Once a child is diagnosed with diabetes, parents often go to the library for information on the subject and face the possibility of complications. After a period of related anxiety, parents take the next blow when they find out the statistics of morbidity and mortality associated with diabetes.

Viral hepatitis in early childhood

Relatively recently, the hepatitis alphabet, in which hepatitis A, B, C, D, E, G viruses were already listed, was replenished with two new DNA-containing viruses, TT and SEN. We know that hepatitis A and hepatitis E do not cause chronic hepatitis and that hepatitis G and TT viruses are most likely “innocent bystanders” that are transmitted vertically and do not infect the liver.

Measures for the treatment of chronic functional constipation in children

When treating chronic functional constipation in children, important factors in the child's medical history must be considered; establish a good relationship between the healthcare provider and the child-family to implement the proposed treatment properly; a lot of patience on both sides with repeated guarantees that the situation will gradually improve, and courage in cases of possible relapses are the best way to treat constipated children.

Scientists' study results challenge the concept of diabetes management

Results from a 10-year study have proven indisputably that frequent self-monitoring and maintenance of blood glucose levels near normal levels leads to a significant reduction in risk. late complicationscaused by diabetes mellitus, and decreasing their severity.

Manifestations of rickets in children with impaired formation of the hip joints

In the practice of pediatric orthopedics, traumatologists, the question of the need to confirm or exclude formation disorders is often raised. hip joints (dysplasia of the hip joints, congenital dislocation of the hip) in infants. The article shows the analysis of a survey of 448 children with clinical signs violations of the formation of the hip joints.

Medical gloves as a means of ensuring infectious safety

Gloves are disliked by most nurses and doctors, and for good reason. In gloves, the sensitivity of the fingertips is lost, the skin on the hands becomes dry and flaky, and the instrument strives to slip out of the hands. But gloves were and remain the most reliable means of protection against infection.

Lumbar osteochondrosis

It is believed that one in five adults on earth suffers lumbar osteochondrosis, this disease occurs both in young and old age.

Epidemiological control of health workers who have been in contact with the blood of HIV-infected

(to help medical workers of medical institutions)

The guidelines cover the issues of monitoring medical workers who had contact with the blood of a patient infected with HIV. Proposed actions with a goal, warnings occupational infection HIV. A logbook and an official investigation report in case of contact with the blood of an HIV-infected patient have been developed. The procedure for informing higher authorities about the results of medical supervision of medical workers who came into contact with the blood of an HIV-infected patient has been determined. Designed for medical workers of medical institutions.

Chlamydial infection in obstetrics and gynecology

Chlamydia of the genitals is the most common sexually transmitted disease. Worldwide, there is an increase in chlamydia infections among young women who have just entered the period of sexual activity.

Cycloferon in the treatment of infectious diseases

Currently, there is an increase in certain nosological forms infectious diseases, first of all, viral infections... One of the directions for improving treatment methods is the use of interferons, as important nonspecific factors antiviral resistance. These include cycloferon - a low molecular weight synthetic inducer of endogenous interferon.

Dysbacteriosis in children

The number of microbial cells present on the skin and mucous membranes of the macroorganism in contact with the external environment exceeds the number of cells of all its organs and tissues combined. The weight of the microflora of the human body is on average 2.5-3 kg. The importance of microbial flora for a healthy person was first noticed in 1914 by I.I. Mechnikov, who suggested that the cause of many diseases is various metabolites and toxins produced by various microorganisms that populate the organs and systems of the human body. The problem of dysbiosis in last years causes a lot of discussions with an extreme range of judgments.

Diagnosis and treatment of female genital infections

In recent years, throughout the world and in our country, there has been an increase in the incidence of sexually transmitted infections among the adult population and, which is of particular concern, among children and adolescents. The incidence of chlamydia and trichomoniasis is increasing. According to WHO, trichomoniasis ranks first in frequency among sexually transmitted infections. Every year 170 million people fall ill with trichomoniasis in the world.

Intestinal dysbiosis in children

Intestinal dysbiosis and secondary immunodeficiency state are increasingly common in the clinical practice of doctors of all specialties. This is due to changing living conditions, the harmful effects of the preformed environment on the human body.

Viral hepatitis in children

The lecture "Viral hepatitis in children" presents data on viral hepatitis A, B, C, D, E, F, G in children. All are listed clinical forms viral hepatitis, differential diagnosis, treatment and prevention, existing at the present time. The material is presented from a modern perspective and is designed for senior students of all faculties of medical universities, interns, pediatricians, infectious disease specialists and doctors of other specialties who are interested in this infection.

1. General Provisions

1. This job description defines job duties, rights and responsibilities nurse general practice.
2. A person with a secondary medical education and related training in General Practice.
3. A nurse of general practice should know the basics of the legislation of the Russian Federation on healthcare; regulatory documents governing the activities of health care institutions; structure and main directions of activity of medical and preventive and sanitary-epidemiological institutions; the state of health of the population served; fundamentals of labor legislation; internal labor regulations; rules and norms of labor protection, safety, industrial sanitation and fire protection.
4. A general practitioner nurse is appointed and dismissed by order of the head of the institution in accordance with the current legislation of the Russian Federation.
5. The general practitioner nurse reports directly to the general practitioner.

2. Job responsibilities

Carries out treatment-and-prophylactic and diagnostic measures prescribed by a doctor in a polyclinic and at home, participates in outpatient operations. Provides the sick and injured with the first pre-medical medical assistance with injuries, poisoning, acute conditions. Arranges hospitalization of the sick and injured on urgent indications. Organizes an outpatient appointment with a general practitioner (family doctor), prepares a workplace, devices, instruments, outpatient patient records, prescription forms. Conducts a preliminary examination of the patient and taking anamnesis. Complies with the sanitary and hygienic regime in the hospital premises, the rules of asepsis and antiseptics, the conditions for sterilization of instruments and materials, measures to prevent post-injection complications, serum hepatitis and AIDS in accordance with the current regulatory documents. Fills in medical records (statistical coupons, emergency notification cards, referral forms for diagnostic tests, dispatch sheets to the medical and social expert commission, spa cards, control cards dispensary observation etc.). Provides the office of a general practitioner (family doctor) with the necessary medicines, sterile instruments, dressings, and protective clothing. Keeps track of the expenses of medicines, dressings, instruments, special accounting forms. Carries out control over the safety and serviceability of medical equipment and equipment, their timely repair and write-off. Carries out a personal record of the population served, identification of its demographic and social structure, records of citizens in need of home-based medical and social services. Conducts pre-medical preventive examinations of the population in the clinic (outpatient clinic) and at home. Organizes the registration of dispensary patients, invalids, often and for a long time ill, etc., promptly invites them to outpatient appointments, monitors their visits to health care facilities. Conducts sanitary and educational work at the site (dissemination of hygienic knowledge, propaganda healthy way life, balanced nutrition, hardening, physical activity, etc.). Carries out the preparation of the sanitary assets of the site, conducts classes on the provision of self-help and mutual assistance in case of injuries, poisoning, acute conditions and accidents. Teaches relatives of seriously ill patients in the methods of care, the provision of primary first aid... Prepares patients for laboratory and instrumental research... Timely filling of the accounting and reporting documentation established by the current regulatory legal acts. Skillfully and in a timely manner fulfills orders, instructions and instructions of the management of the institution, as well as regulatory legal acts in its own way. professional activity... Complies with the internal regulations, fire safety and safety, sanitary and epidemiological regime. Promptly takes measures, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the health care institution, its employees, patients and visitors. He systematically improves his qualifications.

A general practitioner nurse has the right to:
1. make proposals to the management of the institution to improve the treatment and diagnostic process, incl. on the organization and conditions of their work;
2. supervise the work of the younger medical staff (if any), give them orders within the framework of their official duties and demand their strict implementation, make proposals to the management of the institution to encourage them or impose penalties;
3. to request, receive and use information materials and regulatory documents necessary for the performance of their official duties;
4. take part in scientific and practical conferences and meetings at which issues related to its work are considered;
5. to undergo certification in accordance with the established procedure with the right to receive the appropriate qualification category;
6. to improve their qualifications in refresher courses at least once every 5 years.
A general practitioner nurse enjoys all labor rights in accordance with Labor Code RF.

4. Responsibility

The general practitioner nurse is responsible for:
1.implementation of the duties assigned to it;
2. failure to provide medical care to patients in life-threatening conditions for unlawful actions or omissions that resulted in damage to the health or death of the patient;
3. organization of their work, timely and qualified execution of orders, orders and instructions of the management, regulatory legal acts on their activities;
4. observance of internal regulations, fire safety and safety measures;
5. timely and high-quality registration of medical and other service documentation provided for by the current regulatory documents;
6. provision in the prescribed manner of statistical and other information on their activities;
7. Prompt adoption of measures, including timely notification of management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the health care institution, its employees, patients and visitors.
For violation of labor discipline, legislative and regulatory legal acts, a general nurse may be brought to disciplinary, material, administrative and criminal liability in accordance with the current legislation, depending on the severity of the offense.

General practitioner (family doctor) nurse

Job responsibilities. Organizes an outpatient appointment with a general practitioner (family doctor), provides him with individual cards of outpatient patients, forms of prescriptions, referrals, prepares devices and instruments for work. Maintains personal records, information (computer) database of the health status of the population served, participates in the formation of groups of dispensary patients. Carries out preventive, therapeutic, diagnostic, rehabilitation measures prescribed by a general practitioner (family doctor) in a polyclinic and at home, participates in outpatient operations. Provides a general practitioner (family doctor) with the necessary medicines, sterile instruments, dressings, and protective clothing. It takes into account the consumption of medicines, dressings, instruments, special registration forms. Carries out control over the safety and serviceability of medical equipment and equipment, the timeliness of their repair and write-off. Conducts pre-medical examinations, including preventive ones, with the recording of the results in the individual card of the outpatient. Identifies and solves, within the competence, medical and psychological problems of the patient. Provides and provides nursing services for patients with the most common diseases, including diagnostic measures and manipulations (independently and in conjunction with a doctor). Conducts classes (according to specially developed methods or a plan drawn up and agreed with the doctor) with various groups of patients. Accepts patients within his competence. Carries out preventive measures: performs preventive vaccinations attached population according to the vaccination schedule; plans, organizes, controls preventive examinations of the contingents subject to examination with the aim of early detection of tuberculosis; carries out measures for the prevention of infectious diseases. Organizes and conducts hygienic training and education of the population. Provides first aid in case of emergencies and accidents to the sick and injured. Timely and efficiently maintains medical records. Gets the information you need to perform well functional responsibilities... Supervises the work of junior medical personnel, controls the volume and quality of the work performed by him. Collects and disposes of medical waste. Carries out measures to comply with the sanitary and hygienic regime in the room, the rules of asepsis and antiseptics, the conditions for sterilization of instruments and materials, the prevention of post-injection complications, hepatitis, HIV infection.

Must know: laws and other regulatory legal acts of the Russian Federation in the field of healthcare; theoretical foundations of nursing; the basics of the treatment and diagnostic process, disease prevention, promotion of a healthy lifestyle, as well as family medicine; rules for the operation of medical instruments and equipment; rules for the collection, storage and disposal of waste from medical institutions; statistical indicators characterizing the state of health of the population and the activities of medical organizations; the basics of the functioning of budgetary insurance medicine and voluntary medical insurance; basics of medical examination; the social significance of diseases; rules for maintaining accounting and reporting documentation of a structural unit; main types medical records; medical ethics; psychology of professional communication; fundamentals of labor legislation; internal labor regulations; rules for labor protection and fire safety.

Qualification requirements. Secondary vocational education in the specialty "General Medicine", "Obstetrics", "Nursing" and a certificate of a specialist in the specialty "General Practice" without any requirements for work experience.

As evidenced by the literature, the obvious advantages of the general medical practice system include a decrease in morbidity and an improvement in the quality of life, leading to a prospective decrease in the cost of medical care, which is associated with a predicted decrease in the need for expensive inpatient and specialized treatment due to systematic preventive work and constant observation by teams of general medical practice for the level and state of health of the assigned contingent.

In support of the development of general practice-based primary health care, the Ministry of Health approved in 1999 the sector program “General (family) practice”. It defines the training requirements, rights and obligations of general practitioners, specifies the legal, organizational and financial basis for the existence of a general practice.

Family medicine involves the work of a medical team with the family as a whole and with each of its members over a long period of time. In the system of general medical practice, the functions of a doctor and a nurse are much wider than that of district therapists and pediatricians and nurses working with them, here there is a more diverse spectrum medical services, many of whom are traditionally specialized doctors, so patients do not need to use their help, for example, to determine visual acuity or to change a postoperative dressing. In more complex cases requiring the intervention of a specialist, the general practitioner, who determines the need for consultation, can refer the patient to him, but the same specialist should have more time to work with those who need his help, and this time will appear if part its functions will be taken over by a general practitioner.

Nursing personnel play a significant role in the work of general medical practices. Knowing the social status of the family, the level of health of each of its members, the characteristics of the development and course of diseases, using the trust and authority of their patients, the family nurse can more effectively engage not only in coordinating activities, but also in the development and implementation of specific preventive measuresnecessary for each family, in accordance with the living conditions of the family, as well as the development and implementation of nursing care plans for patients.

For successful work, a general nurse needs extensive knowledge and skills that exceed those acquired at the basic level of education, since the functions of a family nurse are much more diverse than that of hospital nurses and nurses working in the therapeutic and pediatric areas of outpatient clinics ...

The functions of a general nurse include, among others:

* conducting personal records, collecting demographic and medico-social information about the attached population;

* identification of risk factors, implementation of measures aimed at reducing their impact on the health of the population;

* Carrying out measures for hygienic education and education of the population: teaching nursing, teaching pregnant women and their families, teaching the population a healthy lifestyle, knowledge and skills related to specific diseases, caring for children and the disabled;

* training the population to provide self-and mutual assistance in trauma, poisoning, emergency conditions;

* counseling on medical and social aspects of the family, family planning;

* organization of medical and psychological support for family members, taking into account the state of health and age characteristics;

* implementation of preventive, therapeutic, diagnostic and rehabilitation measures prescribed by a doctor in the clinic and at home.

At present, the training of nurses is focused mainly on working with people who are already sick; predominantly cadres are trained for hospitals, which does not allow paying sufficient attention to the issues of preventive activities of nurses, although at all levels of training of nursing personnel great importance should be given specifically to the maintenance of health healthy peopleas well as prevention further development already existing diseases. However, such an orientation in the training of general practice nurses is unacceptable: along with knowledge of the characteristics of nursing, various diseases they need extensive knowledge in the field of family relations, and in the field of psychology, and in the field of preventive medicine. She should know the peculiarities of nursing in the primary health care system, be able to provide palliative care, helping families with disabled people and much, much more. Therefore, the main task in the training of general practice nurses is to create conditions that ensure the maximum approximation to the realities of modern society, modern families with their medical and social problems, to ensure a holistic approach to the activities of a nurse when working with a family.

It is this approach in teaching - the breadth of skills, knowledge and views required for a nurse of general medical practice - that is provided for by the State Educational Standard, in accordance with which family nurses are trained. Currently, the State Educational Standard adopted in 2004 is in force. This is a second generation standard (the first educational standard was in force from 1997 to 2003), it takes into account the changes that have occurred in recent years in society and health care.

The training of sisters of general medical practice has been carried out since 1992, when the Order of the Ministries No. 237 "On the phased transition to the organization of primary medical care on the principle of a general practitioner (family doctor)" was issued. During this time, considerable experience has been accumulated in training general nurses in the direction of in-depth training "Family Medicine".

In accordance with the State educational standard for elevated level nurses with experience and who have just completed training at the basic level are studying education.

Family medicine nursing professionals include:

A general practitioner nurse (secondary education plus three years of college, level 1) works with a general practitioner;

A paramedic (secondary education plus four years of college, level 2) works as an assistant to a general practitioner in rural medicine structures and in separate offices - independently;

The Academic Nurse (Graduate, Level 3) is a General Practitioner Manager, Head Nurse or Head Nurse.

Family medicine, an integral part of nursing, focuses on the individual, family, society as a whole, is based on the concept of public health in a given country and the most important social and hygienic problems. Training and retraining of a general nurse should include in-depth knowledge of nursing subjects horizontally (therapy, surgery, obstetrics and gynecology, etc.) and vertical interdisciplinary cooperation (pedagogy, psychology, etc.). The cornerstone of many disciplines should be the nursing process as an evidence-based method for a nurse to solve a patient's problems.

With the transition to the organization of primary health care for the population (PHCS) on the basis of the family principle, the role and workload of the general nurse sharply increases, her responsibility towards the patient increases, and at the same time the patient's responsibility for his health increases.

The process of transition to family medicine requires a revision of the principles of medical education and approaches to it. In contrast to the existing system of training medical personnel with a priority on the study of clinical disciplines. Medical education at the present stage must necessarily include not only individual treatment, but also medical and social prevention, the study of family problems.

The establishment of the institute of general practitioners (family doctors) involves the expansion of the function of nurses, training of nurses and managers of general medical practices.

A nurse manager with a higher nursing education serves as a connecting bridge between doctors and nurses. Knowledge of the basics practical psychology, marketing, law and economics significantly increases the value of this specialist for the functioning of general medical practice.

Future organizers of various departments of health care facilities (deputy chief physician for nursing, head and head nurse of the hospital, manager of the department of general practitioners) undergo in-depth training in all areas of the team of general practitioners, taking into account the peculiarities of their work in departments, offices and outpatient clinics.

The Nursing in Family Medicine program for the Faculty of Higher Nursing Education is based on the qualified characteristics of these specialists. The main task of training nurses with higher education on the organization of nursing in family medicine - training in the technologies of organizing primary health care for the population in general medical practices.

In this regard, the nurse-leader must clearly understand the features of the work of all divisions of general medical practice, modern tendencies development of nursing and family medicine in Russia and abroad, the direction of the development of insurance medicine, the role and tasks of a general nurse in the system of improving the family and society, the main social and psychological problems of the family.

A family sister is an equal participant in all types of medical and preventive work on the site, along with a family doctor.

Higher education nurses should know:

* Fundamentals of Healthcare Legislation;

* Resolutions of the Government of the Russian Federation;

* Orders of the Ministry of Russia;

* Orders of the Main Department of Health at the regional administration;

* other documents regulating the work of general medical practices.

And also be able to:

* use them when working as managers of general medical practices;

* ensure the clear and uninterrupted work of the team of general practitioners;

* draw up programs for medical, psychological, social and vocational rehabilitation patients of general medical practices.

Job description general nurse

1. General Provisions

1. This job description defines the duties, rights and responsibilities of a general nurse.

2. A person with secondary medical education and appropriate training in the specialty "General practice" shall be appointed to the position of a nurse of general practice.

3. A nurse of general practice should know the basics of the legislation of the Russian Federation on healthcare; regulatory documents governing the activities of health care institutions; structure and main directions of activity of medical and preventive and sanitary-epidemiological institutions; the state of health of the population served; fundamentals of labor legislation; internal labor regulations; rules and norms of labor protection, safety, industrial sanitation and fire protection.

4. A general practitioner nurse is appointed and dismissed by order of the head of the institution in accordance with the current legislation of the Russian Federation.

5. The general practitioner nurse reports directly to the general practitioner.

2. Job responsibilities

Carries out treatment, prophylactic and diagnostic measures prescribed by a doctor in the clinic and at home, participates in outpatient operations. Provides the sick and injured with the first pre-medical care for injuries, poisoning, acute conditions. Arranges hospitalization of the sick and injured on urgent indications. Organizes an outpatient appointment with a general practitioner (family doctor), prepares a workplace, devices, instruments, outpatient patient records, prescription forms. Conducts a preliminary examination of the patient and taking anamnesis. Complies with the sanitary and hygienic regime in the hospital premises, the rules of asepsis and antiseptics, the conditions for sterilization of instruments and materials, measures to prevent post-injection complications, serum hepatitis and AIDS in accordance with the current regulatory documents. Fills in medical records (statistical coupons, emergency notification cards, referral forms for diagnostic tests, dispatch sheets to the medical and social expert commission, spa cards, dispensary observation control cards, etc.). Provides the office of a general practitioner (family doctor) with the necessary medicines, sterile instruments, dressings, and protective clothing. Keeps track of the costs of medicines, dressings, instruments, special accounting forms. Carries out control over the safety and serviceability of medical equipment and equipment, their timely repair and write-off. Carries out a personal record of the population served, identification of its demographic and social structure, records of citizens in need of home-based medical and social services. Conducts pre-medical preventive examinations of the population in the clinic (outpatient clinic) and at home. Organizes the registration of dispensary patients, disabled people, often and for a long time ill, etc., promptly invites them to outpatient appointments, monitors their visits to health care facilities. Conducts sanitary and educational work at the site (dissemination of hygienic knowledge, promotion of a healthy lifestyle, rational nutrition, hardening, physical activity, etc.). Carries out the preparation of the sanitary assets of the site, conducts classes on the provision of self-help and mutual assistance in case of injuries, poisoning, acute conditions and accidents. Teaches relatives of seriously ill patients in the methods of care, the provision of primary first aid. Prepares patients for laboratory and instrumental research. Timely filling of the accounting and reporting documentation established by the current regulatory legal acts. Skillfully and in a timely manner fulfills the orders, orders and instructions of the institution's management, as well as regulations for their professional activities. Complies with the internal regulations, fire safety and safety, sanitary and epidemiological regime. Promptly takes measures, including timely informing the management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the health care institution, its employees, patients and visitors. He systematically improves his qualifications.

3. Rights

A general practitioner nurse has the right to:

1. make proposals to the management of the institution to improve the treatment and diagnostic process, incl. on the organization and conditions of their work;

2. control the work of junior medical personnel (if any), give them orders within the framework of their official duties and demand their strict implementation, make proposals to the management of the institution for their encouragement or imposition of penalties;

3. to request, receive and use information materials and regulatory documents necessary for the performance of their official duties;

4. take part in scientific and practical conferences and meetings at which issues related to its work are considered;

5. to undergo certification in accordance with the established procedure with the right to receive the appropriate qualification category;

A general practitioner nurse enjoys all labor rights in accordance with the Labor Code of the Russian Federation.

6. provision in the prescribed manner of statistical and other information on their activities;

7. Prompt adoption of measures, including timely notification of management, to eliminate violations of safety, fire and sanitary rules that pose a threat to the activities of the health care institution, its employees, patients and visitors.

For violation of labor discipline, legislative and regulatory legal acts, a general nurse may be brought to disciplinary, material, administrative and criminal liability in accordance with the current legislation, depending on the severity of the offense.