Therapeutic schools of patients allow. School of the patient as a tool for improving the quality of medical care. School AG - new information and motivational technologies

Patient School - is an organizational form of preventive group counseling (hygienic education and upbringing)11. Target patient schools:

Increasing the awareness of patients about the disease and risk factors for the development of diseases and complications;

Increasing the responsibility of the patient for the preservation of health;

Formation of a rational and active attitude of the patient to health, motivation for recovery, adherence to treatment;

Formation of skills and abilities for self-control and self-help in emergency situations;

Formation in patients of skills and abilities to reduce the adverse impact on health of behavioral, manageable risk factors.

With the group method of counseling (patient school), the process of preventive counseling is facilitated and its effectiveness is increased, patients not only receive important knowledge, but also the social support they need.

Benefits of group preventive counseling. Training in a group enhances the effectiveness of training - a team atmosphere is created, the feeling of loneliness is leveled, and emotional contact is improved. Efficiency is increased through the exchange of experience between patients, examples from their lives, etc. It must be remembered that group training is more effective if it is supported by individual counseling. In a number of situations, it is desirable that the training be carried out at the family level, in particular when counseling addresses issues of nutrition, physical activity, behavioral habits, which, as you know, often have a family character. The School of Patients, as a form of group counseling, makes it possible to fully ensure the effective implementation of the foundations of in-depth preventive counseling - in a group discussion, conditions are created for a more effective application of the basic principles and techniques of adult education, taking into account the psychology of behavior change and behavioral habits.

The history of the establishment of schools for patients with various diseases of the chronic course in our country has more than 15 years. A wealth of experience has been accumulated in group training of patients with various diseases: diabetes mellitus, arterial hypertension, bronchial asthma, coronary heart disease and other diseases, the clinical, social and economic effectiveness of this method of preventive counseling has been convincingly proven.

Basic principles for conducting patient schools:

(1) the formation of a "thematic" target group of patients with relatively similar characteristics: for example, patients with uncomplicated arterial hypertension, coronary heart disease; patients with coronary heart disease who have had myocardial infarction, acute coronary syndrome, interventional intervention, etc.; patients with a high risk of cardiovascular diseases without clinical symptoms of the disease, etc. This formation of groups creates an atmosphere

11 Health promotion and disease prevention. Basic terms and concepts // Ed. Vyalkova A.I., Oganova R.G. - M., GEOTAR-Media, 2000. - 21s.

social support, which is important for effective counseling and long-term sustainable results.

(2) for a selected target group is carried out lesson cycle according to a predetermined plan and according to an agreed schedule; one of the main requirements is to attend the entire cycle of classes;

(3) the size of the target group of patients should be no more than 10-12 people; control is needed so that patients attend all (or most) of the scheduled classes;

(4) the organization of group counseling should be carried out in a specially equipped room (table, chairs, demonstration material, handouts, notepads, etc.).

The most common mistake when organizing a school should be avoided. The school of patients, unfortunately, is often replaced by a "lecture hall", when topics are announced in advance at certain days and hours, and patients with a variety of diseases come to these lectures. This form of work, although very time-consuming for medical specialists, is practically ineffective, because. the main principles of group counseling are violated.

Schools of patients within the framework of medical examinations, preventive medical examinations are carried out by medical workers of the cabinets (departments) of medical prevention (doctor, paramedic of medical prevention). Schools require trained staff and facilities for effective group counseling.

If necessary, specialized specialists can be involved in conducting individual classes (if they are available in the institution, psychologists, etc.). Patients are referred to the patient's school by the district doctor. It is desirable that the doctor (paramedic)

office (department) of medical prevention has previously familiarized himself with the data of the outpatient card of patients.

The training program is built from a cycle of structured sessions, lasting about 60 minutes each. In total, 2-3 lessons are optimal in a cycle, depending on the target group.

Each lesson includes informational material and active forms of learning aimed at developing the skills and practical skills of patients. All classes must be timed in advance, have clear instructions for conducting.

Information part Classes are held during each lesson fractionally, in blocks of no more than 10-15 minutes, in order to avoid the lecture form of work with patients. The content of the training is set out in special methodological literature and partly in the basic information material on in-depth preventive

counseling.

Active part of classes contains active work with patients, which can be carried out in different forms and simple actions:

Questions and answers;

Filling out questionnaires related to the topic of the session and discussing their results - targeted advice can be given during the discussion, which is more efficient and effective than unaddressed advice;

Carrying out calculations and assessments, for example, calculation of body mass index, daily caloric content, etc.;

Training in practical skills - measuring blood pressure, counting the pulse, etc.

Acquaintance with reference tables and postorennye diet, etc.

A health school patient education program can be developed based on the material outlined in the section on in-depth preventive counseling.

All visual information used at school should be: colorful, demonstrative, memorable, understandable, interesting, accessible.

patients) as part of the medical examination:

School for the correction of the main risk factors for chronic NCDs / CVD, detected during medical examinations and preventive examinations;

School for reducing excess body weight, optimizing physical activity and rational nutrition;

School for patients with high blood pressure.

Therapeutic patient education as a tool for chronic disease management

Therapeutic training. one

The role of the healthcare worker. 3

The role of the patient. four

Patient schools. 5

Learning objectives. 5

Factors affecting the effectiveness and efficiency of therapeutic education in the "Schools of Patients". 6

Components of the behavior rehearsal methodology: Modeling, coaching and reinforcement. 7

Self-observation diary (behavioral). eight

Examples of sessions with patients. 9

TOPIC OF THE LESSON: "METABOLIC CONTROL" "COMPLICATIONS OF DIABETES MELLITUS". 9

THE TOPIC OF THE LESSON: "NUTRITION PLANNING IN TYPE 1 DIABETES MELLITUS". fourteen

Examples of tasks for patients. twenty

Evaluation of the quality of therapeutic education in the School for Patients. 21

List of schools for patients in accordance with OK NKMU.. 21

Methods of informing and motivating. 22

From the book of Lozovoy V.V. "Prevention of addictions: school, family". - Yekaterinburg, Publishing House of the Ural State University, 2000. 22

Algorithm for informational and motivating communication. 26

How to deal with objections: 29

FOCUS GROUP.. 32

DISCUSSION. 37

BRAINSTORM. 41

SIMULATION.. 46

Therapeutic training

According to WHO, 80% of diseases are chronic. With most of them, therapeutic measures have been developed (proven and justified) that allow slowing down the progression of the pathology and preventing its exacerbation. However, less than 50% of patients correctly carry out the prescribed treatment. It was found that patients do not have the necessary knowledge for the daily "management" of their disease and do not realize their responsibility for this. And modern methods of treatment today require understanding, because they are quite complex and sometimes dangerous.

Therapeutic education is designed to develop in patients the skills of self-management of their specific chronic disease and differs from previous forms of medical education of patients in its focus on becoming an active participant in the treatment process and inclusion in the standards of care. Therapeutic education in Health Schools for patients with various pathologies is reflected in the order of the Ministry of Health of the Russian Federation dated July 16, 2001 No. 269 “On the introduction of the industry standard “Complex and comprehensive medical services”.

Therapeutic education of patients is an integral part of the arsenal of therapy for many chronic diseases: arterial hypertension, diabetes mellitus, obesity, etc.
The results of treatment directly depend on the behavior of the patient: he must follow the instructions of the doctor, have the necessary knowledge and skills to make independent decisions of a medical nature, and be motivated. And this, in turn, requires special training of patients with the participation of medical professionals.

Therapeutic training of patients is considered as a continuous process integrated into the medical care system, including education, psychological support, cooperation between the patient and the medical worker in matters of optimal management of the patient's life and disease.( WHO working group report, 1998). The Report of the WHO working group names the diseases and conditions for which they should be used. These are diabetes mellitus, arterial hypertension, and coronary heart disease, obesity, and decreased vision and blindness, kidney failure, dialysis, organ transplants, conditions after limb amputations, osteoporosis, depression.

Fundamentals of Therapeutic Patient Education (TEP) :

The patient must learn the skills to optimally manage their life with the disease;
learning is a continuous process that must be integrated into the health care system;
TEP includes information, "self-help" education and psychological support related to the disease and prescribed treatment;
TOP helps patients and their families achieve better interactions with healthcare professionals and a better quality of life.

The role of the patient

The role of the patient in the treatment of a chronic disease cannot be limited to passive obedience to medical prescriptions. He must be an active, responsible participant in the therapeutic process. Among the psychological influences on the effectiveness of learning, a factor that can be called "readiness for changes in behavior" plays a significant role. In 1983 - 86 years. I. Prochaska and C. Di Clemente substantiated the so-called "spiral model" of the process of behavior change. Its main concept is the substantiation of the staging of changes in the behavior of a person who is trying to give up certain addictions or switch to a different, healthier lifestyle. According to this model, the process of change consists of several stages:

Indifference.

The patient does not realize that his behavior is problematic, harmful to health and avoids discussing this problem, the possibilities of change.

Thinking about change.

The patient begins to think about the possible consequences of his behavior. He admits that his lifestyle is not correct, and this largely determines the standing of his health. This stage involves an active search for information and is characterized by a high preoccupation with misbehavior.

Preparing for change.

The patient begins to realize the problem, thinks about specific action plans, overcoming difficulties and obstacles. The stage ends with a decision, which is characterized by the patient's firm intention to change his behavior.

Action stage.

The patient modifies his behavior associated with the disease: changes habits, monitors control parameters, participates in the treatment process.

Maintaining behavior appropriate to the disease.

This is the final stage of the process in which self-control becomes more or less stable. The process of change comes to an end when a maximum of confidence is developed in one's ability to withstand a breakdown in treatment.

It should be borne in mind that in the process of behavior change, relapse is typical, i.e. return to the previous, "wrong" behavior, which can happen at any of the listed stages. Relapse does not mean the end of the process. Most patients who experience such an episode are re-introduced into the process of change as they a person who at least once experienced doubts and considered the need to change his lifestyle, still inevitably returns to this.

These data are directly related to the education of patients, tk. the actual behavior of patients corresponds to the listed stages, and the patient cannot enter each subsequent stage without going through all the previous ones. Sometimes the patient himself finds an incentive to change behavior. Most patients are in the contemplative or indifference stage, and education can facilitate the process of "moving" up the spiral.

Patient schools

Therapeutic patient education can be carried out in the form of so-called "Schools of Patients" (SHP).

From a formal point of view ShP is a medical preventive technology based on a combination of individual and group effects on patients and aimed at increasing their level of knowledge, awareness and practical skills in the rational treatment of a particular disease, increasing the accuracy of the patient's implementation of the prescribed treatment regimen to prevent complications of the disease, improve prognosis and improving the quality of life

Learning objectives

The objectives of training in Schools of Patients are:

ü raising patient awareness, and the goal is not to fill the vacuum of knowledge, but to progressively change the patient's ideas about the disease and its treatment, leading to a change in behavior, to the true ability to manage the treatment of the disease in active alliance with the doctor;

ü ensuring the quality and completeness of the implementation of medical recommendations;

ü increased adherence to the implementation of medical prescriptions;

ü motivating the patient to change behavior, habits, attitudes towards his disease in favor of an active approach.

ü developing self-control skills

As a result, the patient must acquire the skills to manage the course of the disease and the treatment process in active cooperation with the doctor.

One of the goals of TOP- the formation of motivation and new psychological attitudes so that they can take on most of the responsibility for the competent, independent treatment of their disease, i.e. change in their disease-related behavior.

Therefore, the focus of training programs should be strictly practical, consistent with the principle of "reasonable sufficiency".

You should not delve into the details of biochemistry, pathogenesis, medical terminology. They are affected insofar as they are directly related to treatment.

Patient education has nothing to do with mere lecturing. After all, when giving a lecture, a specialist does not receive direct information about whether students achieve learning goals, there is no feedback from patients, lectures are usually accompanied by passivity and emotional non-involvement of students. In teaching patients to ensure cognitive, emotional and behavioral activity, it is better to use interactive teaching methods (brainstorming, role modeling, training).

Duration of training.

Single, intensive, one- or two-week programs have only a limited effect. Thus, the training system should be aimed at providing long-term motivation, updating and consolidating knowledge and skills, that is, training should be a permanent component of long-term treatment.

Basic forms of education- group (groups of no more than 7 - 10 people, which is much more effective than individual training when working with adult patients) and individual (more often used for children, as well as for a newly diagnosed disease or disease in pregnant women)

Examples of sessions with patients

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TOPIC: "METABOLIC CONTROL" "COMPLICATIONS OF DIABETES MELLITUS"

1. PURPOSE OF THE LESSON: to motivate patients to conduct

self-control of carbohydrate metabolism.

2. OBJECTIVES OF THE LESSON:

2.1. Teach patients:

2.1.1. Independently determine the level of sugar in the blood and in

urine by express methods using a glucometer and visually

test strips.

2.1.2. How to record the results of self-control in a diary.

2.1.3. How to correctly evaluate the results based on the results

adequacy of insulin therapy.

2.2. Provide patients with general information about complications

diabetes mellitus and measures to prevent their occurrence.

3. LESSON PLAN:

3.1. What is carbohydrate metabolism control:

3.1.1. What is the purpose of monitoring blood sugar levels?

blood throughout the day.

3.1.2. What indicators of glycemia are considered "normal"; to which

blood sugar levels should be aimed at.

3.1.3. At what time should the sugar content in

blood to assess the adequacy of the insulin regimen and dose

insulin.

3.1.4. The value of determining sugar in urine; is it possible to judge

compensation of carbohydrate metabolism according to the daily content of sugar in the urine.

3.1.5. What is a "fresh" or "half hour" urine sample; for what

determine the sugar content in a half-hour portion of urine.

3.1.6. What is acetone; when to determine the reaction of urine to

acetone; How often should the sugar content be measured?

blood, if there is a positive reaction of urine to acetone.

3.1.7. What is "glycated" hemoglobin; what are his indicators

3.2. Acquaintance with the "Diary of a diabetic".

3.3. "Good" metabolic control is the most effective measure

to prevent diabetic complications.

3.4. Solution of situational problems on the topic: "EXCHANGE CONTROL

SUBSTANCES".

4. REQUIRED MATERIAL FOR THE LESSON:

1. Orange methodical cards on the topic "Control

metabolism" - 25 pcs.

2. Board, chalk.

3. Visual aids:

- "Blood sugar measurement".

4. Devices-glucometers and test strips for monitoring blood sugar.

5. Lancets for taking blood for analysis.

6. Clock with a second hand.

7. Diary of a diabetic for the registration of tests.

8. Test strips to determine the reaction of urine to sugar content

and the presence of acetone.

9. Situational tasks on the topic "Metabolism control" - 8 pcs.

COMPLICATIONS OF DIABETES MELLITUS 2.0:

1. Methodological yellow cards on the topic "Complications" - 15

2. Visual aids:

- "Foot care in diabetes";

- Control examinations in diabetes mellitus.

3. Tuning fork.

5. AT THE END OF LESSONS, THE PATIENT SHOULD KNOW:

At what time should blood sugar be measured in order to

correctly assess the adequacy of the regimen of insulin therapy and the dose of insulin;

When it is necessary to determine the reaction of urine to acetone;

How often do you need to monitor glycated hemoglobin;

Causes of complications in diabetes mellitus;

Maintaining a "good" blood sugar level is the most

an effective measure to prevent diabetic complications.

6. AT THE END OF LESSONS, THE PATIENT SHOULD BE ABLE TO:

It is technically correct to take blood from a finger for

determining the content of sugar in the blood;

Self-determine with a glucometer and visual

Self-determine content using test strips

sugar in the urine;

Keep a diabetic diary;

Evaluate the results of analyzes during the day from the point

view of the adequacy of the regimen of insulin therapy and the dose of insulin;

Evaluate glycated hemoglobin;

- take care of your feet.

REPEAT the material of the lesson "WHAT IS DIABETES?" for the following

main questions:

1) What blood sugar levels are considered normal?

diabetic?

3) What will happen to a patient with IDDM if he does not

insulin injections?

4) What is acetone and when does acetone appear in urine?

ASK: Why should a diabetic's blood sugar levels

be well regulated?

LISTEN to patients' responses.

FIX wrong answers.

ADDITION:

1. A good metabolic state helps to avoid

occurrence of diabetic complications.

2. With a "bad" state of metabolism in a diabetic, more often

infectious diseases occur and become more severe.

UNDERLINE: “feeling good” does not always mean

"good" diabetes control!

WRITE on the board:

"INDICATORS OF BLOOD SUGAR DURING THE DAY IN A DIABETIC"

80 - 140 mg /% (4.4 mmol - 7.7 mmol) - this should be strived for;

80 - 180 mg /% (4.4 mmol - 9.9 mmol) - this is the range

which you can reach around 140 mg/% (7.7 mmol) - great if

You have achieved these milestones.

ADDITION: blood sugar readings to be

to avoid is 200 mg/% (11 mmol) and above. If such indicators

are recorded more often than normal, the threat of

diabetic complications are significantly increased.

ASK: do you feel the sugar content in

LISTEN to patients' responses.

DEMONSTRATE the visual aid "Blood Sugar".

SPECIFY: You may feel a change in your condition

only when the blood sugar level is either too high or

too low, i.e. in extreme cases. However, you won't notice

no change in how you feel if your blood sugar is

200 mg/% or 280 mg/%. If you don't "react" to leveling up

sugar in your blood, you may develop a serious emergency

"ketoacidosis"!

UNDERLINE: remember that maintaining normal or close to

normal blood sugar is the most reliable measure of

prevention of diabetic complications! That's why

it is so important to constantly measure the level of sugar in the blood!

ASK: how do you measure blood sugar when

help of "visual" test strips?

LISTEN to patients' responses.

EXPLAIN: based on the visual aid "Measuring the content

blood sugar levels as follows:

1. Prepare the necessary materials, including suitable

Light source.

2. Inject with a lancet into the lateral surface of the terminal phalanx 4

or 3 fingers.

3. Squeeze a large drop of blood onto the test strip.

4. Immediately look at the clock and note this time.

5. After 60 seconds, blot the drop of blood on the test strip well.

6. After another 60 seconds, compare the color of the test strip with the color

scale (compare between two nearby shades).

ASK: at what time should blood sugar be measured during

LISTEN to patients' responses.

WRITE on the board:

In the morning on an empty stomach;

In the afternoon before dinner;

Evening before dinner;

At night before bed.

DISCUSS:

1. What do you evaluate in this way?

2. How important are these measurements?

UNDERLINE: there is a rule: "THE SUGAR FIRST SHOULD BE CHECKED

BLOOD, THEN INJECT INSULIN, AND THEN EAT.

You solve the problem: how much short-type insulin should be injected

Actions - You need to know your blood sugar!

ADDITION: if you register normal content indicators

blood sugar - it means that the dose of insulin administered earlier was

"sufficient" for the absorption of sugar by cells.

ASK: What do you prick your finger with to get a drop of blood?

DISCUSS the different types of finger prick lancets.

ASK: where do you inject to get a drop of blood for

UNDERLINE: not at the tip of the finger, but at the lateral surface 3 or 4

finger. You can make an injection in the tip of the ear. Do not under any circumstances

kick in the toes!

ASK: is pre-disinfection required?

ANSWER: not required. But you need to wash your hands first.

ASK: How many times can the same lancet be used?

ANSWER: 1 time.

ASK: Are you already familiar with blood sugar test strips?

DISCUSS what is written on the test strip vial?

Color scale;

Best before date;

Test control program number.

DISCUSS visual material (various test strips).

UNDERLINE: In most cases, blood sugar measurements

are carried out 3-4 times a day before meals and at bedtime.

It is important that you record your performance in a special diary. it

will help you to correctly "orient" in various situations.

DISTRIBUTE AND DISCUSS "Diary of a diabetic".

ASK: what are the benefits of regularly measuring sugar

blood and entering them in a diary?

REPLY:

1. Help yourself.

2. Help the attending physician.

DEMONSTRATE with one of the patients how

PRACTICAL SKILLS: all patients self-measure sugar

ENTRY of the received results of control in diaries.

UNDERLINE: From now on, you will always be in parallel

with the measurement of blood sugar with a glucometer, which

will be conducted by the teacher, independently control the level

blood sugar by changing the color of the test strips (on the "eye"). We will

compare the findings and discuss. Small differences are not

are of particular importance. Most importantly, the sugar content in

Your blood has always been within normal limits!

DISCUSS blood glucose meters. If you

learned to visually "read" blood sugar indicators and you do not have

discrepancies with the results of the analysis on the device, then your diagnosis

accurate enough. Glucometers versus visual analysis,

of course, give greater measurement accuracy. But at the same time, it is impossible

eliminate technical interference. You need to rely on

own measurements!

ASK: what other methods of self-monitoring do you

LISTEN to patients' responses.

DISCUSS various assays to determine the sugar content in

ASK: for what purpose do you examine the sugar content in

"accumulated" urine for the whole day? How informative is the measurement

LISTEN to patients' responses.

SPECIFY: This analysis shows "daily loss" of sugar

organism. But measuring the sugar content in urine collected over a

day, does not give you exact data on the period of time when

excretion of sugar into the urine due to a deficiency of insulin in

body, i.e. You will not be able to estimate at what time of the day you "do not

enough insulin to maintain normal blood sugar levels

REPORT: more informative measurement of sugar in the urine,

collected in a few hours, for example: from morning to lunch, from lunch to

supper. The results of this study make it possible to evaluate

"sufficiency" of the dose of "food" insulin for absorption by cells

carbohydrates received in breakfast, lunch or dinner.

ADDITION: "loss" of sugar in the urine during the night (i.e.

examination of the sugar content in the early morning urine) will indicate

You "correct" dosage of "evening" long-term insulin

actions.

ASK: what portion of urine should be tested for the content

sugar to get an idea of ​​your blood sugar levels

a certain point in time?

SPECIFY "fresh" (half-hourly) portion of urine!

ASK: What does the term "fresh" urine mean?

EXPLAIN: this is the portion of urine "entered" into the bladder for

a short period of time for 15 - 30 minutes. For this

research is needed:

1. "Free" the bladder.

2. After 15` - 30` again collect urine and examine it for

REPORT how to correctly assess the results of the study

"fresh" portion of urine:

If in the "fresh" portion of urine sugar is not determined, then the level

it in the blood does not exceed the "renal" threshold, i.e. 10 mmol/l.

ASK: So when do you expect sugar to show up in your urine?

LISTEN to patients' responses.

SPECIFY when the "kidney" threshold for sugar is exceeded!

SPECIFY: In most diabetics, the "renal" threshold for

penetration of sugar into the urine is the blood sugar content of 9 - 10

EMPHASIZE that only at a "normal" renal threshold can

use this assay to "indirectly" monitor blood sugar levels

SPECIFY: You can test your "kidney"

threshold. To do this, it is necessary to repeatedly examine the level of sugar in

blood 1 - 1.5 hours after a meal (i.e. during the hours of maximum

results you will conclude "when" (at what level of sugar in

blood) you have sugar in your urine.

DISCUSS Urine Response Test Strips

it has sugar in it.

SPECIFY: must be specified:

date of manufacture;

exposure time;

Color scale.

DISTRIBUTE to all patients a pack of blood sugar test strips

DISCUSS how to assess the color change of a test strip in

according to the control color standard.

DEMONSTRATE how the color of the test strip changes according to

the presence of sugar in the liquid. For this:

Dip the test strip into a glass of water with dissolved

a piece of sugar;

Shake the strip;

Wait 2 minutes;

Check the color change on the color scale.

ASK with a test strip to measure the sugar content in

sweet water solution of any of the patients.

CHECK if the patient evaluates the result correctly.

SPECIFY: If there is no sugar in the urine or it contains up to

0.5% check the color change of the strip along the top of the color

scales. From 1% to 5% - check the result on the bottom of the color

ASK: when should you check your urine for

the presence of acetone?

LISTEN to patients' responses.

ADDITION: if blood sugar levels are higher than

240 mg /% (12.9 mmol) in repeated studies. Especially important

this analysis if there are clinical signs of an increase

ASK: How do you monitor urine for acetone?

LISTEN to patients' responses.

EXPLAIN:

1. Substitute the test strip under the stream of urine.

2. Shake.

3. After 1 minute, compare the color change of the scale on the strip with

control standard.

ADDITION: "negative" reaction is called - absence

color changes. "Positive" is a reaction when there is

stripe color change. (During the explanation, urine control is carried out

any of the patients.)

ASK what glycated hemoglobin values ​​mean

(HbAl and HbAlc)?

LISTEN to patients' responses.

SPECIFY: Al and Alc glycated hemoglobin levels are

indicators of long-term control of blood sugar (for the last 2 - 3

UNDERLINE: you should ask your doctor about the upper limit of normal

the research methodology used in your laboratory, because there are

different normative ranges for these indicators.

REPORT: Have you had a

"good" diabetes control if HbAl is between 8% and 9% or HbAlc

From 6% to 7%.

UNDERLINE: You must pay attention to the level

glycated hemoglobin Al was measured every 8 - 12 weeks.

OFFER patients to solve situational problems on the topic of the lesson.

DISCUSS patients' responses.

TOPIC: "MEAL PLANNING FOR TYPE 1 DIABETES"

ESSENTIAL NUTRIENTS 1.0 CHARACTERISTICS OF HYDROCARBON FOOD 2.0 MEAL PLAN 3.0 FOOD EQUIVALENT SUBSTITUTION 4.0 EATING OUTSIDE 5.0 2. OBJECTIVES OF THE LESSON: 2.1. Teach the patient how to create an individual menu that is balanced in terms of calories and biological value. 2.2. Teach the patient an equivalent replacement of carbohydrate-containing products, taking into account the quantity and quality of carbohydrates included in them (dietary or carbohydrate units), as well as the content of dietary fiber in the product. 2.3. Teach the patient to eat out. 3. LESSON PLAN: 3.1. To acquaint the patient with the characteristics of food products in terms of the content of essential nutrients in them. 3.2. Explain to the patient how to calculate the physiological energy requirement, in the main food ingredients, how to calculate the sugar value of food. 3.3. Familiarize the patient with the concept of the glycemic effect of food. 3.4. Explain to the patient what factors affect the glycemic effect of food. 3.5. Explain to the patient what dietary fibers are, their importance in the processes of digestion and metabolism. How to make a menu enriched with dietary fiber. 3.6. Explain the need to eat at a certain time. 3.7. Explain to the patient what an equivalent product substitution is, how to use the product equivalent substitution tables. 3.8. Practical work on the preparation of an individual menu for each patient. 3.9. Solving situational problems in nutrition planning. 4. MATERIAL NEEDED FOR LESSONS: BASIC NUTRIENTS 1.0 1. Methodological green cards - 6 pcs. 2. Visual aid "Energy value of nutrients". 3. Table of the content of the main nutrients in the daily diet. MEAL PLAN 2.0 1. Methodological green cards - 2 pcs. 2. A set of drawings ("plates") depicting HC-containing products for 1 - 2 HC units. CHARACTERISTICS OF HYDROCARBON-CONTAINING FOOD PRODUCTS 3.0 1. Methodological green cards - 10 pcs. 2. Table of equivalent replacement of carbohydrate-containing products. 3. A set of drawings ("plates") depicting HC-containing products for 1 - 2 HC units. EQUIVALENT REPLACEMENT OF PRODUCTS 4.0 1. Methodological cards of green color - 12 pcs. 2. Table of equivalent replacement of products by bread or carbohydrate units. 3. A set of drawings ("plates") depicting HC-containing products for 1 - 2 HC units. 4. Visual aid "Sugar substitutes". EATING OUTSIDE THE HOME 5.0 1. Methodological green cards - 5 pcs. 2. Table of equivalent replacement of products by carbohydrate or bread units. 3. A set of drawings ("plates") depicting HC-containing products for 1 - 2 HC units. 4. Situational tasks - 18 pcs. 5. AT THE END OF THE LESSON, THE PATIENT SHOULD KNOW: - the importance of diet in the treatment of diabetes mellitus; - what are proteins, fats and carbohydrates and what products can be attributed mainly to protein, fat or carbohydrate; - how to determine the daily amount of calories needed by the patient, depending on age, physical development and physical activity; - how to distribute meals throughout the day; - what is the sugar value of food, "bread unit", "carbohydrate unit"; - what foods can be consumed in excess of the calculated calories; - the importance of dietary fiber in nutrition. 6. AT THE END OF THE LESSON, THE PATIENT SHOULD BE ABLE TO: - use special tables to make a nutrition plan for the day and for each meal; - replace one dish with another, taking into account the content of proteins, fats and carbohydrates in it (according to "bread" and "carbohydrate" units), as well as taking into account the content of dietary fiber in the product; - make "your" menu when eating out. BASIC NUTRIENTS 1.1 REPORT: All food products are divided into 3 large groups depending on the predominant content of essential nutrients in them: 1. Carbohydrate-containing, for example: SUGAR, BREAD, CEREALS, FRUITS, POTATOES. 2. PROTEIN containing, for example: FISH, MEAT, EGG. 3. Fat-containing, for example: CREAM AND VEGETABLE OIL, LAD. INVITE patients to give examples of carbohydrate, protein, or fat foods. OFFER patients drawings - "plates" depicting various food products. ASK to categorize the proposed foods as rich in fats, proteins or carbohydrates. SPECT: A person with diabetes can eat the same amount of carbohydrates, protein, and fat as they did before the disease. At the same time, "sweet" carbohydrate-containing foods are excluded and insulin is administered in accordance with the diet! ASK: Which foods have the greatest effect on blood sugar? LISTEN to patients' responses. ADDITION: CARBOHYDRATES mainly affect the increase in blood sugar. However, the SUGAR VALUE of food also depends on the content of PROTEINS in it. To calculate the sugar value of a product, you need to "add" the carbohydrates and 50% of the protein that make up this product. REPORT: In order to determine the amount of essential nutrients in your meal plan, you must first calculate the so-called. ENERGY VALUE of your diet. When calculating the daily calorie intake of a diabetic, the physiological energy costs of the body should be taken into account, allowing you to maintain a normal level of physical and mental performance; for women and men who are not engaged in heavy physical work, respectively, 1800 - 2500 calories (30 - 35 kcal per 1 kg of body weight). Thus, already at the very beginning of nutrition planning, the individual needs of your body are taken into account. INDICATE: the amount of carbohydrates, as the main energy material, should "cover" 50% of the daily calorie intake, the amount of proteins and fats, respectively, 20% and 30%. ASK, how much energy (calories) do fats, proteins and carbohydrates "give" to the body? REPORT: 1 gram of protein - 4 calories; 1 gram of fat - 9 calories; 1 gram of carbohydrates - 4 calories. DEMONSTRATE the visual aid "Energy value of the main nutrients". ASK patients to calculate their daily calorie intake based on work profile and body weight. ADDITION: if the patient was overweight before diabetes, then the daily calorie calculation is based on the "ideal" weight. At the same time, it is necessary to limit fats and carbohydrates in the diet and include various vegetables in the diet more widely (link to the table "Energy?..."). REPORT: if you have normal blood fat levels with a good metabolism, then you can not limit the fat diet, but give preference to vegetable oils. MEAL PLAN 2.1 REPORT: A diabetic's diet includes 3 main meals (breakfast, lunch and dinner) and 3 additional snacks (2nd breakfast, afternoon snack and "late" dinner). The main meals account for approximately 25% (lunch - 30%) of the daily calorie intake, and additional - 10 - 5% each. ASK patients to calculate the calories, essential nutrients, and sugar value of each of "their" meals (breakfast, lunch, dinner, and snacks). ASK patients to create menus for individual meals (breakfast, lunch, dinner, and "snacks"). DISCUSS patient-composed "breakfasts", "lunches", "dinners" and "snacks". ASK patients to change their meal plan according to their own eating habits. CHARACTERISTICS OF HYDROCARBON-CONTAINING FOOD 3.1 REPORT: Carbohydrates are found in all plant foods, and in animal foods only in milk and dairy products. ADDITION: Carbohydrate foods include both regular "food" sugar and starch. However, sugar is an easily digestible (simple) carbohydrate and therefore, after its consumption, the level of sugar in the blood quickly and "highly" rises. Starch refers to "difficult" digestible carbohydrates (complex) - therefore, the blood sugar content after its use rises slowly. ASK patients to give examples of carbohydrate-containing foods that affect blood sugar in different ways. LISTEN to patients' responses. UNDERLINE: when compiling a menu, you need to learn how to interchange carbohydrate-containing foods, taking into account both the content and the type of carbohydrates! REPORT: It is important for a diabetic to distinguish between 2 groups of carbohydrate-containing foods: 1. Which can be ignored when planning meals. 2. Which must be taken into account. ASK: what carbohydrate-containing foods can you ignore? LISTEN to patients' responses. ADDITION: all types of vegetables (except potatoes and sugar beets) you can use in the usual amount and do not count. ASK: which of you eats vegetable dishes willingly? LISTEN to the answers

Please send your questions related to pain relief and palliative care to our specialists through the form ? ASK A QUESTION located in the right sidebar.

What is pain

One of the symptoms of many diseases is pain. Our knowledge and experience allow us to cope with it. But without your help, our efforts would be ineffective, so in this article we want to inform you about pain and methods of dealing with it.

There are two types of pain: acute and chronic.

Acute pain comes on suddenly. Its duration is usually limited.

Chronic pain continues for a long time. A person who has been in pain for a long time behaves differently than one for whom pain is a new sensation. People who have been in pain for a long time may not moan, may not show motor anxiety, their pulse and breathing rates may be normal, but the restrained behavior of the patient does not mean that he does not experience pain.

Pathways of distribution and manifestation of pain are complex. Many components are involved in the formation of the sensation of pain. Feeling pain, expecting its intensification, a person experiences not only unpleasant physical sensations, but also suffers mentally. Suffering is a mental reaction to pain or a psychological component of pain, and this component can often prevail over the true (physical) pain. When a person experiences chronic pain, he is constantly forced to limit himself in some way. Some habitual actions become difficult or inaccessible to him.

It is not always possible to get rid of severe pain completely, but you can learn to reduce it to a tolerable level.

When regulating pain, one should strive to bring it within reasonable limits and avoid emergency situations when it becomes unbearable.

Indeed, many diseases at different stages are accompanied by pain. But pain is not a necessary companion of the disease. Many people do not experience pain. Remember this!

In most cases, the cause of chronic pain in patients is volumetric formations that change the structure and function of the organs and tissues involved in the painful process.

But pain can also be caused by other causes. For example, abdominal discomfort may be the result of prolonged stool retention, exacerbation of chronic gastritis or gastric ulcer; joint pain caused by chronic arthritis; pain behind the sternum - to be a manifestation of heart disease, etc. In other words, the patient "has the right" to exacerbate his chronic and "acquire" new diseases, one of the symptoms of which may be pain.

Pain is often the result of previous radiation therapy or surgery. This is due to the traumatization of nerve fibers, their involvement in the inflammatory or cicatricial process, with pressure in the development of lymphostasis of the limb, etc.

It follows from the above that patients can have several types of pain with different localization, and our specialists strive to identify the cause of each and take the necessary measures.

Treatment of chronic pain

The treatment of chronic pain will always be successful if you follow a few mandatory rules:

If a doctor prescribes painkillers for chronic pain, then they should be used according to the recommended scheme, under the supervision of hospice specialists.

Chronic pain requires regular, “hourly” use of analgesics. Taking drugs should "outstrip" the increase in pain.

The dose of anesthetic medication and the intervals between doses are selected in such a way as to maintain a stable concentration of it in the blood and avoid increasing pain during these intervals.

Night pain relief is a top priority, because a badly spent night inevitably entails a “bad” day. During the 7-8-hour sleep at night, one should strive to maintain the concentration of the analgesic in the patient's blood, sufficient to block pain receptors. If necessary, this is achieved by taking a slightly larger dose of pain medication just before bedtime and/or by combining it with a drug that has a calming effect, which will increase and prolong the effect of the analgesic. If necessary, you can take an emergency dose of pain medication at night.

If there is pain, and the time for the next dose of the drug has not yet come, you must urgently take an extraordinary dose of painkiller, and at the right time, take the medicine according to the scheme and then stick to it. With the repetition of cases of "breakthrough" of pain, the anesthesia scheme is adjusted by the doctor.

It is not necessary to wake the patient if it is time to take pain medication, and he is sleeping. The missed dose is given immediately after waking up; the diagram may change somewhat. If the patient is unconscious, then the hours of medication are not missed.

A number of drugs in the first days from the start of administration can cause an increase in general weakness, drowsiness. During the first 4-5 days from the start of taking strong narcotic drugs, hallucinations, some confusion, and nausea may develop. All these symptoms are short-term and are subject to medical correction. If the side effects do not disappear, the doctor can replace the analgesic with another from the same group, recalculating the equivalent dose.

Conclusions about the effectiveness of the anesthesia scheme are made no earlier than 1-2 days from the start of its use. To facilitate the analysis of the effectiveness of pain relief for the patient or you, it is advisable to regularly keep diary entries according to the scheme, where it is necessary to note the date and time of taking the drug, the effectiveness of the drug taken. Such records help to correct the anesthesia scheme.

Sometimes patients tell us, "Taking painkillers doesn't cure the cause of the pain, it only brings relief." This is true, but it is not the whole truth. If pain captures the entire territory of life, preventing eating and sleeping, thinking and acting, then the body loses the strength to fight the disease itself. More precisely, we can deprive him of this opportunity by neglecting anesthesia.

An adequate anesthesia scheme is achieved by using an analgesic of one or another group or a combination of drugs from different groups.

During the visits, the doctor asks the patient questions about the pain he experiences. The intensity of pain is determined by the patient himself, and not by anyone around him, because each person has his own threshold of pain sensitivity. It is very important that the patient speaks frankly about his pain. Some patients tend to underestimate the pain in the story.

You should not be afraid that a patient experiencing severe pain will become dependent on narcotic drugs used for a long time. After all, here he takes medicine for the purpose of pain relief, and not in order to cause new sensations. The opiates used are used by the body mainly in the area of ​​pain receptors, which means that the patient does not become dependent on them even with long-term use.

The need to increase the dose of drugs may arise due to increased pain with the progression of the disease. Depending on the severity of the pain syndrome, the doctor prescribes one of the three steps of the pain relief ladder developed by the World Health Organization as the main drug, supplementing it, if necessary, with drugs of the previous stage and / or co-analgesics - drugs that enhance the action of the main analgesics. It is necessary to use tablet painkillers, unless otherwise indicated by the doctor, after meals in order to minimize their irritating effect on the gastric mucosa. If your loved one is used to eating breakfast late, do not delay taking analgesics because of this. Offer him something to eat and give him medicine. The same should always be done if the appointed time for the use of painkillers does not coincide with the main meals. “Put something in your mouth before you take medicine” should be the rule, because in the treatment of chronic pain, drugs taken on an empty stomach can be counted on the fingers, and the doctor will tell you about them specifically.

We try to deliver the least discomfort to patients, therefore, drug injections are used only if oral administration is not possible due to nausea, vomiting, swallowing disorders, and through the rectum - due to exacerbation of rectal diseases or the patient's refusal from this route of administration. .

In the case of parenteral (in the form of injections) administration of analgesics, the principle of applying "by the clock" naturally remains.

In the case of rectal administration, it is necessary to carefully monitor the regularity of the stool, since the presence of feces in the rectum makes it difficult for the absorption of drugs.

Non-drug ways to relieve pain

Non-pharmacological methods of pain relief that can and should be used along with medical pain relief. These include:

massage of arms and legs, the whole body, gentle stroking over the epicenter of pain; “weak” family members and visitors who want to help, who can be entrusted with massage, can be connected to this;

cold or dry heat to the painful area, which, along with massage, helps to reduce pain impulses in the spinal cord;

maximum physical activity, provided with personal care devices and a conveniently equipped home place for interesting activities and work. It prevents the "stiffness" of the muscles that causes pain and connects the brain to activities that distract it from the analysis of pain;

communication with pets, which give us examples of serenity and bestow unconditional love;

regular exercise to relax the muscles.

Regarding the last method, I would like to say in more detail.

The reaction to almost any pain is muscle spasms - like striated muscles, the work of which we can largely regulate consciously, because. it makes up the muscles of our body, as well as smooth muscles, which is contained in the structure of all internal organs, as well as blood and lymphatic vessels.

Muscle spasms make the pain worse. All methods that promote muscle relaxation thus reduce any pain, or may even completely remove some types of pain, making it available to the body's own pain control systems. Some of the simplest relaxation techniques that can be done without the help of a therapist include progressive relaxation, breathing exercises, and the “forgiveness and release” method of pain.

In translational relaxation, you first tense certain muscle groups and then relax them. This sequence allows you to do relaxation more deeply. In Peter Lendorff's book, it is written as follows: “Sit comfortably in a quiet room in an armchair or in bed and begin to breathe slowly and deeply. Focus on your breathing, and start working on the different muscle groups in turn. Start with your hands. Clench your fists as tightly as possible, stay in this position for 10 seconds. If this proves tiring, start small and gradually build up the time. After 10 seconds, relax your hands and arms, mentally repeating the words: "RELEASE AND RELEASE". Feel the tension flowing out of your fingertips. Now turn your attention to your forearms and shoulders. Tighten their muscles as hard as possible for 10 seconds, then relax, mentally repeating: "RELAX AND RELEASE". Then go through the toes, calves, thighs, buttocks, stomach, back, chest, neck, face and forehead in this way. Just RELAX AND RELAX. Feel the tension flow out of your body and heat spread.

It is quite possible to carry out these exercises without prior muscle tension, if for some reason it is difficult.

Breathing exercises when dealing with pain are as follows. Having performed muscle relaxation as described, you begin to imagine with your eyes closed that the air you exhale can pass through the pain. After a few attempts, you easily begin to "exhale" through the pain - at the same time, it seems to begin to dissipate in space.

You can use this method as an ambulance in case of any unpleasant sensations of the soul and body, sitting comfortably, with your eyes closed, benevolently focusing your inner attention on the area of ​​unpleasant sensations and starting to "exhale" through them.

You must be sure that with a thoughtful and attentive approach, the family and the patient, who have information about the principles of chronic pain treatment and are constantly in contact with the doctor, take control of it in a matter of days and even hours with any change in the situation. You must be sure of this, as specialists working in this field of medicine know about it from their daily practice.

Everyone who has faced pain - their own or someone else's - should know three simple things:

Quality of life is possible with any diagnosis.

You can live without pain and you can die without pain.

If a person cannot be cured, this does not mean that medicine is powerless to help him.

This is an axiom that has long been known abroad. Unfortunately, in our country the words "disease" and "pain" are not just the same root, they are perceived by many as equivalent. "If you're sick, then you must be sick." That's what doctors think. This is what patients think. If you think so, please read carefully and remember your legal rights and options.

What every patient needs to know about pain management

The effectiveness and quality of pain (analgesic) therapy (therapy of pain syndromes) largely depends on its proper organization. At the same time, the choice of the necessary medicines is within the competence of the doctor, but the timeliness of contacting the doctor depends on the patient, who must understand where he should first go with complaints of pain.

In the event of (intensification) of pain, the patient must contact the clinic at the place of residence, where, simultaneously with the initial examination, excluding acute pathology (requiring immediate intervention), he is required to prescribe effective analgesic therapy. All additional stages of the examination (if necessary) should be carried out against the background of adequate therapy for pain syndromes.

The local (family) doctor is authorized to prescribe all the necessary medicinal analgesics, even those that were previously prescribed only after additional consultations with an oncologist or other specialist.
prior consultation with an oncologist is not required ( Order of the Ministry of Health of Russia dated 20.12.2012 No. 1175n“On approval of the procedure for prescribing and prescribing medicinal products, as well as the forms of prescription forms for medicinal products, the procedure for issuing these forms, their accounting and storage”).

In this way, not only the problems of timely prescription of analgesic therapy are solved, but also the problems of drug supply - the control of the availability of the necessary painkillers is entrusted to the medical institution located at the patient's place of residence.

The quality of pain therapy largely depends on the patient's compliance with several basic rules for the treatment of chronic pain:

• Medicinal analgesics should be taken by the hour, in pain prevention mode. The next dose is taken before the end of the previous dose.
• Analgesics are prescribed "in ascending order" - with the ineffectiveness of weaker drugs, stronger ones are prescribed. If the effectiveness of analgesic therapy is insufficient, the patient must inform the doctor of the polyclinic at the place of residence.
• The basis of effective pain therapy are non-invasive (non-injectable) dosage forms of analgesics (tablets, capsules, suppositories, special patches or transdermal systems). Injectable dosage forms of analgesics should be used in exceptional cases.

It should be understood that the quality of analgesic therapy largely depends on the coordination of the actions of the district (family) doctor, the patient himself and his relatives, and in cases of any problems with anesthesia, the patient can always solve these problems by contacting the administration of the medical institution at the place of residence.

Reminder for patients and their relatives on the treatment of chronic pain

Where to go if a patient with cancer has severe pain?

The treatment of chronic pain in patients suffering from both oncological disease and non-oncological diseases is carried out by a doctor at the place of his actual residence.

Patients for whom pain relief is indicated at this stage of treatment are provided with full-fledged assistance in treatment by a local therapist, neurologist, rheumatologist, oncologist or palliative care doctor at the place of residence. These doctors have the right to issue a prescription for all groups of painkillers.

It is necessary to contact the district clinic at the place of actual residence, where you should be prescribed the necessary medicines for adequate pain relief.

If you still have pain, you have problems with prescribing and prescribing painkillers, you can call the mobile palliative care service of City Clinical Hospital No. 30 of the Moskovsky district of Nizhny Novgorod by phone - 274-01-98 from 08.00 to 15.00.

How to get medicine?

1. The patient, or an authorized representative, goes to the clinic at the place of actual residence, provides the doctor with all medical documents (certificates, results of studies and treatment).
2. The health worker examines the patient (including at home) and writes out a prescription. When prescribing a narcotic analgesic for the first time, the prescription is signed by the head of the medical organization or another authorized person. When re-issuing a prescription, a second signature is not put. In all cases, the usual stamp “for recipes” is put on the recipe.
3. The patient or his authorized representative receives the drug at the pharmacy (by prescription). A patient's relative can receive a narcotic analgesic by providing a pharmacy worker with a power of attorney written in any form and certified by his signature.

With an unexpected increase in pain, anesthesia is performed by a mobile ambulance team (as part of the provision of emergency medical care in an emergency form).

The patient should always remember that pain management should be based on the principles of the World Health Organization (WHO):

Prescribing the NON-INVASIVE form of the medicinal product:(i.e. no injections - avoid injections)

BY HOURS: analgesics (painkillers) are taken by the hour, in pain relief mode

ASCENDING: analgesics are prescribed, starting with a weak to a strong analgesic

INDIVIDUALLY: taking into account the patient's individual response to the drug;

WITH ATTENTION TO DETAILS: you need to monitor the effectiveness of the analgesic and its side effects, carefully read the instructions and strictly follow all the doctor's recommendations. It is not allowed to increase the dose of narcotic analgesic on your own !!!

In order for the doctor to choose the optimal pain relief tactics, the patient (his relatives) should always be ready to provide the doctor with detailed information about the drugs taken (name, dose, frequency and duration of administration) and the effect of these drugs.

What is the patient entitled to?

Pain can be treated for any diagnosis. Pain cannot be tolerated: pain takes strength and does not make it possible to alleviate other symptoms of the disease.

The right to anesthesia is guaranteed by law. Paragraph 5 of Article 19 of Federal Law No. 323-FZ dated November 21, 2011 “On the Basics of Protecting the Health of Citizens in the Russian Federation” determines that the patient has the right to “relieve pain associated with the disease and (or) medical intervention, available methods and drugs ".

The attending physician, as well as the midwife and paramedic, if they have the authority of the attending physician, have the right to prescribe painkillers, without the consent of the medical commission (see paragraph 2 of the order of the Ministry of Health of Russia dated December 20, 2012 N 1175n (as amended on April 21, 2016)).

The doctor and patient should rate pain on a scale of 1 to 10, and the doctor should prescribe the drug according to the scale and not according to their opinion of the level of pain.

If after the appointment of pain relief and medication, the pain does not go away, then the wrong drug or the wrong amount was prescribed. Please change appointment!

The doctor is obliged to issue a repeat prescription to the patient without the requirement to return the used packages.

The patient is entitled to receive narcotic pain medication free of charge, even without a recognized disability, simply on the basis of a diagnosis. At the same time, in the absence of free drugs in the pharmacy, the patient has the right to receive a prescription for a paid drug.

Doctors of hospitals and polyclinics should note the presence of pain in the patient in the card and in the extract.

If the patient has a confirmed diagnosis and has a chronic pain syndrome, you can get pain relief from emergency doctors, including potent narcotic drugs, which all teams are equipped with.

When discharged from the hospital home, the patient is given a five-day supply of drugs or a prescription for them at the pharmacy to which the patient is attached. If the institution does not have a license to work with narcotic substances, doctors are required to report a patient with pain syndrome to the clinic at the patient's place of residence for registration. It is forbidden to discharge patients with severe pain from the hospital on the eve of weekends and long holidays, if the person is not provided with a supply of painkillers for these days.

Remember: any diagnosis involves helping the patient and his family. If the doctors cannot offer you a radical treatment, they are obliged to transfer you to a palliative care specialist!

Hospices and palliative care units should help primarily at home, not in a hospital. The patient and his relatives have the right to demand that doctors come to the patient's home when the patient needs it.

Palliative care includes not only medical support, but also psychological support. If you feel that you or your relatives find it difficult to cope with stress, seek the help of a psychologist.

If you do not receive proper support or pain relief, please call the field service of City Clinical Hospital No. 30 of the Moskovsky District of Nizhny Novgorod and the hotline of the Ministry of Health of the Nizhny Novgorod Region for help:

Outreach palliative care service City Clinical Hospital No. 30 of the Moskovsky district of Nizhny Novgorod

274-01-98

Pain relief hotline
Ministry of Health of the Nizhny Novgorod Region:
435-32-12

The introduction of schools for patients with arterial hypertension into real practice allows, within one year, to obtain significant medical and socio-economic efficiency of this new organizational and functional model of preventive activities. There is evidence that as a result of patient education and the formation of a partnership between the doctor and the patient in the treatment process, the frequency of achieving the target level of blood pressure in patients doubled (from 21% to 48%). The number of patients with obesity significantly decreased (by 5.4%), with moderate and severe hypercholesterolemia (by 39%), and the number of smokers decreased (by 52%).

Significantly reduced the number of patients abusing fats, carbohydrates and salt. The proportion of patients with hypochondriacal and depressive manifestations, with a high level of stress, has decreased. Patients' attitudes and attitudes towards health have changed significantly: patients' motivation to implement preventive recommendations has improved; the number of patients who consider the actions of medical personnel ineffective has decreased; the economic factor has ceased to be considered the main obstacle to the implementation of the doctor's recommendations for recovery.

Organization of Health Schools

in the primary health care system

An analysis of the health indicators of the population of the Chelyabinsk region revealed that chronic non-communicable diseases (cardiovascular, oncological) form the main cause of supermortality and premature mortality of the population. It is these diseases that are associated with lifestyle and risk factors (smoking, unhealthy diet, low physical activity, diabetes mellitus, arterial hypertension, stress, etc.), which have an extremely high prevalence among residents of the Chelyabinsk region.

A study of human rights to health promotion and disease prevention, conducted on a representative sample of the population of the Chelyabinsk region in 2001-2002, showed that 82.6% of respondents would like to improve their health status. Determining those responsible for their own health, 80% indicated themselves, 13% - health workers. At the same time, 85% of respondents believed that health authorities should pay more attention to disease prevention and health promotion.

Under these conditions, the role of a medical worker in the issues of teaching patients a healthy lifestyle, disease prevention (primary, secondary, tertiary) is increasing. Most chronic diseases cannot currently be cured, but it is possible to really control and prevent complications, which can significantly prolong the life of patients and improve its quality. However, it is not possible to successfully control a chronic disease, even with the maximum use of the arsenal of modern medicine, but without the active participation of the patient, is not possible.

The creation of Schools of Health in the system of primary health care can contribute to the solution of these tasks. Education at the School of Health is defined as helping patients acquire and maintain the skills they need to manage their lives as much as possible in the setting of a chronic illness, or during certain periods of life (pregnancy, feeding a newborn). This is a medical and educational process, which is a full-fledged area of ​​​​health, an integral and continuous part of patient management. Therapeutic education is patient-centered, designed to help patients and their families understand their illness/condition, treat effectively, lead a healthy lifestyle, learn to take care of themselves, and collaborate with healthcare professionals. All this ultimately leads to an improvement in the quality of life of the patient. Health schools should enhance the therapeutic effect of the traditional professional treatment of chronic diseases through patient education and contribute to:

To improve the quality and increase the life expectancy of patients;

In reducing the personal costs of patients associated with the disease;

In reducing the material costs of medical institutions and society as a whole for medical care for patients.

Curricula for Schools of Health should be based on:

On active learning and strengthening the patient's ability to plan and develop their own lifelong learning;

Based on ideas about the health, needs and problems of the patient;

On the active partnership of the health worker and the patient in health management;

On the cooperation of patients with each other.

Core learning topics are common to many chronic diseases and include: the causes of the disease; explanation of some aspects of the pathological process and associated symptoms; classification of the severity and severity of the disease, since the validity of treatment is closely related to these issues; treatment, list of drugs indicated for this patient, basic concepts of therapy, side effects of drugs; disease complications and worsening symptoms; what can happen with the progression of the disease and insufficient treatment; practical skills for monitoring the condition (measurement of blood pressure, body mass index, glucometry, peak flowmetry); recommendations for a healthy lifestyle: diet, physical activity, giving up bad habits, principles for reducing the effects of stress.

In the implementation of such programs, along with medical workers, the media, heads of enterprises, the administration of a district or city should take part.

The health school should be conducted by health professionals who have the skills to educate patients. Training in these programs should be part of the continuing education of health workers and can be included in the basic medical education of physicians, nurses and other health professionals.

The School of Health is a special form of work with the sick, and health workers conducting Schools of Health should be able to:

Adapt your professional behavior to patients and their diseases;

Empathize with patients when communicating;

Recognize the needs of patients;

Take into account the capabilities of patients, the decline in cognitive functions that exists in chronic patients;

Take into account the emotional state of patients;

Intelligibly tell patients about their disease and methods of treatment;

Help patients manage their lifestyle;

Advise patients on how to manage various factors that may interfere with the treatment process;

Evaluate the learning process in terms of therapeutic outcomes (clinical, psychological, social, economic impact);

Periodically evaluate and correct teaching methods at the School of Health.

Health professionals trained in therapeutic education programs are becoming an important resource and should be encouraged to engage in individual and group health education work in Schools of Health.

The medical worker helps the patient to understand the essence of what is happening, shows the connection between his behavior and the danger to health, the need to follow the recommendations for treatment and maintaining a healthy lifestyle to prevent complications. Knowledge is an important but not sufficient incentive to change one's behavior. For each person, the reason and motivation for change is individual, and the doctor should try to help in finding the motive. The patient himself must choose those risk factors that he must influence. Giving up bad habits right away is an overwhelming task for many. The doctor is obliged to advise the patient what problems he needs to deal with in the first place. Lifestyle change goals should be realistic, clearly defined, time-bound and measurable.

In the process of conducting the School of Health, a medical worker must:

To learn and adapt to the patient's ideas about health, chronic disease and its treatment;

Adapt the training to the level of preparedness, past experience and understanding of the patient;

Consider the patient's readiness to perceive information;

Practice active listening to the patient;

Involve him in the learning process;

Encourage personal goal setting and self-assessment;

Identify the patient's ways of coping with their illness and treatment;

Assess the skills and behavior of the patient based on the patient's personal experience;

Explain and instruct the patient about the prescribed treatment;

Educate to cope with the difficulties associated with the patient's compliance with the diet;

Identify barriers to effective long-term treatment and care;

Model and solve various problem situations;

Preside over a group discussion of treatment management issues, a group discussion;

Individually conduct supportive conversations with the patient;

Assess the extent to which the patient understands the explanations and instructions for the prescribed treatment.

The role of the patient in the treatment of a chronic disease cannot be limited to passive obedience to medical prescriptions. He must be an active, responsible participant in the therapeutic process.

Among the psychological influences on the effectiveness of training, a factor that can be called "readiness for changes in behavior" plays a significant role. In 1983 - 86 years. I. Prochaska and C. Di Clemente substantiated the so-called "spiral model" of the process of behavior change. Its main concept is the substantiation of the staging of changes in the behavior of a person who is trying to give up certain addictions or switch to a different, healthier lifestyle. According to this model, the process of change consists of several stages:

1. Indifference.

The patient does not realize that his behavior is problematic, harmful to health and avoids discussing this problem, the possibilities of change.

2. Consider change.

The patient begins to think about the possible consequences of his behavior. He admits that his lifestyle is not correct, and this largely determines the state of his health. This stage involves an active search for information and is characterized by a high preoccupation with misbehavior.

3. Prepare for change.

The patient begins to realize the problem, thinks about specific action plans, overcoming difficulties and obstacles. The stage ends with a decision, which is characterized by the patient's firm intention to change his behavior.

4. Stage of action.

The patient modifies his behavior associated with the disease: changes habits, monitors control parameters, participates in the treatment process.

5. Maintaining behavior adequate to the disease.

This is the final stage of the process in which self-control becomes more or less stable. The process of change comes to an end when a maximum of confidence is developed in one's ability to withstand a breakdown in treatment.

It should be borne in mind that in the process of behavior change, relapse is typical, i.e. return to the previous, "wrong" behavior, which can happen at any of the listed stages. Relapse does not mean the end of the process. Most patients who experience such an episode are re-introduced into the process of change as they a person who at least once experienced doubts and considered the need to change his lifestyle, still inevitably returns to this.

These data are directly related to the education of patients, tk. the actual behavior of patients corresponds to the listed stages, and the patient cannot enter each subsequent stage without going through all the previous ones. Most patients are in the contemplative or indifference stage, and education can facilitate the process of "moving" up the spiral.

Sometimes the patient himself finds an incentive to change behavior. However, if there is no such incentive, there is no need to insist. The views of the patient must be respected. If the patient flatly refuses to accept responsibility for his health, he should be given the opportunity to remain in this position. After all, the doctor is just an assistant, not a nanny.

Organization of the School of Health in a medical institution

1. Issuance of an order for a medical institution, which specifies the conditions for the organization of the School of Health, the procedure for work, the training program, the duration of training, technical equipment, and determines: the person responsible for organizing the activities of the School of Health in the institution, the doctors-lecturers responsible for training, paramedical workers.

2. Information about the School of Health should be presented in the form of an announcement at the reception of the polyclinic, if possible, covered in the media.

3. Equipment of a separate study room:

3.1. Special equipment necessary for conducting classes at the School of Health on a specific pathology: tonometers, spirometers, peak flow meters, glucometers, scales, centimeter tapes, gymnastic rugs, board, chalk, exercise therapy equipment, overhead first aid kit, TV, VCR.

3.2. Visual aids for patients: dummies, posters, booklets, memos, brochures, videos.

4. When conducting Schools of Health, unified programs (or training modules of programs) approved by the Ministry of Health and Social Development of the Russian Federation, the Ministry of Health of the Chelyabinsk Region, the educational and medical commission and the Academic Council of medical academies of higher professional and additional professional education are used.

4.2 The program of the School of Maternity was approved by the order of the Ministry of Health of the Russian Federation dated February 10, 2003 N 50 "On the improvement of obstetric and gynecological care in outpatient clinics" (Appendix 3).

5. A doctor / paramedic conducting classes at the School of Health must have a specialist certificate or a state-issued certificate of thematic improvement. For classes, you can attract specialists in dietetics, physiotherapy exercises (doctors, nursing staff).

6. Organization of classes at the School of Health:

The duration of patient education is usually 1 to 2 months;

Duration of classes 1 - 1.5 hours;

Classes can be held in hospitals around the clock and day stay, in the clinic, at the feldsher-obstetric station;

Time of the lesson: second half of the day, for the convenience of working patients, compliance with the medical and protective regimen for people who are on inpatient treatment;

Class structure:

20 - 30% - lecture material;

30 - 50% - practical training;

20 - 30% - answers to questions, discussion, discussion;

10% - individual consultation.

Learning objectives

MAIN OBJECTIVES OF EDUCATION OF PATIENTS WITH CHRONIC NON-COMMUNICABLE DISEASES

Conditions for effective implementation of patient education

arterial hypertension -

School AG - new information and motivational technologies

Essential Structural Elements for Organizing an AG School

Forms of study:

Criteria for the effectiveness of patient education in school

Important Conditions for Keeping Patient Knowledge and Skills Up to Date

Accounting and reporting documentation of the patient's schools

Health school option for patients with arterial hypertension

Lesson 1. "Arterial hypertension: how to recognize it?".

Lesson 2. "Arterial hypertension: what contributes to its development?".

Lesson 3. "Hypertension: how to correctly measure the level of blood pressure?".

Features of measuring blood pressure in the elderly

Lesson 4. "Methods for the prevention of arterial hypertension."

Lesson 5. "Hypertension: when and to whom should medications come to the rescue?"

The purpose of "ASTMA-SCHOOL"

Conditions for organizing a school of bronchial asthma

Asthma - set

OBJECTIVES OF "ASTTHA-SCHOOL"

Factors affecting the effectiveness of teaching in asthma schools

Asthma School Program

Option "Asthma School"

THE SYSTEM OF COLOR ZONES FOR A PATIENT WITH BRONCHIAL ASTHMA

Criteria for the effectiveness of training in the school of a patient with AD

School of patients with CHF

Patients with CHF, their relatives need

School of patients with CHF

School of patients with CHF

Monitoring the clinical condition of patients trained at the CHF school

Conclusion