General care

Providing competent care for patients with mental illness It has great importance in the general complex of therapeutic measures. As a rule, the method of caring for mental patients is similar to that for somatic diseases and depends on the severity of the condition, the patient’s ability or inability to self-care, etc. If the patient is agitated, has suicidal thoughts, or is in a state of stupor, he bed rest is indicated in a special ward with an observation post, where he will be monitored around the clock. Constant monitoring of patients in a psychiatric clinic is established for certain purposes, namely:

1) protecting the ward from wrong actions in relation to himself;

2) preventing dangerous actions towards other persons;

3) preventing suicide attempts.

Constant monitoring of the course of the disease is also important, since in many cases mental disorders The patient's condition may change several times during the day. The patient is monitored directly by the attending physician and nurses.

Medicines are given to patients at strictly specified times. In this case, the nurse’s task is to monitor their intake. It is necessary to make sure that the patient swallowed the tablet and did not spit it out or hide it. You should periodically check the contents of patients' bedside tables and pockets, since sometimes they have a habit of accumulating medications, unnecessary things and just garbage.

The linen of psychiatric patients is changed regularly. They must take a bath weekly. Physically weakened patients are wiped weekly with aromatic vinegar for hygienic purposes. Such patients are likely to develop bedsores, so the condition of their skin should be monitored, especially in the area of ​​the sacrum, shoulder blades, etc. Their bed should be flat and regularly remade, and the linen should not have wrinkles; If necessary, a special backing circle can be used. Weak patients are turned over several times a day to prevent the occurrence and development of congestive pneumonia. In each department, in addition to observation wards, there should also be wards for patients recovering, as well as rest rooms and rooms for occupational therapy.

Occupational therapy is the use of work or its elements to restore the patient’s performance, lost functions and his adaptation to normal life.

In addition to bed rest and observation, great attention in a psychiatric hospital is paid to the daily routine, which must correspond to the ongoing treatment measures. Morning hygiene procedures for weakened, overly excited and stupor-ridden patients are carried out with the direct participation of medical personnel.

The daily routine in a psychiatric department should include hours intended for occupational therapy, the type of which is determined by the attending physician on an individual basis. In addition to working indoors or in the surrounding area, patients whose condition is gradually improving are allowed to read the press and fiction. Patients are allowed to attend specially organized film screenings and watch television programs.

The diet should be varied and tailored to the characteristics of specific patient groups. In particular, one cannot fail to take into account that excited patients expend a lot of energy, and the use of antipsychotic drugs for therapeutic purposes can lead to disturbances in vitamin metabolism. It is not uncommon for a patient to completely refuse to eat or drink, or to drink or eat only certain foods. The reasons for refusing to eat can be very diverse. The task of medical personnel in in this case is to patiently and affectionately persuade the patient to eat and drink.

Caring for psychiatric patients also involves providing symptomatic therapy. For sleep disorders, patients are prescribed sleeping pills. It is extremely important to carry out general strengthening therapy. On the recommendation of the attending physician, patients can be prescribed pine and ordinary warm baths, as well as physiotherapy, massage and other types of physiotherapy.

In addition to standard care measures, special attention should be paid to the tactful and respectful treatment of patients and the behavior of medical personnel. Regardless of the condition, behavioral characteristics and incorrect from the point of view healthy person actions, patients with mental illness deserve attentive and caring treatment from doctors and other medical personnel. Under no circumstances should you be allowed to address the patient on a first-name basis or call him out rudely or make inappropriate remarks. However, if excessive agitation or aggression occurs, or attempts to harm themselves or others, the medicinal worker must be able to carefully restrain the patient until the agitation is relieved by administering medical supplies. All medical staff in psychiatric clinics must acquire the skills of proper general care for patients under their care, learn to be attentive and careful in their mental health. unhealthy people. An employee of a psychiatric department must have such an important quality as observation, which will help prevent suicide attempts and aggressive actions.

Carrying out general care For patients in psychiatric departments, medical personnel with all their behavior must make patients feel that they are truly cared for. The department must constantly maintain a low noise level so as not to provoke unwanted reactions from patients with sharp or loud sounds. In this regard, in no case should you slam doors loudly, rattle dishes, etc. You should also try to walk as quietly as possible, for which you should change into the softest shoes possible. Silence in the department at night is especially important, since many mental patients already suffer from sleep disorders.

Caution should be exercised when talking to patients; This is especially true for communicating with patients suffering from persecution mania.

In addition to implementing ongoing vigilant control, to prevent accidents, it is necessary to ensure that patients do not have objects in their field of vision that pose a potential danger, so that they do not pick up sharp objects while walking, do not take them from workshops during occupational therapy, and do not receive them from family and friends during visits .

The staff of psychiatric hospitals must maintain impeccable order in the territory intended for walking of patients, carry out regular cleaning and inspection. Workers in departments of psychoneurological hospitals must constantly monitor their patients how they spend their time. It is necessary to note all changes in the behavior and mood of mental patients; whether they tend to lie down all the time or are active, whether they communicate with anyone or not, if they talk, then with whom and on what topics, etc. Sudden changes mood and behavior changes are a reason to call a doctor and take emergency measures.

Sensitivity, responsiveness, friendliness and patience when dealing with a mentally ill person are crucial in many difficult situations.

Special care

Caring for people with epilepsy

When an epileptic seizure occurs, the patient suddenly loses consciousness, falls and convulses. The duration of a seizure can range from a few seconds to 2 – 3 minutes. If the patient has a history of epilepsy, then in order to avoid injury when a seizure develops at night, he is placed on a low bed.

During a seizure, unbutton his tight clothing and place him in a horizontal position, face up, with his head turned to one side. If the patient is convulsing on the floor, quickly place a pillow under his head to prevent head injury. Until the seizure ends, you must stay near the victim and try your best to reduce the likelihood of bruises, but you should not hold him. To prevent him from biting his tongue during convulsions, place a spoon or other metal object wrapped in several layers of gauze between his molars. It is important to remember that it is unacceptable to insert a spoon between the front teeth, as this can lead to their fracture; you also cannot use wooden objects, since during convulsive clenching of the jaws they can break, and the fragments can injure the patient’s oral cavity. To prevent tongue biting, you can also recommend a towel with the end tied in a knot.

An epileptic seizure may begin in a patient while eating. In this case, to prevent aspiration, the nurse should immediately clean the patient's mouth.

If fainting occurs frequently in a relatively healthy person, a consultation with a psychiatrist is necessary to rule out epilepsy.

After the epileptic seizure has ended, put the patient to bed. Typically, in this situation, the patient sleeps for several hours after the seizures have ended and wakes up in a severely depressed mood. Since in most cases the patient does not remember anything about an epileptic seizure, one should not talk about this topic, so as not to worsen the already difficult psycho-emotional state of the patient. If involuntary urination occurs during a seizure, the patient needs to change his underwear.

Caring for depressed patients

The main task of medical personnel when caring for a depressed patient is to protect him from suicide. Such a patient should not be left literally for a minute, he should not be allowed to cover his head with a blanket, he must be accompanied to the toilet, bathroom, etc. The bed and bedside table of a depressed patient should be constantly inspected in order to find out whether he has hidden any dangerous objects, such as broken glass or earthenware or rope.

Such patients should take medications under the strict supervision of a nurse; Care must be taken to ensure that the patient swallows powders and tablets and does not accumulate them in his pockets with the goal of subsequently committing suicide.

Even if there are obvious positive changes in the patient’s condition, control over it must be fully maintained, since with some improvement the patient may sometimes be more dangerous to himself, unexpectedly attempting suicide.

Patients who are constantly in a state of melancholy do not take care of themselves. In this regard, nurses should help them change clothes, make the bed and carry out hygiene procedures. It is constantly necessary to ensure that sad patients take food on time; often it takes a long time to persuade them to eat.

Such patients are always silent and so self-absorbed that it is even quite difficult for them to maintain a dialogue. You should not tire a sad patient by trying to start a conversation with him. If such a patient turns to the medical staff with any request, then you need to listen to him carefully and provide all possible support.

Depressed patients need peace, and any attempts to distract them can provoke a worsening of their condition. You should not conduct conversations on abstract topics in the presence of a depressed patient, since he can interpret everything in his own way. Depressed patients often experience constipation, so you need to monitor their bowel movements.

They often experience a feeling of melancholy, which is accompanied by pronounced anxiety and intense fear. From time to time they experience hallucinations, and delusions of persecution are often noted. During such periods, patients cannot find a place for themselves and rush around the ward, sometimes attempting suicide. If such patients develop feelings of restlessness and anxiety, they should be restrained and, in some cases, even fixed on the bed.

Caring for agitated patients

If the patient is in a state of severe agitation, then first of all, all medical personnel need to maintain composure and try to calm the patient as tactfully and gently as possible, switching his attention. In some situations, it makes sense not to touch the patient at all to allow him to calm down on his own. The main thing is to ensure that the excited patient does not harm himself or others. If he is aggressive or rushes to the window, then, by order of the attending physician, he must be kept in bed for a certain time. It is also necessary to secure the patient before administering the enema. If the excitement does not go away for a long time, and the patient is clearly dangerous to himself and others, he is fixed in bed using fabric tapes. This manipulation is carried out according to the direct instructions of the doctor; At the same time, the time and duration of fixation of the patient is noted.

Caring for frail patients

If the patient is weakened and cannot move independently, you should support him when visiting the bathroom and help him in carrying out hygiene procedures, in eating. At least twice a day, the bed of a weakened patient should be straightened.

Such patients can often be untidy, and therefore it is necessary to periodically remind them that they need to go to the toilet, give them bedspreads or urine bags, and, if necessary, give them enemas. There are situations when a weakened patient still “got under control.” Of course, you need to wash it, wipe it dry and change your underwear and bed linen. Bedridden patients often develop bedsores. To prevent their occurrence, the position of a weakened patient should be periodically changed, which helps to avoid excessively prolonged pressure on the same areas of the body. You should also make sure that there are no wrinkles or crumbs on the bed after eating. It is advisable to use underlay rubber inflatable rings. If altered areas are found on the patient’s skin, which are the first signs of the onset of bedsores, they should be periodically wiped with camphor alcohol.

Particular attention should be paid to the cleanliness of the hair and body of weakened patients in the psychiatric department. Under no circumstances should patients be allowed to fall on the floor or pick up various types of garbage.

If a weakened patient has a febrile reaction, you should put him to bed, measure his body temperature and blood pressure and invite the attending physician for consultation. If you have a fever, give the patient plenty of fluids, and if you are sweating, change your underwear as needed to prevent hypothermia and colds.

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There are certain features of care and supervision of mentally ill patients in the department: providing maximum convenience for both general and special treatment, special precautions, removing dangerous objects from everyday use, taking measures to prevent suicide attempts, escapes, violence, etc., careful monitoring of patients' nutrition, medication intake, physiological needs. The allocation of a so-called observation chamber with a fixed 24-hour sanitary post for patients who require special monitoring (aggressive patients, patients with attempts at suicide, with thoughts of escape, with refusal to eat, excited patients, etc.). All changes in somatic and mental state patients are recorded in the “Observation Log”, which is kept by the nurse on duty. Since mentally ill people are often in hospital long time, special attention should be paid to creating coziness and cultural entertainment in the departments (cinema, TV, games, library, etc.).

There are 4 types of psychiatric regimes in the department:

Restrictive surveillance. It is intended for patients with aggressive tendencies and suicidal thoughts and intentions. These patients are in the observation ward and are monitored around the clock. All sharp and piercing objects (glasses, dentures, chains, elastic bandages) are removed from such patients. Patients leave the observation ward only when accompanied by staff. A special nurse post has been installed near the observation room.

Therapeutic-activating mode. For patients who do not pose a danger to themselves or others. They move freely around the department, read, play board games, and watch TV. These patients leave the department only accompanied by staff.

Open door mode. Such patients, as a rule, stay in the hospital for a long time for social reasons. They can go out unaccompanied by staff.

Partial hospitalization mode. Patients are sent home medical holidays for 7-10 days, accompanied by relatives. For the entire period, the patient is given medications and instructions on how to take them. As a rule, patients are sent on home leave for rehabilitation purposes; they re-establish contacts with relatives and get used to normal life.

In addition to psychiatric regimes, there is differentiated observation in the departments. It is intended for monitoring patients with epileptic seizures, impulsive actions, for the somatically weakened, for patients with refusal to eat and those undergoing compulsory treatment.

The experience of psychoneurological institutions shows that the maximum permissible non-constraint of patients is possible only with proper organization monitoring them in order to warn them publicly dangerous actions. As a rule, such actions are observed extremely rarely, therefore regime restrictions should be applied only in necessary cases and in such a way that the patient cannot clearly feel this.

Social rehabilitation measures should be carried out in stages. The first stage is restorative therapy, which includes preventing the formation of a personality defect, the development of hospitalism, and restoring functions and social connections impaired by the disease.

The second stage is readaptation. This stage involves various psychosocial influences on the patient. An important place here is given to occupational therapy with the acquisition of new social skills, psychotherapeutic activities carried out not only with the patient, but also with his relatives.

The third stage – perhaps more full recovery the rights of the patient in society, creating optimal relationships with others, providing assistance in everyday life and work. Thus, the system of rehabilitation measures includes a variety of biological and socio-psychological influences aimed at restoring the patient’s optimal level of functioning.

Conclusion

Understanding a mentally ill person is not an easy task. Mentally ill patients are fundamentally different from patients of other profiles, primarily in their cognitive activity, violation of correct connections with reality. Patients come into conflict with life itself, they have thoughts that contradict a healthy mind and are not perceived by normal thinking. Here are examples of such painful thoughts: they mix poison into the food of the sick, they irradiate them with terrible rays through the walls, they are chased, they are constantly monitored, they talk about them on the radio, newspaper articles write about them, etc. To understand thoughts that contradict sober reason, be able to to understand them, to be able to determine the pathological structure of these thoughts is not at all easy. Everyone who strives to understand a mentally ill person has to face all these difficulties when working with him, and the art of a psychiatrist lies precisely in the knowledge of pathology and its correction.

Love, care and attention towards the sick are components of contact with them that also have a healing effect. Love and care heal many old wounds in our patients, making up for the lack of love and attention, and can serve as compensation for various grievances received in the family, in childhood or adulthood. Care and attention towards patients can also soften their experiences, such as, for example, a feeling of guilt, a sense of inferiority, and aggressiveness.

Everyday experience shows how important the role of social and emotional factors is. Experiences and difficult situations can contribute to the worsening of depression and aggravate the fate of the patient.

Thus, in the diagnostic and treatment process in psychiatry, knowledge of psychotherapy for a mentally ill person and the ability to treat both the disease and the patient strictly individually are very important.

Bibliography

1. Vilensky O.G. Psychiatry: textbook. manual for doctors, medical students. Institute and Fak./ O.G. Vilensky. - M.: Educational book plus, 2000. - 256 p.

2. Derner K. Citizen and madness. On the social history and scientific sociology of psychiatry: scientific publication / trans. with him I. Ya. Sapozhnikova; edited by M. V. Umanskaya. – M., 2006.

3. Popov Yu.V. Modern clinical psychiatry: guidance based on ICD-10/ Yu.V. Popov, V.D. View. - St. Petersburg. : Speech, 2000. – 402 p.

4. Psychiatry. National manual/ ch. ed. T.B. Dmitrieva, V.N. Krasnov, N. G. Neznanov and others; resp. ed. Yu.A. Alexandrovsky. - M.: GEOTAR-Media, 2009. - 992 p. - (National project "Health". National guidelines).

5. Tölle R. Psychiatry with elements of psychotherapy: trans. from German / R. Tölle. - Minsk: Interpressservice, 2002. - 496 pp.: color illus, incl.l

Plan

1. The importance of psychiatry in our lives....

2. Features of caring for mentally ill people....

2.1. Caring for patients with epilepsy.....

2.2. Caring for depressed patients.....

2.3. Caring for agitated patients...

2.4. Caring for weakened patients....

3. The role of medical personnel in caring for mental patients....

4. List of sources used...

1. The importance of psychiatry in our lives

The Greek word “psychiatry” literally means “the science of treatment, the healing of the soul.” Over time, the meaning of this term has expanded and deepened, and currently psychiatry is the science of mental illness in the broad sense of the word, including a description of the causes and mechanisms of development, as well as the clinical picture, methods of treatment, prevention, maintenance and rehabilitation of mentally ill people .

It should be noted that in Russia mental patients were treated more humanely. And in our country, the provision of psychiatric care to the population is carried out by a number of medical institutions. Patients can receive outpatient care in psychoneurological dispensaries. Depending on the nature of the disease and its severity, the patient is treated on an outpatient basis, in a day hospital or in a hospital. All procedures and rules of the psycho-neurological hospital are aimed at improving the health of patients.

Caring for psychiatric patients is very difficult and unique due to unsociability, lack of contact, and isolation in some cases, and extreme agitation and anxiety in others. In addition, mental patients may have fear, depression, obsession and delusions. The staff is required to have endurance and patience, a gentle and at the same time vigilant attitude towards patients.

2. Features of caring for mentally ill patients

2.1. Caring for people with epilepsy

During a seizure, the patient suddenly loses consciousness, falls and convulses. Such a seizure can last up to 1, 2, 3 minutes. In order to, if possible, protect the patient from bruises during a seizure at night, he is placed on a low bed. During a seizure, men should immediately unbutton their shirt collar, belt, trousers, and women's skirt, and place the patient face up, with his head turned to the side. If the patient has fallen and is convulsing on the floor, then you must immediately place a pillow under his head. During a seizure, you need to be near the patient to prevent bruises and damage during convulsions, and you do not need to hold him at this time. To prevent the patient from biting his tongue, the nurse places a spoon wrapped in gauze between his molars. Do not insert a spoon between your front teeth, as they may break during cramps. Under no circumstances should a wooden spatula be inserted into your mouth. During a seizure, it can break and the patient can choke on a piece of it or get injured in the oral cavity. Instead of a spoon, you can use a corner of a towel tied in a knot. If the seizure began while the patient was eating, then the nurse should immediately clean the patient’s mouth, as the patient may choke and suffocate. After the seizure ends, the patient is put to bed. He sleeps for several hours, wakes up in a heavy mood, remembers nothing about the seizure and should not be told about it. If the patient wets himself during a seizure, then he needs to change his underwear.

2.2. Caring for depressed patients

The first responsibility of the staff is to protect the patient from suicide. You must not take a single step away from such a patient, day or night, do not let him cover his head with a blanket, you must accompany him to the toilet, bathroom, etc. It is necessary to carefully inspect his bed in order to find out whether dangerous objects are hidden in it: fragments, pieces of iron, ropes, medicinal powders. The patient must take medications in the presence of his sister, so that he cannot hide and accumulate medications for the purpose of suicide; we must also examine his clothes to see if he has hidden anything dangerous here. If there is a noticeable improvement in the patient’s condition, then, despite this, vigilance when caring for him should be fully maintained. Such a patient, in a state of some improvement, may even be even more dangerous to himself.

Sad patients do not pay attention to themselves, so they need special care: help them dress, wash, tidy up the bed, etc. You need to make sure that they eat, and for this they sometimes need to be coaxed for a long time, patiently and affectionately. Often you have to persuade them to go for a walk. Sad patients are silent and self-absorbed. They find it difficult to carry on a conversation. Therefore, there is no need to bother them with your conversations. If the patient needs treatment and he himself turns to the service personnel, then he must be patiently listened to and encouraged.

Depressed patients need peace. Any entertainment can only worsen his condition. In the presence of sad patients, extraneous conversations are unacceptable, since these patients tend to explain everything in their own way. It is necessary to monitor bowel movements in such patients, because they are usually constipated. Among patients with a bad mood, there are those who experience melancholy, accompanied by severe anxiety and fear. They sometimes have hallucinations and express delusional ideas of persecution. They can’t find a place for themselves, don’t sit or lie down, but rush around the department, wringing their hands. Such patients need the most vigilant eye, because they also tend to commit suicide. Such patients have to be slightly restrained when they have a state of severe anxiety from the feeling of hopelessness and despair that they experience due to their illness.

2.3. Caring for agitated patients

If the patient becomes very agitated, then first of all the nursing staff must remain completely calm and self-controlled. We must try to gently and affectionately reassure the patient and distract his thoughts in another direction. Sometimes it is useful not to disturb the patient at all, which helps him calm down. In these cases, it is necessary to ensure that he does not harm himself or others. If the patient becomes very agitated (attacks others, rushes to the window or door), then, as directed by the doctor, he is kept in bed. You have to restrain the patient even when you need to do an enema. If the patient’s agitation persists and he becomes dangerous to himself and others, he is restrained in bed for a short time. For this purpose, soft long ribbons of fabric are used. The patient is fixed in bed with the doctor's permission, indicating the beginning and end of the fixation.

2.4. Caring for frail patients

If he is painfully weak, but can move on his own, then you need to support him when moving, accompany him to the toilet, help with dressing, washing, eating, and keep him clean. Weak and bedridden patients who cannot move must be washed, combed, fed, while observing all the necessary precautions, and the bed must be straightened at least 2 times a day. Patients may be untidy, so at certain times you should remind them that they need to perform a natural bowel movement, give them a bedpan in a timely manner, or do enemas as prescribed by the doctor. If the patient goes under himself, then you need to wash him dry, dry him and put on clean underwear. Untidy patients have oilcloth placed in their beds and are washed more often. Weak and bedridden patients may develop bedsores. To prevent them, it is necessary to change the patient's position in bed. This is done to ensure that there is no prolonged pressure on any part of the body. To prevent any pressure, you need to make sure that there are no folds or crumbs on the sheet. A rubber circle is placed under the sacrum to reduce pressure on the area where bedsores are especially likely to form. The nurse wipes the areas suspected of bedsores with camphor alcohol.

Particular care must be taken to ensure the cleanliness of the hair, body and bed of such patients. Patients should not be allowed to lie on the floor or collect garbage. If the patient has a fever, you need to put him to bed, measure his temperature and blood pressure, call a doctor, give him something to drink more often, and change his underwear if he sweats.

3. The role of medical personnel in caring for mental patients

In their care of mental patients, staff must behave in such a way that the patient feels that he is truly cared for and protected. To maintain the necessary silence in the department, you should not slam doors, knock while walking, or rattle dishes. We must take care night sleep. At night in the wards there is no need to enter into arguments or arguments with patients. You need to be especially careful when talking with patients. You need to be especially careful in conversations with patients who suffer from delusional ideas of persecution.

In addition to vigilant supervision of patients to prevent accidents, it is necessary to ensure that there are no sharp or dangerous objects in the department. It is necessary to ensure that patients do not collect fragments while walking, that they do not bring anything from workshops, and that during visits, relatives do not hand over any objects or belongings to them. Service staff must carry out the most thorough inspection and cleaning of gardens where patients walk. During medical work, it is necessary to ensure that patients do not hide needles, hooks, scissors or other sharp objects.

The medical staff of a psychoneurological hospital should pay attention to what the patient does and how he spends the day, whether the patient tends to lie in bed, whether he stands in one position or silently walks around the ward or corridor, if he talks, then with whom and what he talks . It is necessary to carefully monitor the patient’s mood, monitor the patient’s sleep at night, whether he gets up, walks, or does not sleep at all. Often the patient’s condition quickly changes: a calm patient becomes agitated and dangerous to others; a cheerful patient - gloomy and unsociable; the patient may suddenly experience fear and despair and have a seizure. In such cases, the nurse takes the necessary measures and calls the doctor on duty.

Sometimes the patient refuses all food and drink, or does not eat, but drinks, or eats certain foods, etc. The staff should notice all this. Refusal to eat is due to various reasons. If the patient refuses to eat, then first of all we must try to persuade him to eat. An affectionate, patient and sensitive approach to the patient is again of primary and decisive importance.

Constant concern for the success of the case, friendliness in dealing with patients, strict performance of their functional duties by all medical personnel, allows us to achieve good results in caring for mental patients.

4. List of sources used

1. Care for mental patients in a neuropsychiatric hospital. N.P. Tyapugin.

2. Mental illnesses: clinic, treatment, prevention. ON THE. Tyuvina.

3. Nurse's Handbook of Care. V.V. Kovanova.

INTRODUCTION

The role of the nurse manager in organizing the treatment process and care for mental patients is difficult to overestimate, since it includes a wide range of issues, without which it would be impossible to implement a therapeutic approach to patients and, ultimately, register remission states or recovery. This is not a mechanical implementation of medical prescriptions and recommendations, but a creative solution to everyday issues, which include the direct implementation of treatment processes (dispensing medications, parenteral administration of drugs, carrying out a number of procedures), which should be carried out taking into account and knowledge of possible side effects and complications.

Ultimately, this means taking responsibility for carrying out a number of urgent events. Preparing a patient for a particular procedure or event sometimes requires a lot of strength, skill, knowledge of the patient’s psychology and the nature of the existing psychotic disorders from the nurse manager.

Convincing a patient of the need to take medicine and undergo a particular procedure is often difficult because of its painful effects, when, due to ideological and delusional motives of hallucinatory experiences or emotional disorders, he sometimes resists carrying out all therapeutic measures. In this case, knowledge of the clinical picture of the disease helps to correctly solve the therapeutic problem, making a positive treatment solution possible.

To this day, the care and supervision of mentally ill people, which is carried out by a nurse leader, remains relevant. It includes feeding the sick, changing linen, carrying out sanitary and hygienic measures, and so on.

Monitoring the entire contingent of patients is especially important.

This applies to depressed patients, patients with catatonic symptoms, patients with acute psychotic disorders and behavioral disorders. Care and supervision are undoubtedly important links in in general terms treatment of patients, since it would be impossible to carry out therapeutic measures without these important hospital factors. Speaking about these responsibilities of nurse managers, we should especially emphasize the importance of their daily five-minute reports. Information about patients, the dynamics of their diseases, changes in healing process and so on is invaluable during the complex treatment process that is carried out by mental patients in psychiatric hospitals. Only a nurse manager can detect the appearance of a number of patients with delirious symptoms in the evening, prevent the implementation of suicidal tendencies, establish daily mood swings in patients based on indirect, objective characteristics, and predict their socially dangerous impulses.

Being among sick people throughout her working time, a nurse is an example of dedication, humanism, and altruism.

Thus, the role of the nurse leader in the overall treatment process is extremely relevant and significant.

GOALS AND OBJECTIVES OF THE RESEARCH.

The purpose of this work is to substantiate medicines and ECT in a mental health clinic.

RESEARCH OBJECTIVES.

• 1. Analyze the use of antipsychotics in the treatment of mental patients.
• 2. Assess the dynamics of the use of antidepressants in the clinic for depressed patients.
• 3. To study the effectiveness of the use of lithium salts in the treatment of patients with manic symptoms.
• 4. To study the therapeutic effectiveness of the use of modified “chemoshocks” in mental patients.
• 5. Investigate the use of ECT in psychiatric patients.
• 6. The role of psychocorrectional care in complex treatment mental patients.
• 1. ORGANIZATION OF MEDICAL CARE FOR MENTALLY ILL PERSONS

treatment manic psychocorrective antidepressant

Foreign and domestic psychiatry emphasizes that the cost of treating mental illnesses is gradually increasing.

General economic losses of society are divided into direct ones (costs of hospital and non-hospital services, wages medical workers and support staff, costs of medicines and equipment, Scientific research, professional training and indirect losses in the wages of patients, loss of market products caused by a decrease or loss of working capacity of patients. At the same time, little consideration is given to the “burden” of the family and the moral costs of maintaining a mentally ill person. It is noted that regardless of the level of socio-economic development of a particular country, the creation of psychiatric services meets the interests and needs of any society, since the mental health of the nation is a prerequisite for good socio-economic development. Mental illness is extremely costly when measured in terms of lost productivity and benefit to society, so service planning should be based on the objective of reducing social costs rather than focusing on immediate and ambulance. It is obvious that until now this aspect of the allocation of material resources is a consequence of the attitude of the population towards the mentally ill.

Most of the national health budget in developing countries quite rightly allocated to the elimination of infectious diseases, which are associated with high morbidity and mortality of the population. The enormous costs associated with mental illness are rarely taken into account.

From this point of view, mental health programs should become a priority for most countries, especially since mental illness(including alcoholism and drug addiction) are considered by some researchers as one of the main threats to the health and productivity of humanity in general. In this regard, data on investment in health care in different countries of the world and their share in allocations for psychiatry are interesting. In 1950, the cost of treating and maintaining the mentally ill in the United States amounted to $1.7 billion. In 1965, the United States was spending $2.8 billion on mental health services. The US National Institute of Mental Health in 1968 estimated the cost of treating all forms of mental illness at $3.7 billion. Half of the amount was spent on inpatient treatment. A quarter of all hospitalizations and 1/10 of all outpatient visits were for patients with schizophrenia. 40% of the allocated amount, or $1.5 billion, was spent on treating such patients. The “price” of schizophrenia for US society in the mid-70s was determined at 11.6-19.5 billion dollars annually. About 2/3 of the amount was lost productivity of patients and only 1/5 was actually spent on treatment. The amounts would be significantly larger if it were possible to more accurately estimate the costs to society of supporting such patients outside the hospital walls. In 1993, the “cost” of mentally ill patients to society in the United States (excluding substance abusers and alcoholics) amounted to almost 7.3 billion dollars, about 1/2 of the amount relates to direct costs (treatment, support for patients) and 1/2 to indirect costs (loss of ability to work and qualifications). The growth of psychiatry payments was 1.7% per year and by the 1970s reached approximately 7.7% of the total US health care budget. For comparison, it should be noted that in the USSR in 1971-1975. State budget expenditures on health care were about 52 million rubles, which amounted to 6% of all state budget expenditures and over 4% of national income. Allocations for psychiatry in the United States continue to increase every year. In 1990, they were expected to increase by 9.1% compared to 1989.

The presented data clearly shows the increase in the cost of mental health care in 3 types of US institutions: state hospital, private hospital, community mental health center. In a public hospital, per-patient costs were $56.47 per day in 1978 and $85 in 1982. In private mental hospitals, the figure was $96 in 1978, and costs doubled in 1982. The cost of a 1-day stay in a general psychiatric hospital in the OCCH system reached $214.52 in 1979 and $300 in 1982. In Germany the cost of treatment is psychiatric hospital in 1980, the cost of out-of-hospital treatment was $20-$100 per year, $85.77. In comparison, the data of Soviet authors are also of interest. The cost of 1 day of stay in a psychiatric hospital in the 70-80s was about 4.5 rubles, and in 1980-1990 - 7.5-9 rubles. The extremely low cost of one day of stay in a psychiatric hospital in Russia indicates the insufficiently high quality of medical care and the low scientific and technical potential of hospitals.

All current national plans to reduce the cost of health care are based on efforts to reduce insurance reimbursements, as well as on prospective payments and encouragement of the development of competitive insurance systems. However, the implementation of these plans gives rise to a number of complex problems, since the reduction in insurance compensation, first of all, affects long-term ill people and those persons whose treatment effect is difficult to predict and, in turn, can increase the costs of services. In this regard, direct and indirect costs for a group of “severe and expensive” patients in psychiatry are studied. The selection of the group was based on the frequency of visits to the medical institution and for some patients it reached 25 times a year. The costs for them amounted to 50% of all registered patients, despite the fact that the share of these “expensive” patients was 9.4%. Differentiation of types of psychiatric care and its financing depending on the needs of the identified groups of patients makes it possible to more fully use the capabilities of existing psychiatric services. These authors also believe that it is difficult to divide patients according to their required share of system resource use (depending on diagnosis, age, gender). It is considered fundamental to highlight small group long-term illness, which consumes a disproportionate share of the system’s funds and resources. What matters is the cost of daily patient care, which is likely to decrease as the patient's hospital stay shortens.

Prioritization of specific groups of patients in psychiatry with the development of subspecializations and more differentiated treatment has been reported. Domestic authors identify groups of “economic risk”. These are patients formed on the basis of the differential indicator of “severe and expensive” patients.

According to a number of authors, the highest priority in working with “expensive” patients at the present time should be measures aimed at reducing the duration and frequency of hospitalization, prevention of relapses, attempts to stop exacerbations in an outpatient setting, intensive treatment in hospitals with early discharge and follow-up treatment in day hospitals. Data are provided on a high rate of disability (up to 30%) in cases of paroxysmal schizophrenia. The percentage of remissions with a moderate and severe defect increases after each of the first three attacks, and then after the 4th and 5th attack it clearly decreases. Therefore, drug interventions should be based primarily on productive symptoms. Based on this, it is possible to plan a social and labor prognosis and select aspects of work orientation for the patient. According to foreign authors, only by calculating the economic costs associated with schizophrenia will it be possible to establish how much the very rough estimates of costs based on the prevalence of the disease and mortality underestimated the consequences of a disease such as schizophrenia, which often entails disability rather than death.

The processes leading to a reduction in the number of hospitalizations, lengthy hospital stays and an increase in the number of outpatients, which have affected many countries around the world, continue to spread. Medical, organizational, economic, socio-legal, and ethical problems arising in connection with this are widely discussed. Numerous comparative data have shown that community care has some economic, clinical and social advantages over hospital care and no obvious disadvantage in terms of outcomes.

WHO documents and a number of authors indicated that most developed countries are moving along two paths towards the main goals in mental health care. The first movement is from open institutions, which were common back in the 19th century, to smaller departments located in district general hospitals and to different forms out-of-hospital services such as outpatient clinics, day and night hospitals, club houses, centers or shelters. The second movement is towards undifferentiated closed services, when patients of all ages and diseases are placed together, towards separate treatment of mentally ill and mentally retarded persons. According to the findings working group Over the past decade, the WHO Regional Office for Europe has seen a shift from traditional inpatient services to community-based, outpatient services.

As a result of these changes, inpatients represent only a small percentage of the burden of modern mental health services. Staying in partial hospitals is more profitable in an economic sense. According to the most common estimate, it costs 1/3 of the cost of round-the-clock hospital care. According to other authors, different kinds outpatient care mental patients are not only more economical, but can be profitable. A number of studies look at the cost of treatment and the benefits of day hospitals for patients with schizophrenia. An intensive outpatient treatment program was acceptable to them. New approach did not improve the prognosis regarding psychiatric symptoms, the social role of disability, but the total cost of treatment was lower than for ordinary patients. A short-term stay facility for the mentally ill is considered an innovation. It can act as a point of emergency psychiatric care. This hospital not only solves the financial problems of providing emergency care, but also promises to be profitable as a 24-hour hospital. Semi-stationary institutions are quite diverse: Sunday hospitals, “end of the week” hospitals, day departments, day centers, day and night clinics, etc. The most common day care, which is considered a successful alternative 24-hour treatment. Deinstitutionalization policies were based on the opinion that treating patients in the community while maintaining familiar living conditions would have a positive impact on the course and prognosis of mental illness.

It was believed that mentally ill people could easily adapt to society. However, it turned out that patients living in the community differed not only in their ability to withstand hardships real life, but also in terms of the desire and opportunity for readaptation. For some patients, restoration of their previous social status is possible, others are forced to function at a lower level and require some assistance, and still others cannot survive without significant social support. Understanding the limits of each individual patient's capabilities is largely considered the key to success in his treatment.

On the contrary, presenting excessive and unrealistic demands on him leads to decompensation. It has now been proven that social measures play a role important role in the treatment and rehabilitation of mentally ill patients. However, some authors note a significant overestimation of “environmental factors”. Although improving the environment reduces the risk of relapse of the schizophrenic process, the “biological component” is no less important, and the exacerbation of the disease is not always associated with stress. Without denying the possibility social services and assistance in resolving crisis situations, the author emphasizes the need for long-term drug therapy, often throughout life. In this case, the possibility of self-regulation of the dose is allowed. In this case, the patient is prescribed the maximum permissible dose, which can be increased by himself if the condition worsens. This desire to cooperate with the patient regarding his treatment is quite widely popular, despite the appearance of works indicating the impossibility of an adequate assessment by the patient of his mental state.

Treatment of psychosis has undergone significant changes over the past decades. Since the 1930s, shock therapy has been the main method of treatment and was carried out exclusively in hospitals. The introduction of antipsychotics towards the end of the 1950s brought profound changes to the treatment of psychosis in hospital settings. In addition, this treatment method has been successful in out-of-hospital settings. During the last decade there has been a further increase in the number of outpatients treated. Considerable attention is drawn to this fact, emphasizing the importance of psychotherapy and rehabilitation in the treatment of psychoses, especially of a functional nature.

In Helsinki, the duration of the first hospitalization of patients with schizophrenia decreased by 2/3 in the period before 1970. However, there are a number of studies showing that the introduction of antipsychotics into practice has also led to an increase in rehospitalizations. Increasing the volume of out-of-hospital care is the most important factor reducing the need for hospital treatment. In places where community care was underdeveloped, drug therapy alone did not reduce the need for hospital treatment.

In numerous works by G.Ya. Avrutsky and his colleagues indicate that for the correct indication for therapy, at least two circumstances must be taken into account:

• 1. knowledge of the spectrum of psychotropic activity of medications, taking into account the characteristics of both psychotropic and neurotropic and somatotropic effects;
• 2. the relationship of these data with the holistic picture of the condition and the qualitative characteristics of its constituent psychopathological disorders.

In this case, the correct clinical qualification of the status and the identification of the range of disorders that acquire primary significance in the clinical picture are important, i.e. determining the condition of patients at the moment. As a result of many years of research by the Department of Psychopharmacology of the Moscow Research Institute of Psychiatry of the Ministry of Health of the RSFSR, scales for the increase in general and selective antipsychological effects in the main classes of psychotropic drugs were created. As an example, a number of antipsychotics are given, compiled according to the increase in the general antipsychotic effect: teralen - neuleptil - thioridazine - propazine - tizercin - cloprothixene-aminazine-leponex-frenolone-eperazine - meterazine - triftazine - haloperidol - fluorophenazine (moditene) - trisedyl - mazeptyl.

Long-term research in the field of psychopharmacotherapy has also shown differences in the action of psychotropic drugs within the same class. So, if we consider the class of antipsychotics, we can distinguish:

• 3. drugs that provide predominantly psycho-emotional blockade (aminazine, tizercin, chlorprothixene, leponex);
• 4. drugs with a pronounced antidelusional and antihallucinatory effect (triftazine, etaprazine, chlorprothixene, trisedil);
• 5. drugs with a balanced sedative-stimulating and mild thymoanaleptic effect (thioridazine, teralen, neuleptil).

Among antidepressants, one can distinguish drugs with a predominant stimulating effect (melipramine, desipramine, MAO inhibitors), with a predominant sedative component (amitriptyline, fluorazine) and drugs with a balanced effect, an example of which is pyrazidol.

The quality of life indicator makes a more complete assessment of the therapeutic effect of antidepressants. In the process of treating patients with anxious depression with amizole, these indicators show a steady improvement almost in parallel with the reduction of affective disorders. With melancholy and apathetic depression, at the beginning of treatment and especially at the end of the second week of therapy, a discrepancy with the reverse dynamics is detected depressive disorders. The impact of such discrepancies in the process of pharmacotherapy in an outpatient setting is important and should be taken into account to avoid unnecessary interruptions of medication.

40% of patients with schizophrenia admit to having thoughts of suicide, 9-13% commit suicide. Risk factors may include post-psychotic depression, belief in the unfavorable prognosis of the disease, making him an outcast from society; half of all suicides occur during inpatient treatment, the other half during outpatient treatment. General approaches in order to increase the effectiveness of treatment with existing antipsychotics, they include the use of lower doses when taking drugs orally, antiparkinsonian treatment, moderate doses of cumulative drugs, more closely monitoring the course of the disease, more intensive use of therapeutic measures aimed at resolving crisis conditions and the possibility of partial or complete hospitalization for the required period of time. From all that has been said, it follows that it is necessary to look for other, less expensive ways to reduce the incidence of suicide in schizophrenia. Of interest is clozapine, a typical antipsychotic, although in 1-2% of cases it causes the development of granulocytopenia and agranulocytosis. A decrease in suicidality during treatment with clozapine may be associated with its antidepressant effect, a decrease in the severity of tardive dyskinesia, the absence of parkinsonism, and activation of cognitive function and social activity.

Over time, the concept of target syndromes was replaced by the concept of the dynamic principle of psychosis therapy, implying changes in indications and treatment methods in accordance with natural shifts in the clinical picture and course of the disease that arise during psychopharmacotherapy.

This was due to several reasons. Firstly, psychopathological syndromes, which are a combination of several of their component symptoms, respond unevenly to the use of a drug with a certain “local” spectrum of action. Thus, in the case of acute psychoses within the framework of periodic and closely related paroxysmal schizophrenia with predominant affective-delusional and schizoaffective structures of attacks, the prescription of antipsychotic sedatives will only contribute to the normalization of affect and behavior while maintaining hallucinatory and delusional experiences. This, in turn, requires the prescription of drugs with a selective antidelusional and antihallucinatory spectrum of action, i.e. haloperidol, triphthazine. Secondly, it is necessary to take into account the changes that have occurred in the overall picture and course of psychoses in connection with many years of pharmacotherapy, i.e. factor of drug pathomorphosis.

Comparison of the currently prevailing schizophrenic syndromes in general reflects an increase in the depth of damage or severity of the disease. End states (secondary catatonia, full-blown paranoid syndromes) began to be observed much less frequently than in the 50s. On the other hand, the number of asthenic, affective and neurosis-like syndromes has increased significantly. This, according to G.A. Avrutsky and A.A. Neduva (1988), is especially noticeable in the analysis of hallucinatory, hallucinatory-paranoid and paranoid syndromes, which, during psychopharmacotherapeutic influence, relatively quickly lose intensity, remain at an incomplete level and are often accompanied by a critical or semi-critical attitude, which brings them closer to obsession. These data also apply To affective disorders, which are currently rapidly transforming from psychotic level(symptoms of fear, anxiety, confusion) into prolonged submelancholic outpatient states.

Summarizing these observations, it can be noted that under the influence of a constantly acting pharmacogenic factor, peculiar force interactions arise between symptoms, which supposedly enter into new connections with each other, forming new, but quite typical syndromes. These observations allow the use of the clinical-psycho-pharmacotherapeutic method as an additional method to the main clinical-psychopathological one in the study of certain patterns of general psychopathology.

Another feature of the clinical picture of psychoses in conditions of drug-induced pathomorphosis is the tendency of syndromes to both long-term existence and lability and incompleteness. In other words, a state of dynamic equilibrium arises between the disease and remission. At the same time, there are often fluctuations in the direction of deterioration. The considered features of syndrome formation in endogenous psychoses under conditions of long-term psychopharmacotherapy are called “protracted subacute conditions.”

Within the first direction, methods of so-called “shock” therapy using high doses of antipsychotics in the form of “zigzags” were studied. "Zigzag" with increasing doses to maximum is accompanied by a large therapeutic effect with less pronounced extrapyramidal syndrome.

In addition to “zigzags”, other clinical, psycho-pharmacotherapeutic techniques were recommended for the purpose of intensive therapy:

• 1. Changing the routes of drug administration, i.e. transition from oral administration to intramuscular and especially intravenous administration;
• 2. The use of polyneurolepsy, i.e. simultaneous combination of several antipsychotics;
• 3. Application of polythymoanalepsy, i.e. simultaneous combination of several antidepressants;
• 4. Application of thymoneurolepsy and polythymoneurolepsy;
• 5. Combination therapy which means a combination of insulin therapy in any of its variants with various psychotropic drugs. Domestic and foreign authors note electroconvulsive therapy (ECT) as the most effective method, which in the “pre-pharmacological era of psychology” took second place in importance after insulin therapy.

A number of works by Soviet psychiatrists provide detailed methods for using ECT; a modification of the ECT method is proposed, which consists of monopolar application of electrodes to the non-dominant hemisphere, which reduces by-effect ECT in the form of memory impairment.

Along with this, various modifications of ECT were used, providing for its combination with muscle relaxants and narcotics. The issues of clinical effectiveness of ECT and indications for its implementation deserve special attention, which is also reflected in the works of Soviet authors. ECT produces the most satisfactory results in affective psychoses, as well as in fresh cases (with a disease duration of up to 1 year), catatonic and catatonic-paranoid forms of schizophrenia. The beneficial effect of ECT is observed in chronic cases of the disease, when there are acute procedural symptoms: intense affect, confusion, delusional alertness.

In works related to the effectiveness of ECT, it is concluded that the ECT method is best used for the so-called “partial catatonic syndrome,” which is characterized by a stuporous state and expressed by negativism. Patients with such conditions are distinguished by a combination of pronounced motor adynamia with a lively expression of the eyes and face, quick facial reactions to the environment, which indicates the absence of adynamia in the ideational sphere and suggests the presence of “informational” inclusions behind the catatonic facade in the form of hallucinations, delusions, and obsessions.

On the other hand, with “empty stupor”, when there are no “information” formations and intense motor excitation is observed with minimal speech, ECT rarely has a positive effect.

In recent years, in the department of psychosis therapy of the Moscow Research Institute of Psychiatry of the Ministry of Health of the RSFSR, a method of so-called forced insulin therapy (FICT) has been developed. This method, unlike the traditional one, is based on drip intravenous insulin and allows one to achieve a state of severe stupor or coma already in the first days of treatment, promotes a more rapid reduction of psychotic symptoms and shortens the treatment period. Along with this, this method gives fewer complications, allows for a more global break in psychosis and obtains deeper and more lasting results.

In the opinion of a group of authors, insulin comatose therapy has the best effect in paranoid-depressive, catatonic-depressive, hallucinatory-paranoid, catatonic-oneiric, catatonic-paranoid and acute depressive-hypochondriacal forms of schizophrenia. Insulin therapy is less effective for stuporous catatonic and sluggish depressive-hypochondriacal forms.

Psychotherapy for endogenous psychoses without pronounced hallucinatory-delusional symptoms can have an important therapeutic effect, become a means of preserving the working capacity of patients, and adapting them to the environment. Determining the possibility of psychotherapeutic methods is noted in the stabilization of the antipsychotic effect of psychopharmacological drugs, the formation of criticism of the disease, mental activation, and the mitigation of negativistic and autistic tendencies. Increased attention is being drawn to the complex issue of using methods of mental influence in endogenous depression - caution remains in acute course and severe symptoms. However, erased, asthenic, sluggish forms of depression make it possible to quite actively seek to relieve tension, increase the level of activity, and strengthen hope for restoration of health. Psychotherapy is a cheaper remedy, it is 1/6 of the cost of a six-month hospitalization.

In the rehabilitation system according to M.M. Kabanov identifies three stages, each of which has specific tasks.

The task of the first stage - restorative treatment - is to prevent the formation of a mental defect, disability, the so-called hospitalism observed in an improperly organized hospital environment, as well as to eliminate or reduce these phenomena. This problem is solved by biological therapy with psychosocial activities (environmental treatment, employment, entertainment, psychotherapy).

At the second stage - readaptation - the task is to develop the ability of patients to adapt to environmental conditions. The role of occupational therapy is increasing, and it is possible to retrain the patient with the acquisition of a new profession. Active psychotherapy and psychocorrectional work is carried out both with patients and with their relatives with the participation of a doctor and a medical psychologist. Doses of biological agents are reduced and serve as “maintenance” therapy.

At the third stage - rehabilitation in the literal sense of the word - the main task is to restore the patient to his rights. It is necessary to study life, work and employment.

The effectiveness of the rehabilitation system increases significantly when it is used not only in hospitals, but also in semi-hospitals and in psychoneurological dispensaries. Such a system of rehabilitation at all stages of psychiatric service logically follows from the essence of rehabilitation itself, since its ultimate goal is the return of the patient (or disabled person) to society.

Thus, according to an analysis of the literature, when assessing current trends in mental health care, it is necessary to note, first of all, a significant increase in healthcare costs. This is due to the expansion of medical care, the introduction of increasingly complex and expensive diagnostic technologies, and the use of expensive drugs. At the same time, the huge economic losses to society as a result of mental illness are emphasized.

FEATURES OF NURSING CARE FOR MENTALLY ILL ELDERLY AND SENILE AGE PATIENTS

A.V.Averin, M.A.Shuvalina

Republican Clinical Psychiatric Hospital, Cheboksary

Achievements of civilization and successes in the development of healthcare have contributed to a significant increase in the average life expectancy of the population and a significant increase in the proportion of elderly people. According to the classification of the World Health Organization (WHO), people aged 60–74 years are considered elderly, those aged 75 years and older are considered senile, and those over 90 years are considered long-lived.

Older people are more likely to suffer from mental disorders (MD) than young and middle-aged people. Thus, according to WHO, the frequency of mental illness among older people is 236 per 100 thousand population, while in the age group from 45 to 64 years old it is only 93. The number of mentally ill elderly people in the Russian Federation for 1999–2004. increased by 12.4%, and in 2004 the incidence of PR in this group was 2443.3 per 100 thousand population. In the Chuvash Republic this figure is 444.23.

The trend toward an increase in the population of older people has led to an increase in their need for medical and social care. The projected increase in the number of people with mental retardation makes us look for optimal models of providing psychiatric care to such patients. One such model is the nursing unit (NU).

OSUs are widespread in healthcare, including psychiatry. Against the backdrop of the depopulation processes taking place in Russia, their number increases every year, as they have shown their effectiveness and demand among the older population.

Psychiatric hospital patients more often suffer from diseases of the cardiovascular and respiratory systems, disorders of hormonal functions and fat metabolism, as well as neoplasms than the general population. The most severe, both mentally and physically, are patients with various forms of dementia. Therefore, the vast majority of patients in a psychiatric hospital require combined treatment of PD and concomitant somatic diseases, and more than 1/3 need care.

In 2001–2005 425 people were treated at the Republican Clinical Psychiatric Hospital (RPH). The number of people receiving medical and social assistance in OSU is growing from year to year. So, if in 2001 46 people were treated here, then in 2005 – already 120, i.e. 1.6 times more. Accordingly, the bed turnover increased from 1.9 to 4.8. The average bed occupancy per year also increased by 1.4% and amounted to 310 days in 2005. The average length of hospital stay decreased from 156.0 to 63.7 days.

The quality performance indicators of any department depend on the effectiveness of the nursing process (NP). SP in OSU has been used since 1999. The average length of stay of a patient in the department is 85 days. The patient's condition is assessed in 2 stages - at the time of admission and discharge.

The effectiveness of the joint venture in the OSU is assessed according to the following criteria:

l mental status of patients;

l decreased ability of patients to self-care;

l risk of developing pressure ulcers with completion of the Waterlow scale;

l the number of patient falls and their consequences.

Mental status assessment is carried out using an express method, which allows us to identify problems that go unnoticed with a less systematic approach. The specificity of the method for organic PR in hospitalized patients is 82%, sensitivity is 87%. The patient is asked to complete several tasks, after which a score is made indicating possible delirium or dementia, mild, moderate or severe impairment.

Patients with ASU usually have impaired short-term memory. They cannot remember current events, dates, seasons, locations. Long-term memory is less impaired, and patients are able to provide some information about their past and illness. The nurse shows the patient his room, repeating its number several times during the day for better memorization. She systematically trains the patient's memory by showing everyday objects and highlighting their distinctive features. For example: “Your bed is near the window, your room is opposite nursing station" In a number of patients in the early stages of dementia, a non-drug method of memory stimulation is used. This kind of work requires patience and endurance from the nurse. Usually after 2–3 weeks the patient begins to navigate the department. When assessing the ability to self-care, special attention is paid to the ability to move independently, eat food, use the shower, toilet, control urination, etc.

When providing care, it is necessary to know the factors that worsen the patient’s functional abilities and, if possible, eliminate them. Factors that increase symptoms of dementia include:

l unfamiliar places;

l being alone for a long time;

l excessive amount of external stimuli and irritants (for example, meeting a large number of strangers);

l darkness (suitable lighting is necessary, even at night);

l all infectious diseases (most often urinary tract infections);

l surgical interventions and anesthesia (used only for absolute indications);

l hot weather (overheating, loss of fluid);

l taking a large number of medications.

If the patient is unable to provide self-care, the nurse identifies factors that influence the inability to self-care (side effects of medications, a state of severe mental defect, physical helplessness), involves family members to collect information and develop a care plan. She teaches self-care skills and provides an atmosphere of intimacy in such moments to maintain patients' self-esteem.

OSU patients often suffer from loneliness and social isolation. Taking this into account, the nurse introduces the patient to his roommates, places him in the ward taking into account age, sociocultural and communication factors, as well as the specifics of the disease, and demonstrates interest in his stories about himself. The patient is accepted as he is and is encouraged to speak about his mood. The nurse keeps the patient in touch with reality by using sensory stimuli, updating him on news, and reminding him of dates. Problems arise not only for patients, but also for their relatives (for example, ineffective adaptation to caring for a disabled person in the family). Entering into psychological contact with the patients’ relatives, the nurse teaches them how to care and discusses with them all the issues that arise.

The purpose of recording the number of falls is to identify and reduce the number of factors contributing to them, reduce the number of falls and injuries, maintain a sense of independence, and maintain a sense of self-worth in patients. The nurse provides an assessment of a client after a fall that includes:

l description of the fall (patient, staff, other witnesses);

l level of consciousness of the patient;

l basic indicators of neurological condition;

l basic indicators of the body’s condition;

l cognitive changes;

l absence/presence of limb deformities;

l range of voluntary movements;

l Inspect the skin for bruises or lesions.

After the examination, the nurse makes a decision independently or (if there are complications) seeks advice from the staff and notifies the doctor.

Monitoring results are recorded within 48 hours after the fall. An analysis of the situation that led to the fall is also carried out, and the actions of the multi-professional team are planned.

The presence of various specialists, nursing and junior medical personnel in the OSU allows us to provide round-the-clock comprehensive care for patients. The work of a nurse with a patient is based on the principle “My nurse is my patient,” which involves providing psychiatric care, providing basic care, providing the patient with rights and freedoms, and working with family and relatives. Nurses are the main caretakers of patients. They provide basic care, accompany patients for walks, manipulations, and teach patients self-care skills, i.e. spend their working time with the patient in order to identify his problems, monitor the dynamics of his mental state, and provide assistance to patients in adapting to living conditions. That is, the functions of a nurse are not limited to performing nursing manipulations, but include elements of medical, social, psychological and pedagogical work.

The fact that the OSU is located on the basis of a large medical institution in the republic has certain benefits for both patients and their relatives. This, in particular, provides for the provision of advisory and diagnostic assistance from medical specialists (psychiatrist, therapist, neurologist, etc.), the possibility of using modern physiotherapeutic facilities, and qualified emergency care if the condition worsens.

LITERATURE

1. Golenkov A.V., Kozlov A.B., Averin A.V., Ronzhina L.G., Shuvalina M.A. First experience of using the nursing process in psychiatric practice // Medical sister. – 2003. – No. 1. – P. 6–9.

2. Ritter S. Guide to nursing work in a psychiatric clinic: Principles and methods. – Kyiv: Sfera, 1997. – 400 p.

3. Nursing process. Textbook allowance. Translation from English /Under general ed. G.M. Perfileva. – M.: GEOTAR-MED, 2001. – 80 p.

4. Shuvalina M.A., Averin A.V., Kozlov A.B., Golenkov A.V. Providing gerontopsychiatric care in the nursing department // Modern tendencies organizations of mental health care: Clinical and social aspects. Materials of the Russian Conference - M., 2004. - 22 p.