“There is an intimacy nurses and patients share which is understood. The essence of nursing is an unconditional love for mankind. To be called a nurse is an honor – a profession of the highest realm” (Donelan: 2004).
“If only attention and care were enough, any person could be a nurse” – such words were written in the university’s advertisement published in 1990 about the recruitment on the medical nursing department. Medical nursing care was presented as an intellectual trade based on the scientific approach, instead of a trade based on mercy. It seems like our society ceased to appreciate mercy and care.
Community health includes health care of elder people. The programs of organizations for elders are aimed at maintenance of health care of older people and create the most comfortable conditions for receiving health care services. The target is to open accessibility for elders to get necessary qualified medical aid; to have possibility to pay more attention to their health, go in for sports, and to take active part in social life. It is known that health is influenced not only by the conditions of health care service but also by a set of factors, such as environment, habitation, well-being, self-realization and emotional state. The ultimate aim is to decrease the morbidity level and to increase expectancy and quality of life.
The problem of mental frustration in the community is one of the major problems in the modern world. According to the data of World Health Organization (WHO) number of people, suffering from mental illness, makes on average 200-300 million, and it constantly grows. Thus, psychologists face the problem of abnormal behavior and methods of its research.
Care – an indispensable component of treatment
Many rules and requirements of patient care had been known since ancient times. At dawn of medicine development when the doctor was powerless, facing the majority of illnesses, only correct care could return life and health to the patients and to the injured men. However, in spite of the development of the scientific and technical progress, the presence of the most modern medical technologies, high-performance medications and effective surgeries, the correctly organized patient care plays almost the determinative role in patient’s health recovery and working ability.
There are three main principles of the organization of the psychiatric nursing care: specialization of a nursing care to various contingents of patients, aliasing and continuity of the care in the system of various psychiatric facilities.
The specialization of the psychiatric nursing care for the sick of mental illnesses is reflected in the creation of several kinds of the psychiatric care. The authorities create the psychiatric boarding houses for chronic patients.
Aliasing of the organization of the psychiatric nursing care is revealed in the presence of the maximal comfortable types of nursing care such as home-based care and residential care.
The continuity of the psychiatric nursing care is provided with close functional communication of psychiatric facilities of different steps. It allows carrying out continuous supervision over the patient and treatment at transition from one medical institution to another.
Home-based psychiatric care is the offering of services and tools in theplace of house of individuals and families that need such services and tools as a result of severe psychiatric illness, long-term health conditions, or incurable psychiatric diseases. Thus, it contributes to the former to opt for home-based psychiatric nursing care. Home-based psychiatric nursing care includes the creation of confortable atmosphere, favourable psychological climate, provision of the prescribed dieting and bed regimes.
Residential psychiatric care is based on more professional care if compared with home-based care. In this case, the bigger attention is paid to the attitudes between the phychiatrist and the patient with the help of the qualified personnel.
The key rule at communication with the person is spiritual care. Spiritual care is not a luxury accessible to a few; it is an essential right of each person as well as political freedoms, the right to medical aid, and equality of possibilities. The true democratic ideal should include the qualified spiritual care for each person in a number of the most essential positions.
Bioethics is based on representations about insufficiency of one-sided medical interpretation of corporal well-being as medical purposes. An absolute must is interdisciplinary dialogue of physicians with the representatives of a wide range of humanities and dialogue with patients and community representatives.
Cultural grounds of bioethics consist of moral understanding of the inseparable bonds with nature and its preservation leading to the moral responsibility. Bioethics also covers the problems of a holistic character, including a wide spectrum of social problems. Therefore, one of the bioethical aims is the development of the criteria and norms allowing or limiting implementation of such experiments on the human being. Such experiments can change the behavior, mentality and, finally, creating possibility to manipulate person.
Medicine is an absolutely special area of human knowledge as it unites science and values which do not have anything in common with a science. The professional activity of any medical worker, either nurse or physician is based on beneficence. Its nature is not scientifically proved. Ethics and medicine philosophy are based on compassion, on awe of human life. Medical activity can be extremely scientific without it, and can lose its essence. However, what are the grounds of this moral duty?
The ethical problematics with its basic question – about the relation between the medical worker and the patient – is not separable from any kind of medical activity. Since Hippocrates the judgement that the moral culture of the medical worker is not only worth personal characteristics, but also qualities defining professionalism, was indisputable.
National standards of nursing
“The Code of Professional Conduct for Nurses (the Code) is a set of expected national standards of nursing conduct for nurses. The Code is not intended to give detailed professional advice on specific issues and areas of practice; rather, it identifies the minimum requirements for conduct in the profession. A breach of the Code may constitute professional misconduct or unprofessional conduct. The nursing profession expects that nurses will conduct themselves personally and professionally in a way that will maintain public trust and confidence in the profession. Nurses have a responsibility to the individual, society, and the profession to provide safe and competent nursing care which is responsive to individual, group and community needs, and the profession” (Code of Professional Conduct for Nurses in Australia: 2005).
The most important approach to the patient is the fact that each human being consists not only of body but of spirit, soul and body. Each doctor, facing such problems as incurable illnesses, comes to it in his practice. When a competent experienced doctor comes to the understanding of his helplessness, he has to search for the new variants to help the patient.
Substantially, spirituality was promoted by the development of the palliative help, interest to technologies of life quality improvement and occurrence of such new directions of human activity, as integrated and complementary medicine all over the world. The given circumstances have forced many physicians to concern spirituality possibilities in public health services more seriously.
“Generally, professionalism in nursing encompasses a wide range of thoughts and ideas, which in their very inception, are meant to take the profession of nursing to a phenomenal level and establish the brand identity of nursing profession” (Pandey: 2010).
In the medical journal “Annals of Internal Medicine” there is a Code of Medical Professionalism. According to this code, there are three principles and ten duties for any medical worker. The first principle – the priority of patien’t welfare – is known since ancient times. Trust, possibility for the patient to rely on medical worker is the essence of the concept “medical worker – patient”. The second principle is self-determination or autonomous will and personal independence. It is understood from the point of view of patient’s choice. A person decides his life himself and it is only a peson who can make a choice between health and illness. The last principle is of social justice. It summons the whole medical sphere to be equial and fair when distributing the limited resources of health care.
Ten duties for physician or nurse, stipulated in the Code
The first and the foremost duty is professional competence. Nurses as well as any other medical worker should be competent and quailified professionals. They should possess both theoretical and practical knowledge and apply it on practice.
The other duty is respect for the patient. Patient should be aware of what is happening to him. Medical workers should inform the patient before and during the process of treatment. It means that patient should participate in the process of treatment. He can make his mind when choosing the directions of therapy. Even medical mistakes should be known to the patient.
Information about the patient should be kept in complete confidency. Special precautions should be fulfilled not to divulge personal information. Complience with this duty acquires a great importance because of electronic storage systems, which are widely used at present.
The duty to maintain appropriate attitude towards patient is also of great importance. Any medical worker can never exploit patient for the sake of personal, financial or sexual needs.
Nurses should raise the quality of medical aid. It includes not only maintenance of clinical competence but also the joint activity with all participants of the process for increase of safety level of patient, decrease of the number of medical errors and optimization of the results of treatment.
Nursing professionalism requires unified and adequate standards of medical assistance. All medical workers should contribute to the growth of medical health care accessibility. In any social system medical workers should not discriminate people on the basis of intelligence, financial level, social status, gender or race.
Another duty is fair distribution of the limited medical resources. Medical professionals are responsible for the correct use of medical resources on the assumption of the principle “costs – effectiveness”.
The relationship between society and medicine is based on the identity and correct use of scientific knowledge and technologies. Physicians as well as nurses should adhere to the scientific standards and opinions when treating patients. Medical community is responsible for the publicity of medical data based on scientific facts and clinical experience.
The duty of professional responsibility is the last but not the least important. Self-regulation of professional community includes its impact on the discipline of those members whose professional behaviour deviates from the standards of professional activity. All the aspects of medical profession in general and of its members in particular should be open for the internal control as well as for checkups and monitoring.