Professional competence and individual style of activity. Motivation factors for the work of nurses in medical facilities and the main directions for its increase Model of work of a nurse personality activity communication

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State budget educational institution

middle vocational education Moscow city

"Medical School No. 30

Department of Health of the City of Moscow"

(GBOU SPO MU No. 30)

Extracurricular independent work

Professional competence and individual style of activity

(textbook for self-training of students)

Discipline: "Psychology"

Section: "General psychology"

2013

Introduction ………………………………………………………………………3

Professional work …………………………………………………….4

Classification of professions………………………………………………...4

Specialist model ………………………………………………………….5

• Psychogram
• Laborogram

Levels of professionalism……………………………………………………7

• Preprofessionalism
• Professionalism
• Superprofessionalism
• Unprofessionalism (Pseudoprofessionalism)
• Postprofessionalism

Becoming a professional………………….……………………………8

Professional community and professional environment………………9

An obstacle to professionalism………………………………….10

• Types of aging
• Fatigue
• Overwork
• Professional crises

Professional activity………………………………………………………………………13

• The labor of a nurse
• Model of work of a nurse
• Psychological aspects of labor
  nurses - head
• Mental aspects of work
  Nurses - teachers

Relationship Models medical workers and the patient ....... 16

• engineering model
• collegiate model
• Contract model

Psychological preparation of a nurse………………………………….18

• Causes

Conclusion…………………………………………………………………..19

References…………………………………………………………20

Introduction

Professional competence and individual style of activity

In primitive society, there were no problems in choosing a profession, since a person knew how to do everything necessary for life himself - to get food, fire, make clothes, etc. With the development of human society, a gradual division of labor took place: first into cattle breeding and agriculture, then crafts and trade appeared. With the development of material and spiritual life, the activities of people became more complicated. Now the number of professions and specialties exceeds 40 thousand.

professional labor

Man exercises different typeslabor - from self-service and execution to creativity. Labor can become a means not only of maintaining existence, but also of self-expression, self-realization, search, search and achievement.

Two sides of A.K. Markova

Object of labor (the structure of the profession, the normative indicators of the operational and technical structure of the profession. This is an objective composition of labor activity that does not depend on a particular person: the subject of labor, actions and operations, means, conditions.

Subject of labor (psychogram) - these are the psychological characteristics that a particular person needs to master professional standards and effective implementation labor.

Classification of professions

There are different types of job classifications. For example, the distribution of professions by the first letter of their name. The best way answers the classification of professions, built not according to industry characteristics, but according to signs coming from a person. The most successful qualification was proposed by Academician E.A. Klimov, he identifies 5 main types of professions according to the object of labor.

By subject of work, types of professions

• person - person (teacher, doctor, journalist, investigator, etc.)
• man - nature (physiologist, agronomist, veterinarian, etc.)
• man is technology. These are professions related to production and maintenance (civil engineer, mechanics, pilots, etc.)
• man is a work of art. This is a visual, musical, literary and artistic, acting activity (writer, actor, antique dealer)
• a person is a sign system: signs, oral and written speech, notes, symbols (drawer, proofreader, sorter, etc.)

According to the subject of labor, i.e. requirements for the psychobiological characteristics of a person, it is possible to single out professions that requireabsolute suitability(certain, natural data are needed), and professions withrelative aptitude,where the lack of certain qualities can be compensated by motivation and experience.

Professional suitability - ethen the totality of the psychological and psychophysical characteristics of a person, necessary and sufficient for him to achieve, in the presence of special knowledge, skills, skills, socially acceptable

labor efficiency. In addition to abilities, professional suitability includes motivation, job satisfaction. A person has to constantly work on professional suitability, since the requirements of the profession are constantly changing due to its renewal.

Specialist Model

As the worker improves, he turns from a simple performer into a specialist, and later into a professional . Sometimes a person develops further, becomes an innovator,super professionaland enriches the profession. One of the areas of labor psychology is the development of a specialist model, which should reflect the volume and structure of professional and socio-psychological qualities, knowledge and skills, which together represent a specialist as a member of society.

The specialist model includes the following components:

Professiogram (description of psychological norms of requirements for the activity and personality of a specialist). Professiogram includes psychogram -description of psychological qualities desirable for the effective performance of professional activities and labor chart - job description. Professional and job requirements (description of the specific content of the specialist's activity). Qualification profile (a combination of the required types of professional activities and the degree of their qualification, qualification categories for payment).

Psychogram

• Motives, goals, objectives, needs, interests, attitudes, value orientations of a person, psychological positions.
• Professional claims, professional self-esteem, self-awareness of oneself as a professional.
• Emotions, mental states, emotional appearance.
• Satisfaction of a person with work, its process and result.
• Characteristics of the operational sphere of a specialist.

• Psychological knowledge about labor about the profession.
• Professional thinking, the opportunity to enrich the experience of the profession.
• Psychological actions, methods, techniques, skills, techniques of psychotechnology (in their influence on oneself and on other people).
• Professional abilities, professional learning openness to professional growth.
• Professional self-development, the ability to design and implement plans for their professional growth.
• Psychological contraindications (i.e. mental qualities that are absolutely or relatively incompatible with the profession), as well as qualities of absence that can be compensated.
• Lines of professional growth and lines of decay of professional activity and personality of a specialist, ways of their rehabilitation.
• The psychological side of labor can only be determined with the help of a psychologist.

Laborogram

• Purpose, mission of the profession, its role in society, focus on the person.
• Prevalence of the profession (typical institutions for this profession).
• The subject of labor in the profession is the side of the surrounding reality, which is affected by a person in the course of labor. Correct vision of the subject

labor is the first important step of professionalism.

• Professional knowledge.
• Activities, actions, techniques, skills, ways of working necessary to successfully achieve a result.
• The means of labor that a specialist uses to perform on the subject of labor.
• Working conditions, work and rest regime, sanitary and hygienic conditions, mental loads, workplaces.
• Organization and cooperation of labor, forms of individual group activity, types of professional communication, norms, fulfillment, subordination.
• The result (product) of labor is the changes that a person brings to the subject of labor: criteria for evaluating results.
• Possible levels of professionalism and qualifications ranks in the profession category and their pay.
• The rights of a representative of the profession psychological and social security, the presence of a favorable microclimate, social guarantees, wages and holidays, labor protection, the possibility of advanced training and retraining, forms of promotion and encouragement.
• Responsibilities of a representative of the profession competence knowledge of ethical standards compliance with professional and service tasks documentation maintenance job responsibilities.
• The positive influence of the profession is the possibility of self-realization.
• The negative aspects of the profession are important material real losses, the presence of stress, the limitation of time, the initial harm, the professional deformation of the personality and other psychological harm, the lack of professional growth, penalties.

Levels of professionalism

Professional is an expert:who has mastered high levels of professional activity, consciously changing and developing himself in labor, making his individual creative contribution to the profession. Having found its individual purpose, stimulating interest in society, increasing the prestige of its profession in society in the results of its activities. A person does not become a professional immediately A.K. Markova identifies the following levels of professionalism.

1. Preprofessionalism
2. Professionalism
3. Superprofessionalism
4. Unprofessionalism
5. post-professionalism

Preprofessionalism

At this level, a person works like a beginner, having not yet mastered the norms and rules of the profession. Everyone usually goes through this stage, but some people linger on it for a long time. Includes three stages:

I - initial acquaintance with the profession

II - adaptation in the profession

III - self-actualization: awareness of oneself as an individual, development of abilities for self-diagnosis, determination of one's capabilities and one's purpose in the profession.

Professionalism

Having mastered the norms of the profession, a person begins, achieves high results in it, and also begins to realize himself in the profession and develops himself by the means of the profession.

Superprofessionalism

At this level, a person goes beyond the profession and enriches it with his personal contribution. This level of professionalism most significantly affects the progress of society. Superprofessionals are ahead of their time, so often they have to overcome the resistance of society.

Unprofessionalism (Pseudo-professionalism)

At this level, a person outwardly actively works, but at the same time either allows marriage in work: either he devotes his whole life to work and at the same time distorts his professional and personal development, or pursues only the goals of personal prosperity. All this is a lack of professionalism.

Postprofessionalism.

This term refers to people of retirement age. There are different patterns of behavior in this period. A person can be an ex-professional or a mentor helping others become professionals.

Becoming a professional

The formation of professionalism is based on general mental development. In early and preschool age are laidhuman abilityto knowledge, to thinking (to common labor, etc.) at school age arise special (humanitarian, technical, etc.) in youth begin to take shapegeneral professional abilityto different types of professions) in adulthood are formed special professional abilities.The formation of a person as a professional is closely connected with this personality. In today's society, the following indicators are most conducive to becoming a professional. Following professional ethics. Individual social and economic responsibility. Internal control. Noise immunity and competitiveness flexibility and efficiency the ability to find new positive meanings in one's life and work. Internal dialogic personality. adequate self-esteem. Readiness for a differentiated assessment of the level of one's professionalism, etc. The psychological development of a professional means the emergence of new qualities in the human psyche of new knowledge, skills and abilities. Within the level of professionalism, a stage is distinguished adaptation it begins during the assimilation of vocational training and ends in the first 1 - 2 years of work activity (primary adaptation). When young nurses begin to work, the reality surrounding them can cause shock and lead to a condition frustration (experience of failure) and until you get tired of adapting to the new situation. The inability to adapt hinders the subsequent development of professionalism.

Professional community and professional environment

The adaptation period of a young specialist also depends on the professional community of which he becomes a member.

Professional commonalityis a social community, which is organized specifically for the effective solution of common professional tasks. The interaction of people in a community is significantly influenced by the professional environment.Professional environment- this is a set of subject (subject, tools, means of labor, necessary actions, organization of labor, hierarchical relations) and social ( human relationships, microclimate) working conditions. In a professional environment, nurses are team members. The main goals of the professional activity of ensuring and maintaining the optimal life of the patient cannot be achieved alone. The social subsystem is created by members of a professional community, including a young specialist.The psychological climate isthe prevailing and relatively stable mental attitude of the team. According to this point of view, the psychological climate in the team is determined by the type of cooperative relationships between members of the professional community, according to another - by the personal relationships of people.

Psychological characteristics of a holistic professional community

Compatibility -optimal combinations of qualities of people, which ensures the greatest efficiency of activity.

Cohesion -consent, unanimity, mutual acceptance of people.

Harmony - the ability to coordinate actions in the process of joint work.

Stability The opposite of employee turnover.

competitiveness- jealousy, zeal, diligence.

organization- the ability of the team to act in an organized manner in a situation of uncertainty.

Obstacle to professionalism

The most common obstacle to professional development is age-related changes (aging). However, even before the onset of professional aging, a person faces other dangers of mistakes, failures, crises, etc. In professional activities, which can lead to premature negative phenomena in professional development. Knowledge of these dangers is necessary for the nurse to maintain performance and professional longevity.

Types of aging

Biological aging of the body -associated with the wear of its individual systems.

Social psychological aging- this is a weakening of intellectual processes, motivational functions, an increase or decrease in emotional excitability.

Occupational aging- this is immunity to the new, the use of stereotypes, the violation of partnership, aging is not inevitable, and professionalism has no absolute relationship with a person's age.

Proper aesthetic aging- there is an inability to understand young people, in contrasting generations, etc.

Fatigue

May lead to deformation of professional development.

Fatigue - This is a condition caused by hard work and associated with a decrease in efficiency. It can be physical (muscular) and neuropsychic. Recovery from fatigue begins when work is interrupted, reduced in intensity, or changed in character. Research shows that many short breaks are better than a few long ones.physical fatiguebecome a consequence of the depletion of energy reserves and the accumulation of lactic acid (fatigue substance). Neuropsychic fatigue - leads to a decrease in performance due to violations of the central nervous regulation.

Neuropsychiatric fatigue causes

• Prolonged mental work.
• Hard physical labor.
• Monotonous work in a monotonous rhythm.
• Noise, poor lighting, temperature, unfavorable for work.
• Conflicts of preoccupation or lack of interest in work.
• Illness, pain, malnutrition.
• Fatigue of central origin, unlike muscle fatigue, can disappear instantly under certain conditions:
• One tiring activity is replaced by another
• The environment is changing
• There is a state of anxiety with fear or threatening danger
• Interest in the work is renewed thanks to new information
• Mood changes

Overwork

When it occurs personality changes (conflict, irritability, increased emotionality). With severe overwork, aggressiveness and high personal anxiety become personality traits.

tension

Not all people have the same performance fluctuations. Some (Larks) work vigorously in the morning. Others (owls) in the evening. It is useful for each person to know the individual rhythm of working capacity in order to rationally combine periods of work and rest and maintain health for a long time.

mental tension- is caused by difficult conditions of activity, conflicts, an unfavorable forecast for the development of events and is accompanied by a feeling of discomfort, anxiety.

Chronic emotional tensionleads to the development of personality traits similar to signs of overwork can lead to burnout syndrome.

Professional crises

These adverse events can occur repeatedly during the life of any person. They are at different stages of primary adaptation to the profession, when moving to an adjacent specialty. Crises can occur for internal reasons when a person reconsiders his values ​​and motives (why I work). Crises are natural, but if a person fails to cope with it, then personal deformations can occur - a distortion of the personal profile as a result of the extinction of positive attitudes, attitudes towards other people. Nursing profession involves the development of deformations. The main factors are: Constant communication with sick people. Diseases that are difficult to control by the authorities that create a feeling of influence on the dignity of fate, and even the lives of other people.

Occupational diseases

These are chronic or acute diseases as a result of exposure of the employee to harmful factors and resulting in temporary or permanent loss of his professional ability to work. Nursing is referred to as an occupational risk factor. These are neuro-emotional loads and physical efforts, a forced working posture, etc.

Occupational safety is provided by the following psychological qualities of an employee

• Physical health, endurance.
• Ability to quickly mobilize.
• A combination of achievement motives with safety motives.
• Possession of self-regulation techniques.
• Good professional training.
• Willingness to take justified risks.
• Experience, experience.
• Sustainable professional ability to counter emergency, traumatic and stressful situations.
• Experience in communicating missing qualities with existing ones.
• Caution, responsibility, relevance, punctuality, etc.

Psychological features of the work of a nurse

• Nurse's work model.
• Psychological aspects of the work of a nurse providing nursing care.
• Psychological aspects of the work of a nurse-leader.
• Psychological aspects of the work of a nurse-teacher.
• Models of relationships between medical workers and patients.
• Psychological training of a nurse.

Professional activity

Represents the professional activities of a nurse. According to modern theoretical concepts, the nursing process is the basis of patient care; it includes:

Subjective and objective examination of an individual, family, group

Goal setting and nursing intervention planning

Evaluation of results

The professional activity of a nurse can be viewed as a sequence of stages:

Analysis of the problem situation (managerial, pedagogical, etc.)

Formation of an existing or potential problem

Setting goals and planning activities

Implementation of the plan

Evaluation of results

The labor of a nurse

This is a complex mental system that combines various levels, created from the manifestation of personality-activity - communication, united by a single task - achieving the optimal level of the patient's life.

Model of work of a nurse

external society becoming

contribute to the following indicators.

Model of work of a nurse

Model of work of a nurse

Nursing as a form of activity belongs to the professions of the “person-to-person” group, according to the conditions, it is considered work in conditions of increased responsibility for the life and health of people. WHO defines 4 functions of a nurse.

Nursing care and guidance.This includes health promotion, disease prevention, treatment, rehabilitation, or support for individuals, families, and groups.

patient education,clients and staff of health care facilities. This includes the provision of information on health promotion and disease prevention.

Acting as an effective member of an interdisciplinary team. Thisinvolves effective collaboration with others.

Development of nursing practice critical thinking and scientific developments.This includes the development of new methods of work defining the scope of research, the participation of nurses in such research.

Based on these functions, the professional roles of a nurse can be defined:

• Nurse Practitioner
• Nurse - manager, leader
• Nurse teacher
• Nurse member of an interdisciplinary team
• Nurse - Scientist

Wherever a nurse works, her work can be described as a combination of professional activities, professional communication, professional personality.

Psychological aspects of the work of a nurse providing nursing care

The health worker always has a strong influence on the psyche of the patient, and the only thing that he can freely choose is to influence him in a positive or negative sense, for the benefit or harm of the patient. The specifics of the professional work of a nurse is that:

• Labor is focused on a sick person, the extreme complexity of which is determined by the peculiarities of the functioning of his physiological systems during the period of illness, as well as the violation of social ties. The personality of the patient changes and is supplemented by those features that bring the disease into it.
• The nature of the nurse's behavior can influence the course of the disease and the patient's condition.
• The nurse's lack of knowledge, skills and professional communication skills makes her absolutely professionally unsuitable.

Psychological aspects of the work of a nurse - head

In our country, the head nurse has toto operate in difficult conditions of instability, scarcity of resources and limited staff capacity. Henry Minberg divided by 3 large groups roles assumed by leaders

• interpersonal
• Informational
• Roles with decision making

Interpersonal Roles

These are roles when working with people.

• The first role is the face of the organization. The leader represents the organization in official areas.
• The second role is liaison (implementation of internal and external contacts).
• The third role is the leader who manages within the organization.

Information roles

These are roles when working with information. Here the leader is in the role of the recipient of information (receiver) to control the transmitter of information within the organization; In the role of a representative of the conveyor of information.

Making decisions

This is the role of an entrepreneur - a person makes decisions aimed at the development of the organization. The role of a stabilizer is the ability to prevent problems. The role of the distributor of resources - temporary, financial. The role of the decision maker during negotiations with other organizations.

Professional communication

Professional communication of a nurse refers to the process of establishing contacts between a nurse and the subjects of communication (patients, their relatives, colleagues, etc.). Allocate communicative, interactive, perceptual communication.

According to the scheme of Robert Kash, a successful leader must have

Mental aspects of work
Nurses - teachersin the new concept of nursing to the nursethe role of not only the performer, but also the teacher-educator. The last function is defined as the education of patients and their relatives of the staff of the medical and prophylactic institution, students and schoolchildren.

Models of relationships between medical workers and the patient.

The models of the relationship between health workers and patients of the American doctor Robert Wies are quite widely known.

• engineering model
• Paternalistic (father) model
• collegiate model
• contract model

• Contract model

engineering model

The doctor and nurse restore some functions and eliminate breakdowns in the patient's body. The interpersonal aspects of relationships are almost entirely ignored. This model may prevail in X-ray rooms, intensive care units, etc.

Paternalistic (with lat-father) model

Medical staff treat patients like parents. Doctoror the nurse themselves determine what is good for the patient, make important decisions for the patient and, accordingly, take on most of the responsibility.

In the first two models, the relationship between health workers and the patient is built according to the subject-object type, which can lead to mutual deformation of personalities.

collegiate model

Complete mutual trust of the medical staff and the patient. The health worker works with the patient as if he were a colleague. For example, in some chronic diseases, the patient must be prepared to assess his condition and provide self-management.

contract model

In rare cases, it may look like a legally enforceable contract with the patient.

Contract model

It is a combination of positive features of collegial and contract models. The contract is based on the principles of mutual trust and cannot be terminated by the health worker unilaterally.In the last three models, the subject prevails - the subjective type of relationship, which makes them preferable. Such relationships contribute to personal growth and patients, health workers

Psychological preparation of a nurse

The reform of nursing, the emergence of new areas of activity and the gradual change in the status of a nurse require professional training in the field of theoretical and practicalscientific psychology.However, the training program in medical schools and colleges is structured in such a way that nurses' knowledge of the mental properties and states of the individual, the structure of communication, and the ability to act in critical situations are not used in practical activities. This may be due to a number of reasons.

Causes

• Lack of teaching aids for basic nursing
• preparation.
• Insufficient number of qualified psychology teachers with both nursing and psychological specialties, as well as practical work experience.
• Lack of motivation among students and then practicing nurses for self-knowledge and self-development.
• Misunderstanding by senior and middle-level managers, some doctors of the need psychological knowledge and skills for any nurse.

Conclusion

Professional competence and individual style of activity. It consists of a core and a so-called extension; they include different systems of techniques, methods of methods, determined by the individual-specific qualities of a person and being a means of effective adaptation to objective circumstances.

Professional competence is defined as a certain confirmed right of belonging to a certain professional group of workers, recognized by the social system as a whole and by representatives of not only a specific professional group, but also other social and professional groups.

An individual style of activity allows people with different individual typological features of the nervous system, different structure of abilities, character to achieve equal efficiency when performing the same activity in different ways.

Bibliography

N.N. Petrova textbook on psychology

Ostrovskaya I.V. textbook on psychology for medical specialties

Kuraev G.A. Pozharskaya E.V Developmental psychology

Panchenko L.L Adaptation to professional activity

Kondrashikhina O.A. Differential psychology

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

Thesis

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........................ Appendix................

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, a certain picture of the relationship between individual aspects of the motivational sphere of medical personnel today and the most effective methods neither the theory of management, nor the practice of personnel management can manage 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 for belonging to a social group - the need for kind and love 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 still impossible. In accordance with the concept of A. Maslow, a person must first satisfy the needs of more low level so that it can begin to meet 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 by 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 electric shock". 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 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 prospect; 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 - a dynamic approach, appealing mainly to energy (stressed system) or vector-opological characteristics motivated behavior, significantly narrows the scope of the conclusions obtained in the studies of the school of K. Levin. 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 realized 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 theoretical foundations when considering the issue of motives, motivation, the emphasis is on incentive, stimulation, people's needs, reward. 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 security 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 job and were called internal needs personality 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 interesting work which 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.

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, models of nursing behavior were reduced to a simple technical care for 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, in modern model 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.

Nursing as a form of activity on the object of labor belongs to the professions of the “person-to-person” group, according to the conditions - to work with increased responsibility for the life and health of people.

The World Health Organization (WHO) defines four functions of a sister:

Provide and manage patient care. This means promoting, preventing, treating, rehabilitating or supporting individuals, families and groups of people;

Education of patients, clients and health care staff 1 . This function includes providing information for maintaining health, health education, evaluating the results of educational programs, assisting nurses and other personnel in acquiring new knowledge and skills;

Activities as a member of the health care team. This function involves effective collaboration with others in planning, organizing, managing and evaluating nursing services as an integral part of the general health service;

Developing the practice of nursing through critical thinking and scientific development. This means developing new ways of working, defining the scope of research, participating in such research, and using accepted and appropriate cultural, ethical, and professional standards in nursing research.

Based on the listed functions, the following professional roles of a nurse can be defined: sister-practitioner, sister-manager, sister-teacher, sister-member of an interdisciplinary team, sister-scientist. Wherever a sister Works, her work can be described through a combination of three aspects: professional activity, professional communication, professional personality.

Professional activity includes the professional activities of the sister, aimed at achieving the patient's optimal level of life. The basis of the structure of professional activity is the nursing process (5 stages): analysis of the problem situation; problem formulation; goal setting and plan; implementation of the plan; evaluation of results.

Professional communication- the ability to establish and maintain contacts between the nurse and the subjects of communication

professional personality - psychological statuses embodied through self-consciousness and consciousness. This is the status of the individual, the product and condition of the development of which is temperament; the status of individuality, developing through character; the status of the subject, giving birth and generated by motivation; the status of an object, the product and condition for the development of which are organizational and communication skills.

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, it is extremely important to clearly motivate the activities of nurses in the changing management structure of medical institutions.

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 arouse a 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%); provision of benefits for payment of departmental housing and utilities(59%); voluntary medical insurance for personnel (44%); organization of subsidized meals (44%). Among the preferred forms 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 the 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. Expanding the hierarchical structure of health care institutions, creating opportunities career development and more differentiated pay 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 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.