Basic research. Hello student Four basic models of nursing care

A process or phenomenon that is too broad and abstract is usually replaced by a model for ease of understanding. There are various types of models:

• Political
• Economic
• Social
• Medical, etc.

If speak about medical model of a doctor, then, first of all, it is aimed at the disease. In this case, any actions of the doctor may be associated with:

• Diagnosing and identifying defects or deviations in the health of the patient;
• Treatment and elimination of found types of dysfunction, abnormalities and diseases.

Almost all the work of a doctor takes place in the same area. Even if he is engaged in scientific and teaching activities, research, etc., the main task remains the fight against the disease.

nursing models, unlike doctors, are not aimed at the disease, but at the patient! Accordingly, the nurse's attention may be given to:

• to the immediate patient;
• Relatives and relatives of the patient;
• To a healthy contingent of the population (in order to prevent diseases).

Models of nursing care make it possible to compare different concepts of behavior considered over a certain time period (models of the relationship between a nurse and a patient).

Until the 19th century, nursing patterns were limited to simple technical care of the patient, without active general intervention in the recovery process. The brilliant nurse, Florence Nightingale, radically changed this passivity.

She believed that the patient's condition can always be improved by influencing external factors (lighting, ventilation, heating, hygienic care), and since the beginning of the 20s, the masses agreed with her.

It was at that time that the model of nursing care for the patient was radically revised.

Over time, developing medicine shifted to the shoulders of the nurse many responsibilities that were previously handled only by a doctor. For example, the current model of nursing care includes:

• Pressure measurement;
• Temperature measurement;
• Performing a number of medical manipulation procedures, etc.

We should also not forget about the role of the nurse in the rehabilitation of the patient and in the prevention of morbidity. Models of nursing, similar in general, have significant differences depending on the place of work of the nurse, on the procedures and appointments she performs.

• Patient definition
• Designation of the role of a nurse
• Determining the boundaries of intervention
• Limiting nursing interventions
• Analysis of expected and obtained results

Four main models of nursing care

1. Evolutionary-adaptive model

The patient is seen as a person and an individual.

Source of problems: changes in the patient's life associated with past or future events, especially during periods of crisis.

Main tasks: the nurse acts as a mentor-coordinator, providing assistance to the patient during critical periods of life, when there is a threat to human health.

Focus of intervention: assistance to the patient during the period of adaptation to the changed environmental conditions; help in overcoming the crisis period of life.

Methods of intervention: various methods of stimulating the patient.

Expected results: adaptation of the patient's health to crisis changes.

2. The patient as a behavioral system

Source of problems: emotional and functional stress.

Main tasks: the nurse acts as a controller and regulator, ensuring the balance of the emotional and functional state of the patient.

Focus of intervention: mechanisms of regulation and control that ensure the stability of the patient.

Methods of intervention: prevention, protection, relaxation of a patient prone to unstable disorders.

Expected results: an adequate response of the patient to the stressful conditions experienced.

3. Adaptation model

The patient is seen as a person who is constantly adapting to the conditions of the external environment.

Source of problems: lack of activity on the part of the patient, showing passivity to the disease.

Main tasks: the nurse acts as a teacher-organizer who must teach the patient how to adapt to changing environmental conditions.

Focus of intervention: stimulation of the patient to learn to adapt to environmental conditions.

Methods of intervention: the use of stimulation of the patient.

Expected results: complete adaptation of the patient due to the stimulation to adaptation.

4. Self-care deficit model

The patient is seen as having problems with self-care.

Source of problems: the inability of the patient to provide competent and full-fledged self-service.

Main tasks: the nurse acts as a controller and teacher, who is obliged to teach the patient the methods of self-care.

Focus of intervention: dysfunction of self-care in a sick person.

Methods of intervention: assistance and assistance in self-service.

Expected result: stabilization of the patient's ability to self-care and self-care.

It is certainly good that modern nursing no longer refers to outdated patterns of behavior, but forms new, more relevant forms of interaction and assistance to the sick and injured, based on the conditions of today's healthcare system and other real factors.

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SOCIO-PROFESSIONAL COMPETENCE AND MOTIVATION OF NURSING ACTIVITY OF AVERAGE MEDICAL PERSONNEL

Graduate work

Specialty - Nursing

Introduction .............. Chapter 1 Literature Review 1.1 The concept of "motive" and "motivation" in psychology .............................. 1.2 The influence of the motivation of specialists on the effectiveness of their professional activities.................................. 1.3 Features of the motivation of nursing staff ... Chapter 2 Object and methods of research .......... Chapter 3. Results of own research 3.1 Socio-professional characteristics of the nursing staff of the Central Medical and Sanitary Unit No. 1 of the Federal Medical and Biological Agency of Russia in Baikonur.......... 3.2 Motivation of the professional activity of nursing staff .......................................... 3.3 Socio-professional competence ............................... Conclusion........................ Bibliography........................ Application................

INTRODUCTION

An important link in the healthcare system is the category of paramedical workers, the qualifications of which determine the success of the medical institution.

Since the success of the institution's activities is closely related to the skills of personnel management, the principles of the relationship between the leader and subordinates are currently changing dramatically.

Human resource management includes many components. Among them: personnel policy, relationships in the team, socio-psychological aspects of management. The key place is occupied by the definition of ways to increase labor productivity, ways of increasing creative initiative, as well as stimulating and motivating employees.

No management system will function effectively if an effective model of motivation is not developed, since motivation encourages a particular individual and the team as a whole to achieve personal and collective goals.

Leaders have always been aware that motivational aspects are becoming increasingly important in modern management. Motivation of personnel is the main means of ensuring the optimal use of resources, mobilization of existing human resources.

The main goal of the motivation process is to get the maximum return from the use of available labor resources, which allows to increase the overall performance of the medical institution.

A feature of nursing staff management is the growing role of the personality of a medical worker. Accordingly, in the healthcare system, there is a qualitatively different ratio of motives and needs, on which the motivation system can rely. Today, both financial and non-financial methods of remuneration are used to motivate employees of healthcare institutions. Meanwhile, neither the theory of management nor the practice of personnel management gives a definite picture of the relationship between individual aspects of the motivational sphere of medical personnel today and the most effective methods of managing them.

Purpose of the study- to identify the relationship between the characteristics of the motivational sphere of nurses and the results of their professional activities

Research objectives:

1. Give a comprehensive socio-professional description of the nursing staff of the Central Medical and Sanitary Unit No. 1 of the Federal Medical and Biological Agency of Russia in Baikonur (TsMSCh No. 1 of the FMBA of Russia);

2. To study the motivational aspects of the professional activity of the Central Medical School of Medicine No. 1 of the FMBA of Russia.

CHAPTER 1 LITERATURE REVIEW

1.1 THE CONCEPT OF "MOTIVE" and " MOTIVATION" IN PSYCHOLOGY

There are two functionally interconnected sides in human behavior: incentive and regulatory. Motivation provides the activation and direction of behavior, and regulation is responsible for how it develops from beginning to end in a particular situation. Among all the concepts that are used in psychology to describe and explain the motivating moments in human behavior, the most general and basic are the concepts of "motivation" and "motive".

Motive (from lat. moveo - I move) is a material or ideal object that induces and directs an activity or act and for which they are carried out. The development of the motive occurs through a change and expansion of the range of activities that transform the objective reality. In man, the source of motive development is the process of social production of material and spiritual values. Such potential motives in ontogeny are the objective values, interests and ideals inherent in a given society, which, if internalized by a person, can acquire motivating force and become really effective motives.

A motive is something that is inside a person and makes a person move, realize his potential.

Motivation - impulses that cause the activity of the organism and determine its direction. If we study the question of what the activity of the organism is aimed at, for the sake of which the choice of these particular acts of behavior, and not others, is made, we study, first of all, the manifestations of motives as the reasons that determine the choice of the direction of behavior. Until now, the category "motivation" by various psychological schools in modern psychology is used in a double sense: as denoting a system of factors that determine behavior (needs, motives, goals, intentions, aspirations, etc.) and as a characteristic of a process that stimulates and supports behavioral activity. at a certain level. VK Vilyunas defined motivation as a set of psychological causes that explain human behavior, its beginning, direction and activity.

In his studies of behavior, A.N. Leontiev came to the conclusion that it can be explained by both internal and external causes. In the first case, these are motives that characterize the needs, intentions from the current situation. All psychological factors that, as it were, from within, from a person determine his behavior, are called personal dispositions. Based on this, dispositional and situational motivation is distinguished as an analogue of the internal and external determination of behavior. “Dispositional and situational motivation are not independent. Dispositions can be actualized under the influence of a certain situation, and, on the contrary, the activation of certain dispositions (motives, needs) leads to a change in the situation, its perception by the subject, whose attention becomes selective, and the subject himself perceives and evaluates the situation biased, based on actual interests and needs. Almost any human action is doubly determined: dispositionally and situationally.

One of the most famous models of motivation belongs to A. Maslow, who proposed to consider the main motivation of a person as a hierarchy of five levels: 1) physiological needs - the need for oxygen, water, food, physical health and comfort; 2) the need for safety and security - the need for protection from danger, attack, threat; 3) the need to belong to a social group - the need for good and loving relationships with other people; 4) the need for respect and recognition - the need to feel valued by others and by oneself; 5) the need for self-actualization - the need to develop and realize one's full potential. Orientation towards oneself reflects not only the two lower levels of the pyramid, but also its highest level, its top - the desire for self-actualization. A. Maslow identifies special groups of cognitive and aesthetic needs. Cognitive needs (in cognition and understanding), its representation serve to satisfy basic needs, and a clear differentiation of aesthetic needs is not yet possible. In accordance with the concept of A. Maslow, a person must first satisfy the needs of a lower level so that he can begin to satisfy the needs of higher levels. But a person is driven by the higher needs: “A healthy person is motivated mainly by the need to develop and actualize his potential and abilities to the fullest extent. If a person actively manifests other basic needs, and even in a chronic form, then he is simply an unhealthy person. He must be ill, as if he had developed an acute deficiency of salts or minerals. “However, the rule of successive transition from the lower levels of the hierarchy to the higher ones has not received empirical confirmation. As a result of the research, questions arose: 1) whether the satisfaction of needs really ceases to be active; 2) whether the satisfaction of the needs of one level activates the needs of the next level; 3) can't people be motivated simultaneously by the needs of several levels, for example, social needs, the needs of self-esteem and self-actualization? A. Maslow himself later answered the third question: “Practically any behavioral act is determined by a variety of determinants or a variety of motives. If we talk about motivational determinants, then behavior, as a rule, is determined not by one single need, but by a combination of several or all basic needs.”

A.L. Sventsitsky writes: “Our idea of ​​the hierarchy of needs will be more realistic if we introduce the concept of a measure of needs satisfaction and say that lower needs are always satisfied to a greater extent than higher ones. For an average citizen, physiological needs are satisfied, for example, by 85%, the need for security is satisfied by 70%, the need for love is satisfied by 50%, the need for self-esteem is 40%, and the need for self-actualization is 10%. The term "measure of meeting the need" allows us to better understand the thesis of the actualization of a higher need after the satisfaction of a lower one. The process of actualizing needs is not sudden, not explosive; rather, one should speak of a gradual actualization of higher needs, of a slow awakening and activation. For example, if need "A" is satisfied only by 10%, then need "B" may not be detected at all. If need "A" is satisfied by 25%, then need "B" is "awakened" by 5%, and when need "A" receives 75% satisfaction, then need "B" can reveal itself to all 50%, etc. e. "Attempts to experimentally confirm A. Maslow's concept did not lead to a definite answer. A. Maslow's approach is very common and influential among personnel managers.

As A.N. Leontiev pointed out, in modern psychology the scope of the concept of “motive” remains unclear: “... in a motley list of motives one can find such as life goals and ideals, but also such as irritation with an electric current.” In this regard, two categories of phenomena are distinguished: the actual motives of the individual and the entire set of “dynamic forces” or “psychological moments” that, along with motives, determine the holistic behavior of a person. In the second of these cases, the motive is understood as a formal term that does not have its own meaning and serves to designate completely heterogeneous phenomena that in one way or another stimulate and direct human activity. This trend can be traced in the works of such domestic psychologists as V. G. Aseeva, L. I. Bozhovich, V. I. Kovalev, A. N. Leontiev, and others. .M. Teplov indicate that needs are the initial motives of human behavior, but far from the only ones: “Feelings, interests and inclinations play a very important role in motivating our actions, and, most importantly, our worldview, our views and beliefs, our ideals to which we subordinate our behavior. According to P.M. Yakobson, motives can be political, moral ideals, ideas about the future, about the future; sufficiently effective interests to receive impressions; desire to organize life and life, attraction to work, creative activity, family life, etc.; strong need for something a strong enough feeling; effective moral convictions; habits; imitation.

VG Aseev calls needs, drives, goals, interests as the main forms of motivation. An essentially similar view is formulated in the works of B.F. Lomov, where the motive is interpreted as a reflection of a need, and desire, a sense of duty, interest, incentive, etc. - as possible forms of a reflection of a need.

The broad interpretation of the concept of "motive" is especially characteristic of Western psychology. G. V. Allport, based on the idea put forward in 1918 by R. S. Woodworth about the transformation of the mechanism of behavior into its motivation, formulated the idea of ​​functional autonomy of motives. Opposing the reduction of various motives of a mature personality to several, sometimes even to one or two, primary instincts, desires or needs, G.V. Allport wrote: “Neither four desires, nor eighteen inclinations, nor any of their combinations, or even all of them together taken, with all possible additions and variations, cannot adequately explain the infinite variety of goals pursued by the infinite multitude of mortals. Based on the analysis of life observations, as well as on experimental and clinical data, G.V. Allport came to the conclusion that any action, initially subordinated to some specific goal and serving only as a mechanism for achieving it, can turn into a motive that has an independent motivating force. . The main condition for such a transformation, or transformation, of motives is the imperfection of the action that served as a means to achieve the original goal. The motives are "talent in the stage of improvement and skill in the stage of formation." Motives, according to G.V. Allport, are always a kind of striving for completion, they are not discharged tension, which should “lock in” on current activity. As an experimental confirmation of his theory, G.V. Allport cites, in particular, the effect of B.V. Zeigarnik, established in 1927 in a series of studies by K. Levin. In the studies of the school of K. Levin, the concept of "motive" was not specifically included in the system of basic concepts. The motivational sphere of personality was described by such concepts as "need", "quasi-need", "intention" and "tension". As B.V. Zeigarnik points out, K. Levin understood the quasi-need to be a dynamic state (activity) that occurs in a person when an intention is carried out. K. Levin separated quasi-need from stable, in his words, “true” needs, although he emphasized that in its structure and mechanisms, quasi-need does not differ from true needs: “... the tendency to cause action is fundamental for need. This property of a need or a quasi-need can be represented in the coordinates of a "tense system" ... Correlation of "tension discharge" with "need satisfaction" (or "goal achievement"), and "tension" with "intention" or "need in a state of dissatisfaction" "allowed to draw a large number of verifiable conclusions." Formally, the dynamic approach, which appeals mainly to the energy (tense system) or vector-opological characteristics of motivated behavior, significantly narrows the scope of the conclusions obtained in the studies of K. Levin's school. According to V.G. Aseev, this area is limited by diffuse impulses of the lowest structural-genetic level.

Synonymous with the term "motive" are a variety of terms: "psychogenic need"; "quasi-need" or simply "need". J.Atkinson interprets the motive as a fairly stable personal characteristic, as a kind of “normative state”, opposed to the state of an actually acting motive, or actual motivation. In the works of H. Heckhausen, a clear distinction is made between the concepts of "potential" and "real" motivation. Potential motivation is considered as a peculiar structure of value orientations, which, as a frame of reference, determines the desirability or undesirability of this or that state for a given person. Real motivation is, as it were, a “motivational moment”, i.e. a situational state of motivation, a state of an “awakened” motive. A similar division is carried out in the Georgian School of Psychology, such authors as A.S. Prangishvili, D.N. Uznadze, A. Mehrabyan, the concept of "motive" is considered as a transient state that prompts action and disappears after the satisfaction of the corresponding need. Set, on the contrary, is interpreted as a long, permanent state of unity of the motivating and guiding moments of activity, as a long-term readiness to activate a definitely motivated activity. The difference in the interpretation of the Georgian school from the interpretation of J. Atkinson and H. Heckhausen, no less, lies in the fact that in the theory of installation, the motive denotes a variable component of motivation, and in the interpretation of J. Atkinson - a constant component.

SL Rubinshtein interprets the motive as a conscious (conscious) motivation for a certain action, which has become the direct cause of human actions in the outside world. Motives, as well as needs, can be characterized by varying degrees of awareness. A.N.Leontiev generally considered awareness of motives to be something secondary, initially not given, requiring special inner work: “... motives are not actually recognized by the subject; when we perform certain actions, then at this moment we usually do not realize the motives that prompt them. True, it is not difficult for us to give their motivation, but the motivation does not always contain an indication of their real motive. The existence of unconscious, or unconscious, motives is an experimentally proven fact. They appear in studies of perception, attitude, thinking, artistic creation, normal and hypnotic sleep, and so on. In the psychoanalytic tradition, the unconsciousness of motives is a sign of the incompatibility of the repressed motives and impulses with the image of the social, well-controlled "I". The scale of the unconscious is unknown. The forces that move us from these depths can be anything.

Here we point out that in the theoretical foundations, when considering the issue of motives, motivation, the emphasis is on incentives, incentives, people's needs, rewards. Motivation and stimulation are two different things. A motive is something that is inside a person and makes a person move, realize his potential. An incentive is something that is outside, stimulating a person or a group of people to activate this or that activity, occurs to achieve the goal of the organization, to solve a particular problem. Needs are what we don't have. Awareness of the lack of something, causing an impulse to action. Needs are primary, elementary, they are laid at the gene level, have a physiological basis. Unfortunately, nothing can be done about them. Secondary needs arise as necessary, as a person lives and gains life experience. The remuneration is external, it is a remuneration in style: salary, various payments, paid meals, medical care, social benefits, loans, promotion. And there is an internal reward - that which the work itself gives directly. A sense of success in achieving a goal, a sense of self-worth, pleasure in the end.

Theories of motivation to work are divided into two groups: 1) content theories, 2) process theories.

The former emphasizes the study and explanation of what motivates and what are the motives for certain behavior. The latter elucidate the process that promotes the process of motivation that takes place within a person. To really be able to understand motivation as a phenomenon, both concepts are needed, as well as a personal approach to consideration.

The most common "Maslow's Theory". Abraham Maslow was the first to prioritize basic needs, put them in a certain hierarchy. Maslow's classification presents us with the following needs: - physiological (thirst, hunger, sleep, sexual), - need for security (predictability, clarity of life), - social needs (love, belonging to a certain social group), - need for respect (self-esteem, success, status), - the need for self-expression. Maslow argues that the strongest need determines behavior until it is satisfied. A satisfied need no longer determines behavior, that is, it does not act as a motivating factor.

Needs are met in a certain order. Physiological needs and the need for safety are primary needs that must be satisfied before higher-level needs can determine behavior. According to Maslow, if there are two equally strong needs, then the need of a lower level dominates.

Thus, the conditions and the situation, for their part, determine which needs will dominate. The needs associated with the respect of the individual and in this sense are individual. Therefore, in the same situation, different people may have different needs, and a change in the situation entails a change in the needs of one person. It is important that Maslow said that the levels of needs can overlap to a certain extent. A person can be driven by lower level needs, even when he has higher level needs. Work as such can provide an opportunity to meet needs. In this case, often we are talking about higher-level needs related to respect and self-expression. On the other hand, work can be a way to find opportunities to meet such needs outside of work, and then higher-level needs associated with conditions and safety factors dominate.

Another theory that still works today is called Herzberg's Two Factor Theory of Motivation. This theory was created on the basis of interview data taken in various workplaces, in various professional groups and in different countries. If Maslow proposed one hierarchy in the form of a pyramid, then Herzberg made two axes directed in different directions. He analyzed how people relate to their work. Studying the collected material, Herzberg came to the conclusion that job satisfaction and dissatisfaction are caused by various factors.

Job satisfaction is affected by:

Achievements (qualification) and recognition of success,

Work as such (interest in work and task),

A responsibility,

Career advancement,

Opportunity for professional growth.

These factors he called "motivators". The more such factors, the greater the motivation.

Job dissatisfaction is influenced by:

control method,

Organization policy and administration,

Working conditions,

interpersonal relationships in the workplace,

earnings,

Uncertainty about work stability

The impact of work on personal life.

These external factors are called "factors of the complex", or "hygienic".

Motivators that cause job satisfaction were associated with the content of the work and were caused by the internal needs of the individual in self-expression. Factors causing job dissatisfaction were associated with job deficiencies and external conditions. With these factors it is easy to associate unpleasant sensations that must be avoided.

According to Herzberg, the factors that cause job satisfaction are not opposites in the same dimension. Each of them is, as it were, in its own scale of measurements, where one operates in the range from minus to zero, and the second - from zero to plus. If contextual factors create a bad situation, then employees experience dissatisfaction, but at best these factors do not lead to great job satisfaction, but rather a neutral attitude.

Job satisfaction is caused only by motivational factors, the positive development of which can increase motivation and satisfaction from a neutral state to a “plus”.

Popular is Vroom's Expectation Theory, where motivated activity is purposeful. The goal is usually associated with the direct or indirect satisfaction of a need. The strength of the direction of activity towards achieving the goal depends on the extent to which the person feels rewarded for achieving the goal. The strength of the desire for a reward or other goal (in other words, performance motivation) depends on the value of the reward (desirability) and its achievability (the reality of receiving a reward, "the value of expectations").

What a person values ​​depends on his needs. In order for a person to be motivated for a certain activity, his achievements in this activity must be rewarded with what he values, and the reward must be associated with the achievement of the goal so that the person notices it. On the other hand, everyone knows that even persistent efforts do not always guarantee the achievement of the goal. On the basis of previously gained experience, an idea (expectation) is formed about how real the possibility of achieving the goal is. In this case, all the possibilities and obstacles that arise due to the environment and the situation of the moment are also weighed.

If expectations are high, the strength of the incentive motive increases. Previous successful experience also reinforces the expectation that an appropriate result could be obtained. Thus, success enhances motivation. If expectations are not met, obstacles to achieving the goal give rise to a feeling of futility of efforts. The greater the importance (value) of an unachieved goal for a person, the greater the feeling of futility. The next time, perhaps, the level of the goal will be slightly lowered, and if it is not realized several times, the assessment of the reality of its achievement will decrease and the motivation will decrease. Feelings of futility reduce motivation, and low motivation reduces performance input, makes it harder to achieve goals, and creates even more feelings of futility. The circle closes.

Setting realistic goals, bringing expectations closer to reality, and rewarding the achievement of the goal in a way that the employee himself values ​​can relieve the feeling of futility.

So, general motivation, in Vroom's words, depends very much on the hope of a fair reward and on the expectation that the work will succeed, succeed; from the fact that the result will be noticed and rewarded, and that this reward will bring satisfaction to the employee, will be really valuable for him.

Also, from the point of view of psychologists in our country, you need to know and apply the “Theory of Justice by D. Adams”. The theory itself says that a person, if he performs conscious actions, compares the proportion: his own reward divided by his own efforts and, as it seems to him, the reward of others, divided by, as it seems to him, the efforts of others. If this proportion is equal to each other, it is considered that the system works fairly. Yes, he gets more because, in my opinion, he works more.

If this proportion is not equal, then the system in this case is considered inefficient and not fair.

MacGregor's XY Theory is considered useful. This theory defines two polar points of view, two views on a person.

Theory X says that humans are actually lazy. The average person works as little as possible, lacks ambition, dislikes responsibility, prefers to be led. A person is by nature indifferent to the needs of the organization, the main thing for him is his own "I". He resists change, most of the time he's easy prey for the demagogue because he doesn't want to work, he's gullible, not too smart. The average person, according to Theory X, is inherently hostile to work. When working with people X, the carrot and stick method is used.

The other pole is this theory Y. A look at a person as a rather active being. People are not naturally passive - this theory says - they do not oppose the goals of the organization. If people are passive and are, they become so as a result of working in this organization. People love to work in an interesting job that gives them the opportunity to develop, take responsibility, direct their efforts towards achieving a visible, clear goal. An important task of managing people is to create such conditions in the organization and apply such methods of working with people so that they can achieve their own goals and common ones. MacGregor said that a person becomes what he is because he is treated that way, that is how he is perceived.

Ø Honesty

It is important not only never to lie, but also not to hide the shortcomings in the work, your mistakes, even if they were never asked about and there is a possibility that they will never be known.

Pirogov said that from the very beginning of his medical career, he made it a rule not to hide either his errors or his failures, and he proved this by making all his mistakes public. He believed that you need to have an inner need to share your mistakes in order to warn others from them people. This is not only about medical errors - every omission must be corrected in a timely manner.

Admitting mistakes will not diminish the respect for the health worker.

And a hidden error, even if it remains undetected, can have serious consequences both for the health of the patient and for the psychology of the medical worker himself.

Becoming a behavioral stereotype, this habit can increase the risk of problems and conflicts in professional activities.

Ø Personal maturity.

It implies the ability to take responsibility, courage and determination, the ability to overcome difficulties in work.

Ø Accuracy

This is a guarantee of good patient care, maintaining a professional image. Modesty and accuracy should be manifested in outward appearance. Excessive chic in clothes, abuse of cosmetics involuntarily causes patients to think: “Will she, so preoccupied with herself, think and take care of us?”

Ø High self-control

It is directed towards one's own activities, such as dispensing medications, performing procedures, writing prescriptions.

Ø Optimism

It is necessary for a medical worker as a basis for inspiring the patient with hope for a favorable outcome, helping him to mobilize all his strength to fight the disease.

A physician with a pessimistic worldview can project it onto the patient and thereby deprive the patient of faith in the success of treatment. Contribute to the formation of a pathological: apathetic, depressive attitude towards the disease.

Ø Observation

A high level of development, visual, auditory and tactile sensations is of great importance for determining, for example: body temperature, vein detection, etc.

It is important to note minor changes in the condition of patients, which are manifested in facial expression, body temperature, mood, appetite.

Ø Attentiveness

Polite behavior and attentive attitude to the patient are important features of professional behavior.

Overly familiar relationships or behavior bordering on rudeness can injure the patient's psyche and negatively affect the course of treatment and the course of the disease.

Ø Intelligence level

Of particular importance is the concentration of attention and working memory, which are necessary in the process of caring for patients, during manipulations, and the issuance of medicines.

Ø High emotional stability

Excessive emotional reactivity, as well as emotional dullness, can be an obstacle to the implementation of clear and quick actions in extreme conditions.

Ø Sensorimotor development

The activity of a nurse places high demands on the sensorimotor sphere: movements must be accurate, proportionate and dexterous, for example: when performing injections, dressings, and other manipulations.

Model of work of a nurse

Nursing, as a form of activity, belongs to the professions of the "man - man" group. According to the working conditions, this group is considered to be work “in conditions of increased responsibility for the life and health of people” (according to the classification of E.A. Klimov).

WHO defines 4 functions of a nurse.

1, 2 Levina V.A. 12Kuznetsova E.V. 12Lunkova O.A. 12

1 NGO HPE "Saratov Branch of the Samara Medical Institute" REAVIZ "

2 GOU SPO "Engels Medical College", Engels

As a result of the theoretical and practical research carried out, based on the analysis of various theories on the study of motivation, it can be concluded that the motivational sphere of a person is very complex and heterogeneous. With knowledge of the motivational factors that are highly valued by employees, the leaders of nursing teams can think over and build a system of encouragement and incentives that meets the requirements of efficiency. As can be seen from the study, even if there is employee satisfaction with the working conditions, it is possible to highlight a number of points based on a qualitative analysis of individual questionnaires that will allow the manager to increase the efficiency of his management. So, the scope of knowledge on motivation is very extensive. And the result from the practical application of this knowledge is really huge in various fields of activity, including healthcare.

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motivation

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Motivation is a complex psychological phenomenon that causes a lot of controversy among psychologists who adhere to various psychological concepts. One of the simplest and most common definitions of motivation: motive is the intrinsic value of the activity performed. In the most approximate sense, such a definition reflects the internal state of a person, however, it should be noted that the forces that impel to action are outside and inside a person and force him to consciously or unconsciously perform certain actions. At the same time, the connection between individual forces and human actions is mediated by a very complex system of interactions, as a result of which different people can react completely differently to the same effects from the same forces.

Based on this, it can be assumed that the process of human motivation is subject to both internal and external determination. This is where the concept of motivation comes in. Motivation is the process of influencing a person in order to induce him to certain actions by awakening certain motives in him.

The purpose of the work: to determine the practical application of psychological knowledge about motivation in the management of nursing staff in healthcare facilities.

In order to identify motivational factors for nurses of the urological department, we conducted a survey of the nurses of the department. 20 respondents took part in the survey. The survey used the Martin-Ritchie Motivational Profile test, aimed at identifying the needs and aspirations of each employee, and thus getting some idea of ​​his motivational factors. As such, the authors identified 12 needs.

In high wages and material rewards.

Good working conditions and comfortable environment.

In a clear structuring of work, the availability of feedback and information that allows you to judge the results of your work; the need to reduce uncertainty and establish rules and directives.

In social contacts; in the formation and maintenance of long-term stable relationships with a small number of colleagues, while the degree of closeness of relationships, trust is important.

The need for more free time.

In winning recognition from others, in making others appreciate the merits, achievements and successes of the individual.

In setting challenging goals and achieving them.

In influence and power, the desire to lead others; persistent desire for competition and influence.

In diversity, change and stimulation; in an effort to avoid routine.

In creativity; desire to be an analytical, thinking worker, open to new ideas.

In improvement, growth and development as a person.

In the feeling of being in demand, in interesting work filled with meaning and significance with an element of social utility.

The test is based on a comparison of the significance of a number of motivational factors that are important from the point of view of personnel management. Conducting a local study in the organization allows us to conclude that certain motivating factors predominate and thus creates a picture of the motivational environment.

The data we obtained allow us to characterize the motivational environment as follows: high and stable earnings are important and valuable for employees, the opportunity to work in good conditions, the need for recognition by management and colleagues of their merits, achievements and successes (Fig. 1). Among the factors whose stimulation will be considered ineffective, employees noted the need for socially useful work, maintaining and forming long-term relationships with a small circle of colleagues, as well as the need for power, clear structuring of work, and manifestation of a creative non-standard approach (Fig. 2).

Rice. 1. Motivational factors highly valued by employees

With such data, the head nurse can think through and build a system of encouragement and incentives that meets the requirements of efficiency. The presence of non-dominant factors may indicate either sufficient satisfaction in this regard, or a lack of interest in this factor. Satisfying the dominant needs will help to improve the efficiency and quality of work.

Based on the foregoing, the urological department has a high potential for enhancing the work of nurses. These are incentive payments at the expense of established bonuses for performance, taking into account quality criteria.

For our study, we used the Job Satisfaction Test. This is a standard test used in the study of factors affecting motivation, and allows you to identify parameters that satisfy or dissatisfy employees of the organization with working conditions, management organization and relationships in the work team.

Rice. 2. Non-dominant motivational factors

This test contains 14 statements, each statement can be evaluated from 1 to 5 points. In assessing the satisfaction with the work of the workforce, average values ​​of indicators are used. In this case, the results are evaluated according to the following scale:

15-20 points are quite satisfied with the work

21-32 points satisfied

33-44 points are not quite satisfied

45-60 points are not satisfied

over 60 points highly dissatisfied

The respondents were given the following instructions:

Make your choice for each of these statements by ticking the appropriate number.

1 - quite satisfied;

2 - satisfied;

3 - not quite satisfied;

4 - not satisfied;

5 - extremely dissatisfied.

	Statement
	Your satisfaction with the company where you work
	Your satisfaction with physical conditions (heat, cold, noise, etc.)
	Your job satisfaction
	Your satisfaction with the coherence of the actions of employees
	Your satisfaction with your boss's leadership style
	Your satisfaction with the professional competence of your boss
	Your salary satisfaction in terms of matching with your labor costs
	Your satisfaction with your salary compared to how much other companies pay for the same job
	Your satisfaction with official (professional) promotion
	Your satisfaction with your promotion opportunities
	Your satisfaction with how you can use your experience and abilities in your job
	Your Satisfaction with Job Requirements to Human Intelligence
	Your satisfaction with the duration of the working day
	To what extent would your job satisfaction affect your decision if you were currently looking for a job?

11 nurses took part in the testing. It should be noted that 7 nurses were absent at the time of the survey (vacation, sick leave, etc.) and one person refused to take part in the survey, explaining his refusal by the fact that nothing would change from his answers. The structure of the admission department includes a trauma center. The emergency room nurses were interviewed along with the admissions department nurses. Therefore, the test result can be attributed to the entire structural unit. But I immediately wanted to note the fact that those nurses who took part in the study took the proposed task seriously. They carefully listened to the instructions, enthusiastically and thoughtfully began to complete the task. This can serve as an indicator of the significance of the test results for them, as an opportunity to express their opinion on these issues. And for us, this can serve as an indicator of the importance of conducting this kind of research.

In the course of the study, we obtained the following result: the average value obtained by dividing the sum of the results for each individual questionnaire by the number of survey participants is 24.5 points, which corresponds to the “satisfied” indicator on the test scale. Thus, in general, the team is satisfied with the conditions and characteristics of work at this enterprise and specifically in the admissions department (Fig. 3).

But we could see the full picture only by conducting a qualitative analysis of the results. It should be noted that against the background of overall job satisfaction in general, there is a differentiation of results for individual questionnaires.

So, one person is completely satisfied with all the parameters of labor activity, that is, each proposed statement, he estimated at 1 point - “quite satisfied”; four more people rated each statement either at 1 point or at 2 points - “satisfied”, that is, they are also satisfied with the conditions that the organization offers them.

In the questionnaires of the rest of the study participants, a negative assessment of working conditions appears.

For three employees, this dissatisfaction is manifested only once, that is, they rate any parameter at 3 points - “not quite satisfied”. Moreover, these parameters are not related to these survey participants. So, one of them is not satisfied with the length of the working day at the enterprise, the other is not satisfied with the salary, in comparison with other organizations, and the third is not fully satisfied with the requirements of work to the human intellect. But in general, according to the sum of points (24.25 and 26) obtained as a result of processing the questionnaires of these employees, they belong to the category of employees satisfied with their work, that is, we can combine them into the previous group.

Thus, three more questionnaires remain in our field of vision. Let us immediately make a reservation that two of them have total scores (27 and 31), which correspond on the key scale to the “satisfied” indicator, but since many statements are rated as not quite satisfactory, we will consider them in more detail along with the questionnaire, the result of which by the sum of points (34) corresponds to the indicator "not quite satisfied".

The first of the employees (27 points) is not fully satisfied with the coherence of the actions of employees and those parameters that characterize the possibility of using their potential and the possibility of promotion. The second and third employees (31 and 34 points) are also dissatisfied with career advancement and opportunities for their advancement, and one of them is not completely satisfied with the length of the working day and is not satisfied with wages compared to other organizations, while the other is not satisfied with work at all.

Thus, it can be concluded that along with nurses who are satisfied with their work, there are employees who are not completely satisfied with some parameters of work, although they are generally satisfied with their work, and also one employee is not completely satisfied with the work as a whole and is not satisfied with some of its parameters. Moreover, it is interesting to note that all of them are not satisfied, in general, with the possibility of promotion. Although two of them are dominated by dissatisfaction with the content of the work (job satisfaction, the use of their experience and abilities), one employee, against the background of the same dissatisfaction with promotion, clearly dominates external motivating factors (working hours, wages).

So, we can conclude that even with general satisfaction with the work of the entire team, based on a qualitative analysis of the results of the survey, it is possible to see a number of features of the motivation of individual employees and, with the help of properly selected management techniques, increase the efficiency of each employee in order to optimize the work of the entire health facility. So, in our case, for two employees, the greatest motivating beginning will be the opportunities provided for realizing their potential, recognizing their labor contribution and praise for responsible work, as well as the opportunity to see the prospect of development, advancement in the future (this should not be understood as an immediate increase, but also putting their candidacy on the reserve list will serve as a powerful impetus to the work, while not obliging the administration to anything). Unlike the previous example, for an employee focused on external incentives, external incentives (bonuses, benefits, compensatory leave, etc.) will serve as a strong motivational factor, respectively.

Rice. 3. Satisfaction with the work of nurses in the admission department

Staff motivation is an important component in personnel management, as well as a direct way to improve the quality of nursing care with the skillful use of knowledge of the motivation structure and their application in practice.

The art of management is to clearly represent the needs of a person and create the necessary conditions for their satisfaction.

Conclusion

As a result of our theoretical and practical research, based on the analysis of various theories on the study of motivation, we can conclude that the motivational sphere of a person is very complex and heterogeneous.

In modern psychology, there are currently many different theories, the approaches of which to the study of the problem of motivation are so different that sometimes they can be called diametrically opposed.

When studying various theories of motivation, when determining the mechanism and structure of the motivational sphere, we came to the conclusion that human motivation is indeed a complex system, which is based on both biological and social elements, therefore, it is necessary to approach the study of human motivation, taking into account this circumstance.

It is also important to note the importance of knowledge about motivation in the management activities of the management of an organization interested in increasing the productivity of its employees, their full return at the enterprise. Understanding and putting into practice the system of motivation of your employees will lead not only to a general increase in the efficiency of the organization, but also to satisfaction with the work of the employees themselves, and an improvement in the psychological climate. And, as a result, again, an increase in the productivity of the organization itself. A competent leader must clearly know that not all employees are motivated equally. Therefore, he must accurately recognize the actual motives of each of his employees and try to meet the needs of each as far as possible.

With knowledge of the motivational factors that are highly valued by employees, the leaders of nursing teams can think over and build a system of encouragement and incentives that meets the requirements of efficiency.

As can be seen from our study, even if employees are satisfied with the working conditions, it is possible to highlight a number of points based on a qualitative analysis of individual questionnaires that will allow the manager to improve the efficiency of his management.

So, the scope of knowledge on motivation is very extensive, and the result from the practical application of this knowledge is really huge in various fields of activity, including healthcare.

Reviewers:

Andrianova E.A., Doctor of Social Sciences, Professor, Head. Department of Philosophy, Humanities and Psychology, Saratov State Medical University named after V.I. Razumovsky Ministry of Health and Social Development of the Russian Federation, Saratov;

Novokreshenova I.G., Doctor of Medical Sciences, Associate Professor, Head. Department of Economics and Management of Health Care and Pharmacy, Saratov State Medical University named after V.I. Razumovsky of the Ministry of Health and Social Development of the Russian Federation, Saratov.

The work was received by the editors on February 2, 2012.

Bibliographic link

Maslyakov V.V., Maslyakov V.V., Levina V.A., Levina V.A., Kuznetsova E.V., Kuznetsova E.V., Lunkova O.A., Lunkova O.A. MOTIVATION IN THE ENVIRONMENT OF NURSES // Fundamental research. - 2012. - No. 3-2. - S. 352-357;
URL: http://fundamental-research.ru/ru/article/view?id=29607 (date of access: 02/01/2020). We bring to your attention the journals published by the publishing house "Academy of Natural History"

Motivation of personnel is a key direction of the personnel policy of any enterprise. But not all tools that allow highly effective management of the behavior of employees of commercial companies are also effective in managing medical personnel.

In the health care system, nursing staff is the most significant part of the workforce. The professional activities of nurses are particularly affected by such negative factors as insufficient prestige of the profession, relatively low wages, difficult working conditions, which complicates the management process. In this regard, a clear motivation for the activities of nurses in the changing management structure of medical institutions is extremely important.

The concept of labor motivation in the economic sense appeared relatively recently. Previously, the concept of motivation was replaced by the concept of stimulation and was used mainly in pedagogy, sociology, and psychology. Such a limited understanding of the motivational process led to an orientation towards obtaining a momentary result. This did not cause significant interest of nursing staff in their own development, which is the most important reserve for increasing labor efficiency. Work has ceased to be the meaning of life for many people and has become a means of survival. And in such conditions it is impossible to talk about the formation of a strong labor motivation, about labor efficiency, advanced training of employees and the development of initiative.

In health care, a simple material reward is considered sufficient as the main motivational factor. Sometimes this policy is successful. And since a motive is a conscious impulse to achieve a specific goal, understood by a person as a personal necessity, a need, then the structure of the motive includes, in addition to needs, actions to achieve them, and the costs associated with these actions.

Motivation is represented by motivation and stimulation. If motivation is a process of influencing a person in order to induce him to certain actions by awakening certain motives in him, then stimulation consists in using these motives.

With the development of health care, more and more attention is paid to the motivational function of management, when motivation is preferred over administrative and strict control. Moreover, the most common group of motivating factors is not "carrot and stick" and not fear and disciplinary responsibility, but a group of factors, including trust, authority, reward. Job security and working conditions are of great importance.

Five levels in the system of labor motivation of nursing staff of medical institutions can be represented in the form of a kind of pyramid, at the base of which there is such a component of motivation as the principles of leadership, the remaining components of motivation can have the following arrangement according to the levels of the pyramid (see Fig. 2).

Fig.2.

The motivations of medical personnel and their actions to achieve certain goals are guided by values ​​that are prioritized. At the same time, studies often refer to the scoring of values.

On the example of one of the medical institutions in Novosibirsk in 2012, studies were carried out on the distribution of values ​​according to the priorities of nurses (researchers A.I. Kochetov and E.I. Loginova) . As a result of the survey, nurses put forward wages, medical care and job satisfaction in the first place. On the second and third place - respect for colleagues, good relations with them, as well as encouragement from the administration. Equally important for nursing staff is the possibility of self-realization, social package and recognition in the organization. The possibility of self-realization in the profession was indicated by 23% of respondents. This indicator is explained by the fact that the functions of nursing staff are more limited compared to doctors. Work is perceived as monotonous. Sisters often perform it mechanically, without delving into the essence of new tasks. Professionalism in a narrow specialization is growing and interest in self-education is decreasing. It should be emphasized that when asked about further cooperation with the organization, 7% of the nursing staff of the medical institution expressed dissatisfaction with the current state of affairs and 22% avoided answering this question. Thus, a survey of nurses showed that about 30% of the staff did not agree to continue working under the same conditions. This suggests that in order to retain staff, changes are needed both in the pay system and in the structure of nursing staff management.

In order to identify the preferred types of labor stimulation for nursing staff, the same researchers (A.I. Kochetov and E.I. Loginova) conducted a survey of nurses in one of the clinical diagnostic centers in Novosibirsk. The results of the study showed that 77.5% of respondents preferred financial incentives. Among non-monetary material incentives, nurses preferred the provision of preferential vouchers for rest and treatment (71.5%); improvement of working conditions, workplace ergonomics (66.5%); introduction of flexible working hours (62.5%); providing benefits for paying for departmental housing and utilities (59%); voluntary medical insurance for personnel (44%); organization of subsidized meals (44%). Among the preferred forms of moral encouragement, the majority of respondents noted: careful attention to individual proposals aimed at improving the common cause (69%); gratitude announcement (59%); one-time granting of authority in solving certain production issues (22%).

After analyzing the data on the preferred types of motivation, we can conclude that each individual employee has a motivational system peculiar only to him, which depends on the personal qualities of the person and the life circumstances in which he is currently located. It is necessary to strive to focus motivation on values ​​that are of priority for a particular nurse.

The prestige of the profession of a nurse, as noted earlier, plays one of the significant roles in the structure of the labor motivation of nurses. Raising the prestige of a profession is not so easy, and this is a common task not only for the healthcare system, but also for the cultural state of the whole society, the hierarchy of social values. Western-style labor motives and values ​​introduced into the mass consciousness of Russians from the outside do not correspond to the model of attitude to work that has been formed over the centuries-old history of Russia on the basis of internal prerequisites and requirements for economic development. The decrease in the general cultural level of the population, of which nurses are a part, leads to the primitivization of needs, the underdevelopment of the motivational sphere.

There is no widespread propaganda of the social significance of the nursing profession at all levels. Insufficient attention in health care institutions is paid to the development and maintenance of the culture of the organization, in particular, the popularization of the mission of the institution, the formation of loyalty and commitment to the organization of personnel, and other specific aspects of the formation of organizational culture.

Thus, it is possible to determine the main activities of health care managers at various levels of management aimed at maintaining and increasing the labor motivation of nurses (Table 2).

table 2

The main directions of increasing the labor motivation of nurses

at the level of public administration	at the local government level	at the management level of the organization
1. Increasing the prestige and widespread promotion of the social significance of the nursing profession. Providing recognition to workers and veterans of the profession.
2. Establishing a decent level of remuneration for nurses.	2. Organization of seminars, conferences, competitions at city, district, regional levels, exchange of experience between various medical institutions.	2. Development of a system of additional financial incentives for employees, creation of opportunities for preferential medical care for employees and their families.
3. Equipping medical institutions with modern equipment and introducing modern technologies.	3. Allocation of additional funds for the technical and technological equipment of medical institutions.	3. Development of organizational culture: popularization of the mission, formation of loyalty and commitment of employees of the organization and other specific aspects.
4. Popularization of an increased level of secondary and higher nursing education.	4. Organization of targeted recruitment to higher educational institutions of graduates of medical schools and colleges who have shown themselves excellently during their studies.	4. Attention to personnel work: the creation of programs for the adaptation of young professionals, the study of labor motivation of personnel and the creation of motivational programs, etc.
5. Expansion of the hierarchical structure of health care institutions, creating opportunities for career growth and more differentiated remuneration for nurses.	5. Attracting schoolchildren and students of medical schools and colleges to research work and popularization of medical knowledge, establishing nominal scholarships.	5. Prevention of professional stress and professional burnout syndrome: introduction of a position of a psychologist, training of personnel in anti-stress behavior skills, conducting social and psychological trainings.
6. Development of load standards and standards for the provision of medical care. Introduction to the staff of health care facilities of the position of HR manager and psychologist.		6. Creation of comfortable conditions at work. Monitoring compliance with safety regulations. Implementation health-saving technologies.
7. Introduction to advanced training programs for paramedical workers of mandatory social and psychological training (at least 24 hours).	7. Wide involvement of highly qualified medical personnel in teaching activities at the advanced training departments of paramedical workers.	7. Development of the nursing process as the main model for the provision of nursing care.

Some of the measures listed in the table are being successfully implemented in the field of domestic healthcare at the present time, while the other part requires its detailed consideration and application.