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ABOUT EXPANSION OF THE NURSE FUNCTIONS IN APPLICATION OF A SPELEOTHERAPY IN SOME EUROPEAN COUNTRIES AND IN THE REPUBLIC OF BELARUS
Abstract
There is the analysis of the history and state of speleotherapy in different countries of the world, such as Poland, Rumania, Russia, Uzbekistan, Kirgizia and Germany during the XX century. The analysis of speleotherapy in a number of European countries is given; the unique method developed in the Republic of Belarus and possibilities for training of nurses are described.
Keywords
bronchial asthma, quality of life, nurse, rehabilitation, rhinitis, speleotherapy
AUTHORS
Tatyana Vladimirovna Matveychik
PhD, Associate Professor, Public Health and Health Care, Belarusian Medical Academy of Postdegree Education", Minsk, Belarus. E-mail: matveichik51@rambler.ru
Rostislav Ivanovich Delendik Doctor, Republican Hospital of Speleotherapy, Soligorsk, Belarus. E-mail: med-rost@mail.ru
Relevance
Consequences of human activity concerning ecological shifts, impurities of the air environment, increase of respiratory viral infections promote growth of respiratory organs diseases, including allergic diseases of a nose mucous membrane and perirhinal bosoms. Prevalence of allergy in the world represents a global problem of public health care for 30-40% of population with one or several allergic diseases. According to the statistics of the World Health Organization (WHO), hundreds of millions people suffer from allergic rhinitis and about 300 million of people - from bronchial asthma (BA), most of them are children and teenagers. There are over 60 thousand of patients in the Republic of Belarus. In this connection, the research of effective methods of influence at chronic respiratory diseases is actual. Such diseases are bronchial asthma, chronic obstructive pulmonary disease (COPD), allergic diseases - rhinitises, pollinoza, dermatitis, chronic polipoid rhinosinusitis. Efficiency of treatment can be reached by inclusion of nonmedicamentous methods of treatment, including speleotherapy and expansion of nurse's functions.
Research objective is studying regularities of speleotherapy formation on the example of the European countries (Poland, Romania, Russia, Uzbekistan, Kyrgyzstan, Germany), domestic scientific researches with search of possible regularities and sisterly pedagogical potential in instilling skills of health preservation during patients' sanatorium treatment.
Material and methods are analytical, sociological, historical, and statistical. The research was conducted in 2012-2016 on the basis of Republican Hospital of Speleotherapy" and the branch "Rehabilitation Center Green Pine Forest" during treatment of patients from different regions of the Republic of Belarus with various pathology of respiratory organs. The age of patients was from
10 to 65 years, the equal number of women and men took part in the research. The method of anonymous questioning was used. There were 3959 patients before receiving sanatorium treatment, including speleotherapy method. Studying clinical state was confirmed by complex laboratory-tool research. On the basis of public institution of education "Belarusian Medical Academy of Postdegree Education" the advanced training course according to the special program "Bases of Work of the Chief (Seniors) Nurses of the Sanatorium and Improving Organizations" is carried out in 2016. It is carried out according to the resolution of the 64th session of the World assembly of health care (Warsaw, 2011) calling for commitment of idea to strengthen nurse and obstetric business by practical actions (WHA 64.7, river 13.4).
On the Flagman course on strengthening health systems (WHO, Barcelona, May 9-13, 2016) the need to increase nurse's role for scheduled maintenance by means of the versatile approach aligned on a family and coordinated by the nurse was also noted:
• less rigid division in an autonomy between doctors and nurses (high technologies);
• collaboration in team through division of tasks and simple algorithms, and at shortage of doctors - permission to independent practice to nurses with higher education as to the licensed practicing nurses;
• possibilities of carrying out prevention, consultations of population on change of behavior, instilling culture of health with emphasis on decrease of cardio-vascular risk by elimination of negative image of patients with high risk cardio-vascular diseases, involvement of families in strengthening of behavioral strategy;
• acceptance of interdisciplinary experience directed by a nurse.
Results and discussion
The treatment method in underground caves (spelaion from Greek - cave) numbers about 2500 years. The first mentions of it belong to the I-II centuries AD, however scientific data appear in the XIX century, and relative distribution refer to the middle of the XX century. The World War
11 caused relevance of a method for treatment and rehabilitation of wounded and patients with diseases of lungs in Germany, then in Austria, Hungary, Poland, Romania, the Czech Republic, Slovakia, Bulgaria, having been widely used in the countries of the Eastern and Western Europe [1,2,3-7].
Medical factor of speleotherapy is specific air of karst, stone- salt and potassium caves and excavations. Approbation of speleotherapy method of stone-salt mine first was carried out in Austria in 1955. Positive results of health and analysis of incidence of miners in salt mines Solbat - Saltselman among which did not come to light BA, tuberculosis of respiratory organs [1 -4], were an incitement to application. Use of salt mines expanded potential of speleotherapy in other countries.
Poland (Velichka) became the founder of speleotherapy in salt mines, where miners of salt mines, unlike miners of coal and ore mines, didn't have tuberculosis of lungs and BA, as well as in Austria. That is confirmed with materials of ancient chronicles and film documents [1]. Experience of the first sanatorium in Velichka (1826-1846) proved possibility of speleotherapy for patients with allergic and some other diseases of respiratory organs. The mines are still working. The part of the fulfilled drifts is used for tourist routes, underground resort speleosanatorium since 1970 and underground rehabilitation-recovery center since 2003. Since 1995, Bokhniya's mine of Small Poland, which is the unique historical city of miner's type [1, 2] becomes the new base of speleotherapy. The specific microclimate of this mine is characterized by bacteriological purity, high extent of air ionization, lack of fungi, isolation of patients from adverse factors.
The received results from unique treatment in salt mines of Poland did not remain unnoticed by health care of many countries that promoted introduction speleotherapy, growth of its popularity and induced to deep studying of potential opportunities.
Romania introduced speleotherapy in salt mines of Turd, Pride, Tyrgu-Okna and Siget, the resort Pride, known for the huge mines existing since the Roman Empire, and used for treatment of patients with asthmatic and bronchopulmonary diseases since 1969 [1]. Air is sated with aerosols and highly ionized. After mine treatment patients can swim in the salt lake near the entrance.
Salt mines of Turd of Transylvania resort re presented by mine excavations Rudolf and Theresa. Production conducted there since ancient times. For descent in mine Rudolf patients and tourists use specially equipped panoramic ladder and elevator, both mines impress with the sizes, and on the arch bridge it is possible to go down to the esoteric lake.
Since 1972, the sanatorium "Magur" of Tyrgu-Okna has the underground clinic allowing to carry out physiotherapeutic treatment for 4 hours in the afternoon.
Since 1975, speleoclinic of salt-mine Siget presents an unusual underground construction in the form of the two-level excavations Unirea and Mihai, which are one of the biggest salt mines in Europe. The busts and sculptures from salt blocks in Unirea clinic give a special highlight to speleoclinic. Efficiency of treatment is caused by the combined impact of complex environmental factors on surfaces of the earth in conditions of underground clinics. The positive therapeutic effect is reached among 77-90% of adult patients with various BA, chronic obstructive bronchitis, pollen diseases, allergic rhinitis [1].
Russia became the first country, which in 1977 introduced speleotherapy in conditions of potassium mine on the basis of Verkhnekamsky field of potassium salts of the Western Urals (Berezniki). As the initiator of speleoclinic construction on this base acted "Uralkali" production association. Studying the production environment of potassium mines allowed to define set of the factors testifying possibility of its use in medical purposes.
Speleoenvironment had stable parameters: air temperature all the year round was 15-17 °C; its relative humidity was to 40-50% in a cold season and during the summer period near 60-70%; atmospheric pressure - 752-778 mm Hg; mobility of air to 0,15 m/s; concentration of salt aerosol of 3-5 mg/m 3 with a size of aerosol particles less than 5 microns, presented by generally chloride sodium for 54-76% and chloride potassium for 22-42%; the content of oxygen and carbon dioxide respectively 20,7 about % and 0,1 about %; a microbic contamination of 150-210 microbic bodies in 1 cubic meter of air. After treatment function of external breath improved, the positive effect was reached for 73-90% of patients.
In Kyrgyzstan, speleoclinic of medical-healing center Chon-Guz was built in 1981, near the village of Kochkorka of the Naryn area, at the height of 2100m above the sea level. The unique combination of natural factors of highlands and increased concentration of aero ions helps patients from 5 to 65 years. On the basis of the fulfilled excavations of salt mine near the Chuya valley, the speleoclinic "Big Salt" is constructed [1]. Medical natural Chon-Guz salt was created in the ancient Kochkorsky lake about 40 million years ago, medical influence is reached by the sated salt aero ions improving rheological properties of bronchial slime, promoting optimum performance of ciliated epithelium, mucoregulatory influence. Effect of salt is carried out in all departments of respiratory path, as a regidratant aero ions reduce hypostasis of mucous membrane of bronchial tubes, promote reduction of developments of stagnation in vessels. Ions of salt have bactericidal and bacteriostatic effect on microflora of airways, promoting their phagocytic activity, have positive impact on immune and metabolic processes. Speleoclinic " Chon-Guz " significantly differs from other similar underground clinics by features of highlands. The fact of stability of microclimate of underground chambers is unique: total absence of allergens, practically sterility of air (3-5 microbic bodies on 1 cubic meter), air temperature all the year round is 8-10 C°. Use of a speleotherapy in highland conditions within several years gives efficiency of treatment of BA atopic forms to 92%, and of infectious and dependent forms - to 78%.
The regional speleotherapy hospital "Hodzhaykon" is the base of the Republican scientific-practical medical center of therapy and medical rehabilitation in Uzbekistan [1]. Features of complex of factors of her environment cause medical action of a cave of «Hodzhaykon»: existence of a high-disperse multicomponent salt aerosol and negative aero ions in big concentration, minimum pollution and lack of allergens.
Since 1991, in Germany there is a network from ten speleoclinics, which are based on salt mines of Berchtesgaden, where treatment of nonspecific diseases of respiratory organs, cardiovascular system, digestive tract, musculoskeletal device of a rheumatic etiology, metabolic disorders is carried out [1,7].
Formation of speleotherapy in the Republic of Belarus has the own history. The field of potassium salts was open in 1949, having received Starobinsky name. Its feature is the biggest power in Europe with a favorable geographical arrangement, favorable mining-and-geological and hydrogeological conditions of a bedding of potassium salts and perspective for the mechanized
dredging of minerals. Layers of potash salts lie horizontally that promoted successful development of a field since 1958 with construction of the first potash combine in Soligorsk [1, 2, 8].
The analysis of incidence of potassium production workers showed that people working in mines of the Soligorsk pool had no cases of bronchial asthma and tuberculosis of lungs. There was low level of cardio-vascular system diseases, including a hypertensive illness. Studying environment of excavations and incidence of miners gave the grounds about formation of two microclimatic zones on a human body, various on character. In this connection, the complex of specific factors of the environment, which are formed in the excavations not connected with production use for effective speleotherapy treatment [9].
Meanwhile, the researches of the largest companies at the beginning of the 2000 defined 4 main directions of constant attention: market (sale, marketing); indicators of financial and non-financial activity of health care organizations (HCO); innovations and rendering of services; personnel. In the developed countries indicators of successful achievement of the purpose on providing with human resources (HR), i.e. professional shots, are the quantity and quality of workers of this HCO, organizational culture and structure of the organization of work. In this connection, inclusion of medical rehabilitation of this type not of medicamentous influence became perspective in programs. The "Organization of Work of the Chief (Senior) Nurse of the Sanatorium and Improving Organization" program taking into account researches of the Russian scientists was developed for additional training of nurses of the sanatorium organizations.
Professional development of nurses in HCO is based on several external and internal factors (according to Ulumbekova, 2010):
1. External factors: updating acceleration (doubling of information within 3-5 years) and globalization of medical information; increase in number of drugs and hi-tech methods of treatment; rise in price of medical care; growth of number of patients with chronic noninfectious diseases against increase in a share of the aged population to 25% by 2025; increase of knowledge and requirements of the patient.
2. Internal factors: quality and continuity of medical education; motivation to high-quality work and continuous education; working conditions and material support of medical education; quality control of medical care.
3. Standards of ethics, transition from moral obligation of health workers for continuous medical education to legislatively consolidated norm providing the sanctions realized via mechanisms of licensing and contract system.
4. Active application of electronic and telecommunication technologies (problem training in small groups, distance, simulation learning, exchange of experience by webinars).
5. Use of elements of evidential medicine for electronic support of administrative and clinical decisions.
6. Introduction of high-quality change of basic and additional education increasing hours at prevention of chronic noninfectious diseases [10]. 18 European states has this experience within the last 15 years (Peck et al., 2000). In 17 countries, continuous medical education is considered necessary, in 6 countries it is regulated by the law, in 13 countries is provided with professional medical communities. As the senior nurse, besides participation in ensuring labor protection and creation of conditions on a nurse workplace, metrological control, medicinal providing in HCO, organization and control of food in the conditions of the sanatorium and hospital organizations, ensuring infectious safety for the prevention of VBI, the questions of medical rehabilitation especially actual for development of the scientific direction in treatment in the specialized medical organizations is included.
In the conditions of potassium mines, introduction of speleotherapy was carried out on the basis of results of scientific researches of the environment of excavations and complex of organizational actions [7]. The Republican Hospital of Speleotherapy (RHS) (Soligorsk) functions since 1991 and includes a land hospital on 250 beds, branch Rehabilitation Center Green Pine Forest" for 200 children and underground speleocomplex. The land hospital of RHS with all divisions is put into operation in 1997, representing the comfortable three-storied building built on the special project, located in pine forest on the bank of an environmentally friendly reservoir. The underground clinic is designed and constructed on the special scientifically based project prepared on the basis of the sanitary and hygienic requirements developed for these conditions. This construction is with the isolated system of airing and own micro infrastructure that essentially
distinguishes it from all speleoobjects operating now in the territory of the European region [9,11]. The underground office settles down in the massif of rock salt in sylvinite-halite layer that allows to combine at the same time medical effects from impact on an organism of patients of both red, and white salt. The emphasis is placed on features of communication with the patient at different stages of medical rehabilitation that is perspective for increase of its place in system of assistance in sanatorium activity. In addition, the pedagogical potential of these workers is useful for formation patient's culture of health and life with illness [12].
Conclusion
Speleotherapy has diverse forms in the world practice: karst caves, excavations of mines, their fulfilled spaces making the reserve of economy functioning caused by anthropogenic consequences of human activity without additional costs of creation.
Uniqueness of speleotherapy in the Republic of Belarus is caused by the stable underground environment capable to the independent regeneration allowing to reach high therapeutic effect in treatment and rehabilitation of diseases.
The speleotherapy method passed a number of stages and periods in the countries of the European region and the Republic of Belarus, its evidence-based development refer to the 50s of the XX century.
The analysis of work of operating speleoclinics authentically testifies that therapeutic efficiency of a method is high and surpasses success of traditional treatment and medical rehabilitation of the patients having chronic nonspecific diseases of respiratory organs and allergic diseases, chronic diseases of nervous system, locomotor system, metabolism.
During speleotherapy sessions in underground conditions, patient's organism is isolated from influence of ecologically adverse factors of environment, neutralize an adverse effect of urbanization thanks to what there is an activation of immunological forces directed on restoration of the broken physiological functions with the proved positive dynamics in the form of steady medical and improving effect.
Uniqueness of speleotherapy method allows patient's organism to make active potential reserves for achievement of optimum functioning.
Inclusion in programs of medical rehabilitation of this type of non-medicamentous influence allow to expand a range of indications, reduce medicamentous load of a patient, achieve increase in the boundaries of the recurrent period at chronic pathology promoting improvement of quality of life becomes the perspective direction of development of speleotherapy. In the conditions of additional training of nurses in features of interaction with patients, expansion of borders speleotherapy and medical rehabilitation is a perspective way of activation of pedagogical potential of these workers for formation the idea of health culture. It is applied in the Republic of Belarus on the basis of world experience of similar activity according to the life-long learning program (training throughout the life).
The system of vocational training of nurses can be optimized by means of gradual introduction of simulation training elements, motivation to the principle of training throughout the life in continuous medical education and accumulative mark (credit) system. Systematization of professional knowledge and skills of the chief nurses allowed to define features of vocational training of experts in the field of rehabilitation, useful to expansion of opportunities of self-education and quality of patients' life.
Quality of work of nurses with the higher education (medical assistants on the out-patient and polyclinic help) can be higher due to acquisition of bigger independence in preventive activity that is put in their main competences provided with guarantees of policy principles Health-2020 [2, 12]. Improvement of system of additional education of the chief nurses, use of pedagogical elements, informatization, psychology and innovations allow to solve available problems step by step. Training of masters on rehabilitology is the direction, most fully meeting requirement of practical health care of the Republic of Belarus taking into account condition of demographic safety of the state.
Application of an evidence-based method of speleotherapy in the Republic of Belarus is based on an integrated approach of the state to the solution of medical problems on improvement of people's life quality.
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