Organization of the work of the post of a nurse. main types of medical documentation

A ward nurse is a specialist with a secondary medical education who must take care of patients, record data about their condition in a special journal and perform a number of other duties, which will be discussed in this article.

What is a job description

A job description is a document that spells out the basic duties and rights of an employee. Job descriptions can be standard or they are developed in a specific institution, depending on the specifics of its work.

The employee is obliged to familiarize himself with the job description when applying for a job and sign the magazine, thereby making sure that he has studied the document and agrees with the requirements presented in it.

If the employee's actions do not comply with the job description, he may receive a reprimand, lose his bonus or be fired.

IMPORTANT! If the procedure nurse is absent for some reason, the ward nurse takes over her functions. Therefore, she must perfectly master the techniques of medical manipulation: be able to place intravenous catheters, do all types of injections, etc.

General Provisions

A ward nurse works in all departments of hospitals (psychiatric, gynecological, gastroenterological, cardiological, etc.), in sanatoriums and in other medical institutions. The duties of a nurse of the ward are as follows:

• to care for patients and monitor their condition;
• fulfill the appointments made by the doctor and make entries about this in the relevant documents;
• supervise junior medical personnel (for example, demanding timely cleaning, changing bed linen, washing weakened patients, etc.);
• make sure that the order is observed at the department, for example, to prevent violations of the regime by both patients and visiting relatives;
• during work, to constantly be with patients, leaving only in order to take the necessary drugs or make notes;
• accompany the doctor during the round and report on the patient's condition and changes;
• to acquaint patients entering the department with the internal regulations;
• examine patients once a week to detect head lice;
• if the patient's condition worsens, immediately notify his attending physician (or, in his absence, the doctor on duty);
• monitor the observance of the schedule for quartzing the chambers and the cleanliness and order in them;
• report violations by the junior medical staff to the head nurse or the head of the department.

Job responsibilities

The ward nurse has the following responsibilities:

• monitors patients, while observing the norms of medical ethics;
• when receiving patients, places them in wards;
• in children's hospitals, the nurse must ensure that the parents of the children comply with the sanitary and epidemiological regime;
• checks transfers from relatives in order to prevent products from getting to patients that may harm their health;
• makes reports to the attending physician or the doctor on duty about the condition of patients;
• organizes examination of patients in diagnostic rooms;
• is engaged in the isolation of patients who are in a terminal state. If necessary, call the resuscitation team;
• prepares the bodies of the deceased for transportation to the appropriate department;
• makes sure that in the premises assigned to it there is equipment necessary for work;
• monitors the cleanliness in the wards assigned to it, as well as the hygiene of patients, the timely change of underwear and bed linen;
• collects and disposes of medical waste in accordance with the hazard class;
• monitors the correct processing of medical devices in order to prevent infectious diseases (HIV, hepatitis, etc.).

Rights

A ward nurse has the following rights:

• to provide first aid to the patient before the arrival of the doctor. In some cases, the lives of patients depend on the qualifications of the nurse and her knowledge of basic resuscitation techniques;
• to supervise the work of junior medical personnel;
• to receive information about the patient's state of health. This allows not only to provide proper care, but also to protect against infection if the patient has infectious diseases;
• to receive information about changes in orders related to her work;
• for the issuance of overalls and personal protective equipment;
• for help from the management in the performance of their functional duties.

Also, a nurse has the right to demand from the management the creation of conditions for the quality performance of her professional duties.

IMPORTANT! The ward nurse often interacts with the patients' relatives. She can give advice on caring for the patient or his diet, list the treatment and diagnostic measures that were carried out with the patient. However, only the attending physician can report on the state of human health.

A responsibility

The duties of a ward nurse include a section on her responsibilities. The nurse is responsible for:

• for failure to properly fulfill their duties prescribed in the job description;
• for compliance with the sanitary and epidemiological regime and fire safety rules in the chambers entrusted to her;
• for causing material damage to the employer;
• for the safety and proper storage conditions of medicinal products (including narcotic and potent drugs) and medical products;
• for the timely assistance to the patients of the department.

Qualification requirements

A specialist with secondary medical education in the specialties "Nursing" and "General Medicine" can become a ward nurse. Some institutions require nursing experience in the relevant position.

Each department has its own specifics, therefore, nurses may be required to receive certificates of completion of additional advanced training courses.

Necessary psychological qualities

The ward nurse is more likely than other professionals to be in contact with patients. The psychological mood of a sick person depends on her participation, sympathy and attentiveness. The ward nurse should be able to prepare the patient for the upcoming unpleasant manipulations, to cheer up if the condition does not improve or the treatment does not bring results.

To become a ward nurse, you need to have not only an interest in medicine, but also the ability to empathy, kindness, the ability to understand a person and well-developed communication skills. Patients who are emaciated by the disease and tired of prolonged hospitalization may show irritability and even aggression. The physician must be able to listen to the suffering person, to cheer him up, to explain the need for painful manipulations.

The functional duties of a nurse in the internal medicine department involve the implementation of a number of medical interventions. Some manipulations (enemas, bladder catheterization) can affect the patient's feeling of bash. To gain respect and win over patients, a nurse must always be aware of patients' dignity and respect their right to privacy.

The ward nurse must be ready not only for gratitude, but also for the fact that patients will take out the accumulated resentment on her, so she must have a high level of emotional stability. Otherwise, she will experience rapid burnout.

IMPORTANT! The ward nurse should be very observant. She should notice any changes in the condition of patients: sometimes symptoms that are insignificant at first glance are harbingers of the development of life-threatening conditions. For example, restlessness and the urge to sit up may indicate the development of pulmonary edema.

Inpatient (hospital, hospital) medical care is currently the most resource-intensive health sector. In hospitals, the main material assets of the industry are concentrated (expensive equipment, apparatus, etc.), on the maintenance of which an average of 60-70% of all resources allocated to health care are spent. The largest volume of inpatient care in the country is performed by hospitals (Figure 10.1).

Rice. 10.1. Approximate organizational structure of a city hospital

In 2008, more than 6,000 hospitals operated in Russia with a total number of beds of about 1.5 million.

logics that can significantly save available resources without compromising the quality of medical care (see section 10.3).

10.1. ORGANIZATION OF WORK OF THE MEDICAL PERSONNEL OF THE CITY HOSPITAL FOR ADULTS

The head of the hospital is the chief physician, who is responsible for all treatment-and-prophylactic, administrative, economic and financial work. The main nurse is in charge of the activities of the nursing and junior medical personnel. A person with a higher medical education in the specialty "Nursing" or with a secondary medical education, having a diploma in one of the specialties: "Nursing", "General Medicine", "Obstetrics" and a certificate in the specialty " Organization of nursing ”, possessing organizational skills. The chief nurse is appointed and dismissed by the chief physician of the hospital, and is directly subordinate to the deputy chief physician for medical affairs. The orders of the head nurse are binding on the nursing staff of the hospital.

The main responsibilities of the head nurse:

Development of long-term and current plans to improve the qualifications of hospital nurses;

Formation of a reserve and training of nurses for promotion to the position of senior nurses;

Organization of receipt, storage and distribution to departments in accordance with their requirements of medicines, including narcotic, poisonous and potent drugs;

Monitoring the timely and accurate implementation of medical appointments by nursing staff, the correctness of accounting, distribution, consumption and storage of medicines (including narcotic, poisonous and potent) and dressings;

Control over compliance with the requirements of the sanitary-anti-epidemic regime, the quality of the preparation of medical documentation by paramedical personnel.

To fulfill her duties, the head nurse of the hospital has the right:

Give orders to nurses and nurses and monitor their implementation;

Make proposals to the head physician of the hospital on the encouragement and imposition of penalties for middle and junior medical personnel;

Submit proposals to the attestation commission on the assignment of the next qualification category to nursing staff;

To instruct nurses to check the work of the middle and junior medical personnel of the hospital departments.

The patient's first acquaintance with the hospital begins with admission department. It can be centralized and decentralized. Patients can get to the admission department of the hospital in different ways: by the direction of doctors from outpatient institutions (planned hospitalization), on an emergency basis (when they are delivered by an ambulance team), by transfer from another hospital, who independently applied to the admission department ("drift" ).

The tasks of the admission department include:

Reception of patients, making a preliminary diagnosis and resolving the issue of the need and profile of the department for hospitalization;

Providing emergency medical care if necessary;

Sanitary treatment of patients;

Performing the functions of a reference and information center on the condition of patients.

The work of the middle and junior medical personnel of the admission department is organized by senior nurse of the admission department. A person with a higher medical education in the specialty "Nursing" or with a secondary medical education, having a diploma in one of the specialties: "Nursing", "General Medicine", "Obstetrics" and a certificate in specialty "Organization of nursing", with organizational skills. The senior nurse of the admission department is appointed and dismissed by the head physician of the hospital on the proposal of the head of the department, to whom she

directly submits. The orders of the senior nurse are mandatory for the middle and junior medical staff of the department.

In the admission department, it should be possible to carry out urgent X-ray, endoscopic examinations, express analyzes, etc. To provide emergency medical care, the admission department must have a constant set of necessary medicines, medical instruments, etc. At the admission department of large hospitals, intensive care and temporary isolation wards are organized.

For the position admissions nurse a person with a secondary medical education who has a certificate in the specialty "Nursing" is appointed. The nurse of the admission department is appointed and dismissed by the chief doctor of the hospital and reports directly to the head of the admission department (doctor on duty) and the senior nurse of the admission department. Nurse orders are binding on the junior medical staff of the admission department.

The admissions nurse has a wide range of responsibilities:

Acquaints with the referral of the patient and accompanies him to the office of the doctor on duty;

Listens to the complaints of the patient, who entered "by gravity", and directs him to the doctor on duty;

Fills in the passport part of the "Medical card of an inpatient" (form 003 / y);

Keeps the "Register of patients admission and hospitalization refusals" (f. 001 / y);

Examines the patient for head lice and measures body temperature;

Performs procedures and manipulations prescribed by the doctor on duty;

Carries out, at the direction of the doctor on duty, call consultants and laboratory assistants to the admission department;

Monitors the condition of patients in the isolation ward, and timely fulfills all the doctor's instructions for their examination and treatment;

Timely transmits telephone messages to the police station, active calls to city polyclinics, emergency notifications

for infectious diseases to the appropriate territorial body of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Rospotrebnadzor);

Carries out a sampling of feces, urine, vomit and wash water for laboratory research;

Receives medicines from the senior nurse and ensures their storage;

Monitors the sanitary condition in the department and controls the work of junior medical personnel;

Timely hands over the equipment and tools for repair to the sister-owner of the department.

From the admission department, the patient enters the inpatient department. The head of the medical department is in charge. The work of the middle and junior medical personnel of the department is organized by senior nurse of the department.

A person with a higher medical education in the specialty "Nursing" or with a secondary medical education, having a diploma in one of the specialties: "Nursing", "General Medicine", "Obstetrics" and a certificate in the specialty " Organization of nursing ”, possessing organizational skills. The senior nurse of the department is directly subordinate to the head of the department. She is a financially responsible person, her orders are obligatory for the nursing and junior medical personnel of the department.

The main figure of the department is the attending physician (resident), he is helped ward nurses, who are directly subordinate to the head nurse of the department and perform the following duties:

Timely and accurate fulfillment of the prescriptions of the attending physician;

Organization of timely examination of patients in the laboratory, diagnostic rooms, with consulting doctors;

Monitoring the patient's condition: physiological functions, sleep, weight, pulse, respiration, temperature;

Immediate information to the attending physician (in his absence - to the head of the department or the doctor on duty) about a sudden deterioration in the patient's condition;

Providing emergency first aid;

Sanitary and hygienic services for the physically weak and seriously ill (washing, feeding, rinsing the mouth, eyes, ears, etc.);

Isolation of patients in agonal state, calling a doctor to ascertain death, preparing the corpses of the dead for transfer to the morgue.

Work in the department in the morning begins with a morning conference, the so-called "five-minute". Every day, the department resident receives information from the night duty medical personnel about the condition of patients and changes in their health, about newly admitted patients, gets acquainted with the results of laboratory, X-ray and other studies, conducts a round of patients. Patients are visited accompanied by a nurse. At the patient's bedside, the resident checks the fulfillment of the previously given appointments.

There are two systems for organizing patient care: two-stage and three-stage. In a two-stage system, doctors and nurses are directly involved in patient care. In this case, the junior medical staff helps in creating an appropriate sanitary and hygienic regime in the department (cleaning the premises, etc.). In the three-tier system, nurses are involved in direct patient care. For the position junior nursing nurse a person who has completed nursing nursing courses is appointed. She reports directly to the ward nurse.

The hospital must strictly adhere to anti-epidemic and medical-protective regimes.

Control over compliance with the anti-epidemiological regime is carried out by specialists from the territorial bodies of Rospotrebnadzor.

Medical and protective regime is a system of measures aimed at creating optimal conditions for patients to stay in the hospital. Nurses play an important role in adherence to the medical and protective regime. The main elements of the therapeutic and protective regime include:

Rational planning, placement and equipment of wards and departments (isolation of operating rooms, dressing rooms, organization of 1-2-bed wards, etc.);

Elimination or maximum reduction of the impact of unfavorable environmental factors (uncomfortable beds, poor lighting, low or excessively high temperature in the wards, bad smells, moans or cries of patients, noise, tastelessly cooked and untimely served food, etc.;

Fighting pain and fear of pain (psychological preparation for operations, the use of anesthetics for painful dressings, the use of effective pain relievers, high skill in injection technique and other manipulations, proper sharpness of needles and scalpels, refusal from aimless research);

Measures to prevent the possibility of a patient leaving for illness and exaggerated perceptions of adverse consequences (fiction, favorite music, fascinating conversations, painting, television, the opportunity to do something you love, walks around the hospital for walking patients, occupational therapy in departments for chronic patients , educational and pedagogical work in children's hospitals, etc.);

Organization of the patient's daily regimen (lengthening of physiological sleep, combination of rest with permissible physical activity, communication of the patient with relatives and friends);

Reasonable use of the word - one of the strongest conditioned stimuli that can have a significant impact on the course of the pathological process and its outcome (avoiding iatrogenic disorders);

Compliance by personnel with the principles of medical ethics (high culture of medical personnel, sensitive, attentive attitude to the patient, his relatives, adherence to medical secrecy, friendly relations between medical personnel.

The patient is discharged from the hospital in the following cases: with his full recovery; if necessary, transfer to other medical institutions; with a persistent improvement in the patient's condition, when further hospitalization is no longer needed; in the chronic course of the disease, not amenable to treatment in this institution.

10.2. ORGANIZATION OF WORK MEDIUM

MEDICAL STAFF

CHILDREN'S CITY HOSPITAL

(CHILDREN'S DEPARTMENT OF THE CENTRAL

DISTRICT HOSPITAL)

The organization of the work of a children's hospital has a lot in common with the work of a hospital for adults, but there are some differences that determine the specifics of the work of nurses.

Sick children, like adults, are admitted to the inpatient department of a children's hospital in the direction of doctors of children's polyclinics, ambulance stations, children's institutions, "by gravity". Planned hospitalization of the child is carried out through the children's clinic.

The structure of the children's hospital includes an admission department, medical departments (pediatric and specialized: surgical, infectious, etc.), departments of laboratory and functional diagnostics, and others.

The admission department of a children's hospital should be boxed (boxes make up 3-5% of the total number of hospital beds). The most convenient for work are the individual boxes of Meltzer-Sokolov, which include an anteroom, a ward, a sanitary unit, a gateway for personnel. In small hospitals, in the absence of boxes for receiving children, at least 2-3 isolated examination rooms and 1-2 sanitary inspection rooms should be provided.

In case of admission of children without the knowledge of their parents, the latter are immediately notified of this by the employees of the admission department. In the absence of such an opportunity, information about the child is entered into a special book and reported to the police.

Departments (wards) of the hospital are formed according to age, sex, nature and severity of diseases, date of admission. Depending on age, departments (wards) are allocated for premature babies, newborns, infants, young children, and older children. By the nature of the diseases, departments (wards) can be: pediatric general, surgical, infectious, etc. It is advisable to have small wards - for 2-4 beds, which makes it possible to fill

them, taking into account the age of children and the disease. It is advisable to have glazed partitions between the wards so that the staff can observe the condition of the children and their behavior. It is necessary to provide for the possibility of staying in the hospital with the mother's child.

Tasks ward nurse children's hospital:

Reception and placement in wards, care and supervision of a sick child;

Accurate and timely fulfillment of the attending physician's prescriptions;

Emergency notification of a doctor about cases of changes in the condition of a sick child that require urgent action, and the provision of first aid in his absence;

Maintenance of the sanitary condition of the wards.

An important feature of the organization of the work of children's departments is the need for educational work there. For this purpose, positions of teacher-educators are being introduced in children's hospitals. Educational work is carried out with sick children who are being treated in a hospital for a long time. A very important element of creating a medical and protective regime for children is the organization of their leisure time, especially in the evening. Manual labor, sculpting, drawing, and reading aloud at the end of a sick day improve children's mood and promote restful sleep. Ward nurses play an important role in the proper organization of children's leisure time.

Properly organized nutrition is of particular importance in the complex of therapeutic measures. For this purpose, breastfed babies are hospitalized with their mothers or provided with donor breast milk. Children of the first year of life receive all other food products from the children's dairy kitchen. For children over one year old, meals are organized at the hospital's catering unit.

In children's hospitals, more than in hospitals for adults, nosocomial infections should be feared. If a child with an acute infectious disease is identified in the department, quarantine is established for the incubation period for this disease. It is necessary to keep records of children in contact with the sick, which during the incubation period cannot be moved to other wards. In these cases, depending on the diagnosed acute infectious disease, special anti-epidemic measures are also taken (vaccinations, studies on the carrier of bacteria, etc.).

Anatomical and physiological characteristics of newborns, the peculiar nature of the course of the disease determine the need to create special departments for newborns and premature babies as part of children's hospitals. The main task of these departments is to provide qualified diagnostic and therapeutic assistance to full-term and premature newborn sick children, to create optimal conditions for nursing children.

Children born with a mass of at least 2300 g and sick in the neonatal period are sent to the department for newborns. Newborns weighing less than 2300 g, with signs of immaturity and sick in the neonatal period are sent to the department for premature babies. Transfer of newborns and premature babies from maternity hospitals is carried out subject to the transportability of the child and the obligatory agreement with the head of the specialized department where the child is transferred. The transportation of newborns is carried out on a self-directed basis in a specialized resuscitation machine with a resuscitation physician or a pediatrician well-trained in resuscitation of newborns and premature babies. Nursing staff accompanying children should also have specialized training in resuscitation and neonatal intensive care.

In the work of the department for newborns and premature babies of children's hospitals, there should be a close relationship and continuity with maternity hospitals and children's polyclinics.

10.3. ORGANIZATION OF WORK MEDIUM

MEDICAL STAFF

DAY HOSPITAL

Given the high cost of inpatient care, new inpatient technologies are gaining great importance, allowing significant savings in available resources without compromising the quality of medical care. These organizational forms include:

Day hospitals in outpatient clinics;

Day hospitals in hospitals;

Home hospitals.

Day hospital intended for carrying out preventive, diagnostic, therapeutic and rehabilitation measures for patients who do not require round-the-clock medical supervision

(fig.10.2).

Rice. 10.2. Approximate organizational structure of a day hospital with a surgical profile

The main forms of primary medical records of day hospitals:

"Register of patients admission and hospitalization refusals", f. 001 / y;

"Medical card of an inpatient", f. 003 / y;

"Temperature sheet", f. 004 / y;

"A sheet of daily registration of the movement of patients and the bed fund of a 24-hour hospital, day hospital at a hospital", f. 007 / y-02;

"Sheet of daily registration of the movement of patients and the bed fund of a day hospital at an outpatient clinic, a hospital at home", f. 007ds / u-02;

"Consolidated statement of movement of patients and beds in the hospital, department or profile of hospital beds for round-the-clock stay, day stay at a hospital", f. 016 / y-02;

"Extract from the medical card of an outpatient, inpatient patient", f. 027 / y;

"Journal of accounting procedures", f. 029 / y;

"Book of registration of certificates of incapacity for work", f. 036 / y;

"Card of the patient being treated in the physiotherapy department (office)", f. 044 / y;

"Journal of recording of X-ray examinations", f. 050 / y;

"Statistical card of those who left the hospital for a round-the-clock stay, a day hospital at a hospital institution, a day hospital at an outpatient clinic, a hospital at home", f. 066 / y-02;

"Journal of records of outpatient operations", f. 069 / y;

"Medical certificate of death", f. 106 / y-98.

In practice, day hospitals of therapeutic, surgical, obstetric-gynecological, neurological, dermatological and other profiles are most widespread.

Medical nutrition of patients in the day hospital is organized based on local conditions. Usually, if the hospital is part of the structure of the hospital, patients use two meals a day in accordance with the current hospital standards.

It should be noted that day hospitals in hospital and outpatient clinics have some differences. In the conditions of day hospitals on the basis of hospitals, as a rule, it is possible to carry out more complex laboratory and diagnostic examinations, it is easier to organize food. The advantage of day hospitals based on outpatient clinics is the possibility of using a wide range of rehabilitation treatment.

Home hospitals can be organized in cases where the patient's condition and home conditions (social, material) allow organizing medical assistance and home care.

The purpose of the organization of hospitals at home is the treatment of acute forms of diseases, aftercare and rehabilitation of chronic patients, medical and social assistance to the elderly, observation and treatment at home of persons who have undergone simple surgical interventions, etc. Home hospitals in pediatrics and geriatrics have proven themselves well.

The organization of a hospital at home involves daily observation of the patient by a doctor and a paramedical worker, laboratory diagnostic examinations, drug therapy (intravenous, intramuscular injections, etc.), various procedures (banks, mustard plasters, etc.).

If necessary, the complex of treatment of patients includes physiotherapeutic procedures, massage, exercise therapy, etc.

Treatment in hospitals at home is not associated with isolation, impaired microsocial adaptation, it is more easily perceived by patients, and is economically beneficial. Inpatient treatment at home is several times cheaper than in a round-the-clock inpatient hospital, and in terms of efficiency it is not inferior to treatment in a round-the-clock inpatient hospital.

10.4. ORGANIZATION OF THE WORK OF THE SECONDARY MEDICAL PERSONNEL OF THE MATERNITY HOSPITAL, PERINATAL CENTER

The main institution providing inpatient obstetric and gynecological care is the maternity hospital (Figure 10.3). Its tasks include the provision of inpatient qualified medical care to women during pregnancy, childbirth, the postpartum period, with gynecological diseases, as well as the provision of qualified medical care and care for newborns during their stay in an obstetric hospital.

The head physician is in charge of the maternity hospital. The work of middle and junior medical personnel is organized by chief (senior) midwife, whose tasks include:

Regularly conduct rounds of wards, offices and other premises of the maternity hospital;

Ensure the timeliness of discharge, the correctness of accounting, distribution, consumption and storage of medicines and medical products;

To instruct middle and junior medical personnel on the implementation of a complex of sanitary and anti-epidemiological measures in a maternity hospital;

Develop measures to improve the business qualifications of middle and junior medical personnel (conducting nursing conferences, lectures by doctors, etc.);

To systematically carry out work to educate personnel in the spirit of conscientiousness in the performance of their duties, adherence to the principles of medical deontology;

Rice. 10.3. Approximate organizational structure of a maternity hospital

To systematically improve their professional qualifications.

Pregnant women (if there are medical indications), women in labor, as well as women in childbirth in the early postpartum period (within 24 hours after childbirth) in case of childbirth outside the hospital are subject to hospitalization in the maternity hospital. Upon admission to the maternity hospital, a woman in labor or a postpartum woman is sent to admission and examination block of the obstetric department, where he presents his passport and "Exchange card" (f. 113 / y). The reception of women in the admission and examination block is carried out by a doctor (in the daytime - by the doctors of the departments, then by the doctors on duty) or by a midwife who, if necessary, calls a doctor. It is advisable to have one filter room and two observation rooms in the receiving and inspection block. One examination room is provided for admitting women to the physiological obstetric department, the other is an observational one.

The doctor (or midwife) assesses the general condition of the applicant, gets acquainted with the "Exchange card", finds out whether the woman has suffered infectious, inflammatory diseases before and during pregnancy, paying special attention to diseases transferred immediately before admission to the maternity hospital, establishes the presence of chronic inflammatory diseases, the duration of the anhydrous period.

As a result of collecting anamnesis, examination, acquaintance with documents in the filter room, women are divided into two streams: with the normal course of pregnancy, who are sent to physiological obstetric department, and representing an "epidemiological danger" to others who are sent to observational obstetric department.

In addition, women are sent to the observational department if there is no “exchange card of the maternity hospital”, as well as women in the early postpartum period in case of childbirth outside the hospital.

In the examination physiological and observational departments, an objective examination of the woman is carried out, her sanitization is carried out, a set of sterile linen is issued, blood and urine are taken for tests. From the examination room, accompanied by nursing staff, the woman moves (if indicated, is transported on a gurney) to the delivery unit or the department of pathology of pregnant women.

The midwife and junior medical staff of the obstetric department are directly subordinate to the senior midwife. The head midwife of the department is subordinate to the head of the department and the head midwife. The duties of a senior midwife are very similar to those of a senior nurse in a hospital.

The immediate assistant to the obstetrician-gynecologist of the obstetric department is midwife, whose duties include:

Preparing women for the upcoming examination by a doctor;

Assisting a doctor in carrying out medical diagnostic and surgical procedures;

Providing medical care during childbirth and carrying out primary treatment of newborns;

Monitoring compliance with the sanitary and hygienic regime in the department;

Supervision of the work of junior medical personnel;

Ability to carry out the simplest laboratory tests (urine for protein, blood group, hemoglobin and erythrocyte sedimentation rate);

Carrying out some obstetric interventions in situations that threaten the life of a woman in labor or postpartum women (isolation of the placenta by external methods, manual examination of the postpartum uterus, separation and isolation of the placenta, examination of the cervix in case of bleeding);

Suturing of I and II degree perineal tears.

The central division of the maternity hospital - birth block, which includes prenatal wards, birth wards, intensive care wards, children's rooms, small and large operating rooms, sanitary rooms. In the prenatal ward, a woman spends the entire first stage of labor. The midwife on duty or the doctor constantly monitors the condition of the woman in labor. At the end of the first stage of labor, the woman is transferred to the birth ward (delivery room).

If there are two delivery rooms, delivery is carried out alternately. Each delivery room works for 1-2 days, then a general cleaning is carried out in it. If there is one delivery room, delivery is carried out alternately on different Rakhmanov beds. General cleaning of the delivery room is carried out twice a week. A midwife takes care of a normal delivery.

After the baby is born, the midwife shows it to the mother, paying attention to gender and the presence of congenital malformations (if any). Then the child is transferred to the nursery. The postpartum woman should be in the delivery room under supervision for at least 2 hours.

The midwife, after washing hands under running water and processing them, carries out secondary processing of the umbilical cord, primary processing of the skin, weighing the child, measuring body length, chest and head circumferences. Bracelets are tied to the child's hands, and after swaddling, a medallion is placed over the blanket. They indicate: surname, name, patronymic, birth history number of the mother, gender of the child, weight, height, hour and date of birth. After finishing the treatment of the newborn, the midwife (doctor) fills in the necessary fields in the "History of childbirth" (f. 096 / y) and "History of the development of a newborn" (f. 097 / y).

In the normal course of the postpartum period, 2 hours after childbirth, the woman is transferred on a gurney with the child to postpartum ward, which is part of the physiological obstetric department.

When filling the wards of the postpartum department, it is necessary to observe a strict cyclicality - one ward is allowed to be filled within no more than three days. When the first signs of disease appear in women in labor or newborns, they are transferred to obstetric department or to another specialized institution.

The observational obstetric department accommodates: sick women with a healthy child; healthy women with a sick child; sick women with a sick child.

Wards for pregnant women and women in childbirth in the observational department should be profiled as possible. It is unacceptable to accommodate pregnant women and women in childbirth in the same ward.

In the wards of newborns of the observational department there are children: those born in this department, born outside the maternity hospital, transferred from the physiological department, born with severe congenital anomalies, with manifestations of intrauterine infection, weighing less than 1000 g. 1-3 beds. If indicated, children can be transferred to the neonatal unit of the children's hospital.

During the first days after birth, each child is under intensive supervision of the medical staff. Pediatricians carry out daily examinations of children. If one pediatrician works in the maternity hospital, then during his absence, the children are examined by the obstetrician-gynecologist on duty. In necessary cases requiring emergency intervention, the obstetrician-gynecologist calls the pediatrician. At the end of the examination of newborns, the pediatrician (obstetrician-gynecologist) informs the mothers about the condition of the children and conducts sanitary and educational work with them.

In a modern maternity hospital, at least 70% of beds physiological obstetric department should be allocated for the joint stay of the mother and child. Such a joint stay significantly reduces the incidence of diseases of puerperas in the postpartum period and the incidence of diseases in newborns. The main feature of such maternity hospitals or obstetric wards is

active participation of the mother in the care of the newborn child. The joint stay of the mother and the child limits the contact of the newborn with the medical staff, reduces the possibility of infection of the child. With this mode, early attachment of the newborn to the breast is ensured, the mother is actively taught the skills of practical care for the newborn.

When the mother and child stay together, they are placed in boxes or semi-boxes (for 1-2 beds).

Contraindications to the joint stay of the mother and the child on the part of the postpartum woman: severe gestosis of pregnant women, extragenital diseases in the stage of decompensation, fever, rupture or incisions of the perineum of the II degree. From the side of the newborn: prematurity, prematurity, long-term intrauterine fetal hypoxia, intrauterine hypotrophy of II-III degree, birth trauma, asphyxia at birth, developmental anomalies, hemolytic disease.

The joint stay of a mother and a child in a maternity hospital requires the strictest adherence to an anti-epidemic regime.

In order to reduce perinatal mortality, organize constant monitoring of the state of vital functions of newborns, timely carry out corrective and diagnostic measures in obstetric institutions, special resuscitation and intensive care wards for newborns are being created. The creation of such wards in maternity hospitals with a capacity of 80 or more beds for newborns is mandatory. At a lower capacity of the maternity hospital, intensive care posts are organized.

The main criteria for the discharge of a woman from the maternity hospital: satisfactory general condition, normal temperature, pulse rate, blood pressure, condition of the mammary glands, involution of the uterus, normal laboratory results.

In case of exacerbation of extragenital diseases of the postpartum women, they can be transferred to the appropriate hospital, and in the event of complications in the postpartum period, to the observational department.

With an uncomplicated course of the postpartum period in a postpartum woman and the early neonatal period in a newborn, with a dropped umbilical cord and a good condition of the umbilical wound, positive

the dynamics of body weight, a mother with a child can be discharged on the 5-6th day after childbirth.

Discharge is carried out through special discharge rooms, which should be separate for postpartum women from the physiological and observational departments. The discharge rooms should have 2 doors: from the postpartum ward and from the visitor's room. Reception rooms should not be used for the discharge of puerperas.

Before being discharged, the pediatrician, while still in the ward, talks to the mothers about caring for and feeding the baby at home. The nurse (in the ward) must additionally process and swaddle the child. In the discharge room, the nurse of the neonatal department swaddles the child in the brought home linen, teaches the mother how to swaddle, draws her attention to the recording of the last name, first name and patronymic on bracelets and a medallion, the condition of the skin and mucous membranes of the child, once again talks about the peculiarities of care at home ...

In the "History of the development of a newborn", the nurse notes the time of his discharge from the maternity hospital and the condition of the skin, mucous membranes, introduces the mother to the record, which is certified by the signatures of the nurse and the mother. The nurse issues the mother a "Medical certificate of birth" (f. 103 / y-98) and the "Exchange card of the maternity hospital, maternity ward of the hospital" (f. 113 / y).

On the day the child is discharged, the elder sister of the neonatal department informs the children's clinic at the place of residence by phone the basic information about the discharged child.

Department of pregnancy pathology are organized in large maternity hospitals with a capacity of 100 beds or more. The department of pregnancy pathology hospitalizes women with extragenital diseases, complications of pregnancy (gestosis, threat of termination, etc.), with an abnormal fetal position, with a burdened obstetric history. The department employs obstetricians-gynecologists, maternity hospital therapists, midwives and other medical personnel.

The planning of the pregnancy pathology department should provide for its complete isolation from other departments, the possibility of transporting pregnant women to the physiological and observational obstetric departments (bypassing other departments), as well as an exit for

pregnant women from the department to the street. The structure of the department should include: a functional diagnostics room with modern equipment (mainly cardiological), an examination room, a small operating room, a physiopsychoprophylactic preparation room for childbirth, covered verandas or halls for pregnant women to walk.

From the department of pathology of pregnancy, women can be transferred in connection with the improvement of their condition under the supervision of an antenatal clinic, as well as for delivery to the physiological or observational obstetric departments. The transfer of women to one of these departments is carried out necessarily through the reception and examination block, where they undergo complete sanitization.

Gynecological departments There are three types of maternity hospitals:

1) for hospitalization of patients in need of surgical treatment;

2) for patients in need of conservative treatment;

3) for termination of pregnancy (abortion).

The structure of the department should include: its own admission unit, dressing room, manipulation room, small and large operating rooms, physiotherapy room, discharge room, intensive care unit. In addition, other medical and diagnostic units of the maternity hospital are used for the diagnosis and treatment of gynecological patients.

In general, the work of the gynecological department, as well as the duties of the nursing staff, are in many respects similar to the activities of a regular department of a multidisciplinary hospital.

In recent years, departments of artificial termination of pregnancy have been trying to withdraw from obstetric hospitals, organizing them in the structure of gynecological departments of multidisciplinary hospitals or on the basis of day hospitals.

Since 2005, in order to manage the quality of medical care provided to women during pregnancy and childbirth, as well as to improve the financing of antenatal clinics and maternity hospitals, “Birth certificates” have been introduced, the procedure for filling them out is determined by the corresponding order of the Ministry of Health and Social Development of the Russian Federation ...

In recent years, in order to improve the efficiency and quality of medical care for pregnant women, women in labor,

perinatal centers are being created for women and newborn children in the Russian Federation.

The main tasks of perinatal centers:

Provision of consultative and diagnostic, therapeutic and rehabilitation assistance mainly to the most difficult contingent of pregnant women, women in labor, postpartum women, newborn children;

Prevention of long-term consequences of perinatal pathology in children (retinopathy of prematurity, hearing loss from childhood, cerebral palsy, etc.);

Provision of a system of rehabilitation measures and restorative therapy, medical-psychological and social-legal assistance to women and young children;

Implementation of statistical monitoring and analysis of maternal, perinatal, infant mortality;

Organization of information support for the population and specialists on perinatal care, reproductive health and safe motherhood.

The main tasks of the nursing staff of perinatal centers are in many ways similar to the tasks of nurses at antenatal clinics, maternity hospitals, intensive care units and intensive care units for newborn children's hospitals.

The approximate organizational structure of the perinatal center is shown in Fig. 10.4.

10.5. HOSPITAL STATISTICS

The main forms of primary medical records of hospital institutions:

A sheet of daily registration of the movement of patients and the bed fund of a hospital for round-the-clock stay, a day hospital at a hospital institution, f. 007 / y-02;

Statistical card of those who left the hospital for a round-the-clock stay, day hospital at a hospital institution, day hospital at an outpatient clinic, hospital at home, f. 066 / y-02.

The main indicators of the medical activity of the hospital:

The indicator of the provision of the population with hospital beds;

The indicator of the frequency (level) of hospitalization;

Rice. 10.4. Approximate organizational structure of the perinatal center

Indicator of the average number of days a bed is occupied per year (function of a hospital bed);

The indicator of the average length of stay of the patient in bed;

Hospital mortality rate.

The indicator of the provision of the population with hospital beds the most common in assessing the satisfaction of the population with inpatient care.

As a result of the introduction of new hospital-replacing technologies [day hospitals based on outpatient clinics (APU), day hospitals based on hospitals, home hospitals], this indicator for the period 1995-2008. decreased from 118.2 to 92.4 per 10 thousand of the population.

Indicator of frequency (level) of hospitalization It is used to analyze the satisfaction of the population in hospitalization and to calculate the standards for the need for inpatient care.

The value of this indicator in 2008 in the Russian Federation was 22.4%. Taking into account the priority of the development of outpatient care, as well as the introduction of new hospital-replacing technologies, the level of hospitalization of the population should decrease in the future.

Average number of days a bed is occupied per year (function of a hospital bed) characterizes the effectiveness of the use of financial, material, technical, human and other resources of hospital institutions.

The indicator of the average length of stay of the patient in bed-

it is the ratio of the number of bed-days spent by patients in the hospital to the number of patients treated.

Hospital mortality rate allows to comprehensively assess the level and quality of the organization of medical and diagnostic care in the hospital, the use of modern medical technologies.

* The indicator is calculated for individual nosological forms and age-sex groups of patients.

For the period 2004-2008 the value of this indicator has a certain downward trend: from 1.40 to 1.32%, respectively.

In the analysis of the activities of the maternity hospital, the perinatal center, statistical indicators characterizing the qualitative aspect of the activities of the obstetric and gynecological service are of particular importance:

Indicators of the frequency of operational benefits during childbirth;

Indicators of the incidence of complications in childbirth;

Indicators of the incidence of complications in the postpartum period;

An indicator of the frequency of use of pain relief during childbirth. Indicators of the frequency of operational benefits during childbirth(overlay

forceps, vacuum extraction, cesarean section, manual separation of the placenta and others). Over the past 10 years in obstetric institutions of the Russian Federation, there has been a 2-fold increase in the use of caesarean section in childbirth, a 2-fold decrease in the frequency of applying obstetric forceps (Fig. 10.5).

* The indicator is calculated for certain types of operational benefits for childbirth.

Rice. 10.5. Surgical interventions in obstetric institutions of the Russian Federation (1998-2008)

The rate of complications in childbirth (perineal rupture) and the rate of complications in the postpartum period (sepsis).

These indicators in the Russian Federation in 2008 were 0.17 and 0.58 per 1000 births, respectively.

** The indicator is calculated for certain types of complications.

An important characteristic for assessing the use of modern medical technologies for the management of childbirth is an indicator of the frequency of use of pain relief during childbirth. This indicator in maternity hospitals in Veliky Novgorod in 2008 was 800 per 1000 deliveries, which indicates the possibility of expanding anesthetic benefits in the management of childbirth.

The ability to correctly fill out the forms of primary medical records and, on their basis, to collect data, calculate and analyze statistical indicators is of paramount importance in the practical activities of the chief nurse (midwife), head of the feldsher-obstetric center, medical statistics and other medical workers.

Control questions

1. List the main tasks of the city hospital for adults.

2. List the responsibilities of the head nurse of the city adult hospital.

3. What are the main tasks of the admission department of a city hospital for adults?

4. Explain the responsibilities of the senior nurse in the admission department of the city adult hospital.

5. What are the responsibilities of the admissions nurse at the City Adult Hospital?

6. List the main responsibilities of a senior nurse in the City Adult Hospital ward.

7. Expand the functional responsibilities of the ward nurse of the city hospital for adults.

8. List the main responsibilities of a junior nurse in caring for the sick at the City Adult Hospital.

9. What is a curative-protective regime and what are its main elements?

10. List the main tasks of the children's city hospital.

11. Expand the features of the admission department of the children's city hospital.

12. List the tasks and reveal the features of the work of the departments for newborns and premature babies in the children's city hospital.

13. List the main tasks of the maternity hospital.

14. What are the responsibilities of the head nurse of the maternity hospital?

15.How is the work of the admission department of the maternity hospital organized?

16. List the main responsibilities of a senior midwife in the midwife of a maternity hospital.

17. Explain the responsibilities of a midwife in the midwife of a maternity hospital.

18.How is the work of the delivery unit of the maternity hospital organized?

19.How is the work of the physiological postpartum department of the maternity hospital organized?

20. How is the work of the observational department of the maternity hospital organized?

21. How is newborn care carried out in the maternity hospital?

22. Expand the procedure for the work of the pregnancy pathology department of the maternity hospital.

23. How does the gynecological department of the maternity hospital work?

24. List the main tasks of the perinatal center.

25. What is the organizational structure of the perinatal center?

Introduction

Chapter 1. Organization of work of the therapeutic department

Chapter 2. Responsibilities of the procedure nurse in the internal medicine department

Chapter 3. Activities of the procedural nurse of the internal medicine department

Conclusion

Bibliography

INTRODUCTION

A person, his life, health and longevity are the greatest value. Medical science and all medical professionals are called upon to preserve this wealth - human health.

A physician should be someone who puts the life and health of the patient above personal interests. The motto of medicine, proposed by the 17th century Dutch physician Van Tulpius - aliis inserviendo consumer (lat.) - serving others, I burn myself.

Patient care is of great importance in the complex of medical measures. The most effective medicines, skillfully performed surgeries, and more cannot provide recovery unless systematic and careful care is provided at the same time.

Nursing care is keeping the ward and bed clean, timely change of bed and underwear, assisting with eating, holding a hygienic toilet, carrying out physiological procedures and fulfilling doctor's prescriptions. In hospitals and clinics, care is provided by junior and paramedical personnel.

The therapy department requires more careful and careful patient care. The nurse must monitor as closely as possible and have patience with patients.

The relevance of the work lies in the fact that the provision of health care institutions with nursing staff and the number of duties assigned to them has a clear discrepancy. In our time, with an increase in morbidity, an increase in the elderly and senile age, a low social level of some segments of the population, the activities of nurses require revision. In this regard, the issue of the need to develop scientific foundations for the rational use of personnel in health care institutions is quite acute.

The purpose of the work is to study and analyze the activities of a procedural nurse in a therapy department.

In accordance with this, the following tasks have been set:

analysis of the characteristics of patient care in the therapeutic department;

consideration of the duties of a medical procedural nurse in a therapy department;

analysis of the activities of the procedural nurse of the therapeutic department.

The object of work is a nurse in the treatment room of the therapeutic department.

The subject of work is the activity of a nurse in the treatment room of the therapeutic department.

The most characteristic feature for a procedural nurse should be an awareness of her responsibility in the performance of immediate duties, which must be carried out not only correctly, but also in a timely manner.

You need to know the effect of drugs, the effect of medical procedures on the patient. If, instead of a beneficial effect, an unusual effect occurs, you must immediately stop the procedure. You cannot blindly and mechanically carry out appointments. If the prescribed medication shows a new effect, an observant, attentive, and medically educated nurse will invite a doctor to decide what to do.

From all of the above, we can conclude that a nurse is just as important as a doctor. If earlier she was only an assistant, nowadays the specialty "nurse" is allocated to a new independent discipline due to changes in environmental conditions, society, attitudes and scientific discoveries.

The automated process of thinking and acting of a nurse, consisting of a nursing examination, identifying patient problems, planning and implementing care, evaluating results, is a nursing process.

But the development of nursing in Russia and the introduction of a modern nursing process in clinics is being slowed down. The reasons are: a low professional and social level of a sister, an underestimation of the importance of scientific principles and approaches to organizing nursing, economic factors.

CHAPTER 1. ORGANIZATION OF WORK OF THE THERAPEUTIC DEPARTMENT

Inpatient treatment of patients with a therapeutic profile is carried out in general therapy departments. In multidisciplinary hospitals, specialized therapeutic departments (cardiological, gastroenterological, etc.) are allocated, designed for the examination and treatment of patients with certain diseases of the internal organs (cardiovascular system, digestive organs, kidneys, etc.).

The department is headed by a director, who is usually appointed from among the most experienced doctors. He organizes the timely examination and treatment of patients, supervises the work of medical personnel, is responsible for the rational use of the hospital bed fund, medical equipment and medicines.

The staffing table of employees of therapeutic departments provides for the positions of ward doctors (hospital residents) who directly carry out the examination and treatment of patients; a senior nurse who organizes and supervises the work of ward nurses and orderlies; the hostess sister, who is responsible for the timely provision of the department with soft and hard utensils, as well as underwear and bed linen; ward nurses who work at the post and carry out the appointments of the attending physicians for the examination and treatment of patients; a procedural nurse performing certain manipulations in a procedural room; junior nurses, barmaids and cleaning attendants who provide care for patients, their food, and maintain the necessary sanitary condition in the department.

In the therapy department, a different number of beds can be deployed. In turn, each department is subdivided into the so-called ward sections, usually numbering 30 beds each.

In addition to the wards, the therapeutic departments include the office of the head of the department, the office of doctors (internist), the rooms of the senior nurse and the hostess sister, the treatment room, pantry, dining room, bathroom, enema room, room for washing and sterilizing ships and storing cleaning items. storage space for wheelchairs and mobile chairs, toilets for patients and medical personnel. Each department provides premises for the daytime stay of patients - halls, verandas, etc.

For the organization of full-fledged treatment of patients and their care, the correct equipment of the wards, in which patients spend most of their time, is of great importance. From the point of view of ensuring the necessary medical and protective regime, such a situation is considered ideal when 60% of the wards in the department are deployed to 4 beds in each, 20% to 2 beds and 20% to one. In other words, in the ward section for 30 beds, 6 four-bed wards should be allocated, two double and two single, with the condition that one patient in the general ward has 7 m2 of area, and in a single room - 9 m2. The smaller area has a negative impact on the organization of treatment and patient care.

The wards are equipped with the necessary medical equipment and furniture: medical (functional) beds, bedside tables or bedside tables, a common table and chairs. In general wards, it is advisable to use special portable screens that allow, in necessary cases (performing some manipulations, sending out physiological needs, etc.) to protect the patient from outside observation. For this purpose, stationary screens in the form of a curtain attached to a special frame are also used. The curtain can easily be drawn around the patient and then reopened.

In the wards, beside each bed, individual lamps for night use and radio points are installed. It is advisable to bring an alarm to each bed so that any patient, if necessary, can call medical personnel.

In the ward section (in the corridor), a nurse's post is equipped, which is her direct workplace.

At the post there is a table with pull-out and lockable drawers for storing the necessary medical records, a table lamp and a telephone.

It is better to keep medical records in a separate drawer or locker, divided into compartments (according to the number of wards), which allows you to quickly find the required medical history.

There should also be a closet (or several lockers) at the nurse's post for storing medicines (Fig. 1). At the same time, lockable compartments must be distinguished in which drugs of group A (poisonous) and B (potent) are located.

Medicines for external and internal use, as well as preparations for injection are placed on special shelves.

Separately store tools, dressings, flammable substances (alcohol, ether). Medicines that quickly lose their properties during storage (infusions, decoctions, serums and vaccines) are placed in a special refrigerator.

Patient care items (thermometers, heating pads, banks, etc.), as well as dishes for taking tests are stored separately. Scales for weighing patients are installed next to the post.

Fig. 1. Medicine storage cabinet.

A treatment room is also equipped here (Fig. 2). It has a specially trained procedural nurse.

The functioning of the therapeutic department also provides for the maintenance of the necessary medical records. Its list is quite extensive and includes many items.

The documents, which are mainly processed by doctors, include, for example, a medical history, a card of a person who left the hospital, a certificate of incapacity for work, etc.

A number of medical documents in the department are filled out and maintained by sentinel nurses. This is a notebook (journal) of medical appointments, where, when checking the case histories, the nurse enters the appointments made by the doctor, summary records of patients in the department, which reflects data on the movement of patients (i.e. admission, discharge, etc.) per day, temperature sheets , portions with an indication of the number of patients receiving this or that table.

One of the main documents that the nurse constantly maintains at the post is the shift log. It notes data on the movement of patients per shift, indicate appointments regarding the preparation of patients for research, focus on the condition of seriously ill patients who need constant monitoring.

Fig. 2. Treatment room of the therapeutic department.

Reception and transfer of duty is a responsible event, and requires a lot of concentration from nurses. Formally carried out, crumpled reception and transmission of shifts lead, as a rule, to various kinds of omissions, unfulfilled appointments, etc.

The effectiveness of treatment of patients in a hospital to a large extent depends on the organization of the necessary medical and protective regime in the department.

The creation of such a regime involves protecting the patient from various negative emotions (associated, for example, with pain), providing conditions for sufficient and adequate sleep and rest (rational placement of patients in wards, silence in the department), allowing walks in the warm season and visiting sick relatives , providing patients with fresh newspapers and magazines, organizing a buffet in the hospital with a fairly wide range of products necessary for dietary nutrition, which has a certain value, for example, for patients from other cities, etc.

In hospitals, a fairly large number of factors are still often observed that significantly violate the principles of the therapeutic and protective regime.

These include cases of improper or untimely fulfillment of the necessary appointments, rudeness and inattention to patients on the part of medical personnel (for example, insufficient anesthesia for patients during painful manipulations).

Disorders that sometimes occur in the work of the medical staff of departments (for example, knocking of doors and jingling of buckets, accompanied by exclamations of medical personnel in the early morning hours, irregular wet cleaning, difficulties with timely change of bed linen, poorly cooked food), problems in sanitary technical support (interruptions in the supply of hot water, disruptions in heating, faulty telephones, etc.).

The list of such costs could be continued. The listed "little things" adversely affect the condition of patients and reduce the authority of the medical institution.

The creation of an optimal medical and protective regime in a hospital is a task in the solution of which all services of a medical institution should actively participate.

CHAPTER 2. RESPONSIBILITIES OF THE PROCEDURAL NURSE OF THE THERAPEUTIC DEPARTMENT

Persons with completed secondary medical education, as well as work experience in this department for at least 3 years, are accepted for the position of a nurse in a treatment room. Accepted and dismissed by the head physician of the hospital on the recommendation of the head. department of the head nurse of the hospital. Before starting work, he undergoes a compulsory medical examination in the department service of the hospital.

The procedure nurse is directly subordinate to the head of the department and the head nurse of the department. The office nurse is directly subordinate to the procedural nurse.

The procedural nurse of the department works according to the schedule drawn up by the head nurse, approved by the head. department, deputy. the chief physician of the relevant profile, agreed with the trade union committee.

The main responsibilities of a procedural nurse are to properly organize the work of the office and perform the prescribed procedures.

) Perform manipulations only as directed by a doctor.

) Start work only after preparing the office for the implementation of the procedures, thorough preparation of the instruments.

) Follow the sequence of the procedures in accordance with the hourly work schedule.

) Strictly observe the requirements of asepsis and antiseptics when performing procedures.

) During work, maintain the necessary order, appropriate work culture and sanitary condition.

) Strictly observe the technology of procedures and manipulations:

intradermal tests;

taking blood from a vein for diagnostic tests;

conducting (under the supervision of a doctor) determination of the blood group and Rh factor, transfusion of blood and blood substitutes, setting up systems and administering drugs by the drip method;

preparation of instruments for delivery to the central sterilization room;

preparation of material for the procedures.

) Immediately inform the doctor about the complications associated with the production of manipulations and procedures in the office, master the methods of providing first aid. Prepare the necessary set of tools and materials and assist the doctor in carrying out other manipulations in this office.

) Maintain high-quality documentation of the treatment room.

) Make daily notes on the prescription sheets of the procedures performed.

) Strictly observe the sanitary and epidemiological regime of the office, wear overalls that meet the requirements of the treatment room.

) Timely replenish the cabinet with the necessary amount of instruments, medicines, serums for determining the blood group, and another set of solutions, drugs, inventory, antiseptics necessary for work during the day.

) Own the technology of setting samples for occult blood, washing from disinfectants and detergents.

) Carry out daily control over the availability of the required amount of drugs in the pharmacy for emergency assistance.

) Make timely changes to the instructions for the sanitary and epidemiological regime, methods of preparing hands for work, etc.

) Monitor the work of the nurse's office.

) Observe the requirements for sterilization in a dry heat oven and maintain the corresponding documentation.

) Ensure control over the rational use of tools, correct accounting. Timely carry out the replacement of worn-out medical equipment and instruments.

) Provide the correct storage conditions for medicines, solutions and serums in the office.

) Observe the internal regulations, safety measures, do not leave the department without the knowledge of the head nurse, do not leave the treatment room unlocked when leaving home. Hand over the keys to the ward nurse of the post.

) Continuously improve their medical knowledge by reading special literature, participating in industrial studies, nursing conferences, at least 5 years later to undergo specialization and improvement courses in refresher courses, to take part in the training of nurses of the department to work in a treatment room.

In his work, he is guided by the job description, orders and instructions for organizing the work of the office, instructions from the head. department, chief physician of the hospital.

CHAPTER 3. ACTIVITIES OF THE PROCEDURAL NURSE OF THE THERAPEUTIC DEPARTMENT

In the treatment room, various diagnostic and therapeutic manipulations are performed: subcutaneous, intramuscular and intravenous injections, taking blood for clinical and biochemical analyzes, determining the blood group, pleural puncture to remove fluid from the pleural cavity, puncture of the abdominal cavity for ascites, diagnostic liver puncture, measuring venous pressure and blood flow velocity, gastric and duodenal intubation.

In the treatment room, systems for intravenous drip administration of drugs are assembled, syringes and needles are sterilized by boiling (if the hospital does not have a central sterilization room). nursing care therapeutic

Since many of the manipulations performed in the treatment room are invasive (that is, they are associated with the danger of microbial flora entering the patient's body), great requirements are imposed on the sanitary state of this room, in particular, regular air disinfection is carried out using a bactericidal lamp.

It is important to carry out quartzing, adherence to the disinfection regime. Quartzization is a process of treatment (disinfection) of a room (air) by ultraviolet radiation of a quartz lamp. As a result of quartzization, the air is enriched with ozone, which, in turn, also disinfects the air. Ozone is poisonous, therefore, after quartzing, the room should be ventilated. With proper observance of the mode of use of the lamp, quartzing is not harmful. May cause eye burns if misused. In medical institutions, quartzing is currently widely used for bactericidal purposes. Leave the room while the quartz lamp is operating. It is categorically impossible to look at a working lamp and try to sunbathe from it.

The irradiators are designed for air disinfection in medical centers, children's and sports facilities, production workshops.

Bactericidal irradiators are of open, closed and combined type. The open type is used exclusively in the absence of people. The closed type is used in the presence of people and animals, in the treated room.

Combined irradiators have been developed for rooms with a volume of up to 50m / cube, which allow you to process rooms both in the absence of people and in their presence, without harming health.

A quartz lamp (Fig. 3) is a quartz glass bulb that transmits ultraviolet rays. A gas-discharge lamp with the addition of mercury is used for disinfection of premises, products, objects.

Fig. 3. Quartz lamp.

The bactericidal irradiator (Fig. 4) is an effective means of preventing and combating infections, viruses, bacteria.

In medicine, such lamps are used for general and intracavitary irradiation, for inflammatory diseases in otorhinolaryngology. On the recommendation of a doctor, lamps are used independently at home for respiratory diseases, treatment of pustular infections, bedsores, stomatitis.

Fig. 4. The irradiator is bactericidal.

Ultraviolet germicidal irradiator is effective against microorganisms. It is intended for disinfection of air and surfaces of premises by means of ultraviolet rays. If the operating rules are observed, the application is safe for human and animal health. Irradiators are capable of destroying almost all currently known microbes and viruses.

Irradiation with a quartz lamp has a beneficial effect on metabolism.

The duration of effective irradiation te of the air in the room during the continuous operation of the bactericidal installation, at which a given level of bactericidal efficiency is achieved, should be within 1 - 2 hours for closed irradiators, and 0.25 - 0.5 hours for open and combined irradiators, and for supply and exhaust ventilation £ 1 h (or with air exchange rate Кр ³ 1 h-1). In this case, the calculation of the bactericidal installation is carried out taking into account the minimum value of the duration of effective irradiation te, i.e. for open and combined irradiators 0.25 h, and for closed irradiators 1 h.
Closed irradiators and supply and exhaust ventilation in the presence of people must work continuously during the entire working time.
Bactericidal installations with open and combined irradiators can be used in a repeated-short-term mode when people are removed from the room for the irradiation time (te) within 0.25 - 0.5 h. In this case, repeated sessions of irradiation should be carried out every 2 hours during the working day.

In rooms of the first category, it is recommended to use germicidal installations consisting of open or combined and closed irradiators or supply and exhaust ventilation and open or combined irradiators. In this case, open and combined irradiators are turned on only in the absence of people for a time (te) within 0.25 - 0.5 hours for the period of preoperative preparation of the room. This allows you to reduce the time and increase the level of air disinfection in rooms with increased epidemiological requirements.
Bactericidal installations with supply and exhaust ventilation and additional closed irradiators are used when the existing supply and exhaust ventilation provides a given level of bactericidal efficiency for a time te more than 1 hour.
When using supply and exhaust ventilation, bactericidal lamps are placed in the outlet chamber after the dust filters.

The procedural nurse performs all manipulations with gloves. Sterile styling is prepared for one work shift (6 hours). Tweezers for grasping sterile materials are stored in sterile containers filled with sterilant solutions (6% H2O2, triple solution, in exceptional cases - "Sidex"). The filling level of solutions in the container should be no more than the level of the working surfaces of the jaws.
Used syringes, needles, tweezers, clamps, gloves, transfusion systems, probes, catheters, etc. are immersed in one of the disinfecting solutions, then rinsed with running water and handed over to the central office for pre-sterilization cleaning and sterilization. (Or, in the absence of CSOs, they are subjected to pre-sterilization cleaning.)
Used balls and other dressings are immersed in a 3% solution of chloramine or bleach for 2 hours, or in a 0.03% solution of neutral anolyte for 30 minutes. Dishes for determining the blood group (Fig. 5) are processed according to OSG42-21-2-85.

Fig. 5. Dishes for determining the blood group.

Technology of setting amidopyrine test: mix equal amounts of 5% alcohol solution of amidopyrine, 30% acetic acid and 3% hydrogen peroxide solution (2-3 ml each).

The above reagent is applied to non-sterile cotton wool. After a few seconds, if there is no color reaction on the cotton wool, this cotton wool is used to wipe the syringe plunger, the cylinder from the outside, the needles, and the cannula inside. Then the reagents are poured into the syringe barrel, passed through the syringe onto another cotton wool (the syringe barrel is checked). After that, the needle is fixed on the syringe, the reagent is again poured into the cylinder and passed through the syringe and the needle (the needle is checked):

a) in the presence of blood contamination, a blue-green color appears on the cotton wool. Staining can be observed if there are drug residues, triple solution and chloramine on the syringe;

b) in case of positive samples, repeated control of the instruments is carried out daily until a 3-fold negative result is obtained.
The technology of setting an azopyram sample: a 1.0-1.5% solution of aniline hydrochloric acid in 95% ethyl alcohol is prepared. The finished solution can be stored in a tightly closed bottle in the dark at 40 ° C (in the refrigerator) for 2 months; in a room at room temperature 18-23 ° С - no more than a month. Moderate yellowing of the reagent during storage without precipitation does not reduce its working qualities. Immediately before the sample is prepared, a working solution is prepared by mixing equal volumetric amounts of azopyram and 3% hydrogen peroxide. The working solution can be used within 1 - 2 hours. Longer storage may cause a spontaneous pink coloration of the reagent. At temperatures above 25 ° C, the working solution turns pink faster, so it is recommended to use it within 30-40 minutes. Do not test hot tools or keep them in bright light or near heating appliances.

The suitability of the working solution of azopyram is checked if necessary: ​​2-3 drops are applied to the blood stain. If, no later than 1 minute later, a violet color appears, which then turns into a blue color, the reagent is usable; if staining does not appear within 1 minute, the reagent cannot be used.

When providing emergency care, the procedural nurse should:

In case of bronchial asthma - call a doctor, calm the patient, sit with an emphasis on his hands, unbutton tight clothes, measure blood pressure, count the pulse rate and respiratory rate, take 1-2 breaths from the inhaler, which the patient usually uses, give 30-40% humidified oxygen, give a hot drink, make hot foot and hand baths. Prepare equipment and instruments: a system for internal administration, syringes, tourniquet, Ambu bag (Fig. 6).

Fig. 6. Bag of Ambu.

In case of pulmonary hemorrhage, call a doctor, calm the patient down, make the patient sit comfortably, give a towel, a kidney-shaped basin, explain that it is impossible to talk, put an ice pack on the chest. Prepare equipment and instruments: a system for internal infusion, a tourniquet, everything you need to determine the blood group.

With angina pectoris - call a doctor, calm down, comfortably seat the patient, measure blood pressure, calculate the heart rate, give nitroglycerin tab. 0.0005 gr. or aerosol (1 press) under the tongue, re-taking the drug in the absence of effect after 3 minutes, repeat 3 times under the control of blood pressure and heart rate, give corvalol or valocordin (25-35 drops), or valerian tincture 25 drops, put mustard plasters on the heart area, give 100% humidified oxygen, control of pulse and blood pressure, take an ECG, give 0.25 g while maintaining pain. aspirin, chew immediately. Prepare equipment and instruments: syringes and needles for intramuscular and subcutaneous injections, an Ambu bag, an ECG apparatus.

In case of myocardial infarction, call a doctor, observe strict bed rest, calm the patient, measure blood pressure and pulse, give nitroglycerin 0.5 mg sublingually (up to 3 tablets) with a break of 5 minutes, give 100% humidified oxygen, take an ECG, connect to cardiomonitor (Fig. 7). Prepare equipment and instruments: as prescribed by a doctor: fentanyl (amp.), Droperidol, promedol (amp.), System for internal administration, tourniquet, electrocardiograph, defibrillator, cardiomonitor, Ambu bag.

Fig. 7. Cardiomonitor.

In case of cardiogenic shock, call a doctor, put the patient to bed, lower the head end of the bed, raise the foot end by 20º, measure blood pressure, count the pulse, give 100% humidified oxygen, make an ECG, connect to a heart monitor. Prepare equipment and instruments: a system for intravenous infusion of drugs, a tourniquet, a cardiac monitor, an ECG machine, a pulse oximeter, a defibrillator, an Ambu bag.

In case of cardiac asthma, pulmonary edema - call a doctor, sit down comfortably (without tension) the patient with legs lowered from the bed, calm down, measure the heart rate, pulse, respiratory rate, give 1 nitroglycerin tablet under the tongue, repeat after 5 minutes under the control of blood pressure and heart rate, if systolic blood pressure is above 90 mm. rt. Art. apply venous tourniquets on both limbs for 15-20 minutes (remove one by one, gradually) or make hot foot baths, give 100% humidified oxygen. Prepare equipment and instruments: a system for intravenous administration, a tourniquet, an electrocardiograph, a defibrillator (Fig. 8), a cardiac monitor, a pulse oximeter, an Ambu bag.

Fig. 8. Defibrillator.

In case of arrhythmia - call a doctor, lay down and calm the patient, measure blood pressure, calculate heart rate, register a standard ECG in ΙΙ lead, record about 10 QRS complexes, connect to a heart monitor, prepare equipment and instruments: syringes for IV and IV , s / c injections, tourniquet, defibrillator, electrostimulators, ambu bag.

In case of a hypertensive crisis, call a doctor, calm the patient down, lay him down with a high headboard, turn his head to one side when vomiting, measure blood pressure, heart rate. Prepare equipment and instruments: an apparatus for measuring blood pressure, syringes, an internal infusion system, a tourniquet.

In case of gastrointestinal bleeding - call a doctor, calm down and lay the patient down, turn your head to one side, an ice pack on the epigastric region, prohibit drinking, eating, talking, measuring blood pressure and heart rate. Prepare equipment and instruments: a system for internal infusion, syringes, a tourniquet, everything you need to determine the blood group and Rh factor.

In case of hypoglycemic coma, fix the time, provide a call to a doctor, laboratory assistant, give the patient a stable lateral position, and revise the oral cavity. Prepare equipment and instruments: system for intravenous drip infusion, syringes, needles, tourniquet, 40% glucose solution, 0.9% sodium chloride solution.

In case of hyperglycemic coma (diabetic) - fix the time, provide a call to a doctor, a laboratory assistant, give a stable lateral position, control the pulse, blood pressure, respiratory rate, determine the blood sugar level from a finger using a portable glucometer (Fig. 9). Preparation of medicines, equipment and instruments: system for intravenous drip infusion, syringes, simple insulin (actropid).

Fig. 9. Blood glucose meter.

In case of angioedema (laryngeal edema) - call a doctor, calm the patient, provide fresh air, give 100% humidified oxygen, drip vasoconstrictor drops (naphthyzin, sanorin, glazolin) into the nose. Prepare equipment and instruments: a system for internal infusion, a tourniquet, syringes, needles, an ambu bag, a large-diameter Dufo needle or a conicote, a set for tracheostomy, a laryngoscope (Fig. 10), a set for intubation, a heart rate monitor.

Fig. 10. Laryngoscope.

Fig. 11. Ventilator.

In case of a collapse, call an ambulance, lay him down without a pillow with raised legs, provide an influx of fresh air, measure blood pressure. Prepare equipment and instruments: syringes, needles, tourniquet.

In case of acute respiratory failure - call emergency care, try to understand the cause of the condition, ensure an elevated position, unfasten clothes, pick up a small child, examine, free the upper respiratory tract (suck mucus, vomit), provide fresh air, oxygen supply ... Prepare equipment and instruments: humidified oxygen, an ambu bag, syringes, needles, tourniquet.

In case of nosebleeds - call a doctor, calm the patient down, sit comfortably, tilt your head forward, give a kidney-shaped tray in your hands, stop the bleeding with the help of: introduction of a cotton-gauze swab moistened with 3% hydrogen peroxide solution into the nasal cavity; hemostatic sponge; imposition of anterior nasal tamponade; put an ice pack on the bridge of the nose and back of the head; measure blood pressure and heart rate. Prepare equipment and instruments: a system for intravenous infusions, a tourniquet, syringes and needles for intramuscular and subcutaneous injections, a set for external and posterior nasal tamponade.

In case of status epilepticus, call a doctor, carry out measures according to the "convulsive seizure" standard, prevent tongue sinking, cleanse the mouth of saliva and secretions in the interval between seizures. Prepare equipment and instruments: syringes, needles.

In case of a convulsive seizure, put a pillow, a hat or something else under your head, soft will provide air access (unfasten the collar, belt), turn the patient to one side when vomiting, call a doctor or an ambulance. Prepare equipment and instruments: syringes and needles.

Technology of indirect (closed) heart massage

It is produced in order to restore blood circulation in the body, i.e. support blood circulation in vital organs during cardiac arrest (Fig. 12). The earlier the massage is started, the sooner the effect will be obtained. It must be remembered that from the moment of cardiac arrest to the development of irreversible changes in the brain, a very short period of time elapses, amounting to 4-6 minutes. During this time, resuscitation measures should be started.

A

B

Fig. 12. Performing an indirect (closed) heart massage: a - hand position; b - the moment of pressing on the sternum.

For a successful chest compressions, the patient must be placed on a hard surface. If cardiac arrest occurs on a bed with a spring mattress, then the patient should be placed on the bed so that the thoracic spine is in a firm bend. For this, the upper half of the body is shifted to the edge of the bed; the head will hang down. The nurse should stand to the side of the patient and expose his chest.

Indirect cardiac massage is performed as follows. The left palm is placed on the lower third of the sternum, and the right palm is placed on the left. Both arms should be straight and the shoulder girdle above the ribcage. Massage is carried out with vigorous sharp pressure on the sternum; in this case, the sternum should be displaced by 3 - 4 cm to the spine. The number of presses is 50-60 per minute.

The heart is compressed between the sternum and the spine, and blood from the ventricles is released into the aorta and pulmonary artery. When the pressure stops, the sternum rises, and the heart is refilled with blood from the full veins. Thus, artificial circulation is carried out. The massage should be continued until the full-fledged independent activity of the heart is restored, until a distinct pulse appears and the pressure rises to 80-90 mm Hg. Cardiac massage must be accompanied by mechanical ventilation.

Artificial respiration technology

It is carried out for the purpose of periodic replacement of air in the lungs in the absence or insufficiency of natural ventilation. It is better to perform mechanical ventilation with the help of hand-held devices: an Ambu bag, DP-10, KAMA, RDA-1, etc. In the absence of a respirator, you cannot waste minutes on its delivery, and it is necessary to immediately start ventilation in an expiratory way.

Mouth-to-mouth method. Efficiency with this method is achieved by throwing the patient's head back as much as possible. In this case, the root of the tongue and the epiglottis are displaced forward and open free air access to the larynx.

Standing on the side, the nurse presses with one hand with the wrist on the patient's forehead and throws his head back, and puts the other under the neck. Artificial ventilation is based on the rhythmic blowing of air from the nurse's airways into the patient's airways under positive pressure. During mechanical ventilation, the patient's mouth must be constantly open (Fig. 13).

Fig. 13. Technique of artificial respiration by the "mouth-to-mouth" method: a - throwing back the victim's head, b - opening the mouth, c - inhale, d - exhale.

The way from mouth to nose. Air is blown into the respiratory tract through the nose: the patient's mouth must be closed in this case (Fig. 14). This method does not fundamentally differ from that described above.

In the presence of a breathing fur (Ambu bag) or a ventilator mask, it is better to perform with their help, since this improves the physiological basis of ventilation - oxygen-enriched air is introduced into the respiratory tract. In this case, the mask should be tightly pressed around the patient's nose and mouth.

Fig. 14. Artificial respiration by the "mouth-to-nose" method: a - exhalation of the victim; b - air blowing.

CONCLUSION

After analyzing the activities of the procedural nurse of the therapeutic department, the following conclusion can be drawn.

The procedure nurse plays a very important role in the therapy department. She is responsible for the correct organization of the work of the treatment room around the clock, for the timely fulfillment of the doctor's prescriptions for the procedures, for the implementation of the sanitary and epidemiological regime at her workplace, the rules of asepsis and antiseptics, for providing the room with the required number of instruments and medicines during the day. , solutions, sterile material for performing procedures, for observing the conditions and rules for storing medicines, inventory, tools, cabinet equipment, for high-quality documentation of the cabinet and making notes on the procedures performed, for the correct organization of the work of the nurse's nurse.

A procedural nurse must be able to professionally carry out a huge number of, sometimes vital for the patient, manipulations, such as providing emergency care, covering a sterile table, measuring body temperature, measuring pulse, determining the number of respiratory movements, measuring blood pressure, determining daily urine output, setting cans, setting mustard plasters , setting a warming compress, using a heating pad and an ice bladder, preparing a medicinal bath, supplying oxygen, supplying a vessel and urine bag, setting a gas tube, setting all types of enemas, catheterization of the bladder, seeing the documentation for drug registration, using ointment, plaster, powder , instilling drops in the nose, ears and eyes, putting ointment behind the eyelid, using an inhaler, a set of insulin doses, all types of injections, collecting the drip system, venipuncture, taking an ECG, taking a throat swab, collecting sputum, hemoglobin blood test, ESR, leukocytes, urine analysis according to Zimnitsky , fractional sounding of the stomach, probing of the gallbladder, collecting feces for research, preparing the patient for endoscopy, preparing the patient and participating in all types of punctures, conducting artificial respiration, applying all types of dressings, determining the blood group, test for individual compatibility, stopping bleeding from superficially located vessels, pre-sterilization cleaning of syringes, needles, instruments, use of a sterile bix, disinfection of hands, etc.

Thus, a nurse should be a professional in her field, an educational psychologist, a consultant, and a friend of the patient. Then the title of a nurse will sound proudly.

BIBLIOGRAPHY

1. Weber VR Fundamentals of nursing. M .: Publishing house "Medicine", 2001. - 496 p.

Dvoynikov S.I. Fundamentals of nursing. M .: Publishing house "Academy", 2009. - 336 p.

Kotelnikov G.P. Nursing. Rostov-on-Don: Phoenix Publishing House, 2007. - 704 p.

Kuleshova L.I. Fundamentals of nursing. Rostov-on-Don: Phoenix Publishing House, 2011. - 736 p.

Lychev V.G., Karmanov V.K. Fundamentals of nursing in therapy. - Rostov - on - Don: Phoenix, 2008 - 512s.

Makolkin V.I., Ovcharenko S.I. Semenkov N.N. Nursing in therapy. - M .: Medical Information Agency, 2008 - 544p.

Mukhina S.A., Tarkovskaya I.I. Theoretical foundations of nursing - M., 1996.- 56p.

Myshkina A.K. Nursing. Directory. M .: Publishing house "Drofa", 2008. - 256 p.

Obukhovets T.P. Fundamentals of nursing. Workshop. Rostov-on-Don: Phoenix Publishing House, 2011. - 608 p.

Obukhovets T.N. Nursing in therapy with a course of primary health care. - Rostov - on - Don: Phoenix, 2008. - 416p.

Oslopov V.N., Bogoyavlenskaya O.V., General patient care in a therapeutic clinic.- M .: GEOTAR - Media, 2009 - 464p.

Otvagina, T.V. Therapy.- Rostov-on-Don: Phoenix, 2008.- 368p.

Smolyaeva E.V., Nursing in therapy with a course of primary medical care. - Rostov - on - Don: Phoenix, 2010 - 474p.

Sopina Z.E. Modern methodology of nursing. M .: Publishing house "GEOTAR-Media", 2009. - 256 p.

Sprints A. M. Fundamentals of nursing. St. Petersburg: SpetsLit Publishing House, 2009. - 464 p.

Frolkis, L.S. Therapy with a course of primary care. - M .: GEOTAR - Media, 2010 - 448s.

Shutov E.Yu., Apodiakos E.V. Therapy with a course of primary health care.- Rostov - on - Don: Phoenix, 2007 - 538p.

Yarovinsky M.Ya. Medical worker and patient // Medical assistance. - 1996. - No. 3.

Working on the post requires me to clearly and competently fulfill the entire list of functional duties presented below, while strictly following the principles of medical deontology and ethics in my work

1. to provide adequate care and supervision of patients;
2. accurately carry out all medical appointments with an accurate mark in the journal;
3. supervise the work of junior medical personnel;
4. to ensure that the department maintains proper order, cleanliness and compliance by patients with the regime established for them;
5. while on duty, constantly be among the patients, entering the office only for medicines, to record, fill out a patient observation diary;
6. accompany during the round of the doctors, the head of the department and the doctor on duty who visited the department, report on the condition of patients, enter all comments and orders in the journal;
7. in the absence of a procedural nurse, perform all appointments (setting all types of injections and intravenous infusion therapy);
8. to receive newly admitted patients, to acquaint them with the internal regulations;
9. when admitting a patient admitted to the department, especially an agitated one, pay attention to bodily injuries, bruises, dislocations, and so on. Get acquainted with the mental and physical condition, pay attention to painful signs. The patient should not have objects with which he can harm himself and others. Check the quality of the previous sanitization of patients in the emergency room;
10. regularly at least 1 time in 7 days, examine patients for head lice. Sauna and change of bedding and underwear is held once a week.
11. examine the patient's pharynx and, for prophylactic purposes, take BL swabs from the pharynx and nose;
12. while working as a day ward nurse, note all the features of the condition, behavior of patients, states of aggression towards other patients and staff, their unusual statements, change or deterioration of the condition - in the observation log and report to the attending physician;
13. in the absence of the attending physician and the head of the department, notify the doctor on duty;
14. the nurse makes sure that all patients are neat, washed, shaved on time, and when going out for a walk - dressed for the weather;
15. in the department, the schedule for quartzing the wards and premises assigned to the post, bathing patients must be observed;
16. the nurse makes sure that patients lie down only on their own beds, so that underwear and bedding are clean;
17. special attention is paid to weakened patients, severe in mental and somatic conditions. At the same time, explaining to junior staff the peculiarities of an individual approach to such patients, paying attention to their condition, behavior, especially careful care of them;
18. supervise the work of the junior shift personnel, monitor the implementation of the relevant instructions, correcting the corresponding violations in the course of work;
19. report all violations to the head of the department and older sister;
20. all comments, instructions to junior staff should be made in the absence of patients;
21. the ward nurse on duty is obliged to know all patients by name, the characteristics of the condition and behavior, the regime;
22. to promote the involvement of patients in work processes;
23. make sure that during the shift in the department there are only personnel employed on the shift;
24. twice a day to measure the body temperature of patients under control - blood pressure, NPV, PS;
25. send for a walk only those patients for whom there is an appropriate doctor's order;
26. issue and ensure the administration of medications, for which timely submit to the head nurse a list of medications required for the post;
27. transmit information about the availability of patients to the admission department (summary per day);
28. observe that all rooms not intended for permanent use are locked and opened only during use;
29. carefully monitor patients during and after visits, so as not to get into the department of items that are not allowed for transfer;
30. correctly take all analyzes and control their delivery to the laboratory;
31. know and follow safety rules;
32. to treat patients who violate the regime strictly, not to give indulgences. Maintain the regime and status of the department.
33. the duty personnel on duty should not be distracted, discuss patients, talk among themselves about treatment, about their personal affairs - patients catch everything;
34. to provide individual care for severe patients - to treat the oral cavity, eyes, to monitor diuresis, feeding, stool, temperature, blood pressure, patient hygiene.

All functional duties of a ward nurse are included in the scope of my work and I try to fulfill them in good faith, clearly and quickly.

Job description of a ward nurse [name of organization, institution]

This job description was developed and approved in accordance with the provisions of the order of the Ministry of Health and Social Development of the Russian Federation dated July 23, 2010 N 541n "On approval of the Unified qualification reference book of positions of managers, specialists and employees, section" Qualification characteristics of positions of workers in the health sector ", and other regulations governing labor relations.

1. General Provisions

1.1. The ward nurse (guard) belongs to the category of specialists and is directly subordinate to [the name of the position of the head].

1.2. A ward nurse (guard) is appointed and dismissed by the order of [name of the position].

1.3. A person who has a secondary vocational education in the specialty "General Medicine", "Obstetrics", "Nursing" and a certificate of a specialist in the specialty "Nursing", "Nursing in Pediatrics", "General practice "without any requirements for length of service.

1.4. A ward nurse (guard) should know:

Laws and other regulatory legal acts of the Russian Federation in the field of healthcare;

Theoretical foundations of nursing;

Fundamentals of the treatment and diagnostic process, disease prevention, promotion of a healthy lifestyle;

Rules for the operation of medical instruments and equipment;

Rules for the collection, storage and disposal of waste from medical institutions;

Fundamentals of the functioning of budgetary insurance medicine and voluntary health insurance;

Fundamentals of valeology and sanology;

Fundamentals of Disaster Medicine;

Rules for maintaining accounting and reporting documentation of a structural unit, the main types of medical documentation;

Medical ethics and deontology;

Psychology of professional communication;

Fundamentals of Labor Law;

Internal labor regulations;

Sanitary and personal hygiene rules;

Rules and regulations of labor protection, safety and fire protection.

2. Job responsibilities

The ward (guard) nurse has the following job responsibilities:

2.1. Caring for and monitoring patients based on the principles of medical deontology.

2.2. Acceptance and placement of patients in the ward, checking the quality of sanitization of newly admitted patients.

2.3. Checking transmissions to patients in order to prevent the intake of contraindicated food and drinks.

2.4. Participation in bypassing doctors in the wards assigned to it, reporting on the condition of patients, recording the prescribed treatment and patient care in the journal, monitoring the fulfillment by patients of the attending physician's prescriptions.

2.5. Implementation of sanitary and hygienic services for the physically weak and seriously ill.

2.6. Fulfillment of the prescriptions of the attending physician.

2.7. Organization of examination of patients in diagnostic rooms, at consultant doctors and in the laboratory.

2.8. Immediate message to the attending physician, and in his absence - to the head of the department or the doctor on duty about a sudden deterioration in the patient's condition.

2.9. Isolation of patients in agonal state, calling a doctor to carry out the necessary resuscitation measures.

2.10. Preparation of corpses of the deceased for sending them to the pathological and anatomical department.

2.11. When taking on duty, inspection of the premises assigned to it, checking the state of electric lighting, the presence of hard and soft equipment, medical equipment and instruments, medicines.

2.12. Reception of duty under the signature in the diary of the department.

2.13. Monitoring the implementation by patients and their relatives of the regimen of visits to the department.

2.14. Control over the sanitary maintenance of the wards assigned to it, as well as the personal hygiene of patients, over the timely reception of hygienic baths, change of underwear and bed linen.

2.15. Control over the receipt of food by patients in accordance with the prescribed diet.

2.16. Maintaining medical records.

2.17. Surrender of duty in wards at the bedside of patients.

2.18. Ensuring strict accounting and storage of group A and B drugs in special cabinets.

2.19. Collection and disposal of medical waste.

2.20. Implementation of measures to comply with the sanitary and hygienic regime in the room, the rules of asepsis and antiseptics, the conditions for sterilization of instruments and materials, the prevention of post-injection complications, hepatitis, HIV infection.

2.21. [Other job responsibilities].

3. Rights

A ward nurse (guard) has the right to:

3.1. For all social guarantees stipulated by the legislation of the Russian Federation.

3.2. For the free distribution of special clothing, special footwear and other personal protective equipment.

3.3. Receive the information necessary for the performance of functional duties on the activities of the organization from all divisions directly or through the immediate superior.

3.4. Require the management of the organization to assist in the performance of their professional duties and the exercise of rights.

3.5. To get acquainted with the draft orders of the management concerning its activities.

3.6. Participate in meetings that address issues related to her work.

3.7. Require the creation of conditions for the performance of professional duties, including the provision of the necessary equipment, tools, a workplace that meets sanitary and hygienic rules and regulations, etc.

3.8. Improve your professional qualifications.

3.9. [Other rights provided for Labor legislation Russian Federation].

4. Responsibility

The ward nurse (guard) is responsible for:

4.1. For non-fulfillment, improper fulfillment of the duties provided for by this instruction - within the limits determined by the labor legislation of the Russian Federation.

4.2. For offenses committed in the course of carrying out their activities - within the limits determined by the current administrative, criminal and civil legislation of the Russian Federation.

4.3. For causing material damage to the employer - within the limits determined by the current labor and civil legislation of the Russian Federation.

The job description is developed in accordance with [name, number and date of the document].

HR manager

[initials, surname]

[signature]

[day month Year]

Agreed:

[initials, surname]

[signature]

[day month Year]

I have read the instructions:

[initials, surname]

[signature]

[day month Year]