Nursing skills for M.D.: does it make sense? First-year student`s clinical education in medical school in Russia Ufa Rasul Farshatov, M.D., Ph.D. Bashkir State Medical university The Chair of Therapy, Nursing and General Patient Care

Nurses are front-line workers Nurses see OUR patients more often - First who is able to see patient`s condition is worsen Nursing has huge impact to pt`s outcome -Pressure ulcers -Nosocomial infections -Falls in hospital -ect. Why nursing?

What do you need to be a good doctor? 4С-model: competency, communication skills, compassion, convenience (Manoj K. Jain, MD, MPH) Knowledge Skills Awareness for “do no harm” charity

The Institute of Medicine Core Principles of Health care safe effective patient-centered timely efficient effective Institute of Medicine Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press, 2001

A piece of history Nursing Tribe`s chieftain Witch-doctor Priest

Symptoms Diseases Basic human needs ? illness-oriented care Patient-centred care Balint E. The possibilities of patient-centered medicine. J R Coll Gen Pract 1969;17:

Who are our patients? Does our patients are just “a set of symptoms”?

“…the secret of the care of the patient is in caring for the patient” “The Care of the Patient” Francis W. Peabody (1927)

What is patient care? Treatment providing favorable conditions for treatment Internal medicine Surgery Obstetrics Basic science

Are you nurse still act like a robot?

Public Health Challenges Emerging Diseases (SARS, Pandemic Flu) Re-emerging Diseases (XDR-TB, Ebola) Food Safety Bioterrorism Natural Disasters Obesity Aging Population Health Disparities Global Warming

Basic science Pre-clinical science Clinical medicine Basic science Pre-clinical science Clinical medicine Old: Knowledge- based NEW! Skill-based Paradigm`s shift Introduction to clinical medicine

KEY FEATURES OF PATIENT CARE 1.Safety 2.Quality 3.Privacy 4.Respectfulness 5.Easy to access 6.Transparency 7.Infection-free We give our students an “introduction” to that topics

Patient Care 1) Helping the patient to meet their basic needs 2) Achieving hygiene of patient’s environment 3) Maintaining patient’s personal hygiene 4) Adequate nutrition 5) Observing patient’s condition 6) Performing doctor’s prescription

Healthcare system Worker Environment Patient Pt`s features: 1.Age 2.Gender 3.Stage or Severity of illness

Patient`s journey To provide favorable conditions for treatment (recovery) Curable Incurable To alleviate suffering Life- limiting Life- threatning

Patient-centered care

Teamwork

Doctor-Patient Relationship Paternalism: The doctor should act in a way that protects or advances the patient’s best interests, even if it is against the patient’s will. Patient autonomy: The doctor should help the patient to make real choice, and provide intervention under the constraints of (a) informed consent and (b) confidentiality. PATIENT AUTONOMY PATERNALISM “ The amount of paternalistic intervention justified or required, is inversely proportional to the amount of autonomy present”

Ethical models at a glance Paternalistic model Informative model Interpretive model Deliberative model Ezekiel J. Emanuel and Linda L. Emanuel. "Four Models of the Physician-Patient Relationship." JAMA 267:2221-6, “If I’ve told you once I told you 1,000 times, stop smoking!!”

Any procedure has step-by- step algorithm 1.Preparation 2.Implementation 3.Finishing

SAFETY FIRST Identification of patient Avoiding falls Avoiding drug-related harm Avoiding equipment-related harm Fire & Electrical safety Avoiding infections