Basics of nursing work, development history, nursing process.
Plan :
1. "Fundamentals of nursing" science, its tasks and its place among clinical sciences.
2. Emergence of medicine, development history of nursing work.
3. Understanding of the nursing process.
The science of "Fundamentals of Nursing" teaches nurses theoretical and practical ways of treating and caring for patients, medical ethics, disease prevention and human health care. The theoretical part of this science explains the basics of morality, manners, duty, rights and responsibilities, sanology to future nurses, and the practical part is how to behave directly in front of the patient, perform treatment-diagnostic procedures, take care of patients and help patients in critical situations. provides information about directions.
The science of "Fundamentals of Nursing" is the role of a nurse in helping people, families, groups achieve physical, mental and social health, as well as in their socio-ecological environment, to encourage people to care about their health, to maintain and strengthen health, and to prevent diseases. It also explains how to alleviate the negative impact of the disease on the patient or how to reduce it as much as possible.
Taking these into account, the science "Fundamentals of Nursing" occupies an important place among other clinical sciences and serves as a foundation for these sciences.
Since 1991, the specialty "Nursing work" numbered 0408 was introduced in the medical schools, and the relevant qualification descriptions were also developed.
By 2001, the laws of the Republic of Uzbekistan "On Education", "On Standardization", "On the National Program of Personnel Training" and the Cabinet of Ministers dated January 1998, 5 No. b On the basis of the decision "On the development and introduction of state education standards for the continuing education system", a network standard was developed and implemented for the purpose of training junior specialists in the field of "Nursing". In this network standard, full information about the professional description of the specialist was given. In the description, the tasks that a medical nurse must know and be able to perform, as well as the demands placed on her, are reflected. During the study of the subject "Fundamentals of Nursing", students will be able to fully master all the conditions in the description.
In the process of teaching the science of "Fundamentals of Nursing", most of the practical exercises are carried out directly in hospitals, with the participation of the patient and the patient himself. Therefore, during training, it is necessary to pay special attention to the requirements of diligence of students in their relations with patients. Because every patient, regardless of his condition, pays careful attention to the student or nurse who is looking after him. His clothes, behavior, behavior are strongly affected by any shortcomings in speech etiquette. For example, taking care of the patient's private parts, jerking, humiliating, neglecting the patient by forcing his appearance, grossly violating the rules of ethics and deontology will definitely not go without a trace. Those who want to take up the profession of nursing should fully feel the responsibility and trust in front of people.
As the Polish doctor Begansky said, "A person who is indifferent to human needs, who does not know how to be gentle, who does not have the willpower to control himself everywhere and always, it is better to choose another profession, because he will never be a good medical worker."
Nursing philosophy.
Nursing philosophy is a system of ideas that approach the world from the point of view of a medical nurse. It reflects the work of a nurse and her outlook on personal and professional skills. Of course, the basis of this philosophy is the personality of the patient with his biological, spiritual, social and other requirements. Its main principle is to respect the patient's life and rights. A nurse should be able to interact with a person of any complex character and be ready to provide medical services to him. This is one of the indicators of his professional skills. It creates an atmosphere of respect for the past, present and future of each patient, life values, habits, outlook and religious beliefs.
One of the main components of a nurse's interaction with a patient is her ethical code. It evaluates the activity of a medical nurse and illuminates the main principles of behavior, that is, it reflects the purpose, obligations and values of the profession. A nurse must make decisions that are consistent with ethical standards within this limit and fulfill the obligations assigned to society, colleagues, and his profession.
As with any profession, nursing is constantly changing, and opinions about the profession of nursing are also changing. The philosophy of nursing work can differ not only in different regions, national groups, but also in preventive treatment and medical-educational institutions.
There are 4 main concepts in nursing philosophy:
1. Nursing is an art and a science.
2. Treating the patient as a person
3. Environment
4. Health
Art has a great influence on the spiritual world of a person. It has long been known that it has a positive effect on a person's general condition, mood and health. As F. Nightingale pointed out in his time, nursing is one of the oldest care-based arts and at the same time the most modern science.
Nursing work as a science relies not only on medical, but also spiritual, social, cultural, historical, legal and educational knowledge. In the course of their professional activity, a certain conceptual direction is formed in them, and on the basis of it, comprehensive features of nursing work are created. These characteristics serve as a solid basis for creating the theoretical part of nursing work.
The concept of "person" occupies a special place in the philosophy of nursing work. In philosophy, the problem of personality is first of all to determine the position of a person in society. A person is a whole, moving, self-regulating biological system, i.e., a set of physiological, spiritual, social and spiritual needs, their satisfaction, growth, development, interaction with the environment. leads to Biological, mental, social and spiritual factors together make a person whole. Although they are common to all people, each individual patient's past, present, life values, traditions and decisions should be treated with respect.
It is known that the environment has always influenced a person and his activities. In his time, Hippocrates emphasized that the influence of the environment is of great importance in the formation of physical and spiritual characteristics of a person. He divides these factors (climate, weather, wind directions, water and soil conditions, the region where a person lives, lifestyle, customs, laws of the country, forms of the state system, etc.) into different groups from the point of view of their effect on the human body. Also, the world-famous medical nurse F. Nightingale considered the influence of the environment as an important factor in the prevention of diseases and health care.
The environment is a complex of natural, social, spiritual and spiritual factors and conditions in which a person lives. The following are its components:
- Natural factors include geographical situation, climate, weather, water quality, etc. In addition to them, it is necessary to take into account the man-made environment.
— Social factors (family, school, friends, colleagues, etc.) that have a strong influence on the patient's personality.
- Spiritual - includes human behavior and its interactions with others (language, traditions, customs, religious views, behavior, etc.).
A medical nurse builds relationships with a patient taking into account the environment in which the patient grew up, lives and works. The living environment affects the behavior and physical condition of a person, which means their diseases and health.
In 1947, the experts of the World Health Organization defined the concept of health as not only the absence of disease or disability, but also complete physical, mental and social well-being. Sometimes it is difficult to determine what constitutes health, but it should be taken into account that it is a process in constant motion. Nursing is considered one of the most humane professions on earth. It is a profession that embodies positive qualities such as compassion, impartiality, patience, sensitivity, attention, cheerfulness, kindness. These must be strengthened with deep knowledge and high professional skills.
The nurse plays an important role in the treatment process. Fulfilling doctor's instructions, caring for patients in critical condition, performing numerous, sometimes complex procedures - all these are the direct tasks of medical staff. Also, they directly participate and monitor the patient in medical examinations, preparation for surgical operations. All this requires from the nurse not only professional, but also spiritual and moral qualities, the ability to establish a positive relationship with the patient and his relatives. Patients sometimes need the sensitivity, spiritual support, and warmth of a medical nurse more than different medicines. It is not for nothing that medical nurses were called "sisters of kindness" in the long past. In this name, not only the professional, but also the spiritual aspects of their activity are expressed. The task of a medical nurse is to help specific individuals, families and human groups to achieve physical, mental and social health in the environment surrounding them.
The emergence of medicine.
Medicine (lat. medicina - I heal), medicine, medicine - a set of knowledge and practical activities in this field of maintaining and strengthening human health, prolonging life, prevention and treatment of diseases. The origin of modern medicine includes long historical periods and different worldviews: the basis of knowledge about various diseases, their treatment and prevention was known through the experience and observations of our people. Medicinal buds have been around since the dawn of man. "Medical activity is equal to the first man," wrote IP Pavlov. Humanity has been exposed to various negative effects of nature throughout its life, and as a result of these effects, it has suffered from various diseases. During the struggle for life, he suffered various injuries. Naturally, people began to look for measures to eliminate such sufferings, and the observant and educated among them found ways to solve this problem. They began to treat patients using various drugs, powders, and ointments. As a result, people who are engaged in treatment began to be known gradually. The remedies are the same. But with the beginning of the slavery system, there was a division among people. Those who had certain occupations had to make a living from their occupations. Diseases increased among the population living in such harsh conditions, and the skills of those treating them increased day by day. During the period of slavery, more attention was paid to massage, water treatments, physical education, etc., surgical methods, for example, caesarean section (cutting the abdominal wall and uterus to remove the fetus) and other minor operations were performed. In the formation of the medical profession in this period, the contribution of the medical scientist Bukrat (Hippocrates) (460-377 BC) is extremely large. He described the external symptoms of many diseases, the influence of the patient's lifestyle, environment and climate on the origin of the disease, and with his instruction on the types of the client and the structure of the body, he laid the foundation for a unique approach to the treatment and diagnosis of patients. . Of course, at that time, the treatment was not based on science, the treatment was not based on the exact knowledge of certain organs and their physiological function, but was determined according to the changes in the 4 different types of organs (mucus, blood, bile and bile). The first studies on the structure and function of the human body appeared as early as the 3rd century BC. Alexandrian physician Herophilus and Erasistratus dissected the corpse and conducted various experiments on animals. As a result of the above achievements, a considerable shift in medicine began to occur, but in the process of treating diseases that are increasing among the population, one more person is missing.
Development of nursing work.
With the appearance of the nurse, the scope of her duties has also expanded. He becomes not only a person who carries out the ordered vazikalvr, but also communicates with the patients, takes care of the patient and performs nursing work. Today, a lot of research is being conducted on how nursing work was created and developed in ancient times. People have always been interested in the problems of disease prevention and health care. They tried to find ways to treat their diseases. As a result, three systems of medical care are of great importance in the emergence and development of nursing. and occupied by independent healers, whose activities are focused on treatment. The second system of assistance is related to the emergence of religious views, which includes the organization of treatment of orphans, widows, and the poor. It was in this system that the first buds of nursing work appeared, and the first aid was given to the sick and the poor. The first system is recognized as modern European medicine, and the second system developed between 1300 and 1450. As the activity of the second system continued, the third system became a system based on treatment and with increased attention to practical medicine. Acquired innovations, inventions have increased the importance of the nurse as an assistant to doctors by expanding the scope of care. After the Crimean War, Florence Nightingale became the first organizer of nurse training, publishing her clear and orderly notes and diaries and biographical information. However, general medical workers and doctors have dominated the training and education of nurses. This caused the nurse to become subordinate to the doctor and the requirements of general medicine. Nurses were considered necessary only to work in hospitals. By the end of the 1899th century, the growing interest in nursing led to the establishment of the International Association of Nurses (Council) in XNUMX. In 1900, the Charter of the Council was adopted and Bezfard Fenwick, a nurse from Anguilla, was elected as its first president. On the initiative of this organization, starting from 1971, May 12 (F. Nightingale's birthday) is celebrated as "Nurses' Day". Activities of this council include approval of the code of ethics of the International Nurses Association on nursing education, duties of nurses, working conditions and attitudes towards nurses, and holding international conferences with its support. Conferences are held once every 4 years. To this day, this council contributes to the improvement of nursing work and to making fundamental changes in the work of nurses. The assignment of leadership positions to nurses and the organization work are the reason for increasing the status of nursing work.
The founders of nursing. Teachings of F. Nightingale and W. Henderson
Women are naturally close to showing love and care, they take care of their children, loved ones, the sick and the poor with love. Because of this, more women are involved in helping and caring for sick people. According to information, women's labor was used for the first time in Russia during the reign of Peter II. According to the decree of Peter II, orphanages were established in 1715, where women had to serve. However, later, the involvement of women in this task was stopped, and it was assigned to retired soldiers. Later, women's labor began to be used again in civilian hospitals. This activity was first started by wives and widows of soldiers in the hospital. From this period, there were no special nurses for the care of patients in hospitals, so nursing work is considered to have started in 1803. In the same year, a "widows' home" was established for widows of soldiers in military service, elderly and homeless women under educational institutions in Moscow and Petersburg.
In 1818, an institute for widows called "Mercy" was established in Moscow, and a special course for nurses was organized in hospitals. Doctors taught the lessons according to H. Oppel's book. The first manual for medical personnel was devoted to patient care, which was published in Russian in 1822.
X. Oppel's guide describes how to select patient care staff. Their physical and mental maturity and moral deontology are taken into account. Special attention is given to the care of intensive care patients, convalescent, injured, dying, newborns and other patients. X. Oppel paid great attention to the sanitary and hygienic conditions of the patients. All methods of basic medical procedures and ways of taking medicine are indicated. In 1844, on the initiative of Grand Duchess Alexandra Nikolayevna and Princess Theresa Oldenburgskaya, the "Volunteer Nurses" organization was established in Petersburg. It was the first charitable organization of nurses in Russia and was called "Svyato-Troitskaya". Women and girls between the ages of 20 and 40 are admitted to this organization. At first, training was conducted in hospitals, and later it was conducted by local doctors in the organization itself.
Nurses learned patient care, dressing, pharmacy and prescription here. They helped patients in hospitals and private homes. In 1845-1856, NI Pirogov periodically conducted experiments on operations and dissecting corpses in the hospitals of this organization of nurses. In 1847, for the first time, 10 women who studied in this organization were given the title of "nurses of mercy". This organization was supported by sponsors. Such organizations were established in St. Petersburg and Odessa to meet the need of community nurses. At the end of 1850, monks of the Voznessensky Temple worked in a hospital for the common people in Moscow. But during the Crimean War in 1853-1856, there was a great demand for nurses. In October 1854, when Sevastopol was fired upon for the first time, it was besieged by British, French, and Turkish troops for almost a year. In the same month, Yelena Pavlovna, the sister of Emperor Nicholas II, founded the "Krestovoz Dvizhenskaya team" of compassionate nurses, who cared for sick and wounded soldiers in Petersburg, not only in the dressing station, but also in military hospitals. did Out of 28 of those trained in the association, 3 squads were formed and sent to Crimea, NIPirogov divided them into 3 groups. At the end of November 1854, the first detachment reached the Crimea. The head of this detachment was AP Stakhovich. In January 1855, the second detachment of Mercy nurses led by Merkulova arrived in Sevastopol. The head of the third detachment was EM Bakunina. NI Pirogov divided nurses into the following groups:
— assistants to doctors during surgery, dressing wounds;
— pharmacist nurses who prepare, store and distribute medicine;
— nurses who supervise cleanliness, change of underwear, sheets and folders, housekeeping and service.
They began to help doctors during operations and dressing wounds, preparing medicine, storing and distributing it, cleaning, changing beds, folders and clothes, and household work. Most of the nurses would die of sweating, some would be wounded or concussed. Nevertheless, all bravely endured the dangers and hardships and helped the sick and wounded warriors without reproach.
"The first nurses of the Krestovozdvizhenskaya team had to go directly into the fire of the Crimean company," NI Pirogov wrote.
"If they continue to act in the same way, they will definitely benefit a lot. They were in hospitals around the clock, taking turns, helping to dress wounds.
The presence of well-dressed women and sincere help will reduce the pain of hardship and suffering." For the first time in the history of the world, nurses of mercy began to help the wounded and sick directly on the battlefields.
M. Bakunina started nursing work and was the creator of Russian medicine. After leaving the team, he opened a small hospital for peasants at his own expense in his village, Tver province, and when necessary, he consulted doctors at his own expense. In 1877, 65-year-old EM Bakunina was again sent to the Caucasian War to lead the work of the Compassion Nurse Detachment at the invitation of the Russian Red Cross Society.
Florence Nightingale, the English nurse, is the founder of nursing in the world
(1820-1910)
Florence Nightingale (1820-1910). From a young age, he considered it a human duty to devote himself to the holy work of helping people, warning them against illness and death, and providing unbiased help. At the age of 20, she dreamed of becoming a nurse.
But her dreams could not be realized at that time, because the society considered nurses among women of light nature with seemingly irrefutable evidence.
He continued to take care of patients, enter hospitals, and raise children, relying on the religious books that it is meritorious to help the mentally and physically ill. After reading the book "Dwellers in the Forest" he begins to get closer to his dream, only at the age of 33, after gaining experience in a hospital, he reaches it and begins to manage a Catholic institution "nurse of mercy". In 1853, Florence Nightingale works as a supervisor at an institution for sick women of noble descent in London.
His task was to monitor the work of nurses, control the condition of medical equipment and the preparation of medicines. Although the institution is very exemplary, Florence Nightingale suggests that special schools for training nurses are needed.
But in 1854, when Turkey and Russia were at war, the British army moved to Crimea to help Turkey. After the battles near Sevastopol, according to the English "Times" newspaper, British soldiers sent the sick and wounded to the English military hospital in Scutari (near Constantinople) without any help. At this time (October 1854, 21) a detachment of 38 nurses led by Florence Nightingale arrived in Turkey.
He works in a hospital and comes to the conclusion that thousands of lives can be saved and repaired if cleanliness is improved in hospitals and barracks.
Despite being busy with public works, he helped patients at night. Florence returned to England in July 1856 at the age of 36.
In 1857, as a result of Nightingale's comments in the book "Reflections on health care in the English army, effective management of hospitals", the royal military-medical commission was formed. Reforms will be carried out to improve the sanitary conditions of barracks and military hospitals.
In addition, a military-medical educational institution will be opened, and special training programs will be developed that set high requirements for the work of nurses.
Florence Nightingale had always wanted to return to nursing, but after returning from the Crimea, she became seriously ill.
The illness lasts for a long time, despite being weak, he writes his famous "Memoirs of Care".
It gives an understanding of nursing as a profession, explains its difference from the profession of a doctor.
According to his model, the first nursing school was established first in Europe and then in America.
Such a school will be opened in England with the funds collected in honor of this heroic woman.
Even now, the professional values written by Nightingale remain unchanged.
The International Society of the Red Cross established the Florence Nightingale Medal in 1912.
Florence Nightingale Medal
Nurses who showed heroism in the field of military operations were awarded with such a medal. During the Second World War, 46 nurses from the former Soviet Union were awarded this medal. Matluba Eshonhojayeva, nurse of the 4th children's polyclinic of Tashkent city, was also the first in Uzbekistan to be awarded this medal for her selfless work.
It is necessary to recognize the tolerance and kindness born in the hearts of people, which brings salvation to the sick and wounded. Swiss Henri Dunant, who was impressed by the brave work of the nurses in the Crimean War, thought about creating an international private and voluntary organization to help the wounded. He was impressed by the work of Florence Nightingale on the one hand, and the "Krestovozdvizhenskaya team" on the other. In 1859, during the Franco-Italian-Austrian war, when he accidentally went to Solferino in Italy, the scene was imprinted in front of his eyes: the wounded, the inability to get help in time, and those who were suffering without help, terrified Henri Dunant. In 1862, he published "Reminiscences of Solferino" and decided to establish the International Organization for the Relief of War Victims. In 1863, the Permanent International Committee for Aid to the Wounded was established in Switzerland, and from 1876 it was called the International Committee of the Red Crescent. After that, the first national societies were formed. In 1864, the first Geneva Convention for the Amelioration of the Condition of the Wounded on the Battlefield was adopted at a diplomatic conference. Four conventions have been adopted today. Convention:
— the wounded and sick on the battlefield;
— wounded and sick people who suffered from a shipwreck at sea;
— prisoners of war;
— protects local citizens who suffered during military conflicts.
Two additional protocols were adopted to supplement this. The International Committee of the Red Cross soon became a strong, developed organization. But it does not deal with the problems of providing assistance to victims of military conflicts, as before. There are currently 150 national Red Cross and Red Crescent Societies. Despite the fact that their main task is to provide assistance during military conflicts, they now also carry out their activities in peacetime: donation, disease prevention, refugees, assistance to the needy, first aid, to those affected by natural disasters. it is enriched with directions such as providing assistance.
Virginia Henderson lived in America from 1897 to 1997 and contributed to the development of the medical field. At the beginning of the XNUMXth century, infectious diseases were widespread and considered one of the most important human problems. In particular, diseases such as perspiration, smallpox, ichternalma, and children's dysentery broke out, as a result of which many people died. V. Henderson identified the problems of nursing care at that time, proved that the nurse is not a physician's assistant or a person who performs repetitive work, and together with this he developed his theory of nursing care.
V. Henderson believed: "A nurse should be a professional who can think independently and freely." He emphasized that it is very important to have a sincere, warm attitude to each patient during the care process. Finding that many people end up in the hospital due to poor lifestyles, he identified 14 basic needs that are important for human life. In 1966, he created the "Henderson model" focused on biological, psychological and social needs that can be satisfied through nursing care. W. Henderson also justified the need to teach relatives or the patient himself to care for the patient at home.
V. Henderson defined nursing care as follows: "If a person has enough physical strength, desire and knowledge, he can probably live a healthy life, recover or die peacefully without the help of others. Helping with this is the independent work of nursing care, in which care should be provided that helps a person to become independent as soon as possible."
A special place in nursing care is to help the patient to improve his health and not need the help of other people.
International Red Cross and Red Crescent Society and their role in the development of nursing.
In the history of global medicine, the main place in the nursing work and the training of nurses was played by the public figure of the International Red Cross (cross) and the Red Crescent Society N.I. It was founded by Pirogov, Henri Dunant from France and Florence Nightingale from England. Employees of the Red Cross Society trained nurses of compassion to help the wounded in the wars that took place at that time. Realizing that the work of helping the wounded on the battlefield and in hospitals is not good, NI. Progov founded the Krestovozdvigensk Nurses' Union in 1844 in Petersburg. Nurses of Mercy showed heroism in the Crimean War (1854-1856), the bloody war of the XNUMXth century. Dasha Sevastopolskaya was the first charity nurse to study in this association. Thus, the training of nurses was started under the leadership of Red Cross Society employees.
In Uzbekistan, the Red Cross and Red Crescent Society was established in 1925, although it achieved the status of an independent National Society in 1992. In 1995, it was recognized by the International Committee of the Red Cross and became a member of the International Federation of Red Cross and Red Crescent Societies. Today, the Red Cross and Red Crescent Society serves to increase the sanitary culture of the population, to prepare it for the sanitary defense of the homeland, and to improve the health and living conditions of the workers. Promotion of free donation and involvement of people in this work is one of them.
The International Red Cross Society established its highest honor - the Florence Nightingale Medal - for selfless nursing. During World War II, 2 members of the Red Crescent Society, including 17 members of the Red Crescent Society, and 4 nurses directly helped the soldiers and heroes in the battlefields. Salima Qublanova, Matluba Eshonkhojayeva were awarded the Florence Nightingale medal, the highest award of the International Red Cross Society, for their bravery and bravery. After the war, this award was also given to the charity nurse Antonia Pikhteyeva.
Medicine of Central Asia in the Ancient East and the Renaissance.
In the Middle Ages, the science of medicine began to develop in the East, including Central Asia. Most of the medical works written in Greek, Sanskrit and other ancient Eastern languages, including Aristotle, Dioscorides and Galen, were translated into Arabic during this period.
The only source of information about the development of medicine in Central Asia is the ancient Zoroastrian book "Avesta", the first pages of which were written in Khorezm three thousand years ago. By the seventh century, it was formed by Zoroastrianism, the founder of the Zoroastrian religion, who came from a tribe of camel herders on the banks of the Amudarya.
In the words of the ancient Greek sage Rlinius, "consisting of a million songs", this book contains very valuable information. In this book, families with twins, who have paid great attention to their protection, are rewarded with a camel and a permanent allowance is set for them.
Great attention was paid not to pollute the water of the pond, well, and stream. It was not allowed to water the horses to graze on the banks of the stream. It is considered that "every person should know the country where he was born and raised as sacred." In "Avesta" great attention is paid to family purity, personal purity, gardens and cemeteries. At the same time, "Avesto" pays great attention to child education, human development, and rules of etiquette. It also contains some information about human anatomy and physiology.
"Avesta" contains the names of more than a thousand medicinal plants, and it also describes the methods of treating patients and preparing medicines. The oath of medicine, the image of a snake spewing poison, which has become a symbol of medicine, was first expressed in "Avesta". In the Middle Ages, science and culture were highly developed in Central Asia, where special importance was given to medical science. Hospitals, outpatient clinics and pharmacies have been opened in densely populated areas. Special higher medical schools were established in some hospitals, and students were taught the secrets of medicine.
Experienced and knowledgeable judges working in these centers of knowledge wrote medical textbooks and manuals for students.
In the XNUMXth-XNUMXth centuries, scientists from Khorezm joined the "Society of Scientists" established in the Horn Palace, and it was named "Mamun Academy" in the history of the society. It was headed by the great Uzbek encyclopedist scholar Abu Raykhan Beruni. Famous physicians and doctors, such as Abu Hanifa al-Dinavari, Abu Mansur Samani, Muhammad ibn Samarkandi, who worked in this society, made a great contribution to the development of medicine in the East with their scientific works and practical works on the causes of various diseases, their prevention, and treatment. those who
The medical works of Abu Bakr ar-Razi (865-925), a famous physician of the East and lexicographer, are of great importance in the formation of world medicine.
Ar-Razi's greatest work on medicine is called "Kitab al-Hawi" ("The comprehensive book"). This book contains all the information known in the field of medicine until Razi, and it is bigger than Ibn Sina's "Medical Laws" in terms of size. Abu Bakr al-Razi's student Rabi ibn Ahmad al-Ahawayni al-Bukhari created a book called "Hidayat al-mutallimin fit-tibb" (A guide for those who study medicine), summarizing the ideas expressed by Razi before and before Razi, perfectly the guide creates a masterpiece.
A great Central Asian encyclopedist who made a great contribution to the development of world science, Abu Ali ibn Sina, known in the west as Avicenna, was born in the village of Afshona near the city of Bukhara. occupied He served as a court physician in Khorezm and Iran, became famous throughout the world through his incomparable services and discoveries in medicine.
Various sources report that he wrote more than 450 works, but 242 of them have reached us, 43 of them are related to medicine. Ibn Sina's major and main work on medicine, even the masterpiece of his work, is "The Laws of Medicine". "Laws of Medicine" consists of five books.
The first book is about the theoretical foundations of medicine and general issues of practical medicine, it describes the tariff of medicine, its tasks, the instruction about the client and the "normal" parts of the human body - bones, tendons, arteries, veins, tendons. , information about bones and muscles is given.
In the second book, the necessary information about the drugs used in the medicine of that time is described.
The third book is devoted to "private" or "local" diseases that occur in the joints of the human body from head to toe, that is, private pathology and therapy.
The fourth book describes "general" diseases that are not specific to any of the human organs.
The fifth book is pharmacology, which describes the methods of preparation and use of drugs with complex composition.
Chinese folk medicine has a long history. Shen-Nung, who ruled 33 thousand years ago, is considered the founder of Chinese medicine. Shen Nung's "Book of Wonders" contains synonyms of plants, botanical tariff, season and methods of preparation of products from them, geographical location of plants, range of effect of these drugs, their use, drug recipes, as well as what can be treated with these drugs. A general list of diseases is given. The great works of medical representatives have not lost their importance and value, they are the basis for the development of medicine in many European countries, and the study of their rich heritage is still ongoing.
The nursing process
2004 of SSV of the Republic of Uzbekistan. According to the order of March 30, No. 270, it is planned to introduce the "Nursing process and records" in medical institutions in order to implement the recommendations of international experts in order to improve the nursing work in the Republic and improve the quality of medical care provided to patients.
The word "process" means a sequence of actions to achieve a certain goal. The essence of the nursing process is to define a clear system of tasks of a nurse to achieve a professional goal, a sequence of actions of a nurse to achieve his professional goal. Therefore, the nursing process is a scientifically based method of professional nursing care aimed at the needs of the patient.
The nursing process includes the following five steps:
1. Step 1. Examination of the patient.
2. Stage 2. Diagnosing the patient's condition (identifying the patient's needs and problems)
3. Step 3. Nursing care planning
4. Step 4. Implementation of planned nursing care
5. Step 5. Evaluating Nursing Care Outcomes
Stage 1. Examination of the patient.
The purpose of the stage: to obtain information to assess the patient's condition, or in other words, to collect objective and subjective data about the patient's health (collecting an anamnesis) and analyze them.
This stage is based on the principle of "holism", i.e. an approach to the individual taking into account not only his physical, but also his mental, emotional, social and spiritual needs.
Subjective information is obtained by the nurse during the interview process. The main source of information is the patient, who expresses an opinion about his health and related problems. In some cases, that is, if the patient is unconscious, or if he is mentally retarded, or if he is a young child, the patient's relatives, friends, colleagues, acquaintances, parents, or medical staff may provide information about him. can give
All information obtained during the examination of the patient is reflected in the "disease history" (nursing process) written by the nurse.
Objective information is obtained by the nurse through direct examination and observation of the patient. Results of palpation, percussion and auscultation, data on arterial blood pressure, pulse, respiration, body temperature, results of all laboratory tests are objective data. These data are also recorded by the nurse in the patient's "disease history" (nursing process).
Stage 2. Diagnosing the patient's condition (identifying the patient's needs and problems)
This stage is the stage where the nurse makes a diagnosis (nursing diagnosis).
The concept of nursing diagnosis (nursing problems) was first recognized and legalized in the USA in 1973. The list of nursing problems approved by the American Nurses Association currently includes 114 main conditions. Including high body temperature (hyperthermia), pain, mental stress, social isolation, lack of attention to personal hygiene, restlessness, decreased physical activity, etc. At this stage, the nurse identifies the existing and most potential (anticipated) problems that caused the patient's illness, studies the causes that cause and develops these problems, and identifies the strong qualities of the patient that can be used to eliminate the identified problems.
Problems that the patient currently has are called existing problems. Problems that do not exist yet, but may arise over time, are called potential problems. For example, the possibility of bedsores as a result of impaired mobility is a potential problem.
During the examination, the patient may have two, three or even more problems at the same time. In such situations, the nurse should determine the primary, intermediate and secondary problems, taking into account the level of their impact and threat on the patient's life and health. High-risk and urgent problems are the primary problems. Intermittent problems are problems that are not life-threatening and may delay nursing care for a while. Problems that are not directly related to the disease and its future development are secondary problems.
The main methods of nursing assessment are observation and interview. The nurse examines not the disease, but the external reaction of the patient to the pathological process. There is a difference between a nurse's diagnosis and a doctor's diagnosis. A doctor's diagnosis is aimed at identifying pathological conditions, while a nurse's diagnosis is based on the interpretation of the patient's reactions to health problems.
Nursing problems can be divided into physical, mental, spiritual and social classes. In addition, the following types of nursing problems are distinguished:
• Existing – problems that bother the patient at the moment (for example: pain, shortness of breath, swelling).
• Extimoli - problems that do not exist at the same time, but may occur after a certain time (for example: the appearance of bedsores in an immobile patient, the risk of developing dehydration during frequent diarrhea and vomiting).
After identifying the two types of problems, the nurse determines the factors that create conditions for their development or cause them to appear, as well as the factors that cause problems in the patient, as well as the strengths that can be put against the problems in the patient.
Because the patient often has multiple problems, the nurse must be able to prioritize them.
Primary, secondary and intermediate problems are distinguished. The priorities are the sequence of the most important problems that the patient has, and they should not exceed 2-3 necessary to determine the procedures that should be performed in turn by the nurse. When the patient is not treated, the problems affecting his life are considered the main, that is, priority.
Intermittent - problems that are not necessary for the life of the patient. Problems that are not directly related to the patient's disease or its consequences have a secondary priority (for example, in a patient with a spinal cord injury, the primary problem is pain, range of motion, and the secondary problem is discomfort).
Criteria for selecting priority issues:
• All urgent situations, (for example: acute pain in the heart, the risk of development of pneumonia, etc.)
• At the same time, it is the problem that bothers the patient the most. For example: when there is a heart disease, a patient who is bothered by chest pain, headache, swelling, wheezing attacks, wheezing itself is the main problem. can show as a problem. In this case, "panting" is considered the priority problem of patients for the nurse.
• Problems that can lead to worsening of the patient's condition and various complications. For example: the risk of developing bedsores in an immobile patient.
• Problems that, when eliminated, lead to the solution of a number of other problems. For example: A successful surgical procedure in a patient leads to improvement of vision, sleep, appetite and mood.
The nurse makes a diagnosis based on the identified problems.
A "nursing diagnosis" is a clinical judgment by the nurse that details the patient's current and potential health problems with possible causes and symptoms. The nursing diagnosis consists of three components and is summed up in the PES formula (Gordon, 1987), that is, "P"-problem, "E"-problem cause, "S"-disease set of signs and symptoms. A nurse's diagnosis differs from a doctor's diagnosis in the following ways:
• the doctor's diagnosis determines the disease, and the nurse's diagnosis determines the reaction of the patient's organism to the disease;
• the doctor's diagnosis may not change during the entire treatment of the disease, while the nurse's diagnosis may change every day, even several times a day, depending on the reaction of the patient's body to the disease;
• the doctor's diagnosis implies the treatment of the disease at the level of medical practice, and the nurse's diagnosis implies care within the framework of the nurse's participation;
• the doctor's diagnosis is based on the pathophysiological changes in the body, while the nurse's diagnosis is based on the patient's judgment about his own health.
Stage 3. Nursing care planning.
The purpose of the stage is to determine the expected results of the patient's treatment. The nurse determines what to do to achieve these outcomes.
After the patient is examined, diagnosed, and the priority problems are determined, the goal of nursing care, the expected results and their duration, as well as the nursing action and method necessary to achieve the set goal are developed.
Eliminating all factors that lead to complications by choosing the right way of care for the natural course of the disease.
A goal and plan of care for the patient is created when planning to solve the priority problem.
Two types of goals are distinguished:
• short-term (for 1-2 weeks)
• long-term (intended for more than 2 weeks). They have been achieved for a long time and are aimed at the recurrence of diseases, prevention of complications, prevention, rehabilitation, social skills and acquisition of medical knowledge. Each goal consists of 3 components:
• Actions
• Criteria - date, time, distance.
• Circumstances – with the support of a person (or thing).
Once the goals are established, the nurse creates a plan of care for the patient, which lists all the actions necessary to achieve them. Requirements for goals:
Goals should be clear
Determination of specific deadlines for achieving it
The goal of nursing care is not the level of a doctor, but the duties of a nurse.
After defining the goal and creating a care plan, the nurse should explain her actions to the patient, get his consent and goodwill, and get his support. Through these actions, he proves that the goal can be achieved, and jointly determines the ways to achieve them, and directs the patient to positive results.
Step 4. Implementation of planned nursing care.
The purpose of the stage: to implement nursing care based on the established plan and to document the work done.
The following types of nursing care are distinguished:
1. Independent care - performed by a nurse based on his professional judgment only, without direct orders and instructions.
2. Subordinate care - is carried out under the written or oral instructions and direct supervision of a doctor.
3. Collaborative care is carried out together with a doctor, nurse, other medical personnel and relatives of the patient.
In any type of care, the responsibility of the nurse is equally high. Care is provided based on a plan and information is recorded on a nursing care card.
The patient's need for medical care
*temporary
*permanent
*rehabilitation
Can have properties.
Temporarily - for people with limited self-care, injured legs and arms, who have undergone minor surgery.
Permanent - the patient needs support throughout his life. These conditions include leg amputations, complicated spinal and pelvic injuries, and others.
Medical rehabilitation - that is, rehabilitation assistance - is a long-term process. For example, therapeutic physical education, massage, breathing exercises, conversation with the patient, etc.
During the fourth step of the nursing process, the nurse addresses the following two important issues:
— Observing and observing the patient's reaction to the doctor's instructions, returning the obtained results to the nursing history.
— Monitor and control the patient's reaction to actions related to nursing diagnosis, return the obtained results to the nursing history (card).
Step 5. Evaluating Nursing Care Outcomes.
The purpose of the stage: to evaluate the patient's reaction to the treatment and care performed by the nurse, to analyze the quality of the care provided and the results achieved.
In evaluating nursing care, the following factors serve as sources and criteria:
• Evaluation of nursing care, level of goal achievement.
• Assessing the patient's reaction to the nursing procedures and the medical staff's treatment, the feeling of satisfaction and wishes from the hospital.
• Evaluating the effectiveness of the help provided by the nurse on the patient's condition.
• Actively seek out and evaluate other existing patient problems.
If necessary, the plan of nursing activities is revised, sometimes it is stopped. Or changes are made. In cases where a specific goal has not been achieved, the evaluation allows to review some of the factors that prevent them from being achieved. In cases where the end of the nursing process is ineffective, the process is repeated step by step to identify deficiencies and change the plan of nursing actions.
Comparing the achieved and expected results with each other requires the ability of the nurse to think deeply. When the goals are achieved, that is, the problem is solved, the nurse returns the corresponding notes on a special card, signs and writes the date.
All performed procedures should be reflected in the nurse's documents.
References:
1. Kadirkhan Inomov "Fundamentals of Nursing" Tashkent - 2007.
2. A. Gadayev, MXAlimova, XS Salikhodjayeva, LXMusajonova "A set of practical skills for general practice nurses" Tashkent-2011.
3. T. Yu. Umarova, IA Kayumova, MQ Ibragimova "Nursing work" Tashkent-2003.
4. KU Zakirova, DU Tokhtamatova "Fundamentals of Nursing" Tashkent - 2010.
