Ethics and deontology in the work of nurses and patients. Principles of nursing ethics and deontology

The main aspects of medical ethics determine the attitude of a medical worker to the patient, society and the relationship of medical workers with each other. Nursing ethics is one of the sections of bioethics, the meaning of which is to demonstrate humanism in all areas of medical activity.

Medical ethics refers to a combination of moral standards that medical workers are required to follow in the performance of their professional duties. At the same time, medical ethics is very closely related to medical deontology - the doctrine of problems of morality and morality, which is a section of ethics. Deontology mainly determines the norms of the relationship between a medical worker and a patient. Ethics and deontology are closely interrelated. The term “deontology” was first introduced into use by the British philosopher I. Bentham at the beginning of the 19th century, meaning by it the doctrine of the norms of behavior of a representative of any profession. The word “deontology” is derived from two Greek roots: deon – “ought”, and logos – “teaching”. Therefore, medical deontology is the doctrine of the duty of medical workers to the patient. According to the formulation of the ancient Greek physician Hippocrates, “... attention must be paid to ensure that everything that is used is beneficial.”

The definition of “ethics” is used when it comes to the theory of morality, one or another interpretation of such concepts as duty, conscience, honor, justice, etc. Compliance with ethics and deontology seems extremely important in the system of relationships between a health worker and his ward. It is known that doctors, when starting their professional activities, take the Hippocratic oath, which defines the concepts of medical ethics. An analogue of this text for nurses was the oath of the English nurse Florence Nightingale in the 19th century.

After the end of World War II, the World Medical Association, founded in 1947, began its activities with the development and adoption of the Geneva Declaration, which was essentially an updated version of the Hippocratic Oath. The impetus for the creation of the declaration came from well-known events, when the “doctors” of the Third Reich and its allies discredited the medical profession itself: in order to carry out so-called “scientific research,” tens of thousands of inhumane experiments were carried out on people, which claimed a huge number of lives. The Geneva Declaration not only once again emphasized the importance of the medical worker’s striving for humanistic ideals, but also guaranteed the independence of his profession from ideology and politics.

According to modern rules of ethics and deontology, work in a medical institution must be subject to strict discipline and subordination. In relation to the patient, the medical worker is obliged to show attentiveness and correctness.

Deontology also includes such an aspect as maintaining medical confidentiality. There are situations when it is advisable to hide the real state of his health and further prognosis from the patient, especially in oncology. Not only doctors, but also all members of the medical staff who come into contact with the patient are required to maintain secrecy.

Iatrogenesis, a painful condition that develops in a patient due to the negative influence of a medical worker on him, is directly related to medical deontology. Careless voicing of a serious diagnosis in the presence of a patient, mention of a possible death and other information - all this can negatively affect his mental and physical condition. It is also unacceptable to discuss the health status and diagnoses of other patients in the presence of the patient. If a patient is characterized by excessive suspiciousness and psychological instability, then it is easy to convince him that he has some kind of pathology. In this case, a person begins to look for symptoms of a non-existent disease. In such a situation, the medical professional should try to convince the patient that there are no fictitious diseases. Iatrogenesis also includes diseases and injuries resulting from unqualified or thoughtless actions of a doctor.

The relationship between a medical worker and colleagues is part of deontology. It is unacceptable to criticize the actions of a colleague or even an unfamiliar healthcare worker in the presence of a patient. Remarks to colleagues should be made exclusively face to face, thus maintaining their authority. A healthcare professional should listen to any advice, even if it comes from a lower rank employee. Under no circumstances should a patient be told that the specialist who advised him is bad.

The tactics of a medical worker and his relationship with the patient should always be built taking into account the individual characteristics of the patient’s character, his level of education and the severity of his condition. The relationship between a medical worker and the patient’s relatives and friends represents the most difficult problem in modern medical deontology. If the disease is not dangerous, the prognosis is favorable, and the treatment is proceeding according to the planned plan, then you can be as frank as possible.

If there are any complications, we will allow a tactful conversation with the closest relatives. In severe cases, the most reasonable answer on the part of the nurse is “ask your doctor.”

The Code of Ethics for Nurses in Russia is of particular importance in determining the rules of conduct for nurses. When compiling it, new ideas that influenced the professional ethics of nurses were taken into account.

First of all, this document reflects modern ideas about the rights of the patient, which largely determine the responsibilities of a medical worker.

For violation of the Ethical Code of Nurses of Russia, the nurse bears responsibility as provided for in the Charter of the Interregional Association of Nurses of Russia.

According to the documents on which the Code was drawn up (such as the Constitution of the World Health Organization (1946), the Code of Ethics for Nurses of the International Council of Nurses (1973), etc.), nurses are not only executors of doctor’s orders , but also representatives of an independent profession who have the skills of comprehensive patient care and have the necessary level of knowledge in the field of psychology.

The first impression of a medical institution is based, among other things, on how the medical staff greeted you, and this is what determines the further relationship between the patient and the medical staff, the presence or absence of trust between them, etc. Both the appearance and the internal emotional state of the nurse should position the patient towards it. The nurse should not call the patient “sick” in a distant manner, as this indicates an indifferent attitude. To create an atmosphere of trust in communication between a nurse and a patient, it is necessary to give the patient the opportunity to feel that you are not indifferent to his fate and that you really want to help him. Only in such a situation can a degree of trust arise in which the nurse can obtain complete and objective information about the patient, the characteristics of his psyche, and find out his opinion about his own illness and hospital conditions. Such information will make it possible to make a nursing diagnosis, which will subsequently facilitate the healing process.

The nurse must remember to always retain a leading role and not cross the line between trust and familiarity. The nurse should try to promote the emergence of empathy between her and the patient, but under no circumstances should she identify herself with the patient: with all the understanding of his problems and the desire to alleviate his condition, to help him, she should be critical of her actions and not allow herself to go wrong. about him. To establish a trusting relationship, you need to convince the patient of the confidentiality of your conversations.

Having gained an understanding of the patient’s personality and emotional experiences, the nurse can tactfully explain to him not only his rights, but also his responsibilities, and also carefully prepare the patient for examinations and therapeutic procedures, presenting the necessary information in an accessible form. The patient's reluctance to undergo certain procedures should not provoke the development of a negative attitude towards him on the part of the nurse.

When building a nurse-patient relationship, the individual work style and personal characteristics of the nurse are important. The necessary qualities in this case are professionalism, compassion, mercy, boundless patience, responsibility and politeness.

The work style and behavior of a nurse largely depend on the ethical standards established in a given medical institution. Unfortunately, a common shortcoming of nursing staff is moral indifference (indifference). Some actions that contradict the basic concepts of ethics and deontology are explained by doctors by the presence of objective factors of modern reality. However, there are no circumstances that could justify unethical actions by a medical professional.

Deontology and ethics in medicine have always been of great importance. This is due to the specific nature of the work of hospital staff.

Fundamentals of medical ethics and deontology today

Currently, the problem of relationships (both within the workforce and with patients) has acquired particular importance. Without the coordinated work of all employees, as well as in the absence of trust between the doctor and the patient, it is unlikely that serious success will be achieved in the medical field.

Medical ethics and deontology are not synonymous. In fact, deontology is a kind of separate branch of ethics. The fact is that she is an inferior complex of only a professional person. At the same time, ethics is a much broader concept.

What can deontology be?

Currently, there are several variants of this concept. It all depends on what level of relationship is being discussed. Among their main varieties are:

• doctor - patient;
• doctor - nurse;
• doctor - doctor;
• - patient;
• nurse - nurse;
• doctor - administration;
• doctor - junior medical staff;
• nurse - junior medical staff;
• junior medical personnel - junior medical personnel;
• nurse - administration;
• junior medical staff - patient;
• junior medical staff - administration.

Doctor-patient relationship

This is where medical ethics and medical deontology are most important. The fact is that without observing them, a trusting relationship is unlikely to be established between the patient and the doctor, and in this case the process of recovery of the sick person is significantly delayed.

In order to gain the patient’s trust, according to deontology, the doctor should not allow himself unprofessional expressions and jargon, but at the same time he should clearly tell the patient both the essence of his disease and the main measures that must be taken in order to achieve a full recovery. If the doctor does exactly this, then he will definitely find a response from his ward. The fact is that the patient can trust the doctor 100% only if he is truly confident in his professionalism.

Many doctors forget that medical ethics and medical deontology prohibit confusing the patient and express themselves in an unnecessarily complex manner, without conveying to the person the essence of his condition. This gives rise to additional fears in the patient, which do not at all contribute to a speedy recovery and can have a very detrimental effect on the relationship with the doctor.

In addition, medical ethics and deontology do not allow the doctor to talk about the patient. Moreover, this rule should be followed not only with friends and family, but even with those colleagues who do not take part in the treatment of a particular person.

Nurse-patient interaction

As you know, it is the nurse who has more contact with patients than other healthcare workers. The fact is that most often after a morning round the doctor may not see the patient again during the day. The nurse delivers pills to him several times, gives injections, measures his blood pressure and temperature, and also carries out other appointments from the attending physician.

The ethics and deontology of a nurse instruct her to be polite and responsive towards the patient. At the same time, under no circumstances should she become an interlocutor for him and answer questions about his illnesses. The fact is that a nurse may misinterpret the essence of a particular pathology, as a result of which harm will be caused to the preventive work carried out by the attending doctor.

Relationships between junior medical staff and patients

It often happens that it is not the doctor or the nurse who is rude to the patient, but the nurses. This should not happen in a normal healthcare facility. Junior medical staff must care for patients, doing everything (within reasonable limits) to make their stay in the hospital as convenient and comfortable as possible. At the same time, they should not engage in conversations on distant topics, much less answer questions of a medical nature. Junior staff do not have a medical education, so they can only judge the essence of diseases and the principles of combating them at a layman level.

Relationship between nurse and doctor

And deontology calls for staff to treat each other with respect. Otherwise, the team will not be able to work harmoniously. The main link in professional relations in a hospital is the interaction between doctors and nursing staff.

First of all, nurses need to learn to maintain subordination. Even if the doctor is very young, and the nurse has worked for more than a dozen years, she should still treat him as an elder, fulfilling all his instructions. These are the fundamental foundations of medical ethics and deontology.

Nurses should adhere to such rules especially strictly in relationships with doctors in the presence of a patient. He must see that appointments are made to him by a respected person who is a kind of leader capable of managing a team. In this case, his trust in the doctor will be especially strong.

At the same time, the basics of ethics and deontology do not prohibit a nurse, if she is experienced enough, from hinting to a novice doctor that, for example, his predecessor acted in a certain way in a specific situation. Such advice, expressed in an informal and polite manner, will not be perceived by the young doctor as an insult or an understatement of his professional capabilities. Ultimately, he will be grateful for the timely hint.

Relationships between nurses and junior staff

The ethics and deontology of a nurse instruct her to treat junior hospital staff with respect. At the same time, there should be no familiarity in their relationship. Otherwise, it will decompose the team from the inside, because sooner or later the nurse may begin to make complaints about certain instructions of the nurse.

If a conflict situation arises, a doctor can help resolve it. Medical ethics and deontology do not prohibit this. However, middle and junior staff should try to burden the doctor with such problems as rarely as possible, because resolving conflicts between employees is not part of his direct job responsibilities. In addition, he will have to give preference in favor of one or another employee, and this can cause the latter to have complaints against the doctor himself.

The nurse must unquestioningly carry out all adequate orders of the nurse. In the end, the decision to carry out certain manipulations is made not by her herself, but by the doctor.

Interaction between nurses

As with all other hospital employees, nurses should behave with restraint and professionalism in their interactions with each other. The ethics and deontology of a nurse instruct her to always look neat and be polite with colleagues. Disputes that arise between employees can be resolved by the head nurse of the department or hospital.

At the same time, each nurse must perform exactly her duties. There should be no evidence of hazing. This especially needs to be monitored by senior nurses. If you overstrain a young specialist with additional job responsibilities for which he will not receive anything, then he is unlikely to remain in such a job long enough.

Relationships between doctors

Medical ethics and deontology are the most complex concepts. This is due to the variety of possible contacts between doctors of both the same and different profiles.

Doctors should treat each other with respect and understanding. Otherwise, they risk ruining not only their relationships, but also their reputation. Medical ethics and deontology strongly discourage doctors from discussing their colleagues with anyone, even if they are not doing exactly the right thing. This is especially true in cases where a doctor communicates with a patient who is seen by another doctor on an ongoing basis. The fact is that it can forever destroy the trusting relationship between the patient and the doctor. Discussing another doctor in front of a patient, even if a certain medical error was committed, is a dead-end approach. This, of course, can increase the status of one doctor in the eyes of the patient, but it will significantly reduce the trust in him on the part of his colleagues. The fact is that sooner or later the doctor will find out that he was discussed. Naturally, after this he will not treat his colleague the same as before.

It is very important for a doctor to support his colleague, even if he made a medical mistake. This is exactly what professional deontology and ethics prescribe to do. Even the most highly qualified specialists are not immune from mistakes. Moreover, a doctor who sees a patient for the first time does not always fully understand why his colleague acted this way and not otherwise in a given situation.

The doctor must also support his young colleagues. It would seem that in order to start working as a full-fledged doctor, a person must study for many years. During this time, he indeed receives a lot of theoretical and practical knowledge, but even this is not enough for the successful treatment of a particular patient. This is due to the fact that the situation in the workplace is largely different from what is taught in medical universities, so even a good young doctor who has paid great attention to his training will not be ready to deal with a more or less complex patient.

The doctor’s ethics and deontology instruct him to support his young colleague. At the same time, talking about why this knowledge was not acquired during training is meaningless. This may confuse the young doctor and he will no longer seek help, preferring to take the risk rather than seek help from the person who judged him. The best option would be to simply tell you what to do. Over the course of several months of practical work, the knowledge acquired at the university will be complemented by experience and the young doctor will be able to cope with almost any patient.

Relationships between administration and health workers

The ethics and deontology of medical personnel are also relevant within the framework of such interaction. The fact is that representatives of the administration are doctors, even if they do not take much part in the treatment of the patient. All the same, they must adhere to strict rules when communicating with their subordinates. If the administration does not quickly make decisions on those situations where the basic principles of medical ethics and deontology have been violated, then it may lose valuable employees or simply make their attitude to their duties formal.

The relationship between the administration and its subordinates must be trusting. It really does not benefit hospital management when their employee makes a mistake, so if the chief physician and medical director are in place, they will always try to protect their employee, both from a moral point of view and from a legal point of view.

General principles of ethics and deontology

In addition to specific aspects in the relationship between various categories, one way or another related to medical activities, there are also general ones that are relevant for everyone.

First of all, a doctor must be educated. The deontology and ethics of medical personnel in general, not just doctors, prescribe in no case to cause harm to the patient. Naturally, everyone has gaps in knowledge, but the doctor must try to eliminate them as quickly as possible, because the health of other people depends on it.

The rules of ethics and deontology also apply to the appearance of medical personnel. Otherwise, the patient is unlikely to have sufficient respect for such a doctor. This may lead to non-compliance with the doctor’s recommendations, which will worsen the patient’s condition. At the same time, the cleanliness of the robe is prescribed not only in streamlined formulations of ethics and deontology, but also in medical and sanitary standards.

Modern conditions also require compliance with corporate ethics. If it is not guided by it, then the medical profession, which today is already experiencing a crisis of trust on the part of patients, will become even less respected.

What happens if the rules of ethics and deontology are violated?

In the event that a medical worker has done something not very significant, even if it contradicts the basics of ethics and deontology, then his maximum punishment may be deprivation of bonuses and a conversation with the chief physician. There are also more serious incidents. We are talking about those situations when a doctor does something truly out of the ordinary, capable of harming not only his personal reputation, but also the prestige of the entire medical institution. In this case, a commission on ethics and deontology is assembled. Almost the entire administration of the medical institution should be included in it. If the commission meets at the request of another medical worker, then he must also be present.

This event is in some ways very reminiscent of a trial. Based on the results of its conduct, the commission issues one or another verdict. He can either acquit the accused employee or bring him a lot of trouble, including dismissal from his position. However, this measure is used only in the most exceptional situations.

Why are ethics, as well as deontology, not always respected?

First of all, this circumstance is associated with the banal syndrome of professional burnout, which is so characteristic of doctors. It can occur in workers of any specialty, whose duties include constant communication with people, but it is among doctors that this condition occurs most quickly and reaches its maximum severity. This is due to the fact that, in addition to constantly communicating with many people, doctors are constantly in a state of tension, because a person’s life often depends on their decisions.

In addition, medical education is received by people who are not always suitable for work in the world. However, we are not talking about the amount of necessary knowledge. Here, the desire to do it with people is no less important. Any good doctor should be at least to some extent concerned about his work, as well as the fate of his patients. Without this, no deontology or ethics will be observed.

Often, it is not the physician himself who is to blame for non-compliance with ethics or deontology, although the blame will fall on him. The fact is that the behavior of many patients is truly defiant and it is impossible not to react to this.

About ethics and deontology in pharmaceuticals

Doctors also work in this area and very, very much depends on their activities. It should not be surprising that there are also pharmaceutical ethics and deontology. First of all, they are to ensure that pharmacists produce sufficiently high-quality drugs, and also sell them at relatively affordable prices.

It is under no circumstances acceptable for a pharmacist to launch a drug (even in his opinion, simply excellent) into mass production without serious clinical trials. The fact is that any drug can cause a huge number of side effects, the harmful effects of which collectively exceed the beneficial ones.

How to improve compliance with ethics and deontology?

No matter how it sounds, a lot depends on money issues. It has been noted that in countries where doctors and other medical workers have fairly high salaries, the problem of ethics and deontology is not so acute. This is largely due to the slow development (compared to domestic doctors) of professional burnout syndrome, since foreign specialists for the most part do not have to think much about money, because their salaries are at a fairly high level.

It is also very important that the administration of the medical institution monitors compliance with ethical and deontological standards. Naturally, she herself will have to adhere to them. Otherwise, there will be many facts of violation of the rules of ethics and deontology by employees. In addition, in no case should you demand from some employees something that is not fully demanded from another.

The most important point in maintaining the team’s commitment to the basics of ethics and deontology is periodic reminders to medical personnel of the existence of such rules. At the same time, it is possible to conduct special trainings, during which employees will have to jointly solve certain situational problems. It is better if such seminars are not held spontaneously, but under the guidance of an experienced psychologist who knows the specifics of the work of medical institutions.

Myths of ethics and deontology

The main misconception associated with these concepts is the so-called Hippocratic oath. This is due to the fact that in disputes with doctors, most people remember her. At the same time, they indicate that one needs to be more compassionate towards the patient.

Indeed, the Hippocratic Oath has a certain relationship to medical ethics and deontology. But anyone who has read its text will immediately note that it says practically nothing about patients. The main focus of the Hippocratic Oath is the doctor's promise to his teachers that he would treat them and their relatives free of charge. Nothing is said about those patients who did not participate in his training in any way. Moreover, today not all countries take the Hippocratic oath. In the same Soviet Union, it was replaced by a completely different one.

Another point regarding ethics and deontology in the medical environment is the fact that patients themselves must follow certain rules. They need to be courteous to all levels of medical personnel.

Ministry of Health of the Chelyabinsk Region

GBPOU "Satka Medical College"

AGREED: REVIEWED

Deputy Director for SD: at the Central Medical Center "Nursing"

Sevostyanova I.A. protocol___ ______Evseeva I.L.

"___"_____________ 20___ "____"_________________20___

Basic lecture notes

Topic: “Nursing ethics and deontology”

PM 04 (07) “Performing work in the profession

junior nurse for patient care"

MDK. 04. (07) 01. Theory and practice of nursing

Speciality:

34.02.01 “Nursing”

31.02.01 “Medicine”

Course 1.2

teacher

first qualification category

Nursing ethics and deontology.

THEORETICAL PART

" Ethos" - custom, manners ETHICS studies morality, that is, normswe are people's behavior, their moral attitudes.

DEONTOLOGY ( deontos- due, appropriate,logos- teaching) from teaches professional relationships. The concepts of ethics and deontology are usednims in any field of professional activity: legal, agronomic and so on, including medical. Medical ethics studies the moral relationships between the doctor, the nurse, the patient and his relatives. Medical deontology studies professional relationships in the same block: doctor, nurse, patient, relatives.

Brief historical sketch of the development of ethics and deontology .

One might think that the first person who provided medical assistance to his neighbor did so out of a feeling of compassion, desireto help in misfortune, to relieve pain, in other words, out of a sense of humanity. Humanity has always been a feature of medicine. Since antiquity andUntil now, people have been concerned with questions of ethics and deontology: howthere should be a physician’s behavior, attitude towards patients and their relatives,relationships with each other. The searches and reflections of doctors of many countries and peoples are evidenced, in particular, by Babylonian, Egyptian,Indian, Chinese, Russian ancient monuments. But only a thinkerand the doctor Hippocrates, in his famous “Oath,” first formulated the moral, ethical and ethical standards of the medical profession. GreatnessHippocrates is that he considered man to be the crown of nature. BannersIt is clear that the participantsIInternational Congress on Medical Ethicsand deontology (Paris 1969) found it possible to supplement it with just one phrase: “I swear to study all my life.”

The concept of medical deontology was introduced relativelylong ago: at the beginning of the last century, an English scientist and philosopherI. Bentham, as a designation for the science of professional human behaviorcentury. Great influence on the formation of medical ethics and deontologyRussian scientists provided assistance: Mudrov, Pirogov, Botkin, Bekhterev.They laid the foundations of ethical and deontological principles. And also withSoviet scientists and healthcare organizers: Semashko, Danilevsky, Kassirsky and many others contributed to the development of ethics and deontology.

Duty and responsibility.

Duty and responsibility are fundamental issues in both ethics and deontology. In ethics, these problems are considered from the point of view of moral relations. In deontology - in the aspect of official (professional) responsibilities.

THE MAIN ETHICAL PRINCIPLE IS DO NO HARM!

The duty of a health worker provides for the qualified and selfless performance by each medical worker of his professional duties, provided for by the norms of moral, ethical and legal regulation of medical activities, in other words, the duty of a health worker:

moral - this is the provision of medical care regardless of social status, religion, and so on,

professional - never, under any circumstances, commit actions harmful to the physical and mental state of people.

Among the problems of theoretical medicine and practical health care, ethical and deontological issues have not yet enjoyed prestige. In this regard, there are a large number of complaints from the population about violations of medical ethics and deontology. If the low professional qualifications of a medical worker cannot always be recognized by the patient or his relatives, then the moral character is revealed without difficulty and can receive, obviously, a negative assessment from the population. This means that such moral qualities as empathy and mercy should not be introduced from the outside, but become the moral core of a medical worker, an ethical norm.

There are also certain rules for the behavior of a medical worker in the team of a medical institution. Medical etiquette consists of observing the rules of external and internal culture of behavior of a health worker.

External culture of behavior:

appearance (clothes, cosmetics, hairstyle, shoes),

observance of external decency: the tone in which they speak, do not use swearing, rude words.

Internal culture of behavior:

attitude towards work,

maintaining discipline,

friendliness, respect for subordination

Subordination is a system of official subordination of a junior to a senior, based on the rules of official discipline. It must be remembered that

intrigues and rudeness lead to discord in the team, to dividing it into groups, which significantly worsens the work of the medical institution.

We must always observe the main ethical principle - DO NO HARM! Your discord in the team can harm the patient. The team must have an atmosphere that would contribute to the good work of medical personnel and the speedy recovery of patients. Otherwise, hospitalization may not alleviate the patient’s suffering, and may even cause harm. To prevent this from happening, the work of the nurse, the contact between the patient and the nurse, is very important. A nurse can perfectly perform her professional duties, achieve automatism in her work: she gives excellent injections and so on, but there is no patient behind all this. And she must be with the patient, understand him, be able to keep secrets, and inspire trust. Trust is the path to recovery. If the patient has faith in the nurse and the doctor, he feels safe and knows that he will receive everything he needs to restore his health. Otherwise, he has doubts about the treating staff. They find their expression in a variety of requirements: convening a council, inviting specialists, special research, and so on. A condition caused by severe experiences of the patient due to defects in activity and communication of medical staff, are observed more often in suspicious patients. In such cases, the following arise:

hasty and unfounded opinion about the diagnosis and prognosis;

misinterpretation of treatment and diagnostic procedures;

depression from inaction or inattention of staff.

As a consequence of all of the above, the patient may develop a fear of any disease (cancer - cancerophobia, disease

It is very important for recovery - with whom the patient communicates at home, in the ward.

The mutual influence of patients can be positive and negative: the patient sees how his roommate with a much worse prognosis is fighting for life, and this instills in him the desire to do the same. But the opposite may also be true: the sight of seriously ill patients has a depressing, depressing effect. Therefore, it is very important to select patients in the ward so that they match each other in character. And it’s absolutely ideal if communication with each other brings them satisfaction.

The nurse should not forget about such a property of the patient’s psyche as influence on himself. The person gets sick. At first, he hides from himself, explaining the onset of symptoms of the disease to various reasons (fatigue, nervous at work, troubles at home, so he got a headache). Then he realizes the fact of the disease, but for some time

hopes for quick improvement. Subtly remembers everything that he read, heard, saw among relatives and friends with the same symptoms of the disease. A feeling of fear appears: can I bear it? Will I stay alive? What will happen to the children? The patient develops a feeling of guilt, he searches for what he is to blame for, what is he paying for? For what sins? Cases of self-accusation are common. Patients often declare that it is “their own fault.” We weren't careful, we overlooked something somewhere. People who are often sick endure suffering with great humility and calm. Those patients who have become ill for the first time or for whom much in life depends on their physical health: artists, athletes, are subject to extremely serious manifestations of fear. That is, it is very important to know the personality reactions that are formed during the disease.

Chronic patients may experience more profound mental changes. The patient may become a pessimist, may become touchy, sensitive, envious, even a hater. Or maybe infantile behavior (like a small child). In these cases, trust and contact between the patient and the doctor, the patient and the nurse are very important. The nurse constantly communicates closely with the patient, while the doctor sees him only on rounds, and must, through her caring, respectful attitude and conversations with the patient, orient him toward recovery. This is especially difficult: to maintain faith in a person in cases of serious illness, with a serious outcome.

Professional secret.

The concept of professional confidentiality also applies to nurses. It is mentioned in all the oaths and promises of doctors in the world, starting with Hippocrates. Information about the results of the patient's examination, diagnosis and prognosis of the disease is communicated to the patient or his relatives only by the doctor himself (this is his competence), or with his permission by the nurse. You need to be especially careful when communicating information over the phone. It is best to ask to come to the hospital and talk to the doctor in person. But this does not mean that the patient has absolutely no right to information about his condition from the nurse. The nurse should teach the patient a new way to meet needs in connection with a change in lifestyle (explain how to follow the regimen prescribed by the doctor, how to eat depending on the prescribed diet, and so on). The nurse must explain the purpose of the prescribed manipulations, prepare the patient for them, and in case of refusal, warn about the negative consequences of this step. In addition, the nurse should orient the patient toward recovery; for this, it is good to use the patient’s life values. The nurse is independent in caring for the patient and must teach the patient himself and his relatives

some manipulations and elements of care. Thus, the range of activities of a nurse is very wide.

ETHICS AND DEONTOLOGY IN CONNECTION WITH AGE

It is very important to take into account the age of patients when communicating. If these are children, they have a hard time with separation from their mother, separation from their usual environment, are not aware of pain, do not know how to formulate complaints, and medical and diagnostic procedures frighten them. Defects of character and upbringing appear very clearly: i.e. if a child is capricious, he screams and becomes capricious even more, if he is quiet, he withdraws into himself, if he is fearful, he is constantly afraid of everything, etc. In these circumstances, the mother should be allowed visitation. After she leaves, you need to distract the child, read to him, play with him, do drawing, modeling, etc. Afraid of manipulation - to distract attention. The most important thing is the child’s trust in the nurse!

In a teenager, there is self-affirmation of the individual, hence the bravado, harshness, claims to adulthood, and a disdainful attitude towards the disease. Here you also need a lot of patience, endurance, respect, the ability to find an approach, and perhaps emphasize the attitude of an adult.

Patients of working age. It all depends on the patient’s personal qualities, how he perceives the disease, and how he treats the staff. Trust and contact are especially important here.

Elderly and senile patients. They are characterized by a feeling of loneliness, “life has already passed”, this is the dominant feature of their age. Helplessness increases, hearing and vision decrease, it becomes more and more difficult to move, memory decreases, sensitivity and vulnerability increase. The ability to self-care worsens, motivation for treatment and recovery weakens. In these cases, warmth and care are very important. The nurse must warm the elderly person, talk with relatives, with the patient himself, find what still interests him in life (life values) and build motivation for recovery on this.

TYPES OF NURSES, ACCORDING TO I. HARDY

As part of the contact between the sister and the patient - in addition to the personality of the patient and the emotional threads connecting him with the sister - special attention should be paid to the personality of the sister. In everyday practice you can meet many excellent nurses with excellent data and professional skills. However, despite this, each nurse needs to carefully understand the characteristics of her personality in order to know what her style of work is and how it affects the sick.

Let us turn to the characteristics of individual types.

Sister-routineer. The most characteristic feature of this type of sisters is the mechanical performance of their duties.

The type of sister "playing a learned role." Such sisters work consciously playing a certain role, striving for the realization of a certain ideal. Her behavior becomes artificial, ostentatious. All this can interfere with the formation of proper contact between her and the patient.

The type of "nervous" sister. A sister's emotionally labile personality, prone to neurotic reactions, can serve as a serious obstacle in working with patients. The result of such tension can be rudeness, irritability, and short temper, which has a harmful effect on patients.

The sister type with a masculine, strong personality. This sister is distinguished by persistence, determination, and indignation at the slightest disorder. In favorable cases, sisters with such a decisive personality can become excellent organizers and good teachers. about which their pupils will begin to say: “Strict, but fair.” “With a lack of culture, education, and a lower level of personality development, sisters of this type are too inflexible, straightforward, often rude and even aggressive with the sick.

Maternal nurses perform their work with maximum care and compassion for the sick. Work for them is a natural condition of existence. Caring for the sick is a life calling.

Type of nursing specialists. This should include those sisters who, due to some special abilities or personality traits, receive a special assignment. Such nurses work in laboratories, X-ray rooms, and functional diagnostic rooms.

The nursing profession is a difficult profession. You can often hear about T nurses "I'm very tired." Really:

the work is difficult - physically;

heavy emotional and mental stress.

Due to the severity, both physical and moral, a nurse may have a professional personality deformation, its main manifestations are:

coldness and indifference;

rudeness and irritability;.

depression from "powerlessness".

To prevent professional deformation, it is necessary to comply with ethical standards as a factor in the nurse’s self-regulation:

maintaining the patient’s mental balance;

activation of his position on health;

prevention of professional deformation.

Thus, the range of problems of medical ethics and deontology is extremely wide. Many of them are reflected in the “Ethical Code of Nurses of Russia”, adopted in 1997 (carefully read Appendix No. 2).

Medical deontology (from the Greek deontos - due, proper and iogos - doctrine) about the professional behavior of a medical worker. The term “deontology” itself was introduced into use at the beginning of the 19th century by the English philosopher Jeremy Bentham to designate the science of professional human behavior. The concept of “deontology” is equally applicable to any field of professional activity: medical, engineering, legal, pedagogical, etc.

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.

One of the main problems of medical deontology is duty. Medical deontology determines the proper behavior of a medical worker.

Ethical categories. These include the concepts of “duty”, “dignity”, “conscience”, “honor” and “happiness”. These concepts are thousands of years old; they were developed in a wide variety of ethical theories and teachings.

Duty. Literally means a certain range of professional and social obligations in the performance of one’s duties, established on the basis of professional or social relations. The concept of “debt” is quite capacious. To fulfill a duty correctly, it must be fully understood. In these cases, a person has a need to fulfill his duties reasonably. Fulfilling one's duty is inextricably linked with the moral qualities of an individual and the level of social consciousness. A medical worker who has high moral qualities and is well aware of his duty performs it clearly and efficiently.

The moral duty of a medical worker is: high indicators of medicine in the fight against epidemics, infant mortality, constant improvement of the culture and quality of medical care for the population.

The moral duty of a medical worker is to participate in the public life of the team.

Duty of a medical worker.- show humanism and always provide assistance to the patient, never, under any pretext, participate in actions directed against the physical and mental health of people or threatening their lives.

A medical worker never, under any pretext, has the right to hasten the death of even a hopeless and deeply suffering patient. He must use all possible means to reduce the suffering of the patient and fight for every hour of his life. The purpose of a physician is to prolong, not shorten, a person’s life.

The concept of “honor” is inseparable from the concept of duty. The concept of honor in the most general form expresses the social significance of a person (as an individual, a citizen, a master of his profession, etc.) It expresses the corresponding self-awareness of the individual, that is, his desire to maintain his reputation, good fame, and his dignity.

Dignity and honor represent not only an individual’s awareness of the social significance of his profession, love for it and professional pride, but also a constant desire for moral improvement, improvement of qualifications and quality of work.

A closely related concept with a sense of duty, honor and personal dignity conscience. The understanding of conscience represents internal moral self-awareness, awareness of a person’s moral responsibility for his behavior, assessment of his thoughts, feelings and actions in accordance with the moral norms in force in society. Conscience is the internal moral judge of a MAN. Conscience is combined with such moral values ​​as honesty and truthfulness, justice and moral purity, respect for the rights of other people and one’s responsibilities. In people's understanding, a medical worker is a person with a clear conscience, crystal honesty, fair and highly moral.

A sense of conscience can truly develop only among people who live in the interests of the collective, the people, and who fight for these interests. Conscience is related to self-esteem. It is inseparable from a person’s ideology and conviction. Public opinion is of enormous importance for the education of conscience. The opinion of the team awakens a person’s conscience, strengthens it, helps to understand one’s shortcomings, criticize them and correct them. Conscience is, first of all, awareness of one’s social duty.

Medical workers are entrusted with a huge public duty - taking care of people's health and returning sick people to the community, i.e. they are entrusted with the most precious thing - the health and life of people. The solution to many issues of a family, everyday, industrial, social nature depends most of all on the conscience and moral culture of a person.

In philosophical and ethical systems, the concept of “happiness” was considered as the starting point for all ethics. The question of happiness is a question of the meaning of life, which people see in giving their strength to society, backgammon.

The concept of happiness, a happy life is inseparable from the concept of health. Without good health there can be no complete happiness.

Ethical qualities:

Appearance

Accuracy

Neatness interior appearance

Moral qualities (inner world)

Take part in the social life of the team

Feeling of patriotism

Honesty

Philanthropy

Intellectual qualities:

Versatile development (communication skills), the ability to maintain a conversation, depends on being well-read.

The heart is treated with the heart

It is not the place that makes the person, but the person the place.

Having chosen medicine, give it everything

The word heals, the word hurts

Euthanasia, as the act of deliberately taking the life of a patient, is unethical.

Palliative medicine is the active, holistic care of terminally ill patients.

A public institution intended for incurable cancer patients to provide palliative care is a hospice. Medical ethics is the science of morality.

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 set of 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 the practical problems of 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 The concepts of medical ethics that 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 the norms of behavior of 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.

Currently, 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, frequent 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, incorrectly indicated the hours of re-appointment, the time of appearance for a 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 the medical institution has 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, when they strictly fulfill their professional duties, have a beneficial effect on the treatment 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, communicates directly 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 professional.

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.

The 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 their 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 between nursing staff and 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 areas of 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 unique system in the history of medicine for providing medical care to the poor. They laid 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: blue-collar workers, office workers, etc. They must behave in accordance with the requirements of a 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 and replenishment of 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. The nurse should not enter into disputes 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.

The basic principles of nursing ethics and deontology, as set out in the oath of Florence Nightingale, the Code of Ethics of the International Council of Nurses and the Code of Ethics for Nurses of Russia, are:

· humanity and mercy, love and care

· compassion

· goodwill

· unselfishness

· hard work

· courtesy and more

Morality- this is a form of social consciousness of people, which is determined by social existence, that is, socially conditioned. It, like ethics, reflects the nature of people’s relationships and, consequently, the structure of a particular social system.

One of the categories of morality is duty. The concept of duty means the moral necessity of fulfilling one's duties in relation to other people, to society as a whole. The duty of an average medical worker is a set of historically established norms and requirements governing his relationships with patients, colleagues and society. This is not only conscientious fulfillment of duties towards the patient, but also caring for people’s health, carrying out preventive and sanitary educational work, maintaining medical secrets, providing medical care regardless of nationality, race, political and religious beliefs.

Moral- this is the real embodiment of morality through a set of customs, mores, and the behavior of people under a certain system of social relations.

Morality is based on the following basic principles:

1. The principle of humanity– considers a person as the highest value, encouraging his creative and moral development.

2. The principle of mercy– means “to do good.” It involves treating others and being responsive to those in need.

3. The principle of excluding malfeasance. This is the principle of “do no harm”, which obliges both the doctor and the medical worker to protect others from danger, relieve pain and compassion to the best of their competence.

4. The principle of justice. Includes impartiality, respect for human equality, and equal distribution of scarce funds.

5. The principle of truthfulness ( telling the truth to the patient ). It informs the basis of an open relationship between the patient and the health care provider and the performance of the latter's responsibilities.

6. The principle of informed consent, appeared at the end of the twentieth century and underlies the collegial model of relationships (or, as it is also called, the informed consent model). One of the principles of the informed consent model is the requirement to tell the patient the absolute truth about his illness and the possible immediate tragic outcome. The law requires that the patient be given truthful information about the diagnosis and prognosis, no matter how severe they may be.

A patient who trusts his sister with his health, and often his life, wants to receive effective nursing care as soon as possible, so he must be confident in the sister’s high professionalism, her kindness, sensitivity, mercy, and responsiveness. Since the time of Hippocrates, society has made special demands on the moral and ethical qualities of nursing personnel. The great physician of Ancient Greece repeatedly emphasized the importance for a medical worker of not only the ability to treat, but also strict adherence to the requirements of ethical standards. It is generally accepted that it was Hippocrates who formulated the basic principles of medical ethics (“Oath”, “Law”, “On Doctors”). Russian clinicians M. Ya. Mudrov, S. T. Zabelin, D. S. Samoilovich et al.

A nurse (paramedic, midwife) must have professional observation, allowing him to see, remember and, in a nursing way, evaluate the smallest changes in the physical and psychological condition of the patient.

She must be able to control herself, learn to manage her emotions, and cultivate emotional stability.

The culture of behavior of a medical worker can be divided into two types:

1. Internal culture. This is an attitude to work, adherence to discipline, careful handling of furnishings, friendliness, and a sense of collegiality.

2. External culture. Decency, good manners, culture of speech, appropriate appearance, etc.

The main qualities of a medical worker, and the qualities of his internal culture, are:

· modesty– simplicity, artlessness, which testify to the beauty of a person, his strength;

· justice– the highest virtue of a medical worker. It is the basis of his inner motivations. Cicero spoke of two principles of justice: “Harm no one and benefit society”;

· honesty– must correspond to all the affairs of a medical worker, become the basis of his daily thoughts and aspirations;

· kindness- an integral quality of the internal culture of a good person. A good person is, first of all, a person who treats the people around him favorably, understands both sorrows and joys, and, in case of need, readily. At the call of his heart, without sparing himself, he helps in word and deed.

What is the external culture of a medical worker?

1. Appearance. The main requirement for a doctor’s clothing is cleanliness and simplicity, the absence of unnecessary jewelry and cosmetics, a snow-white robe, a cap and the availability of replaceable shoes. Clothing, facial expression, and demeanor reflect some aspects of the medical worker’s personality, the degree of his care and attention to the patient. “Doctors should keep themselves clean and have good clothes, for all this is pleasant for the sick” (Hippocrates).

The medical uniform does not need decoration. She herself adorns a person, symbolizes purity of thoughts, rigor in the performance of professional duties. The patient will not have confidence in a medical worker who has a gloomy look, a careless posture, and speaks as if he is doing a favor. The medical worker must keep things simple, speak clearly, calmly, and with restraint.

2. Speech culture is the second component of external culture. The speech of a medical worker should be clear, quiet, and emotional. You cannot use diminutive epithets when addressing a patient: “granny”, “darling”, etc. You often hear people say about a patient: “diabetic”, “ulcer sufferer”, “asthmatic”, etc.

Sometimes the speech of medical workers is peppered with fashionable, slang words, primitive, the patient does not gain confidence in them. Such costs of the speech culture of medical workers seem to fence them off from patients, push the patient’s personality, his individuality into the background, and cause a negative reaction in the patient.

A medical worker is entrusted with the most precious things - life, health, and well-being of people. He is responsible not only to the patient and his relatives, but also to the state as a whole. We must remember: The patient's interests come first.

TOPIC: Patient rights

After studying the topic

The student must be able to:

Analyze information and choose the main thing

Use the acquired knowledge in practical activities

Organize communication with the patient taking into account the standards of professional ethics;

The student must know:

Patient's rights.

Ethical issues in modern healthcare

Questions for self-study

1. Define:

Patient

Patient problems

Iatrogenesis

Empathy

Subordination

Medical deontology

2. Legislative support for patients' rights

3. List the patient's rights

4. Name the ethical and legal aspects of the nurse’s observance of patients’ rights

The problem of human rights in modern society is one of the most complex and painful. It becomes especially acute where issues of life and death, health and illness are directly decided. It is in medicine, more than anywhere else, that any injustice, indifference, or humiliation of human dignity is clearly visible. Based on this, it is obvious that the role of the nurse in respecting the rights of the patient is becoming increasingly important.

The rights of patients in the Russian Federation have legislative support and no one doubts the need to comply with them, but when it comes to their actual implementation, certain difficulties arise.

1. Legislative support for the rights of patients in the Russian Federation.

The legal basis for ensuring the rights of patients in the Russian Federation is:

Federal laws (“On the fundamentals of protecting the health of citizens in the Russian Federation” dated November 21, 2011 No. 323-FZ, “On compulsory health insurance in the Russian Federation” dated November 19, 2010 No. 326-FZ, “On immunoprophylaxis of infectious diseases” dated September 17 .1998 No. 157-FZ, other federal laws);

Laws of the subjects of the Russian Federation;

Decrees of the President of the Russian Federation;

Decrees of the Government of the Russian Federation;

Resolutions of the Ministry of Health and Social Development of the Russian Federation;

other legal acts;

international treaties of the Russian Federation (World Declaration of Human Rights (1948), Helsinki Declaration of the World Medical Association (1964) and a number of others).

According to Art. 41 of the Constitution of the Russian Federation, everyone has the right to health care and medical care. Medical care in state and municipal health care institutions is provided to citizens free of charge at the expense of the corresponding budget, insurance premiums, and other revenues.

The basic rights of patients in medical institutions are listed in Federal Law No. 323 of November 21, 2011 - Federal Law “On the fundamentals of protecting the health of citizens in the Russian Federation.” According to Art. 19 of this law, everyone has the right to medical care in a guaranteed volume, provided without charging a fee in accordance with the program of state guarantees of free medical care to citizens, as well as to receive paid medical services and other services, including in accordance with a voluntary medical agreement insurance.

When seeking and receiving medical care, the patient has the right to:

1. respectful and humane attitude on the part of medical and service personnel;

2. choosing a doctor, taking into account his consent;

3. examination, treatment and maintenance in conditions that meet sanitary and hygienic requirements;

4. holding, at his request, a council and consultations of other specialists;

5. relief of pain associated with the disease and (or) medical intervention, using available methods and means;

6. maintaining professional secrecy by medical workers;

7. informed voluntary consent to medical interventions;

8. refusal of medical intervention;

9. obtaining information about your rights and responsibilities and the state of your health;

10. receiving medical and other services within the framework of voluntary health insurance programs;

11. compensation for damage in the event of harm to his health during the provision of medical care;

12. access to a lawyer or other legal representative to protect his rights;

13. admission to the patient of a clergyman or provision of conditions for the performance of religious rites, if this does not violate the internal regulations of the hospital institution.

2. Ethical and legal aspects of the nurse’s observance of patients’ rights

The nurse must know and respect the rights of the patient and act in accordance with these rights in his professional activities.

The ethical and legal aspects of the nurse-patient relationship are most fully disclosed in the Code of Ethics for Russian Nurses, adopted by the Russian Association of Nurses in 1997.