Nursing in the practice of internal diseases: textbook

96 Pages·2020·15.133 MB·Russian

by  Коллектив авторов

The ministry of health of the Russian Federation
Izhevsk State Medical Academy
DEPARTMENT OF PROPAEDEUTICS OF INTERNAL DISEASES
WITH A COURSE OF NURSING
NURSING IN THE PRACTICE
OF INTERNAL DISEASES
TEXTBOOK
Izhevsk
2020
UDC 616-083+614.253.5 (075.8)
BBC 53.5+51.1 (2)ya73
Nur 94
Compilers: associate Professor, candidate of medical Sciences O. D. Mi­
khailova; Professor, doctor of medical Sciences N. A. Khokhlacheva; head of the
Department, Professor, doctor of medical science Ya. M. Vakhrushev
Reviewers: the head of department of Disaster Medicine and Life Safety
of ISMA, doctor of medical Sciences E. Yu. Shkatova, associate Professor of the
department of Policlinic Therapy of ISMA, candidate of medical Sciences A. V. Ni­
kolaeva
Recommended by the Central coordination and methodological Council
of the Izhevsk State Medical Academy
Nursing in the practice of internal diseases: textbook / Comp.
Nur 94 O. D. Mikhailova, N. A. Khokhlacheva, Ya. M. Vakhrushev - Izhevsk,
2020. - 96 p.
The training manual covers the basics of organization of nursing (with elements of
special therapeutic care), taking into account modern special care products, the sequence of
medical procedures and manipulations. Features of care of patients with various pathology
of organs and systems are given.
The manual is intended for foreign students enrolled in the main professional
educational programs-programs of specialty on 31.05.01 «General Medicine», 31.05.02
«Pediatrics», 31.05.03 «Dentistry».
UDC 616-083+614.253.5 (075.8)
BBC 53.5+51.1 (2)ya73
© Izhevsk State Medical Academy, 2020
© O. D. Mikhailova, N. A. Khokhlacheva,
Ya. M. Vakhrushev, formulation, 2020
PREFACE
The main goal of the course is to master students ‘ knowledge of the theoretical
and practical foundations of nursing, creating a base for the competent use of
manipulative techniques and nursing skills in their professional activities.
To successfully study the course, the student needs to know that the success
of treatment and prognosis of the disease is largely determined by the quality of
nursing care. It should be noted that the doctor should know the issues of nursing
much more widely than the average medical staff, in order to help the nurse
master certain manipulations, check the correctness of their implementation, and
eliminate possible errors.
As a result of studying a nursing course the student should know:
• risk factors, clinical manifestations and prevention of diseases of the cardio­
vascular, respiratory, digestive, urinary system, duties of the nurse in the course of
medical and diagnostic measures and organization of patient care;
• legal and ethical aspects of the work of a nurse;
the student must be able to:
• interview the patient;
• conduct a General examination of the patient;
• carry out the nursing process: conduct an initial assessment, identify the pa­
tient’s problems, plan nursing care, conduct current and final assessment of the
results of care;
• to ensure the infectious safety of patients and staff; to prevent nosocomial in­
fection;
• perform nursing manipulations, carry out drug therapy as prescribed by a
doctor;
• be able to provide a safe hospital environment;
• be able to provide first aid in emergency situations.
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THEME 1. SUBJECT «THEORY OF NURSING», PURPOSE
AND OBJECTIVES. HISTORY OF NURSING.
PHILOSOPHY OF NURSING. ETHICAL CODE OF NURSES
Purpose:
• introduce the student to the subject under study, define the basic concepts of
nursing philosophy.
As a result of studying the topic, the student must know:
1. Definition of nursing;
2. The purpose and objectives of nursing;
3. Main stages of nursing development in Russia and abroad;
4. Principles of nursing philosophy;
5. Ethical duties, values and virtues of a nurse;
6. The main provisions of the Ethical code of nurses.
As a result of studying the topic, the student must be able to:
1. Correlate the provisions of the Ethical code with practice;
2. Define the concepts of duties, values, and virtues of a nurse.
Content of the training material
Definition of nursing, its purpose and objectives
Nursing is a part of the health care system that combines science and art,
aimed at solving existing and potential patient problems connected with health in
a changing environment.
Nursing is the science and art of diagnostic and correction of person’s responses
to existing or potential illness.
Nursing as an art involves:
• the art of systematically applying knowledge and skills;
• the art of caring, which requires creative imagination, intuition, and artist­
ry in expressing your feelings.
The art of nursing involves protecting the patient if they are unable to make a
decision on their own.
Nursing as a science is an organized, systematic structure of knowledge
obtained and verified through research activities.
Previously, nursing was empirical and intuitive, and nurses relied more on ex­
perience and observation than on scientific research. At various times, the nurses
did and still do the work of doctors, nutritionists, nannies and cleaners. Now nurs­
ing is creating its own unique knowledge structure. The nurse has performed and
will continue to perform doctor’s appointments, but at the same time is becoming
more independent in making independent decisions to meet the individual needs
of the patient. Florence Nightingale is the founder of the care system that allowed
nursing to become an independent profession. She was the first to note that «in
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essence, nursing as a profession differs from doctors’ one and requires special
knowledge, different from doctors’» She considered that caring for the sick and
caring for the healthy are two important areas of a nurse’s work. While caring for
a patient, a nurse has to actively influence to the course of the disease, be able to
help a person to live with his disease as fully as possible, quickly gain indepen­
dence, and restore a sense of harmony with themselves and the world. According
to the WHO definition, «the main task of nursing is to help individuals, families
or groups of the population to identify and realize their physical, mental and social
potential, taking into account the adverse human conditions of life and work». This
task is based on the fact that the disease poses a number of questions and problems
to the patient, his family, and the team where the patient works or studies.
A nurse can be master of manipulative techniques, but if she can’t help the
patient psychologically adapt to stress, such as the disease, does not see him as a
living suffering person - she will not achieve the goals of care. Thus, nursing is
more focused on a person or group of people (family, collective, society) than on
the disease. It is aimed at solving the problems and needs of people, their families
and society as a whole that have arisen and may arise due to health problems.
This makes nursing different from medicine. Medicine is focused on the disease,
diagnostics and correction of the pathological process, and the purpose of medicine is
to diagnose, treat and prevent diseases. Nursing is focused more on the person than on
their illness, on nursing, on providing comfort and restoring harmony. It studies the
patient’s response to the disease. The purpose of nursing is to teach a person to live
with the disease, to ensure an acceptable quality of life in the disease and the maxi­
mum possible physical and psychological comfort for the patient in his state.
Nursing solves the following tasks:
• development and implementation of new technologies in the field of nursing
care;
• implementation of consulting nursing care;
• ensuring a high level of medical information;
• conducting sanitary-educational and preventive work;
• development and expansion of organizational and managerial reserves for
working with personnel;
• consolidation of professional and departmental efforts to provide medical
services to the population;
• conducting work to ensure professional development and professional skills
of personnel;
• conducting research in the field of nursing;
• creating standards for nursing practice.
Thus, nursing is a branch of medicine that has acquired the right to
an independent significance, being separated into a special science.
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Historical aspects of nursing development
Development of nursing abroad
The development of nursing is inextricably linked with the development of med­
icine. Nursing is called the oldest art and the youngest profession. The art of caring
for the sick, the injured, the disabled, women in labor, babies, and the elderly has
existed since the advent of human society. More than 2500 years ago, the famous
medical school in Kos was opened, associated with the name of Hippocrates. The
history of nursing, as an independent profession, has a little more than 150 years.
The main role in the development of nursing was played by Florence Nightin­
gale (1820-1910) - an English nurse who devoted her entire life to improving sani­
tary conditions in hospitals, did much to reduce the death rate among the wounded
on the battlefield, and created a system of training nurses in England. Thanks to
her work, nursing has become an independent profession.
In 1860, Florence opened the Nightingale test school for nurses at St. Thomas
‘ hospital in London, using her experience in hospitals, F. Nightingale wrote many
books, articles about the purpose, role and training of nurses, which first outlined
the concept of nursing as a profession other than medicine; created the scientific
basis of nursing, which laid the Foundation for the prevention of diseases, defin­
ing it as «the task of caring for the healthy». She saw the task of caring of the
patient in improving the quality of his life, and attached special importance to
the healing effects of nature, cleanliness, fresh air, silence, and proper nutrition.
In the future, schools in Europe and America were created based on the model of
her school, and teaching there was conducted by nurses themselves. Special atten­
tion was paid to the formation of special nursing knowledge, skills and values. In
1864, in Geneva, Henri Dunant (1828-1910) organized the International Red Cross
society, based on the recommendations of F. Nightingale, set out in the «Notes». In
1912, the League of the International Red Cross established the Florence Nightin­
gale medal as the highest award for people distinguished in saving the lives of the
wounded and sick. every 2 years, 50 outstanding nurses of the world are awarded
this medal. The day of her birth, May 12, in 1971 was officially approved by the In­
ternational Council of nurses as the International Nurses day.
F. Nightingale’s ideas, views and beliefs are widely recognized in many coun­
tries of the world.
In 1886, the world’s first professional nursing organization, the nurses Soci­
ety, was established in the United States of America. In 1960, doctoral scientific
programs in nursing appeared. This was a period when nursing was completely
transformed as an independent science, having equal importance with scientific
medicine and developing in parallel.
From 1955 to 1973, the United States actively developed a systematic approach
to providing nursing care, focused on the needs of the patient. For the first time, the
concepts of «nursing process» and «nursing diagnosis» appeared.
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History of nursing in Russia
Traditionally in Russia, monasteries were not only spiritual, but also physical hos­
pitals. After the adoption of Christianity, «hospital wards» were created in monaster­
ies. The place where pain puts a person «prostrate» became known as «hospitals».
Since 1829, paramedic (nursing) schools have been established in large hospitals.
The new stage in the development of nursing care in Russia is associated with
the organization of communities of nurses. The sisters of mercy took care of the
sick, both in the community and at home, and also served on duty in the city’s
hospitals. On the initiative of N. I. Pirogov, the Holy cross community of sisters
of mercy was established in 1854 to provide assistance to the wounded during
hostilities. In 1867, The Society for the care of wounded and sick soldiers was
organized in Russia, which was renamed to the Russian Red Cross Society in 1879.
From that time on, the training of nurses became one of its tasks.
In the following years, the sisters of mercy worked to eliminate the epidemics
of cholera (1880-1881), typhus and scurvy (1899), and participated in providing
medical assistance to migrants (1880-1890). In 1917, the first Congress of the sisters
of mercy was held. Currently, nurses may receive education at medical schools as
well as in medical colleges. A multi-level system of training nurses from basic to
higher and postgraduate has been introduced.
In 1994, the interregional Association of nurses of Russia was established. The
ethical code of nurses in Russia has been developed.
In 1998, the first all-Russian Congress of secondary medical workers (the
official name for nurses) was held and congresses were held in many regions of
Russia, including the Udmurt Republic in 1999. Departments of nursing care were
organized in hospitals and health care centers. The nursing process as the scientific
method of organizing nursing care began to be introduced.
Philosophy of nursing
Philosophy is an integral system of views on nature, society, and thinking, based
on the moral ideas of a certain group of people. It is an expression of the worldview
and affirms the core values, beliefs, and intentions of this group of people. This is
a way to understand your role and your meaning in society.
The philosophy of nursing is a part of the General philosophy that gives an un­
derstanding of nursing, represents the established beliefs about it. This philosophy
defines the significance, goals, place in the society of nursing, the system of views and
principles on which it is based. Nursing is the worldview of a nurse in relation to basic
human values, a system of views on the relationship between medical professionals,
the patient, society and the environment. This philosophy is based on universal princi­
ples of ethics and morality. The philosophy of nursing is based on four basic concepts:
• patient as a person;
• nursing as a science and art;
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• environment;
• health.
From the standpoint of the philosophy of nursing, a nurse acts as:
• organizer and performer of patient care;
• advocate for the patient’s interests;
• teacher-consultant;
• researcher;
• leader;
• active member of the medical team.
The basic principles of nursing philosophy are respect for the life, dignity and
rights of the patient.
The philosophy of nursing provides answers to the following questions:
• definition of nursing, its goals and objectives;
• the ratio of nursing and medicine;
• nurse-patient interaction;
• professional ethics;
• relationship between nurses and society;
• the environment and its impact on the patient’s health.
At the center of the philosophy of nursing is a person who has biological, psy­
chological, social and spiritual needs, a person who has the right to an active, har­
monious life and development, receiving nursing services, regardless of religion
and social status. A patient is a person (individual) with certain personal charac­
teristics who needs medical care and nursing care.
Professional ethics of a nurse
Ethics is a philosophical and theological teaching about morality; a set of prin­
ciples that separate right behavior from wrong.
Deontology (from the Greek «deonthos» - due) - the doctrine of proper be­
havior. It claims that the correctness of people’s actions is determined by motives,
principles and rules. I. Kant wrote: «Good deeds are done out of respect for duty.»
Deontology considers how, from the point of view of nursing ethics, a nurse should
act in specific situations that arise in the course of her professional activity. What
principles are used in making ethical decisions?
1. Benevolence-the ability to do good for the benefit of others.
2. Confidentiality - non-disclosure of medical secrets.
3. Informed consent.
4. Do not harm - non-harm to the patient.
5. Reliability - ability to keep a promise.
6. Autonomy - to help to the patient make independent decisions.
7. Utility - maintaining the good for the majority, if non-acceptance is impossible.
8. non-Acceptance-equality in relation to people.
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9. Protection - encouragement to do good, keeping from bad.
Medical ethics includes the moral aspects of medicine:
• human qualities of a nurse;
• examples of heroism and courage, self-sacrifice;
• professionalism;
• appearance of the nurse;
• communication with the patient;
• maintaining medical confidentiality;
• ability to distinguish mistakes from offenses.
In dealing with a patient, the nurse assumes the following ethical responsibilities:
• respect the patient’s personality and maintain their dignity;
• do no harm;
• do good;
• to be principled;
• be loyal.
In her professional career, a nurse strives to achieve goals or ideals that are
defined by philosophy as values. They are the next ones:
• professionalism;
• health;
• healthy environment;
• independence;
• human dignity;
• harmony.
The third ethical component of the philosophy of nursing is the virtues (excel­
lence), or personal qualities of a nurse that encourage a person to do good things:
• knowledge;
• skills;
• compassion;
• mercy;
• patience;
• diligence;
• purposefulness (ability to think, observe, analyze, lead, collaborate, teach,
take responsibility in critical situations, etc.).
Thus, when performing professional duties, the nurse must constantly behave in
a way that does not undermine the confidence in the profession.
Ethical code of nurses in Russia
The International code of nurses was first adopted by the International Coun­
cil of Nurses in 1953. In Russia, the Ethical code of nurses was adopted in 1996.
The development of nursing practice, medical science and technology, changes in
public values and views on the role of the patient in the provision of medical care
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caused the need to review the code of Ethics, it was adopted in a new version in
2010. As before, the highest value of nursing work is defined as service to people,
loyalty to the principles of charity and the highest priority of the patient’s interests.
Here are the main provisions of the Code.
Part I. Generalities
Part II. The nurse and the patient
Article 1. The nurse and the patient’s right to quality health care
Article 2. The main condition of nursing is professional competence
Article 3. Humane treatment of the patient, respect for his legal rights.
Article 4. Respect for the patient’s human dignity
Article 5. First of all, do no harm.
Article 6. The nurse and the patient’s right to information
Article 7. The nurse and the patient’s right to accept medical intervention or to
refuse it
Article 8. Duty to keep professional secrets
Article 9. Nurse and the dying patient
Article 10. The nurse as a participant in scientific research and educational
process
Part III. Nurse and her profession
Article 11. Respect for her profession
Article 12. Nurse and colleagues
Article 13. Nurse and questionable medical practice
Part IV. Nurse and society
Article 14. Responsibility to society
Article 15. Maintaining the autonomy and integrity of nursing
Article 16. Guarantees and protection of legal rights of a nurse
Part V. Validity of the Ethical code of the Russian nurses, responsibility
for its violations and the procedure for its revision
Article 17. Effect of the code of Ethics
Article 18. Responsibility for violation of the code of Ethics
Article 19. Revision and interpretation of the code of Ethics
Test tasks
Choose one correct answer:
1. When was the International Red Cross society organized?
1. 1886; 3. 1920;
2. 1864; 4. 1912.
2. the Founder of the patient care system is:
1. Yulia Vrevskaya; 3. Ekaterina Bakunina;
2. Florence Antigal; 4. Daria Sevastopol.
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