Sezvo zvidzidzo zvakawanda pamusoro pehunhu hwekutungamira mumakosi eRAC aive nehupupuri hwakaderera, National Resuscitation C Council (NRCs) yakatanga ongororo kuti ione kana yakashandisa chero hunhu hwekuita mhando muEERC yakaratidza makosi uye nemabatirwo akaitwa padanho renyika kuburikidza nemidziyo yekupa mhinduro , yakakwirira kuvimbika manikins, simulation uye ekunze zvinhu.

 

SEPTEMBER 14, 2018 - European Resuscitation Council (ERC) manejimendi manejimendi mukudzidzisa rutsigiro rwehupenyu: ongororo kumatunhu eNational Resuscitation Councils (NHANGANYAYA)

Authors

• Renier Walter S [1], Khalifa Gamal Eldin [2], Krawczyk Paweł [3], Truhlář Anatolij [4] uye Raffay Violetta [5]
• 1 Dhipatimendi Rehutano Hwevanhu Nehutano (General Practice), KU Leuven, Yunivhesiti yeLeuven, Leuven, Belgium uye Belgian Resuscitation Council, Brussels, Belgium
• 2 Emergency and Disaster Medicine, Military Production Hospital uye Egyptian Resuscitation Council, Cairo, Egypt
• 3 Dhipatimendi reAnaesthesiology uye Kuchengetedza Kwakanyanya Mishonga, Jagiellonian University Medical College, Cracow, Poland
• 4 Emergency Medical Services dzeHradec Králové Region, Hradec Králové, Czech Republic uye Dhipatimendi reAnaesthesiology uye Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
• 5 Serbian Resuscitation Council, Novi Sad, Serbia

Nhoroondo uye midzi yehutano inogona kuteverwa shure kwemazana emakore apo mhizha dzakatanga kurongeka mumabato ehurumende anonzi masangano. Apo Shanduro yeZvishoni yauya, maitiro ekutanga maitiro ekugadzirisa akashandiswa semitemo inodzora chigadzirwa uye zvinogadziriswa. Sezvo vanhu vakawanda vaifanira kushanda pamwe chete kuti vabereke zvibereko uye zvigadzirwa zvakakura zvakakura, zvakanakisisa maitiro zvaidiwa kuitira kuti zvive nemigumisiro yemigumisiro.

Izvi ndezvechokwadi kune European Resuscitation Council (ERC) zvidzidzo. The 2015 ERC Mirayiridzo uye Consensus on Science ne Treatment Recommendations (CoSTR) pane Dzidzo, Kutevedzera uye Matangi [2] kusimbisa matanho anokosha anoponesa Basic Life Support (BLS) uye kukosha, kwehupamhi hwepamusoro cardiopulmonary resuscitation (CPR): kureva kudzikisirwa muyero, kudzika, kudzikama, uye kushomeka kwechipfuva kumanikidza. Pakanga pane yakaderera kusvika kumhando yepasi kwazvo yeuchapupu yakataurwa munenge zvidzidzo zvese zvinotarisisa hunyanzvi hwekutanga-chipatara hwekumutsiridza hunyanzvi. Mukuwedzera, heterogeneity pakati pezvidzidzo zvakare yaive iripo mune dzinenge zvese zvidzidzo. Zvidzidzo zvichangoburwa zvakasimbisa izvo zvakawanikwa.

Zvinhu zvakasiyana zvinokanganisa hutano hwekudzidzisa uye nekudaro CPR kutumira, uye zvakare pamusoro pekuvandudzwa kwemhando. Midziyo yekupa mhinduro, semuenzaniso iwo anoyera chipfuva kumanikidzwa panguva yekudzokorora kwekufungidzira, ipa mugumo wakanaka wekupedzisira-panzira pane kuraira kwekuraira wega. Kunyangwe, ichiri inogona kukanganisa. Munguva pfupi yapfuura Pavo et al. akacherekedza kuti kutungamirirwa kwevanhu kwakanakira senge meystem (nechidimbu) mhinduro. Cheng et al. akagumisa kuti kushandiswa kwepamusoro kutendeka manikins kwehupenyu hwepamusoro hwekutsigirwa kwehupenyu hwekudzidzisa kunosanganiswa chete nemabhenefiti ane mwero ekuvandudza kugona kwehunyanzvi pamhedzisiro yekosi, ichisimbisa zvawanikwa zveCoSTR. Kune nyika dzine mari shoma, dzisingakwanise kukwirisa manikins emhando yepamusoro, hutongi hwemakosi emakosi uye evarairidzi anogona kuvandudza mhedzisiro. Kufungidzira kunovandudza hunyanzvi uye ruzivo, asi hazvisi kuvandudza mhando nekuti chete makumi mashanu muzana emapoka matatu evatori vechikamu akasvikira pakugadzikana pachipfuva. Vanyori veCoiff vakashamisika zvakare kana vadzidzi vanogamuchira vega-yekuraira makosi vanofanirwa kuve nehunyanzvi hwekuita mukutamisa chaiko uyezve nekuvandudza mwero wekudzoka kwekutenderera (ROSC) uye kupona kuenda kuchipatara kuraswa kwevarwere kana tichienzanisa nevaya vari kugamuchira dzidzo dzechivanhu. Kunyangwe, munguva pfupi yapfuura, Yeung et al. chakaratidza kuti mhedzisiro iri nani nekubatanidzwa kwekuzvirayiridza uye kudzidzisa kumeso.

 

Unhu hunokanganiswazve nezvinhu zvekunze: kunaka kwehunyanzvi kunoderera mukati megore rimwe. Naizvozvo, ERC inokurudzira kukurumidza kudzokorora. Kunyange hazvo, iyo nguva pakati pekudzidzira haina kunyatsozivikanwa. Kuvandudza mashandiro asina kusimba eiyo Chain yekupona (semuenzaniso mamwe maCPR, vazhinji vakadzidziswa, vanoona zviri nani kufambiswa kweruzivo rwekukurumidza kufona, nezvimwewo), yaive, pamwe nekuvandudza mhando ye ALS neyekuvanzika kwekumuka kwekutarisira, yakabatana ne kuwedzera kupona mushure mekusungwa-kwechipatara kusungwa kwemwoyo (OHCA). Ichi chidzidzo, tichienzanisa nemhedzisiro yeiyo ERC Nongedzo shanduko pakati pa2005 na2015 dzakaona kuti kusungwa kunokatyamadza kwakaderera, kuti kwaive nevashoma vakasungwa vakapupurirwa, kuti kupindurana kwakawedzera asi asi kupona kuzere kwakawedzera, kunyanya muboka repasiripo rakapupurira VF / VT kusungwa pamwe nemwoyo aetiology. Zvidzidzo zvichangobva kuitika zvakasimbisa maitiro aya. Hatina kukwanisa kuziva chero pepa pane zvemhando yekutonga kweiyo ERC makosi kana pamusoro pekudzidzisa uye mhinduro yevarairidzi uye vatungamiriri vezvidzidzo. Kunyange zvakadaro, kukanganisika kweiyo mhando pakudzidzisa kwehunyanzvi panguva dzekosi kwakakosha sekushandisa simulation, yakakwirira kuvimbika manikins, mhinduro zvishandiso etc. Iko kuzvidavirira kwevadzidzisi kunoenderana nekupihwa kwavo chitupa uye bvunzo. Kudyidzana kwevanhu kuri kupesvedzera hunhu hwekuita semunyowani. Nokuda kwekusiyana kwezviitiko zvichienderana nezvakataurwa pamusoro apa uye kusavapo kweuchapupu pamusoro pehutano hwekudzidzisa nekudzidzira ivo, kunaka kwehutano, panzvimbo yekutaridzika kwehutano, zvinotenderwa. Tine chinangwa chekuziva kana National Resuscitation Councils (NRCs), vashandisi veE ERC, vanoita chero hutano hwehutano pamakambani uye, kana zvakadaro, iyo inoshandiswa sei, ndiani ane mhosva, kuti yakanyorwa sei uye chii chingaitwa kuti uvandudze hutsika hweE ERC zvidzidzo uye zvinoita kuti vadzidzisi vave nekugadzirisa mune zvidzidzo.

Ongororo pamusoro peNational Resuscitation Councils pamusoro pehupenyu hwekutsigira manejimendi - METHODI

MunaJanuary 2017 yose 33 NRC yakakokwa nemamwe maimeri akaendeswa kuNRC vanhu vanobatana kuti vazadze kuongorora kwekutsvaga pamusoro pehutano hwakanaka munyika yavo. Iyi tsvakurudzo yakaiswa pane ERC website. Kubvumirana kweshanduro yekupedzisira yeongororo yakasvika kuburikidza nenzira yeDelphi, isati yatumirwa kuNRCs. 

Mushure mekutsanangurwa kweNRC uye munhu anopindura, kuongorora kwakabatanidza mibvunzo gumi neshanu ine misoro minomwe. Mibvunzo mina yakanga iine huwandu, gumi chete inyanzvi, uye imwe yakavhenganiswa yakawanda uye inoenderana. Mibvunzo inotevera yakashandiswa:

•  Iko NRC yako inoita chero hutungamiri hwehutano pane zvidzidzo zveE ERC?
• Ndezvipi zvidzidzo zvaunofambisa?
• Ndiani ane basa rekudzora mhando?
• Yakarongeka sei?
• Ndiani ane kodzero yekuita uhu hwehutano?

Zvakanyorwa sei?

- NRC yako ine chero mahwendefa ezvinyorwa zvemashoko ekuchengetedza maitiro here?

- Ndezvipi zvakakwana kune hutano hwakanaka hunoitwa mumhando yega yega yemunyika yako? Ndapota, fungidzira uwandu hwehutano hwehutano kune zvese zvakarongwa (mu%).

- Ungada kuva nehutano hwekushandisa paIndaneti inoshandiswa muChete System (inofadza) (semhinduro kuburikidza nevadzidzi uye / kana vadzidzisi)?

- Mazano uye mazano pamusoro pehutungamiri hwekutengesa inowanikwa mumutauro unosanganiswa munyaya dzakanaka (semuenzaniso mhinduro nevadzidzi uye / kana vadzidzisi)?

• Iwe unofunga kuti zvivako zvakakosha zveE ERC (semuenzaniso maitiro emakambani emakambani ose) anofanirwa kuziviswa nezvekugadzirisa kwehutano hwakanaka hwakaitwa munyika yose here?
• Iko NRC yako inoronga chero zuva redzidzisi kana masangano okudzidzisa ERC uye / kana vatungamiri vezvikoro?

Mazano uye mazano pamusoro pekudzidzisa mazuva kana masangano okudzidzisa vaE ERC uye / kana vatungamiri vezvikoro

• Ko ERC inogona sei kusimudzira kutaridzika kwehutano munyika yako? Une mazano eE ERC here?

- Chero mimwe mhinduro?

Mhinduro dzese dzakabatanidzwa pakuongorora. Pamubvunzo wega wega, mhinduro dzakafanana kubva kuNRC dzakasiyana dzakawedzerwa pamwechete uye kurangana kusvika pakukosha kwavo (nhamba yemhinduro dzakafanana). Munyaya yekubatana munhu weNRC akabvumidza kupinda muongororo kune anopfuura munhu mumwe, mhinduro dzese dzakabatanidzwa asi dzakabatanidzwa kumhinduro imwe chete yenyika iyoyo. Kana pakanga paine mhinduro dzinopesana, NRC yakabvunzwa zvakare kuti itsanangure zvakadzama. Vaongorori vacho vakafananidza mhinduro dzakakodzera kuitira kuti dzive dzinodudzirwa mhinduro. Izvi zvainyanya kufananidzwa neAT. Kana pane kusava nechokwadi, muongorori wechitatu akabatanidzwa.

 

Kuongorora kwakapfuura National Resuscitation Kanzuru pane hupenyu hwekutsigira manejari - RESULTS

Makumi maviri nematanhatu kubva kune 33 NRCs (79%) (Mufananidzo 1) akatitumira 31 mafomu mafomu kumashure: imwe NRC yakatumira mafomu matatu ekupindura uye zvitatu zveNRC mbiri. Izvo zvaiva, sezvakatsanangurwa, zvakabatanidzwa kune imwe fomu yeNRC.

Quality management: Yakanga isina kuitwa muNRC mapfumbamwe (35% ye26 yaisanganisira NRCs). Zvikonzero zvaiva: haana kumbofunga nezvazvo (n = 2), hapana mazvipiri (n = 2), yakanga yakarongwa isingashandisirwi (n = 1), isina maitiro kana chigadzirwa (n = 1), haina kumbofanotaurwa kuita saizvozvo (n = 1) uye maviri NRCs haana kupa mhinduro (tafura 1). Makumi nemaviri NRCs akazivisa hutano hwekuita basa mu ERC courses (tafura 1). ALS uye BLS dzaive dzakafukidzwa kupfuura dzose.

Sangano uye mutoro wehutano hwehutano: Kwaiwanzo kutorwa neNRC (n = 5), dzimwe nguva nemudzidzisi wezvikoro (n = 1), mudzidzisi (n = 1), nedare rimwe (n = 2) kana mutungamiriri wehutano (n = 1). Mune dzimwe NRCs mutungamiri wenyika yose (NCD) ndiye munhu ane mutoro (n = 3), mutungamiri wemitambo (CD) (n = 3) oga kana pamwe chete nemutevedzeri wemutambo (CO) (n = 1). Kuenzanisa nhamba yemhando dzakasiyana dzinotarisirwa kumutungamiri wemutungamiri, mutungamiriri wehutano, NCD, komiti kana mudzidzisi anotarisirwa pakati pemashanu kusvika kumatanhatu emhando dzemhando, apo CDs neNRCs zvinongoita zviviri kana zvitatu chete.

Zvinyorwa zvakashandiswa: NERCs shanu dzakashandisa maitiro chaiwo (mafomu emhinduro kana mafomu ekudzora mashizha akavakirwa pane zvakatarwa neCD). Zvimwe NRCs dzakashandisa mhinduro yemibvunzo yemhando (n = 1), mushumo wechikoro (n = 3). Mune imwe NRC, NCD inotarisa nyaya yacho. Mishumo yakanyorwa pamapepa chete (n = 9), pamapepa akabatanidzwa neyemagetsi (n = 2) kana kusanganiswa nevhidhiyo (n = 2), kana kuti electronically chete (n = 1). Imwe NRC haina kuchengetedza chero rekodhi uye vaviri havana kupa mhinduro. Ndiwo mapfumbamwe chete aya anonzi 17 NRCs (53%) ane chirongwa chaiwo cheE ERC courses quality management.

Nhamba yemakambani anotarisirwa: Zvigumi nemashanu kubva kune 16 NRCs zvakapa kuongororwa, muzana, yehuwandu hwemhando dzeimwe rudzi rwakarongedzwa kuti ruve (Table 2). Nyika imwe bedzi haina kutarisira zvidzidzo zvakarongwa zveB BLS. Kunyange zvazvo, BLS neAlS ndiyo inowanzotarisirwa zvidzidzo (maererano ne9 uye 14 NRCs). Zvikamu gumi nemana NRCs zvinotarisira 62% yezvikoro zvose zveAls (range: 10-100%) uye 8 NRCs inotarisira 43% yevose Generic Instructor Courses (GIC) (nzvimbo: 50-100%). Mune dzimwe nyika mari yacho yakadzika (Tafura 2). IGermany NRC haina kupa kuongororwa pamadzidzo akadzikamwa. Saka, hazvigoneki kuziva kana ivo vanotarisira kana kwete. Kuongororwa kweDutch NRC kwakanga kusina kubatanidzwa nokuti mhinduro yacho yakanga isiri pachena: vakapa imwe chete yezvikoro zvose kunze kweEuropean Pediatric Intermediate Life Support (EPILS).

Nhare yekushandisa: Vane gumi nevatanhatu kubva ku26 vakapindura NRCs (94%) vakataura kudiwa kwekushandisa paIndaneti. NRC mbiri dzakapa "Hapana mhinduro" uye zvitatu hapana mhinduro. Vane vatanhatu kubva kune 11 NRCs vakaratidza kuti vangada kuva nepepanhau rekupindura kwevadzidzi, VAK, CD, Vadzidzi Vanodzidzisa (FI), Instructor Trainers (IT), vadzidzisi vekudzidzisa (IC) kana Vadzidzi Vanodzidzisa Vanodzidzisa (ITC). Zvine NRCs dzaida kuti kuwanikwa kwefomu yezvemagetsi kuve kwakanyatsonaka, kana kuti nyore kushandisa grid yekuongorora kana fomu, sezvaiwanika mune yekare yekambani yekushandisa (CMS). Imwe NRC yakabvunzwa zvakananga kune imwe yehutano yehutungamiri chekushandisa.

Supervision: Zvinomwe NRCs zvakabvumirana kuti Science neSchool Committee (SEC) inofanira kuziviswa nezvekambani 'hutano; hupfumi NRCs dzakasarudzwa kuzviita chete kana kune matambudziko. Mhinduro isina kunaka yakauya kubva kuNRC mbiri.

Mutungamiri weNyika kana wepasi rose kana CD zuva: NRC gumi nemitatu yakaronga pachavo zuva redzidzisi kana musangano wevarayiridzi ve ERC uye / kana vatungamiri vezvikoro. NRC mbiri dzakaronga. Imwe NRC yakataura kusakosha kwekuwanikwa kwevanhu kuti varonge uye mumwe akanga asina vadzidzisi. Apo yakarongeka, misangano yakaitika pakati peviri pagore kusvikira makore maviri ose. Inogona kunge iri musangano wezuva rimwe chete kana kwemazuva maviri. Vakaronga ndivo NRC kana imwe komiti. Zvinyorwa izvi zvinongorongedza unyanzvi 'zviratidzo, tsika, kuvandudza nekukurukurirana, kuitira kugadzirisa unyanzvi hwemaCD ose, maFIs uye vanyori vekudzidzisa. Uyezve, NRCs dzinotaura kuti dzinoda zuva redzidzisi paEuropean, uye dzakakumbira mamwe mahofisi pamusangano we ERC congresses. Vatatu NRCs havana kutaura.

Ko ERC ingaita kuti hutungamiri huve nani? Mhinduro dzaiva dzakasiyana kwazvo. Vashanu NRCs vakakumbira shanduro chaiyo nekusimudzirwa kwehutungamiri hwehutano uye vatatu vavo vakatsvaga kuongororongororwa nguva dzose nedare renyika dzakawanda kana vevatariri vekunze (kubva kune dzimwe nyika kuitira kuti varambe vakagadzikana nehuwandu hwemashoko) pamwechete nevamiririri veNRC. Kubatanidzwa kweNRCs muhutano hwehutano kunotarisirwa (n = 2).

Mazano maNRCs: ERC inofanirwa kunge iine kosi-chaiyo yekubatira maneja maneja uye nyore kushandisa zvivakwa zvine mutsindo (mhinduro mafomu…) kana chishandiso kuitira kuenzanisa kosi yekuita mukati meNRC uye zvakare pakati peNRCs (sezvaivapo kare). Vakurudzirawo kuvandudza kusapindurwa kwemhinduro nevatori vechikamu pafomu rekupindura kudzidza kwakabatanidza kuzadzikiswa kwefomu rekupindura nekutorwa kwechitupa chedzidzo.

 

Kuongorora kwakapfuura National Resuscitation Kanzuru pane hupenyu hwekutsigira manejari - KUSVIRA

Iyi tsvakurudzo yakaratidza kuti hutano hwehutano hwave huchienderera mberi muRC courses. Nhafu chete yeNRCs yakashandisa chero yehutano yekushandisa ye ERC zvidzidzo. Iviri chete NRCs yakashandisa fomu yakarongeka yehutungamiri fomu.

Takazokwanisa kusvika ku79% mhinduro yeNRCs, nhengo dze ERC. Nokudaro, tinogona kugumisa kuti izvi zvitsva zvinotsvaga zvinomirira maonero ose.

Kurongeka kwehutano kwakanyanya kuitwa paB BLS, ALS uye Generic Instructor zvidzidzo. Ihutungamiri hwehutano mukati meE ERC nhengo dzenyika haisi yunifomu. NRC imwe neimwe yakashandisa mapepa akasiyana-siyana kana mafomu emagetsi, kana vanhu vazhinji vanogona kutarisira hutano; vanhu ava vaiwanzobatanidzwa mune zvidzidzo. Zvinosuruvarisa, isu tanga tisina mvumo yekuona mienzaniso yezvishandiso kana zvinyorwa zvinoshandiswa mukugadzirisa kwepamhando kana mamwe maitiro emhando dzose dzemhando kana yemhando yekudzidzisa.

Ikoko kunoratidzika kuva nehukama pakati pehutano hwehutano hwehutano hwehutano muNRCs uye nhamba yemhando dzemhando dzakachengetedzwa: yepamusoro yepamusoro (inhengo komiti uye yakafanana), iyo yakawanda yemhando dzakarongeka. Nyika zhinji dzakafunga kuti kuisa mutungamiriri wehutano kunofanira kuva danho remangwana. VaDutch NRC havana kunyora kuwandisa: naizvozvo hatina kukwanisa kutsanangura kuti mangani emitambo yemhando imwe yemhando yakarongedzwa.

Zvinyorwa zvakarongedzwa zvakapa ruzivo pamusoro pekuti maitirwo acho akaitwa sei, nzvimbo uye / kana zvidzidzo zvayo. Icho chakanga chisine chizivo chinangwa pamusoro pekushanda kwe CO, CD kana vadzidzisi. Kunyange zvazvo, kushanda kwavo pakudzidzisa uye / kana unyanzvi kana unyanzvi 'kuratidza kune zvakakosha kune unyanzvi hwevadzidzi uye ruzivo.

Inenge yose NRCs inotarisira fomu yemagetsi yehutano hwavo hwehutano. Pane chido chekusika kwechigadzirwa chakadaro neE ERC. Inofanira kunge iri yakakwirira uye iri nyore kushandisa fomu, yakashandurwa kune imwe yerudzi rwechikwata uye yakabatanidzwa muChozy. Migumisiro inofanirwa kuwanika kune NRC kana NCD inokodzera nekusarudza kushandiswa kwevamwe mapato mune zvinodiwa, kureva SEC yakakodzera. NRCs inotarisira rubatsiro rwekunze chete mumatambudziko anonetsa. Kana hutsika huri kutarisirwa uye husingatungamiri, izvi zvinoderedza nRCs 'kutya kwekupindira kwakanyanyisa.

Kune NRCS ine ruzivo rwekuongorora mabhizimisi ERC nevamwe vanhu vanobva kunyika kana kubva kune dzimwe nyika. Zvinosuruvarisa, havana kushandisa yunifomu uye fomu chaiyo. Mimwe yemigumisiro yemabhuku akaongororwa uye mitsara inoenzaniswa kubva kune imwe NRC kune imwe. Zvizhinji zvezvakaitika zvayo hazvina kuongororwa mu situ kuburikidza nevatariri vanozvimiririra, izvo hazvisi maererano nemitemo yekuongorora. NRCs yakataura mazita emhinduro dzakasiyana kana mitsara, kupa pfungwa yakanaka asi isina kukwana pamusoro pehutano. Kushingairira chiyero chinokosha chehutano [16,17], asi kushingaira kana kusagutsikana kwevatungamiri, vadzidzisi kana kuti vakatsvaga vanovhenekera zvidzidzo zvadzo nekutendeseka, nechokupedzisira ichi chinhu chinokosha pakuyera maonero avo pamhando yakagadzirwa [19]. Nemhaka yehuviri ihwohwo, vanocherechedza vanozvimiririra vanodikanwa.

Imwe nyanzvi inotsvaga inongorongedza zvakarongeka hutsika hunovaka mune imwe nzira uye inofanira kuitwa nevanopinda mavanze vepamberi kana vekunze kana yeboka rekuongorora, panguva dzakataridzirwa uye zvichibva pamagariro anozivikanwa anoongorora [19]. Kuongorora kune imwe yenzira dzakasimba zvikuru dzekuongorora uye nzira inobatsira yekudzivisa kusava nehanya uye kusimbisa zvishoma nezvishoma kuora kwemaitiro, kunyanya apo kuongorora kunongotarisa kwete kungoteerera asi kubudirira [20]. Nokudaro, kukurudzirwa nekugadziriswa kwezvivako zvitsva mukugadzirisa kwehutano, zvichibva pamagwaro akanyorwa uye zvinyorwa zvakajeka, zvinofanira kutanga. Vaya vaizoshandira kubhadhara kwakadai hazvizove zvakabatanidzwa mukuitisa zvidzidzo asi vaizoita semuviri wakazvimiririra mubato revatariri vemunharaunda nekunze.

Imwe midziyo yekutarisira yakanga yakatogadzirwa neE ERC yehutano hwekushanda yeboka uye yakakurukurwa munguva yeE ERC Course Director Day mu2017 neNCDs iripo pamusangano. Mushure mokunge mhinduro dzakabvunzwa uye nekuda kweizvozvo, boka rekushanda rakagadzira rugwaro rwekupedzisira. Kuti uwane hukama hwakanaka muNRC yose, mumwe anoda mutevedzeri, nyanzvi inobatsira kutarisira kwakanaka, inokwanisa kunzwisisa uye kuita mabasa ehutarisiri wehutano kuitira kuti buri NRC iwedzere mukuraira kwehutano hwavo basa. Uyu munhu anofanira kushamwaridzana neE ERC yehutano hwekushanda kweboka kusvikira boka rimwe nerimwe reNRC richikwanisa kuva nomurongi wavo kana boka rakanaka.

Simba rekudzidza iyi nderokuti takakwanisa kuratidza kukosha kwekushandisa nekugadziriswa kweE ERC zvidzidzo zvehutano. Kunewo zvimwe zvisingakwanisi. Takanga tisina mvumo yekuona mienzaniso yezvishandiso kana zvinyorwa zvakashandiswa kutaridzika kwemhando kana mamwe maitiro emhando dzose dzemhando kana pamusoro pehutano hwekudzidzisa. Chero 13 NRCs yakaronga zuva redzidzisi kana semusangano wevarayiridzi ve ERC uye / kana vatungamiri vezvikoro. Uyu mubvunzo unopera simba, nokuti hauna kubvunzwa kuNRCs iyo isina kuronga chero hutungamiri hwehutano asi huchiri kuronga mazuva akadaro kana misangano yekudzorera. Hatizivi kuti izvo zvisiri izvo zvinopindura NRCs zviri kuita sei zvakare.

ONA ZVINANGWA: SOURCE

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