Basic requirements for the work of the nurse of general practice

The principle of the nurse's activity until recently was based on a clear and "automatic" fulfillment of the doctor's appointments with no consideration of questions concerning any patient's emotional experiences. For this, the nurse should have not only knowledge in terms of care for the patient, but also awareness of the main issues of philosophy, psychology. In view of the fact that the nurse devotes much of her work to teaching patients something, she needs competence in the field of pedagogy. Currently, there are significant shortcomings in the organization of the nursing process, associated primarily with misunderstandings and ambiguities in many definitions. Nurses sometimes speak to each other in "different languages", unlike doctors who hold generally accepted definitions. The organization of the nursing process is based on the V. Henderson model. The structure of the nursing process is the elements of scientific knowledge used by the nurse for the organization and implementation of care for the patient. It is a continuous, constantly evolving system that has certain stages. The nursing process is aimed at preserving and successfully rehabilitating the patient's health after suffering a disability. For this, the nurse must solve several questions.

The first question is the organization of a certain basis, which includes complete information about the patient. The second task for the nurse is to identify the patient's disturbed needs. Further, it is necessary to determine the priority actions to be taken in relation to the patient. The following points are the implementation of planned activities and the analysis of the work done by the nurse. The above issues are the main stages of the nursing process. The activities of the general nurse in the structure of rendering primary care to citizens of our country are based on the standards of the nursing system, although it has its own peculiarities.

The first stage of the nursing process includes diagnostic measures for a certain disrupted need of the disease. The second element is the setting of priorities. In this case, the family nurse makes a list of the information received by talking to the patient or his relatives using the survey method, and also applies data obtained from medical personnel and from the accompanying documents. The first stage of the nursing process involves the use of certain methods of collecting information about the patient. The main of them is the compilation of a list of subjective information, which includes complaints of the patient( basic and secondary).Then the nurse collects objective information that provides the patient's anthropometric data, the state of the psyche, and the skin. Here she explores the cardiovascular and respiratory system in terms of basic parameters - pulse, arterial pressure, spirometry, etc. An important element of family medicine is the analysis of the patient's mental state, ethnic characteristics. It is also necessary to pay attention to the industrial facilities located next to the house, the working and educational activities of each member of the family. Careful observation of the behavioral reactions of the interviewed clients and their emotions is also important. The nurse of general practice compiles a list of patient data continuously and continuously in work with this family.

The second stage of the patient's nursing process is the evaluation of the collected information, aimed at identifying the main disturbed needs. The success of the family nurse at this stage depends on the knowledge and experience of her professional communication with the patient, as well as the application of the basic positions of medical deontology and ethics. She must immediately and competently analyze the patient's condition in order to move to the second stage of her activity - the production of a sister diagnosis. A general nurse who works in the primary care service at this stage must accurately and competently determine the diagnosis of the population according to the needs, the satisfaction of which for the residents of this area is violated for one reason or another. Then it determines the priority problem of the population( illness) and carefully analyzes the elements of its solution. To do this, the nurse often uses the basic indicators of public health. These include the total number of diseases, deaths, the quality of the medical and preventive measures carried out, and the source of material support is also important.

A five-point scale is used to analyze the relevant indicator separately. Following the establishment of a priority problem for citizens of a certain territory, the nurse forms groups of them depending on gender, age, and the presence of elements of increased danger. The activity of a nurse in relation to a particular family is similar and involves identifying problems of clients, divided into two groups. The first group consists of real, the second - the future problems of the patient. Identifying the main problems, the family nurse must adhere to the diagnostic decision of the doctor, have certain information about the features of the patient's life, the elements of increased danger to his health, as well as his intrapersonal characteristics. The work of the nurse at this stage has a great responsibility, since the conclusions that it will make regarding the patient's condition depend on the favorable outcome of his illness. The diagnosis, which the nurse sets, should reflect the patient's disturbed need and the cause that caused it. Examples of nursing diagnoses include: urination disorder caused by inflammatory kidney damage and fear due to the upcoming surgical intervention. Diagnostic decisions of the family nurse characterize the problems in various areas of the patient's life - from the disturbed need for nutrition, to the need for his self-realization in society. Unfortunately, the relevant list of nursing diagnoses has not been established by the relevant organizations involved in the nursing process, and there is only an indicative list of them.

The third stage of the nursing process involves setting the goals of the family nurse. This work must be carried out sequentially, i.e. To begin it is necessary with the permission of the main problem of the patient. Necessity of definition of the purposes of nursing activity is caused by individual personal and physiological features of patients, and also by an establishment of a level of quality of the done work. The family nurse should actively involve the patient in the work in resolving the goals and methods of obtaining them, which will ensure his motivation for a favorable outcome of the disease.

There are two types of goals, the first of which must be fulfilled in the next week, and the second - in later terms. A separate goal consists of three elements: the action, time, and the "instrument" for the fulfillment of the goal. Further, a thorough analysis of the existing issues is carried out, followed by the approval of an appropriate action plan in each specific case. After that, the medical staff realizes their plans with a subsequent critical analysis of the work performed. For a better presentation of the stages of the nurse's activities, it is necessary to describe in detail each stage. An example of a long-term goal: a patient will be able to engage in athletics two months after discharge from the hospital. An important element in the activity of the family nurse at this stage is setting goals that meet specific needs. Targeted approvals should be achievable, accurate in terms of implementation.

The fourth stage of the nursing process involves planning the activities of a nurse. In the system of primary care for the population, this stage includes the selection of the nursing area, the establishment of its indicators and the creation of an intervention program, which is reflected in the relevant document. Then the functions are divided between the participants of this service and a personal data recording structure and a control system are organized. The activity of the family nurse at this stage consists in writing an instruction, where she details the medical and preventive measures performed in relation to her clients.

There are several types of nursing work. The dependent form includes the work of the sisters, consisting in the implementation of the doctor's recommendations and under his supervision. An independent type presupposes the independent activity of a nurse. These actions include the systematic monitoring of vital health indicators, the provision of emergency care before the doctor's arrival, ensuring the personal hygiene of the seriously ill, measures to prevent the spread of infectious diseases in the ward, etc. The interdependent type provides for the joint work of the nurse with other specialists, aimed at implementing appropriatemeasures for the care and treatment of patients. This activity includes preparatory manipulations for various types of hardware and laboratory diagnostics. This also includes the consultation of a physician of physiotherapy and physiotherapy.

At this stage, the nurse must determine how to implement their activities, which are formulated according to the patient's problems. These include: the implementation of emergency care before the arrival of a doctor, the implementation of his recommendations, the provision of favorable living conditions for the patient, assistance in the case of physiological and psychological problems, measures to prevent complications of the disease and arrange consultations for family members. Then the nurse performs a set of planned activities according to the formulated goals. There are certain conditions, with the strict presence of which the nursing activity plan is suitable for implementation. These include the continuous implementation of planned actions, as well as the active participation of family members in their implementation. These actions may not be performed in case of unforeseen situations. When carrying out emergency measures, it is necessary to use certain templates, which are specially designed for nursing practice. An important point is the attention of the nurse to the subjective characteristics of the patient. Nursing activities are recorded in a special form, taking into account the periodicity, the time of their execution, and also there the reaction of the patient to the measures taken is noted.

In the practice of the nurse of general practice in the service of providing primary care to the population at the stage of implementation of the planned activities, great attention is paid to clear management of actions. At the same time, the favorable success of this stage depends on clearly defined goals, strictly planned actions, and availability of appropriate means for achieving positive results. Essential components of the correct implementation of the planned work are a clear division of functions between the participants of this activity, their good knowledge of certain information and their fidelity to their work.

The fifth stage of the nursing process involves analyzing the activities of the nurse and, if necessary, conducting corrective actions. This stage also includes comparative conclusions of nursing activity with the set goals. In case of a favorable result, the family nurse fixes this in a special form with an exact indication of the time parameters. In the opposite case, when the patient needs nursing care, a careful analysis of the nurse's actions should be carried out to determine the cause of the situation. To do this, you can use the advice of other specialists to plan your work correctly. These measures ensure the effectiveness of nursing activities, the study of the patient's response to appropriate manipulation, and also provide an opportunity to identify other disturbed client needs. An important characteristic of a nurse in performing qualitative work at this stage is the ability to make a comparative analysis of the results obtained with the goals set. Carrying out corrective actions is possible only in the presence of unfavorable changes in the state of health of the patient. The activity of the family nurse at each stage of the nursing process is regulated by an appropriate document - a nursing history of the disease or a sister card for monitoring the patient's condition, which includes a nursing care card. At present, intensive work is underway to create documentation that is universal and entirely appropriate for the family medicine nurse.

The stage of analysis of the practice of the nurse of general practice in the service of primary care for the population provides an objective examination of the level of compliance of the results with the goals. This stage is based on the application of systematic and everyday regulation in the implementation of the activity plan of this service. The analysis of the work, in particular the nurse of general practice, can be carried out both at the final stage of its activities, and at the stage of planning actions or their implementation. There are certain requirements for assessing the actions of the nurse, including its simplicity with simultaneous correctness, as well as ensuring a certain quality for citizens. The final stage of nursing in the primary care service is reassessment. This step should be taken into account in the event of a negative work result. At the same time, it is necessary to re-organize the program of activities, which is more deliberate and focused on achieving a positive result in comparison with the previous one. Thus, the general nurse is an initiative participant in the primary care service for the population. She actively works in various projects of the healthcare system: she conducts all kinds of questionnaires and tests among citizens, identifies and maintains statistical records of the main groups of health. One of the main functions of the nurse of general practice is to perform a variety of therapeutic and prophylactic appointments by a general practitioner to persons who are under the influence of factors unfavorable for their health( for example, ionizing radiation).A family nurse should be competent in the use of a personal computer in the context of mass computerization of all areas of the population. An important task of the nurse of general practice is to take statistical account of the results obtained as a result of the work of the Primary Care Service. It also proactively functions in the organization of three-level preventive measures.

At present, the system of providing primary assistance to the population is subject to reform. For this purpose it is necessary to analyze both positive and negative aspects of the activity of the present polyclinic service. The formation of this structure was initially aimed at providing citizens with a certain area near their place of residence with qualified medical services. The above-mentioned function of the polyclinic is carried out today, however, the level of professionalism of many doctors has significantly decreased. As a result, a large number of polyclinic institutions are organized at specialized hospitals, when doctors have the opportunity to combine outpatient reception of patients in a polyclinic and practical work in hospitals. At the same time, a high level of professional knowledge and skills is maintained.

The organization of an outpatient polyclinic structure has created for the majority of citizens certain conveniences in the passage of labor expertise, laboratory and instrumental examinations and the implementation of preventive and recovery measures. In this system of primary care, there is no position for the transfer of a patient from one specialist to another. The main drawback of this structure is the inseparability of the collective and qualified practice of doctors. In this case, the patient goes to admission to the narrow specialists, bypassing the office of the district doctor, which often leads to conflicting methods of diagnosis and therapy of patients. At the same time, the number of patients with misdiagnosed diagnosis and inadequate treatment with a corresponding illness increased significantly, which led to its chronic course. Therefore, a systematic check of the activities of their subordinates was added to the functions of the chief physicians of the polyclinic.

The negative features of the organization of primary care today are to exclude the choice of citizens by the attending physician, as well as the focus on dividing the "steps" of helping the population, instead of making every effort to unite these structures. The last statement is confirmed, for example, by the introduction of a variety of specialties of doctors of a narrow profile. For the successful and correct management of the patient, the knowledge and skills of the district doctor should be universal, which is sometimes not observed. Consequently, the current situation in the health care system requires the approval of a new specialty of a doctor that would meet the needs of modern society - a family doctor, or general practitioner. The work of this specialist is entirely aimed at the patient and his family, and not only on his illness. A family doctor carries out his / her activities according to a uniform scheme and qualifications. This presupposes a high level of training of a general practitioner in medical universities, since it is a medical worker who carries out specialized and multidisciplinary therapeutic and prophylactic measures. This specialist should have a comprehensive knowledge of the issues of psychology, pedagogy, etc.

At present, the family doctor's work schedule is clearly designed. His activities include: stay in the office( from 8.00 to 17.00), work on calls( from 6 pm to 8 pm), and provide recommendations by phone( from 8.00 to 22.00).For each general practitioner, the number of families served is set( an average of about 100, including a total of 350 people).

A modern family physician should be competent in the use of a personal computer, since all his activities are organized on the basis of electronic programs. The general practitioner's office should be of adequate size and contain a personal computer with a printer, the necessary furniture and appropriate medical equipment. At the disposal of this doctor there is a device for auscultation of the lungs, measurement of blood pressure, vital capacity of the lungs, as well as an electrocardiograph, a rostomer, etc. A cabinet with medicines for emergency care is mandatory. To organize an effective and immediate activity of a general practitioner, the healthcare system must provide this specialist with motor transport for carrying out the patient's call. In this case, the doctor should provide maneuverable means of communication.

The general practitioner can be employed by persons who graduated from the medical and pediatric faculties of a medical university and who have completed residency at a clinic specializing in family medicine, or district doctors retrained in the same specialty. These specialists work in family medicine institutions, polyclinics or hospitals, functioning on a district basis, as well as departments of polyclinic or hospital establishments. The duties of a general practitioner include setting up a serviced site, conducting sanitary education work with the patient and members of his family, conducting preventive measures, the purpose of which is to identify latent diseases and factors of increased danger in the occurrence of various diseases. Then he organizes and calls the appropriate group of patients for the next dispensary examination, writes out directions to narrow-profile doctors for the full diagnosis of the disease and the conduct of adequate therapy.

The main functions of general practitioners are the creation and implementation of a set of therapeutic and prophylactic measures for patients in the clinic( at the reception) and at home. The family doctor, in conjunction with the nurse, establishes systematic monitoring of pregnant and newborns in accordance with the developed standard, and also organizes and implements the immunization of the population of the site. The duties of a general practitioner include resolving the question of sending a patient to a sanatorium-preventorium, carrying out regular monitoring of the patient's health at any stage of medical and preventive measures. The general practitioner needs to work closely with various medical and preventive structures, including health insurance institutions, as well as organizations for social assistance to citizens. The latter provides material, psychological and medical assistance to disadvantaged families, orphans, old people, disabled people, etc. The activity of this medical worker provides for certain specialized requirements. The family doctor should be competent in matters of bills, functioning and basic positions of the health care system. This specialist must observe moral and moral principles in his activities. The main activities of the family doctor include the implementation of medical and preventive measures and examination of the patient, immediate manipulation in the event that the patient has a life-threatening condition, as well as performing various activities to organize the work of this medical institution. The general practitioner must perfectly master the methods of examining and analyzing the information of an objective and subjective examination of the patient. He must have the skills to develop a standard of hardware-laboratory diagnostics, and also be able to apply one or another method of preventing diseases and restorative manipulation. The family doctor should have appropriate knowledge in the interpretation of the results of analyzes of the patient's biomaterials, electrocardiograms and other survey methods.