<<
>>

2.1. 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

The educational activity of the doctor directed on familiarising of the patient to zdorovesoobraznomu to a way of life, - one of key directions of work of the expert. Its essence consists in change of intellectual sphere of trained (patient) and its behavioural sphere (behaviour of the patient in the field of health preservation).

Realise educational activity the doctor can only by means of language, by means of addressing to patients (or to the people who have addressed to the doctor) of certain educational speech messages who should influence them specifically. It is important, that this influence was predicted and has been realised for the good of patients (people to whom it is addressed). Professional speech of the expert is the tool of its professional influence, and each tool of the doctor should be prepared and be used in appropriate way with observance of some rules. The expert should, including, have representation about possibilities and risks of application of the given tool, to understand all measure of responsibility for possible consequences of its misuse.

In the course of realisation of educational activity, the doctor addresses to the patient a certain file connected among themselves and subordinates of an overall aim of educational speech messages which we suggest to name
The educational text. The text - initially linguistic concept which later has got specific value in literary criticism, cultural science, philosophy. Attempts to make definition to the text are connected with existence of the various points of view (actually jazykovedcheskoj and semiotics) (A.JU.Maslov, M.A.Lukatsky) [132, 126]. Thus and in text linguistics there is no common opinion concerning the given phenomenon (J.V.povetkina) [168].

In most general understanding as the text it is possible to consider «the sequence of the sign units united by sense which basic properties are connectivity, integrity, completeness» [132, with. 25]. Within the limits of linguistics following treatments of the text are most extended: as «units of a highest level of language system» [132, with. 26] (uzkolingvististicheskoe understanding); as result of speech activity; as units of the dialogue, differing some semantic integrity (A.JU.Maslov) [132]. There are also various points of view concerning ways of registration of the text. For example, according to I.R.Galperin, by the text the result issued in writing rechetvorcheskogo the process, an including complex of the statements having logic, grammatical and lexical communication, the specific purpose and pragmatical installation [47] can be named. Thus the text can be understood and more widely and to include, including, samples of oral speech [131, 223]. So, according to A.M.Pyatigorsk, the text represents the certain purposeful, spatially fixed message, thus a way of fixing can be both optical, and acoustic (it is important that the addressee had possibility to decode the text) [183]. As a whole, the problematics of studying of the text is connected with attempt of the decision of a wide spectrum of problems, definitions of the status of the text, development of the uniform approach to studying of the given phenomenon.

semiologija assumes possibility enough wide treatment of considered concept: as the text any can be understood
Product of purposeful human activity (G.I.Bogin) [26], any intentionally created system of signs which is the carrier of certain sense (E.A.Zhigareva, E.A.Yelin) [62, 64].

E.Benvenistom had been allocated following signs of the text as semiotics (semiologicheskoj) systems:

1) the Operational way (with which help the text influences system, its perceiving) means, that the text can be apprehended by means of visual, audialnogo, kinesteticheskogo the perception channel.

2) the action Sphere means that area in which there is a text. For example, it can be linguistics, pedagogics, music, a cinema etc.

3) the Nature of the text and number of signs mean material characteristics of the symbols used in the text.

4) the Type of functioning of the text is defined by its features. Depending on what the text is, it can be extent of the text in space or time, that is linearity (for verbal texts); izobrazitelnost, a continuity, spatiality (for graphic texts) [21]. In the light of our research we will stop on semiologicheskom (semiotics) understanding of this term as product of purposeful educational activity of the doctor.

The educational pedagogical text addressed to the patient, represents a product of speech activity of the doctor in a situation of an explanation to the patient of regulations of conducting zdorovesoobraznogo a way of life. Such text is verbal. As pedagogical educational activity assumes interaction of the doctor and the patient in the course of dialogue on reception, it, as a rule, the oral. In case of graphic (that is written) registrations, it is expedient to represent this text to trained patients in written form (for example, as the training brochure).

We suggest to understand as the educational text oral (or written) the speech product created by the doctor and addressed to the person, addressed for the medical aid, focused on formation at the patient of representations about sense of conducting zdorovesoobraznogo a way of life, treatment forecasts, principles and rules of behaviour in the conditions of the disease, consisting of a number of the specific educational speech messages logically among themselves connected, subordinates of the uniform purpose and possessing the certain stylistic colouring caused by features of the addressee, the sender, and also a situation of their interaction.

The maintenance and composition of the educational text are defined on the basis of spent in chapter 1 of the dissertation of the analysis of the researches devoted to educational activity of the doctor. The educational text should be structurally presented as follows:

- Bioethical component;

- Biomedical component;

- prognosticheskaja a component.

The bioethical component is connected with translation to the patient of the information that itself represent smyslozhiznennye orientations of the person conducting a way of life, conformable to a condition of its health. During discussion with the patient of regulations zdorovesoobraznogo behaviour the doctor, in essence, convinces the patient that it is necessary for it to conduct zdorovesoobraznyj a way of life. For this purpose the doctor uses rationally issued speech means. This component of the text allows to mention a problematics of meaning of the life and health preservation, to shine ethical aspects zdorovesoobraznogo behaviour. In the given substantial block questions of responsibility of the person before themselves and before significant people (both responsibility as a whole, and responsibility in the field of health) can be brought up.

Illumination smyslozhiznennyh aspects zdorovesoobraznogo behaviour of the patient is in many respects connected with increase of its motivation to conducting an appropriate amount of a life. Without a mention of this component of the maintenance of the educational text it is impossible to move further during educational activity. As a matter of fact, educational bioethical making - that base on which educational activity of the doctor is based.

It is necessary to notice, that this part of educational conversation - the most difficult from the point of view of an embodiment. How the doctor can affect the patient that that has realised all importance zdorovesoobraznogo behaviour and, in wider key, sense and value of the life? It is obvious, that the doctor herself should be sufficient image philosophically and eticheski is prepared to be capable to have similar conversation. The appeal by a life as Is represented important to the higher value, to the importance of human life for its relatives and for whom it in the answer (for example, children or relatives of the patient of whom he cares). To realise this component of the maintenance of the educational text to the doctor such professionally significant personal quality, as ability to bioethical thinking and behaviour helps.

Representations about what it is necessary to do to keep the health at optimum possible level, are formed thanks to the second substantial component of the text - biomedical.

Those biomedical imperatives, those immutable requirements which allow the person to keep the life and health enter into a biomedical component of the educational text. This substantial component includes the information on a diet, the drug intake schedule, an impellent mode, inspections and necessary medical interventions. These data are based on results of scientific researches and clinical practice. Each specific branch of medicine (for example, cardiology, endokrinologija, stomatology) on
Today has enough wide experience of preservation of health of patients by means of familiarising with a correct way of life. Doctors are experts who can transfer corresponding knowledge to the patient.

The third component of the maintenance of the educational text - prognosticheskaja. It is connected with scoring of prospects of the patient which wait for it in a case zdorovesoobraznogo behaviour. It is obvious, that the future changes in a habitual way of life, the fear of uncertainty connected with absence of the information concerning disease and its consequences, can cause in the patient alarm [275, 309]. The person, faced problems with health, can not realise the prospects connected with treatment, or can have certain erroneous representations about principles of preservation of the health. For this reason within the limits of educational work it is necessary to tell to the patient as his life will look as a whole in the future (for example what restrictions it should face, what rates of recover are possible at correct behaviour). As a matter of fact, in this case the doctor gives installation on observance of doctor's instructions and performance of medical recommendations, showing, that conducting zdorovesoobraznogo a way of life has positive prospects. Thus, the doctor leading educational discussion, implants the person not only in today (speaking as how to do in respect of health preservation), but also in a bottom tomorrow's (telling, what for it is necessary to conduct zdorovesooraznyj a way of life and what prospects wait for the person in case of its observance). This substantial component also carries out a motivational role, showing, that zdorovesoobraznoe the behaviour has serious positive consequences.

Thus, substantially educational text includes three components: bioethical, biomedical, prognostichesky. It is necessary to define, how the specified components are connected among themselves is composite, as they correspond in the text.

The composition, according to Explanatory dictionary Ozhegova is «a parity and a relative positioning of parts» [149, with. 283]. The statement composition represents its internal structure [141, with. 84]. A text composition - a way of its construction and interrelation of its parts, certain orderliness, a sequence of components of the text [216]. In the given research we understand a way of a parity of its components, its structure as a composition of the educational text.

The considered substantial components correspond as follows. The most expedient stage-by-stage transition from the first substantial component to the second and - to the third sees further. At their such arrangement the sense of the text and educational intentions of the doctor will be most logically and consistently informed to trained (patient).

Necessity of the account in the course of creation of the educational text lingvokommunikativnyh aspects of educational activity of the doctor about which it was spoken in dissertation chapter 1, finds the expression as follows. At text creation features of the author and the addressee of the text, that is the doctor and the patient should be taken into consideration. It will allow to come into more precisely contact between the addressee and the sender of the educational text, to make its relevant to each of participants of educational interaction.

Each expert - the unique person and as the professional was formed long years. In this connection by working out of a complex of educational messages it is necessary to consider, that features of the sender leave traces on the educational text - the doctor. Formation of the doctor and style of its professional work is affected by set of factors, for example, personal features of the doctor. Considerable influence that model of the interaction renders also, that style of work with the patient, which physician has got in the course of the professional formation. Not a secret is that fact, that the doctor as the expert, is in many respects formed thanks to senior colleagues,
To instructors with whom it works in clinic, since the occurrence moment in a trade (internship or clinical internship). The doctor who is brought up in the certain professional environment, anyhow, adopts the specific style peculiar to this environment.

Certain influence is rendered also by specialisation which was chosen by the doctor: there are developed patterns of behaviour in each medical speciality. For example, if to compare styles of professional behaviour of the therapist in a polyclinic and the anaesthesiologist - reanimatologa in branch of intensive therapy, it is possible to see basic differences both in a work essence, and in style of interaction with the patient. In the first case interaction more the patient-aligned and dialogichnyj, as a rule, carries character, the doctor can be a sign with the patient and observe its long time. In the second case the doctor frequently meets the patient when last is not in consciousness, and dialogue between them is simply impossible. Accordingly, there is an emphasis on perception of the patient not as persons, and as «physiological mechanism» which is necessary for supporting in a condition of balance during operation.

The specified factors influence a choice of style of interaction with the patient within the limits of that model of doctoring which the expert adheres. The most known classification of models of interaction of the doctor and the patient is offered by American researcher Robert Vitchem. It includes 4 models: engineering (technical), paternalistskuju (pastorskuju), joint and contractual (contract) [128, 246]. Realisation of these models has steady character, therefore characteristics of model of doctoring as style of performance of professional work should be reflected in specificity of speech messages.

The engineering (technical) model assumes the relation to the patient as to a certain impersonal mechanism, and the essence of work of the doctor within the limits of the given model is reduced to "debugging" in a human body.
Safe functioning of all systems of an organism admits the blessing for the patient. The doctor as the expert possessing special preparation and knowledge, defines a treatment trajectory to provide functioning of an organism of the patient up to the mark. Thus the doctor carries out the professional functions on the basis of objective scientific data, not being guided on own interests. Use of the given model is characterised depersonalizatsiej, that in many respects contradicts the modern approaches which are guided by a recognition of each patient by the person. Thus there is a number of the medical specialities which are not assuming interpersonal contact of the doctor and the patient where such model is quite justified (for example, situation already described above when the doctor has no interpersonal contact to the patient in resuscitation branch) [128, 246].

Paternalistsky (pastorskaja model) the model is in many respects similar to relations on type «the parent - the child» where the first operates under the relation to the second patronising, on the basis of mercy and love to the near. However interaction of the doctor adhering to this model, and the patient occurs not on the equal: the patient is perceived by the doctor as the child who is necessary for "conducting" in the course of treatment. As a matter of fact, interaction of participants of medical process within the limits of the given model is under construction on the basis of submission of the patient to authority of the doctor [128, 246].

The joint model means parity interaction of the doctor and the patient, underlining a generality of values of partners in medical process. The doctor and the patient as though stay in «the therapeutic union against illness». The patient is to a certain extent equalised with the doctor, and relations can be characterised not as relations on type "from top to down", and as ravnourovnevye. Thus given model does not cancel a recognition of that fact, what exactly the doctor - the expert possessing full, scientific representations about disease and treatment. Original "alignment"
Positions within the limits of the given model consists that the expert listens to opinion of the patient, respects its right to a choice and decision-making, for the patient the right to reception of all information on own condition admits. The therapeutic union in this case consists in cooperation of the general efforts on achievement of necessary medical result [128, 246].

The contractual model assumes not only specific mutual relations of the doctor and the patient, but also their certain legal registration (by means of the informed consent). Symbolical value of the contract is reflected within the limits of this model in possibility of each of participants of interaction to have the certain rights and certain duties and to derive from this benefit for itself. Unlike the previous model the doctor here is represented more expert, and the patient does not position itself equal in rights in respect of knowledge. Certain imperious powers are transferred to the doctor by the patient, thanks to it it has own benefits and can terminate «the therapeutic contract» in case will consider it necessary [246].

Definition of features of behaviour of the doctor, caused by model of doctoring which the expert adheres, is possible now by means of a technique «Models of interaction of the doctor with patients on R.Vitchu». This questionnaire allows to define, what model of profession of a physician (technical, paternalistskuju, joint or contractual) is used by the doctor. The questionnaire consists of 24 questions which reflect the most typical representations of the doctor about the patient and process of interaction with it. The respondent is offered to agree or disagree (ranzhirovanno) with some statements [8, 242]. As a whole, as conducting zdorovesoobraznogo a way of life assumes readiness for cooperation from the patient, use of joint model of interaction is represented to the most pertinent at creation of the educational text.

The information on the second subject of interaction - the patient (or the person who has addressed for any reason to the doctor) also should be taken into consideration by working out of educational texts. Each patient - the unique person having the personal lines, thinking type, a way of expression of during lives, the unique life experience and a course of life (K.A.abulhanova) [3].

By working out of educational texts into consideration age characteristics of patients to which the text will be addressed first of all should be taken. The patient can be the child, the person of youthful, mature, elderly, senile age. Dynamics of mastering of a material, level of complexity of a material can differ in different age groups, that is caused by psychological and psychophysiological laws of training (features of perception, understanding, attention and memory, motivation trained) (JU.I.Alexander, B.G.Ananev, J.N.Kuljutkin, G.S.Suhobskaja, H.B. Long) [6, 9, 111, 217, 283]. In case of work with the minor patient educational activity can be addressed not only to the child, but also the representative of its family-related environment (for example, to parents). The similar decision can be accepted in case of presence at patients expressed kognitivnyh infringements (especially at people of elderly and senile age).

Cultural-educational features of the patient also should be taken into consideration by working out of educational texts. It is necessary to consider an educational level of the person, its professional accessory, specificity of work performed by it. It is important to take also into consideration, whether there lives such person in a large city, small settlement or village; whether lives with a family or separately.

By working out of the educational text the account of features of patients should correspond with those actions which are carried out by the doctor at also
Conversation carrying out on an educational theme. First of all, the doctor should involve and fix attention of the patient (proceeding from its personal features to make it it is possible in one way or another). Direct scoring of the educational text becomes following step. Thus it is important to be guided by some personal features of the patient (for example, whether the patient is ready to accept responsibility for own state of health and behaviour; whether has experience constructive sovladanija with difficult vital situations).

That the doctor could fix attention of the patient, it should have representations about level of uneasiness of the patient as this factor can influence perception of the information received by the person. For today there are various approaches to research of phenomena of alarm, uneasiness, fear; there are discussions, whether it is necessary to distinguish them, or these are the identical phenomena. There are works in sphere of psychology, neurophysiology, the psychiatry, the devoted interpretations of the given phenomena. As a whole, now the alarm can be differentiated with fear on the reason basis: the alarm unlike fear has no communication with a certain concrete stimulus [307]. Uneasiness, unlike alarm, is most often considered not so much as a condition, how many as the property of the person defining its propensity to test alarm [211] at enough low thresholds of occurrence of directly reaction of alarm [182].o S.D.Spilbergera's point of view, offering to consider uneasiness in two measurements became one of the most widespread points of view on an uneasiness phenomenon: as the steady property of the person meaning

Perception of a considerable quantity of various situations as potentially dangerous (Spilberger has suggested to name its personal uneasiness) and as the condition connected with emotional reaction of anxiety, tested «here and now» (situational uneasiness) [301].

It is important to understand, that uneasiness - the integral human quality, any live person necessarily possesses certain level of uneasiness: it helps people to be guided with the difficult world, to answer those stimulus which this world shows [143]. At the same time it is important to understand, how much this or that level of uneasiness corresponds to a situation in which it is shown; how much the person, with that or other level of uneasiness is adaptive in concrete conditions [27]. It is accepted to allocate the moderate, raised and lowered levels of uneasiness. Moderate level of uneasiness means possibility of adequate reaction to certain stimulus; such level of uneasiness is not connected with occurrence of possible neurotic reactions. The raised level of uneasiness of the person is expressed that the person perceives a significant amount of various situations as the situations bearing threat to its well-being or ability to live. At the lowered level of uneasiness the person can have low enough motivation, is weak react to external stimulus [302].

It is important to take into consideration, that uneasiness as personal property helps to "find out" dangerous signals and to "avoid" danger (that is, it is connected with vigilance) [264, 295]. Uneasiness plays the important role including, in occurrence at the person of representations about disease [264]. For example, low levels of uneasiness speak about propensity of the person to distracting from the signals of threat connected with disease (thus not clear signals are usually interpreted by the patient with low level of uneasiness as harmless) [264]. Thus, the patient having low level of uneasiness, can not notice "preventions" of an organism which speak about deterioration of its condition, not to listen to symptoms which speak about health hazard or not to take seriously the prevention of the doctor. As marks L.D.Cameron (L.D. Cameron), levels of situational and personal uneasiness can play adaptive and dezadaptivnuju roles in the various situations connected with
Treatment, and optimum zdorovesoobraznoe the behaviour corresponds with moderate levels of uneasiness [264].

The above-stated information is especially important in a context of formation at the patient zdorovesoobraznogo a way of life. When level of personal uneasiness of the patient below norm, probably too thoughtless relation of the person to the problems connected with health or to signals which are sent by an organism. The frivolous relation is possible and to that information which is informed by the doctor within the limits of educational conversation. The patient with low level of uneasiness can lose vigilance and, in some cases, it will not manage to avoid potential threat to health. It can find following expression in educational activity: the patient can not react to words of the doctor, "pass" them or lightly concerns preventions of principles and rules zdorovesoobraznogo behaviour or treatment regulations. To such patient is "comfortable enough" in those conditions in which it stays that can have sad consequences for its health.

Work with the patients having high levels of uneasiness, first of all, is connected with tactful informing of the patient on its condition, the forecast. Such informing should be correct enough, delicate not to cause in the patient of the panic, at the same time full and informative. In the researches devoted, to questions of training of patients it has been revealed, that high levels of uneasiness have correlation with absence of the information on a state of health and forecasts of its preservation. In case of full, tactful, competent informing of the patient, uneasiness level, as a rule, decreases [275, 309]. Thus it is important to consider, that uneasiness level also refuses influence on kognitivnye processes [263, 295]. The problem of the doctor - to construct process of interaction with the patient so that the raised or lowered level of uneasiness has not prevented the patient to hear
The expert. It can achieve by means of reduction of level of situational uneasiness of the patient to optimum (normal) level. For example, the doctor, knowing, that before it the disturbing patient, inclined to perceive the information in the hypertrophied kind, should calm, first of all, the patient, that is lower situational uneasiness to an optimum level. In the event that the patient is inclined to low levels of uneasiness, it is necessary to "stimulate, focus it its attention on important points, to let know, that the educational work spent with it at present - a significant component of maintenance of his life and health. If the patient has the underestimated level of personal uneasiness, the information should move very brightly, accurately, imperatively so that the person did not have"chance"it to ignore. Repetition defined« portions of educational knowledge »on some times is necessary: They should be identical on sense, are a little various under the form. Thus the information should be enough figurative to influence the patient and to motivate it on observance of rules zdorovesoobraznogo behaviour.

Important at drawing up of the educational text such characteristic as level nejrotizma also is. nejrotizm - the line of the person expressed in emotional instability and lability, propensity to anxiety. For people with high level nejrotizma frequent differences of mood, anxiety, an impressionability are characteristic. Such person is excessively emotional, too strongly reacts to all kinds of stimulus, it is difficult to it to recover from emotionally mentioning experience. Strong emotional reactions can force to behave it sometimes in the irrational image [267]. As for people with high level nejrotizma frequent change of moods is characteristic, it is important to pay attention of the patient to independence of performance of doctor's instructions of a momentary emotional condition. For this purpose it is possible to use following designs: «nevziraja on what...», «How...» For example, to the patient
The following statement can be addressed: «As though to you it was not sad, you should take yourselves in hands and come on inspection». In the considered example the doctor addresses to the person of the patient by means of a pronoun "you", uses «retelling of its experience» (conversation on fear, the grief caused by disease). Influence minimisation nejrotizma on behaviour of the patient and on process of perception of the educational speech message becomes the purpose of the doctor in this case.

Ekstraversii-introversion level, as well as level nejrotizma, is one of characteristics of temperament and the same as also level nejrotizma, has biophysiological preconditions [76, 236]. As the detailed analysis nejropishologicheskih and psychophysiological features of introverts and extroverts is not included into problems of our research, we will be limited to consideration of applied questions of influence of this characteristic on informative processes and behaviour of the patient. As a whole, the ekstraversija-introversion can be defined as «the characteristic of typical distinctions between people, extreme poljusy which correspond to a primary orientation of the person or on the world of external objects (at extroverts), or on own subjective world (at introverts)» [76, with. 134].

G.Ajzenkom (H. Eysenk) it is noticed, that introverts focus attention to private world, orientation of extroverts - on perception of the world around. The typical extrovert likes to be in the company, to communicate with other people, does not like to study something alone. To the introvert it is peculiar, mainly, introspektsija, independent noegenesis from books (or other sources). Extroverts, as a rule, more physically also are verbally active, introverts are more independent, are reserved both verbally, and physically [269, 252].

Data about introversion-ekstraversii influence on kognitivnye processes and the speech behaviour, received in kognitivnoj psychology,
Psychophysiology, to psycholinguistics and kognitivnoj to linguistics speak about the following. Introverts are more susceptible to the arriving information, more deeply and carefully it analyze, thus they react to changes more slowly and less intensively [303]. Introverts prefer to speak on themes, important for them, is detailed and deep in them to understand [305, 306].

Extroverts jump from a theme on a theme easier, in their speech relationships of cause and effect [274] are less actively traced. The neural contour of extroverts is more susceptible to social stimulus [271], accordingly, speech of extroverts reflects their high social orientirovannost by means of references to other people. Extroverts use more words designating action that reflects their activity; active use of pronouns, adverbs and as a whole, operating by a considerable quantity of various words [274] also is peculiar to them. For extroverts conversations on the social experience are characteristic, corresponding words are used in their speech [292].

In a context of rendering of educational influence on the patient, it is necessary to understand, how the patient can receive the information: being guided on external or private world. The introvert - the person having propensity to leave in, for it it is more peculiar to listen to itself. Thus in the course of educational conversation important that such patient also listened also to the doctor. Accordingly, to solve educational problems, the doctor can appeal to private world of the patient. The introvert is necessary for shipping in itself by means of certain speech designs. It can be made at the expense of use in speech of following phrases «Recollect, how you usually.», «think of how it seems to you...», «Imagine...» Etc. For example «Think, it becomes how much better to you if you exclude smoking from the life».

That the extrovert listened to the doctor, it is necessary for expert to speak in such form that the attention of the patient has been focused on educational speech of the doctor and did not distract on extraneous stimulus. That is, that the educational speech message of the doctor has reached consciousnesses of the patient, it is necessary to keep focus of attention of the patient definitely. Accepting installation, that with the person it is necessary to speak in its language, we consider necessary at formation of educational speech messages of the doctor to consider results mentioned above researches. For the extrovert it is possible to use the additional introduction designs focused on «here and now», references to a social life and authorities. For example, the reference to neighbours in chamber, as on representatives of microsociety is possible.

Whether the patient considers, what it is responsible for preservation of the health? Or he assumes, what responsibility for health - sphere of care of the doctor? Whether there is at the patient an experience constructive sovladanija with difficulties and problems? Depending on it, from answers to the put questions, in the educational text it is possible to place certain semantic accents (for example to do an emphasis on acceptance of responsibility for the health or to appeal to experience of the decision of difficult vital situations).

That the patient has started osoznanno to conduct zdorovesoobraznyj a way of life, it should be ready to accept responsibility for the life and the health. To estimate, how the patient is able to do it, the control locus - property of the person of the person helps, characterising localisation of responsibility for the various parties of the life it is more on itself or on world around [13]. Itself kontsept a control locus the J have been developed. Rotterom and initially has been directed on the description of level of the subjective control of the person as a whole. Further there was more detailed studying of the given phenomenon, in particular, by domestic scientists E.F.Bazhinym, E.A.Golynkinoj, A.M.Etkindom is described
Possibility of definition of a locus of the control in various spheres of a life. At the moment, there is a possibility of that definition, how much the person is ready to accept responsibility for various spheres of the life: family, professional, the area of achievements, failures, health area etc. to the Doctor is important for understanding, whether the patient of responsible for an event considers or transfers responsibility for the health and the life on world around factors: other people, circumstance, destiny [13].

It is accepted to allocate internalnyj a control locus (property to accept responsibility for certain areas of a life) and eksternalnyj a control locus - (propensity to attribute responsibility for various spheres of a life to external forces) [13]. The patient with internalnym a locus of the control in the field of health, as a rule, recognises the responsibility for its preservation, treatment, performance of recommendations of the doctor. Such person can see and realise relationships of cause and effect between the actual condition (for example, problems with lungs) and previous behaviour (for example, the patient recognises, that itself is guilty in occurrence of problems owing to smoking). Patients with internalnym a control locus, as a rule, more komplaentny, that is follow all doctor's instructions [39]. For patients with eksternalnym a control locus the rearrangement of responsibility for own condition and health on external factors is characteristic: The doctor, the medical personnel, the family, - and also obuslovlivanie diseases by exclusively "heredity", "ecology" etc. According to researches, such patients are less attached to treatment and conducting zdorovesoobraznogo a way of life [39].

Studying of a locus of the control of the patient is connected with necessity of understanding the doctor of how the patient can take responsibility for own zdorovesoobraznoe behaviour. Thus the problem of the doctor during educational activity - to make the patient responsible for conducting zdorovesoobraznogo behaviour and everything, that is connected with it (reception
Medicines, visiting of procedures etc.). Having data about a control locus, the doctor can consider this feature at creation of speech messages.

In the event that the patient characterises internalnyj a locus of the control, the patient easily makes itself responsible, and the doctor should not focus in addition on it attention, and it can save time. If the patient possesses eksternalnym a locus of the control in the field of health or eksternalnostju as a whole, it is necessary for doctor to formulate statements so that the patient could understand unequivocally, where a zone of its responsibility. It is necessary to underline activity of the patient in every possible way. For example, use of active voice instead of the passive is possible. So, instead of the statement «Smoking harms to you», it is possible to tell: « You harm to yourselves smoking ». In the second case the patient from passive"object"turns in the"subject"showing activity. It is important to use such designs which will allow the patient to understand unequivocally in speech, that its correct zdorovesoobraznoe the behaviour in the conditions of treatment - its duty, for example, is possible use of modal verbs with value of obligation (such how"to be forced ", try").

Zdorovesoobraznoe behaviour in the conditions of chronic disease - the original behaviour connected with sovladaniem with a difficult vital situation which is represented by any heavy illness. The problem of the doctor - to develop together with the patient a certain line zdorovesoobraznogo behaviour of the last. It is obvious, that efficiency of observance of such line of conduct is in many respects caused by features of behaviour of the patient in difficult situations (which disease concerns also), and also its life experience. For this reason for the doctor it is important to estimate, how much the patient is ready to sovladaniju with a heavy situation for it and how it it will do.

It is traditional to describe this aspect of behaviour of the patient, is used concept of koping-strategy - certain lines of conduct,
Which are used by the person that will cope with a heavy vital situation. According to Lazarusu and Folkman, it «kognitivnye and behavioural efforts» [tsit. On 24, С.8], undertaken by the person to master not which vital situation to develop in relation to it tolerance or to change the relation to those conditions in which there was a person. Koping-strategy (that is strategy sovladajushchego behaviour) assume original regulation of interaction of the person and surrounding his environment. [24]

Koping-strategy are the significant factor at research of questions of the behaviour connected with health and illness [41], thus at the moment there is no uniform classification of koping-strategy. Various ways of their estimation (for example, technique Lazarusa, technique Hejma) and the analysis of the received results are applied. There is a point of view according to which it is impossible to divide essentially kopingi on "good" and "bad" as all always depends on the person and a situation in which it stays (L.I.Vasserman) [41]. At the same time, at the analysis of koping-strategy of patients with certain diseases researchers (N.P.Vanchakova, I.A.Vasileva) speak about more or less constructive koping-strategy used by patients in the given concrete situation [31, 37].

At realisation of educational activity the doctor should know about that, how much the patient can cope with such heavy vital situation as disease. If the person requiring medical aid, applies not constructive koping-strategy, in speech messages it is possible to staticize motive of overcoming of a heavy situation. For example: «taking into consideration your fears, All of you equally should begin therapy», «it is necessary for you to keep to a diet, considering all complexity of your position».

Data about the patients considered above personal features and their personal properties it is possible to receive by means of special techniques.
These techniques are actively enough used in the researches directed on research of personal features of patients with various diseases. To research of levels of uneasiness most actively apply test Spilbergera-Hanina. This technique has been developed by S.D.Spilbergerom and adapted in our country JU.L. Khanin. The questionnaire consists of 2 sections: the first includes 20 questions and is directed on researches of situational uneasiness (here and now); the second section also consists of 20 questions and allows to estimate level of personal uneasiness of the individual (that is how it reacts usually) [79].

Level nejrotizma and ekstraversii-introversion level can be defined thanks to G.Ajzenka's questionnaire. There are some updatings of the given technique differing on volume. For the patients receiving treatment by a hemodialysis, it is the most convenient to use questionnaire EPI (Eysenk Personal Inventory), consisting of 50 statements. Such form allows to save time for researches and not to overload with a considerable quantity stimulnogo a material of the people having problems with health [123].

The estimation of level of the subjective control of patients can be carried out by means of technique USK (Level of the subjective control), developed Rotterom and the adapted E.F.Bazhinym, E.A.Golynkinoj, L.M.Etkindom. The given technique consists of statements, with each of which it is necessary for the respondent will agree or to disagree in the graduated form (from - 3 to + 3). The given questionnaire allows to define the general internalnost, internalnost in the field of achievements, area of failures, family sphere and sphere of interpersonal relations, professional area and area of health [13].

Studying of koping-strategy can be carried out by various ways. There is questionnaire Lazarusa (in our country some attempts of its adaptation are undertaken), a questionnaire sovladajushchego behaviour
Hejma. In the given research R.Lazarusa and S.Folkman's questionnaire in T.L.Krjukovoj and E.V.Kuftjak's adaptation [102] is used.

Data gathering about the patients considered above personal features is carried out by clinical psychologists who work in medical institutions. These data can be used doctors at creation of educational speech texts.

Thus, the doctor addresses to the patient the pedagogical educational text. Starting with semiologicheskogo understanding of the given phenomenon, we understand the educational text as the verbal oral or graphically issued speech product created by the doctor and addressed to the person, addressed for medical aid. Such text is focused on formation at the person of representations about sense of conducting zdorovesoobraznogo a way of life, principles and rules of behaviour in the conditions of disease and treatment. It consists of a number of the specific educational speech messages logically among themselves connected, subordinates of the uniform purpose and possessing the certain stylistic colouring caused by features of the addressee, the sender, and also a situation of their interaction.

The educational text includes bioethical, biomedical and prognosticheskuju components. The composite interrelation of these components is caused by their maintenance and assumes consecutive transition from a component to a component in that order.

Necessity of the account in the course of creation of the educational text lingvokommunikativnyh aspects of educational activity, causes the account of features of the patient and the doctor. Age, cultural-educational characteristics of the patient, uneasiness level, ekstraversii, level of the subjective control, and also strategy most often used by the patient sovladajushchego behaviour should be taken into consideration. Also it is important to take into consideration the model of profession of a physician applied by the doctor.

<< | >>
A source: Vatskel Elizabeth Aleksandrovna. the Lingvodidaktichesky component of educational activity of the doctor. The dissertation on competition of a scientific degree of the candidate of pedagogical sciences. Moscow - 2018. 2018

More on topic 2.1. 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:

  1. an 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
  2. 2.2. The theoretical bases and algorithm of forming by the doctor of speech interaction with the patient in a context of realisation of educational function
  3. approbation of algorithm of educational speech interaction of the doctor and the patient
  4. § 1. An autonomy of the educational organisations in definition of the maintenance of formation
  5. types of cultural-speech behaviour of immigrants
  6. 3.1 Designing of the optimum maintenance, forms and methods of formation key educational kompetentsy at senior pupils
  7. § 2. Freedom of the educational organisations in a choice of uchebno-methodical maintenance and educational technologies
  8. THE CHAPTER II. EDUCATIONAL ACTIVITY OF THE DOCTOR AS PROCESS OF PURPOSEFUL FAMILIARIZING OF THE PATIENT TO CONDUCTING ZDOROVESOOBRAZNOGO OF THE WAY OF LIFE
  9. 1.3. The maintenance of the legal capacity of the higher institution of formation of the Ministry of Internal Affairs, in sphere of rendering of paid educational services
  10. 1.1. Formation of representations about the reasonable nature of the right