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THE BASIC MAINTENANCE OF WORK

In Introduction of dissertational work the research urgency, degree of a level of scrutiny of a problem reveals, its object and a subject is defined, the hypothesis, the purpose and research problems, its theoretical and methodological bases, scientific novelty, the theoretical and practical importance, the positions which are taken out on protection are formulated.

In introduction reliability and validity of the results received during research are characterised, and how their approbation was carried out is described.

Dissertation chapter 1 «Educational activity of the doctor: the essence and functional mission» is devoted research of essence and specificity of the educational activity realised by the doctor and features of use by it of the basic tool of such activity - language.

In the first paragraph of chapter 1 of dissertational work «Bioethical and deontologicheskoe the maintenance of educational activity of the doctor» on the basis of judgement of the maintenance of the researches devoted to phenomena of educational activity and pedagogics in medicine, is presented definition of the educational activity realised by the doctor and aimed at formation at the patient (or the person who have addressed to the doctor) of bioethical and biomedical representations about how it is necessary to support own health. In it the data received during realisation of the content-analysis normativnoyopravovoj of the documentation, system regulating functioning are resulted and characterised
Domestic medical education, and also the documentation containing data on norms operating now of professional behaviour of workers of domestic sphere of public health services and about professional standards to which there should correspond their qualification. In the paragraph position according to which educational function is a base component of professional work of the doctor is proved, and ability to carry out this function - professionally important quality which should be formed purposefully at students of medical universities and is improved to (develop) at doctors - students of improvement of professional skill. The basic part of the paragraph is devoted the description bioethical and deontologicheskih components of educational activity of the doctor. It contains the detailed description of an extensive circle of the existential and moral problems arising during interaction of the doctor and the patient. The questions, concerning constructive discussion with the patient of moral aspects of achievements of biological and medical sciences, are considered in the paragraph as directly connected with understanding the doctor of what mental readiness of the patient for perception and judgement of such information.

In the second paragraph of chapter 1 of the dissertation features of the speech influence rendered by the doctor on the patient within the limits of their communicative interaction are considered. The paragraph carries the name: «the Originality of speech influence of the doctor on the patient during the decision of an educational problem of formation of representations on regulations zdorovesoobraznogo behaviour». The initial theoretical message laying in the basis of research: language - the main implementer of educational activity. Speech interaction of the doctor and the patient provides their communicative interrelation, allows the expert: 1) to broadcast to the patient actual for it bioethical, biomedical and prognosticheskuju the information, concerning its psychosomatic condition in the future; 2) to make purposeful impact on intellectual sphere of the patient and to change a format of its behaviour in necessary for preservation of health a channel.

The analysis psihologo-pedagogical, lingvodidakticheskih, communicatively-linguistic, kognitivno-linguistic,

pragmalingvisticheskih, the mediko-semiotics works devoted
To speech interaction of subjects of medical process, has allowed to reveal features of use (use) by the doctor of language means in a context of realisation by it of the professional work. The received results testify that speech of the doctor (narrativ the doctor) including the educational speech messages addressed to the patient, it is necessary to consider not only as set of morphemes, word forms and offers but also as diskursivnoe formation that is as ordered definitely and consisting of a number of components a discourse. The support on such understanding allows to treat the speech activity of the doctor which are carried out according to norms and regulations of statusno-role relations accepted in sphere of public health services, as the complete formation showing unity of the language form, values of language units and the purposes (plan) of language influence.

The special attention in the paragraph is given the description of an originality of a situation of speech interaction of the doctor and the patient, stereotypic circumstances of their meeting and typical educational intentsy the expert. In the paragraph factors (communicative literacy, communicative behaviour, language competence), causing efficiency of educational speech influence of the doctor on the patient are characterised. In the paragraph text the speech portrait of the doctor structurally solving an educational problem of familiarising of the patient to conducting of a way of life conformable to its psychosomatic condition is presented.

The third paragraph of chapter 1 of the dissertation «Lingvodidaktichesky, lingvokommunikativnye and lingvopragmaticheskie aspects of educational activity of the doctor» contains the description of, how within the limits of the carried out research were used theoretical konstrukty (the theory of speech certificates, theoretical installations lingvodidaktiki, lingvokulturologii, pedagogical semiologii, pragmalingvistiki) for working out of algorithm educational under the maintenance of speech influence of the doctor on the patient. In the paragraph it is shown, how making a start from the theoretical statement according to which elementary base communicative speech unit is the statement, it is possible to develop algorithm of interaction of the doctor with the patient in which context the first effectively realises the educational function, immanently inherent it
Professional work. In the paragraph it is proved, that during working out of such algorithm it is necessary to consider a number of the requirements shown to educational statements (communicative units), namely to: 1) to their sign structure; 2) to concrete value;

3) to impressive properties (a rhythm, rate, a pronouncing tonality);

4) to conformity to a plan of the doctor - the sender of the message;

5) to a site in the educational text (point of placing of an arrangement in a speech stream). What on the structure and the maintenance should be is in details characterised in the paragraph:

1) descriptive statements (describing the validity of a psychosomatic condition of the patient and a situation of its treatment);

2) deonticheskie statements (concerning permissions and prohibitions to the patient of those or other formats of behaviour); 3) perlokutivnye statements (statements - the actions connected with achievement perlokutivnogo of effect - the possible influence rendered by the statement on the patient).

Has found reflexion in the text of the paragraph and the analysis of communicative failures of the doctor solving educational problems. Among the factors which have caused communicative failures, the following is in details considered: 1) cultural (the doctor does not consider that it and the patient - carriers of different cultural representations); 2) language (the doctor uses in speech of a word which are not clear to the patient; 3) psychosocial (the doctor does not take into consideration that its biomedical treatment occurring to the patient can not coincide with treatment the patient of the reasons which have caused in it psychophysical trouble). The special attention in the paragraph is taken away to a theoretical substantiation of the statement that success of educational activity of the doctor in many respects depends on its abilities to build speech interaction with the patient according to imperatives lingvodidaktiki.

The second chapter of the dissertation «Educational activity of the doctor as process of purposeful familiarising of the patient to conducting zdorovesoobraznogo a way of life» is devoted the description of algorithm of construction of the educational text as which sender the doctor acts, and by the addressee - the patient. In the head the composite structure of the educational text is characterised and its substantial filling is presented. In it the questions, concerning approbations of the developed algorithm of construction of the educational text also are taken up.

In the first paragraph of the second chapter «the Maintenance and a composition of the educational speech messages addressed to the patient and focused on formation at it of relevant representations about zdorovesoobraznom behaviour» are considered the questions connected with the organisation, orderliness, an arrangement and interrelation of parts of the educational text, and also the questions, concerning selection of a speech material for a presentation to the patient. A substantiation of a way of construction of the educational text - one of the important components of the given paragraph. In it it is shown, how the account of parametres of oral (speech) communications of the doctor and the patient (ofitsialnost meeting situations, definiteness of a theme of interaction, standartnost dialogue conditions, level of professional competence of the doctor) allows to solve a problem of construction of the educational text rationally. Paragraph materials also contain a substantiation of how the educational text in formalnoyogrammaticheskom the relation should be built: How much it should be sated by biomedical terminology; what should be logic chains of the statements brought home to the patient; what structure of the nominal and verbal word-combinations used in the oral message of the doctor should be. A position substantiation according to which the educational text should consist of three sections (blocks) containing bioethical, biomedical and prognosticheskie data, giving the chance to the patient to build a line of conduct of its health conformable to a condition, - a key part of the first paragraph.

Examples of the statements containing in the educational text which has been developed in a context of the carried out research and it is addressed the patient receiving treatment in the form of replaceable nephritic therapy. The educational text contains 76 statements, the part from which is resulted more low.

I. Bioethical section.

1. By means of corresponding treatment and efforts of you we can keep yours a life and health - this invaluable gift.

2. But you should understand, your health is a zone and your responsibility too.

3. You should keep health and a life for the sake of yourselves and the relatives, those people who requires you.

4. Maintenance of health and preservation of a life by means of replaceable nephritic therapy will allow you to continue to be engaged in that is important in your life, that you love.

5. Anybody except you cannot carry out completely all necessary medical instructions appointed the doctor.

II. Prognostichesky section.

1. If you observe all necessary instructions and a medical mode, duration of your life will be long, practically same, as well as at healthy people.

2. If you observe a medical mode and to co-operate with the doctor concerning treatment we can support quality of your life at as much as possible accessible high level.

3. That you could continue to conduct an active life and to be engaged in that love, it will be necessary for you to reconstruct the way of life definitely.

III. Biomedical section.

1. Henceforth the hemodialysis is a vital procedure for you.

2. The hemodialysis is the procedure allowing by means of the artificial filter, out of an organism, to clear blood of toxins collecting in it and a superfluous liquid.

3. Procedure of a hemodialysis is carried out by means of connection to the device «an artificial kidney».

4. At you on a hand the fistula - the artery and vein connection, providing possibility of access to system of blood for carrying out of procedure of a hemodialysis is for this purpose generated arteriovenoznaja.

5. You necessarily should watch hygiene of a fistula.

In the paragraph how examination of the developed educational text was carried out is described also, examples from which have been resulted above. Expert otsenivanie informative pithiness of the educational text it was spent by group of 15 qualified doctors among which there were 5 doctors and 10 candidates of medical sciences.

In the second paragraph of the second chapter «the Theoretical bases and algorithm of forming with the patient in a context of realisation of educational function» are stated by the doctor of speech interaction principles of working out of the given algorithm and characterised
Its logiko-composite and composite-speech components. In the paragraph position according to which, the algorithm of forming of the educational text - the difficult speech formation possessing semantic and substantial integrity, is a step-by-step (consecutive) realisation of the actions organically connecting together the statements bioethical, biomedical and prognosticheskogo of the maintenance which addressee is the patient is proved.

In the paragraph it is shown, that as a building material of the educational text the statements united in a logic chain, information, argumentatsionnogo and the demonstrative character, including clear words for the patient and a word-combination act. Feature of the majority of these statements is that they are marked by following words (lexical means): for this reason; considering all aforesaid; because...; taking into consideration that...; because...; thus, etc. the Sign role in the educational text play performativnye the statements as which markers such words said by the doctor and word-combinations as act: I will especially note, I will underline, further I will explain also a number of others. Besides performativnyh statements the structure of the educational text includes and diskursivnye stating, containing data on sequence of fulfilment by the patient of those or other actions. As markers of such statements words serve: In - the first, at last, in the beginning, first of all, finally etc.

In the paragraph the questions, formings of the educational text concerning principles are considered. In it it is proved, that as such principles it is expedient to consider four maksimy kooperativnosti, described by P.Grajsom:

1. «Maxim informativnosti, or quantities» (the text should be informative so, how much it is required);

2. «Maxim of the validity, or qualities» (in the text should not not confirmed data);

3. «Maxim of relevance, or relations» (the text should be relevant to the purposes of communication interaction);

4. Maxim of clearness, or a way of a statement »(the text should not contain not clear words and formulations, should not bear in itself a polysemy).

In the third paragraph of the second chapter «Approbation of algorithm of educational speech interaction of the doctor and the patient» are characterised diagnostic procedures which have been spent for reception of the answer to a question on constructibility of the carried out working out, and interpretation of the results received during carrying out of research is given.

Studying of efficiency of speech influence of the doctor on process of formation at patients of a line of conduct conformable to their state of health was spent under the following scheme. In the field of diagnostic attention there was a group of patients with the terminal nephritic insufficiency, receiving chronic replaceable nephritic therapy by means of a hemodialysis.

123 patient have taken part in research, middle age of patients made 55,01± 13,83 (min 19, max 77). The patients who were taking part in research, were at initial stages of treatment by a hemodialysis. Among the investigated patients there were 57 women (46 %) and 66 men (54 %). With patients from experimental group the conversation which has been built in exact conformity with the maintenance of the developed educational text was spent. With patients from control group doctors who within the limits of speech interaction with patients did not use such text co-operated. During the decision of educational problems these doctors leant against a way of speech dialogue habitual for them with patients. The experimental group consisted of 63 patients, (34 men, 29 women), middle age - 54,17± 13,7 8. The control group included 60 patients, (32 men, 28 women), middle age 55,9± 13,94.

After carrying out with patients from experimental and control groups of educational conversation level of their knowledge of regulations zdorovesoobraznogo behaviour (by means of specially developed questionnaire containing 22 questions) was defined. Participants of interrogation should read attentively containing in the form of a questionnaire questions and to choose one the fullest and correct on the answer to each of them.

Examples of the questions containing in the form of a questionnaire.

Treatment by a hemodialysis method is capable to keep a life and health of the patient within long years?

Yes;

Is not present;

I do not know.

Health of the patient who is on treatment with a method of a hemodialysis is a zone of full responsibility:

A) the doctor;

The patient;

B) a zone of joint responsibility of the doctor and the patient.

For health maintenance at the greatest possible high level the patient should:

A) to accept the recommended preparations and to reconstruct the schedule of the life according to recommendations of the doctor;

To trust in the best and to try to conduct a former way of life;

B) to go in for sports and improving experts to win illness.

At you on a hand the fistula, it is generated:

A) the device for a blood sampling on the analysis;

The device for introduction of medical products;

B) the artery and vein connection, providing possibility of carrying out of procedure of a hemodialysis.

Before a session of a dialysis and after a session it is necessary for patient to be weighed since:

A) weighing disciplines the patient who should support optimum weight not to suppose adiposity;

Weighing allows to define, how many a liquid has been deduced from an organism during a hemodialysis;

B) weighing gives the chance to the doctor to watch that the patient did not have the proof weight reduction complicating a current of illness.

The use of a considerable quantity of the products rich with phosphorus, such as whole milk, cheese, yolks of eggs, nuts, sunflower seeds, fishes, etc. at the person, passing treatment by a hemodialysis

Leads to accumulation of inorganic connections of phosphorus in blood, and it is good, since phosphorus is the vital element;

Leads to phosphorus accumulation in blood, and phosphorus is necessary for brain work, for maintenance of health of cardiovascular system, for normal functioning of muscles;

Leads giperfosfatemii (to accumulation of inorganic connections of phosphorus in blood), and it involves infringement of an exchange of calcium that leads to infringement of work of parathyroid glands, damage of bones, cardiovascular system.

Data about results of interrogation of patients are presented on the diagramme №1.

The diagramme №1 Answers of the patients receiving treatment by a hemodialysis, from experimental and control groups on the questions containing in a questionnaire

During research work supervision over behaviour and a psychosomatic condition of patients of experimental and control groups (data within one year) was carried out.

Following the results of the analysis of case records of patients in which features of their behaviour (on the basis of specially selected criteria - regularities of visiting of procedure of a hemodialysis have been reflected; results of analyses of blood; results of measurement of weight before hemodialysis procedure), the following has been revealed. In control group the ordered mode of treatment was broken by 23 patients (38,3 %) - 10 women and 13 men. In the experimental group which members have heard
The developed variant of the speech educational message, 4 patients (all 4 - men), breaking the ordered medical mode (6,3 % of patients) have been revealed only. Results are presented on the diagramme №2.

The diagramme №2

Observance of a mode of treatment by patients from experimental and control groups

For the purpose of studying of efficiency of the developed speech educational influence of the doctor on process of formation at the patient of behaviour conformable to its health statistical data processing which consisted in an estimation of level of interrelation of knowledge of patients about zdorovesoobraznom a way of life and their indicators zdorovesoobraznogo behaviour has been spent.

The analysis of results of the spent statistical data processing received during studying of knowledge of patients from experimental and control groups about zdorovesoobraznom behaviour and indicators of observance by these patients zdorovesoobraznogo of a way of life, has allowed to reveal the following.

1. There is a direct interrelation between following indicators: level of knowledge of patients about the importance of observance of regulations of conducting zdorovesoobraznogo a way of life and level of their adherence zdorovesoobraznomu to behaviour. Than above at patients level of knowledge of norms zdorovesoobraznogo behaviour, especially komplaentno they conduct themselves, that proves to be true results of the statistical analysis (rs =0,783; p

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A source: VATSKEL Elizabeth Aleksandrovna. the LINGVODIDAKTICHESKY COMPONENT of EDUCATIONAL ACTIVITY of the DOCTOR. The dissertation AUTHOR'S ABSTRACT on competition of a scientific degree of the candidate of pedagogical sciences. Moscow - 2018. 2018

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