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Providing nursing care to patients with cerebrovascular diseases Uktamova Z.1, Urazalieva I.2 (Republic of Uzbekistan) Оказание сестринской помощи пациентам с цереброваскулярными заболеваниями Уктамова З. Р.1, Уразалиева И. Р.2 (Республика Узбекистан)
'Уктамова Зулхумор Рустамжановна/ Uktamova Zulhumor - студент,
факультет высшего сестринского дела, Ферганский филиал Ташкентской медицинской академии, г. Фергана;
2Уразалиева Ильмира Равкатовна / Urazalieva Ilmira — ассистент, Школа общественного здравоохранения, Ташкентская медицинская академия, г. Ташкент, Республика Узбекистан
Abstract: according to the survey visiting nurses of family policlinics in Almazar region revealed, that 10 % knows nothing about the notion of cerebral-vascular diseases, 59 % know superficially, 31 % have sufficient knowledge to carry out preventive measures, known risk factors, preventive measures in their competence, based on nursing protocols. Almost the same results were obtained in the survey ofnurses in family policlinics ofYashnabad region. Аннотация: опрос патронажных медсестер семейных поликлиник Олмазарского района показал, что 10 % из них с понятием цереброваскулярных заболеваний абсолютно не знакомы, 59 % знают поверхностно, 31 % обладают знаниями, достаточными для проведения профилактических мероприятий, знают факторы риска, меры профилактики на основе сестринских протоколов. Практически такие же данные были получены при опросе медсестер семейных поликлиник Яшнабадскогорайона.
Keywords: cerebralvascular diseases, nurses, primary health care, prevention, risk factors.
Ключевые слова: цереброваскулярные заболевания, медицинские сестры, первичное звено здравоохранения, профилактика, факторы риска.
Now the problem of cerebrovascular diseases and stroke joined around themselves experts of different disciplines: neurologists, cardiologists, therapists, neurosurgeons, vascular surgeons [1, с. 10-12].
In Uzbekistan, according to statistics, annually about 48 thousand persons get over the stroke. For this reason actions on decreasing morbidity, mortality and disability became one of the leading problem of medicine. System for quality improvement of diagnostics, treatment and prevention of CVD is necessary to create more modern system of rendering medical aid to patients with stroke and others cerebrovascular diseases.
From the position of the system approach it should be especially note an increasing role of nurses in early revealing, diagnosing and prevention of especially primary CVD [2, с. 34-42].
Objective of the research is study and evaluate activity of nurses on prevention of cerebrovascular diseases in a primary level of healthcare.
Material and methods of the research. Selective research has been carried on the basis of family polyclinics of Almazarsky and Yashnabad districts of the Tashkent city. Research was realized in two stages from May, 2014 till October, 2014. At the first stage by a method of casual sample were conducted interview of 286 persons, at the age from 30 till 70 years and elder (middle age 49±2.7 years), living on the sites served by given polyclinics. Depending on age and sex all respondents have been divided into 5 groups and interviewed. Among interviewed were 147 (51,4 %) women and 139 (48,9 %) men. Specially developed questionnaire included 34 questions on measures of prevention measures of CVD and adjacent with them diseases, balanced dietary and daily caloric content of a diet, carrying out by nurses conversations with the population on the given themes, their frequency, regularity, and also about satisfaction of the population from the rendered nursing service. The second stage of questionnaire included study activity of patronage nurses as in the sphere of sanitary-educational work, and in the sphere of services rendered during the patronage to the population. 220 nurses took part in the questionnaire who work in family polyclinics. The questionnaire contained 38 questions concerning not only questions on prevention measures of stroke that is propagate during conversations with the population, but also qualification of nurses, their experience, knowledge on conducting reports in nursing about prevention measures of acute disorder of brain blood circulation which are developed within the frame of the national project «Health-2».
Results and their discussion. Results of research have shown that women at the age from 30 till 40-45 years, mainly were inclined to overeating, more than 87 % from them intake fat high-calorific food and only 13 % corresponded to energy spent and intake food with moderate fat content. Caloric content of a daily diet of 80 % men of this age also has been exceeded. Accordingly both at men, and at women in age groups of 30-40 and 40-50 years observed adiposity, including at 47 % - I, at 28 % - II and at 4 % - III degree, meaning only in 21 % of population of the studied age groups had a normal body weight index. 46,3 % of the respondents did not know level of their
arterial blood pressure. At the measuring of arterial blood pressure almost in half of respondents (46,3 %) arterial blood pressure ranged from 16090 to 180/100 mmHg.
From remaining 53,7 % respondents knew the level of their arterial blood pressure, 42,5 % suffered from arterial hypertension II or III degrees, at 11,2 % from arterial hypertension of I degree. Besides, 6 % of respondents confessed about smoking, 43 % of women used hormonal contraception, from them 12 % were used last 10 years. 30 % of men and 34 % of women of the senior age groups (50-60 and 60-70 years) suffered from diabetes.
According to the patients, the significant role in activity of nurses is played by appearance of nurses which defines psychology of communication with patients. The most of respondents in both groups have estimated appearance of nurses as a good, 16,3 % - as satisfactory, 9 % - as unsatisfactory. Communication psychology of nurses with patients in a skilled group has been satisfied of 69 % questioned, and in a control group - 51 %. Not last role in mutual relations of nurses and patients is played by personal characteristics of nurses. According to patients, «good» nurse should possess with such qualities as attentiveness (55,7 %), sense of duty (24,6 %), and tolerance (19,7 %). Interviewed have putted into first two places attentiveness (46 %) and sense of duty (27,8 %), and into the third place - responsiveness (26 %). However, it is figured out as reasons of a dissatisfaction of patients by quality of nursing's work in a primary level of Healthcare 29,8 % of respondents have specified in indifference and not attentiveness of nurses to patients' problems.
On a question: whether «you trust your nurse?» the greatest number of the interviewed have answered in the affirmative and pointed that the relation of nurses to patients is good (86,7 %). The others have estimated it as a bad (10,6 %) and very bad (2,7 %). Quality of work of nurses in a primary level of Healthcare substantially depends on professional skill of nurses, on their discipline and conscientiousness.
Professionalism of nurses estimated as a very high by 3,3 % interviewed, as a good 41,7 %, as a satisfactory -49 %, as a not satisfactory - 6 %. Work of nurses in family polyclinics has the specificity: It demands carrying out actions for sanitary-and-hygienic education of the population taking into account concrete risk factors, training of patients to simple, accessible methods of recovery of health and the prevention of diseases.
The majority of interviewed from family polyclinics, have noticed that nurses with the general practice give good advices on day regimen (21,3 %), and 51,3 % of interviewed estimated their advice as a satisfactory, others -27,4 % of patients consider that their nurse does not give correct advices about day regimen observance. The same question was answered negatively with 46,4 % of interviewed in the control group.
Table 1. Sanitary-and-hygienic education ofthe population by nurses of family polyclinics, (%)
Almazar District Yashnabad District
Nurse gives advices about a healthy life style Do not give advice Give «satisfactory» advice Give «good» advice Do not give advice Give «satisfactory» advice Give «good» advice
On day regimen observance 27,4 51,3 21,3 46,4 21,2 32,5
On a rest mode 23,3 48,7 28 31 53 31
On a mode and character of a food 26,7 44 29,3 28,0 55,6 16,4
About harms of smoking and alcohol 28,7 41,3 30 29 47 24
Average 27, 7 45,2 27,1 33,6 44,2 22,2
Interviewed patients have noticed that their local nurses in most of cases do not give advices about observance of a mode of rest (23,3 % and 31 %), about a mode and character of food (26,7 % and 28 %), also do not warn about bad habits (28,7 % and 29 %), such as smoking and alcohol consumption (table 2).
On a question about conducting conversation and household detours by nurses the majority (75 %) of interviewed have affirmative answered, however, when they asked to list themes of conversations, 58 % were difficult to answer that testifies to insufficient work of nurses of primary level of Healthcare. In the process of the research the other 42 % of interviewed have listed themes which were close to a problem of stroke and others cerebrovascular diseases, such as healthy life style, balanced nutrition, and hypertensive disease.
Research has shown that mainly respondents are satisfied by how nurses carry out appointments of the general practitioner. Not satisfied by work of nurses only 5,4 % of the interviewed in main group and 16,4 % in control group.
Material and technical equipment of polyclinics were equipped according to 78,4 % of interviewed have estimated as a sufficient for rendering of the qualified nursing aid, however 21,6 % of interviewed noted that the nurse have no sufficient equipment for rendering to patients of the qualified nursing aid.
According to results of the second stage of the research it is necessary to notice also that at present higher qualification of 29 % of nurses of family polyclinics in Almazar District, 1st qualification - 3 %, and 2nd - 3 %, but the majority 65 % had no qualification. According to archive records that were obtained in Almazar District, in 2011 has been planned to raise qualification of 7 nurses of the general practice, 8 nurses have passed courses of increasing qualification, in 2012 according 19 and 22, in 2013 from 19 courses of increasing qualification have passed only 8. In family polyclinics of Yashnaabad District nurses with high qualification made 27 %, with 1st qualification - 6 %, and with 2nd qualification - 3 %, 64 % of nurses had no qualification. In 2011 has been planned to increase qualification of 22 nurses, have increased qualification 18, in 2012 were planned and realized increasing qualification of 9 nurses, in 2013 from 10 courses of increasing qualification have passed 9.
According to results of the survey nurses of the family policlinic in Almazar District, 10 % were absolutely not familiar with conception of Cerebrovascular Diseases, 59 % from them superficially know this problem, 31 % of nurses possess knowledge that is sufficient for carrying out of preventive actions (risk factors, preventive maintenance measures from its part, on the basis of nursing reports). Almost the same data has been received during interview of nurses of the family policlinic in Yashnaabad District: 62,4 % from them were not competent in this area, 37 % well know and carry out necessary actions in the given direction. 73 % nurses practically do not lead up available data as, according to the program of household detours on this theme were not present in the list of spent conversations to the population. Acquaintance to the plan of the conversations spent with the population, has shown that conversations about such global and priority at present to a problem as sharp disorder of brain blood circulation, unfortunately, are not provided.
Conclusions: Patients from family polyclinics were partially satisfied by the personal characteristic and professional work of nurses, however, the accurate organization of workplaces and rational use of working hours, creation of optimal working conditions for nurses is necessary for improvement of quality of the nursing aid with use of computer technologies. Perfection of material and organizational-methodical base of activity of the nurses working in family polyclinics, will promote improvement of quality and efficiency of their activity.
References
1. Skvortsova V. I., Stakhovskaya L. V., Chazova I. E. Secondary stroke prevention. // Nursing. 2006. № 8. P. 10-12.
2. Kanin I. R. Analysis of public satisfaction with the quality of the work of nurses primary care as an example of a city polyclinic // Home med.sestra. - 2009. - № 9. P. 34-42.
