Assessment of patient’s condition in nursing
The main objective of the evaluation of the status of each patient nurses nursing. Patient many things: the patient’s origin, history of the disease, the disease and the general state of life, history, and other data, and so on. Based on this information the patient’s next treatment process is carried out and observed.
And to identify the problems of the patient’s physical and social the main line to collect them. According to the assessment of the condition of the patient depends on the skills of the nurse. To talk, to check the general condition of the patient, tips engaged in assessing the overall condition of the patient.
The time to check the patient’s general clinical symptoms. These include palpation percussion and auscultation methods. All nurses database. Then the collection of information will be the basis for the clinical diagnosis and the doctor’s recommendations.
Assessment of the patient’s nurse, physical therapy are required in different directions. Series and a comprehensive assessment of the status of the patient to perform a systematic method. Nurses to evaluate their own work experience and practical skills on the basis of physical principles can be further extended without a thorough grasp.
Common methods of data collection: talk, the general examination, the patient’s physical condition, the medical staff’s recommendations, a list of publications, palpation, auscultation and percussion the basis of the evaluation of the physical. As well as a source of information about patients: illness (history), written information about the status of the patient’s current and past medical diagnoses and recommendations of the experts, problems, methods of treatment and the patient and his friends the information given to the members of the family.
There is no specific accumulation of information about the patient. Regardless of which method to use nurses to carry out a full physical check.
The accumulation of data requires the same, but the methods of their implementation may be different. Methods differ from each other depending on the patient’s condition. The nurse developed a unique method, the existing techniques, the comparison between them and the systematic analysis of the data obtained.
Cross talk (request) – the construction of a conversation with the patient. At this time, a nurse specialist to gather information about problems related to the patient and how to deal with patients in the future. The first meeting with the patient, a single nurse to be sure they strengthen the relationship between the foundation. The nurse’s speech, morals, manners, be considerate, sweet talk the patient should be assured of the frame. The patient’s subjective information. If the patient is unable to participate in the process to communicate the changes in the physical or psixo emontial it is necessary to involve family members or friends.
• She first questions may determine the extent of the patient’s condition. This request allergic or chronic diseases (with the time of applying a continuous or ongoing proceedings diseases). There are a number of questions, the answers, depending on the patient’s current status and type of the disease. Nurse, the patient can apply to the following questions:
• Why do you bother to tell us in your own words;
• For this reason, you can contact us Have ?;
• This is a problem before you even bother?
• You may be able to influence what the situation?
• In any case improve the situation?
• How does your family members?
• care about the health of your family?
• How do you think we are, that the medical staff can help you with what you?
Nursing history collection – a conversation with the patient documentation. Writing about the symptoms of the disease, regardless of what appears to be the use of patient data collection. The nurse can assess the following questions a delay in pain:
Painful: ‘Where does it hurt?’
• suffering from the beginning and continued: ‘When does the pain come from?’, ‘When will continue to come?’
• to determine the increase or decrease the angle: 0 to 5 points system, fu-day intensive pain do you think? ‘
• the impact of the external environment: What Whose power we’re wondering what will help to reduce the pain?
• This pain affects how you adapt to it or this, do you?
• Do you worry about how you can evaluate your pain ?, yes yacht dangerous?
The necessary information to be able to, you do not need all the questions. Sometimes you can get answers to a few questions. Conversation process, depending on the patient’s cornea. If a patient is in serious condition, one or two of the required clear enough questions. During the conversation with the nurse, the patient does not feel that this dialogue will remain ineffective. It is important to know that the nurse fact this should be a positive benefit to the health of the patient, otherwise it will be the truth loses its importance. A conversation with the patient should be constructive ijodiy- character. We think this interview are closely linked to each other in a drama. The first part of this subjective side, in which the chief executive role of the patient. The nurse must be able to manage the execution of this role, otherwise this dialogue has become a monologue, can not produce the expected results. The second part of this oby’ektiv side, where nurses play a key role. During this process a wide range of physical methods, detailed information to be able to do it. It should be noted that the first and especially the second part of the nurse within the direct knowledge of the effectiveness depends on its width and depth.
Ask the patient investigated and paid after the examination routine check. Meaning Palpatsiya- palpation. In many cases, along with palpation examination. The palms of the hands, fingers and body parts fingers are investigated with the help of a nurse or a member of softness, elasticity, hardness and can feel the temperature, as well as to determine its location and size. This method lymph nodes, thyroid gland, chest, heart and cardiovascular system is particularly important in the examination of the members of the abdominal cavity. Chest palpable political elasticity, sound vibration, ribs and pain (cracks, chips) and the intercostal space (neuralgia, myositis, and b.) Are checked. This method is examining the cardio-vascular system (if the cancer summit strokes to characterize the cat xirillashi to identify the symptoms of mitral valve defects).
Abdominal cavity plays an important role in the investigation of members of the palpation method
. This method Obrazsov VP Strajesko P.D. created by the scientists, called methodical deep sliding palpation.
Palpation method yirdamida peripheral pulse assess the number and quality.
Using the method of percussion
Percussion body surface per to’qillatish Kuss is to determine the density of organs or tissue, the method used to determine the air or liquid filled. Perkussiyada created different sounds depending on the density of the tissues. The nurse should be able to assess the results of the perkussiyaning. Percussion vibration of the tissues in the process of this method is only spread to a depth of about 6 to 7 cm deep naughty attributable to detect pathological processes.
Sort Percussion
1) percussion method of examining the patient’s condition should be available, and it is sitting or standing position, and the position of critically ill patients.
2) the purpose of the room warm and become silent.
3) Nurse favorable situation.
4) the field of construction finger to’qillatish density.
5) Perkussiyada used to work with the movement of the palm of the same Kuchnia, fingers upright (vertical) position, short construction.
6) Topographic perkussiyada carried out into a loud sound, low noise and finger plessimetrning boundary line marked by a clear crisp sound.
7) Comparative percussion only symmetric spaces.
percussion – The method is based on the change in the sound surges to the surface of the body of clinical investigation. This method initially by L.Auenbrugger (1761). In different parts of the body to’qillatganda different sound will be heard. percussion sounds feature to’qillatgan body density, ductility, tension gardens are interdependent. perkussiyada vibrations, which we hear as sound is played. Does not keep the air density at the absolute bo’giq sound. Therefore, liver, spleen, kidney, lung, fluid to’qillatishda hard to be different from each other. Chest and abdominal cavities of percussion sounds that they felt when the amount of air. At the moment, the fingers of the finger into the habit of beating percussion. This is called indirect percussion. Finger-finger percussion work when only the hand. Percussion with the same strength, speed, and short, fingers upright (vertical) position.
Direct percussion is performed using the index finger. Beating sounds through the borders of the member, the size, the location is determined.
Each member of the topographic percussion position is determined by the shape and size. Simmering chest can identify areas where to to’qillatish pathological oven.
During percussion purpose of each shot with the same power: the power of the sound to’qillatish (typical;) and slow (low) level can be reflected in high and low franchise tympanic notimpanik on and ensure the sound-reflecting metal sounds different. The speed of the vibrations of the sound volume. For example: when the increase in lung tissue (emphysema), the lower the sound of to’qillatish (vibration speed of 70-80 sec). Normal vibration rate of 100-130 s. Lung tissue hard it will increase up to 400.
Formed in the body auscultation sounds (fonendoskop) method in order to detect diseases listen. Auscultation should be familiar with the sound of normal variation. With the growing practical experience learned to differentiate progress beyond the norm. Only to learn the skills and experience to be able to assess the pathological sounds. This method is used when the bodies will be listening sounds. Accordingly, the body’s normal or think of the condition of the patient. Introduction of the practice of auscultation method French doctor Laennik name.
Direct and indirect auscultation, Proc. Indirect auscultation this or that part of the body of the patient directly to the ears to hear let direct auscultation of the medical devices (fonendoskop or stethoscope) to listen to. Fonendoskops usually consists of membrane. If staying in contact with the skin fonendoskop light, low tones of the rule of tunes will be heard. If the diaphragm heard together in a tightly sealed hear high tone sound supremacy.
When the method of auscultation to control the level of outside noise, so the room should be quiet. While the patient heard him speak, please.

Control Questions
1. General information collection methods?
2. nursing history collection?
3. To identify the problems of the patient’s physical and psixoijtimoiy?
4. palpation held nimalarg attention to?
5. In order to conduct percussion?
6. Auskultatsiyaning any different?

THEME No 5. Inspection of patients during the respiratory system diseases
The general condition of the patient during the examination es senses, and they’re Ameri-evaluated. Sianotik skin, pale, giperemiyalangan temperature and hay.
A layer of the skin and mucous membrane cyanosis, a number of diseases (lung inflammation, lung emfize Christ, pnevmoskleroz, and infection of the lungs, and b.). As such, the lungs in patients with symptoms of heart failure.
In particular, clearly expressed in the primary sianozi (Aerzen disease) and secondary pulmonary artery sclerosis.
Cyanosis, characterized by acute pulmonary emboliyasida pnevmotoraksda.
Cases of these diseases cyanosis, mainly as a result of violations of gas exchange in the lungs. As a result, O2 saturation of the blood in the lungs is not enough. Exudative pleurisy sick patients catching color. In particular, a sharp peep lungs or skin color bleeding.
Lobar lung inflammation occurs in cases of cyanosis, and hyperemia in the form and shohpardaning little yellow mucous layer of the skin around the nose, lips, small rash on the back of the shoulder and breast.
Respiratory system disease patients are forced situation. Eksudatli bleeding broxoektazda and lies by the pneumonia patients were infected, which is a forced situation. Bronchial asthma attack during occupies a half-sitting or sitting position, the hands of the bed trailers, additional respiratory muscles have been difficult to breath a little yengillashtiradi.Umurtqaning called scoliosis, and tilt it to the side of the top of the students’ body part of the development of abnormal behavior as a result.
Dismantle back and spine (kyphosis), sometimes in conjunction with scoliosis. This condition is referred to as kifoskolios. This change in the situation of the members of the lungs and mediastinum chest and breathing and blood circulation disorders.
Vertebral forward bent Estella said. In addition to determining the shape of the chest bulging, or rather one-sided attention to deep breathing to stay behind drowning in our country, this diagnostic role. Breast tumor half the size of the side size’s pleural cavity air or fluid is collected, exudation bleeding pnevmatoroks piop nevmatoroks hemotoraks hydrotoraks.
Or expand intercostals space between this tier. At the same time, the affected side of the chest when taking deep breaths backward in the direction of an active healthy breathing.
Chest shriveled lungs drowning in the process, as a result of the growth of connective tissue (OP-ka tuberculosis, pnevmoskleros and other diseases) acquired exsudative pleurisy caused by the formation of pleural adhesions, in particular, abscesses, bleeding, and finally, the studios obturating significant, especially due to bronxogen tumor cases. At the same time, the chest down, melons, becomes narrow. Depending on the diseases of the spine than in the direction toward the sunkeni. Deep respiratory disease, healthy breathing sudden behind. Examination of chest breathing space, number, depth and rhythm.
Breath type to be the difference as follows:
 Breast
 abdominal
 Mixed
If the act of breathing movements, mainly due to the reduction in intercostals muscle do the chest or ribs, called a breathing space. This breathing space, especially in women. It is in males (normal abdominal type), shows the limitations of the activity of the diaphragm. In women, abdominal or diaphragmatic breathing lung tissue derived from damage or evidence of the development of pleural adhesions.
The mixture is derived form the lower part of the chest to breathe and take part in the upper part of the abdomen. This is the age old people, as well as hot chest and lung tissue elasticity increases (pulmonary emphysema pnevmoskleros).
The number of breath. The normal number of respiratory movements 1 minute 16-20 times. He considered putting the number of patients felt. At the same time, such as in the determination of the patient’s pulse technique in the epigastric region. Actions include the hand-breath for 1 minute. Respiration may be accelerated or Sparse.
Manhattan acceleration of healthy physical strain after a nervous excitement is usually a short period of time. Manhattan pathological acceleration in malaria cases, and a variety of diseases of the lungs (pneumonia, pulmonary tuberculosis, various tumors, pulmonary emphysema, and others).
Manhattan acceleration. In this case, the gas in the lungs caused by accumulation of carbonate in the blood and metabolic disorders caused by excitation of the respiratory center.
Lesions of the pleura (exudation pleurisy, gemotorax pneumothorax) disease Manhattan, accompanied by acceleration, and reduce the likelihood of shortness of breath caused by lung. Manhattan often be superficial or myositis, dry, bleeding, ribs injury, neuralgia.
Manhattan fall to slow down the activity of the respiratory center. This brain tumors, brain hemorrhage, meningitis, a serious infectious disease areas, may uremia and other diseases.
Chronic supportive disease (bronchiestatsis, chronic lung abscess) characteristics common to the drum stick in the form of fingers, the hand and foot sparks the size of the part. At the same time, the surface of the nail and blister forms ‘window’ tab.
Chest examination.
Inspected the chest of his form is active on both sides symmetrical chest breathing and participate in typical attention.
Form chest. In accordance with the types of Konstitutsional chest 3 Proc.
• normostenic
• asthenic
• hypertonic
Normostenic chest. At the same time, the chest is well developed at the front of the breast, back, and will be proportional to the size of the cross. In the form of small cavities above and below the collar. Epigastric angle is approximately 90 degrees.
Asthenic type of chest. At the front of the chest and the back will be reduced size compared to the size of the cross-and therefore we will have a flat. Eating the gaps above and below the collar. Parental up to weaning. X ribs, acoustical light. Epigastric angle of 90 °.
Giperstenik of the chest. The size of the rear of the front transverse size is relatively large. Therefore, the cross-sectional circle of the breast. Intercostal space above and below the narrow collar strength. Epigastric angle of 90 degrees.
Pathological forms of diseases of various members of the chest cavity chest or skeletal deformation develops. Emfizematoz across his chest and the back of the front is characterized by the expansion of the size. He will take the form horizontal ribs. Intercostals space expands. Grinding depth above and below the collar. The neck is short, epigastria corner, a chest of such a form of lung take a deep breath for a long time, but they preferred.
That emphysema lung or bronchial asthma’s heavy attacks at the same time, accompanied by accumulation of air in the alveoli.
Paralytic chest. Emfizematos chest with the opposite characteristics. He is prolonged, the long and the front-to-back size of the transverse size is relatively small. Collars sharply formed, the collar will be floating in the surface and underground caverns. The ribs were cut down. Epigastric acute angle. Chest such a feature of tuberculosis in patients with diseases of chronic lung or pleura. The above-mentioned diseases, connective tissue growth and wrinkling, lead to the development of pleural adhesions, which leads to a change in the shape of the chest. This is attributable to the development of the skeleton of congenital anomalies, acquired in childhood rickets or chronic diseases due to changes in the spine.
Funnel chest. – breasts with the deepening of the funnel to the bottom. It is spread associated with congenital anomalies of development. In some cases, this is due to the pressure on long-term display in the permanent childhood. Therefore, the emergence of his professional factors associated with the early start. Rachitis is characterized by chest forward and spread out. Chicken breast with the name acquired in childhood rickets ribs at the same time build a name for the thickened part of rachitis view.
Cuneiform chest and its structure. Part of the pavement because of the navicular clicked. The formation of spinal diseases (siringomieliya). Chest can affect the shape of the spine dismantle. Dismantle the Parties to the spine called scoliosis, students upper part of the body caused by improperly handled.
Shortness of breath slow swelling of the mucous membrane of the larynx and trachea caused due soon. In this case, the noisy breathing as a result of the weather, to. This is called stridoros breath. Some of the disease (diabetic coma), deep breathing a little sparse. This is called the breath of breath KUSSMAUL. This is the center of the development of coma patients, acidosis, respiratory movement.
Respiratory failure. Healthy people the act of breathing rhythm. Severe respiratory diseases circulatory disorder or brain damage respiratory failure. If the sequence in clear violation of the rhythm of breathing persists kind of breathing is called periodic breathing. Four distinct difference in the periodic breathing;
 Cheney in stock
 Biot
 Grokko
Cheney is characterized by two features breath-stock. The first periodic breathing and movements that they will stop. Second, efforts to breathe slowly rise, then fall, and until the complete cessation. Between the breathing will stop for a few seconds the minutes. This violation of the circulation of blood in the brain in patients with respiratory atherosclerosis, hypertension disease, brain hemorrhage, brain tumors, meningitis, severe intoxication and narcotics (morphine) poisoning by drugs and in many other diseases. In some cases, elderly people occur during sleep. This is the basis of the pathogenesis of breathing respiratory center leads to the deterioration of the oxygen supply. This leads to a decrease in excitability. Cheney indication of bad breath-stock effect blood circulation which is a serious violation. Biotin breath respiratory movements with the temporary suspension of the talks. It takes a few seconds to minutes. This is the mechanism of formation of breathing Cheney -Stoks like nafasinikiga. Meningitis and other diseases of the brain. Sometimes dissociated Grokka Vrugonni breath. This central coordination occurs as a result of the property. Separate groups of respiratory muscles characterized by the violation of the intention of the work of the joint garmo. For example: intercostal muscles and diaphragm Coordination destroyed di decline. At the same time, the middle of the chest and respiratory phase, while the lower part of the respiratory movement in the bed. Breathing disorders, brain abscess, in some cases, basal meningitis, sometimes during the Agony.
Manhattan rhythm of pathological dissociation with the end of the meeting, is dangerous.
Examination of patients with lung diseases.
• Patients color.
• respiratory rate, rhythm, depth and difficult.
• Asthma is actively adding more muscle.
• narrowing of the intercostals perineal.
• rise in the nose wing.
• deformation, chest the asymmetrical
Examination: the density norm
• Deformation or asymmetric.
• Deformation of the chest funnel.
• Barrel chest.
• Brought to justice.
• Severe obstructive lung disease.
• Chronic pulmonary obstructive disease.
• Asthma.
Asking the patient members of the respiratory system diseases
Members of the respiratory system disease patients with chest pain, dry cough or cough with sputum divorce, general malaise, include raising the temperature can be monitored.
Pain (dolor) in the chest resulting in many cases, the damage of the pleura (dry pleurisy, eksudat bleeding during the initial pleural improvement, malaria, pleural endothelium) as well as lung disease (I o ‘ lungs croupous inflammation, pulmonary infarction, lung cancer, and b.).
Exuded bleeding, chest pain occurs only in the initial stages of the disease, caused by accumulation of fluid exudate away from one of the sheets of pleura, the pain disappears, and dyspnea. Herpes zoster pain is very strong intensity, intercostals neuralgia and ribs in the form of a skin rash bubble. Periostit ribs cracked or broken, the wound surface is determined by palpation pain.
Cough (Tussis) reflex Protection Act and respiratory tract inflammation (iodine or other body part) as a result of the impact of secret (phlegm, mucus, and blood) caused by the accumulation of. Cough mechanism after the patient takes a deep breath, closed during the breathing was elevated at the same time, the act of coughing clearing mucus in the airways. Dry bleeding occurs in patients with a cough reflex. At the same time, when the coughing and deep breathing. Divorce or dry cough, phlegm, patients always or occasionally, sometimes appears in the form of sensitivity.
Dry cough – laryngitis, tracheitis, pnevmoskleroz, bronchial asthma, dry pleurisy, bronchitis, Brox swelling of the mucous membrane, and it will be moved into the dark, hard exudates. Separation of cough with phlegm, chronic bronchitis, and bronchitis occurs in the liquid consistency secret, as well as pneumonia, tuberculosis, lung abscess, bronchiestatsis patients a day 200ml of separation is observed. Persistent cough, respiratory tract, chronic lung disease (chronic laryngitis, tracheitis, bronchitis, bronchiestatsis disease, pulmonary tuberculosis). attack cough, respiratory tract, or when the body of iodine in the food.
Quiet cough – ligament damage due to tuberculosis and syphilis or recurrens nerve fibers that would shrink (spasm).
Spitting blood (haemoptoe). Sputum or blood separation spit in form of bleeding from the lungs. Spitting blood and pulmonary tuberculosis, sometimes bronchiestatsis, lung abscess, gangrene, cancer, flu and respiratory inflammation.
One must not forget that, spit blood, heart disease (mitral stenosis and myocardial infarction), and sometimes in the lungs due to distension or pulmonary infarction. Make sure spitting blood from lungs to join the sputum, blood and other members of the mucous membrane of the nose or gum bleeding, blood licked teleangiektas agree it is necessary to reject the MV ‘ Track and nasal cavity should be examined.
Sometimes it can be difficult to distinguish from lungs to the blood flow leaving the stomach. Stomach bleeding, blood orange-colored food products will react with acidic coffee with a form of deposit. Lung disorders of the blood is bright red in color, sparkling, alkaline environment with a cough.
Dyspnea (Dyspnoe), respiratory diseases often patent is one of the main characters. Dyspnea alveoli of the lung ventilation disorder caused by changes in the Lung and leads to a decrease in oxygen. The increase of carbonic acid in the blood and the metabolic oxidation products increased excitation of the respiratory center, and lead to the emergence of dsypnea.
Dyspnea 3 different kinds: – Inspirator dyspnea, a mechanical barrier makes it difficult to breathe air. This type of dsypnea’s respiratory sound when the foreign substance ligament sudden swelling of the throat, and due to the narrow narrow, goiter or aortic aneurysm due to stress, often associated with heart disease. In such cases, the noisy breathing (breathing stridoros).
– Expiratory dyspnea bronchial asthma attack due to the sudden contraction of bronchial bronxiolit and lung emphysema.
– The mixture was panting difficult breathing, respiratory arrest and its production. This type of respiratory surface of the lungs to breathe in reduction inflammation of the lungs, pleural fluid collection, pnevmotorax obturating atelectasis, reaching the top of the diaphragm. Strongly expressed dyspnea suddenly appeared and called choking. This pnevmotorax pulmonary artery embolia, pulmonary edema and acute ligament edema. Called episodes of asphyxiation associated with asthma. The rise in body temperature in patients with various lungs observes. For example lung lobar bronchopneumonia in temperature up to 39-40 0C, bleeding, inflammation, and the temperature gradually rise. Supportive lung diseases (abscesses, gangrene, bronchiestatsis), abscesses, bleeding, trembling, sweating, mostly in the morning and in the evening the temperature will be, among others, the rise in Tabriz returned to nature. TB disease, the body temperature of different – sub febril Lamb rises up to 380C and up to the time of severe cases, the body temperature of hectares of nature.
Control Questions
1. General examination should pay attention to what nurses?
2. What will be the difference in types of respiratory?
3. The task of nurses during the examination of the chest?
4. What is the destruction of the respiratory rhythm?
5. inquires of patients with respiratory diseases nurses tactics?

Methodical works








The field of education – “Healthcare” -720000
5510700 – Designed for the students of Higher Nursing

I.S.Razikova – Doctor of Medical Sciences of the TMA, Professor
M.A. Mirpayziyeva – TMA assistant
N.K. Djurayeva – TMA assistant
S.A. Alimova – teacher at Olmazor medical college

X.E. Rustamova – TMA, dean of the faculty of Higher Educated Nurse, d.m.s., Professor
Sh.T. Muxammedxonova – TPMI, Dean of the Faculty of Higher Educated Nurse, c.m.s., Associate Professor

Training manual for the sudents of the “Higher Educated Nurse” faculty of Higher Education Medical Institution

Training manual was discussed in the central methodical coincil of the Tashkent Medical Academy.
Protocol №___________ “_____” 2015
Training manual was approved at the scientific council of the Tashkent Medical Academy.

The content of the study adviser

1 Professional ethics of a nurse
2 Specific concepts of ethics and nursing tasks
3 Basic principles of communications
4 Main objectives of the health deontology
5 Communication skills and personal characteristics of a nurse
6 Basic communications skills
7 Specific features of communication with the elderly
8 Conclusion
9 Glossary
10 List of references

The accordance of higher educated nurses prepared in the Republic of Uzbekistan to the world standards and the preparation of medical specialists which can meet the international medical requirements are one of the urgent issues of today. Adaptation of “The national training program” of “The Law on education” demands improvement of the quality and contents of whole learning process. The modern technical equipment, information technologies and innovative teaching methods are widely used at present. Binding together the theoretical and practical training provides positive results.
This training manual meets all the requirements and is prepared taking into account all the news in nursing science. This training manual positivity contributes to student’s practical skills on” Nursing” science. A glossary and test questions are also introduced in this manual in order for the topics to be understandable for students and so they are able to assess their own knowledge.
The authors welcome any ideas and feedback that can help in preparing of the next editions of this manual.

THEME №1.Professional ethics of a nurse

Nursing ethics is a branch of applied ethics that concerns itself with activities in the field of nursing. Nursing ethics shares many principles with medical ethics, such as beneficence, non-maleficence and respect for autonomy. It can be distinguished by its emphasis on relationships, human dignity and collaborative care.
Development of subject. The nature of nursing means that nursing ethics tends to examine the ethics of caring rather than ‘curing’ by exploring the everyday interaction between the nurse and the person in care ]Early work to define ethics in nursing focused more on the virtues that would make a good nurse, which historically included loyalty to the physician, rather than the focus being on nurse’s conduct in relation to the person in the nurse’s care.However, recently, the ethics of nursing has also shifted more towards the nurse’s obligation to respect the human rights of the patient and this is reflected in a number of professional codes for nurses. For example, this is made explicit in the latest code from the.International Council of Nurses. Distinctive nature. Although much of nursing ethics can appear similar to medical ethics, there are some factors that differentiate it. Brier-Mackie] suggests that nurses’ focus on care and nurture, rather than cure of illness, results in a distinctive ethics. Furthermore, nursing ethics emphasizes the ethics of everyday practice rather than moral dilemmas. Nursing ethics is more concerned with developing the caring relationship than broader principles, such as beneficence and justice. For example, a concern to promote beneficence may be expressed in traditional medical ethics by the exercise of paternalism, where the health professional makes a decision based upon a perspective of acting in the patient’s best interests. However, it is argued by some that this approach acts against person-centred values found in nursing ethics. The distinction can be examined from different theoretical angles. Despite the move toward more deontological themes by some, there continues to be an interest in virtue ethics in nursing ethics and some support for an ethic of care. This is considered by its advocates to emphasise relationships over abstract principles and therefore to reflect the caring relationship in nursing more accurately than other ethical views. Themes that emphasize the dignity of the patient by promoting a respectful and caring attitude from nurses are also commonly seen. Some themes in nursing ethics Nurses seek to defend the dignity of those in their care. Being able to respond to the vulnerability of patients in a way that provides dignifying care is a key concept in the field. In terms of standard ethical theory, respecting dignity can also be aligned with having a respect for people and their autonomous choices. People are then enabled to make decisions about their own treatment. Amongst other things this grounds the practice of informed consent that should be respected by the nurse. Although much of the debate lies in the discussion of cases where people are unable to make choices about their own treatment due to being incapacitated or having a mental illness that affects their judgement. A suggested way to maintain autonomy is for the person to write an advance directive, outlining how they wish to be treated in the event of them not being able to make an informed choice, thus avoiding unwarranted paternalism. Another theme is confidentiality and this is an important principle in many nursing ethical codes. This is where information about the person is only shared with others after permission of the person, unless it is felt that the information must be shared to comply with a higher duty such as preserving life.[7] Related to information giving is the debate relating to truth telling in interactions with the person in care. There is a balance between people having the information required to make an autonomous decision and, on the other hand, not being unnecessarily distressed by the truth. Generally the balance is in favour of truth telling due to respect for autonomy, but sometimes people will ask not to be told, or may lack the capacity to understand the implications Finally, the role of empirical ethics has become prominent in recent years. By giving consideration to the themes above, the nurse can endeavour to practice in an ethical way. Unfortunately,this key outcome in nursing practice is sometimes challenged by resource, policy or environmental constraints in the practice area, which can lead to moral distress.

THEME №2. Specific concepts of ethics and nursing tasks

Roles and Functions of the Nurse
What exactly does a nurse do? Your answer probably depends on the experiences that you have had in the past. Most people think a nurse is someone who gives a shot at the doctor’s office – or simply is a doctor’s assistant. Furthermore, images of nurses in the media also paint a different picture of who a nurse really is. However, a nurse has a number of roles that he or she performs, often at the same time, depending on a patient’s needs. With all of the changes in healthcare over the last few decades, that role has expanded even more. Let’s explore a few of these roles.
As a caregiver, a nurse provides hands-on care to patients in a variety of settings. This includes physical needs, which can range from total care (doing everything for someone) to helping a patient with illness prevention. The nurse maintains a patient’s dignity while providing knowledgeable, skilled care. In addition, nurses care holistically for a patient. Holistic care emphasizes that the whole person is greater than the sum of their parts. This means that nurses also address psychosocial, developmental, cultural, and spiritual needs. The role of caregiver includes all of the tasks and skills that we associate with nursing care, but also includes the other elements that make up the whole person. Decision Another role of the nurse, as a decision maker, is to use critical thinking skills to make decisions, set goals, and promote outcomes for a patient. These critical thinking skills include assessing the patient, identifying the problem, planning and implementing interventions, and evaluating the outcomes. A nurse uses clinical judgment – his or her ability to discern what is best for the patient – to determine the best course of action for the patient. Communicator As a communicator, the nurse understands that effective communication techniques can help improve the healthcare environment. Barriers to effective communication can inhibit the healing process. The nurse has to communicate effectively with the patient and family members as well as other members of the healthcare team. In addition, the nurse is responsible for written communication, or patient charting, which is a key component to continuity of care.
Patient Advocate being a patient advocate may be the most important of all nursing roles. As a patient advocate, the nurse’s responsibility is to protect a patient’s rights. When a person is sick, they are unable to act as they might when they are well. The nurse acts on the patient’s behalf and supports their decisions, standing up for his or her best interests at all times. This can empower a patient while recognizing that a patient’s values supersede the health care providers’.
Communication was measured by two dimensions: openness and accuracy. Communication openness refers to “the degree to which physicians or nurses are able to ‘say what they mean’ when speaking with members of the other group, without fear of repercussions or misunderstanding” [19, page 712].” Four questions on the survey instrument addressed the openness of communication among nurses and four additional questions considered the openness of communication between nurses and physicians. Each item was measured by a 7-point Likert scale with anchors 1 (strongly disagree) to 7 (strongly agree). Communication accuracy refers to the “degree to which nurses and physician believe in the accuracy of the information conveyed to them by the other party .” Four questions on the survey instrument addressed the accuracy of communication among nurses and four additional questions considered accuracy of communication between nurses and physicians. Each item was measured by a 7-point Likert scale (1, strongly disagree, to 7, strongly agree). Validity and reliability of the instrument had been previously reported. Reliability estimations in this study also supported consistency in the items: open communication among nurse andbetween nurses and physicians, accuracy of communication among nurses and between nurses and physicians.
Nursing Characteristics
Nursing characteristics included in this study were education, years of experience, and self-reports of expertise. Level of education was measured categorically with the following options being present: diploma, associate’s degree, bachelor’s degree master’s degree, or higher. Nursing experience was measured through a single-item question: How many years have you been working in your current job category? The final measure of nursing expertise required the nurses to identify their perceived level of expertise on a 10-point scale with anchors novice (1) to expert (10). Respondents were asked to circle the number on the scale that best reflects his/her level of expertise. Other nursing characteristics included in the study were job category (e.g., LPN or RN), unit of employment, and shift worked (e.g., day, evening, night, or rotating).
Environmental Values
The previous literature has identified environmental values as important precursors to the development of effective communication and collaborative relationships, including trust, respect, power equity, and time availability. Questions related to each of these values was developed and measured by a single question on a 7-point Likert scale with anchors strongly agree to strongly disagree . Data from this study supported a highly positive correlation between the four factors, as noted by the following correlation values: trust and respect , trust and time , trust and status ), respect and time, respect and status, and finally time and status for each bivariate association. This supported the development of an overall environmental value variable, which was the combined average of each of the unit value items (per nurse). Reliability estimation for the environmental value variable was considered well above the acceptable range.
Prior to distribution of the survey, nurses were presented with a 10-minute overview of the study. This overview was given to each unit at four different times of the day, in an effort to attain maximum participation. Upon completion of the in-service, each nurse received a copy of the survey. A reminder was placed in each nurse’s mailbox two weeks after the initial survey distribution in an effort to increase response rate. A secure box was also placed in the nursing lounge of each unit for completed surveys.
Data were analyzed with SPSS 18.0. Descriptive statistics were used to examine the demographics of nurses; analysis of variance (ANOVA) and chi-square tests were performed to test homogeneity of unit characteristics. To identify the difference in communication between nursing characteristics, -tests were performed. Hierarchical multiple regression analysis was conducted to identify predictors of openness and accuracy of communication. A test for multicollinearity was conducted using tolerance and VIF; no multicollinearity was identified. Residual analysis identified a normal distribution, linearity of residual, and homoscedasticity of errors. A significant value below 0.05 was considered statistically significant.

THEME № 3 Basic principles of communications
Communication is a two-way process of giving and receiving information through any number of channels. Whether one is speaking informally to a colleague, addressing a conference or meeting, writing a newsletter article or formal report, the following basic principles apply:
• Know your audience.
• Know your purpose.
• Know your topic.
• Anticipate objections.
• Present a rounded picture.
• Achieve credibility with your audience.
• Follow through on what you say.
• Communicate a little at a time.
• Present information in several ways.
• Develop a practical, useful way to get feedback.
• Use multiple communication techniques.
Communication is complex. When listening to or reading someone else’s message, we often filter what’s being said through a screen of our own opinions. One of the major barriers to communication is our own ideas and opinions. There’s an old communications game, telegraph, that’s played in a circle. A message is whispered around from person to person. What the exercise usually proves is how profoundly the message changes as it passes through the distortion of each person’s inner “filter.”
Environmental factors
Communication can be influenced by environmental factors that have nothing to do with the content of the message. Some of these factors are:
• the nature of the room, how warm it is, smoke, comfort of the chair, etc
• outside distractions, what is going on in the area.
• the reputation/credibility of the speaker/writer.
• the appearance, style or authority of the speaker.
• listener’s education, knowledge of the topic, etc.
• the language, page layout, design of the message.
People remember:
• 10% of what they read
• 20% of what they hear
• 30% of what they see
• 40% of what they hear and see
Principles of Effective Persuasion
Whether making a formal presentation at a meeting or writing a report or fact sheet, the following principles hold.
• Do not oversell or overstate your case. Make effective use of understatement.
• Outline the topic you are trying to cover into two parts. The first part should give broad background information, while the second part provides a detailed summary.
• Persuasion depends on clarity and simplicity. Avoid the use of jargon and buzz words.
• Be prepared to back up claims or facts immediately.
• Incorporate major anticipated objections into your program or presentation.
• Address all relevant aspects of a topic, especially those that may affect the functioning of an organization.
• Use graphics and audiovisuals appropriately.
• Consider ways to get meaningful input from people. Find out what they think about the innovation or change.
• In order to conduct a thorough observation and examination of a patient, fine-tuned listening skills are a must for a nurse. Not only is it important for a nurse to listen to orders given by a physician, but to also pay attention to the verbal cues of patients, as well as the remarks of their relatives.
• “As a pediatric nurse by background, I had to rely on the identification of subtle changes in infants and children to ensure quality care and outcomes,” says Emon. “That included refining my listening skills relating to family members.”
• “No matter how much time a nurse spends with a patient, they will never know the patient at the emotional depth that a loved one does,” adds Emon. “When a family member comments that something seems different, it is as critical as a monitor alarm going off.”
• As a caregiver, nurses cannot deliver adequate care if they lack proper communication, which goes beyond the act of simply speaking with a patient.“Good communication skills and being a good listener are a must because what you say and how you say it, and what you hear from a resident, a family member, physician or a team member could have a profound effect on clinical care,” says Love.For example, using a soft, polite voice makes patients feel at ease during appropriate times, whereas a firmer tone is necessary when explaining medication and discharge instructions.
• “Critical thinking skills are so important as a nurse,” says Kavalam. “For example, if a patient complains of chest pain, you can’t just call the doctor and relay that sentence…”
• Kavalam says that doctors have follow-up questions and orders that a nurse must anticipate which include possible pain triggers, pain ratings, vital signs, telemetry reading, EKG, and acknowledging other physical signs of the patient.“…so you have to be a detective trying to figure out the cause and be mighty quick about it,” says Kavalam.
“Time management skills are crucial as a nurse,” says Kavalam, “from a hospital floor where you can have 6 to 12 patients to an ICU where you can have 1 to 3 patients sometimes in a 12 hour shift.”“You have to hit the ground running as there are set items to do, such as patient assessments, documentation, medications to give, procedures to do… [and] repositioning patients every two hours,” says Kavalam. “Then layer on doctors needing your assistance at the bedside [and] chasing down items they requested for procedures.”In addition to tending to new patient arrivals, Kavalam also says that patient’s families often request updates and emotional support. This can take time away from a nurse managing patient care.“Layer on top actual patient emergencies and problems,” says Kavalam, ” and at times the nurse doesn’t have time to even go to the bathroom – you have to find coverage from another nurse before you can leave the floor.”Time management skills also helps a nurse evade workplace burnout by increasing his or her ability to avoid creating stressful situations that can drain overall levels of energy and enthusiasm.
• From rushing to the aid of an emergency to being able to help lift a patient from bed to wheelchair, nurses are expected to maintain a certain level of physical strength and endurance.
• All nurses are in a position to lead regardless of his or her title, and effectively developing leadership skills allows a nurse to better steer patients towards wellness and away from sickness, guide new co-workers, and even lead physicians towards achieving a better understanding of their patients.To enhance personal leadership skills, a nurse must develop as an individual first, and then experience growth, enhance communication skills, increase self-confidence, and exhibit a bit of valor as well.Catherine Robinson-Walker, best-selling author and expert in healthcare leadership, touches upon the importance of nurse leadership in her latest book, Leading Valiantly in Health Care, published by STTI Honor Society of Nursing. One point she addresses is the significance of strong leaders being able to contemplate the role they play in the problems and challenges they encounter in the workplace.“Keeping up with the demands of providing quality patient care is, by itself, both an inspired calling and a daily challenge,” Robinson-Walker writes. “We have natural tendencies to become too attached to attitudes and strategies that just don’t work.”As a result, Robinson-Walker says “common leadership pitfalls” tend to follow, which she refers to as “Leadership Seductions.” She identifies the following six “seductions” that hinder the ability of a nurse to effectively lead, and to make a difference with patients and amongst co-workers

THEME № 4. Main objectives of the health deontology
The deontologist, like the utilitarian is looking for an objective basis to ground all moral actions. Unlike a utilitarian, though, a deontologist would completely reject the idea that the goodness or badness of an act can be determined by its consequences. For the deontologist there must be something intrinsic to the act itself that determines its moral status. Wrong actions are wrong per se and actions which are right are not necessarily those which maximise the good. Deontology identifies those actions which are wrong even if they produce predicted or actual consequences, and are right simply because of the kind of actions that they are.
Deontology takes several forms, these include:
Rights – an action is morally right if it respects the rights which all humans have. This is known as Libertarianism, a political philosophy which claims that people should be free to act as they wish, as long as their actions do not impact on the rights of others.
Contractualism – an action is morally right if it is in agreement with the rules that rational moral agents would accept onto a social relationship or contract.
Divine command ethics – an action is morally right if, and only if, it is in agreement with the rules and duties established by God.
Monistic deontology – an action is morally right if it agrees with a single deontological principle which guides all other principles. Duty – an action is morally right if it coheres with a set of agreed duties and obligations. The deontologist is not simple obliged to perform actions which are good in themselves, they must also refrain from performing actions which are known to be wrong. These are known as deontological constraints, or what we more commonly call rules or laws. Obedience to these constrains is totally inflexible. A deontologist will maintain that we are not permitted to violate a rule or constraint even if serious harm will otherwise occur. No-one can be favoured and the preservations of another’s life is less important than the preservation of out own virtue. Hence, for example, a deontologist cannot lie even when the lie would prevent the loss of several innocent lives. Deontology constraints or laws are always formulated as negatives: ‘do not’ rather than ‘do’. These constraints start to define what is obligatory or what constitutes our duty. Deontology therefore consists of two strands – identifying what is permissible and what is impermissible. Immanuel Kant’s theory of ethics is considered deontological for several different reasons. First, Kant argues that to act in the morally right way, people must act according to duty. Second, Kant argued that it was not the consequences of actions that make them right or wrong but the motives of the person who carries out the action. Kant’s argument that to act in the morally right way, one must act from duty, begins with an argument that the highest good must be both good in itself, and good without qualification. Something is ‘good in itself’ when it is essentially good, and ‘good without qualification’ when the addition of that thing never makes a situation ethically worse. Kant then argues that those things that are usually thought to be good, such as intelligence, perseverance and pleasure, fail to be either essentially good or good without qualification. Pleasure, for example, appears to not be good without qualification, because when people take pleasure in watching someone suffering, this seems to make the situation ethically worse. He concludes that there is only one thing that is truly good:
“Nothing in the world—indeed nothing even beyond the world—can possibly be conceived which could be called good without qualification except a good will.”

THEME№ 5. Communication skills and personal characteristics of a nurse
The real meaning of communication is getting the receiver and the sender tuned together for a particular message. Communication takes place when one person transfers some understandable data to another person. It also includes the exchange of thoughts, opinions, sentiments, facts, and information between two or more persons. Feedback is very important as it assures that your message should be properly conveyed to the receiver. The essential features of an effective communication system are keys for productive communication. The chief principles or characteristics of an effective communication system are as follows:
– Clearness and integrity of message to be conveyed.
– Adequate briefing of the recipient.
– Accurate plan of objectives.
– Reliability and uniformity of the message.
– To know the main purpose of the message.
– Proper response or feedback.
– Correct timing.
– Use of proper medium to convey the message properly.
– Use of informal communication.
The following are some important guidelines to make communication effective:
– Try to simplify your thoughts before communicating your message.
– You must analyze the intent of each and every message.
– Consider the overall physical setting whenever you communicate.
– You must discuss with others, where appropriate, in planning communication.
– Be careful while communicating, of the overtone as well as basic content of your message.
– Take the opportunity to suggest something of help or value of the receiver.
– Follow-up your communication.
– Prepare yourself for transmitting the message in a proper way.
– Be sure your actions support your communication.
– Seek not only to be understood but understand.
Effective communication is crucial for the success of an organization. Communication takes place when one person transfers data and understanding to another person. An effectual communication is one which is properly followed by the ‘receiver of the message and his feedback is known to the ‘sender’ or transmitter. The below are some points that may be taken to lessen communication barriers for making it more valuable:
– It is very important to be familiar with the ‘audience’ for whom the message is meant. The message to be communicated must be clear in the mind of the communicator because if you don’t comprehend an idea, you can never convey it to other person. The message should be adequate and apposite towards the communication purpose.
– In order to avert semantic barriers, the message should be conveyed in easy, concise and understandable language. The expressions or signs chosen for communicating the message must be suitable to the reference and understanding of the recipient.
– To make business communication effective, the structure of the organization must be sound and suitable to the requirements of the organization. The management should make efforts to make communication process more effective and understandable.
– To avoid creditability gap, management must guarantee that their procedures and activities are in accordance with the communication. Communication is not complete unless the reply or response of the receiver of the message is received by the sender or communicator. The success of communication can be evaluated from the reaction. Therefore, feedback must be bucked up and examined.
Communication through words may be in writing or oral. Written communication entails transmission of message in black and white. It mainly consists of diagrams, pictures, graphs, etc. Reports, policies, rules, orders, instructions, agreements, etc have to be conveyed in written form for proper functioning of the organization. Written communication guarantees that everyone concerned has the same information. It provides a long-lasting record of communication for future. Written instructions are essential when the action called for is crucial and complex. To be effectual, written communication should be understandable, brief, truthful and comprehensive. The main advantages and disadvantages of written communication are as follows: –

 Intra verbal: intonation of word and sound
 Extra verbal verbal: implication of words and phrases, semantics
 Gestures
 Postures
 Unwillingness to say things differently
 Unwillingness to relate to others differently
 Unwillingness to learn new approaches
 Lack of Self-Confidence
 Lack of Enthusiasm
 Voice quality
 Prejudice
 Disagreement between verbal and non-verbal messages
 Negative Self Image
 Lack of Feedback
 Lack of Motivation and Training
 Language and Vocabulary Level
 Lack of Self Awareness
 Selective Perception
 Unwillingness to Change
 Lack of Interest in the Topic/Subject
 Prejudice & Belief System
 Rebuttal Instincts
 Personal Value System
 Here-and-Now internal & external factors
External Barriers in Communication
 Environment
 The venue
 The effect of noise
 Temperature in the room
 Other People – Status, Education
 Time
5 Basic reasons we Do Not Listen
 Listening is Hard Work
 Competition
 The Rush for Action
 Speed differences (120 wpm v/s 360 wpm)
 Lack of Training
4 Levels of Listening
 The Non-Listener
 The Marginal Listener
 The Evaluative Listener
 The Active Listener
Improving Listening Skills
 By not being Preoccupied
 Being Open Minded & Non Defensive
 Minimizing Interruptions
 Effective Listening is: Hearing, interpreting when necessary, understanding the message and relating to it.
 By Asking Questions

THEME № 6. Basic communications skills
1 – Speak Slowly
Certain words sound very similar to one another if they are spoken very quickly. Take the time to speak slowly and carefully, and your words may be less likely to be mistaken by others.
2 – Speak Clearly, Not Loudly
With some people, especially those who are elderly, the inclination might be to raise your voice dramatically in an effort to make them understand you. Shouting only tends to make it harder to comprehend what you are saying. Instead of speaking louder, try speaking more clearly, especially whencommunicating with older patients.
3 – Avoid Using Slang
A common mistake that many people make is to try to use bigger and more complicated words. Another common mistake is to try to use slang terms that are not fitting or appropriate. Avoid both of these mistakes for better communication.
4 – Remember Your Audience
What you might say to a doctor or a fellow nurse might be very different from what you would say to a patient or a patient’s family. For example, use the word ‘medicine’ rather than ‘drug’ when talking to patients. Many people associate the word ‘drug’ with illicit substances, whereas health professionals view the word ‘drug’ as any pharmaceutical preparation. Choose your words to fit the situation and the audience.
5 – Stop and Listen
One of the most important skills you can have for effective communication is being able to actually stop and listen to what is being said by the other person. Listening is a very powerful communication tool.
6 – Reflect
To make sure that the communication is flowing, learn the simple trick of reflecting on what the person is saying to you. To do so, you simply repeat what has been said in your own words, back to the person. If you are wrong, the person can say so before you walk away.
7 – Use Body Language
In addition to the words that you say, you communicate with those around you with your face, your hands your posture etc. Make sure that what you are saying and what your body is saying are in agreement, and you are not sending conflicting messages.
8 – Know Your Communication Roadblock
If you have ever stumbled on a word or you have ever found yourself so frustrated that you could not communicate at all, then you know the roadblocks. Everyone has a few of them, knowing yours can help you to find ways around those issues. For instance, if you know that a person crying will effectively make your communication skills disintegrate then learn ways to manage such situations better.
9 – Consider Learning a Foreign Language
It might sound strange but learning a new language puts you in better touch with your native tongue and can open your eyes to the way you use the words you already know.
10 – Don’t Forget Other Methods of Communication
In addition to speaking and listening, don’t forget that there are other skills that you should work on such as reading and writing.
Communication can be defined as a transaction and message creation. The entire process occurs in a context consisting of physical space, cultural and social values and psychological conditions . Communication assists in the performance of accurate, consistent and easy nursing work, ensuring both the satisfaction of the patient and the protection of the health professional. When health professionals are not trained in communication skills, they face more difficulties separating work from their personal life, tending to transfer problems from one side to the other.
Communication is an intrinsic characteristic of human nature. Nobody cannot communicate. Communication has content and value. The contents regards to what was said, whilst the relationship regards as to how it was said. The nature of the relationship depends on how the two parties understand the communication sequence. Communication is never unidirectional. It is an interaction in which each sender becomes receiver and vice versa. The failure to recognize the two-way communication capability, quite often leads to negative conclusions and attitudes.
Moreover, the message sent is not the same as the message received. The decoding of the messages is based on individual factors and subjective perceptions. This fact, in conjunction with the process of feedback makes communication. We interpret something that we heard not according to what the sender actually said but according to our own code . Particular attention should be given by the caregivers to use technical terms and medical terminology during their contact with the ill, because it is often found that the patient ascribes different interpretations to what he hears or even more cannot understand what is meant exactly, mainly by the therapist, thus increasing mental stress, a fact which makes it more difficult to communicate with the patient.
Communication happens without words. It is an ongoing process. This non-verbal communication is expressed by facial expressions, gestures, posture and physical barriers such as distance from the interlocutor. It is important that there is an agreement between verbal and nonverbal communication. Particularly under stressful conditions where it is difficult to see the changes in the non-verbal messages of the patients with whom we mostly communicate . Moreover, each patient has his own specific characteristics that influence not only behavior in the process of communication, but also if and how to cooperate with nursing services and how they will undertake self-management of health .
Listening is important in communication. It is responsible nursing practice and requires concentration of attention and mobilization of all the senses for the perception of verbal and non-verbal messages emitted by each patient. By listening, nurses assess the situation and the problems of the patient; they enhance his/her self-esteem and integrate both the nursing diagnosis and the process of care at all levels.
Good personal relationships are described as the ability of the nurse to ask questions with kindness and provide information in a way that does not scare, that demonstrates interest, creates feelings of acceptance, trust and a harmonious relationship, especially in modern multicultural society. The therapeutic relationship is an important prerequisite to effective communication between health professionals and patients in order not only to transmit information, but also to effectively address mental processes which are activated by it. The communication between health professionals and patients include the ability to express sincere concern for the care of the patient and the patient becomes a partaker of this interest.

THEME № 7. Specific features of communication with the elderly
Talking with our elderly parents about their living situations and the possible need for change is not always easy. A successful conversation depends to an extent upon the relationship we have with the parent, as well as on the parent’s mental, emotional, and physical condition. While many people put off serious conversations to avoid conflict or awkwardness, both parent and adult child may lose an opportunity for closeness, understanding, access to information that may affect the decision, and optimum peace of mind.
To the extent possible, talk with your elderly parents gently and honestly about their wishes, their abilities and their options. Far more often than not, these conversations are helpful and put the adult child in a better position to make decisions later when the parent may not be able to do so. The following are suggestions for conversations with your elderly parent:
• Share your own feelings and reassure the parent that you will support them and help them solve their problems.
• Help the parent to retain whatever control is possible in making his or her own decisions. Respect and try to honor their wishes wherever feasible.
• Encourage the smallest change possible at each step so that the parent is more able to adjust to the change.
• Educate yourself on legal, financial, and medical matters that pertain to your parent as background for your conversations, including current knowledge on the aging process.
• Respect your own needs and be honest with your parents about your time and energy limits.

Physicians and geriatric social workers warn that there are a number of danger signs that indicate an elderly person needs extra help or a change in living arrangement. Any marked change should be noted; however, no change in lifestyle should be made without discussions with the elderly person, other family members, and doctors or other health professionals.
Danger Signals
• Sudden weight loss could be an indication that the elderly person is simply not eating or not preparing foods.
• Failure to take medication or overdosing may indicate confusion, forgetfulness, or a misunderstanding of the doctor’s instructions.
• Burns or injury marks may indicate physical problems involving general weakness, forgetfulness, or a possible misuse of alcohol.
• Deterioration of personal habits such as infrequent bathing and shampooing, not shaving, or not wearing dentures could be the result of either mental or physical problems.
• Increased car accidents can indicate slowed reflexes, poor vision, physical weakness, or general inability to handle a vehicle.
• General forgetfulness such as not paying bills, missing appointments, or consistently forgetting name, address, phone number, and meal times could be a signal.
• Extreme suspiciousness could indicate some thought disorder. Your parents thinking that their neighbors, friends, family, doctor, and lawyer are all conspiring against them would be an example. Intense ungrounded fears about dire consequences may be a danger signal.
• A series of small fires could be caused by dozing off, forgetting to turn off the stove or appliances, or carelessness with matches. They may indicate blackouts or dizzy spells.
• Bizarre behavior of any kind could be a warning sign. This behavior could be dressing in heavy gloves and overcoat in 90 degree weather or going outside without shoes when it’s snowing. Watch for uncharacteristic actions or speech.
• Disorientation of a consistent nature may indicate a need for help. Examples include not knowing who one is, where one is, who the family is, or talking to people who are not there.
Aging in Place
Options such as Naturally Occurring Retirement Communities (NORCs), apartment buildings, condominiums, or cooperatives not designed as retirement communities but where at least 50 percent of the residents are 62 years old or older (which often include amenities such as grocery stores, pharmacies, limousine service, or shopping services on the premises) and/or recent technological advances (such as Velcro fasteners, lightweight wheelchairs, walk-in bathtubs, devices to control appliances, and dial telephone numbers) are available to help the elderly person stay in his/her home often make aging in place easier.
• Home care services are available in many communities, providing appropriate, supervised personnel to help older persons with either health care (giving medications, changing dressings, catheter care, etc.) or personal care (bathing, dressing, and grooming).
• Meals and transportation are available to older people to help them retain some independence. Group or home-delivered meal programs help ensure an adequate diet. Meals-On-Wheels programs are available in most parts of the United States. A number of communities offer door-to-door transportation services to help older people get to and from medical facilities, community facilities, and other services.
• Adult day care is similar to child day care. The elderly person goes to a community facility daily or two to three days per week. Activities include exercise programs, singing, guest lectures, and current events discussions. Cost varies and there are often long waiting lists at such centers.
• Respite care brings a trained person into the home to allow the full-time caregiver time off to get a haircut, visit the dentist, or take a vacation. Service is generally offered through area Departments of Social Services and is based on a sliding fee scale.
Other Housing Options
There are several types of retirement communities that provide living arrangements and services to meet the needs of both independent seniors and those who need assistance. It is important when investigating these housing options to understand completely the services provided and the cost.
• Adult congregate communities are designed for the fully able-bodied, 55 and older. Residents buy co-ops or condominiums and pay a monthly fee for grass mowing, leaf raking, and snow shoveling. A pay-as-you-go medical center is on site and a nurse is on duty 24 hours a day to make home visits in emergencies. Leisure World is the most famous example of an adult congregate community.
• Assisted living communities are rental retirement communities for independent seniors who need some assistance. A homelike atmosphere, three meals a day, maid, linen, and laundry service, availability of a registered nurse, and many personal care services are provided in the all-inclusive rent.
• Rental retirement communities with fee-for-service nursing units charge residents an entrance fee plus a substantial monthly rent. When the need for nursing care arises, residents pay an extra daily fee and stay in a nursing unit, usually located on site or nearby.
• Life care or continuing care communities provide a continuum of care from independent living to nursing home care on the premises. The individual must be independent when s/he enters the community. These communities require a substantial entrance fee and monthly service fee. Residents get one meal a day in a dining room, maid service, linen service, maintenance, transportation to shopping and cultural events, travel planning, and a pull cord to an emergency nurse. If nursing care is needed, it is provided at no extra cost.
• Personal care homes (board and care) are licensed in many communities to provide shelter, supervision, meals, and personal care to a small number of residents.
• Subsidized housing for the elderly is an option for the elderly poor in reasonably good health. Subsidized by Department of Housing and Urban Development, income limits apply. No round-the-clock care is provided but nurses come in to check blood pressure and assess a resident’s functioning. Residents take meals in a dining room and may have use of a library, recreation area, or beauty shop.
Nursing Facilities
If the elderly person is not capable of independent living, a nursing home may be the appropriate option. Nursing homes offer two levels of care – skilled nursing and intermediate care – depending on the patient’s needs. Most nursing homes offer both levels of care on a single site.
• Skilled nursing facilities provide 24-hour nursing services for people who have serious health care needs but do not require the intense level of care provided in a hospital. Rehabilitation services may also be provided.
• Intermediate care facilities provide less extensive health care than skilled nursing facilities. Nursing and rehabilitation services are provided but not on a 24-hour basis. These facilities are for people who cannot live alone but need a minimum of medical assistance and help with personal and/or social care.
Paying for Long-Term Care
It is important to understand the different types of insurance that are available to older people. Many people believe that Medicare will cover long-term care needs. It will not.
Medicare is a Federal health insurance program, which helps defray many of the medical expenses of most Americans over the age of 65. Medicare has two parts:
Hospital Insurance helps pay the cost of inpatient hospital care. The number of days in the hospital paid for by Medicare is governed by a system based upon patient diagnosis and medical necessity for hospital care. Once it is no longer medically necessary for the person to remain in the hospital, the physician will begin the discharge process. If the person or the family disagrees with this decision, they may appeal to the state’s Peer Review Organization.
Medicare does not pay for custodial care or nursing home care. It will, however, cover up to 60 days in a nursing home as part of convalescence after hospitalization.
Medical Insurance pays for many medically necessary doctors’ services, outpatient services, and some other medical services. Enrollees pay a monthly premium.
Medicaid is a joint federal-state health care program for people with a low income. The program is administered by each state and the type of services covered differs. There are strict income requirements so it is necessary for the person to “spend down” all income and assets to poverty levels before becoming eligible. Medicaid is the major payer of nursing home care.
The Medicaid requirement to “spend down” all income and assets created a great hardship for the spouse of a person needing nursing home care. Changes in the Medicaid rules now allow the spouse to keep a monthly income and some assets, including the primary residence. The amounts allowed change, so you must check for current levels.
Communication between health officials-in this case nurses-and patient is a process that begins with the first contact of the two and lasts as long as the therapeutic relationship. The nurse, who wants to create the right relationship with the patient, must win him/her from the first moment. This will happen if the conversation is held in appropriate conditions. Even though it seems obvious, it should be noted that courtesy and kindness on part of the nurse is required.
The patient should feel comfortable with the nurse, but the latter should protect his/her prestige and not give rise to misunderstandings. A key element is the need for a peaceful environment with no external distractions, which will ensure appropriate confidentiality of the dialogue. Frequently we see the phenomenon of serious discussions taking place in the middle of the corridor of the outpatient department or the nursing department, clinic, or in some office of the hospital, in which third parties unrelated to the care of the individual patient are coming in and out. In such an environment the patients are ashamed to express themselves freely.
Unfortunately, the concept of privacy is pretty much unknown to the Greek hospital system. Skilled nursing operations for the patients are made in chambers without screens or in hallways, in front of others. Patients and visitors of hospitals move without restriction in all the areas of the nursing and clinical departments. However, it is up to us to teach our colleagues and especially the new nurses and their patients setting the right example, in order for things to slowly change for the better.
Even more than the comfort of space, communication with the patient requires ample time. Each patient has his own way and pace to reveal his problem, but it takes some time to get to know the nurses and feel the confidence necessary to face them. The patient should have the feeling that the time-whether it is five minutes or an hour-is entirely his. The patient who has the undivided attention of the nurse reveals his problem sooner, with the satisfaction that the nurse has listened and observed him. After the nurse has listened to the ill, he/she should also talk to him. The language he uses for this purpose is very important. Often the patient is bombarded with big words with little or no significance for him. Once again the nurse may be directed to the ill in an incomprehensible way. Patients that are ashamed of their ignorance or are hesitant, avoid seeking an explanation, and as a result the consultation is inadequate and does not lead to the right outcome for the patient. The language of communication should therefore be at the level of the listener, who is not able to assess our scientific knowledge, but has to understand what we are telling him.
Another important requirement for proper and successful communication between nurses and patients is frankness and honesty. The discussion with the patient should leave no suspicions, doubts and misunderstandings. For example, if the patient suspects that while chatting with him we are making gestures to an escort, he/she will suspect that we are not telling him the whole truth. Where there is a need for a separate and private discussion with someone from the patient’s environment, we should be very careful of the place, manner and time of this communication, which should be independent of the discussion with the patient.
Communication as already stated is bidirectional, but the nurse or other health professional is responsibility for its proper conduct. The patient comes into the dialogue under stress and the emotional events he/she is facing. Moreover, depending on the psychosynthesis it can be more or less calm. Reactions such as anger, disbelief, moaning, aggression and denial of reality are known defence mechanisms, which are recruited to help him adjust to the new situation he is facing. The angry patient usually does not have any previous personal differences with health professionals, although they are the direct recipients of his anger. The latter should understand and accept these mechanisms which serve the underlying anxiety of the patient and to respond with information, awareness and readiness to provide all possible assistance.
Finally, people differ in their needs for communication. Some expect or require patient listening, without caring much about the answers. Others want a specific explanation for everything that happens to them. These different needs should be treated accordingly by the nurses, who should be able to detect what each patient wants. What of course in any case should be avoided by the caregivers is silence and indifference to the questions of the patient. In the best cases, the patient will leave disappointed and in the worst really indignant with nurses.
Patient Education
In addition to administering treatments, nurses must explain to patients the medications and treatments they’re receiving. Nurses often have more day-to-day contact with patients than their doctors, so it’s up to nurses to help patients understand their diagnosis and prognosis and teach them how to participate in their recovery. Nurses must also tailor their communication to the patient’s ability to understand. A small child or an elderly patient with dementia, for example, will have more difficulty grasping her situation. In addition, nurses must be skilled in listening to patients, especially regarding their symptoms or concerns.
Cultural Differences
Nurses work with patients from diverse backgrounds, including those from other countries, cultures and religions. They also frequently treat patients who don’t speak English. To ensure effective communication, nurses must consider each patient as an individual instead of approaching them in a one-size-fits-all way. Some cultures, for example, don’t speak openly about private health matters, so nurses might have to be more discreet. Also, some cultures disapprove of physical contact between strangers, so if a nurse pats a patient’s hand to comfort him, he may take offense.
Body Language
When people think of effective communication, they often consider what they say and how they say it, but verbal communication is only part of the equation. Body language plays an equally important role in making a connection with patients and fellow health care workers. If a nurse looks at her watch or makes very little eye contact when talking to a patient, he may feel she’s not taking an interest in his case or that he’s imposing on her by asking questions or discussing his symptoms. When talking to co-workers, similar behaviors may be interpreted as a sign of disrespect. It’s important that nurses consider non-verbal cues, taking the time to make eye contact, smile and stop what they’re doing to focus their attention on the other person.t’s no secret that as baby boomers age and Americans live longer, health care professionals will feel the strain of an overused and understaffed system. According to the American Hospital Association’s Hospitals & Health Networks, “About 3 million baby boomers will hit retirement age every year for about the next 20, and will affect how caregivers and policymakers shape the health care system for decades to come.” To put it another way, in 15 years we will be caring for 73% more retirees than we are today. While the medical care of baby boomers creates many looming and important questions for society, it also ensures that careers in the health care sector will be more necessary and abundant than ever. The outlook for certified nursing assistants is very strong, as they work in all forms of health care: nursing homes, hospice care, hospitals, home care, assisted living and more. Anyone who has set foot in a doctor’s office or hospital knows that nurses and nursing assistants are picking up extra duties due to understaffed offices. If you or someone you know is considering a career as a certified nursing assistant, it’s important to examine these unique and important traits that will help you succeed.
Ability to Adapt
Not only is the health care system changing, but every single day brings different encounters and challenges for nurses or nursing assistants. One day the nursing assistant may work primarily with a handful of patients, but he or she may be working with dozens the next week. Over the course of a couple of hours, a nursing assistant may take vital signs, change bedding, feed meals and complete patient intake forms. No two days in nursing are the same and you have to be able to adapt without any adverse effect on the patients or practice.
t’s no secret that as baby boomers age and Americans live longer, health care professionals will feel the strain of an overused and understaffed system. According to the American Hospital Association’s Hospitals & Health Networks, “About 3 million baby boomers will hit retirement age every year for about the next 20, and will affect how caregivers and policymakers shape the health care system for decades to come.” To put it another way, in 15 years we will be caring for 73% more retirees than we are today. While the medical care of baby boomers creates many looming and important questions for society, it also ensures that careers in the health care sector will be more necessary and abundant than ever. The outlook for certified nursing assistants is very strong, as they work in all forms of health care: nursing homes, hospice care, hospitals, home care, assisted living and more. Anyone who has set foot in a doctor’s office or hospital knows that nurses and nursing assistants are picking up extra duties due to understaffed offices. If you or someone you know is considering a career as a certified nursing assistant, it’s important to examine these unique and important traits that will help you succeed.

Ability to Adapt
Not only is the health care system changing, but every single day brings different encounters and challenges for nurses or nursing assistants. One day the nursing assistant may work primarily with a handful of patients, but he or she may be working with dozens the next week. Over the course of a couple of hours, a nursing assistant may take vital signs, change bedding, feed meals and complete patient intake forms. No two days in nursing are the same and you have to be able to adapt without any adverse effect on the patients or practice.
As a nursing assistant you will be dealing with people who are hurting every day. A natural compassionate spirit is a must-have personality trait for those in the medical field. Knowledge isn’t the only thing you need to do your job. Many nursing assistants work in nursing homes and urgent care centers, where your care and compassion can have just as much impact as taking care of that person’s physical needs. Patient charts and forms contain pages of important details that must be transcribed correctly. However, there are other ways to pay attention to detail as well. Has your usually impeccably-dressed patient been missing buttons and zippers, perhaps signaling a loss of dexterity? Did your patient mention a change in diet or sleep that should be examined further by their doctor? Do you have to repeat yourself to a patient, perhaps revealing memory issues that didn’t exist before? As a certified nursing assistant, you’ll spend more time with your patients than registered nurses, nurse practitioners and doctors. In fact, according to the National Network of Career Nursing Assistants, you’ll provide about 80-90% of direct care to the residents in your facility. Attention to detail is critical to the successful care of your patients. Nurse assistants need to communicate with a variety of audiences: patients, doctors, other nurses, patients’ families, facility administrators and more. With a patient, you may need to speak slowly and use basic terminology to help them understand your plan. With a doctor, you may need to give a quick summary while they are between patients. Understanding various situations and being an active listener are the foundations of clear, effective communication. Delivering important and sometimes emotional messages in an empathetic and diplomatic way is also a must-have skill for medical professionals.
Patience with Patients
Your grandmother may have always told you, “Patience is a virtue.” Many certified nursing assistants find that patience is the top skill they need to succeed. Your patients are often scared, sometimes very ill and maybe even suspicious of their new surroundings in assisted living or hospice. You may be the target of their aggression — you may be the one to bathe the woman with the worst attitude or feed the man who complains about everything. Controlling your reactions to patient behavior and maintaining a patient demeanor is critical to being a successful certified nursing assistant. It helps to always remind yourself that they aren’t frustrated or upset with you. They’re frustrated with their current circumstances.
Physical Strength
It might not seem like the largest feat to stand on your feet for over 10 hours at a time, but it certainly takes training and getting used to. You may also need to lift patients in and out of chairs, push a medicine cart, and complete other physically demanding tasks during your shifts. Regular exercise and a healthy diet is something you’ll talk to your patients about, so you might as well practice what you preach. Your body will thank you at the end of a long day, and you’ll set an example for your patients.
Emotional Strength
Nursing assistants are in high demand. The Bureau of Labor and Statistics reports that nursing assistant employment is expected to grow 21% from 2012 to. Given the high demand, nursing assistants are fortunate enough to easily find open jobs and switch jobs if necessary. While many nursing assistants list flexible work hours as one of the perks of the job, working three 12-hour shifts in a row is draining, even more so if working the overnight shift. On the bright side, you’ll have four free days ahead of you after the long hours. If a flexible schedule is one of the bonuses of nursing, working in understaffed facilities with high turnover is a chief complaint. Be prepared to have an over-stuffed schedule and deal with staff shortages.

Adaptation of “The national training program” of “ The law on education” demands improvement of the quality and contents of whole learning process. The modern technical equipment, information technologies and innovative teaching methods are widely used at present. The accordance of higher educated nurses prepared in the Republic of Uzbekistan to the world standards and the preparation of medical specialists which can meet the international medical requirements are one of the urgent issues of today. Binding together the theoretical and practical training provides positive results. Through new scientific knowledge, methods and ways related to the study of human activities, the nursing science teachers to maintain and strengthen the health of the population, to take care of patients, to responsibly approach the healthcare, the methods and tools focused on disease prevention and rehabilitation. Today, higher educated nurses are highly skilled nurses who have expert knowledge, clinical competence and are able to make complex decisions. This training manual contributes to student’s practical skills on the “Nursing” science

Morbi history – the history of the disease
Vita history – the history of life
Auscultation – heard auscultation method
The patient problem – in any case, the patient’s optimal position
Bioetica – human problems of modern medicine and the rights of Sciences.
Deontology – a concrete situation, the nurse morality, ethics and deontology, taking the behavior of self-control and case studies
Therapeutic diet food – some diseases may be the main type of treatment. Some nutrients use is one of the hereditary disorder or other types of claims.
Subjective data – the mind, the spirit, the concept of the idea of the needs of the patient and family.
Egogeniya – affect the patient’s disease due to self-
Egrotogeniya – mutual influence of patients
Epidemiological history- survey of the history of infectious diseases
Verbal skills – the ability to ask questions
Gospitalizm- the state of the disease and its conditions flexibility
Privacy – privacy
Objective data – as a result of their professional point of view of object tracking data collected by nurses
Nonverbal skills – to hear the spoken skills
Preventive- Prevention of diseases prevention
Diet – is designed as a method of treatment or prevention of complications and nutritional composition of the diet
Nursing care – on a regular basis will interfere with the process of achieving scientific and logical concepts yeg’indisi health seaching, including disease and death are seaching
Yatrogeniya – medical staff treated exercising his crass


Basic literature
1. Fundamental of nursing the art science of nursing care.
Carol Taylor., Carol Lilles., Priscilla Lemone
2. Advanced practice nursing.
Soanne V.Hickey., Ruth M.Oumette., Sandra L. Venegani
3. Medical – surgical nursing.
Suzanne C. Smeltzer., Brenda G. Bare

Additional Nye literature
1. Foundations community health nursing.
Community-Oriented practice
2. Nursing diagnosis Lynda quall carpenter 7th edition.