Principles of communication with the patient. There are two main rules of communication

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Abstract on the topic

"Peculiarities of communication with elderly patients"

Completed by a student of group II m / s I

Kharitonova Svetlana Ilyinichna

Cheboksary, 2012

Psychological characteristics of the elderly

Caring for the elderly is an occupation that requires special knowledge, not only in medicine, but also in psychology. You need to know what kind of behavior you will encounter.

One of the main psychological features of people in old age is the feeling of loneliness. Unfortunately, there are often objective reasons for this - lack of communication, inattention on the part of relatives, the inability to conduct habitual image life, etc.

The feeling of loneliness also arises because of the difference in generations - it is difficult for older people to find mutual understanding with their children and grandchildren, it is difficult to navigate in their interests. And friends of the same age, for obvious reasons, are becoming less and less, old people have no one to share their feelings with, or often they remain misunderstood. As a result, a feeling of loneliness develops, which causes a person mental trauma.

Another feature is that older people tend to find it difficult to adapt to anything new. An unwillingness to develop plays a big role in this, and the motivation is simple - “Why do I need this? Life is practically lived!”

Many associate old age with infirmity, and sometimes so strongly that they themselves begin to feel infirm. All this is exacerbated by diseases - old man begins to plunge into them, constantly think about his sores, visit the clinic, looking for new diseases. As a result - prolonged depression and fear for their lives.

Caring for elderly people, it is important to understand what the elderly need, what feelings they experience, what help they need. Older people need communication, understanding, so that they have someone to discuss their problems with. And, of course, you need to be patient with constant complaints, especially from sick people, do not break out crying at their antics and quirks. If older people feel sincere attention, care that someone needs them, then many problems will be left behind.

As can be seen from the above, caring for the elderly requires not only a sincere desire to help, but also special knowledge and a lot of free time.

Problems inherent in old age

The aging process is closely related to the constant increase in the number of patients suffering from various diseases, including those inherent only in the elderly and senile age. There is a constant increase in the number of old people, seriously ill, in need of long-term medication, care and care.

In the process of aging, the adaptive capabilities of the organism decrease, vulnerabilities are created in the system of its self-regulation, mechanisms are formed that provoke and reveal age-related pathology. As life expectancy increases, morbidity and disability increase. Diseases are getting chronic with an atypical course, frequent exacerbations of the pathological process and a long period of recovery.

In old people, a whole “bouquet” of such chronic diseases is often found. In old age, it is not even the very presence of a particular disease that is especially important and significant, but the extent to which it limits a person’s daily activities.

The general physical condition of old people is integral indicator health and work capacity. For them, it is most important to maintain the ability to live normally, that is, to self-service, and therefore their main characteristics should be considered:

* degree of mobility;

* degree of self-service.

Undoubtedly, such an objective indicator of the state of health in old age is confinement to a limited space. On this basis, the following categories of old people are distinguished: a) freely moving; b) due to limited mobility chained to a house, apartment, room; c) immobilized, helpless, bedridden.

Taking into account this feature that is universal for all old people, it is possible to quickly and, most importantly, objectively determine how much medical and social assistance and in what order is required in each individual case.

Urinary dysfunction is one of the most unpleasant symptoms old age. This disorder, while causing physical pain, often causes mental suffering. It is observed more often in women; in men, urinary retention is typical in case of prostate adenoma, but there may also be spontaneous excretion of urine in drops. Urinary incontinence causes bad smell, invariably accompanying such a person. This disorder, in case of non-compliance with the rules of personal hygiene, can lead to conflicts and isolation of the old person in the family, since the smell spread by him invariably arouses the hostility of all those around him.

With aging, the risk of such diseases of civilization as sclerosis of blood vessels increases, coronary disease obesity, diabetes, hypertension, etc.

Senile infirmity is a condition in which a person, as a result of a long-term chronic illness, becomes unable to perform the daily functions necessary for a normal independent life. This condition is also called "senile vital failure". In this case, constant guardianship and assistance is already required; a frail old person cannot live alone, he must either be surrounded by his loved ones who are ready to care for him, despite all the difficulties, or move to a nursing home. Senile infirmity may be due to a mental or physical defect (marasmus), but more often - the combined influence of both.

The second place is occupied by post-stroke lesions. Such phenomena may be accompanied by dementia, but quite often the intellect and memory do not suffer at all. Neurological shocks are expressed in varying degrees:

Fracture of the neck of the femur is the third cause that confines the old man to bed. The older the age, the less chance of successful union of the fracture; in extreme old age, as a rule, surgical treatment is not performed. These fractures often cause death in very old people days or weeks after the fracture.

In fourth place are dystrophic changes in the joints, chronic deforming polyarthritis, which not only cause deformation of the joints, but sometimes completely immobilize the patient, and make many of the usual daily activities difficult. This is especially difficult for old people who, while maintaining clarity of mind, become completely helpless and dependent on strangers.

psyche curative old age communication

Features of communication and holding medical measures old man

It is well known that it is the everyday communication of a specialist with a patient with the skillful use of communication skills that inspires hope for recovery, improves his mood and self-confidence, mobilizes his adaptive mechanisms, optimizing his defenses. This is especially true for older patients.

It is in dealing with such people that the success of verbal influence and therapy depends on trust and respect for the doctor or paramedical worker, on an attentive attitude to complaints, requests and a subjective description of the disease about which they apply.

On the other hand, when dealing with elderly patients, one often has to deal with people who have the duration of their disease, and age itself caused such changes in the psyche and personal qualities that cannot be ignored.

With a long chronic course of the disease, the patient fixes attention on his painful symptoms. First, it is a fixation on those self-perceptions that accompany vegetative changes in the body (palpitations, shortness of breath, pain in the abdomen or chest, etc.). This is a natural stage of any long-term current disease. The focus should be on the characteristics of the patient's personality, the internal picture of the disease, the features of the hypochondriacal fixation on their painful experiences, the features of his attitude to the methods of treatment, to himself. And this is possible only with everyday skillful communication with patients, analysis of the difficulties and barriers that arise in the process of communication, and skillful overcoming of them.

The general principles for helping frail old people are:

* timely prosthetics, the use of hearing aids, orthopedic shoes, the use of various improvised means and devices;

* kinesitherapy, i.e. exercises to restore the ability to move and self-service skills;

* physiotherapy and water procedures;

*pharmacotherapy that promotes physical and mental rehabilitation;

* rational nutrition (diet according to the disease), psychotherapy;

* occupational therapy, i.e. occupational therapy with specially selected occupations.

Methods for restoring the ability to move in bedridden old people are passive and active. Usually passive method applied immediately after the violation motor functions. It includes massage and passive gymnastics performed with the help of loved ones or nurse. Active recovery is carried out by the efforts of the patient himself. The stages of passive and active recovery may have different duration depending on the cause of the disease, age and general condition old man. An important role is played by the mental state of the patient, his desire to restore his independence as soon as possible.

Thus, knowledge of the characteristics of the psyche of the elderly and senile age, understanding the mechanism of mental changes caused by old age, should be the basis of the approach of medical staff to patients of older age groups and be taken into account when providing geriatric care. Sometimes not so much somatic pathology as unfavorable social factors (change of stereotypes in work and everyday life, family conflicts, etc.) are the reason that an elderly or old person feels sick. Therefore, it is especially important to pay attention to the mental status of patients of older age groups. Any stressful situation can cause them a number of shifts that cause exacerbation of latently occurring pathological processes and development severe conditions. Many elderly and old people need, first of all, to eliminate loneliness, self-isolation. Good advice, help with lifestyle changes, normalization of relationships with loved ones are often the main factors contributing to improved health. And the role of the nurse in this is far from the last.

The transmission of information is generally carried out using verbal and non-verbal means. When communicating with an elderly patient, a nurse must organize the transfer of information, taking into account the involutional changes taking place in his body. For example, as a result of age-related changes in the organ of vision, visual acuity, adaptation to light and dark, the ability to distinguish colors decrease, and sensitivity to bright light increases. To reduce the impact of these changes, we recommend:

· increase the illumination during reading, teaching, demonstrations, etc., but at the same time reduce exposure to bright sunlight, using glasses, curtains, blinds, etc.;

· increase the size of teaching aids, letters in the text, etc.;

use bright contrasting colors for marking the boundaries of rooms, steps, positions of handles of instruments and devices;

Avoid expressions like: "Take the yellow pill in the morning and the white pill in the evening."

Changes in the hearing organs lead to senile hearing loss - presbycusis; decrease:

the ability to perceive all tones, but most of all - high ones due to atrophy, primarily of cells in the region of the basal whorl of the cochlea, responsible for the perception of high sounds;

the ability to perceive speech, and it almost does not improve with increasing volume; conversational speech is perceived especially badly in a noisy environment.

In older people, ototopic is deteriorating - the ability to localize the source of audible sounds in space, to determine their direction, which increases the risk of injury, especially road traffic.

· more closely follow the criteria for the effectiveness of a verbal message, putting the patient's age characteristics at the forefront, and on the basis of this create a "simple, clear, trustworthy, relevant message";

Come closer to the person so that he can see with whom he communicates;

use as verbal level transmission of information, and non-verbal (facial expressions, gestures, touch, etc.);

Speak slowly, in short sentences, in a low tone;

Eliminate outside noise as much as possible

Look into the face (but not always into the eyes) of a person;

write down the necessary information or use the alphabet and, pointing to the letters, form words;

· talk to the hard of hearing through a phonendoscope, etc.

The sense of smell can remain good until old age, but in general, over the years, its sharpness gradually decreases, which leads to the inability to detect the smell of smoke, gas, and spoiled food. A person does not pay attention to their smells. He has less interest in food.

Taste is at least 2/3 dependent on the sense of smell (try eating candy with your nose closed, and close your eyes...). With age, atrophy of the taste buds occurs, their sensitivity decreases. The papillae that perceive sweet and salty are especially affected, which leads, on the one hand, to increased consumption of sweet and salty and maxims like: “In our time there were sweets, but what is this ...”. On the other hand, a decrease in taste perception can lead to decreased appetite and weight loss, as well as the consumption of poor quality food.

All the described changes can contribute to the impoverishment of emotional life, since we not only see, hear, smell, taste food, but also accompany the perception of the information received with positive or negative emotions. In some cases, all this can be complicated by senile dementia.

What can be done to reduce such losses? According to some scientists, “... we have glasses to improve vision; hearing aids to hear better; and we also need food ingredients that allow us to taste and smell like at the age of 25” (Schiffman S., 1997). Indeed, the addition of various aromatic spices to food stimulates the appetite. Studies have shown that good oral hygiene also improves the ability to perceive taste, for example, the perception of salty improves by 68% (Langan, M., Yearick, E., 1976).

With age, changes occur in the skin. In the practice of a nurse, there are such disorders of skin sensitivity as violations of touch, sensations of pressure, temperature, pain, etc. This increases the risk of damage due to the deprivation of the protection mechanisms provided by skin receptors (especially in the fingertips, in the area of ​​​​the palms and feet). Slowing down the reaction to cold and hot leads to burns when taking a bath, when using heating pads, electric blankets. Elderly patients have a slower response to pain, which can make diagnosis difficult.

Human contacts are very important for all of us through the skin. In illness and mental distress, touch may be the most acceptable form of communication, but the nurse notes the patient's attitude towards contact through other non-verbal channels. Some researchers believe that older people may perceive the lack of touch as a sign of personal and social rejection.

In the process of communication, the perception and understanding of the partner is realized.

The extent to which the nurse perceives and understands the patient, and through him - and herself, largely determines the process of communication and the level of relations between them, as well as the ways of carrying out their joint activities.

It is essential that the nurse has a complete and adequate understanding of each patient. That is what underlies individual approach, allows you to better understand the characteristics of the patient's personality and create the most favorable conditions for him to achieve an optimal level of vital activity.

It seems to us that a more adequate perception of elderly and senile patients by a nurse is facilitated by the use of simulation exercises in training, which allow one to feel the patient's condition with age-related changes in the main channels of information perception. Try talking and listening to those around you with cotton balls in your ears; put on a blindfold from a not very transparent film and try to read some text; try to thread a needle with rubber gloves and sew on a button, bandage your hand and then do something with it, etc.

It is necessary to communicate with an elderly person as with wise experience, constantly emphasizing that old age gives certain advantages: freedom from professional duties and material goals, from bodily desires and the opinions of others; that at this age one can finally do things that used to be put off all the time; that this age gives a chance of spiritual birth, comprehension of the idea of ​​forgiveness, gaining beauty and harmony. Sometimes our patients really show such presence of mind that they become an example for both nurses and other patients.

Therefore, one of the main goals of the activity of a geriatric nurse is to adapt to the objectively and subjectively changing conditions of life of the elderly and senile people by expanding opportunities to meet the needs of patients. Another goal is to form in ourselves and the population an idea of ​​old age not as a “second, but more difficult childhood with a bunch of sores”, but as the result of a life of a harmonious personality. And when ideas change, the reality in which a person lives changes, and he himself changes.

Bibliography

1. Actual problems of caring for patients at home and in a hospital and the importance of patronage services in their solution. Conference materials. M., 2000.

2. N. Yu. Koryagina, N. V. Shirokova, Yu. A. Nagovitsyna, E. R. Shilina, V. R. Tsymbalyuk - Organization of specialized nursing care.- M., 2009

3. elderly patient. M.: Publishing house "Russian doctor". - 2007. - 104 p. Supplement to the journal "Nurse".

4. Nurse's Handbook for Nursing. Ed. Paleva. M., 2003.

5. Flint A. Features of care for the elderly in the hospital // Nursing. - 1997, No. 1.

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The art of nursing lies in the harmonious combination of creativity and scientific validity of procedures, manuals, verbal influences and conversations in the process of caring for the patient; in the ability to sometimes protect the patient from overwhelming him negative thoughts and feelings are known to significantly delay recovery. Such protection is important for people of any age, but especially for children and the elderly.

To implement it, the nurse must be ready for empathy, must show kindness, responsiveness, participation. But in some cases, just good human qualities are not enough. To apply them professionally, and therefore with a high degree of reliability, it is necessary to master certain elements of medical psychology and psychotherapy.

The psychotherapeutic activity of a nurse should first of all be directed to such a complex pathopsychological complex as the internal picture of the disease, i.e. the patient's understanding of the nature of his disease. The patient's attitude to his illness may be hypernosognosic or anosognosic in nature; in addition, many transition states are possible.

Hypernosognosia is a subjective overestimation of the severity of the disease, its possible complications, the probability of an unfavorable outcome. It, as a rule, occurs with rapidly developing, acute somatic diseases (angina attacks, acute gastrointestinal pain, etc.). In individuals with anxious and suspicious, demonstrative (hysterical), less often - with authoritarian-tense (epileptoid) character traits. People with anxious and suspicious character traits are characterized by a constant readiness for anxiety for any reason, constant fears for their health and the health of their loved ones. Naturally, a somatic disease for them is almost a disaster: what if the disease does not go away, goes into a chronic form? maybe the doctor made a mistake or hides the true state of affairs from me, and everything is much more serious? oh all of a sudden it's over lethal outcome? etc. These patients sometimes, "just in case" or on purpose, may exaggerate their complaints in order to "take a closer look at them." They also tend to listen anxiously to themselves, to their most insignificant sensations. Such patients need to be reassured, they cannot be "swept aside" - this will only increase their fears and complicate the course of the disease.

They, as a rule, have a labile vegetative-vascular system, which easily responds to nervous overload fluctuations in blood pressure, heart rate, the appearance of extrasystoles. It is necessary to measure their blood pressure not immediately upon arrival in the office, but after at least a short soothing conversation and, if possible, not fixing their attention on this procedure. Otherwise, the pressure may increase, which will only reflect the patient's anxious state, and not be a symptom of a somatic disease.

Such personalities are prone to posturing, theatrical drawing, the desire "not to be, but to seem"; they require a special attitude for themselves, they are prone to deliberate exaggerations, bright egocentrism, stormy in external manifestations, but unstable and shallow emotions. Their hypernosognosia is usually formed according to the mechanisms of “secondary benefit”, “escape to the disease” - the patient solves his internal or interpersonal problems with the help of the disease (for example, the solution of a serious family conflict is postponed, he seems to say to others: “Do not touch me, I sick!"). Whatever feelings such manifestations cause in a medical worker, he must still behave correctly. It is impossible to succumb to hysterical manifestations and surround such a patient with special care (this usually only leads to increased demonstrativeness), at the same time, in no case should complaints be ignored, since the motives for such behavior are unconscious and the patient is not aware of the “secondary benefit”; moreover, the presence of hysterical character traits and hysterical exaggerations in itself does not at all exclude the existence of a really serious somatic pathology.

In individuals with a thorough, stiff, viscous, authoritarian thinking, hypernosognosia can also be formed according to the mechanisms of the so-called "overvalued formations". These people are characterized by increased demands on others, unwillingness to reckon with their opinion, selfishness, resentment, suspicion. It is not easy to dissuade them, here one must use hard "scientific" arguments; Of course, this is the doctor's business, but the nurse should help him in every possible way in this.

If the patient is difficult to dissuade, does not change his behavior, despite the absence of objective signs of the disease (data from clinical and paraclinical studies), it may be necessary to consult a psychotherapist. When referring a patient to such a consultation, both the doctor and the nurse should be extremely tactful. In no case should the patient get the impression that he is being mistaken for a pretender-simulant, that he is not appreciated for the severity of his condition, or that he is considered “crazy.” It is necessary to explain to him that from various nervous disorders often suffer as much, if not more, than physical pain, and that the appeal to a psychotherapist does not indicate madness, but the presence of serious emotional neurotic problems that can be dealt with as a result of competent treatment, which should be carried out by a qualified specialist.

Anosognosia - on the contrary, active denial of the disease, underestimation of the obvious, attributing the existing symptoms to random circumstances or other, not serious, diseases. Anosognosia is observed with a gradual, slow development of the disease, without bright, frightening manifestations (for example, in chronic pulmonary tuberculosis).

An anosognosic internal picture of the disease is formed in sthenic (overconfident), hyperthymic (prone to elevated, euphoric mood) personalities, as well as in frivolous people. When working with such patients, it is necessary to insist on mandatory, regular visits. medical procedures emphasizing their importance, to explain the possibility various complications with a dishonest attitude to treatment, emphasizing that the unfavorable course of the disease or the occurrence of complications will significantly reduce the ability of patients to social functioning. Sometimes it is not a sin to frighten patients of this category even a little, exaggerating, but very carefully so as not to cause a reverse, hypernosognosic reaction.

PSYCHOLOGICAL COMMUNICATIONS - PATIENT - NURSE - DOCTOR

The nurse-patient relationship

The nurse must be patient and friendly in communicating with the patient. Both familiarity and familiarity, as well as excessive dryness and formality, are unacceptable. Patients should be addressed with "you" and by name and patronymic.

It is impossible in the presence of patients to discuss the diagnosis, the treatment plan, to talk about the diseases of the neighbors in the ward. It is forbidden to question the correctness of the treatment in the presence of the patient.

before heavy and painful procedures the nurse should explain accessible form meaning, meaning and necessity for them successful treatment and relieve psycho-emotional stress.

Reminder for nurses

1. Try to create a comfortable psychological environment for a conversation

First of all, ask the patient if he is ready to talk, maybe he is tired, afraid of something, or something hurts him very much - then he will probably be too dejected and taciturn.

It is important that in the room where communication will take place there are no annoying factors(for example, too bright light or loud music). If there are such factors, you can try to change them. If this is not possible, just try moving to another room.

It is possible that the patient will feel uncomfortable in the presence of strangers, so it is better to plan the conversation so that there are no roommates at this moment, and visitors can be asked to temporarily go out into the hall, unless the patient objects.

If the patient is in pain, perform the manipulations prescribed by the doctor. Allow at least 15 minutes for the conversation. Take your time - for good results, the conversation can last up to an hour. Let's assume that you don't have time for a continuous conversation. Divide it into several parts and explain to the patient why you are doing this.

2. Get information about your patient before talking to him

Find as much information about the patient as possible from available sources and previous treatment sites (if any). Thus, you save your time and do not tire the patient with unnecessary questions. However, do not forget to verify the accuracy of the information you received.

3. Set a friendly tone of conversation

Start the conversation with a question about how you feel and let the patient talk about his illness, while showing him your interest, understanding and sympathy.

Give the patient the opportunity to answer your questions freely, but if he deviates too much from the topic, return him to the subject of the conversation. To do this, tactfully ask him leading questions about his illness. (eg: "Tell me more about your stomach pain")

If you are not sure that the patient understood you, do not hesitate to ask him about it and, if necessary, explain everything again.

Do not disclose information received from the patient.

Do not express your own assumptions about the patient's unexplained problems without consulting a doctor.

4. Formulate accurate and unambiguous phrases

During the conversation, control yourself, speak simply and clearly. Avoid using medical terms. Remember that your patient will not want to be ignorant of their meaning.

5. Take notes

Don't rely on your memory. It is better to take notes during the conversation than to have the patient repeat the same information over and over again.

Write down information briefly, do not get carried away and do not create pauses in the conversation. Write only dates, keywords and phrases that you can add later.

A Few Rules therapeutic communication with the patient.

Be sure to introduce yourself to the patient and tell him the purpose of the conversation. Be polite, address the patient with "you" and by name and patronymic.

When communicating with the patient, look into his face, find his eyes, smile, nod approvingly.

Listen carefully.

Show empathy, sincere interest and participation, be natural.

Speak clearly, intelligibly and slowly.

Use exclusively positive intonation of your voice. It is very important.

Don't expect the patient to perform brilliantly on a task following your instructions.

Do not burden the patient with too much responsibility.

Do not demand exact identification of the names of medical personnel, the names of objects or medicines.

Do not evaluate the patient's behavior as a personal attitude towards you.

Never swear or argue with patients.

Don't show your feelings, especially if you're upset.

Relations "nurse - relatives (and friends) of the patient:

It is necessary to maintain restraint, calmness and tact;

Persons caring for seriously ill patients to explain the correctness of the procedures and manipulations;

Talk only within their competence (does not have the right to talk about symptoms, about the prognosis of the disease, but must refer to the attending physician);

Answer questions calmly, slowly, teach proper care for the seriously ill.

Relationship "nurse - doctor":

Rudeness, disrespectful attitude in communication are unacceptable;

Perform medical appointments in a timely, accurate and professional manner;

Urgently inform the doctor about sudden changes in the patient's condition;

When in doubt during the execution medical appointments in a tactful manner, find out all the nuances with the doctor in the absence of the patient.

Relationship "nurse - nurse":

Rudeness and disrespectful attitude towards colleagues is unacceptable;

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

Experienced nurses should share their experiences with younger ones;

IN difficult situations should help each other.

Relations "nurse - junior medical staff":

Maintain mutual respect;

Control tactfully, unobtrusively the activities of junior medical staff;

Rudeness, familiarity, arrogance are unacceptable;

It is unacceptable to make comments in the presence of patients and visitors.

PREVENTION OF CONFLICT SITUATIONS WITH PATIENTS

It is necessary to highlight the following risk factors that affect the occurrence of conflict situations.

These include:

The appearance of a doctor is an element of establishing a trusting relationship between the doctor and the patient. The presence of an untidy appearance, a stale dressing gown, the absence of a badge indicating the position of the last name and patronymic, uncombed hair, dirty fingernails do not contribute to establishing trust in a medical worker.

The style of speech used by the doctor to communicate with the patient. It can be even, mocking, emotional, or, conversely, academic or semi-slang - any that is compatible with the characters of a particular patient and doctor. But what a conversation should never be is disrespectful to the patient, no matter how antipathetic this patient may seem to the doctor. The swearing style of conversation, threats, intimidation, raising the timbre of the voice do not contribute to the prestige of the doctor in the eyes of the patient and the listeners of this conversation.

Having bad habits. Persistent smell of smoke from a cigarette or the day before eating aromatic food. Talking against the background of chewing gum or a cigarette that is not removed before talking with the patient cannot increase the authority of the doctor.

Moral and psychological climate in health care facilities. The psychology and behavior of a medical worker depend not only on the personal qualities of a particular person, but also on the medical society, which is a complex society. In a medical society, people are united with each other in various groups, due to subordination vertically and horizontally, into large and small ones. The personality of each person is dependent on the psychology and relationships that exist in small and large groups, where the relationship is formed in various ways: both positive and negative. In the process of achieving mutual understanding, difficulties often arise, that is, relations in groups can be conflicting.

Nervousness in the team, an unhealthy environment can often pass and affect relationships with patients and manifest as psychological intolerance or bias towards the patient. Clinical etiquette is needed not so much for the patient as for the doctor himself. If the mask of etiquette on the doctor's face is only to please the patient, this is hypocrisy, which patients easily recognize and which is a burdensome duty for the doctor. Compliance with the traditional external rules of behavior of medical personnel also improves the quality of the treatment process, i.e. improves its results, and - most importantly - contributes to the resuscitation of psychological contact between the patient and the doctor.

Facilities mass media. In recent years, due to the development of market relations and commercialization medical services, this factor has an increasing impact on patients. Through television, radio and newspapers, in conditions of high competition, there is an intensified struggle not for the patient, but for his wallet. Advertising "who is better" is used, involving not only medical workers, but also popular artists. Promises are made about a quick and high-quality disposal of diseases. Often they are not true. A situation of a conflict of interest is created, in which, on the one hand, the patient, who wants to receive high-quality treatment, on the other hand, health care facilities, misleading the patient, but wanting to receive his money. This situation has developed due to the lack of a legislative framework.

Deontology is a part of medical ethics and is a set of historically established norms, modern legal acts and regulated requirements stipulated by the practical, professional activities of a doctor. Deontology is closely related to such problems as medical secrecy, medical error, medical intervention without the consent of the patient, human trials, moral and ethical problems of organ transplantation, issues of reproduction and genetic engineering and others. Therefore, deontology is closest to the law. And as long as the law is not changed, it is a priority in assessing the actions or inaction of people, no matter how inhumane it may seem to society with a changed morality.

So, for example, the patient has the right to respectful and humane treatment by medical and attendants, examination, treatment and maintenance in conditions that meet sanitary and hygienic requirements; holding, at his request, a consultation and consultations of other specialists; relief of pain associated with the disease, accessible ways and means; keeping confidential information about the fact of applying for medical care, about the state of health, diagnosis and other information obtained during his examination and treatment, the choice of persons to whom, in the interests of the patient, information about the state of health can be transferred.

According to the legislation, the attending physician organizes timely and qualified examination and treatment of the patient, provides information about the state of health, invites consultants at the request of the patient or his legal representative and organizes a consultation.

All these activities should be carried out by medical personnel in a gentle, correct form, taking into account the lack of special knowledge in the field of medicine among patients. Speaking about the rules of conduct for medical workers, based on moral standards, in the performance of their civil and professional duty, it should be noted that every doctor should be guided by the doctor's oath, which he takes upon graduating from a higher medical educational institution.

In conclusion, in order to prevent and reduce the risk of conflict situations in the provision of medical services, we can recommend the following:

• 1. Increasing the cultural level of the medical staff of health facilities, which should consist of raising the level of individual and collective. This includes appearance, form of communication, accessibility in communication, etc. It is achieved by analyzing specific cases at weekly general hospital conferences, meetings of labor collectives of departments.
• 2. Formation of trusting relationships in the team at all levels of interaction between medical workers, the patient, management and service personnel.
• 3. Conducting trainings with medical workers, primarily with medical and management staff, to develop tolerance for the patient, correct construction conversations with the patient, the ability to form the patient's self-confidence.
• 4. Formation of an attentive attitude towards the patient among medical personnel, which includes:
  • - timely provision of information about the state of health of the patient;
  • - discussion with the patient of tactics of treatment, examination, prognosis of the disease, etc.;
  • - exclusion of providing information about the patient's condition without his permission to relatives and other persons;
  • - correct, reasonable, accurate medical records
  • - first of all medical history.
• 5. Carrying out explanatory work and raising the general cultural level of patients on the planned results of treatment in order to prevent the formation of the "unfulfilled desires" syndrome.

Of course, the above recommendations are general character, and for practical application, it is advisable to organize psychological assistance in health care facilities to resolve conflict situations. However, this will require financial costs. Therefore, according to the established practice, the solution of these issues falls on the shoulders of the administration of the health facility and the legal adviser due to the lack of regular psychological support.

PSYCHOLOGICAL CHARACTERISTICS OF AN ELDERLY PATIENT, ETHICAL ASPECTS OF COMMUNICATION

Among the individual sections of developmental psychology, gerontology is the "youngest" area of ​​research. Right now, old ideas about old age are breaking down. Its two aspects - physical and psychological - are becoming more and more differentiated. Old age is a natural stage in human development, and the possibilities of lengthening human life are becoming more and more obvious, including through the internal self-development of the individual himself, the development of his psychological resistance against aging.

Elderly patients need special attention. Such age mental changes as a decrease in memory, attention, a decrease in the mobility of the psyche as a whole, a deterioration in the processes of adapting the psyche to new requirements, emotional lability, sharpening character traits, psychological problems(for example, those associated with losses, limitations, feelings of loneliness, abandonment, with a “generation gap”) make them especially vulnerable to negative psychological influences. Therefore, it is necessary to create a comfortable climate for this category of people, to be more attentive, to help in various situations.

Rules for communicating with elderly patients.

Avoid disputes, conflicts, harsh criticism in a conversation with an elderly person.

He treats a patient of this age as a difficult child: if he rebels, then he feels bad. Find out the real reason for his behavior.

Takes seriously the fears and anxieties of the old person. Help him voice his fears, talk about them. This will partially relieve mental stress and will serve as an impetus to finding a solution to the problem that caused fear.

Often, the anxiety of an elderly person is associated with a deterioration in health. He is terrified at the thought of health care will not be provided on time. It is necessary to calm him down and thereby rid him of these fears.

Listen to an elderly patient under any circumstances to the end; if this is not possible, gently stop the conversation, promising to continue it at the first opportunity.

Never force your communication on an elderly person, but never refuse him this.

Always address a person in years with respect, pronounce words slowly, loudly enough; postpone the conversation if he is in a state of irritation, anger, resentment.

Never force an elderly patient to do anything by force. To persuade and convince, to resort to the help of people who have authority over him, to give examples from books, history, the lives of famous people.

Encourage the desire of an elderly person to self-care, cleanliness, neatness, provide opportunities for this: choose comfortable clothes that are easy to remove and hygienic, strengthen assistive devices in the bathroom and toilet.

If the patient is unable to care for himself, it is necessary to look after such a patient more often.

To establish psychological contact, always be tactful. Remember that genuine concern and love can overcome all difficulties in dealing with an elderly person. Always call for help humor. Seek experience of communication with specialists - psychologists and psychotherapists.

Long-term communication with an elderly person requires a lot of mental strength and patience.

Features of communication

When considering issues of ethical behavior of medical workers, there are basic and general rules that must be observed regardless of the profile of the medical institution.

The relationship between doctor and patient is the core of any medical practice. According to Hardy, a “doctor, sister, patient” bond is formed.

The purpose of the contacts between the patient and the health worker is the health care provided by the latter. Based on this, the ambiguity of the role of contacts in the system of interaction "health worker-patient" is assumed. However, it does not follow at all that the interest in such interaction exists only on the part of the patient. A medical worker should be no less interested in helping the patient, since this activity is his profession, the choice of which is determined by his own motives and interests.

For effective and conflict-free interaction between the patient and the medical worker, it is necessary to communicative competence- the ability to establish and maintain the necessary contacts with people, which can be considered as a system of internal resources necessary to build effective communication in a certain context of situations of interpersonal interaction. It should be noted that in situations where the patient is faced with the need to consult a doctor for help, communicative competence is also important for him. The main thing is that the incompetence in communication of at least one side can disrupt the diagnostic and treatment process. The inability of the patient to establish a relationship with the health worker is as negative as the unwillingness of the latter to establish effective contact with the patient.

There are the following types of communication:

« Contact masks» - formal communication. The usual masks are used (politeness, courtesy, modesty, sympathy, etc.). As part of the diagnostic and therapeutic interaction, it manifests itself in cases of little interest of the doctor or patient in the results of the interaction (for example, during a mandatory preventive examination, where the patient feels not independent, and the doctor does not have the necessary data to conduct an objective comprehensive examination and make a reasonable conclusion ).

Primitive - evaluating the other according to the degree of "need". If needed, then actively enters into contact, if it interferes, they repel. This type of communication can occur within the framework of manipulative communication between a doctor and a patient in cases where, when contacting a doctor, the goal is to obtain any privileges (for example, a sick leave certificate, a formal expert opinion, etc.). Interest in the contact participant disappears immediately after the desired result is obtained.

Formally - role-playing - regulates the content and means of communication, and instead of knowing the personality of the interlocutor, they manage with knowledge of his social role. Such a choice of the type of communication on the part of the doctor may be due to professional overload.

Business - takes into account the features character personality, age, mood of the interlocutor while focusing on the interests of the case, and not on possible personal differences. When a doctor communicates with a patient, this type of interaction becomes unequal. The doctor, considering the patient's problems from the point of view of his own knowledge, autonomously makes decisions without the consent of the person concerned.

Manipulative - drawn to profit using special techniques. There is a manipulative technique called "hypochondriacization of the patient", the essence of which is to present the doctor's conclusion about the patient's health in the light of a clear exaggeration of the severity of the detected violations. The purpose of such manipulation may be to reduce the patient's expectations for the success of treatment, associated with the desire of the medical worker to avoid responsibility in the event of an unexpected deterioration in the patient's health, as well as to demonstrate the need for additional and more qualified actions by the medical worker in order to receive remuneration.

Currently, many experts insist on the need to exclude such a concept as “sick” from the lexicon and, accordingly, the process of communication, replacing it with the concept of “patient”, in view of the fact that the term “sick” has a certain psychological burden. Address sick people: “How are you, sick?” unacceptable. It is possible to address the patient by name and patronymic, especially since the sound of the name is psychologically comfortable for him.

Tactical actions of a medical worker

Communication with the patient - the most important element of the treatment process - is an art that must be mastered in order to successfully interact with him.

When entering the hospital environment, the life stereotype of a person changes, which is covered by feelings of longing, loneliness, fear, caused not only by the disease itself, but also by isolation from home, family, colleagues, from everything that was still familiar. If the hospital is clean, comfortable and neat, and the health worker looks just as neat, then this already disposes the patient, inspires respect for the medical profession, setting in a positive way and thereby having a favorable therapeutic effect. Clothing, facial expression, demeanor reflect some aspects of the health worker's personality. According to the characteristics of the sides of the personality of a health worker, one can assume, in particular, the degree of her care, attention to the patient, the ability to empathize.

One of the foundations of medical activity is the ability of a medical worker to understand and listen to the patient, which helps to diagnose the disease and has a beneficial effect on establishing psychological contact between the health worker and the patient.

The need to take into account the characteristics (profile) of the disease, which is of no small importance when in contact with the patient. In therapeutic departments there are patients with diseases of various organs and systems: with diseases of the cardiovascular system, gastrointestinal tract, respiratory organs, kidneys, etc. Often their diseases are chronic in nature and require long-term treatment, respectively, they stay in the hospital for a long time, which influences the process of the relationship between the medical worker and the patient. Isolation from the family and usual professional activities, concern for the state of one's health cause various psychogenic reactions in the patient.

As a result of psychogeny, the course of the underlying somatic disease may worsen, which in turn complicates the mental state of patients. It should be noted that in therapeutic departments there are patients with complaints of disorders of internal organs, often not even suspecting that these are somatic disorders of a psychogenic nature.

Complaints of various kinds, emerging ethical problems indicate the lack of necessary psychological knowledge and practically appropriate communication between medical workers and patients.

The difference in the points of view of the health worker and the patient may be due to their social roles and other factors. While the doctor first of all reveals the objective signs of the disease, seeks to limit the anamnesis to determine the prerequisites for further somatic research, etc., the subjective, personal experience of the disease is in the focus of the patient's attention and interests. With this in mind, the physician must analyze these subjective sensations as real factors.

He needs to try to feel or catch the patient's experiences, understand and evaluate them, find the causes of anxieties and experiences, support their positive aspects, which can be used to more effectively assist the patient in examination and treatment.

The response of the health worker should be a resonance to what they heard.

The personality traits of a medical worker, as well as the individual characteristics of the patient, his psyche, affect the establishment of positive psychological relationships and trust between medical workers and patients. The main responsibility for the nature of these relationships, so important for successful treatment, lies with the medical professional. To do this, you must be a qualified specialist, have experience and possess the art of communication, follow the principles of ethics and deontology.

The effectiveness of treatment largely depends on the patient's belief in recovery, which in turn is closely related to the degree of trust that he has in the doctor and the medical staff of the department.

For the emergence of trust in a medical worker, the first impression of the patient from meeting with him is important. This includes the health worker's facial expressions, gestures, tone of voice, facial expressions, manner of speaking, and appearance. The direct duty of medical workers is to break the psychological barrier in contact with patients, to inspire his trust based on participation and warmth. The strength of contact between the doctor and the patient directly depends on the degree of support for the patient in an effort to tell about himself.

A medical worker can earn the patient's trust if he is harmonious, calm, confident, but not arrogant, his demeanor is persistent and resolute, accompanied by human participation and delicacy. Only after establishing contact with the patient, it is possible to proceed to the evaluation of the results of tests and other auxiliary methods of examination. It is necessary to make it clear to the patient that the medical workers to whom he turned for help are interested not only in diagnostic issues, but also in the person who turned to them. The patient's trust in medicine can be seriously undermined if he notices that there is a strained relationship between the doctor and the nurse, if the nurse makes irrelevant remarks during the appointment, does not clearly follow the doctor's orders. When making a serious decision, the doctor must be aware of its results, the consequences for the health and life of the patient and increase his sense of responsibility.

The activity of a medical worker has special requirements - the need to be patient and control oneself. This is due to the great emotional tension that occurs when communicating with patients, increased irritability, exactingness, and painful resentment.

There are facts when people with unbalanced, uncertain and absent-minded manners gradually harmonized their behavior in relation to others. This was achieved both through their own efforts and with the help of other people. However, this requires certain psychological efforts, work on oneself, a certain critical attitude towards oneself, which for a health worker is and should be taken for granted.

The health worker should provide for various options for the development of the disease and not consider unwillingness to be treated as ingratitude or even a personal insult on the part of the patient if the patient's health does not improve. In certain situations, it is appropriate to show a sense of humor, but without a hint of mockery, irony and cynicism, according to the well-known principle “laugh with the sick, but never the sick.” It should be noted that some patients cannot tolerate well-intentioned jokes and perceive them as disrespectful and humiliating.

The work of a doctor and a medical worker is rich in a variety of situations, has dynamics and contradictions. In order to correctly draw a moral line through the changing diversity of life, one must learn to gain experience. The peculiarities of medicine consist not only in the external side of the conditions of activity, but, above all, in their semantic significance for a person of his destiny. This is such a sphere of activity where there are no trifles, unnoticed actions, views, experiences. Here everything, even an insignificant everyday fact of human participation, excites with no less force than great vital deeds. Conscientiousness and decency, generosity and benevolence, nobility and attention, tact and courtesy in everything related to the life and health of the patient, should act as habitual, everyday norms of behavior. M.Ya. Mudrov pointed out: "Whatever you do, do not do it at random, do not do it at random." These qualities should be embodied in practice, working conditions of medical institutions.

The concept of the quality of a health worker's activity is not just a sum of personality traits, but their organic union based on practical skills that answer the questions: "What should be done" and "How should it be done". The quality and culture of the work of a medical worker are associated with the concept of a mode of activity. The object of medical activity, regardless of the medical specialty, is at the same time a subject, a person. Hence the requirement follows: in the activities of a doctor under any conditions, the human factor must be taken into account.

Outside the concept of the nature of the activity of the doctor-patient relationship, the latter becomes for the doctor just a case, and his social functions are reduced to the formal duty of prescribing in accordance with the variations of cases. Medicine has always been viewed as something much more, active, full-blooded social attitude in which the doctor sees his vocation and a way of self-expression of the human essence, and the patient - understanding, sympathy, relief, comprehensive assistance in preserving life and health.

Despite the establishment of contact and the further development of positive relationships between the doctor and the patient, these relationships can be complicated by some negative character traits of the medical worker (anger or, conversely, isolation with weak emotional reactions). The patient loses confidence, and the medical worker loses authority if the patient develops the impression that the health worker bad person". For example, the patient hears how the latter speaks badly about colleagues, sees how he treats subordinates arrogantly and panders to superiors, observes a lack of self-criticism, etc. Such observations may lead the patient to believe that the doctor or nurse would be just as bad a professional.

Features of the personality of a medical worker.

The main personality traits of a medical worker include:

Moral - ( selflessness, diligence, goodwill, optimism, determination, modesty, adherence to principles, responsibility, self-esteem, compassion, care, tenderness, affection, honesty);

aesthetic (neatness, neatness);

Intelligent - consistency , observation, desire for knowledge ).

The condition for success in relationships and professional activities is the appropriate upbringing of the emotional sphere of the personality, which, first of all, is manifested in whether a person knows how to empathize with other people, rejoice and grieve with them.

Communication plays an important role in the life and work of people. Without communication, it is impossible, for example, to develop culture, art, and the standard of living; only through communication, the accumulated experience of generations of the past is passed on to new generations. The topical issue today is the communication between the health worker and the patient. Many of us have been to a hospital, clinic, or some medical institution where each of us interacted with a doctor or nurse. But has anyone thought how much this communication affects us, or rather, the course of our disease, and how a health worker can improve our condition? Of course, we can say that everything depends on the medicines that the doctor prescribes and the nurse gives us, the medical procedures are also prescribed by the doctor, but this is not all that is necessary for a complete recovery. The most important thing is the right attitude, which depends on the mental and on emotional state patient. The attitude of the health worker has a huge impact on the patient's condition. And if the patient is satisfied, for example, with a conversation with a doctor who listened to him carefully, in a calm atmosphere and gave him appropriate advice, then this is already the first step towards recovery.

In everyday life, one often hears about the "good" or "correct" treatment of the patient. And in contrast to this, unfortunately, one hears about a “heartless”, “bad” or “cold attitude towards sick people. It is important to note that various kinds of complaints, emerging ethical problems indicate the lack of the necessary psychological knowledge, as well as the practice of appropriate communication with patients on the part of health workers. Differences in the views of the health worker and the patient.

Differences in the points of view of the health worker and the patient may be due to their social roles, as well as other factors.

For example, a doctor tends to look, first of all, for objective signs of a disease. He tries to limit the history to further determine the prerequisites for further somatic research, etc. And for the patient, his subjective, personal experience of the disease is always in the center of attention and interests. In this regard, the doctor must consider these subjective sensations as real factors. He should even try to feel or catch the patient's experiences, understand and evaluate them, find the causes of anxieties and experiences, support their positive aspects, and also use them to more effectively assist the patient in his examination and treatment. The differences in all the views and points of view of the doctor (nurse) and the patient are quite natural and predetermined, in this situation, by their different social roles. However, the doctor (nurse) needs to ensure that these differences do not turn into deeper contradictions. Since these contradictions can jeopardize the relationship between the medical staff and the patient, and thereby making it difficult to provide assistance to the patient, complicating the treatment process. To overcome differences in views, the health worker needs not only to listen with great attention to the patient, but also to try to understand him as best as possible. What happens in the soul, thoughts of a sick person? The doctor must respond to the patient's story with all his knowledge, reason in the fullness of his personality. The response of the health worker should be a resonance to what they heard.

Communication with the patient is an essential element of the treatment process.

The art of taking an anamnesis is not an easy art. In the language of psychologists, this is a guided conversation designed to collect anamnestic data, and the conversation should be controlled imperceptibly. The patient with whom the conversation is being conducted should not feel this. In the process of collecting an anamnesis, he should give the impression of a casual conversation. At the same time, the doctor needs to assess the seriousness of complaints, the manner in which they are presented, to separate the main from the secondary, to verify the reliability of the testimony, without offending the patient with distrust, to help remember, without inspiring. All this requires great tact, especially when it comes to clarifying the state of mind, mental trauma, which play a large role in the development of the disease. When questioning a patient, one should always take into account his cultural level, degree of intellectual development, profession and other circumstances. Empty, meaningless words, indulgence in the unreasonable whims and demands of some patients should be avoided. In other words, it is impossible to offer a standard form of conversation between a health worker and a patient. This requires ingenuity and creativity. Particular attention should be paid to elderly patients and children. The attitude of a doctor or nurse to a child, a patient of mature age and an old man, even with the same illness, should be completely different, due to the age characteristics of these patients.

It should be noted that the prerequisite for the emergence of positive psychological relationships and trust between health workers and patients is the qualifications, experience and skill of the doctor and nurse. At the same time, as a result of expanding and deepening information in modern medicine is increased value specialization, as well as the creation of various branches of medicine aimed at certain groups of diseases, depending on the localization, etiology and methods of treatment. It can be noted that in this case, specialization carries with it a certain danger of a narrowed view of the doctor on the patient.

Medical psychology itself can help offset these negative aspects of specialization through a synthetic understanding of the patient's personality and body. And qualification is only a tool, the greater or lesser effect of which depends on other aspects of the doctor's personality. We can note the definition of the patient's trust in the doctor, given by Gladkiy:

"Confidence in the doctor is a positive dynamic relationship of the patient to the doctor, expressing the previous experience due to the expectation that the doctor has the ability, means and desire to help the patient in the best possible way."

Note that the health worker is a young specialist, about whom patients know that he has less life experience and less qualified, is in the search for the trust of patients and at a disadvantage in comparison with their older colleagues with experience. But a young specialist can be helped by the realization that this shortcoming is transient, which can be compensated for by conscientiousness, professional growth and experience.

It should be noted that the personal shortcomings of the health worker may lead the patient to believe that a doctor or nurse with such qualities will not be conscientious and reliable in the performance of their direct duties.

In general, the balanced personality of a health worker is for the patient a complex of harmonic external stimuli, the influence of which takes part in the process of his treatment, recovery and rehabilitation. A health worker can educate and shape his personality, including by observing the reaction to his behavior directly. Let's say, according to the conversation, assessment of facial expressions, gestures of the patient. Also indirectly, when he learns about the view of his behavior from his colleagues. Yes, and he can help his colleagues, direct them towards more effective psychological interaction with patients.

Types of nurses and their characteristics:

I. Hardy describes 6 types of sisters according to the characteristics of their activities.

Routine sister. Its most characteristic feature is the mechanical performance of its duties. Such sisters perform the assigned tasks with extraordinary thoroughness, scrupulousness, showing dexterity and skill. Everything that is necessary for caring for the sick is done, but there is no care itself, because it works automatically, indifferently, without worrying about the sick, without sympathizing with them. Such a nurse is able to wake up a sleeping patient only in order to give him sleeping pills prescribed by a doctor.

A sister "playing a learned role." Such sisters in the process of work strive to play some role, striving for the realization of a certain ideal. If their behavior goes beyond acceptable limits, spontaneity disappears, insincerity appears. They play the role of an altruist, a benefactor, showing "artistic" abilities. Their behavior is artificial.

Type of "nervous" sister. These are emotionally labile individuals prone to neurotic reactions. As a result, they are often irritable, short-tempered, and can be rude. Such a sister can be seen gloomy, with resentment on her face among innocent patients. They are very hypochondriacal, afraid of contracting an infectious disease or getting sick." serious illness". They often refuse to perform various tasks, allegedly because they cannot lift weights, their legs hurt, etc. Such sisters interfere with work and often have a harmful effect on patients.

Sister type with a masculine, strong personality. Such people can be recognized from afar by their gait. They are distinguished by perseverance, determination, intolerance to the slightest disturbances. Often they are not flexible enough, rude and even aggressive with the sick; in favorable cases, such sisters can be good organizers.

Maternal sister. Such sisters perform their work with the utmost care and compassion for the sick. Work is an essential part of their lives. They can and do everything. Caring for the sick is a life calling. Often, care for others, love for people is imbued with their personal lives.

Specialist type. These are sisters who, thanks to some special property Individuals with a special interest receive a special appointment. They dedicate their lives to fulfilling challenging tasks e.g. in specialized laboratories. They are fanatically devoted to their narrow activities.

Conclusion. The role of the health worker in communicating with the patient.

As in ordinary life, so in medical activities, there is communication. In both cases, it has a certain meaning and psychological characteristics. In medical activities, there are several types of communication between a health worker and a patient. And it depends only on the health worker what kind of communication he will have with the patient. But in any case, the doctor or nurse must follow certain tactics in relation to the patient and, most importantly, the health worker, as a person, must have certain characteristics in all respects in order to earn the patient's trust in himself. Indeed, without trust, a normal relationship between a health worker and a patient is impossible. Because the nurse spends more time in direct contact with the patient, her role in communicating with the patient becomes important. Consequently, the personality of a nurse, the style and methods of her work, the ability to influence patients and treat them is an important element not only of the treatment process, but also of the psychological communication between the medical worker and the patient.

1. Create a pleasant atmosphere for communication

2. Build trust with the patient

3. Speak the language of the patient

4. Be able to listen

5. Pay attention to your appearance and distance to the interlocutor

6. Formulate questions accurately

Algorithm for the actions of a nurse when communicating with a patient Getting to know the patient The first impression is made strong effect, stays for a long time and creates an opinion about you, therefore good start there will be a warm welcome, a sweet smile. Even if there are many other things to do in the department or clinic, the patient should clearly feel a kind and sincere disposition. 1) look the patient in the face, smile, greet the patient warmly; 2) introduce yourself, tell your name, position; 3) ask the patient's name; 4) explain the situation in the department and the role that you will play in the treatment process; 5) familiarize with the department and the medical-protective regime; 6) escort the patient to the ward, point the patient to his bed; 7) check if everything is in order on his bed, in the ward; 8) introduce the patient to his roommates. Communication with a visually impaired patient Algorithm of communication with a visually impaired patient (accompaniment to an ultrasound examination) 1) explain in detail the purpose and course of the study; 2) explain to the patient the preparation for the study; 3) make sure she understands you; 4) take the patient to the ultrasound room; 5) provide the necessary assistance; 6) escort to the ward. Dealing with a Hearing Impaired Patient - always approach from the front so that the patient can see you. Use in conversation simple words, speak loudly, clearly, but do not shout so that the patient can follow your lips and facial expressions. Watch carefully non-verbal means expressions. Use touch as a means of encouraging the patient to communicate. Use picture cards, diagrams, or written messages. Write neatly and without mistakes. 1) reduce background noise (close the door, window, turn off the radio, TV, etc.); 2) before talking, approach so that the patient can see you; 3) invite him to use the device; 4) explain the necessary information to the patient in an accessible form; 5) make sure that the patient understands you; 6) write the information on the sheet. Training in nursing

“Do not think that anyone can take care of the sick. This is a difficult task, requiring skill, skill, knowledge. (F. Nightingale.)

Education in nursing or nursing pedagogy includes the teaching activities of nurses and the organization of education for patients and their relatives.

The objectives of the training are: preventive work with the population, promoting a healthy lifestyle and preparing the patient for maximum adaptation to the disease. The nurse must be able to arouse in the patient the desire to learn, i.e. motive, for example, maintaining and strengthening health, restoring lost health, alleviating the patient's condition, the need to take care of themselves. Each student has an individual motivation, it depends on the content, techniques, forms and variety of teaching methods.

Means of education: verbal, technical, educational and visual aids and special equipment provide high-quality assimilation of knowledge and the formation of patient skills.

Functions of a nurse as a teacher

Therapeutic education becomes a part of the patient's daily life, his psychological environment, family, relatives. The objectives of quality education are to prepare the patient for self-care, improve the quality of life, improve health status or adapt to an altered state. Today, the patient is a direct participant in the treatment process. Modern approaches to treatment, the work of "schools" of nursing education of patients enable patients suffering from various diseases to live long and lead an active lifestyle. Patients are given classes to teach injection techniques, calculate drug dosages, provide information about the disease, prevent complications, and diet principles.

Learning can be done in two ways: formal and informal. The training takes into account the gender, age, profession, education of the patient, the presence of self-control skills, visual and hearing impairments. Education is an important function of nursing, helping patients to adapt to their condition, to maintain the highest possible comfortable standard of living. The process of teaching the patient and his family depends on the professionalism of the nurse, her experience, knowledge, skills and abilities. It should teach the patient and his family members specific skills of self-care and mutual care, child care, medication, preparation for research, rational nutrition, adequate physical activity. To do this, she needs knowledge of the cognitive, emotional and psychomotor areas of patient education, which she can professionally influence. Information should be given to the patient, observing the principles of training: accessible, step by step, from simple to complex, in order to master the knowledge, skills and habits of self-care.

A nurse must have organizational skills, be communicative and constructive, and always remember medical ethics, deontology and nursing philosophy, be distinguished by a culture of communication and high creative potential.

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Regional State Educational Budgetary Institution of Secondary vocational education"State Medical College of the city of Bratsk" (OGOBU SPO "State Medical College of the city of Bratsk")

Communication in nursing

Specialty "Medicine"

Discipline "Theory and practice of nursing"

Completed:

group student LD - 141 Andryushkina A.WITH.

Bratsk, 2014

Introduction

1. Features of relationships in medical activities

1.1 Types of communication

2. Health worker tactics

2.1 Features of the personality of a medical worker

2.2 Nurse and patient, principles of communication with the patient

2.3 Types of nurses and their characteristics

Conclusion

Bibliography

Introduction

Communication is a complex multifaceted process of establishing and developing contacts between people ( interpersonal communication) and groups (intergroup communication), generated by the needs of joint activities and including at least three various process: communication (exchange of information), interaction (exchange of actions) and social perception (perception and understanding of a partner). Without communication, human activity is impossible.

The topical issue today is the communication between the health worker and the patient. Many of us have been to a hospital, clinic, or health care facility where each of us interacted with a doctor or nurse. But has anyone thought how much this communication affects us, or rather, the course of our disease, and how a health worker can improve our condition? Of course, we can say that everything depends on the medicines that the doctor prescribes and the nurse gives us, the medical procedures are also prescribed by the doctor, but this is not all that is necessary for a complete recovery. The most important thing is the right attitude, which depends on the mental and emotional state of the patient. The attitude of the health worker has a huge impact on the patient's condition. And if the patient is satisfied, for example, with a conversation with a doctor who listened to him carefully, in a calm atmosphere and gave him appropriate advice, then this is already the first step towards recovery.

That's why purposeourwork was the study of communication in nursing.

To achieve this goal, we set tasks:

1. Analysis of the literature on this topic;

2. Disclosure of types of communication and principles of communication;

3. Describe the types of nurses

The object of the research is communication in nursing.

The subject of the research is the study of types of communication in nursing.

Communication is a complex socio-psychological process of mutual understanding between people, occurring with the help of verbal (verbal) and non-verbal (non-verbal) information.

In recent years, instead of the word "communication" the term "communication" has been used in science.

Verbal information is reflected in statements or written (letter) feelings, thoughts, observations. Non-verbal information reflects the actions or behavior of someone who conveys information without the use of speech or writing (writing).

Communication in nursing is a process generated by the needs of the joint activities of the patient and the nurse, the art of influencing the patient's personality in order to adapt (adapt) to changes in life due to changes in health status.

The psychological characteristics of the patient in terms of therapeutic relationships and interactions come into contact with the psychological characteristics of the medical worker. In addition, persons involved in contact with the patient may be a doctor, psychologist, nurse, social worker.

In medical activity, a special connection is formed, a special relationship between medical workers and patients, these are relations between a doctor and a patient, a nurse and a patient. According to I. Hardy, the connection “doctor, sister, patient” is formed. Daily medical activity is connected with psychological and emotional factors in many nuances.

1. PeculiaritiesrelationshipsVmedicalactivities

The relationship between doctor and patient is the basis of any medical activity. (I. Hardy).

The purpose of contacts between a medical worker and a patient is medical assistance provided by one of the participants in communication in relation to another. Such relationships are determined to a certain extent by the conditions in which medical activities are carried out. Based on the main goal of therapeutic interaction, one can assume the ambiguity of the importance of contacts in the system of interaction between a health worker and a patient. However, it should not be understood that there is an interest in such interaction only on the part of the patient. The health worker, in theory, is no less interested in helping the patient, because this activity is his profession. The health worker has his own motives and interests to interact with the patient, which allowed him to choose the medical profession.

In order for the process of the relationship between the patient and the medical worker to be effective, it is necessary to study the psychological aspects of such interaction. Medical psychology is interested in the motives and values ​​of the doctor, his idea of ​​the ideal patient, as well as certain expectations of the patient himself from the process of diagnosis, treatment, prevention and rehabilitation, the behavior of the doctor or nurse.

We can talk about the importance for the effective and conflict-free interaction of the patient with health workers of such a concept as communicative competence, i.e. the ability to establish and maintain the necessary contacts with other people. This process implies the achievement of mutual understanding between communication partners, a better understanding of the situation and the subject of communication. It should be noted that communicative competence is a professionally significant characteristic of a doctor and a nurse. However, despite the fact that in a clinic the patient is forced to seek help from a doctor, communicative competence is also important for the patient himself.

With good contact with the doctor, the patient recovers faster, and the treatment used has best effect, far less side effects and complications.

One of the foundations of medical activity is the ability of a health worker to understand a sick person.

In the process of medical activity, an important role is played by the ability to listen to the patient, which seems necessary for the formation of contact between him and the health worker, in particular, the doctor. The ability to listen to a sick person not only helps to determine and diagnose the disease to which he may be susceptible, but the process of listening itself has a favorable interaction on the psychological contact between the doctor and the patient.

It is important to note that it is also necessary to take into account the characteristics (profile) of the disease in contact with the patient, since patients of various profiles are found in therapeutic departments common in clinical medicine. These are, for example, patients with diseases of cardio-vascular system, gastrointestinal tract, respiratory organs, kidneys, etc. And often their painful conditions require long-term treatment, which also affects the relationship between the health worker and the patient. A long separation from the family and the usual professional activities, as well as anxiety about the state of one's health, cause a complex of various psychogenic reactions in patients.

But not only these factors affect the psychological atmosphere and the patient's condition. As a result, psychogeny can complicate the course of the underlying somatic disease, which, in turn, worsens the mental state of patients. And, in addition, in the therapeutic departments for examination and treatment are patients with complaints about the activity of internal organs, often without even suspecting that these somatic disorders psychogenic nature.

In the clinic of internal diseases, specialists deal with somatogenic and psychogenic disorders. In both cases, patients express big number various complaints and are very wary of their condition.

Somatogenically conditioned mental disorders often occur in anxious and hypochondriacal patients with hypochondriacal fixation on their condition. In their complaints, in addition to those caused by the underlying disease, there are many neurosis-like ones. For example, complaints of weakness, lethargy, fatigue, headache, sleep disturbance, fear for one's condition, excessive sweating, palpitations, etc. There are even various affective disorders in the form of intermittent anxiety and melancholy of varying severity. Such disorders are often observed in patients with hypertension, ischemic disease hearts, in persons suffering peptic ulcer stomach and duodenum. And neurosis-like symptoms can often mask the clinic of the underlying disease. As a result of this phenomenon, sick people turn to specialists of various profiles.

In everyday life, one often hears about the "good" or "correct" treatment of the patient. And in contrast to this, unfortunately, one hears about a “heartless”, “bad” or “cold attitude towards sick people. It is important to note that various kinds of complaints, emerging ethical problems indicate the lack of the necessary psychological knowledge, as well as the practice of appropriate communication with patients on the part of health workers. Differences in the views of the health worker and the patient.

Differences in the points of view of the health worker and the patient may be due to their social roles, as well as other factors.

For example, a doctor tends to look, first of all, for objective signs of a disease. He tries to limit the history to further determine the prerequisites for further somatic research, etc. And for the patient, his subjective, personal experience of the disease is always in the center of attention and interests. In this regard, the doctor must consider these subjective sensations as real factors. He should even try to feel or catch the patient's experiences, understand and evaluate them, find the causes of anxieties and experiences, support their positive aspects, and also use them to more effectively assist the patient in his examination and treatment.

The differences in all the views and points of view of the doctor (nurse) and the patient are quite natural and predetermined, in this situation, by their different social roles. However, the doctor (nurse) needs to ensure that these differences do not turn into deeper contradictions. Since these contradictions can jeopardize the relationship between the medical staff and the patient, and thereby making it difficult to provide assistance to the patient, complicating the treatment process.

To overcome differences in views, the health worker needs not only to listen with great attention to the patient, but also to try to understand him as best as possible. What happens in the soul, thoughts of a sick person? The doctor must respond to the patient's story with all his knowledge, reason in the fullness of his personality. The response of the health worker should be a resonance to what they heard.

1.1 Types of communication

There are the following types of communication:

"Mask Contact" This is formal communication. There is no desire to understand and take into account the personality traits of the interlocutor. Using the usual masks (politeness, courtesy, modesty, compassion, etc.). A set of facial expressions, gestures, standard phrases that allow you to hide true emotions, attitude towards the interlocutor.

Within the framework of diagnostic and therapeutic interaction, it manifests itself in cases of little interest of the doctor or patient in the results of the interaction. This can happen, for example, when a mandatory preventive examination in which the patient feels dependent, and the doctor does not have the necessary data to conduct an objective and comprehensive examination and make a reasonable conclusion.

Primitive communication. They evaluate the other person as a necessary or interfering object, if necessary, they actively come into contact, if it interferes, they repel.

This type of communication can occur within the framework of manipulative communication between a doctor and a patient in cases where the purpose of contacting a doctor is to receive any dividends. For example, a sick leave certificate, a certificate, a formal expert opinion, etc. On the other hand, the formation of a primitive type of communication can occur at the request of a doctor - in cases where the patient turns out to be a person on whom the well-being of the doctor may depend. For example, a leader. Interest in the contact participant in such cases disappears immediately after the desired result is obtained.

Formal role communication. Both the content and means of communication are regulated, and instead of knowing the personality of the interlocutor, they manage with knowledge of his social role.

Such a choice of the type of communication on the part of the doctor may be due to professional overload. For example, at the local doctor's appointment. medical patient sick medical

Business conversation. Communication, taking into account the peculiarity of the personality, character, age, mood of the interlocutor, while focusing on the interests of the case, and not on possible personal differences.

When a doctor communicates with a patient, this type of interaction becomes unequal. The doctor considers the patient's problems from the standpoint of his own knowledge, and he is inclined to take directive decisions without coordination with another participant in communication and an interested person.

Diagnostic and therapeutic interaction does not imply such contact, at least, due to the professional orientation, it does not provide for the confession of a medical worker.

manipulative communication. Just like the primitive, it is aimed at extracting benefits from the interlocutor using special techniques. Many may be familiar with a manipulative technique, more commonly referred to as "hypochondriacization of the patient."

Its essence lies in presenting the doctor's conclusion about the patient's health in line with a clear exaggeration of the severity of the detected disorders. The purpose of such manipulation can be:

lowering the patient's expectations for the success of treatment due to the avoidance of responsibility by the health worker in the event of an unexpected deterioration in the patient's health, demonstrating the need for additional and more qualified interventions on the part of the health worker in order to receive remuneration.

Communication between a health worker and a patient can, in principle, be called forced communication. One way or another, but the main motive for meetings and conversations of a sick person with a health worker is the appearance of health problems in one of the participants in such an interaction. On the part of the doctor and the nurse, there is a compulsion to choose the subject of communication, which is due to his profession, his social role. And if the patient's appeal to the doctor is, as a rule, due to the search for medical assistance, then the doctor's interest in the patient is explained by considerations of his professional activity.

The interaction between patient and physician is not something forever fixed. Under the influence of various circumstances, they can change, they can be influenced by a more attentive attitude towards the patient, a deeper attention to his problems. At the same time, the very good relationship between the health worker and the patient contributes to the greater effectiveness of treatment. Conversely, positive treatment outcomes improve the interaction between patient and provider.

Currently, many experts believe that it is necessary to gradually remove such concepts as “sick” from the process of communication and lexicon, replacing the concept of a patient, due to the fact that the very concept of “sick” carries a certain psychological burden. And appeals to sick people like: “How are you, sick?” It is unacceptable to use, and it is necessary to try everywhere to replace such appeals to the patient with appeals by name, first name, patronymic, especially since the name itself for a person, his pronunciation, is psychologically comfortable.

2. Health worker tactics

Communication with the patient is an essential element of the treatment process.

The art of taking an anamnesis is not an easy art. In the language of psychologists, this is a guided conversation designed to collect anamnestic data, and the conversation should be controlled imperceptibly. The patient with whom the conversation is being conducted should not feel this. In the process of collecting an anamnesis, he should give the impression of a casual conversation. At the same time, the doctor needs to assess the seriousness of complaints, the manner in which they are presented, to separate the main from the secondary, to verify the reliability of the testimony, without offending the patient with distrust, to help remember, without inspiring. All this requires a lot tact especially when it comes to elucidating the state of mind, mental trauma that play an important role in the development of the disease.

When questioning a patient, one should always take into account his cultural level, degree of intellectual development, profession and other circumstances. Empty, meaningless words, indulgence in the unreasonable whims and demands of some patients should be avoided. In other words, it is impossible to offer a standard form of conversation between a health worker and a patient. This requires ingenuity and creativity.

Particular attention should be paid to elderly patients and children. The attitude of a doctor or nurse to a child, a patient of mature age and an old man, even with the same illness, should be completely different, due to the age characteristics of these patients.

2.1 Peculiaritiesthe identity of the medical worker

It should be noted that the prerequisite for the emergence of positive psychological relationships and trust between health workers and patients is the qualifications, experience and skill of the doctor and nurse. At the same time, the result of expanding and deepening information in modern medicine is the increased importance of specialization, as well as the creation of various branches of medicine aimed at certain groups of diseases depending on localization, etiology and methods of treatment. It can be noted that in this case, specialization carries with it a certain danger of a narrowed view of the doctor on the patient.

Medical psychology itself can help offset these negative aspects of specialization through a synthetic understanding of the patient's personality and body. And qualification is only a tool, the greater or lesser effect of which depends on other aspects of the doctor's personality. We can note the definition of the patient's trust in the doctor, given by Gladkiy:

"Confidence in the doctor is a positive dynamic relationship of the patient to the doctor, expressing the previous experience due to the expectation that the doctor has the ability, means and desire to help the patient in the best possible way."

For the manifestation of trust in a health worker, the first impression that a patient has when meeting with him matters. At the same time, the actual facial expressions of a medical worker, his gestures, tone of voice, facial expressions arising from the previous situation and not intended for the patient, the use of slang speech turns, as well as his appearance are important for a person. For example, if a sick person sees an untidy, sleepy doctor, then he may lose faith in him, often believing that a person who is not able to take care of himself cannot take care of others. Various behavioral and appearance Patients tend to forgive only providers they already know and trust.

A health worker gains the trust of patients if, as a person, he is harmonious, calm and confident, but not arrogant. Basically, in cases where his demeanor is persistent and resolute, accompanied by human participation and delicacy. It should be noted that when making a serious decision, the doctor must be aware of the results of such a decision, its consequences for the patient's health and life, and increase his sense of responsibility.

Special requirements for the health worker are the need to be patient and self-controlled. He must always consider various possibilities for the development of the disease and not consider ingratitude, reluctance to be treated, or even a personal insult on the part of the patient if the patient's condition does not improve. There are situations when it is appropriate to show a sense of humor, however, without a hint of mockery, irony and cynicism. Such a principle as “laugh with the patient, but never at the patient” is known to many. However, some patients cannot stand humor even with good intentions and understand it as disrespect and humiliation of their dignity.

There are facts when people with unbalanced, uncertain and absent-minded manners gradually harmonized their behavior in relation to others. This was achieved both through their own efforts and with the help of other people. However, this requires certain psychological efforts, work on oneself, a certain critical attitude towards oneself, which for a health worker is and should be taken for granted.

It should be noted that a medical worker - a young specialist, about whom patients know that he has less life experience and less qualifications, is in the search for the trust of patients and is in a more disadvantageous position compared to his older colleagues with work experience. But a young specialist can be helped by the realization that this shortcoming is transitory, which can be compensated by conscientiousness, professional growth and experience.

It should be noted that the personal shortcomings of the health worker may lead the patient to believe that a doctor or nurse with such qualities will not be conscientious and reliable in the performance of their direct duties.

In general, the balanced personality of a health worker is for the patient a complex of harmonic external stimuli, the influence of which takes part in the process of his treatment, recovery and rehabilitation. A health worker can educate and shape his personality, including by observing the reaction to his behavior directly. Let's say, according to the conversation, assessment of facial expressions, gestures of the patient. Also indirectly, when he learns about the view of his behavior from his colleagues. Yes, and he can help his colleagues to direct them towards more effective psychological interaction with patients.

2.2 Nurse and patient, principles of communication with the patient

The position and role of the nurse is becoming more important in our time. She spends much more time with the patient than the doctor. The patient seeks understanding and support from her. The work of a nurse is associated not only with great physical exertion, but also with great emotional stress. The latter occurs when communicating with patients who are distinguished by increased irritability, painful exactingness, touchiness, etc. It is very important to establish contact with the patient. The sister is constantly among the sick, so her clear actions and professional implementation of the doctor's instructions, her benevolent, warm attitude towards the patient have a psychotherapeutic effect on him. The nurse should be able to show understanding of the difficulties and problems of the patient, but should not seek to solve these problems.

Repeat the last sentence of the patient in the form of a question, for example: “So, did your spouse offend you?”

Ask a question that summarizes everything said by the patient: "If I'm not mistaken, do you want to return home as soon as possible?"

The nurse does not speak out about the unexplained problems of the patient without consulting with the doctor.

Ask an abstract question, for example, in case of family problems during an illness: “Who takes care of the children?”

Say an unfinished phrase: “And if you return home now, right ...?

In contact between sister and patient great importance has the personality of a nurse. A sister can love her profession, have excellent technical data and skills, however, if she often conflicts with patients due to personal characteristics, she professional quality do not give the desired effect. The path to true mastery is always long and difficult. Therefore, it is necessary to develop the necessary style of work and master the art of a beneficial effect on patients.

2.3 Types of medicinesky sisters and their characteristics

I. Hardy describes 6 types of sisters according to the characteristics of their activities.

routine sister. Its most characteristic feature is the mechanical performance of its duties. Such sisters perform the assigned tasks with extraordinary thoroughness, scrupulousness, showing dexterity and skill. Everything that is necessary for caring for the sick is done, but there is no care itself, because it works automatically, indifferently, without worrying about the sick, without sympathizing with them. Such a nurse is able to wake up a sleeping patient only in order to give him sleeping pills prescribed by a doctor.

A sister "playing a learned role." Such sisters in the process of work strive to play some role, striving for the realization of a certain ideal. If their behavior goes beyond acceptable limits, spontaneity disappears, insincerity appears. They play the role of an altruist, a benefactor, showing "artistic" abilities. Their behavior is artificial.

Type of "nervous" sister. These are emotionally labile individuals prone to neurotic reactions. As a result, they are often irritable, short-tempered, and can be rude. Such a sister can be seen gloomy, with resentment on her face among innocent patients. They are very hypochondriacal, afraid of contracting an infectious disease or falling ill with a "serious illness." They often refuse to perform various tasks, allegedly because they cannot lift weights, their legs hurt, etc. Such sisters interfere with work and often have a harmful effect on patients.

Sister type with a masculine, strong personality. Such people can be recognized from afar by their gait. They are distinguished by perseverance, determination, intolerance to the slightest disturbances. Often they are not flexible enough, rude and even aggressive with the sick; in favorable cases, such sisters can be good organizers.

Maternal sister. Such sisters perform their work with the utmost care and compassion for the sick. Work is an essential part of their lives. They can and do everything. Caring for the sick is a life calling. Often, care for others, love for people is imbued with their personal lives.

Specialist type. These are sisters who, due to some special personality trait, special interest, receive a special appointment. They dedicate their lives to performing complex tasks, such as in special laboratories. They are fanatically devoted to their narrow activities.

Conclusion

The topic covered by us in this essay is of great importance for health workers.

As in ordinary life, so in medical activities, there is communication. In both cases, it has a certain meaning and psychological characteristics. In medical activities, there are several types of communication between a health worker and a patient. And it depends only on the health worker what kind of communication he will have with the patient. But in any case, the doctor or nurse must follow certain tactics in relation to the patient and, most importantly, the health worker, as a person, must have certain characteristics in all respects in order to earn the patient's trust in himself. Indeed, without trust, a normal relationship between a health worker and a patient is impossible. Because the nurse spends more time in direct contact with the patient, her role in communicating with the patient becomes important. Consequently, the personality of a nurse, the style and methods of her work, the ability to influence patients and treat them is an important element not only of the treatment process, but also of the psychological communication between the medical worker and the patient.

Ten"Yes!"therapeuticcommunication:

1. Address the patient by name and patronymic and “You”;

2. Start a conversation by indicating your name - patronymic and positions;

3. Look into the patient's eyes at the same level, smile; if the patient is lying down, sit down on a chair nearby;

4. Keep your conversation private. Remember that confidentiality is a condition for building trust with the patient;

5. Encourage questions from your patient;

6. Speak slowly, intelligibly, use exclusively positive intonation of your voice;

7. Follow the principles of effective listening skills;

8. Show skill of communication of the nurse with the patient;

9. Show continuous initiative in creating a psychological microclimate when communicating with the patient;

10. Be natural when talking, create an atmosphere of mutual understanding and trust.

WITHlist of literature

1. Kosenko, VG Medical psychology for nurses and paramedics: textbook. allowance / V. G. Kosenko, L. F. Smolenko, T. A. Cheburakova. - Rostov n / a: Phoenix, 2002. - 416 p.

2. Matveev. V.F. Fundamentals of medical psychology, ethics and deontology. Moscow, "Medicine", 1989, 178 pages.

3. Mashkova, T. V. Ethical norms and problems associated with the work of nursing staff / T. V. Mashkova // Ch. honey. sister. - 2003. - N 2. - C. 115-119.

4. Shkurenko. YES. General and medical psychology. Rostov-on-Don, "Phoenix", 2002, 352 pages.

5. http://www.serdechno.ru/enciklopediya/4254.html

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