Deontological features of the activities of a local nurse. The role of ethics and deontology in the work of a nurse. Solving ethical and deontological problems in the work of a nurse

An important aspect of the interaction between a medical worker and a patient is ethics and deontology - the doctrine of the moral foundations of human behavior, including in conditions of diagnostic and therapeutic interaction. In addition, the most important problems are considered to be the problems of medical confidentiality, euthanasia, informing the patient of the true diagnosis of his disease, patterning MA, personality reconstruction in psychotherapy and others. Some of the listed problems can be attributed to the sphere of legal regulation of the diagnostic and treatment process. However, traditions existing in society often lead to their clash. For example, the need to inform a cancer patient about the true diagnosis of his disease, determined by a legal principle, often comes into conflict with the point of view of a doctor or community of doctors about the inhumanity of this action, about the need to use the principle of “holy lies” to maintain a psychologically comfortable state of the patient.

The qualifications of a medical worker include such qualities as the level of knowledge and skills that he possesses, and the use of moral principles in his professional activities. In no other specialty is there such interdependence of a person’s ethical and professional qualities.

Medical ethics and deontology are a combination ethical standards and principles of behavior of a medical worker when performing his professional duties. Ethics defines the laws of morality and ethics, violation of which often does not lead to criminal or administrative liability, but leads to a moral court, a “court of honor.” Ethical standards of behavior are quite dynamic. First of all, they are influenced by social factors and norms of public morality.

In theoretical terms, the tasks of medical ethics are to identify the ethical justification and validity of moral standards. In the field of medical ethics

Two theories of morality dominate: deontological and utilitarian. The first considers the basis of moral life to be duty, the fulfillment of which is associated with internal command. Following duty, a person renounces selfish interest and remains true to himself (I. Kant). The main criterion of morality is honesty. The second theory of morality is based on the belief that utility is the criterion for evaluating human actions.

The principles of non-maleficence, beneficence and justice are derived from the Hippocratic Oath and guide the healthcare professional accordingly.

Specific ethical standards applied in medicine include truthfulness, privacy, confidentiality, loyalty and competence. The ethical standards of physician behavior, developed by Hippocrates, are now increasingly subject to critical analysis.

Informing a patient about the diagnosis of his illness (for example, in oncology practice) is considered a difficult ethical situation. The problem of informing patients about the diagnosis of their cancer in domestic medicine is quite acute. As a rule, an attempt is made to resolve it on the basis not so much of medical as of deontological or legal principles (A.Ya. Ivanyushkin, T.I. Khmelevskaya, G.V. Malezhko). It is understood that the patient’s knowledge of the diagnosis of his cancer will interfere with the adequate implementation of the necessary therapy due to the possible and “highly probable” negative emotional reaction of the patient (up to and including suicide attempts). At the same time, uncertainty can have protective psychological functions (V.N. Gerasimenko, A.Sh. Tkhostov). In order to confirm the correctness of this or that position, attempts were made at statistical research. However, uncertainty can also have protective functions. “In essence, informing a patient of a diagnosis does not remove uncertainty, but transfers it to another, even more important area: the uncertainty of the prognosis, which in oncology cannot be final and sufficiently definite” (A.Sh. Tkhostov). And in such a situation it is better if the patient is not completely

to know what is wrong with him, than knowing this, he will think about how long he has left to live.

1. Development of ethical concepts and teachingsEthics is one of the oldest theoretical disciplines, the object of study of which is ismorality.

The morals and customs of our distant ancestors constituted their morality and generally accepted norms of behavior. A person’s relationship to his clan, family, and other people was then fixed by custom and had authority, often stronger than the legal norms and laws of society. Morality is usually understood as a set of principles or norms of behavior of people that regulate their attitude towards each other, as well as towards society, a certain class, state, homeland, family, etc. and supported by personal conviction, tradition, upbringing, and the strength of public opinion of the entire society.

The most general and essential norms of human behavior are referred to as moral principles. It can be said that Morality is a set of norms of behavior.

Norms of behavior, since they are manifested in people's actions, in their behavior, create what is called the moral attitude of people.

The task of ethics is not only to develop a moral code, but also to clarify the question of the origin of morality, the nature of moral concepts and judgments, the criteria of morality, the possibility or impossibility of free choice of actions, responsibility for them, etc. Ethics is closely related to practical tasks people's lives.

Plato (427-377 BC) put forward an ethical system of the unconditionally eternal good of the “idea of ​​good”, located outside human consciousness in the world of eternal ideas. Plato distributed the moral qualities of virtue among classes, defining moderation and obedience to the lower class, while the dominant ones were endowed with wisdom, courage, and noble feelings.

Over the centuries, morality has been derived from an ahistorical beginning - God, human nature, or certain “cosmic laws” (naturalism, theological

ka). Also from the a priori principle or self-developing absolute idea (Kant, Hegel).

In the 18th century Kant argues that moral concepts have their source in absolute human reason. Determined by reason, independent of circumstances, the will (Kant calls it “good will”) is capable of acting in accordance with the universal moral law, which rejects the possibility of lies.

In the 18th century materialism becomes the idea of ​​the French bourgeoisie, who fought against the feudal system and its institutions And ideology. Such representatives of French materialism of the 18th century as Holbach, Helvetius, Diderot demanded a combination of personal interest with public interest through the creation of reasonable laws and education, with the help of which social orders could be introduced in which a person’s personal interest would be directed to actions for the common good.

The ethics of L. Feuerbach (1804-1872) occupies a certain place in the history of the development of ethical thought. He strongly opposed the theological foundation of morality. Moral education, according to Feuerbach, consists of instilling in everyone a consciousness of his duties towards others. However, many other thinkers, on the contrary, substantiated precisely the theological principle of justification of morality.

Among Russian thinkers, such Russian philosophers as, for example, N.G. came especially close to the scientific understanding of moral issues. Chernyshevsky, N.A. Dobrolyubov. They associated the issue of improving morals with fundamental social restructuring.

Crisis of methods of developing morality in the 20th century. found expression in the thesis about the impossibility of theoretical substantiation of moral ideas, as well as in the split into two directions - irrationalism and formalism.

Ethics arose during the formation of states, standing out from the spontaneously everyday consciousness of society as one of the main parts of philosophy, as a “practical” science of how one should act, in contrast to purely theoretical knowledge about existence. Subsequently, ethics itself is divided into theoretical and practical areas, philosophical and normative ethics.

The doctrine of morality - ethics - continues to develop throughout the history of mankind. In recent centuries, due to the growing differentiation of various professions, the need has arisen to isolate special sections of ethics.

2. DevelopmentAndformation of medical Ethics Concepts medical ethics, which have come down to us from the depths of centuries, are recorded in the ancient Indian book “Ayurveda” (“Knowledge of Life”, “Science of Life”), in which, along with consideration of problems of goodness and justice, instructions are given to the doctor to be compassionate, benevolent, fair, patient, calm and never lose your composure. Medical ethics received great development in Ancient Greece And clearly represented in the Hippocratic Oath. The medical ethics of progressive doctors of antiquity was directed against money-grubbers, charlatans, and extortionists seeking to profit at the expense of a sick person.

The Hippocratic Oath had a great influence on the development of medical ethics in general. Subsequently, students graduating from medical schools signed a “faculty pledge”, which was based on the moral precepts of Hippocrates.

A characteristic feature of the development of medical ethics is the scrupulous detailing of norms of behavior medical workers. For example, in the East Galician Code of Deontology, approved at the end of the 19th century, provisions are made that specify how to divide the fee when inviting a second doctor to a patient, how long to wait for a colleague who is late for a consultation, etc.

At this time, medical ethics is gradually degenerating into corporations of medical societies, the focus of which is the interests of private medical practitioners. workers. Even before the revolution, professional and corporate organizations of medical workers were active in many provinces of Russia in the 19th and early 20th centuries. and had their own codes.

Many outstanding domestic doctors had a great influence on the development of medical ethics in our country.

M.Ya. Mudrov believed that it was necessary to educate medical workers in the spirit of humanism, honesty and selflessness. He wrote that acquiring a medical profession should not be a matter of chance, but of vocation. Issues of medical ethics were further developed in the works of N.I. Pirogova, SP. Botkina, I.P. Pavlov and many other scientists.

The development of revolutionary democratic ideas in Russia at the beginning of the 20th century. is also reflected in issues of medical ethics. This concerned the understanding of medical duty. The doctor is a public figure, according to V.V. Veresaev, must not only indicate, he must fight and look for ways to put his instructions into practice.

During the years of Soviet power, moral problems also arose in medicine. Most of these shots are needed was prepare workers and peasants from among the children. Therefore, issues of medical ethics had to be addressed in a new way.

A great contribution to the development of domestic medical ethics was made by such outstanding healthcare organizers and prominent scientists as N.A. Semashko, Z.P. Soloviev, V.Ya. Danilevsky, V.I. Voyachek, V.P. Osipov, N.I. Petrov, P.B. Gannushkin, V.N. Myasishchev, R.A. Luria, A.F. Bilibin, I.A. Kassirsky, B.E. That's it, M.S. Lebedinsky, V.E. Rozhnov et al.

The main objectives of medical ethics are: conscientious work for the benefit of society and the sick person, readiness to always and under all conditions provide medical care, attentive and caring attitude towards the sick person, following in all one’s actions universal principles of morality, awareness of the high calling of a medical worker, preservation and enhancing the noble traditions of their highly humane profession.

Organizers of Soviet healthcare - N.A. Semashko and Z.P. Soloviev - argued that a medical worker is not only a representative of a certain profession, but, above all, a citizen of society.

The formation of the principles of medical morality in our country was also facilitated by the works of outstanding figures in domestic medicine (M.Ya. Mudrov, V.A. Manasein, S.G. Zabelin, N.I. Pirogov, S.S. Korsakov, SP. Botkin, V.M. Bekhterev and others). These principles consist of high humanity, compassion, goodwill, self-control, selflessness, hard work, and courtesy.

The basic principles of medical ethics include the principles of: a) autonomy, b) non-harm, c) beneficence, d) justice. Autonomy refers to a form of personal freedom in which an individual acts in accordance with his freely chosen decision. Seven basic aspects of autonomy: respect for the person of the patient; providing the patient with psychological support in difficult situations; providing him with the necessary information about his state of health, proposed medical measures; the ability to choose from alternative options, the patient’s independence in decision-making; the ability to monitor the progress of research and treatment on the part of the patient; patient involvement in the process of providing medical care.

3. Ethics of behavior of medical workers By revising problems of ethical behavior of medical workers necessary highlight the main and general questions that should be observed regardless of where the medical worker works, and specific ones, in relation to the specific conditions of a clinic, dispensary or hospital.

In general questions, two main ones can be distinguished:

Compliance with the rules of internal culture.

That is, the rules of attitude to work, adherence to discipline, respect for the public domain, friendliness and a sense of collegiality:

Compliance with the rules of external culture of behavior.

Rules of decency, decency, good manners and appropriate appearance (external neatness, the need to monitor the cleanliness of one’s body, clothes,

shoes, lack of unnecessary jewelry and cosmetics, medical uniform).

All this can be called medical etiquette.

The rules of external culture also include the form of greeting and the ability to behave among colleagues and patients, the ability to conduct a conversation according to the situation and conditions, etc.

The rules of etiquette have been developed over the centuries-old history of medicine. These requirements for the external behavior of a medical worker apply to all members of the medical team. Unfortunately, among medical workers, especially young ones, there is a disregard for appearance.

One of the requirements of external culture of behavior is the requirement of mutual politeness. First of all, this concerns the need to greet each other without showing familiarity.

It is very important to be restrained and tactful, to control yourself and take into account the desires of other people. When talking with a colleague, especially with senior colleagues, you must be able to listen to your interlocutor, without stopping him from expressing what he thinks, and then, if necessary, calmly object, but without rudeness and personal attacks, because this does not help clarify issues , but indicates tactlessness and lack of restraint. Loud conversation in medical institutions is tactless and inappropriate, not to mention an attempt to sort out personal relationships.

Restraint and tact are also necessary in relationships with colleagues depressed by personal experiences. It is tactless to ask them about the reasons for their bad mood, so to speak - “to get into the soul.” The ability to value one’s own and other people’s time is an external manifestation of a person’s internal composure and discipline.

External culture of behavior, according to A.S. Makarenko is not only useful for each team, but also decorates it.

Cohesion, friendly mutual understanding, normal relations of all team members with each other, adherence to a certain subordination, respect for the work of each person, the spirit of honest, frank criticism created

They have a certain “psychological climate” and have a beneficial effect on the quality of work.

Intrigues disintegrate the team, which under these conditions breaks up into warring groups. These moods often become known to patients. In such cases, the team becomes difficult to manage. Such actions are contrary to the ethics of a medical professional.

Ethics of relationships in out-of-hospital medical institutions.

Working conditions in out-of-hospital medical institutions and hospitals have their own characteristics and, to a certain extent, influence the nature of the relationships between medical workers.

In a clinic or dispensary, the main local link (doctor, nurse) provides ongoing medical care to the population of the assigned area. There should be a good relationship between the local doctor and the local nurse, based on mutual respect for each other, mutual understanding based on subordination and strict fulfillment of their professional duties. When this link works harmoniously, the quality indicators of their work are high. With poor relationships, working in a team becomes more difficult. A patient may become a witness to this relationship, which is unacceptable.

The clinic is a large medical institution serving large areas of the city and rural areas. Several areas are united into specialized departments (surgical, therapeutic, neurological, etc.), as a result, department teams are formed. In addition, the clinics have specialized consultants (urologist, ophthalmologist, dermatovenerologist, otolaryngologist, etc.) on staff. In general, the clinic’s staff, taking into account all services and departments, includes quite a lot of medical workers. At the same time, very different relationships can develop in each link, department, division.

The main task of management and the trade union organization is to ensure that the team is friendly, united, focused on fulfilling a single

tasks - protecting public health. This work is complicated by the fact that it is difficult to bring medical workers of a polyclinic institution together, since half of them work on different shifts. In addition, a significant part of a local medical worker’s time is spent outside the clinic (dispensary) in the assigned area.

Due to the above-mentioned specifics, the heads of newly organized clinics and departments are not always able to achieve good relationships between medical workers at all levels. For this zero but time. In the process of long-term work, as a rule, the best work patterns are developed, implemented and updated. The task of the polyclinic service is to ensure that every resident of the site knows his local doctor and nurse and trusts them. Sick very thin feels the nature of the relationship between the doctor and the nurse and reacts vividly to them. Good relationships strengthen the trust of the patients of the site in them, their ability to provide the necessary qualified assistance in a timely manner and at the same time strengthen the authority of the department and the clinic* Good word of mouth quickly spreads among the population of the site, and patients treat their doctors with love and gratitude. However, common mistakes and flaws in work, failure to fulfill promises, being late for calls, cause moral damage to patients,

There are cases of rudeness in the relationships of local medical workers, irresponsible attitude to their work, and lack of discipline. In some cases, rudeness and tactlessness may be motivated by improper behavior of a medical professional, but in all cases it is necessary to observe the ethics of the relationship.

The patient should not see any complications in their relationship. For example, a patient may experience unpleasant experiences in cases where a nurse made a mistake when writing out a referral for a laboratory test or indicated the hours incorrectly. readmission, time of attendance for consultation, etc.

Mutual assistance is also necessary within specialized departments. Illness or absence from work for some other objective reason of a local health worker requires his immediate replacement. If this is not possible, then you have to do much more work. This does not always coincide with the personal interests of the medical worker; it can cause dissatisfaction, and sometimes even aggravate the relationship. These issues become especially acute during seasonal influenza epidemics, when the working day of each medical worker becomes significantly longer, and any additional workload requires increased effort. In addition, the very nature of community work - numerous contacts with a large number of patients and their relatives - requires considerable neuropsychic and physical stress.

The senior nurse of the department plays a role in strengthening the cohesion of the team of nurses. A lot depends on her ability to establish proper contact with the district nurses and gain authority with them. Good knowledge of character traits, family and living conditions of district nurses and other factors gives her the opportunity to find the right solution in all difficult situations. The attitude of seniors to juniors should be tactful, based on respect for the work and personality of the subordinate. The level of industrial relations between paramedical workers and nurses in a clinic largely depends on the experience, authority, moral and human qualities of the personality of the head nurse of a clinic or dispensary. institutions in general.

The difficulties of district work contribute to a certain turnover of personnel. However, in institutions where good comradely relations reign between employees, where good traditions have developed, the team is stable.

Ethics of relationships V hospital conditions.

Working conditions in a hospital, in contrast to a dispensary clinic, are more stable. Each department always has a certain number of patients with certain treatment periods. If the local medical

While the composition of patients changes daily and the period of relationship between them is quite short, in a hospital the contact of medical workers with the patient is constant, many days, and sometimes many months. This requires that relations between staff meet ethical and deontological requirements, and that the external and internal culture of behavior is at a high level.

The saying “even walls heal” will be true if in medical institution there is an appropriate level of relationships between medical personnel, high discipline, culture and quality of service.

Each defect in the behavior of the staff in the department easily comes to the attention of several dozen patients at once and becomes the subject of their discussion, undermining the authority of both the medical worker who committed this violation and the entire team.

High ethics of relationships at all levels of the medical structure of the department: nurse, guard nurse, procedural nurse, hostess sister, head nurse, residents, head of the department, with strict fulfillment of their duties professional responsibilities has a beneficial effect on the healing process.

However, there are often cases when a nurse responds rudely to a patient, does not respond for a long time to his request to help him, and the nurse does not seem to notice these facts and does not want to spoil the relationship with the nanny. The remark to a junior in position must be made tactfully; it must be explained that helping a patient is the duty of a medical worker. Of course, you should not do this demonstratively in front of the patient, but ask the nanny to go into the treatment room or another room and talk to her. The nurse sometimes allows a familiar “you” to the patient and makes comments when he hesitates when dispensing medications or taking some procedure. These facts cannot be ignored, since a bad example is contagious, especially for young workers.

When considering the problem of ethics in the relationships between medical workers, the question arises:

Is it affected by the specific conditions of the professional work they perform? Are the ethics of relationships different between nurses working in cardiology departments and in pediatric hospitals? The principles of the relationship between them are similar, but there are some features that depend on the working conditions and clinical differences between the disciplines.

These specific features can only be examined comprehensively in terms of private medical ethics and deontology.

The average medical worker, who is constantly among patients, directly communicates with them and who bears the main burden of caring for patients, must always take into account the mental characteristics, feelings, experiences and judgments of their patients and their psychosomatic state.

Diseases of various clinical profiles (surgical, therapeutic, oncological, obstetric-gynecological, phthisiological, etc.) cause fears and experiences that are unique to them, since each painful process has its own specific course and outcome. In addition, each patient has his own individual psychological characteristics. To better understand the patient's condition And the nature of his experiences, the medical worker also needs to know the social, family and official status of the patient.

For example, many patients admitted to an oncology hospital constantly experience painful worries: is their tumor malignant or benign? Naturally, they are constantly trying to figure it out at doctor or nurse. During the conversation, they intensely watch their sister’s facial expressions, the tone of her voice, and the nature of her answer. Patients listen to the doctor's conversations And nurses, nurses among themselves, trying to catch information about their condition in their conversation. The psyche of patients with cancer is very vulnerable, so they perceive violations of the ethics of relationships between medical workers especially acutely.

It should be noted that patients are very susceptible to iatrogenism. This manifests itself quite acutely in cancer patients.

gical patients in a state of severe intoxication, when they anticipate the approaching outcome of the disease. In such cases, loud talking by nurses, especially loud laughter, is inappropriate; this quickly throws patients out of balance.

The treatment process is not only a medicinal effect, but also, to a no lesser extent, psychotherapy, which manifests itself in the specifics of the relationship between the patient and the medical worker.

The ethical side of the impact has a great influence on the patient.

When communicating with a patient, sensitivity is of great importance, that is, listening carefully and striving to understand his changes. This helps to lift the mood, distract from gloomy thoughts about a possible unfavorable outcome of the disease, and calm the patient. It is important to encourage the patient with a sympathetic word, to dissuade his fears from being unfounded.

Each clinic has its own specific ethical and de-ontological requirements. In accordance with this, both medical and nursing personnel must not only observe the ethical and deontological traditions that have developed in a medical institution, but also strengthen them along with raising their professional and cultural level.

When talking with a patient, it is worth remembering the words of M.Ya. The wisdom is that during the study the patient himself examines the medical worker.

A conversation with a patient can give a certain idea about his cultural level, intelligence, education, personal characteristics, and dominant experiences.

This knowledge can help establish contact and find an individual approach to the patient. At the same time, the nurse must be patient with the patient’s annoying statements and questions and give him enough time to talk. Superficial questioning, ill-considered answers, and familiarity during treatment offend the patient and reduce the authority of the medical worker. During a conversation, the patient is often wary and trepidatious.

vozhen, therefore the medical worker must control his statements and take into account the impression they have on the patient.

Painfully altered psyche of some patients when they experience any unpleasant sensations from internal organs or negative experiences inspired by external factors, causes a depressed and depressed mood, gloomy judgments about one’s illness. Medical and nursing staff should strive to cheer up and instill in the patient confidence in a favorable outcome. All persons in contact with the patient must behave in accordance with the “legend” developed by the doctor regarding his disease and not arouse in the patient by their behavior and words guesses about the severity of his condition.

Important issues of medical ethics include the ethics of the relationship between a medical worker and the patient’s family and friends.

The main issues of collecting a life history, the present illness and the dynamics of the condition during the treatment process are dealt with by the doctor, but on the days of transfers and visits, a considerable burden falls on the average medical worker. On such days, relatives turn to nurses with questions about the patient’s condition, inquire about his sleep, appetite, mood and much more. During a working day full of work duties, nurses have little time to contact numerous relatives and loved ones of patients, so their annoying questions can irritate, cause dissatisfaction, and a desire to quickly get rid of them and avoid contact with them. In these cases, you need to mentally put yourself in the place of these people,

Insensitive behavior by a medical professional can lead to justified complaints to the management of the department or hospital and to the perception that the culture and quality of care in this department or hospital are not at a high level, and may lead to a desire to transfer a loved one to another hospital.

The opinion of relatives is transmitted to the patient, causing him a negative attitude and distrust of the staff

and negatively affects his neuropsychic and somatic state.

The nurse’s conversation with relatives should also not go beyond her competence. The sister should not tell the patient’s relatives about the symptoms and possible prognosis of the disease. When relatives talk to a patient, they may convey to him the content of the conversation with the nurse, misinterpret something, or add their own assumptions. As a result, the patient may be misinformed about his disease and worried about its outcome. He assumes that he has a serious, possibly incurable disease. This can lead to iatrogenic behavior, subsequently requiring long-term psychotherapy.

Communication average medical personnel with the patient's relatives and friends requires a certain tact. If the nurse is unable to attend to the relative at the time of the request, she should politely apologize and explain that she has urgent work at the time and ask, if possible, to wait a little. At the same time, it is unacceptable for relatives to wait for hours to talk with medical workers. In cases where the production situation is such that the conversation can take place only in an hour or more, it is advisable to arrive exactly at this time or schedule another day for the meeting. During the conversation, you need to answer briefly and clearly, thinking through each answer. If the question is beyond the scope of competence, in particular, about the nature of the disease, possible outcome, leading symptoms, the nurse should plead ignorance and suggest contacting a doctor for clarification.

The correct tactics of communication between nursing staff and the patient’s relatives and friends creates the proper psychological balance in such an important link in the treatment process as the patient - relative - medical staff.

4. Medical deontology First time term deontology proposed by the English philosopher Ventham. This term comes from the words: “deon” - duty, necessity and “logos” - teaching.

Deontology is the science of duty, moral obligations, and professional ethics.

The importance of deontology is especially important in those sections professional activity, which are widely used forms of complex interpersonal influences and responsible interactions. These include modern medicine, within which various forms of psychological influence of medical workers on sick.

It is no coincidence that such an independent section, such as medical deontology within the framework of medical psychology, which reveals the peculiarities of the duty of medical workers to patients. As well as the peculiarities of the moral responsibility of medical workers to society for the protection of public health and for the most perfect actions aimed at the effective treatment of a sick person.

The term “deontology” was introduced into use at the beginning of the 19th century. to denote the science of professional human behavior. The concept of “deontology” is equally applicable to any field of professional activity - medical, engineering, legal, agronomic, etc.

Medical deontology is the science of professional behavior of a medical worker.

Long before the introduction of this term, the basic principles regulating the rules of behavior of a doctor and medical worker were contained in written sources that came down from antiquity. For example, the Indian code of laws of Manu, the Vedas, lists the rules of conduct for a doctor. In ancient times, the famous “Oath” of the founder of scientific medicine, Hippocrates, had a huge influence on the development of the principles of behavior of a medical worker. It is interesting to note that in the entire history of the development of medicine, only in 1967, at the II World Congress of Deontology in Paris, the first and only addition to the Hippocratic Oath was made: “I swear to study all my life.”

The formation of domestic medical deontology was greatly influenced by the materialistic views of A.I. Herzen, N.G. Chernyshevsky, N.A. Ext.

Rolyubova, D.I. Pisareva and others. In the conditions of the Russian Empire, zemstvo doctors, having extremely limited capabilities, created a system of providing medical care that is unique in the history of medicine. medical care poor sections of the population. They laid down new traditions in relations with patients, which made Russian medicine famous. Zemstvo medicine has produced a large number of doctors, paramedics and nurses who are infinitely devoted to their work.

It must be emphasized that until the end of the 19th century. everything that now constitutes the subject of medical deontology was called medical ethics. Works of domestic medical scientists M.Ya. Mudrova, N.I. Pirogova, SP. Botkina, SS. Korsakova, V.M. Bekhtereva, K.I. Platonova, R.A. Luria, N.I. Petrova et al. laid the theoretical foundations of deontological principles.

The main objectives of medical deontology are: studying the principles of behavior of medical personnel aimed at maximizing the effectiveness of treatment; exclusion of unfavorable factors in medical activities; studying the system of relationships that are established between medical personnel and the patient; elimination of the harmful consequences of inadequate medical work (N.I. Petrov).

One of the main problems of medical deontology, as well as medical ethics, is duty. However, the concept of duty in moral terms is not entirely identical. Medical deontology defines proper behavior not in terms of moral or legal public duty, but in terms of the official duties of a medical worker. It is important to note that medical deontology also applies to workers in non-medical professions: workers, employees, etc. They must behave in accordance with the requirements medical institution.

Medical deontology develops rules of official conduct, which are then formalized in appropriate instructions. Unlike moral rules, deontological standards are determined by instructions and administrative orders.

As a special doctrine in scientific And In practical medicine, deontology is divided into general, which studies general medical-deontological principles, and private, which studies deontological problems in the context of individual medical specialties (G.V. Morozov).

Elements of deontology in the activities of average medical workers.

The leading role in establishing deontological principles belongs to the doctor, who conducts a full examination of the patient, makes a diagnosis, prescribes treatment, and monitors the dynamics of the disease process. And etc. When carrying out these activities, the average medical worker is required to have official And professional discipline, strict implementation of all doctor’s orders. High-quality and timely implementation of doctor’s prescriptions or instructions (intravenous infusion, injection, temperature measurement, dispensing medications, cupping, etc.) is one of the main deontological elements of the activity of a mid-level medical worker. However, the fulfillment of these duties should not be carried out formally, but out of inner motivation, a sense of duty, and the desire to selflessly do everything necessary to alleviate the suffering of a sick person. This requires constant self-improvement, replenishment professional knowledge And skill.

When communicating with a patient, a nurse, in addition to observing ethical standards, must have a high sense of professional restraint and self-control. The nurse must create an atmosphere of trust between the doctor and the patient, help increase the authority of the doctor and the medical institution, and strictly observe medical confidentiality.

Nurse and patient.

The work of a nurse is associated not only with great physical activity, but also with great emotional stress that arises when communicating with sick people, with their increased irritability, painful demands, touchiness, etc. The ability to find quick contact with a sick person is very important. The nurse is constantly among the sick, so her clear actions and professional performance

doctor's prescriptions, her emotional, warm attitude towards the patient have a psychotherapeutic effect on him. The verbal form, emotional coloring and tone of speech are of great importance. Affectionate and polite treatment and a kind smile expresses the sister's caring and attention to her patients. However, attention and warmth from the sister should never be of an intimate nature and should not encourage patients to overcome the distance between them and the sister. The nurse should never forget about the possibility of this and regulate her actions accordingly and monitor the patient’s behavior.

A medical professional, in particular a nurse, must strictly maintain medical confidentiality. Medical confidentiality means the following:1) information about the patient received by a medical worker from the patient or during treatment and not subject to disclosure in society,2) information about the patient that the medical professional should not disclose to the patient (unfavorable outcome of the disease, diagnosis causing psychological harm to the patient, etc.).

“They believe a skillful and benevolent explanation, they are comforted by it And with it, not only the so-called uninitiated people die more easily, but also surgeons with a huge reputation when they fall ill and turn into patients suppressed by the disease... It is often possible to successfully refer to the really existing ambiguity of the diagnosis and thus leave it as a consolation for the patient doubt, which he can use to his advantage” (N.I. Petrov).

It is impossible to disclose information not only about the nature and possible outcome of the disease of patients, but also information about their intimate life, as this may cause them additional suffering And undermine trust in medical professionals.

Faith in recovery, confidence that he is being treated correctly and will receive the necessary assistance in a timely manner if his condition worsens, is of great importance in the communication between the doctor and nurse and the patient. Failure to satisfy requests, a nurse being late to call a patient, careless execution of procedures prescribed by a doctor, an administrator

A rationally cold tone causes the patient to worry about his condition and the desire to complain or ask for a consultation.

The nurse should not talk about what happened in the next department or spread news about seriously ill patients, as this can aggravate hypochondriasis and increase the fear and anxiety of patients for their health. Familiarity and a harsh tone in conversation greatly interfere with the creation of normal relationships and contact between the sister and the patients.

When establishing contact, the sister should try to understand the patient. The nurse's ability to empathize and be compassionate is of great importance. A sympathetic response to the patient’s complaints, the desire to alleviate his painful experiences as much as possible, sometimes have no less therapeutic effect than the prescription of medications, and evokes warm gratitude from patients. At the same time, sometimes it is important to simply listen to the patient, but not formally, but with elements of emotional participation, reacting accordingly to what is heard.

The ability to listen is one of the important properties of the art of a medical professional.

However, this is not given immediately, but is developed through many years of experience. In the process of listening, the medical worker receives the most necessary information about the patient. During the conversation, the patient calms down, his internal tension is relieved.

The staff of the medical institution and the patient. The team of a medical institution, in which there is a unity of work style, coherence, good relationships between team members and high professional knowledge, is also distinguished by a high level of medical care.

The tasks of the head nurse are to monitor the activities of nurses and nurses in caring for the sick, as well as work with the nurses and with the patients themselves. The head nurse should notice shortcomings in the work of the department, any tension in the relationship between nurses and patients and strive to take timely measures to eliminate them, evaluate individual

requests from patients, monitor the quality of care for seriously ill patients and provide assistance in resolving complex issues that arise for nurses and patients.

The professional responsibilities and place of work of nurses are quite clearly defined, so it is important that there are no contradictions in the style of their work. The main requirements should be order in hospital wards and organization in carrying out the daily routine.

A nurse, constantly being among patients and observing their behavior, sees their individual psychological characteristics, the nature of their relationships with neighbors, their reaction to their illness and the illnesses of others. She should tell the doctor in which ward and with whom it is best to place the patient, tell him about the psychological characteristics, behavior and statements of her charges.

During the course of work, many situations may arise in which the correct behavior of nurses plays a special role. For example, patients often turn to nurses with various requests. They must be listened to carefully and if they do not contradict the interests of the patient, meet the requirements of the doctor and local regulations, then it is advisable to satisfy them. If the sister cannot resolve the issue herself, then you need to apologize and answer later, after consulting with the older sister or doctor. If the sister cannot fulfill the patient’s wishes and requests, then she must find the correct and polite form of refusal. A nurse should not enter into arguments with patients, because they are inappropriate within the walls of a medical institution, and the possibility of their appearance should not be allowed. You should also not contact patients with requests or instructions.

A healthy psychological atmosphere in a medical institution is created in cases where a good work style is combined with friendly relations between medical workers. This has a beneficial effect on patients and contributes to the high effectiveness of treatment.

According to the author of the series scientific works and monographs on medicine, Yu. K. Subbotina, “medical ethics is a science that studies the moral side of the activities of health workers, their moral relations and moral consciousness associated with the performance of professional duties.”

Ethics is of great importance in the system of relationships between health care workers and patients. An analogue of the well-known medical Hippocratic oath for nurses became in the 19th century. Florence Nightingale's oath.

After World War II, when information about the monstrous falsification became known to the general public medical profession Nazi “doctors” who carried out inhumane experiments, carried out forced sterilization of “racially inferior” and euthanasia of the elderly and mentally ill, formed in 1947. The World Medical Association began its activities with the development and adoption of the Geneva Declaration, which became a modern version of the Hippocratic Oath. This document not only emphasized the importance of the doctor’s striving for humanistic ideals, but also guaranteed the independence of the medical profession from political regimes and ideology.

The ethical code of Russian nurses is of particular importance in the history of domestic medicine and, in particular, nursing in the twentieth century. On the one hand, the vast majority of medical workers have always remained faithful to their duty and oath, and on the other, we should not forget that back in the 1920s. Official health officials in the Soviet Union regarded professional medical ethics as a “bourgeois relic.” Moreover, these figures were firmly convinced that such a concept as “medical confidentiality” was unacceptable for Soviet medicine and would soon die out. During the reforms, which were not always justified, there was a bias towards the very concept of “nurse”, which was supposed to be replaced by the terms “doctor”, “deputy doctor”, “medical technician”, etc.

Thus, the creation of the Russian Nurse Ethical Code was a kind of repentance and gives hope for the return of moral and ethical health to our medical workers. In drawing up this Code, new ideas that have emerged in the previous few decades and have influenced the professional ethics of nurses have been taken into account. First of all, this Code reflected modern concepts of the rights of the patient, which, in turn, determine the responsibilities of a medical worker.

The Code of Ethics for Nurses in Russia is compiled on the basis of such documents as the Charter of the World Health Organization (1946), the Code of Ethics for Nurses of the International Council of Nurses (1973), the Code professional ethics psychiatrist, admitted Russian society psychiatrists in 1993, etc. According to these documents, nurses are not just obedient executors of doctor’s instructions, but representatives of an independent profession who have the skills of comprehensive patient care and have the proper amount of knowledge in the field of psychology and psychotherapy. According to the founder of nursing F. Nightingale, “a nurse must have a triple qualification: cardiac - to understand the sick, scientific - to understand illnesses, technical - to care for the sick.”

Almost all of us have at least once in our lives sought help from some medical institution, so it’s no secret that the impression of a hospital or clinic depends not only on the quality of the medical services provided, but also on how you were greeted staff. The very first contact of the patient, in particular with the nurse, is of exceptional importance, since it determines the further relationship of the parties, the presence or absence of trust, the emergence of hostility, etc.

Deontology (translated from Greek as “ought”) is the science of problems of morality and ethics. It addresses issues such as responsibility for the life and health of patients, compliance with medical confidentiality, relationships in the medical community, etc.

AND appearance(neatness, hairstyle, facial expression), and the nurse’s internal mood should evoke in the patient a feeling of goodwill, affection, and trust. Under no circumstances should a nurse address a patient impersonally as “sick,” as this indicates her complete indifference. To establish a trusting relationship between a nurse and a patient, it is necessary to make him feel that you care about his fate and you sincerely want to help him. Only in such a situation can a degree of trust arise in which the nurse can find out all the necessary information about the patient, his character traits, his opinion about his own illness, hospital conditions, and plans for the future. After all, it is this information obtained during direct contact that will give the nurse the opportunity to make an objective nursing diagnosis. However, the nurse must remember that it is unacceptable to cross the fine line between a trusting relationship and familiarity; one should always reserve a leading role. The nurse must show sympathy for the patient, promote the establishment of empathy between them, but at the same time she should not identify herself with the patient. A prerequisite for establishing a trusting relationship is the patient's confidence in the confidentiality of conversations with the nurse.

Having information about the characteristics of the patient’s personality and character, his experiences, the nurse can tactfully explain to the patient not only his rights, but also some of his responsibilities, prepare him for upcoming examinations and therapeutic procedures, telling him about them in an accessible form. The patient's reluctance to undergo certain types of examinations or medical procedures should not cause a negative attitude towards him on the part of the nurse. Nurses are required to be honest and truthful when communicating with a patient, but any conversations regarding the diagnosis or characteristics of his disease should not go beyond the limits indicated by the doctor. The same rule must be observed during conversations with the patient’s relatives.

The doctor and nurse may sometimes have slightly different views on certain aspects of patient care. Of course, fundamental disagreements should not arise, but nevertheless, you need to discuss the problem with the doctor with the utmost tact, since achieving complete agreement makes the work much easier. To stipulate similar controversial situations with third parties or directly with superiors should not be done, as this may provoke the development of an unhealthy environment within the work team. Undoubtedly, the nurse has every right to defend her point of view, but at the same time she must be ready to admit and correct her own mistakes. High demands on oneself is one of the most important qualities of any professional, and a nurse is no exception.

The humanism of the medical profession creates the basis for protecting the personal dignity of a nurse, ensuring her integrity, and the right to assistance during the performance of professional duties.

In the system of “nurse-patient” relationships, the nurse’s individual work style is of great importance. The main qualities that a good nurse should have are knowledge, skill, tenderness, affection, compassion, mercy, boundless patience, responsibility and courtesy. Unfortunately, not enough attention is currently being given to identifying and promoting these important qualities. The enormous workload on a nurse during the performance of her professional duties does not always allow her to demonstrate the necessary qualities to the proper extent. Ideally, the organization of work in a medical institution should be such that knowledge, skills, competence and professional growth were expected and rewarded accordingly. Any person who decides to devote his life to medicine must understand that there are no and cannot be circumstances that would justify any unethical act.

Code of Ethics for Russian Nurses

Part I. General provisions

The ethical basis of the professional activity of a nurse is humanity and mercy. The most important tasks of a nurse’s professional activity are comprehensive comprehensive care for patients and alleviation of their suffering; health restoration and rehabilitation; promoting health and preventing disease.

The Code of Ethics provides clear moral guidelines for the professional activities of nurses and is intended to contribute to the legal support of nursing activities, increasing the prestige and authority of the nursing profession in society, and the development of nursing in Russia.

Part II. Nurse and patient

Article 1. Nurse and the patient’s right to quality medical care.

The nurse must respect the inalienable rights of every person to highest level physical and mental health and to receive adequate medical care. The nurse is obliged to provide the patient with quality medical care that meets the principles of humanity and professional standards. The nurse has a moral responsibility for his work to the patient, colleagues and society. The professional and ethical responsibility of a nurse is to provide, to the best of his or her competence, emergency medical care to any person in need of it.

Article 2. The main condition for nursing practice is professional competence.

The nurse should always follow and support professional standards activities determined by the Ministry of Health Russian Federation. Continuous improvement of special knowledge and skills, raising one’s cultural level is the primary professional duty of a nurse. The nurse must be competent regarding the moral and legal rights of the patient.

Article 3. Humane treatment of the patient, respect for his legal rights.

The nurse must place compassion and respect for the patient's life above all else. The nurse must respect the patient's right to relief of suffering to the extent that the current level of medical knowledge allows. A nurse has no right to participate in torture, executions or other forms of cruel and inhumane treatment of people. A nurse has no right to assist a patient’s suicide. The nurse, within the limits of her competence, is responsible for ensuring the rights of the patient, proclaimed by the World Health Organization. medical association, World Organization healthcare and enshrined in the legislation of the Russian Federation.

In the 1930s in Russia for the first time, GSO units (literally – “Ready for sanitary defense”) for the adult population and BGSO (literally – “Be ready for sanitary defense”) for children appeared, sanitary squads, sanitary posts were organized, and the entire population was centrally trained in basic skills care and emergency assistance.

Article 4. Respect for the human dignity of the patient.

The nurse must be constantly ready to provide competent care to patients regardless of their age or gender, nature of the disease, race or national origin, religious or political beliefs, social or financial status or other differences. When providing care, the nurse must respect the patient's right to participate in the planning and implementation of treatment. Showing arrogance, disdain or demeaning treatment of patients will not be tolerated. A nurse does not have the right to impose her moral, religious, or political beliefs on a patient. When determining the priority of medical care for several patients, the nurse should be guided only by medical criteria, excluding any discrimination. In cases where medical indications require monitoring the patient's behavior, the nurse should limit her interference in the patient's personal life solely to professional necessity.

Article 5. First of all, do no harm.

A nurse has no right to violate the ancient ethical commandment of medicine “Do no harm!” The nurse does not have the right to be indifferent to the actions of third parties seeking to cause such harm to the patient. The actions of the nurse to provide care and any other medical interventions associated with pain and other temporary negative phenomena are permissible only in his interests. “The medicine should not be worse than the disease!” When performing medical interventions that are fraught with risk, the nurse is obliged to provide safety measures to relieve complications that threaten the life and health of the patient.

Article 6. Nurse and patient's right to information.

The nurse must be truthful and honest. The nurse has a moral duty to inform the patient of his rights. She is obliged to respect the patient's right to receive information about his state of health, possible risk and the benefits of proposed treatments, diagnosis and prognosis, as well as his right to refuse information altogether. Considering that the function of informing the patient and his relatives mainly belongs to the doctor, the nurse has the moral right to convey professional information only in agreement with the attending physician as a member of the team serving this patient. In exceptional cases, the nurse has the right to hide professional information from the patient if she is convinced that it will cause him serious harm.

Article 7. The nurse and the patient’s right to agree to or refuse medical intervention.

The nurse must respect the right of the patient or his legal representative (when dealing with a child or a mentally incompetent patient) to consent to or refuse any medical intervention. The nurse must be sure that consent or refusal is given by the patient voluntarily and knowingly. It is the moral and professional duty of the nurse to explain to the patient, to the best of her ability, the consequences of refusing a medical procedure. The patient’s refusal should not affect his position and negatively affect the attitude of the nurse and other medical workers towards him. A nurse has the right to provide assistance without the patient’s consent (or without the consent of the legal representative of an incompetent patient - a child under 15 years of age or an incompetent mentally ill person) only in strict accordance with the legislation of the Russian Federation. When providing medical care to incompetent patients, the nurse should, as far as the condition of such patients allows, involve them in the decision-making process.

Article 8. Obligation to maintain professional secrets.

A nurse must keep secret from third parties information entrusted to her or that has become known to her due to the performance of her professional duties about the patient’s health status, diagnosis, treatment, prognosis of his illness, as well as about the patient’s personal life, even after the patient dies. The nurse is obliged to strictly perform his duties to protect confidential information about patients, in whatever form it is stored. The nurse has the right to disclose confidential information about the patient to any third party only with the consent of the patient. The right for a nurse to transmit information to other specialists and medical professionals providing medical care to the patient requires his consent. A nurse has the right to transmit confidential information without the patient’s consent only in cases provided for by law. In this case, the patient should be informed of the inevitability of disclosing confidential information. In all other cases, the nurse bears personal moral and sometimes legal responsibility for disclosing professional secrets.

Article 9. Nurse and dying patient.

The nurse must respect the dying person's right to humane treatment and death with dignity. The nurse must have the necessary knowledge and skills in the field of palliative (life-sustaining) medical care, giving the dying person the opportunity to end his life with the maximum achievable physical, emotional and spiritual comfort. The primary moral and professional responsibilities of a nurse are: prevention and relief of suffering, usually associated with the process of dying; Providing psychological support to the dying person and his family. Euthanasia, that is, the deliberate action of a nurse to end the life of a dying patient (even at his request), is unethical and unacceptable. The nurse must treat the deceased patient with respect. When processing the body, the religious and cultural traditions of the deceased should be taken into account. The nurse is obliged to respect the rights of citizens regarding pathological autopsies enshrined in the legislation of the Russian Federation.

Article 10. Nurse as a participant in scientific research and educational process.

The nurse should strive to participate in research activities, in increasing knowledge in their profession. In research activities involving humans as an object, the nurse must follow international documents on medical ethics (Declaration of Helsinki, etc.) and the legislation of the Russian Federation. For a nurse, the interests of the patient’s personality should always be above the interests of society and science. By participating in scientific research, the nurse is obliged to especially strictly ensure the protection of those patients who are not able to take care of it themselves (children, people with severe mental disorders). Patient participation in the educational process is permissible only in compliance with the same guarantees for the protection of their rights.

Part III. Nurse and her profession

Article 11. Respect for your profession.

The nurse must maintain the authority and reputation of his profession. Neatness and observance of personal hygiene rules are integral qualities of a nurse’s personality. The nurse has a personal moral responsibility to maintain, implement and improve standards of nursing practice. She should not pretend to have a degree of competence that she does not possess. The right and duty of a nurse is to defend her moral, economic and professional independence. The nurse should refuse gifts and flattering offers from the patient if the basis is his desire to achieve a privileged position compared to other patients. A nurse has the right to accept gratitude from a patient if it is expressed in a form that does not degrade the human dignity of both, does not contradict the principles of justice and decency and does not violate legal norms. Intimate relationships with a patient are condemned by medical ethics. The behavior of a nurse should not be an example of a negative attitude towards health.

In the process of communicating with the patient, the nurse establishes a “therapeutic” relationship with him, determines the patient’s attitude towards treatment, begins to form an adequate assessment of his condition in the patient, identifies information that will require additional clarification (about previous diseases, surgical interventions), finds out the nature of the patient’s relationship with family.

Article 12. Nurse and colleagues.

The nurse must give due respect to his teachers. In relationships with colleagues, the nurse must be honest, fair and decent, recognize and respect their knowledge, experience, and contribution to the treatment process. A nurse is obliged, to the best of her knowledge and experience, to help colleagues in the profession, counting on the same help from them, as well as to assist other participants in the treatment process, including voluntary assistants. A nurse is obliged to respect the long-standing tradition of her profession - to provide medical care to a colleague free of charge. Attempting to gain authority by discrediting colleagues is unethical. The moral and professional duty of the nurse is to help the patient carry out the treatment program prescribed by the doctor. The nurse is obliged to accurately and skillfully perform medical procedures prescribed by the doctor. High professionalism of a nurse is the most important moral factor in the friendly, collegial relationship between a nurse and a doctor. Familiarity and the non-official nature of the relationship between a doctor and a nurse in the performance of their professional duties is condemned by medical ethics. If a nurse doubts the appropriateness of a doctor’s treatment recommendations, she should tactfully discuss this situation first with the doctor himself, and if doubt persists, even after that, with higher management.

Article 13. Nurse and questionable medical practice.

A nurse, when faced with illegal, unethical or incompetent medical practice, must protect the interests of the patient and society. The nurse is required to know the legal norms governing nursing, the health care system in general and the use of traditional medicine (healing) in particular. The nurse has the right to seek support from government bodies healthcare, the Association of Nurses, taking measures to protect the interests of the patient from questionable medical practices.

Part IV. Nurse and society

Article 14. Responsibility to society.

The nurse has a moral duty as a member of the health care community to ensure accessibility and high quality nursing care to the population. The nurse should actively participate in information and medical and social education of the population, helping patients do right choice in their relationships with state, municipal and private healthcare systems. The nurse, to the best of her competence, must participate in the development and implementation of collective measures aimed at improving methods of combating diseases, warn patients, authorities and society as a whole about environmental hazards, and contribute to the organization of rescue services. The Nurses Association and the medical community as a whole should help attract nurses to areas of the country where medical care is least developed by providing incentives to work in such areas.

Article 15. Maintaining the autonomy and integrity of nursing.

The moral duty of a nurse is to contribute to the development of nursing reform in Russia. The nurse must support, develop autonomy, independence and integrity in nursing. The duty of a nurse is to attract the attention of society and funds mass media to the needs, achievements and shortcomings of nursing. The nurse must protect the public from misinformation or misinterpretation of nursing. Self-promotion is incompatible with medical ethics. If a nurse participates in an organized collective refusal to work, she is not relieved of her duty to provide emergency medical care, nor is she relieved of her ethical obligations towards those patients who are currently undergoing treatment.

Article 16. Guarantees and protection of the legal rights of a nurse.

The humanistic role of the nurse in society creates the basis for the requirements for the legal protection of the nurse’s personal dignity, physical integrity and the right to assistance in the performance of her professional duties both in peacetime and in wartime. The standard of living of a nurse must correspond to the status of her profession. The amount of the fee determined by the private practicing nurse must be commensurate with the volume and quality of medical care provided, the degree of her competence, and the special circumstances in each specific case. Free assistance to poor patients is ethically approved. Neither medical workers in general, nor any nurses in particular, should be forced to work under conditions that are unacceptable to them. Providing conditions for the professional activity of a nurse must comply with labor protection requirements. A nurse has the right to count on the Interregional Association of Nurses of Russia to provide her with full assistance in protecting her honor and dignity (if her good name is unreasonably defamed by someone); timely receipt of a qualified category in accordance with the achieved level vocational training; creation and application of insurance procedures for professional errors not related to careless or negligent performance of professional duties; professional retraining if it is impossible to perform professional duties due to health reasons; timely receipt of benefits provided for by the legislation of the Russian Federation for medical workers.

Part V. The operation of the ethical code of nurses in Russia, responsibility for its violations and the procedure for its revision

Article 17. Operation of the Code of Ethics.

The requirements of this Code are mandatory for all nurses in Russia. Doctors and nurses teaching at nursing faculties, medical colleges and schools must familiarize students with the Code of Ethics for Russian Nurses. Students, as they enter professional medical practice, are required to learn and comply with the principles and norms contained in the Code. Doctors and nurses who teach should set an example for students by their behavior.

Article 18. Responsibility for violation of the Code of Ethics.

Responsibility for violation of the Ethical Code of Nurses of Russia is determined by the Charter of the Interregional Association of Nurses of Russia. For violation of the Code, the following penalties may be applied to members of the Association:

1) remark;

2) warning about incomplete professional compliance;

3) suspension of membership in the Association for a period of up to one year;

4) exclusion from membership of the Association with mandatory notification of this to the relevant certification (licensing) commission.

Article 19. Revision and Interpretation of the Code of Ethics.

The right to review the Ethical Code of Nurses in Russia and interpret its individual provisions belongs to the Interregional Association of Nurses of Russia. Recommendations and proposals for changing or improving individual articles of the Code are accepted for consideration by the Presidium of the said Association and acquire legal force after approval by this body of the Association.

Medical ethics(lat. ethics, from Greek. ethics– the study of morality, ethics), or medical deontology(Greek deon- duty; the term “deontology” was widely used in Russian literature recent years), – a set of ethical standards and principles of behavior of medical workers when performing their professional duties.

According to modern ideas, medical ethics includes the following aspects:

• scientific – section medical science, studying the ethical and moral aspects of the activities of medical workers;
• practical – an area of ​​medical practice, the tasks of which are the formation and application of ethical norms and rules in professional medical practice.

Medical ethics studies and determines solutions to various problems of interpersonal relationships in three main areas:

• medical worker - medical worker.

Four universal ethical principles include:

The principle of mercy states:"I will do good to the patient, or at least not harm him." Mercy implies a sensitive and attentive attitude towards the patient, the choice of treatment methods proportional to the severity of the condition, the patient’s willingness and ability to cope with the prescribed medical intervention. The main thing is that any action of a medical worker should be aimed at the benefit of a particular patient!

Principle of autonomy

Principle of fairness/no harm requires equal treatment of medical workers and provision of equivalent care to all patients, regardless of their status, position, profession or other external circumstances. This principle also determines that whatever assistance a medical professional provides to a patient, his actions must not cause harm to either the patient or others. When faced with a situation of conflict between a patient and his loved ones or other medical workers, guided by this principle, we must be on the patient’s side.

Implies professional rendering medical care and professional attitude towards the patient, the use of the entire available arsenal of healthcare to conduct high-quality diagnostics and treatment, implement preventive measures and provide palliative care. This principle requires absolute compliance with all laws related to health care, as well as all provisions of the code of ethics.

The moral responsibility of a medical worker implies compliance with all principles of medical ethics.

Nurse-patient relationship

• The nurse must be patient and friendly when communicating with the patient. Both familiarity and familiarity and excessive dryness and formality are unacceptable. Patients should be addressed as “you” and by their first and patronymic names.
• You cannot discuss the diagnosis, treatment plan, or talk about the illnesses of your roommates in the presence of patients. It is forbidden to question the correctness of the treatment in the presence of the patient.
• Before difficult and painful procedures, the nurse must explain in an accessible form their meaning, meaning and necessity for successful treatment and relieve psycho-emotional stress.

Relationships "nurse - relatives (and close) of the patient:

• It is necessary to maintain restraint, calm and tact;
• Explain to persons caring for seriously ill patients the correctness of procedures and manipulations;
• Conversate only within the limits of your competence (you do not have the right to talk about symptoms or the prognosis of the disease, but must refer you to your doctor);
• Answer questions calmly, unhurriedly, and teach proper care for seriously ill patients.

The nurse-doctor relationship:

• Rudeness and disrespectful attitude in communication are unacceptable;
• Carry out medical prescriptions in a timely, accurate and professional manner;
• Urgently inform the doctor about sudden changes in the patient’s condition;
• If you have doubts in the process of carrying out medical prescriptions, tactfully clarify all the nuances with the doctor in the absence of the patient.

Nurse-nurse relationships:

• Rudeness and disrespect towards colleagues are unacceptable;
• Comments should be made tactfully and in the absence of the patient;
• Experienced nurses should share their experience with young ones;
• IN difficult situations must help each other.

Relationships "nurse - junior medical staff":

• Maintain mutual respect;
• Monitor tactfully, unobtrusively the activities of junior medical staff;
• Rudeness, familiarity, and arrogance are unacceptable;
• It is unacceptable to make comments in the presence of patients and visitors.

Ethics and deontology of nursing “Whatever house I enter, I will enter there for the benefit of the patient” (Hippocrates).

Medical ethics (Latin ethica, from Greek ethice - the study of morality, ethics), systems of moral and ethical standards in relation to the patient and medical personnel

Problems of medical ethics in the history of medicine

The first progressive concepts of medical ethics that have come down to us from time immemorial are recorded in the ancient Indian book “Ayurveda”, in which, along with the problems of goodness and justice, instructions are given to the doctor to be compassionate, benevolent, fair, patient, calm and never lose self-control. Medical ethics received great development in Ancient Greece and is clearly represented in the Hippocratic Oath. Five essays from the “Hippocratic Collection” are devoted to medical ethics, giving an idea of ​​the training, moral education of healers and the requirements that were placed on them in society. Today, each country has its own “Oath” or “Oath” of a doctor. While preserving the general spirit of the ancient Greek “Oath,” each of them corresponds to its time, the level of development of medical science and practice, reflects national and religious characteristics and general trends in world development. For example, the ancient Indian “Sermon”, “Faculty Promise”, “Oath of the Doctor of Russia”. During the Renaissance, Paracelsus paid special attention to the moral qualities of a doctor. The term “deontology” was given by D. Bentham, and “bioethics” by V.R. Potter.

Problems of medical ethics on modern stage

Bioethics– like medical ethics – the science of laws, principles and rules of regulation professional behavior medical worker, but in the context of the use of new medical technologies. The main problems of biomedical ethics affect the following range of issues: the relationship between a medical professional and a patient, experiments on humans and animals, passive and active euthanasia, social, legal and ethical aspects of abortion, contraception and sterilization, genetic screening, new reproductive technologies: (artificial insemination, in vitro fertilization, surrogacy), organ and tissue transplantation, genetics and genetic engineering, cloning, legal and moral status of the embryo, rights of the patient and medical worker, etc. Problematic situations in modern medicine are considered from the point of view of philosophy, psychology, sociology, law, morality and religion, from which it follows that bioethics is an interdisciplinary field of modern scientific research.

According to modern ideas, medical ethics includes the following aspects: scientific – a branch of medical science that studies the ethical and moral aspects of the activities of medical workers; practical – an area of ​​medical practice, the tasks of which are the formation and application of ethical norms and rules in professional medical practice. Medical ethics studies and determines solutions to various problems of interpersonal relationships in three main areas:

medical worker - patient,

medical worker – patient’s relatives,

medical worker - medical worker. The four universal ethical principles include: mercy, autonomy, justice and completeness of medical care. Before we begin to discuss the application of the principles in practice, we will give brief description each of them.

The principle of mercy states:“I will do good to the patient, or at least not harm him.” Mercy implies a sensitive and attentive attitude towards the patient, the choice of treatment methods proportional to the severity of the condition, the patient’s willingness and ability to cope with the prescribed medical intervention. The main thing is that any action of a medical worker should be aimed at the benefit of a particular patient!

Principle of autonomy requires respect for the individuality of each patient and his decisions. Each person can only be considered as an end, but not as a means to achieve it. The principle of autonomy relates to such aspects of medical care as confidentiality, respect for the patient's culture, religion, political and other beliefs, informed consent to medical intervention and joint planning and implementation of the plan of care, as well as independent decision-making by the patient or decision-making by a legal representative of this patient.

Principle of justice/ non-harm requires equal treatment of medical workers and provision of equivalent care to all patients, regardless of their status, position, profession or other external circumstances. This principle also determines that whatever assistance a medical professional provides to a patient, his actions must not cause harm to either the patient or others. When faced with a situation of conflict between a patient and his loved ones or other medical workers, guided by this principle, we must be on the patient’s side. The principle of completeness of medical care implies professional provision of medical care and a professional attitude towards the patient, the use of the entire available arsenal of healthcare to conduct high-quality diagnostics and treatment, implement preventive measures and provide palliative care. This principle requires absolute compliance with all laws related to health care, as well as all provisions of the code of ethics. The moral responsibility of a medical worker implies compliance with all principles of medical ethics.

· Medical deontology (Greek deon – duty; the term “deontology” has been widely used in Russian literature in recent years) is a set of ethical standards and principles of behavior of medical workers when performing their professional duties.

The nurse-patient relationship The nurse must be patient and friendly in communicating with the patient. Both familiarity and familiarity and excessive dryness and formality are unacceptable. Patients should be addressed as “you” and by their first and patronymic names. You cannot discuss the diagnosis, treatment plan, or talk about the illnesses of your roommates in the presence of patients. It is forbidden to question the correctness of the treatment in the presence of the patient. Before difficult and painful procedures, the nurse must explain in an accessible form their meaning, meaning and necessity for successful treatment and relieve psycho-emotional stress.

Relationships "nurse - relatives (and friends) of the patient": It is necessary to maintain restraint, calm and tact; Explain to persons caring for seriously ill patients the correctness of procedures and manipulations; Conversate only within the limits of your competence (you do not have the right to talk about symptoms or the prognosis of the disease, but must refer you to your doctor); Answer questions calmly, unhurriedly, and teach proper care for seriously ill patients.

Relationships "nurse - doctor": Rudeness and disrespectful attitude in communication are unacceptable; Carry out medical prescriptions in a timely, accurate and professional manner; Urgently inform the doctor about sudden changes in the patient’s condition; If you have doubts in the process of carrying out medical prescriptions, tactfully clarify all the nuances with the doctor in the absence of the patient.

Nurse-nurse relationships: Rudeness and disrespect towards colleagues is unacceptable; Comments should be made tactfully and in the absence of the patient; Experienced nurses should share their experience with young ones; In difficult situations we must help each other.

Relationships "nurse - junior medical staff": Maintain mutual respect; Monitor tactfully, unobtrusively the activities of junior medical staff; Rudeness, familiarity, and arrogance are unacceptable; It is unacceptable to make comments in the presence of patients and visitors.

CLASSIFICATION OF NURSES ACCORDING TO I. HARDY The author of the book “Doctor, Nurse, Patient,” the famous Hungarian psychotherapist I. Hardy (1983), identified 6 types of nurses. The typology of nurses is based not only on their psycho-emotional characteristics, but also on their attitude towards work and patients. This classification is somewhat exaggerated, but it helps to look at the activities of a nurse “through the eyes of patients.”

1. Nurse-routineer - she carefully, scrupulously, accurately performs all her duties, acting strictly according to instructions, shows diligence, dexterity and skill in caring for the sick, but works mechanically, without empathy, without showing sympathy.

2. A nurse playing a learned role (artistic type) - such a nurse, in the process of her work, tries to play some role (for example, a benefactress) or follow an ideal she likes. Gradually, in the behavior of such a sister, sincerity, spontaneity, openness disappear and pretense and artificiality appear.

3. The type of “nervous” sister - emotionally unstable, quick-tempered, irritable, inclined to discuss personal problems, believes that her efforts are not properly appreciated; is often afraid of contracting any infectious disease; as a result, he may show disgust and even refuse to perform any procedures or manipulations under a plausible pretext. From the point of view of professional ethics, such nurses should not work with patients.

4. A sister with a masculine appearance, a strong personality - patients already recognize her from afar, by her gait or loud voice, quickly trying to put their bedside tables and beds in order, and remove unnecessary things. Such a sister loves order, clarity and discipline. In favorable cases, she can become an excellent organizer and a good teacher. If there is a lack of culture, she can be harsh and rude with patients, but she is always responsible and precise in her work.

5. Maternal type nurse - does her job with maximum care and compassion for patients, succeeds everywhere. For such a nurse, work is an essential condition of life; caring for patients is her calling in life. Such addresses as “mother”, “sister” are the best suited for them. Frequent concern for others and love for people permeates their personal lives.

6. Specialist sister - sisters who, due to some special personality trait, show curiosity in a certain area of ​​​​professional activity and, thanks to the development of this interest, receive a special assignment. Many of them devote their lives to their chosen business, working in physiotherapy rooms, functional diagnostics, and various laboratories.

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Ethics and deontology in the work of a nurse

Medical ethics is a section of the philosophical discipline of ethics, the object of study of which is the moral and moral aspects of medicine.

Deontology (from the Greek dEpn - due) is the doctrine of problems of morality and morality, a section of ethics. The term was introduced by Bentham to designate the theory of morality as the science of morality.

Subsequently, science narrowed down to characterizing the problems of human debt, considering debt as an internal experience of coercion determined by ethical values. In an even narrower sense, deontology was designated as a science that specifically studies medical ethics, the rules and norms of interaction between a doctor and colleagues and patients.

Main issues of medical deontology-- this is euthanasia, as well as the inevitable death of the patient. The goal of deontology is to preserve morality and combat stress factors in medicine in general.

There is also legal deontology, which is a science that studies issues of morality and ethics in the field of jurisprudence.

Deontology includes:

1. Issues of maintaining medical confidentiality

2. Measures of responsibility for the life and health of patients

3. Relationship problems in the medical community

4. Problems in relationships with patients and their relatives

5. Rules regarding intimate relationships between medical personnel and patients, developed by the Committee on Ethical and legal issues at the American Medical Association:

In a narrower sense, medical ethics is understood as a set of moral standards for the professional activities of medical workers. In the latter sense, medical ethics is closely related to medical deontology.

Medical deontology is a set of ethical standards for health workers to perform their professional duties. Medical ethics provides for a wider range of problems - relationships with the patient, health workers among themselves, with the patient’s relatives, and healthy people. These two directions are dialectically related.

Understanding medical ethics, morality and deontology

medical ethics deontology surgical

At the beginning of the 19th century, the English philosopher Bentham used the term “deontology” to define the science of human behavior in any profession. Each profession has its own deontological norms. Deontology comes from two Greek roots: deon - due, logos - teaching. Thus, surgical deontology is a doctrine of what should be done, it is the rules of conduct for doctors and medical personnel, it is the duty of medical workers to patients. For the first time, the basic deontological principle was formulated by Hippocrates: “We must pay attention so that everything that is used is beneficial.”

According to modern ideas, medical ethics includes the following aspects:

scientific - a branch of medical science that studies the ethical and moral aspects of the activities of medical workers;

practical - an area of ​​medical practice, the tasks of which are the formation and application of ethical norms and rules in professional medical practice.

Medical ethics studies and determines solutions to various problems of interpersonal relationships in three main areas:

medical worker - patient,

medical worker - relatives of the patient,

medical worker - medical worker.

The four universal ethical principles include: beneficence, autonomy, justice and completeness of care. Before we begin to discuss the application of the principles in practice, we will give a brief description of each of them.

The principle of mercy says: “I will do good to the patient, or at least not harm him.” Mercy implies a sensitive and attentive attitude towards the patient, the choice of treatment methods proportional to the severity of the condition, the patient’s willingness and ability to cope with the prescribed medical intervention. The main thing is that any action of a medical worker should be aimed at the benefit of a particular patient!

The principle of autonomy requires respect for the individuality of each patient and his decisions. Each person can only be considered as an end, but not as a means to achieve it. The principle of autonomy relates to such aspects of medical care as confidentiality, respect for the patient's culture, religion, political and other beliefs, informed consent to medical intervention and joint planning and implementation of the plan of care, as well as independent decision-making by the patient or decision-making by a legal representative of this patient.

The principle of justice, non-harm, requires equal treatment of medical workers and provision of equivalent care to all patients, regardless of their status, position, profession or other external circumstances. This principle also determines that whatever assistance a medical professional provides to a patient, his actions must not cause harm to either the patient or others. When faced with a situation of conflict between a patient and his loved ones or other medical workers, guided by this principle, we must be on the patient’s side.

The principle of completeness of medical care implies professional provision of medical care and a professional attitude towards the patient, the use of the entire available arsenal of healthcare to conduct high-quality diagnostics and treatment, implement preventive measures and provide palliative care. This principle requires absolute compliance with all laws related to health care, as well as all provisions of the code of ethics.

The moral responsibility of a medical worker implies compliance with all principles of medical ethics.

Nurse-patient relationship

The nurse must be patient and friendly when communicating with the patient. Both familiarity and familiarity and excessive dryness and formality are unacceptable. Patients should be addressed as “you” and by their first and patronymic names.

You cannot discuss the diagnosis, treatment plan, or talk about the illnesses of your roommates in the presence of patients. It is forbidden to question the correctness of the treatment in the presence of the patient.

Before difficult and painful procedures, the nurse must explain in an accessible form their meaning, meaning and necessity for successful treatment and relieve psycho-emotional stress.

Relationships "nurse - relatives (and close) of the patient:

It is necessary to maintain restraint, calm and tact;

Explain to persons caring for seriously ill patients the correctness of procedures and manipulations;

Conversate only within the limits of your competence (you do not have the right to talk about symptoms or the prognosis of the disease, but must refer you to your doctor);

Answer questions calmly, unhurriedly, and teach proper care for seriously ill patients.

The nurse-doctor relationship:

Rudeness and disrespectful attitude in communication are unacceptable;

Carry out medical prescriptions in a timely, accurate and professional manner;

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

If you have doubts in the process of carrying out medical prescriptions, tactfully clarify all the nuances with the doctor in the absence of the patient.

Nurse-nurse relationships:

Rudeness and disrespect towards colleagues are unacceptable;

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

Experienced nurses should share their experience with young ones;

In difficult situations we must help each other.

Relationships "nurse - junior medical staff":

Maintain mutual respect;

Monitor tactfully, unobtrusively the activities of junior medical staff;

Rudeness, familiarity, and arrogance are unacceptable;

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

Features of medical ethics and deontology in the surgical department

Surgery belongs to the area of ​​medicine where the practical skills of medical personnel are extremely important. All the thoughts and attention of surgeons, operating rooms and ward nurses are concentrated on the operating room, where the main work takes place - the surgical operation. During the operation, direct contact between medical personnel and the patient practically ceases and the process of coordinated interaction between surgeons, anesthesiologists, and nursing staff serving the operating room sharply intensifies.

If in the operating room the leading role is given to surgeons and anesthesiologists, then in the preoperative and especially in the postoperative period much depends on the attentive and sensitive attitude of nurses and junior medical staff to the patient. Many surgeons quite rightly argue that surgery is the beginning of surgical treatment, and its outcome is determined by good nursing, that is, appropriate care in the postoperative period.

Psychological problems include fear of surgery. The patient may be afraid of the operation itself, the suffering associated with it, pain, the consequences of the intervention, doubt its effectiveness, etc. You can learn about the patient’s fears from his words, conversations with neighbors in the ward. This can be indirectly judged by various vegetative signs: sweating, rapid heartbeat, diarrhea, frequent urination, insomnia, etc. The patient’s fear is often intensified under the influence of “information” that patients who have undergone surgery willingly provide and, as a rule, exaggerate everything that happened to them. them.

The nurse should report her observation of the patient to the attending physician and work with him on psychotherapeutic tactics. It is advisable to conduct a conversation with patients who have undergone surgery about the adverse effect of their stories on newly admitted patients preparing for surgical treatment.

When preparing for an operation, it is very important to establish good contact with the patient, during a conversation, find out about the nature of his fears and concerns in connection with the upcoming operation, reassure him, and try to change his attitude towards the upcoming stage of treatment. Many patients are afraid of anesthesia, afraid of “falling asleep forever,” losing consciousness, giving away their secrets, etc.

After surgery, a number of complex problems also arise. Some surgical patients with postoperative complications may experience various mental disorders. Surgery and forced bed rest can cause various neurotic disorders. Often, on the 2nd - 3rd day after surgery, patients develop dissatisfaction and irritability. Against the background of asthenia, especially if complications arise after surgery, a depressive state may develop.

In the postoperative period, elderly people may experience a delirious state with the presence of hallucinations and delusional experiences. Its genesis is complex, predominantly toxic-vascular. In patients suffering from alcoholism, delirium delirium quite often develops in the postoperative period.

It is always advisable to transfer patients with psychosis, if their physical condition allows, to a psychiatrist for observation. Often, psychotic states develop in the form of short-term episodes and are easily stopped by the prescription of tranquilizers and antipsychotics. Issues of further treatment should be decided by the attending or duty doctor, taking into account all the circumstances.

Difficult questions arise when communicating with patients undergoing surgery for a malignant neoplasm. They are concerned about their future fate, asking questions whether they have a malignant tumor, whether there have been metastases, etc. You need to be very careful when talking with them. It is necessary to explain to patients that the operation was successful and they are in no danger in the future. It is necessary to conduct psychotherapeutic conversations with such patients.

Patients react severely to operations to remove individual organs (gastric resection, breast removal, amputation of limbs, etc.). Such patients experience real difficulties of a social and psychological nature. Patients with a psychopathic personality structure view their physical defect as a “collapse of later life”; they develop depression with suicidal thoughts and tendencies. Such patients should be constantly monitored by medical personnel.

Modern rules ethics and deontology

Work in a department or in a hospital must be subject to strict discipline, subordination must be observed, that is, the official subordination of a junior in position to a senior.

A medical worker in relation to patients must be correct, attentive, and avoid familiarity.

Deontology includes maintaining medical confidentiality. In some cases, it is necessary to hide his true illness, such as cancer, from the patient.

Maintaining medical confidentiality applies not only to doctors, but also to medical staff, students, that is, to all those who come into contact with patients.

There is a rule: “The word heals, but the word can also cripple.” Medical confidentiality does not apply to the patient's relatives. The doctor must inform the relatives of the true diagnosis, the patient’s condition and prognosis.

Deontology also includes relationships with colleagues. You cannot criticize or evaluate the actions of a colleague in the presence of a patient. Remarks to colleagues should be made, if necessary, face to face, without undermining authority. You should never tell a patient that this consultant is bad if he does not agree with your diagnosis.

If disagreements arise during a joint examination with colleagues, they must be discussed in the staff room, and then, on the basis of the truth achieved in the dispute, it is necessary to communicate the general opinion to the patient exactly like this: “We discussed and decided...”.

Conclusion

Along with the unprecedented progress of various fields of medicine, its moral and philosophical principles cannot remain unchanged.

The concept of medical ethics and deontology has many meanings. This is a relationship with the patient, born and based on deep feedback. This is also a counterpoint between the patient and society, relatives, acquaintances, and colleagues.

The ethical basis of the professional activity of a nurse is humanity and mercy. The most important tasks of a nurse’s professional activity are: comprehensive comprehensive care for patients and alleviation of their suffering; health restoration and rehabilitation; promoting health and preventing disease.

The Code of Ethics provides clear moral guidelines for the professional activity of a nurse and is intended to promote consolidation, increase the prestige and authority of the nursing profession in society, and the development of nursing in the Republic of Kazakhstan.

Bibliography

1. B.V. Petrovsky. “Deontology in medicine”, M.: Medicine, 1988.

2. http://surgery-manual.narod.ru/ethics.htm"Surgical ethics and deontology"

3. http://screens.fatal.ru/etika“Medical ethics and medical deontology”,

4. http://www.saminfo.ru“Some problems of medical bioethics” Telnova K.I., Associate Professor SamSMU

5.TSB. Article "Deontology"

6.Vail S.S., Some issues of medical deontology, 3rd ed., L., 1969;

7. Gromov A. P., Medical deontology and responsibility of medical workers, M., 1969;

8.Golubeva G.V. and Tapilina K.E., Medical ethics. Bibliographic index of literature, M., 1968.

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