room all the time. Thus, if a nurse plans to help a person cope with the discomfort caused by a change in the environment, she should, taking into account the nature of the work and the usual type of recreation of the person, plan activities that replace the usual ones: reading books, magazines, television and radio programs, physical exercise, walks around the territory of a medical institution, etc.
Changing the daily routine often causes anxiety in a person. The lifestyle of an adult is usually determined by his work, or rather, the ratio of time spent on work and rest. In many departments of the hospital there are good reasons for the rigid daily routine, for most patients this gives a sense of calm. It should be remembered that every person is worried about the unknown, so the nurse must necessarily inform the newly admitted patient about the degree of rigidity of the daily routine.
Patients experience serious problems due to the inability to independently make decisions regarding their own treatment. Sometimes the staff of a medical institution deprives a person of this opportunity, forgetting that a person in this case loses self-esteem. For example, if adult patients are required to stay in bed during the daytime rest, especially male leaders and women who are used to being the head of the family resist having young sisters make decisions for them and feel uncomfortable in such situations. Thus, the staff often causes a person unnecessary, sometimes harmful to his health, grief. This disrupts the patient's usual role in Everyday life and renders a disservice during the subsequent restoration in professional activity. If there is a possibility (the patient's health is not deteriorating, the interests of other patients are not violated), the person can be allowed to continue his work activity. Some patients may need to be told why they should not work while in a healthcare facility. There will definitely be patients who will be delighted with temporary idleness.
Visiting patients with relatives, acquaintances and friends most often helps to smooth out feelings of loneliness and abandonment. F. Nightingale in "Notes on Care" wrote that for small children and the sick, each other's company is ideal. Of course, it is necessary to manage such communication so that none of the participants is harmed, which is quite possible. If there is concern that the air in the patient's room is harmful to small child, then it is also harmful to the patient. Of course, this needs to be corrected in the interests of both. But the very sight of a baby invigorates a sick person if they do not spend too long together.
Visiting the sick, both children and adults, is very important. Staying outside the family (in a medical institution) traumatizes the patient. However, not always family members are those whom the patient really wants to see. In some cases, the patient must be protected from a large number(or unwanted for him) visitors. Reception days and hours in a medical institution can become stressful for both visitors and patients, and, conversely, can serve as a means to minimize the discomfort caused by the absence of a person in the family.
There are patients who cannot be visited for one reason or another. In these cases, you need to organize communication by phone (if possible) or by mail.
A lonely or elderly patient who is not visited by anyone can be helped by a nurse if she simply takes the time to talk to him when the person expresses a desire to communicate.
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