THEME 1.
METHODOLOGICAL APPROACHES IN CREATION OF INCLUSIVE SOCIETY
AND WORKPLACE.
THE BASICS OF DEFECTOLOGY AND VICTIMOLOGY FOR MEDICAL
PERSONNEL
PLAN
1. Philosophy of inclusion.
2. The history of inclusive practice.
3. Models of inclusion.
4. Signs and categories of social inclusion.
5. Fundamentals of defectology in the context of inclusion
6. Fundamentals of victimology in working with people with
disabilities
PHILOSOPHY OF INCLUSIVE
There are two directions of the socio-philosophical
approach to inclusion:
person-centred (W. Stern, W. James, K. Rogers, G.
Allport, A. Maslow, etc.)
socio-phenomenological (W. Dilthey, G. Nohl, E.
Spranger, T. Litt, E. Weniger, V. Flitner, K.
Mollenhauer, O. Bolnov and others)
Philosophical approaches are focused on
establishing respectful, spiritual, and responsible
relationships between people in the process of
dialogue communication
FEATURES OF A
PERSON-CENTRED
APPROACH
Personality is
characterized by such
aspects as:
 exteriorization is the orientation of
the individual to self-realization in
society
 internalization is the orientation of
the individual to internal interests
 transcendence is the focus of the
. on the highest spiritual
individual
values, the search for a personal life
mission
 exteriorization
 interiorization
 transcendence
The main idea is the possibility of individual development, contributing
to the building of an independent personality during the interaction
with society
FEATURES OF THE
SOCIOPHENOMENOLOGICAL
APPROACH
The goal of social
development is a
person who is included
in social relations,
having an expanded
supply of situational
patterns, social
behavior
BASICS of the CONCEPT
"situation" includes an
objective analysis of a life
situation
 "social and anthropological
factors" are factors that affect
a person (family, living
conditions, individual
character)
MAIN IDEA - PERSON CAN
CHANGE SELF IF THE IMPACT OF
SOCIETY IS TOLERANT
THE BEGINNING OF THE CONCEPT OF INCLUSION
DEVELOPMENT CONSIDERED FROM THE MIDDLE OF
THE 20TH CENTURY
LEGAL ORIGINS OF INCLUSIVE
Humanization of the world after World War II.
Creation of the UN
Adoption of the Universal Declaration of Human
Rights in 1948
Adoption of the Declaration of the Rights of the
Child in 1959
Adoption in 1989 of the Convention on the Rights
of the Child, ratified by 193 countries of the world
Adoption of the Convention on the Rights of
Persons with Disabilities in 2006
THE HISTORY OF INCLUSION
STAGES OF INCLUSIVE DEVELOPMENT
The beginning of the 20 century - the middle of the 1960s - the
"medical model" - segregation. Persons with disabilities in conditions of
exclusion..
Mid-60s - mid-80s of the 20th century - "normalization model" –
integration. Adaptation of person with disability to living conditions
The mid-80s of the twentieth century - to the present - the "inclusion
model" - inclusion in society . Adaptation of the social environment for
maximum inclusion of persons with disabilities in the life of society.
OVERVIEW OF DISABILITY MODELS*
Medical Model of
Disability
Economic model of
disability
Models of
Disability
Social model of
disability
Biopsychosocial
model of disability
*Professor Alina Zajadach, Adam Mickiewicz University, Poznań, Poland
MEDICAL AND ECONOMIC MODELS
Medical model
Economic model
Proposed by the American
sociologist T. Parsons in 1951.
The model is based on the idea of
usefulness for society.
The main idea is that disability is
connected to the individual features
of a given person and is above all
their own personal tragedy. Any
action undertaken (medical
treatment, physical rehabilitation) is
aimed to adaptation to the
environment.
A person with disabilities may feel
stigmatised in general if seen only
from the perspective of their
dysfunction.
Persons with disabilities are seen as
physically or mentally handicapped,
and able to work with “less workload”
than healthy people, or unable to
work at all. therefore, they are less
productive and economically
disadvantaged, require special state
protection (benefits, monetary
compensation)
SOCIAL AND BIOPSYCHOSOCIAL
MODELS
social model
Biopsychosocial model
Proposed by WHO 2011 (Oliver 1996;
Darcy 2010; Pegg 2011)
Proposed by George Engel in 1977, based on
the ideas of the sociologist Hoffmann
концептуальный подход, который
показывает, что инвалидность не
связана с индивидуальными
особенностями, а является
результатом существующих
ограничивающие факторы в
окружающей среде (включая
социальные и ментальные
барьеры), которые умножают
дисфункцию человека и
препятствуют его/ее участию в
полноценной жизни общества
suggests that to understand a person's
medical condition it is not simply the
biological factors that need to be
considered, but also the psychological
and social factors.
Bio (physiological pathology)
Psycho ( emotions and behaviours such
as psychological distress, fear, coping
methods)
Social (socio-economical, socioenvironmental, and cultural factors such
as: work issues, family circumstances and
benefits/economics)
THE CONCEPT, SIGNS, CATEGORIES OF
SOCIAL INCLUSION.
The term "inclusion" was declared in
1994 by the Salamanca Declaration
about а principles, policies and
practices in the field of education for
persons with special needs.
SOCIAL INCLUSION
• Inclusion is a process of real inclusion in the active life of
society of people who have difficulties in physical
development or mental disabilities.
• Social inclusion is the participation of all individuals in
society as successful members who are equally respected and
able to contribute to this society.
MAIN SIGNS OF INCLUSION
Respect
and
recognition
• it is the recognition of individuals with
disabilities and respect them. It includes
recognition of developmental
differences and does not compare
inferiority with pathology;
• supporting public institutions that are
sensitive to difference;
• Spread of the ideas of humanistic
philosophy and recognition of the
dignity of all people.
MAIN SIGNS OF INCLUSION
Human
development
• help develop skills, gives
opportunities and choices to live
lives that people value.
• this means providing opportunities
for learning and development for
all, recreational programs that aim
to promote and stimulate
development and personal
improvement, and not just looking
after people with disabilities
MAIN SIGNS OF INCLUSION
Involvement
and
participation
• these are laws that protect the rights and
necessary support of the individual in order
to take part in decision-making that
concerns the individual, family and life in
society.
• the state grants persons with disabilities the
right to participate in public life, in those
manifestations in which they want to take
part.
CATEGORIES OF SOCIAL INCLUSION
A person with
an inferiority
•this is a person with certain
psychophysical characteristics that
limits their capacity.
Disability
•it is an injury or illness that lasts
for a long time and as a result
of which a person becomes
different from others and
society determines their status
as a disabled person.
Inclusion
•it is a process of increasing
the degree of participation
of all people in a full-fledged
social life, regardless of their
characteristics
INTEGRATED APPROACH BY V.M.
BEKHTEREV
• V. M. Bekhterev
(psychiatrist, neurologist,
physiologist, psychologist)
was a supporter of an
integrated approach to
the study of man.
• The main idea of
Bekhterev was the need
for the relationship of
individual’s behavior with
the behavior of other
people.
THE THEORY OF EMOTIONAL
DEVELOPMENT G.YA. TROSHIN.
Ideas of the theory of anomalous
development:
- recognition of the potential of the
psychological development of an
abnormal person;
- reliance on the unity of the laws of
normal and abnormal development;
- a holistic study of person;
- it is necessary to focus in medical
care for people with disabilities not
on a defect, but on the compensatory
capabilities of the individual.
AUTHORS OF DEFECTOLOGISTS
Louis Braille (1809-1852), French
tiflopedagogue.
Hauy Valentin (1745–1822) –
French educator
alphabet for the blind
teaching methods for the blind
AUTHORS OF DEFECTOLOGISTS
MONTESSORI Maria (1870-1952) - Italian teacher, creator of a free system of
preschool education for children with various disabilities
DEFECTOLOGY
Defectology is a branch
that studies deviations in
mental development
(congenital and
acquired), and ways to
compensate for them.
an integrated field of
scientific knowledge that
connects the clinicalphysiological and
psychologicalpedagogical areas of
research into the
development processes,
training and education
of people with special
needs of psychophysical
development
CATEGORIES OF DEFECTOLOGY
Term
Definition
Correction
A system of psychological, pedagogical, medical and
social measures aimed at correcting or reducing
physical and (or) mental defects
Compensation
Compensation for lost functions and condition through
restructuring or increased use of preserved functions
Adaptation
Adaptation of the individual to existence in society in
accordance with the requirements of this society and
their own needs, motives and interests
CATEGORIES OF DEFECTOLOGY
Термин
Определение
Rehabilitation
Restoration of impaired functions of the body and ability
to work, achieved by using a complex of medical,
pedagogical and social measures
Habilitation
The initial formation of a disturbed ability to do
something (applied to young children with special needs
of psychophysical development)
Socialization
is the process of internalizing the norms and ideologies of
society. Socialization encompasses both learning and
teaching and is thus "the means by which social and
cultural continuity are attained"
L.S. VYGOTSKY, AUTHOR OF
DEFECTOLOGY
Vygotsky's citation
«…defectology studies
development, which has
its own laws, its own
pace, its own cycles, its
own disproportions, its
own metamorphoses, its
own displacement of
centers, its own
structures; that this is a
special and relatively
independent field of
knowledge about a
deeply peculiar subject».
GENERAL PATTERNS OF COGNITIVE
DEVELOPMENT
L.S. Vygotsky formulated the general patterns of cognitive development
1.
Integration is the unification of mental processes that were disparate at
the beginning into stable, but flexible functional systems.
2. Irregularity of mental development.
For each mental function, there are optimal terms (sensitive periods).
 0-1 years - perceptions
 1-3 years - memory
 2-5 years – forth
 preschool age - visual forms of thinking and imagination.
 School age - verbal-logical thinking.
3. Normally, for each mental function, there are optimal terms for
development.
THE STRUCTURE OF THE DEFECT
ACCORDING TO THE VYGOTSKY
THEORY
Cause of
defect
Primary
defect
Secondary
defect system
Saved
Functions
COMPLEX DEFECT STRUCTURE
The defect structure includes 3 components:
1. Primary organic defect (genetic factor)
2. Hierarchical system of secondary defects. (visual
problems, psychological problems,
communication limitations, character traits).
3. Preserved functions (for example, good hearing).
L.S. Vygotsky introduced the concept of
"extrasensory", which means the hypercompensatory
work of preserved functions.
THE THEORY OF COMPENSATION IS BASED ON THE
IDEA OF THE POSSIBILITY OF COMPENSATION DUE
TO RELIANCE ON PRESERVED FUNCTIONS..
Compensation theory
Saved Functions
Prevention of
secondary defects
Correction of
secondary defects
Defect Compensation
by Strengthening
Preserved Functions
ACCORDING TO THE EFFECTIVENESS OF THE
ADAPTATION PROCESS, VYGOTSKY SINGLED OUT
THREE TYPES OF COMPENSATION.
real (ends with
overcoming the
defect)
fictitious (ends with
"flight into disease")
middle
VICTIMOLOGY IN THE CONTEXT OF
INCLUSION
Victimology (lat. victima - victim, lat. logos teaching) - an interdisciplinary field that explores
the process of becoming a victim of a crime.
Victimization – it is the ability, under certain
circumstances, to become a victim of a crime.
Victimization personality is formed as a result of the
influence of various factors.
Disability often leads to the fact that there are
prerequisites for the victimization of a person with a
disability.
FACTORS OF VICTIMIZATION OF
DISABLED PEOPLE
objective
subjective
• Stigmatization and negative
attitude towards people
with disabilities in society;
• discrimination, exclusion of
people with disabilities;
• low standard of living, lack
of money;
• physical helplessness.
• existential crisis;
• low self-esteem;
• self-doubt, selfconfidence, abilities;
• increased stress levels,
emotional instability,
pessimism;
• loss or decrease in
volitional activity
(aboulia).
SOCIO-GENETIC VICTIMOLOGY (PROF.
E.V. RUDENSKY).
the personality of a person with a disability - a victim of sociopsychological deprivation (restrictions)
adaptive gap syndrome (loss of adequate adaptability of the
personality)
social status of a person with a disability - a socially defective
person unable to overcome the adaptation gap
The disabled person has a deficit of social, psychological and
socio-psychological competence
DEFICIENCY IN SOCIAL AND
PSYCHOLOGICAL COMPETENCE
Subject
Autonomy:
initiative;
making decisions;
self-realization
Authenticity, control
from within
An object
Addiction:
expectation;
rejection of decisions;
subordination to others
External
control,
reactive response
STAGES OF REHABILITATION:
I.
convalescence,
II.
adaptation
(readaptation)
III.
resocialization
CONVALESCENCE
the stage of recovery
of the biological and
psychological
functions of the body.
The process of active
treatment is aimed at
eliminating painful
biological
(physiological)
pathological
manifestations.
ADAPTATION (READAPTATION)
Adaptation - adaptation of
the organism to the
conditions of existence.
There are 2 types
passive (adaptations to real
circumstances)
active (environment
changes)
Readaptation - adaptation
to living conditions at a new
functional level using
reserve, compensatory
abilities.
RESOCIALIZATION
resumption of
contacts of the
individual during or
after illness with
family, neighbors,
friends, exit from a
state of isolation
LECTURE 2. TECHNIQUES FOR BUILDING AN INCLUSIVE
ENVIRONMENT.
CONTENT
1. The concept of a barrier-free environment.
2. Categories of citizens in need of a barrier-free
environment.
3. Basic principles of a barrier-free architecture.
4. Methodology for creating a barrier-free
environment for people with disabilities and
reduce mobility
BARRIER FREE
Barrier Free is pertaining or
referring to structural or
architectural design that does
not impede use by individuals
with special physical needs.
McGraw-Hill Concise Dictionary of Modern
Medicine. © 2002 states in the online The Free
THE MAIN PRINCIPLE OF
THE “BARRIER-FREE
LIVING ENVIRONMENT”
is the accessibility of
residential and public
buildings and the social
environment for people with
disabilities.
ACCESSIBILITY
Accessibility is the degree to which a product,
service or environment is available for use to the
people that need it.
• For example, a person with visual
impairments cannot read printed paper
ballots, and therefore does not have access to
voting that requires paper ballots.
A change that improves access.
• For example, if voting ballots are available in
Braille or on a text-to-speech machine, or if
another person reads the ballot to a person
and recorded the choices, then a person
would have access to voting.
CATEGORIES OF
CITIZENS IN NEED OF
A BARRIER-FREE
ENVIRONMENT
person
with
reduce
mobility
(PRM)
—
generally accepted definition
for
people
who
have
problems with independent
movement, orientation in
space, obtaining information
and services.
A PERSONS WITH REDUCE MOBILITY
people with disabilities
children under 7
pregnant women
senior citizens
parents with prams
people with temporary trauma
people with heavy loads
PEOPLE WITH DISABILITIES
The Convention on the Rights of
Persons with Disabilities, adopted
by the United Nations
General Assembly is based on a
social model of disability,
and defines disability as including
“those who have long-term
physical, mental, intellectual
or sensory impairments which
in interaction with various
barriers may hinder their full
and effective participation in
society on an equal basis with
others“
INVISIBLE DISABILITY
invisible disabilities, also known as Hidden Disabilities
or Non-visible Disabilities (NVD), are disabilities that
are not immediately apparent, or seeable.
Some examples of invisible disabilities include
 intellectual disabilities,
 autism spectrum disorder,
 mental disorders,
 asthma, epilepsy, allergies, migraines, arthritis…
EPISODIC DISABILITY
People with health conditions such as arthritis, bipolar
disorder, HIV, or multiple sclerosis have periods of
wellness between episodes of illness.
During the illness episodes, people's ability to perform
normal tasks, such as work, can be intermittent.
INTERNATIONAL CLASSIFICATION OF
FUNCTIONING, DISABILITY AND HEALTH
• ICF is a classification of
components of health,
disability and functioning.
Under the functioning of
a person is meant not
only the full-fledged work
of all body functions and
the presence of all
anatomical parts of the
body, but also human
activity, which is
associated with
environmental factors
and personal factors of
the patient.
INTERNATIONAL CLASSIFICATION OF
FUNCTIONING, DISABILITY AND HEALTH
Domains* are described from the point of view of the
organism, individual and society through the following
parameters:
1. functions and structures of a body
2. activity and participation
3. contextual factors
*A domain is a practical and meaningful set of interrelated
physiological functions, anatomical structures, activities, tasks, and
areas of life.
HEALTH DOMAINS AND HEALTHRELATED DOMAINS
Organism's functions – are the physiological
functions of various body systems (including mental
functions).
Body structures – are the anatomical parts of the
body such as organs, limbs and their components.
Violations of the functions and structures of the body
– are “problems” arising in functions or structures
(significant deviation or loss).
HEALTH DOMAINS AND HEALTHRELATED DOMAINS
Activity is the performance of a task or action by an
individual.
Activity restriction – are difficulties in carrying out
activities that an individual may experience.
Participation – it is the involvement of the individual in
a life situation.
Restriction on Participation – are problems that an
individual may experience when involved in life
situations.
FUNCTION CODING
ICF-code=prefix+domain cipher+ score
functions (b)
Structure(s)
Activity and
participation (d)
Environmental factors
Example coding: b167.3
to indicate a severe
impairment in specific
mental functions of
language
HOW TO USE ICF
GROUPS OF PEOPLE WITH LIMITED MOBILITY
reduce mobility
group
RM № 1
RM № 2
RM № 3
RM № 4
Characteristics
People who do not have mobility restrictions, including
those with hearing impairments.
People whose mobility is reduced due to aging of the
body (old-age disabled); disabled people on
prostheses; blind, people with mental disabilities.
People using additional support (crutches, sticks) when
moving.
Wheelchair users.
ORGANIZATION OF A BARRIER-FREE
ENVIRONMENT
Ensuring accessibility consists in changing the environment of
person with disability. According to international terminology,
the environment can have different external influences on the
functioning and limitations of an individual's life: contain
barriers or facilitating factors
ENVIRONMENT PARAMETERS INCLUDE
THE FOLLOWING COMPONENTS:
barriers
facilitators
factors of the physical, social environment
that limit the functioning (presence of
obstacles on the way movements)
factors of the physical, social environment
that facilitate the functioning (ramp,
pictogram for the disabled, etc.)
PRINCIPLES OF ORGANIZING A
BARRIER-FREE ENVIRONMENT
Principle of «Universal
Design»
Principle of
«Reasonable
accommodation»
"REASONABLE ACCOMMODATION"
“is a necessary and
appropriate modification
and adjustments not
imposing a
disproportionate or
undue burden to ensure
a persons with disability
the enjoyment or
exercise on an equal
basis with others of all
human rights and
fundamental freedoms"
Accommodations can be religious, physical, mental or emotional, academic, physical,
or employment related and are often mandated by law.
SEVEN PRINCIPLES OF UNIVERSAL
DESIGN
UNIVERSAL DESIGN:
• The design of products and environments to be
usable by all people, to the greatest extent
possible, without the need for adaptation or
specialized design.
• Seven Principles of Universal Design may be
applied to evaluation of existing designs, guidance
of the design process and education specialists and
consumers about the characteristics of more usable
products and environments.
PRINCIPLE 1: EQUITABLE USE
The design is useful and marketable to people with
diverse abilities.
Guidelines:
1a. Provide the same means of use for all users:
identical whenever possible; equivalent when not.
1b. Avoid segregating or stigmatizing any users.
1c. Provisions for privacy, security, and safety should
be equally available to all users.
1d. Make the design appealing to all users.
PRINCIPLE 2: FLEXIBILITY IN USE
The design accommodates a wide range of
individual preferences and abilities.
Guidelines:
2a. Provide choice in methods of use.
2b. Accommodate right- or left-handed access and
use.
2c. Facilitate the user's accuracy and precision.
2d. Provide adaptability to the user's pace.
PRINCIPLE 3: SIMPLE AND INTUITIVE
USE
Use of the design is easy to understand, regardless of the
user's experience, knowledge, language skills, or current
concentration level.
Guidelines:
3a. Eliminate unnecessary complexity.
3b. Be consistent with user expectations and intuition.
3c. Accommodate a wide range of literacy and
language skills.
3d. Arrange information consistent with its importance.
3e. Provide effective prompting and feedback during and
after task completion.
PRINCIPLE 4: PERCEPTIBLE
INFORMATION
The design communicates necessary information effectively to
the user, regardless of ambient conditions or the user's sensory
abilities.
Guidelines:
4a. Use different modes (pictorial, verbal, tactile) for redundant
presentation of essential information.
4b. Provide adequate contrast between essential information
and its surroundings.
4c. Maximize "legibility" of essential information.
4d. Differentiate elements in ways that can be described (i.e.,
make it easy to give instructions or directions).
4e. Provide compatibility with a variety of techniques or devices
used by people with sensory limitations.
PRINCIPLE 5: TOLERANCE FOR ERROR
The design minimizes hazards and the adverse
consequences of accidental or unintended actions.
Guidelines:
5a. Arrange elements to minimize hazards and errors: most
used elements, most accessible; hazardous elements
eliminated, isolated, or shielded.
5b. Provide warnings of hazards and errors.
5c. Provide fail safe features.
5d. Discourage unconscious action in tasks that require
vigilance.
PRINCIPLE 6: LOW PHYSICAL EFFORT
The design can be used efficiently and comfortably
and with a minimum of fatigue.
Guidelines:
6a. Allow user to maintain a neutral body position.
6b. Use reasonable operating forces.
6c. Minimize repetitive actions.
6d. Minimize sustained physical effort.
PRINCIPLE 7: SIZE AND SPACE FOR
APPROACH AND USE
Appropriate size and space is provided for approach,
reach, manipulation, and use regardless of user's body
size, posture, or mobility.
Guidelines:
7a. Provide a clear line of sight to important elements for
any seated or standing user.
7b. Make reach to all components comfortable for any
seated or standing user.
7c. Accommodate variations in hand and grip size.
7d. Provide adequate space for the use of assistive
devices or personal assistance.
THE SYSTEM FOR CREATING AN ACCESSIBLE ENVIRONMENT FOR THE
DISABLED AND OTHER PEOPLE WITH REDUCE MOBILITY INCLUDES
THE FOLLOWING COMPONENTS
methodological (scientific knowledge, ideas, terminology, principles, etc.)
regulatory (laws governing the creation of a barrier-free environment)
financial (funding for the creation of an accessible environment);
expert (organizations, institutions and experts conducting expert assessment
of social infrastructure facilities);
public (public associations of disabled people and parents of disabled
children, patient organizations, etc.);
personnel (development of new professional competencies by employees).
STRUCTURAL AND FUNCTIONAL ZONES OF THE
OSI (PARTS OF THE OBJECT OF SOCIAL
INFRASTRUCTURE)
The area adjacent to the
building
Entrance(s) in the
building
Path(s) of movement
within the building
(including escape routes)
The zone of the intended
purpose of the building
(target visit to the object)
Sanitary accommodation
Site information system
(devices and means of
information and
communication)
ZONE 1 THE AREA ADJACENT TO THE
BUILDING
consists of the following functional and
planning elements:
 Entrance (entrances) to the territory
(adjacent to the building);
 Path(s) of movement within the
territory;
 Staircase (external);
 Ramp (outdoor);
 Car parks.
UNIVERSAL DESIGN
ZONE 1 THE AREA ADJACENT TO THE BUILDING
ZONE 2 "ENTRANCE(S) IN THE BUILDING"
The main functional and planning elements of
the "Entrance in the building" zone include:
 Staircase (outdoor)
 Ramp (external);
 Entrance area (in front of the door);
 Door (entrance)
 Doorway.
ЗОНА 1 «ТЕРРИТОРИЯ, ПРИЛЕГАЮЩАЯ
К ЗДАНИЮ (УЧАСТОК)»
состоит из следующих функциональнопланировочных элементов:
 Вход (входы) на территорию
(прилегающую к зданию);
 Путь (пути) движения на территории;
 Лестница (наружная);
 Пандус (наружный);
 Автостоянки и парковки.
ZONE 3 "PATH(S) OF MOVEMENT INSIDE THE
BUILDING (INCLUDING ESCAPE ROUTES)"
The main functional and planning elements of zone 3
"Ways of movement inside the building" are:
 Corridor (lobby, waiting area, gallery, balcony );
 Staircase (inside the building);
 Ramp (inside the building);
 Passenger elevator;
 Door (doors – if there are several on the same path of
movement);
 Escape routes (including security zones).
UNIVERSAL DESIGN
ZONE 3 "PATH(S) OF MOVEMENT INSIDE THE BUILDING (INCLUDING
ESCAPE ROUTES)"
ZONE 4 "ZONE OF THE INTENDED PURPOSE OF
THE BUILDING (TARGET VISIT TO THE
FACILIT Y)"
General requirements for service areas for citizens
provide for at least 5% of places for the disabled and
other MGN of the total capacity of the institution or the
estimated number of visitors (including when allocating
specialized service areas for MGN in the building).
UNIVERSAL DESIGN
ZONE 4 "ZONE OF THE INTENDED PURPOSE OF THE BUILDING (TARGET
VISIT TO THE FACILITY)"
ZONE 5 "SANITARY ACCOMMODATION»
The functional planning elements of zone 5
include:
 Toilet room;
 Shower/bathroom;
 Household room (dressing room).
ЗОНА 5 «САНИТАРНО-ГИГИЕНИЧЕСКИЕ
ПОМЕЩЕНИЯ»
К функционально-планировочным элементам
зоны 5 относятся:
 Туалетная комната;
 Душевая/ванная комната;
 Бытовая комната (гардеробная).
ZONE 6 "INFORMATION SYSTEM AT THE
FACILIT Y"
Media systems should be comprehensive – for all
categories of people with disabilities (visual, sound,
tactile).
Signs and symbols must be identical within the building,
the complex of structures, the area where the objects are
located; they must comply with regulatory documents on
standardization.
UNIVERSAL DESIGN
ZONE 6 "INFORMATION SYSTEM AT THE FACILITY"
UNIVERSAL DESIGN
A HEARING LOOP DESIGNED FOR INDIVIDUALS WITH REDUCED RANGES
OF HEARING
UNIVERSAL DESIGN
INFORMATION BOARD WITH PICTOGRAMS
Topic "Confidentiality in Medicine"
If the rule of truthfulness ensures the
openness of partners in social interaction the doctor and the patient, then the rule of
confidentiality is designed to protect
against unauthorized intrusion from the
outside. The information about the patient
that he transfers to the doctor or the doctor
himself receives as a result of the
examination cannot be transferred to third
parties without the permission of this
patient.
Medical secrecy is a medical, legal, socio-ethical concept, which
is a prohibition for a medical professional to provide third parties
with information about the patient's health status, diagnosis,
examination results, the very fact of seeking medical help and
information about personal life obtained during examination and
treatment. The prohibition also applies to all persons to whom
this information became known in the cases provided for by law.
The disclosure of medical confidentiality is the communication of
such information to at least one person (with the exception of the
patient himself, his legal representatives or medical staff involved
in the treatment of this patient). At the same time, it does not
matter to whom they became known: an acquaintance, a
colleague of the victim or strangers. Special rules apply to the
patient's family members. The disclosure of medical secrets can
be done both orally and in writing - in particular, by phone, by
publication in the press, etc.
The communication by a medical professional of
information about the state of health to the patient
himself does not constitute disclosure of medical
secrets from a legal point of view and does not
constitute a corpus delicti. For example, according
to article 5 of the Law of the Russian Federation
"On psychiatric care and guarantees of the rights of
citizens in its provision," all persons suffering from
mental disorders, when providing them with
psychiatric care, have the right to receive
information in an accessible form for them and
taking into account their mental state about the
nature of the available they have mental disorders
and the methods of treatment used.
Ethical aspects of medical confidentiality

Medical secrecy as an integral and mandatory part of
medical activity is one of the most important principles
in deontology and professional medical ethics. The
ethical norms of society assume that each person
should keep a secret entrusted to him by another
person. However, the concept of "secrets" is of
particular importance in the field of medicine, where
information about the patient, his current state of health
and prospects, and often about the person's future, are
closely related and intertwined (whether he will be able
to stay at his workplace after the end of the disease, will
he become disabled etc.). Many facts of personal life in
the process of treatment are transmitted by the patient
to the doctor as necessary for the diagnostic and
treatment process, therefore, the relationship between
people in society is significantly different from the
relationship between the doctor and the patient.
Ethical aspects of medical confidentiality
There is evidence that the concept of "medical
secrets" originated in ancient India, where the
aphorism acted in the confidential relationship
between the doctor and the patient: "You can be
afraid of a brother, mother, friend, but never a
doctor!" Since ancient times, the physician has
vowed to keep this secret and to keep this promise.
Medical secrecy also applies to the main postulates
of the Hippocratic Oath:
... Whatever during treatment - as well as without
treatment - I see or hear about human life from
something that should never be divulged, I will keep
silent, considering such things a secret ...
Legal aspects of medical
confidentiality
Unlike other concepts of deontology, medical secrecy is also characterized by the fact
that it simultaneously refers to legal concepts: the safety of medical secrets is
guaranteed by the state and is ensured by law by fixing certain prohibitions and legal
responsibility for its disclosure. The requirement to keep medical confidentiality is
guaranteed by the following international legal acts:
 Universal Declaration of Human Rights (art.12)
 International Covenant on Civil and Political Rights (article 17)
 Convention for the Protection of Human Rights and Fundamental Freedoms
(Article 8)
 Principles for the Protection of Persons with Mental Illness and the Improvement
of Mental Health Care, adopted by the UN General Assembly Resolution
(Principle 6)
 Lisbon Declaration on the Rights of the Patient (point "e") World Health
Organization Framework for Patient Rights in Europe (Section 4.1)
 The World Medical Assembly Principles for the Provision of Health Care in Any
Health System (Principle 6)
 Hawaiian Declaration II, approved by the General Assembly of the World
Psychiatric Association (item 8)
 Declaration on Ethical Standards in Mental Health Practice, adopted by the
General Assembly of the World Psychiatric Association (item 6)
 Council of Europe Convention for the Protection of Individuals with regard to
Automatic Processing of Personal Data (Article 6)
The content of the concept of "medical confidentiality"
The concept of "medical confidentiality" includes information: of a medical nature
(information about the presence or absence of any disorder, disease in a person,
about his diagnosis, as well as other information characterizing his state of health)
non-medical nature:
 information about the very fact that a person sought medical help (made an
appointment with a doctor, was at a doctor's appointment, called a doctor at home,
was hospitalized in a hospital, etc.) or underwent a medical examination or was
involuntarily hospitalized all other information obtained during examination and
treatment, including: anthropometric data, body characteristics, blood groups of a
citizen his behavioral features, details of intimate and family life, interests,
experiences, fantasies, memories, actions (committed and planned), addictions,
bad habits, relationships with others, etc.
 confidential information about the patient, his relatives, friends of the patient, if
such information became known to the doctor in the performance of his duties
Medical secrecy includes both information that a patient entrusted to a doctor or other
person when receiving medical care, and information that has become known to a
doctor or another person in connection with the performance of official and other
duties, including information obtained in the process of medical intervention, in the
provision of care. behind the patient, etc.

Submission of information constituting a medical
secret without the consent of a citizen or his legal
representative is allowed: for the purpose of
examining and treating a citizen who, due to his
condition, is unable to express his will; with the
threat of the spread of infectious diseases, mass
poisoning and injuries; at the request of the
bodies of inquiry and investigation, the
prosecutor and the court in connection with an
investigation or trial; in case of rendering
assistance to a minor under the age of 15 to
inform his parents or legal representatives; if
there are grounds to believe that the harm to the
health of a citizen was caused as a result of
unlawful actions. "
Free informed consent rule

The rights of patients in medical interventions are protected not only by the
observance of the rule of truthfulness and the rule of confidentiality, but also
by the rule of voluntary informed consent.

According to this rule, any intervention, including when conducting
experiments on humans, must include the patient's voluntary consent. In
turn, the doctor and nurse should inform the patient about the goals,
methods, side effects, possible risks, duration and expected results of the
study.

It is the moral duty of the nurse to inform the patient of his rights. Considering
that the function of informing the patient and his relatives is primarily vested
in the doctor, the nurse has the moral right to transmit professional
information only with the agreement of the attending physician as a member
of the team serving the patient.

For the first time, the rule of "voluntary consent" is formulated in the
Nuremberg Code (1947) - the first "Code of practice on conducting
experiments on humans." Then the principle of "free consent" began to be
taken into account in the United States in the proceedings for compensation
for harm in case of negligent treatment. The term “informed consent” took
root in Europe 10 years later. In practice, a situation of natural inequality
really develops between the doctor and the patient. The patient, not
possessing special medical knowledge, entrusts his life to the doctor.
The legal protection of the patient eliminates this inequality, and
the principle of free informed consent reinforces new norms of
the relationship between the doctor and the patient. This is
reflected in Russian legislation in the Constitution of the Russian
Federation "... No one can be subjected to medical, scientific or
other tests without voluntary consent," in the "Fundamentals of
Legislation of the Russian Federation on the Protection of
Citizens' Health" A necessary precondition for medical
intervention is informed voluntary consent of the citizen "," The
right of citizens to information about the state of health. " The
concept of voluntary informed consent enshrines the doctor's
obligation to inform the patient, as well as to respect the patient's
privacy, to be truthful and to keep medical confidentiality on the
one hand, but on the other hand, this principle obliges the doctor
to make the patient's subjective decision for execution. The
incompetence of the patient can render such a model of the
relationship between the doctor and the patient sterile and even
harmful to the patient himself, as well as cause alienation
between the patient and the doctor.

The competence of the patient or subject is a prerequisite for
participating in the informed consent procedure. The law
establishes a fairly simple rule that presupposes two states the competence of the patient or the subject, or
incompetence. Persons under 15 years of age are recognized
as incompetent, as well as citizens recognized as legally
incompetent. The right to give informed consent from an
incapacitated patient is transferred to his legal
representatives.

A positive feature of voluntary informed consent is that it is
aimed at protecting the patient from the experimental and test
intentions of the doctor and researcher, at reducing the risk of
causing moral or material damage. At the same time, in a
situation where harm has occurred, although a voluntary
informed consent was issued between the doctor and the
patient, it is a form of protection for the doctor, weakening the
legal position of the patient.