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

Inpatient (hospital, hospital) medical care currently represents the most resource-intensive sector of healthcare. The main material assets of the industry (expensive equipment, apparatus, etc.) are concentrated in hospital institutions, on the maintenance of which an average of 60-70% of all resources allocated to healthcare is spent. Hospitals provide the largest volume of inpatient care in the country (Fig. 10.1).

Rice. 10.1. Approximate organizational structure of a city hospital

In 2008, there were more than 6,000 hospital institutions in Russia with a total number of beds of about 1.5 million. modern stage great importance acquire new hospital-replacing technology

ologies that allow significant savings in available resources without compromising the quality of medical care (see section 10.3).

10.1. ORGANIZATION OF THE WORK OF NURSING MEDICAL STAFF IN A CITY HOSPITAL FOR ADULTS

The hospital is headed by the chief physician, who is responsible for all treatment and preventive, administrative, economic and financial work. The activities of paramedical and junior medical personnel are supervised by the chief nurse. A person with a higher medical education in the specialty "Nursing" or with a secondary medical education who has a diploma in one of the specialties: "Nursing", "General Medicine", "Midwifery" and a certificate in the specialty " Organization of nursing” with 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 chief nurse are mandatory for the middle and junior medical staff of the hospital.

Main responsibilities of the chief nurse:

Development of promising and current plans advanced training 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 of medications to departments in accordance with their requirements, including narcotic, poisonous and potent drugs;

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

Control over compliance with the requirements of the sanitary and anti-epidemic regime, the quality of medical documentation by nursing staff.

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

Give orders to middle and junior medical personnel and monitor their implementation;

Make proposals to the chief physician of the hospital on rewarding and imposing penalties on middle and junior medical staff;

Make suggestions certification commission about assigning another qualification category nursing staff;

Instruct nurses to check the work of paramedical and junior medical staff of hospital departments.

The patient's first acquaintance with the hospital begins with reception department. It can be centralized or decentralized. Patients can get to the hospital emergency department in different ways: by referral from doctors from outpatient clinics (planned hospitalization), on an emergency basis (when they are delivered by an ambulance), by transfer from another hospital, or by independently turning to the emergency department (“gravity” ).

The duties of the reception department include:

Reception of patients, making a preliminary diagnosis and deciding on 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 about the condition of patients.

The work of paramedical and junior medical staff 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”, “Midwifery” and a certificate in specialty "Organization of Nursing" with organizational skills. The senior nurse of the admission department is appointed and dismissed by the chief physician of the hospital on the recommendation of the head of the department to whom she

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

The emergency department must provide the ability to conduct urgent X-ray, endoscopic examinations, express tests, etc. To provide emergency medical care, the emergency department must have a permanent set of necessary medications, medical instruments, etc. At the emergency department of large hospitals, intensive care wards and temporary isolation of patients are organized.

For the position admissions department nurse a person with secondary medical education and a certificate in the specialty “Nursing” is appointed. The admission department nurse is appointed and dismissed by the chief physician of the hospital and reports directly to the head of the admission department (doctor on duty) and the senior nurse of the admission department. The nurse's orders are mandatory for junior medical staff in the admissions department.

The admissions department nurse performs big circle responsibilities:

Gets acquainted with the direction of the patient and accompanies him to the office of the doctor on duty;

Listens to the complaints of a patient admitted “by gravity” and refers him to the doctor on duty;

Fills out the passport part of the “Inpatient Medical Card” (f. 003/u);

Maintains a “Register of admission of patients and refusals of hospitalization” (f. 001/u);

Examines the patient for lice and measures body temperature;

Performs procedures and manipulations prescribed by the doctor on duty;

Calls consultants and laboratory technicians to the emergency department as directed by the doctor on duty;

Monitors the condition of patients in the isolation ward and promptly follows all doctor’s instructions for their examination and treatment;

Timely transmits telephone messages to the police department, active calls to city clinics, emergency notifications

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

Collects feces, urine, vomit and rinsing water for laboratory testing;

Receives medications from the head nurse and ensures their storage;

Monitors the sanitary condition in the department and supervises the work of junior medical staff;

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

From the emergency department, the patient is admitted to the inpatient department. The work of the medical department is headed by the head. The work of middle and junior medical staff 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 who has a diploma in one of the specialties: "Nursing", "General Medicine", "Midwifery" and a certificate in the specialty " Organization of nursing” with organizational skills. The senior nurse of the department reports directly to the head of the department. She is a financially responsible person, her orders are mandatory for the nursing and junior medical staff of the department.

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

Timely and accurate implementation of the attending physician’s instructions;

Organization of timely examination of patients in the laboratory, diagnostic rooms, and with consultant 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 care for the physically weakened and seriously ill (washing, feeding, rinsing the mouth, eyes, ears, etc. as needed);

Isolation of patients in an agonal state, calling a doctor to confirm death, preparing the corpses of the deceased for transfer to the morgue.

Work in the department in the morning begins with a morning conference, the so-called “five-minute meeting.” Every day, the department resident receives information from the night duty medical staff about the condition of patients and changes in their health, about newly admitted patients, gets acquainted with the results of laboratory, radiological and other studies, and conducts patient rounds. Patient visits are accompanied by a nurse. At the patient's bedside, the resident checks the fulfillment of previously given assignments.

There are two systems for organizing patient care: two-degree and three-degree. In a two-tier system, doctors and nurses are directly involved in patient care. In this case, junior medical personnel help in creating an appropriate sanitary and hygienic regime in the department (cleaning the premises, etc.). In the three-tier system, auxiliary nurses take part in direct patient care. For the position junior nurse for patient care a person who has completed courses for junior nurses in patient care 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.

Therapeutic and protective regime is a system of measures aimed at creating optimal conditions for patients to stay in the hospital. An important role in compliance with the medical and protective regime is assigned to nurses. The main elements of the therapeutic and protective regime include:

Rational layout, placement and equipment of wards and departments (isolation of operating units, 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 odors, moans or screams of patients, noise, tasteless prepared 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 painkillers, high skill in injection techniques and other manipulations, proper sharpness of needles and scalpels, refusal of aimless research);

Measures to prevent the possibility of the patient going into illness and exaggerated ideas about adverse consequences (fiction, favorite music, exciting conversations, painting, television, the opportunity to do some favorite activity, 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 routine (extension physiological sleep, a combination of rest with acceptable 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 (avoidance of iatrogenicity);

Compliance by staff with the principles of medical ethics (high culture of medical personnel, sensitive, attentive attitude towards the patient and his relatives, observance of medical confidentiality, friendly relations between medical personnel.

The patient is discharged from the hospital in the following cases: upon complete recovery; if necessary, transfer to other medical institutions; with persistent improvement in the patient’s condition, when further hospitalization is no longer necessary; at chronic course a disease that cannot be treated in this institution.

10.2. ORGANIZATION OF WORK OF A SECONDARY

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 much in common with the work of a hospital for adults; however, there are also differences that determine the specifics of the work of nursing staff.

Sick children, like adults, are admitted to the hospital of a children's hospital by referral from doctors from children's clinics, emergency medical stations, children's institutions, "by gravity." Planned hospitalization of the child is carried out through the children's clinic.

The structure of a children's hospital includes an emergency department, medical departments (pediatric and specialized: surgical, infectious diseases, etc.), laboratory and functional diagnostic departments, and others.

The emergency department of a children's hospital hospital must be boxed (boxes make up 3-5% of the total number of hospital beds). The most convenient for work are individual Meltzer-Sokolov boxes, which include a pre-box, a chamber, WC, staff gateway. In small hospitals, if there are no boxes for receiving children, at least 2-3 isolated examination rooms and 1-2 sanitary inspection rooms should be provided.

If children are admitted without the knowledge of their parents, the latter are immediately notified by the reception staff. If this is not possible, information about the child is entered in a special book and reported to the police.

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

them taking into account the age of the children and the disease. It is advisable to have glass partitions between rooms so that staff can monitor the condition of children and their behavior. It is necessary to provide for the possibility of the mother staying in the hospital with the child.

Tasks ward nurse children's hospital:

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

Accurate and timely implementation 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 measures, and provision of pre-medical care in his absence;

Maintaining the sanitary condition of the wards.

An important feature of organizing the work of children's departments is the need to conduct educational work. For this purpose, positions of teacher educators are being introduced in children's hospitals. Educational work is carried out with sick children who are treated in a hospital for a long time. A very important element in creating a therapeutic and protective regime for children is the organization of their leisure time, especially in the evening hours. Manual labor, modeling, drawing, and reading aloud carried out at the end of a sick day improve children's mood and promote restful sleep. Ward nurses play a major 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 children 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 of age, meals are provided at the hospital catering unit.

In children's hospitals, hospital-acquired infections should be a concern more than in adult hospitals. If a child with an acute infectious disease is detected in the department, quarantine is established for the duration of the incubation period for of this disease. It is necessary to keep records of children who have been in contact with the patient, who cannot be moved to other wards during the incubation period. In these cases, depending on the diagnosed acute infectious disease, special anti-epidemic measures are carried out (vaccinations, tests for bacterial carriage, etc.).

The anatomical and physiological characteristics of newborns, the unique nature of the course of the disease determine the need to create special departments for newborns and premature babies within children's hospitals. The main task of these departments is to provide qualified diagnostic and therapeutic care to full-term and premature newborn sick children, and to create optimal conditions for caring for children.

Children born with a weight of at least 2300 g and who become ill in the neonatal period are sent to neonatal departments. Newborns weighing less than 2300 g, showing signs of immaturity and falling ill in the neonatal period are sent to departments for premature babies. Transfer of newborns and premature babies from maternity hospitals is carried out subject to the transportability of the child and mandatory agreement with the head of the specialized department where the child is transferred. Transportation of newborns is carried out on a “self-guided” basis in a specialized resuscitation vehicle with a resuscitator or pediatrician well trained in the resuscitation of newborns and premature infants. Nursing staff accompanying children must also have special training in resuscitation and intensive care of newborns.

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 clinics.

10.3. ORGANIZATION OF WORK OF A SECONDARY

MEDICAL STAFF

DAY HOSPITAL

Taking into account the high cost of inpatient care, new hospital-replacing technologies are of great importance, allowing significant savings of available resources without compromising the quality of medical care. To such organizational forms relate:

Day hospitals in outpatient clinics;

Day care in hospitals;

Hospitals at home.

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 surgical day hospital

The main forms of primary medical records of day hospitals:

“Register of admission of patients and refusals of hospitalization”, f. 001/у;

“Medical record of an inpatient,” f. 003/у;

"Temperature sheet", f. 004/у;

“Sheet for daily recording of the movement of patients and the bed capacity of a 24-hour hospital, day hospital at a hospital institution,” f. 007/у-02;

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

“Summary statement of the movement of patients and beds by hospital, department or profile of beds in a 24-hour hospital, day stay at a hospital institution,” f. 016/у-02;

“Extract from the medical record of an outpatient, inpatient,” f. 027/у;

“Procedures Log”, f. 029/у;

“Book of registration of certificates of incapacity for work”, f. 036/у;

“Card of a patient being treated in a physiotherapy department (office)”, f. 044/у;

"Recording Journal" X-ray studies", f. 050/у;

“Statistical map of people leaving a 24-hour hospital, a day hospital at a hospital institution, a day hospital at an outpatient clinic, a hospital at home,” f. 066/у-02;

“Journal of recording of outpatient operations”, f. 069/у;

“Medical death certificate”, f. 106/у-98.

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

Medical nutrition for patients day hospital organized based on local conditions. Typically, if the hospital is part of the structure of a hospital institution, patients receive two meals a day according to the current hospital standards.

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

Hospitals at home can be organized in cases where the patient’s condition and home conditions (social, material) allow the organization of medical care and care at home.

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

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

If necessary, physiotherapeutic procedures, massage, physical therapy exercises, etc. are included in the complex of treatment of patients.

Treatment in hospitals at home is not associated with isolation, disruption of microsocial adaptation, is easier to accept by patients, and is economically beneficial. Treatment in a hospital at home is several times cheaper than in a 24-hour hospital, and is not inferior in effectiveness to treatment in a 24-hour hospital.

10.4. ORGANIZATION OF THE WORK OF NURSING MEDICAL STAFF OF A MATERNITY HOSPITAL, PERINATAL CENTER

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

The chief physician manages the activities of the maternity hospital. Organizes the work of middle and junior medical personnel chief (senior) midwife, whose tasks include:

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

Ensure timely discharge, correct accounting, distribution, consumption and storage of medicines and products medical purposes;

Conduct instruction for nursing and junior medical personnel on the implementation of a set of sanitary and anti-epidemiological measures in the maternity hospital;

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

Systematically carry out work to educate personnel in the spirit of a conscientious attitude to the performance of their duties and compliance with the principles of medical deontology;

Rice. 10.3. Approximate organizational structure of a maternity hospital

Systematically improve your professional qualifications.

Pregnant women (if there are medical indications), women in labor, as well as postpartum women in the early postpartum period (within 24 hours after birth) in case of childbirth outside a medical institution are subject to hospitalization in the maternity hospital. Upon admission to the maternity hospital, a woman in labor or postpartum is sent to reception and examination block of the obstetric department, where he presents his passport and “Exchange Card” (f. 113/u). Women are seen in the reception and examination block by a doctor (during the daytime - department doctors, then by doctors on duty) or a midwife, who calls a doctor if necessary. In the reception and inspection block it is advisable to have one filter room and two inspection rooms. One examination room is provided for the admission of women to the physiological obstetric department, the other is an observation room.

The doctor (or midwife) evaluates general state applicant, gets acquainted with the “Exchange Card”, finds out whether the woman suffered infectious, inflammatory diseases before and during pregnancy, paying special attention to diseases suffered 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, and familiarization with documents in the filter room, women are divided into two streams: those with a normal pregnancy, who are sent to physiological obstetric department, and presenting an “epidemiological danger” to others who are sent to observational obstetrics department.

In addition, women in the absence of a “Maternity Hospital Exchange Card” are sent to the observation department, as well as postpartum women in the early postpartum period in case of childbirth outside a medical institution.

In the examination rooms of the physiological and observation departments, an objective examination of the woman is carried out, she is sanitized, a set of sterile linen is given, and blood and urine are taken for tests. From the examination room, accompanied by nursing staff, the woman moves (if indicated, she is transported on a gurney) to the delivery unit or the pregnancy pathology department.

The middle and junior medical staff of the obstetric department are directly subordinate to the senior midwife. The senior midwife of the department is subordinate to the head of the department and the chief midwife. The job responsibilities of a senior midwife are in many ways similar to those of a senior nurse in a hospital hospital.

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

Preparing women for the upcoming examination by a doctor;

Assisting the doctor during therapeutic, 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 conduct simple 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 (excretion of the placenta by external means, manual examination of the postpartum uterus, separation and release of the placenta, examination of the cervix during bleeding);

Stitching of I and II degree perineal tears.

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

If there are two maternity rooms, births are performed in them alternately. Each maternity room is open for 1-2 days, then it is thoroughly cleaned. If there is one delivery room, births are carried out alternately on different Rakhmanov beds. Held twice a week spring-cleaning maternity room. A midwife attends a normal birth.

After the baby is born, the midwife shows it to the mother, paying attention to the gender and the presence of congenital anomalies (if any). Next, the child is transferred to the nursery. The postpartum woman must remain in the delivery room under observation for at least 2 hours.

The midwife, after washing her hands under running water and treating them, carries out secondary treatment of the umbilical cord, primary treatment 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 tied on top of the blanket. They indicate: last name, first name, patronymic, mother’s birth history number, gender of the child, weight, height, hour and date of birth. After finishing the treatment of the newborn, the midwife (doctor) fills out the necessary columns in the “History of Birth” (f. 096/u) and “History of the Development of the Newborn” (f. 097/u).

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

When filling the wards of the postpartum ward, strict cyclicity must be observed - one ward is allowed to be filled for no more than three days. When mothers or newborns show the first signs of illness, they are transferred to observational obstetric department or to another specialized institution.

The following are placed in the observational obstetric department: sick women with a healthy child; healthy women with a sick child; sick women with a sick child.

Wards for pregnant and postpartum women in the observation department should be profiled whenever possible. It is unacceptable to place pregnant and postpartum women in the same room.

In the neonatal wards of the observation department there are children: those born in this department, those born outside the maternity hospital, those transferred from the physiological department, those born with severe congenital anomalies, with manifestations intrauterine infection, with a body weight of less than 1000 g. For sick children in the observation department there is an isolation ward with 1-3 beds. If indicated, children can be transferred to the neonatal department of a children's hospital.

During the first days after birth, each child is under intensive supervision by medical staff. Pediatricians conduct daily examinations of children. If there is only one pediatrician working in the maternity hospital, then during his absence, the obstetrician-gynecologist on duty examines the children. 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 carries out sanitary educational work with them.

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

active participation of the mother in caring for the newborn child. Staying together between mother and child limits the contact of the newborn with medical personnel and reduces the possibility of infection of the child. With this regimen, early attachment of the newborn to the breast is ensured, and the mother is actively trained in the skills of practical care for the newborn.

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

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

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

In order to reduce perinatal mortality, organize constant monitoring of the state of vital functions of newborns, timely implementation of corrective and diagnostic measures in obstetric institutions, special intensive care 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. With a lower maternity hospital capacity, intensive care posts are organized.

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

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

In case of uncomplicated course of the postpartum period in the mother and the early neonatal period in the newborn, with a fallen umbilical cord and good condition of the umbilical wound, positive

Based on the dynamics of body weight, mother and child can be discharged on the 5-6th day after birth.

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

Before discharge, the pediatrician, while still in the ward, talks with postpartum women about caring for and feeding the child at home. The nurse (in the ward) must additionally treat and change the baby. In the discharge room, the nurse of the neonatal department swaddles the baby 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 the bracelets and medallion, the condition of the baby’s skin and mucous membranes, and once again talks about the features 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 and mucous membranes, and 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 birth certificate” (f. 103/u-98) and an “Exchange card for the maternity hospital, maternity ward of the hospital” (f. 113/u).

On the day the child is discharged elder sister The newborn department reports by telephone to the children's clinic at the place of residence basic information about the discharged child.

Pregnancy pathology departments are organized in large maternity hospitals with a capacity of 100 beds or more. Women with extragenital diseases, pregnancy complications (preeclampsia, threatened miscarriage, etc.), abnormal fetal position, and a burdened obstetric history are hospitalized in the pregnancy pathology department. The department employs obstetricians-gynecologists, maternity hospital therapists, midwives and other medical personnel.

The layout 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 must include: a functional diagnostics room with modern equipment (mainly cardiological), an examination room, a small operating room, a room for physical and psychoprophylactic preparation for childbirth, covered verandas or halls for walking pregnant women.

Women can be transferred from the pregnancy pathology department due to improvement of their condition under the supervision of the antenatal clinic, as well as for delivery to the physiological or observational obstetric departments. Women must be transferred to one of these departments through a reception and examination block, where they are given complete sanitary treatment.

Gynecological departments Maternity hospitals come in three profiles:

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

2) for patients in need of conservative treatment;

3) to terminate pregnancy (abortion).

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

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

IN last years They are trying to remove abortion departments 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, “Maternity Certificates” have been introduced, the procedure for filling which is determined by the relevant 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, maternity

prostrate and newborn children in Russian Federation perinatal centers are being created.

The main tasks of perinatal centers:

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

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

Providing a system of rehabilitation measures and restorative therapy, medical, psychological and socio-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 issues of perinatal care, reproductive health and safe motherhood.

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

Approximate organizational structure perinatal center shown in Fig. 10.4.

10.5. HOSPITAL STATISTICS

The main forms of primary medical records of hospital institutions:

A sheet of daily records of the movement of patients and the bed capacity of a 24-hour hospital, a day hospital at a hospital institution, f. 007/у-02;

Statistical map of people leaving a 24-hour hospital, a day hospital at a hospital institution, a day hospital at an outpatient clinic, a hospital at home, f. 066/у-02.

Main indicators of medical activity of the hospital:

Indicator of the population's availability of hospital beds;

Indicator of 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 (hospital bed function);

Indicator of the average length of stay of a patient in bed;

Hospital mortality rate.

Indicator of population provision with hospital beds the most common when assessing population satisfaction 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, hospitals at home], this figure for the period 1995-2008. decreased from 118.2 to 92.4 per 10 thousand population.

Indicator of frequency (level) of hospitalization used to analyze population satisfaction during hospitalization and calculate 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 developing outpatient care, as well as the introduction of new hospital-substituting technologies, the level of hospitalization of the population should decrease in the future.

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

Indicator of the average length of stay of a patient in bed-

This is the ratio of the number of bed days spent by patients in a hospital to the number of patients treated.

Hospital mortality rate allows you to comprehensively assess the level and quality of the organization of diagnostic and treatment care in a 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 slight downward trend: from 1.40 to 1.32%, respectively.

In analyzing the activities of a maternity hospital and perinatal center, statistical indicators that characterize the qualitative side of the activities of the obstetrics and gynecology service are of particular importance:

Indicators of the frequency of surgical aids during childbirth;

Indicators of the frequency of complications in childbirth;

Indicators of the frequency of complications in the postpartum period;

Indicator of the frequency of use of anesthesia during childbirth. Indicators of the frequency of surgical aids during childbirth(overlay

forceps, vacuum extraction, cesarean section, manual separation of 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 cesarean section during childbirth, and a 2-fold decrease in the frequency of application of obstetric forceps (Fig. 10.5).

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

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

The rate of complications during childbirth (perineal ruptures) 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 childbirth management is an indicator of the frequency of use of pain relief during childbirth. This indicator in maternity hospitals of Veliky Novgorod in 2008 was 800 per 1000 births, which indicates the possibility of expanding anesthesia during childbirth.

The ability to correctly fill out forms of primary medical records and, based on them, collect data, calculate and analyze statistical indicators is of paramount importance in the practical activities of the chief nurse (midwife), head of the medical and obstetric station, medical statistician and other medical workers.

Control questions

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

2. List the functional responsibilities of the chief nurse of a city hospital for adults.

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

4.Explain the functional responsibilities of the senior nurse in the admission department of a city hospital for adults.

5.What are the responsibilities of a nurse in the emergency department of a city hospital for adults?

6.List the main responsibilities of the head nurse in the department of a city hospital for adults.

7.Explain the functional responsibilities of a ward nurse at a city hospital for adults.

8. List the main responsibilities of a junior nurse in caring for patients in a city hospital for adults.

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

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

11.Explain the features of the emergency department of a children's city hospital.

12.List the tasks and reveal the features of the work of the departments for newborns and premature babies of 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 reception department of the maternity hospital organized?

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

17.Explain the functional responsibilities of a midwife in the obstetric department of a maternity hospital.

18.How is the work of the maternity 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 observation department of the maternity hospital organized?

21.How is newborn care provided in the maternity hospital?

22.Explain the operating procedure of the pregnancy pathology department of the maternity hospital.

23.How it works gynecological department maternity hospital?

24. List the main tasks of the perinatal center.

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

Working at this post requires me to clearly and competently perform the entire list of functional responsibilities presented below, while strictly guided in my work by the principles of medical deontology and ethics

1. provide proper care and monitoring of patients;
2. accurately carry out all medical prescriptions with precise notes in the journal;
3. supervise the work of junior medical staff;
4. ensure that the department maintains proper order, cleanliness and that patients comply with the regimen established for them;
5. while on duty, constantly be among patients, entering the office only to pick up medications, to make notes, and to fill out a patient observation diary;
6. accompany the doctors, the head of the department and the doctor on duty who visited the department during rounds, report on the condition of the patients, record all comments and orders in the journal;
7. in the absence procedural nurse carry out all appointments (administration of all types of injections and intravenous infusion therapy);
8. receive newly admitted patients and familiarize them with the internal regulations;
9. When receiving 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 state, pay attention to painful signs. The patient should not have objects that could cause harm to himself or others. Check the quality of previous sanitary treatment of patients in the emergency room;
10. regularly, at least once every 7 days, examine patients for the presence of head lice. There is a bath and a change of bed and underwear once a week.
11. examine the patient’s pharynx and take BL swabs from the pharynx and nose for preventive purposes;
12. working as a day ward nurse, note all the features of the patient’s condition, behavior, state of aggression towards other patients and staff, their unusual statements, changes or worsening of the condition - in an 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 for a walk, dressed for the weather;
15. the department must adhere to a schedule for quartzing wards and rooms assigned to the post, and bathing patients;
16. the sister makes sure that patients lie down only on their own beds, that their underwear and bed linen are clean;
17. Particular attention is paid to weakened patients with severe mental and somatic conditions. At the same time, explaining to junior staff the features of an individual approach to such patients, paying attention to their condition, behavior, and the features of careful care for them;
18. supervise the work of junior shift personnel, monitor the implementation of relevant instructions, correcting relevant violations along the way;
19. report all violations to the head of the department and the head nurse;
20. all comments and instructions to junior staff should be made in the absence of patients;
21. the ward nurse on duty must know all patients by name, the characteristics of their condition and behavior, and their regimen;
22. promote patient involvement in work processes;
23. ensure that only personnel on shift are present in the department while on duty;
24. measure the body temperature of patients under control twice a day - blood pressure, respiratory rate, PS;
25. send only those patients for a walk for whom there is a corresponding doctor’s order;
26. issue and ensure the administration of medications, for which purpose promptly submit to the head nurse a list of medications required for the post;
27. transmit information about the presence of patients to the emergency department (daily summary);
28. ensure that all rooms not intended for permanent use are locked and opened only during use;
29. carefully monitor patients during and after visits to ensure that items not permitted for transfer do not enter the department;
30. correctly collect all samples and control their delivery to the laboratory;
31. know and follow safety rules;
32. treat patients who violate the regime strictly and do not give any concessions. Maintain the regime and status of the department.
33. the duty personnel on shift should not be distracted, discuss patients, talk among themselves about treatment, about their personal affairs - patients catch everything;
34. provide individual care for seriously ill patients - treat the oral cavity, eyes, 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 perform them conscientiously, clearly and quickly.

Introduction

Chapter 1. Organization of work therapeutic department

Chapter 2. Responsibilities of the procedural nurse of the therapeutic department

Chapter 3. Activities of the procedural nurse of the therapeutic department

Conclusion

Bibliography

INTRODUCTION

A person, his life, health and longevity are the greatest value. Medical science and everything medical workers designed 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.) - while serving others, I burn myself.

In the complex of medical measures, patient care plays a huge role. The most effective medications, skillfully performed operations, and other things cannot ensure recovery if systematic and careful care is not simultaneously provided.

Caring for patients means keeping the room and bed clean, timely changing bed linen and underwear, providing assistance with meals, carrying out a hygienic toilet, performing physiological functions and fulfilling doctor’s orders. In hospitals and clinics, care is provided by junior and nursing staff.

The therapeutic department requires more attentive and thorough patient care. The nurse must follow up 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 paramedical personnel and the number of job responsibilities assigned to them has a clear discrepancy. Nowadays, with an increase in morbidity, an increase in elderly and senile people, and a low social level of some segments of the population, the activities of nurses require revision. In this regard, the question of the need to develop scientific foundations for the rational use of personnel in healthcare institutions is quite urgent.

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

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

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

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

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

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

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

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

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

From all of the above, we can conclude that a nurse is no less important than a doctor. If earlier it was only an assistant, then in our time the specialty “nurse” is distinguished as a new independent discipline due to changing environmental conditions, society, views and scientific discoveries.

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

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

CHAPTER 1. ORGANIZATION OF WORK OF THE THERAPEUTIC DEPARTMENT

Inpatient treatment of therapeutic patients is carried out in general therapeutic departments. In multidisciplinary hospitals, there are specialized therapeutic departments (cardiology, gastroenterology, etc.) intended for the examination and treatment of patients with certain diseases internal organs(cardiovascular system, digestive organs, kidneys, etc.).

The department is headed by a head, who is usually appointed from among the most experienced doctors. He organizes timely examination and treatment of patients, controls the work of medical personnel, and is responsible for the rational use of the department’s bed capacity, medical equipment and medicines.

The staffing schedule for employees of therapeutic departments provides for the positions of ward doctors (hospital residents) who directly examine and treat patients; senior nurse who organizes and supervises the work of ward nurses and orderlies; sister-housekeeper, responsible for the timely provision of the department with soft and hard equipment, as well as underwear and bed linen; ward nurses working at the post and carrying out the appointments of attending physicians for the examination and treatment of patients; a procedural nurse performing certain manipulations in the treatment room; junior nurses, barmaids and cleaners providing care for patients, their nutrition, and maintaining the necessary sanitary condition in the department.

The therapeutic department can have a different number of beds. In turn, each department is divided into 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 doctors’ office (resident’s room), the rooms of the head nurse and the hostess sister, a treatment room, a pantry, a dining room, a bathroom, an enema room, a room for washing and sterilizing vessels and storing cleaning supplies, storage space for gurneys and mobile chairs, toilets for patients and medical personnel. Each department has facilities for day stay patients - halls, verandas, etc.

To organize the full treatment of patients and care for them, the correct equipment of the rooms in which patients spend most of their time is of great importance. From the point of view of providing the necessary medical and protective regime, the ideal situation is when 60% of the wards in the department are equipped with 4 beds each, 20% - with 2 beds, and 20% - with one. In other words, in a ward section with 30 beds there should be 6 four-bed rooms, two double rooms and two single rooms, with the condition that there should be 7 m2 of space per patient in the general ward, and 9 m2 in the single room. A smaller area has a negative impact on the organization of treatment and care for patients.

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, which allow, in necessary cases (performing certain manipulations, fulfilling 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. Such a curtain can be easily closed around the patient and then opened again.

In the wards, individual night lamps and radio points are equipped near each bed. It is advisable to install an alarm at each bed so that any patient can call medical personnel if necessary.

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

At the post there is a table with sliding and locking drawers for storing necessary medical documentation, a desk lamp and a telephone.

It is better to store medical histories in a separate box or cabinet, divided into compartments (according to the room numbers), which allows you to quickly find the required medical history.

At the nurse's station there should also be a cabinet (or several cabinets) for storing medications (Fig. 1). In this case, it is necessary to allocate locked compartments in which there are drugs of groups A (poisonous) and B (potent).

Medicines for external and internal use, as well as drugs for injection.

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

They store patient care items (thermometers, heating pads, jars, etc.) separately, as well as utensils for taking tests. Next to the post there are scales for weighing patients.

Fig.1. Cabinet for storing medicines.

A treatment room will also be equipped here (Fig. 2). It is staffed by a specially trained procedural nurse.

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

Documents that are mainly prepared by doctors include, for example, a medical history, a hospital discharge card, a certificate of incapacity for work, etc.

A number of medical documents in the department are filled out and maintained by guard nurses. This is a notebook (journal) of medical prescriptions, where, when checking medical histories, the nurse enters the prescriptions made by the doctor, patient records of the department, which reflects data on the movement of patients (i.e. admission, discharge, etc.) for the day, temperature sheets , portion tables indicating the number of patients receiving a particular table.

One of the main documents that a nurse constantly keeps at the post is the duty handover log. It notes data on the movement of patients during a shift, indicates appointments regarding the preparation of patients for research, and focuses attention on the condition of seriously ill patients who require constant monitoring.

Fig.2. Treatment room of the therapeutic department.

Reception and transfer of duty is a responsible event, and requires great composure from nurses. Formally carried out, crumpled reception and transfer of duties lead, as a rule, to various kinds of omissions, unfulfilled assignments, etc.

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

Creating such a regime involves protecting the patient from various negative emotions (associated, for example, with pain), providing conditions for sufficient and good sleep and rest (rational placement of patients in the wards, silence in the department), permission to walk in the warm season and visits to 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 significance, for example, for out-of-town patients, etc.

In hospitals, there is still often a fairly large number of factors that significantly violate the principles of the medical and protective regime.

These include cases of incorrect or untimely fulfillment of necessary prescriptions, rudeness and inattention to patients on the part of medical personnel (for example, insufficient pain relief for patients during painful procedures).

Disturbances that sometimes occur in the work of medical staff in departments (for example, knocking doors and clanking buckets, accompanied by exclamations from medical staff in the early morning hours, irregular wet cleaning, difficulties with timely change of bed linen, poorly prepared food), problems with sanitary facilities, have a negative impact on patients. technical support (interruptions in supply hot water, heating failures, 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.

Creating an optimal medical and protective regime in a hospital is a task in which all services of the medical institution must actively participate.

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

Persons with completed secondary education are accepted for the position of treatment room nurse. medical education, as well as work experience in this department for at least 3 years. The chief physician of the hospital is hired and dismissed on the recommendation of the head. department of the chief nurse of the hospital. Before entering work, he undergoes a mandatory medical examination at the hospital shop service.

The procedural 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 treatment nurse.

The department's procedural nurse works according to a schedule drawn up by the head nurse and approved by the head. department, deputy 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 assigned procedures.

) Perform manipulations only as prescribed by a doctor.

) Start work only after preparing the room for procedures and thoroughly preparing the instruments.

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

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

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

) Strictly follow the technology of procedures and manipulations:

intradermal tests;

taking blood from a vein for diagnostic studies;

carrying out (under the supervision of a physician) determination of blood group and Rh factor, blood transfusion and blood substitutes, installation of systems and administration of drugs by drip method;

preparing instruments for delivery to the central sterilization room;

preparing material for procedures.

) Immediately notify the doctor about complications associated with manipulations and procedures in the office, and be familiar with the methods of providing first aid. Prepare the necessary set of instruments and materials and assist the doctor during other manipulations in this office.

) Maintain high-quality documentation of the treatment room.

) Make daily notes on the medical prescription sheets about the procedures performed.

) Strictly observe the sanitary and epidemiological regime of the office, wear special clothing that meets the requirements of the treatment room.

) Timely replenish the cabinet with the necessary amount of instruments, medications, serums to determine blood group, and other sets of solutions, drugs, equipment, and antiseptics necessary for work during the day.

) Know the technology of testing for hidden blood, washing from disinfectants and detergents.

) Carry out daily monitoring of the availability of the required amount of medications in the pharmacy to provide emergency care.

) Timely make changes to instructions on the sanitary and epidemiological regime, methods of preparing hands for work, etc.

) Monitor the work of the office nurse.

) Comply with the requirements for sterilization in a dry-heat oven and maintaining relevant documentation.

) Ensure control over the rational use of tools and correct accounting. Promptly replace worn-out medical equipment and instruments.

) Ensure correct storage conditions for medications, solutions and serums in the office.

) Follow the internal regulations and safety rules, do not leave the department without the knowledge of the head nurse, do not leave the treatment room unlocked when going home. Hand over the keys to the ward nurse at the post.

) Constantly improve your medical knowledge by reading specialized literature, participating in industrial training, nursing conferences, at least after 5 years, undergo cycles of specialization and improvement in advanced training courses, take part in the training of department nurses to work in the 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 manager. department, chief physician of the hospital.

CHAPTER 3. ACTIVITIES OF THE PROCEDURE NURSE IN THE THERAPEUTIC DEPARTMENT

In the treatment room, various diagnostic and therapeutic procedures are performed: subcutaneous, intramuscular and intravenous injections, drawing blood for clinical and biochemical tests, determining blood group, pleural puncture to remove fluid from the pleural cavity, puncture abdominal cavity for ascites, diagnostic liver puncture, measurement of 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). care nurse therapeutic

Since many manipulations performed in the treatment room are invasive in nature (i.e., associated with the danger of microbial flora entering the patient’s body), great demands are placed on the sanitary condition of this room; in particular, regular air disinfection is carried out using a bactericidal lamp.

It is important to carry out quartz treatment and adhere to the disinfection regime. Quartz treatment is the process of treating (disinfecting) a room (air) with ultraviolet radiation from a quartz lamp. As a result of quartzization, the air is enriched with ozone, which, in turn, also disinfects the air. Ozone is poisonous, so after quartz treatment the room should be ventilated. At correct observance mode of lamp use, quartzing does not cause harm. If used incorrectly, it may cause eye burns. In medical institutions, quartz treatment is currently quite widely used for bactericidal purposes. While the quartz lamp is operating, you should leave the room. You should absolutely not look at a working lamp or try to tan from it.

Irradiators are designed for air disinfection in medical centers, children's and sports institutions, and production workshops.

Bactericidal irradiators are of open, closed and combined types. 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 room being treated.

For rooms with a volume of up to 50 m3, combined irradiators have been developed that make it possible to treat rooms both in the absence of people and in their presence, without causing harm to health.

A quartz lamp (Fig. 3) is a quartz glass flask that transmits ultraviolet rays. A gas discharge lamp with the addition of mercury is used to disinfect premises, products, and objects.

Fig.3. Quartz lamp.

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

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

Fig.4. The irradiator is bactericidal.

An ultraviolet bactericidal irradiator is effective in the fight against microorganisms. Intended for disinfection of air and surfaces of premises using ultraviolet rays. If the operating rules are followed, the use is safe for human and animal health. Irradiators are capable of destroying almost all microbes and viruses known today.

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

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

In rooms of the first category, it is recommended to use bactericidal 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 of more than 1 hour.
When using supply and exhaust ventilation, bactericidal lamps are placed in the outlet chamber after dust filters.

The procedural nurse performs all manipulations wearing gloves. Sterile equipment 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 level of filling solutions into containers 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 washed with running water and handed over to the central sanitary center for pre-sterilization cleaning and sterilization. (Or, in the absence of CSO, undergo pre-sterilization cleaning.)
Used balls and other dressing material 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. Glassware for determining blood group (Fig. 5) is processed according to OSG42-21-2-85.

Fig.5. Glassware for determining blood group.

Technology for performing an amidopyrine test: mix equal amounts of a 5% alcohol solution of amidopyrine, 30% acetic acid and a 3% solution of hydrogen peroxide (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, the syringe piston, the cylinder on the outside, the needles, and the cannula inside are wiped with this cotton wool. Then the reagents are poured into the syringe barrel, passed through the syringe onto another piece of cotton wool (the syringe barrel is checked). After this, fix the needle on the syringe, pour the reagent into the cylinder again and pass it through the syringe and needle (the needle is checked):

a) in the presence of blood stains, a blue-green color appears on the cotton wool. Staining may occur when drug residues, ternary solution, and chloramine are present on the syringe;

b) when positive samples Repeated testing of instruments is carried out daily until a 3-fold negative result is obtained.
Technology for performing an azopyram test: prepare a 1.0-1.5% solution of aniline hydrochloride in 95% ethyl alcohol. The prepared 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°C - no more than a month. Moderate yellowing of the reagent during storage without precipitation does not reduce its performance. Immediately before taking the sample, prepare a working solution by mixing equal volumes of azopyram and 3% hydrogen peroxide. The working solution can be used within 1 - 2 hours. With longer storage, a spontaneous pink coloration of the reagent may appear. 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 instruments, or keep them in bright light or near heating devices.

The suitability of the azopyram working solution 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 blue, the reagent is ready for use; If coloring does not appear within 1 minute, the reagent cannot be used.

When providing emergency care, a procedural nurse should:

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

Fig.6. Ambu bag.

In case of pulmonary hemorrhage - call a doctor, calm the patient, make the patient sit comfortably, give a towel, a kidney-shaped basin, explain that you cannot talk, put an ice pack on the chest. Prepare equipment and instruments: a system for internal infusion, a tourniquet, everything necessary to determine the blood group.

For angina pectoris, call a doctor, calm the patient down, sit the patient comfortably, measure blood pressure, count the heart rate, give a nitroglycerin tablet. 0.0005 gr. or an aerosol (1 press) under the tongue, repeat taking the drug if there is no 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, monitor pulse and blood pressure, take an ECG, give 0.25 g orally if pain persists. aspirin, chew immediately. Prepare equipment and tools: syringes and needles for intramuscular and subcutaneous injections, Ambu bag, ECG machine.

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

Fig.7. Heart monitor.

In case of cardiogenic shock - call a doctor, lay the patient down, lower the head end of the bed, raise the foot end by 20º, measure blood pressure, count the pulse, give 100% humidified oxygen, do an ECG, connect to a cardiac 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.

For cardiac asthma, pulmonary edema - call a doctor, sit the patient comfortably (without tension) with his legs lowered from the bed, calm him down, measure blood pressure, pulse, respiratory rate, give 1 tablet of nitroglycerin 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 to both limbs for 15-20 minutes (remove one by one, gradually) or take hot foot baths, give 100% humidified oxygen. Prepare equipment and instruments: intravenous system, tourniquet, electrocardiograph, defibrillator (Fig. 8), cardiac monitor, pulse oximeter, Ambu bag.

Fig.8. Defibrillator.

In case of arrhythmia - call a doctor, place and calm the patient, measure blood pressure, count the heart rate, register a standard ECG in the ΙΙ lead, record about 10 QRS complexes, connect to a cardiac monitor, prepare equipment and tools: syringes for IV and IM , subcutaneous injections, tourniquet, defibrillator, electrical stimulators, ambu bag.

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

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

In case of hypoglycemic coma - record the time, ensure that a doctor or laboratory assistant is called, give the patient a stable lateral position, and inspect 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) - record the time, ensure that a doctor or laboratory assistant is called, give a stable lateral position, monitor pulse, blood pressure, respiratory rate, determine the blood sugar level from a finger with a portable glucometer (Fig. 9). Preparation of medications, equipment and instruments: system for intravenous drip infusion, syringes, simple insulin (actropid).

Fig.9. Glucometer.

In case of angioedema (swelling of the larynx) - call a doctor, reassure the patient, provide access 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 Dufaut needle or conicotome, a tracheostomy set, a laryngoscope (Fig. 10), an intubation set, a pulsometer.

Fig. 10. Laryngoscope.

Fig. 11. Ventilator.

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

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

In case of nosebleeds, call a doctor, calm the patient down, sit him comfortably, tilt his head forward, give a kidney-shaped tray in his hands, stop the bleeding with the help of: inserting a cotton gauze swab moistened with 3% hydrogen peroxide solution into the nasal cavity; hemostatic sponge; anterior nasal packing; place an ice pack on the bridge of your nose and the back of your 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 the tongue from retracting, clear the oral cavity of saliva and secretions in the interval between seizures. Prepare equipment and tools: syringes, needles.

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

Technology of indirect (closed) cardiac massage

It is produced with the aim of restoring blood circulation in the body, i.e. support blood circulation in vital organs during cardiac arrest (Fig. 12). The sooner 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 passes, estimated at 4 - 6 minutes. During this time, resuscitation measures should be started.

A

B

Fig. 12. Performing indirect (closed) cardiac massage: a - position of the hands; b - moment of pressure on the sternum.

To successfully perform 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 curve. To do 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. Left palm is placed on the lower third of the sternum, and the right one is placed on the left. Both arms should be straight and the shoulder girdle should be located above the chest. The massage is carried out with vigorous, sharp pressure on the sternum; in this case, the sternum should shift 3 - 4 cm towards the spine. The number of pressures is 50-60 per minute.

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

Artificial respiration technology

It is carried out with the aim of periodically replacing air in the lungs in the absence or insufficiency of natural ventilation. It is better to perform mechanical ventilation using hand-held devices: Ambu bag, DP-10, KAMA, RDA-1, etc. If you do not have a respirator, you cannot waste minutes on its delivery, and you must immediately begin mechanical ventilation using the expiratory method.

Mouth to mouth method. The effectiveness of this method is achieved by tilting the patient's head back as much as possible. In this case, the root of the tongue and the epiglottis move forward and open free access of air to the larynx.

Standing to the side, the nurse presses her wrist on the patient's forehead with one hand and tilts his head back, and places the other under the neck. Mechanical ventilation is based on the rhythmic blowing of air from the nurse's airway into the patient's airway under positive pressure. When performing mechanical ventilation, the patient's mouth must be constantly open (Fig. 13).

Fig. 13. Method of performing artificial respiration using the “mouth to mouth” method: a - throwing back the victim’s head, b - opening the mouth, c - inhale, d - exhale.

Mouth to nose method. Air is blown into the respiratory tract through the nose: the patient’s mouth must be closed (Fig. 14). This method is not fundamentally different from that described above.

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

Fig. 14. Artificial respiration using the “mouth to nose” method: a - exhalation of the victim; b - air injection.

CONCLUSION

After analyzing the activities of the procedural nurse of the therapeutic department, we can draw the following conclusion.

The procedural nurse plays a very important role in the therapeutic department. She is responsible for proper organization work of the treatment room around the clock, for the timely fulfillment of doctor’s orders for procedures, for compliance with the sanitary and epidemiological regime at your workplace, the rules of asepsis and antiseptics, for providing the room with the necessary number of instruments, medications, solutions, sterile material during the day to carry out procedures, for compliance with the conditions and rules for storing medications, equipment, instruments, office equipment, for high-quality maintenance of office documentation and making notes on the procedures performed, for the correct organization of the work of the office nurse.

The procedural nurse must be able to professionally carry out great amount, sometimes vital manipulations for the patient, such as providing emergency care, laying a sterile table, measuring body temperature, measuring pulse, determining the number of respiratory movements, measuring blood pressure, determining daily diuresis, placing cups, placing mustard plasters, placing a warm compress, using a heating pad and an ice pack, preparing a therapeutic bath, supplying oxygen, supplying a bedpan and urinal, placement of a gas outlet tube, administration of all types of enemas, catheterization of the bladder, vision of documentation for recording medications, application of ointment, patch, powder, instillation of drops in the nose, ears and eyes, placing ointment behind the eyelid, using an inhaler, dialing insulin doses , all types of injections, collection of a system for drip administration, venipuncture, ECG taking, taking a smear from the throat, sputum collection, blood test for hemoglobin, ESR, leukocytes, urine analysis according to Zimnitsky, fractional intubation of the stomach, probing of the gallbladder, collection of stool for research , preparing the patient for endoscopy, preparing the patient and participating in all types of punctures, performing artificial respiration, applying all types of dressings, determining the blood group, individual compatibility test, stopping bleeding from superficial vessels, pre-sterilization cleaning of syringes, needles, instruments, use sterile beaker, hand disinfection, etc.

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

BIBLIOGRAPHY

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

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community nurse (PMC) provides medical care at the assigned medical (therapeutic) site. Specialists with secondary medical education in the specialties “General Medicine”, “Midwifery”, “Nursing” and a certificate in the specialty “Nursing” are appointed to this position.

The main areas of activity of a nurse are the following:

• organizational (organization of the route of medical and social assistance, organization of one’s own work);
• diagnostic and treatment;
• preventive (preventive-rehabilitation);
• ensuring infectious safety;
• training.

The UMS carries out its activities to provide primary health care to the population in the following treatment and preventive institutions (mainly the municipal health care system): polyclinics; outpatient clinics; other inpatient and outpatient facilities of the municipal health care system; other medical and preventive institutions providing primary health care to the population.

The following regulatory document is Order of the Ministry of Health of the Russian Federation dated November 15, 2012 No. 923n “On approval of the Procedure for providing medical care to the adult population in the field of “Therapy””».

This Order determines that medical care is provided in the form of: primary health care (that is, in a clinic, outpatient clinic); ambulance; specialized, including high-tech, medical care (provided in a hospital); palliative care. Medical care can be provided: on an outpatient basis; in a day hospital (in conditions that provide medical supervision and treatment during the daytime, but do not require round-the-clock medical supervision and treatment); stationary. Medical assistance is provided in the form of: emergency medical care (in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient’s life), emergency (for sudden acute diseases, conditions, exacerbation of chronic diseases, without obvious signs threats to the patient's life); planned (when carrying out preventive measures, for diseases and conditions that are not accompanied by a threat to the patient’s life, delaying the provision of which for a certain time will not entail a deterioration in the patient’s condition or a threat to his life and health).

Primary health care includes measures for the prevention, diagnosis, treatment of diseases and conditions, medical rehabilitation, promotion of a healthy lifestyle, including reducing the level of risk factors for diseases and sanitary and hygienic education of the population. The organization of primary health care is carried out on a territorial-precinct principle (in accordance with the order of the Ministry of Health and Social Development of the Russian Federation dated May 15, 2012 No. 543n “On approval of the Regulations on the organization of provision of primary health care to the adult population”). The provision of primary medical care in medical organizations and their departments is carried out on the basis of the interaction of general practitioners, local physicians, local physicians of the workshop medical district, general practitioners (family doctors) and specialist doctors providing primary specialized medical care. - sanitary care according to the profile of the patient’s disease (cardiologists, rheumatologists, endocrinologists, gastroenterologists, etc.). If there is no effect from the treatment carried out on an outpatient basis and/or in the absence of the possibility of conducting additional examinations for medical reasons, a general practitioner, a local general practitioner, a local general practitioner of a workshop medical district, a general practitioner (family doctor) in agreement with the doctor - a specialist in the profile of the patient’s disease refers him to a medical organization for additional examinations and/or treatment, including in an inpatient setting. If there are medical indications, patients are referred for rehabilitation measures to specialized medical and health resort organizations, as well as to medical organizations providing palliative care.

A therapeutic office (as a structural unit of a medical organization) is created to provide advisory, diagnostic and therapeutic assistance in the “Therapy” profile. The staffing level of the Cabinet is established by the head of the medical organization, based on the volume of diagnostic and treatment work carried out and the number of the population served, taking into account the recommended staffing standards.

Qualification characteristics of positions of workers in the field of healthcare of the Unified Qualification Directory of Positions of Managers, Specialists and Employees, approved by Order of the Ministry of Health and Social Development of the Russian Federation dated July 23, 2010 No. 541n.

The main functions of the Cabinet are:

• the formation of a therapeutic (shop) site from among the population attached to it (employees of the enterprise, organizations), as well as taking into account the choice of a medical organization by citizens;
• prevention is not infectious diseases by preventing the occurrence, spread and early detection such diseases, as well as reducing the risk of their development;
• prevention of infectious diseases, aimed at preventing the spread and early detection of such diseases, organizing vaccination in accordance with the national calendar of preventive vaccinations and according to epidemic indications;
• sanitary and hygienic education, formation of a healthy lifestyle, informing the population about risk factors for diseases, creating motivation to lead a healthy lifestyle;
• analysis of the needs of the population served for health-improving activities and development of a program for carrying out these activities;
• training the population in first aid for emergency conditions and diseases that cause the bulk of out-of-hospital mortality of the population of the service area (sudden cardiac death (cardiac arrest), acute coronary syndrome, hypertensive crisis, acute cerebrovascular accident, acute heart failure, acute poisoning, etc. .);
• carrying out dispensary observation and recording of patients with chronic diseases, functional disorders, and other therapeutic conditions, including those eligible to receive a kit social services, according to established order;
• conducting an examination of patients who seek medical help to identify diseases of a therapeutic profile or increased risk their occurrence, treatment of identified diseases and conditions on an outpatient basis or in a day hospital setting based on established standards of medical care;
• implementation of medical rehabilitation of persons who have suffered acute therapeutic diseases or surgical and endovascular (interventional) interventions in connection with therapeutic diseases;
• provision of palliative medical care in accordance with the conclusion and recommendations of medical specialists;
• provision of medical care in emergency and urgent forms to patients with acute diseases, injuries, poisoning and other emergency conditions on an outpatient basis or in a day hospital setting;
• referring patients for consultation to specialist doctors;
• selection and referral of patients for medical care in inpatient settings;
• conducting an examination of the temporary disability of patients, presenting them to a medical commission, referring patients with signs of permanent disability for examination for a medical and social examination;
• issuing a conclusion on the need to refer the patient for medical reasons for rehabilitation and treatment to sanatorium-resort organizations;
• interaction within the scope of competence with other medical organizations, medical insurance organizations;
• participation in the selection of patients for the provision of high-tech types of medical care in accordance with the established procedure for the provision of high-tech medical care, as well as maintaining records of persons awaiting and receiving high-tech medical care in the “Therapy” profile;
• participation in the organization and conduct of medical examination of the population and additional medical examination of working citizens in accordance with the established procedure for its implementation;
• analysis of the activities of the Cabinet, participation in monitoring and analysis of the main medical and statistical indicators of morbidity, disability and mortality in the service area;
• implementation of new modern methods of prevention, diagnosis and treatment of patients in outpatient settings;
• participation in activities to improve the qualifications of doctors and medical workers with secondary medical education on issues of therapy (internal diseases);

• local general practitioner - 1 per 1,700 adult population;
• 1 per 1,300 people of the attached adult population (for regions of the Far North and equivalent areas, high-mountainous, desert, waterless and other areas (areas) with severe climatic conditions, with long-term seasonal isolation, as well as for areas with low population density);
• district nurse - 1 for 1 district general practitioner, except for positions relying on the population of the assigned area served by the medical and obstetric station.

The therapeutic department of the hospital performs the following functions:

• implementation of diagnostic, therapeutic and rehabilitation measures for therapeutic diseases that do not require the patient to be in a specialized department;
• identification of medical indications in the patient and preparation for specialized therapeutic and diagnostic procedures with subsequent transfer for their implementation and further treatment to a specialized department;
• implementation of rehabilitation of patients in inpatient conditions after the main treatment, including surgical and other interventional, in a specialized department;
• development and implementation of measures to improve the quality of the diagnostic and treatment process and introduce into practice new methods of diagnosis, treatment and rehabilitation of patients in the “therapy” profile;
• carrying out sanitary and educational work with patients, teaching them the rules of first aid for emergency conditions, the likelihood of which they are most likely to develop;
• providing advisory assistance to doctors and other medical workers of other departments medical organizations on issues of diagnosis, treatment and prevention of diseases in the field of “Therapy”;
• carrying out examination of temporary disability;
• maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by the current legislation of the Russian Federation;
• participation in activities to improve the qualifications of doctors and medical workers with secondary medical education on the provision of medical care in the “Therapy” profile.

• ward nurse (guard) - 4.75 for 15 beds (to ensure round-the-clock work);
• treatment room nurse - 1 per 30 beds;
• senior nurse - 1;
• junior nurse for patient care - 4.75 for 15 beds (to ensure round-the-clock work).

The therapeutic day hospital is a structural unit of a medical organization and is organized to provide medical care in the “therapy” profile for diseases and conditions that do not require round-the-clock medical supervision. The staffing level of a therapeutic day hospital is established by the head of the medical organization in which it was created, based on the volume of diagnostic and treatment work carried out and the number of the population served and taking into account recommended staffing standards.

• wards for patients;
• room for storing medical equipment;
• room for examining patients;
• nurse's post;
• the housekeeper's room;
• pantry and distribution;
• room for storing clean linen;
• room for collecting dirty laundry;
• shower and toilet for medical workers;
• showers and toilets for patients;
• sanitary room;
• room for visitors.

The therapeutic day hospital performs the following functions:

• provision of medical care based on standards of medical care in the “therapy” profile for diseases and conditions that do not require round-the-clock medical supervision;
• carrying out sanitary and educational work for patients, training them in providing first aid in the most likely emergency conditions that may develop in a patient in connection with his illness;
• development and implementation of measures to improve the quality of the diagnostic and treatment process and introduce into practice new methods of diagnosis, treatment and rehabilitation in the “therapy” profile;
• participation in activities to improve the qualifications of doctors and medical workers with secondary medical education on the prevention, diagnosis, treatment and medical rehabilitation of diseases in the field of “Therapy”;
• maintaining accounting and reporting documentation, providing reports on activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by the current legislation of the Russian Federation.

• head (general practitioner) - 1 per 30 beds;
• general practitioner - 1 per 15 beds;
• senior nurse - 1 per 30 beds;
• ward nurse (guard) - 1 for 15 beds;
• treatment room nurse - 1 per 15 beds.

Since one of the indicators of the quality of medical care is its availability, the Russian Ministry of Health and Social Development issued Order dated 21.02.2011 No. 145n “On approval of indicators for assessing the activities of specialists with higher and secondary medical education participating in the implementation of measures to increase the availability of outpatient medical care" It, in particular, determines that the main accounting medical documents when assessing the activities of specialists with higher and secondary medical education participating in the implementation of measures to increase the availability of outpatient medical care are:

• registration form No. 025/u-04 “Medical record of an outpatient patient”, registration form No. 030/u-04 “Control card of dispensary observation”, registration form No. 025-12/u “Card of an outpatient patient” (approved by the Order of the Ministry of Health and Social Development of the Russian Federation dated November 22, 2004 No. 255 “On the procedure for providing primary health care to citizens entitled to receive a set of social services”);
• registration form No. 030-D/u “Child medical examination card” (approved by Order of the Ministry of Health and Social Development of the Russian Federation dated December 9, 2004 No. 310 “On approval of a child medical examination card”).

The performance indicators include the following:

• 1. To assess the quality of work of specialists with higher medical education:
  • the percentage of fulfillment of standards for the volume of medical care per position of a medical specialist based on the function of the medical position;
  • the percentage of diseases identified at an early stage according to the profile of a medical specialist out of the total number of diseases identified by a medical specialist;
  • the percentage of identified advanced diseases according to the profile of a medical specialist from the total number of diseases identified by a medical specialist;
  • percentage of cases of discrepancy between diagnoses when referred to hospital and clinical diagnosis hospital from the total number of those sent to the hospital;
  • the percentage of complications during operations, therapeutic and diagnostic procedures recorded in medical documentation (for surgical specialists), of the total number of operations, therapeutic and diagnostic procedures performed;
  • the percentage of cases of untimely hospitalization leading to deterioration of the patient’s condition or the development of complications, according to information provided by the medical organization providing inpatient medical care, out of the total number of those sent to the hospital;
  • the percentage of cases of referral for planned hospitalization of patients without a preliminary examination or who were not fully examined in accordance with the established requirements for preliminary examination from the total number of patients sent to the hospital;
  • absence of justified complaints from patients based on the results of consideration by the medical commission of the medical organization;
  • percentage of cases of poor-quality execution of medical documentation from the total number of cases of completed medical documentation based on acts of intradepartmental or extradepartmental examination.
• 2. To assess the quality of work of specialists with secondary medical education:
  • no cases of violation of established sanitary rules and norms;
  • absence of complications during diagnostic and treatment procedures recorded in medical documentation;
  • absence of justified complaints from patients based on the results of consideration by the medical commission of the medical organization.

For any activity medical activities It is necessary to have a number of conditions (requirements) regarding the level of training of specialists. They are defined By Order of the Ministry of Health of the Russian Federation dated February 10, 2016 No. 83n “On approval of qualification requirements for medical and pharmaceutical workers with secondary medical and pharmaceutical education».

In particular, in the specialty “General Practice” for nursing staff it is necessary to have secondary vocational education in the specialty “General Medicine”, “Midwifery”, “Nursing”; additional professional education with advanced training at least once every five years.

Order of the Ministry of Health and Social Development of the Russian Federation dated July 23, 2010 No. 541n “On approval of the Unified Qualification Directory for positions of managers, specialists and employees, section “Qualification characteristics of positions of workers in the healthcare sector"" contains characteristics that are used as regulatory documents, and also serve as the basis for the development of job descriptions containing a specific list of job responsibilities, taking into account the characteristics of the work of employees of medical organizations. The qualification characteristics of each position contain three sections: “Job Responsibilities”, “Must Know” and “Qualification Requirements”. The “Job Responsibilities” section establishes a list of basic functions that can be assigned to an employee holding this position, taking into account the technological homogeneity and interconnectedness of the work and the professional education received. The “Must Know” section contains the basic requirements for the employee in relation to special knowledge, as well as knowledge of legislative and other regulatory legal acts, regulations, instructions and other documents, methods and means that the employee must be able to use when performing job duties. The section “Qualification Requirements” defines the levels of required professional education of an employee necessary to perform the job duties assigned to him, as well as the required work experience. In this case, the job title

“senior” is established on the condition that the specialist supervises the performers subordinate to him.

This Order determines that The duties of a nurse include the following:

• provision of pre-hospital medical care, collection biological materials for laboratory research;
• care for patients in a medical organization and at home;
• sterilization of medical instruments, dressings and patient care items;
• assisting during therapeutic and diagnostic procedures and minor operations in outpatient and inpatient settings;
• preparing patients for various types of studies, procedures, operations, and outpatient doctor appointments;
• ensuring compliance with medical prescriptions;
• accounting, storage, use of medicines and ethyl alcohol;
• maintaining personal records, information (computer) database of the health status of the population served;
• carrying out sanitary and educational work among patients and their relatives to promote health and prevent diseases, promote a healthy lifestyle;
• implementation of collection and disposal of medical waste, measures to comply with the sanitary and hygienic regime, rules of asepsis and antisepsis, conditions for sterilization of instruments and materials, prevention of post-injection complications, hepatitis, HIV infection.

The nurse should know:

• statistical indicators characterizing the health status of the population and the activities of medical organizations;
• rules for the collection, storage and disposal of waste from medical organizations;
• basics of dietetics;
• basics of medical examination,
• basics of disaster medicine;
• medical ethics;

in the specialty “General Medicine”, “Midwifery”, “Nursing” and a specialist certificate in the specialty “Nursing”, “General Practice”, “Nursing in Pediatrics” without presenting requirements for work experience.

The head nurse must have secondary vocational education ( increased level) in the specialty “General Medicine”, “Midwifery”, “Nursing” and a specialist certificate in the specialty “Nursing”, “General Practice”, “Nursing in Pediatrics” without presenting requirements for work experience.

The job responsibilities of a district nurse include the following:

• organizing an outpatient appointment with a local general practitioner (pediatrician), providing him with individual outpatient cards, prescription forms, referrals, preparing devices and instruments for operation;
• formation, together with a local physician (pediatrician), of a medical (therapeutic) area from the population attached to it, maintaining personal records, an information (computer) database of the health status of the population served, participation in the formation of groups of dispensary patients;
• carrying out dispensary observation of patients, including those entitled to receive a set of social services, in the prescribed manner;
• conducting pre-medical examinations, including preventive examinations, recording the results in the outpatient’s medical record;
• carrying out activities on sanitary and hygienic education and education of the population served, consultation on the formation of a healthy lifestyle;
• implementation of preventive measures to prevent and reduce morbidity, identify early and latent forms of diseases, socially significant diseases and risk factors, organize and conduct classes in health schools;
• studying the needs of the population served for health-improving activities and developing programs for these activities;
• organization of diagnostics and treatment of diseases and conditions, including rehabilitation treatment of patients in an outpatient setting, day hospital and hospital at home;
• provision of emergency pre-hospital medical care to patients with acute diseases, injuries, poisoning and other emergency conditions in an outpatient setting, day hospital and home hospital;
• registration of referrals of patients for consultations with medical specialists, including for inpatient and rehabilitation treatment, for medical reasons;
• carrying out measures to prevent infectious diseases, organizing and conducting anti-epidemic measures and immunoprophylaxis in the prescribed manner;
• preparation of documentation for the examination of temporary disability in the prescribed manner and documents for referral for medical and social examination, as well as conclusions on the need to refer patients for medical reasons to sanatorium-resort treatment;
• interaction with medical organizations of state, municipal and private healthcare systems, medical insurance companies, and other organizations. Together with authorities social protection of the population, organization of medical and social assistance to certain categories of citizens: lonely, elderly, disabled, chronically ill, in need of care.
• management of the activities of junior medical personnel;
• maintaining medical records;
• participation in the analysis of the health status of the population served and the activities of the medical (therapeutic) site;
• implementation of collection and disposal of medical waste, measures to comply with the sanitary and hygienic regime in the premises, rules of asepsis and antiseptics, conditions for sterilization of instruments and materials, prevention of post-injection complications, hepatitis, HIV infection.

The local nurse should know:

• laws and other regulations legal acts Russian Federation in the field of healthcare;
• theoretical basis nursing;
• fundamentals of the diagnostic and treatment process, disease prevention, promotion of a healthy lifestyle;
• rules for operating medical instruments and equipment;
• the basics of the functioning of budgetary insurance medicine and voluntary health insurance;
• basics of valeology and sanology;
• basics of dietetics;
• basics of medical examination;
• social significance of diseases;
• basics of disaster medicine;
• rules for maintaining accounting and reporting documentation of a structural unit, main types of medical documentation;
• medical ethics;
• psychology of professional communication;
• basics of labor legislation;
• internal labor regulations;
• labor protection and fire safety rules.

Qualification requirements: secondary vocational education

in the specialty “General Medicine”, “Midwifery”, “Nursing” and a specialist certificate in the specialty “Nursing”, “Nursing in Pediatrics”, “General Practice” without presenting requirements for work experience.

By order of the Ministry of Health and Social Development of the Russian Federation dated December 20, 2012 Mya 1183n “On approval of the Nomenclature of Positions of Medical Workers and Pharmaceutical Workers» Among these positions, the following are highlighted: nurse, general practitioner nurse (family doctor), ward nurse (guard nurse), visiting nurse, district nurse.

When organizing preventive work at the site, the nurse must also know a number of orders relating to various areas of this work, including:

• Order M3 of the USSR No. 770 dated May 30, 1986 “On the procedure for conducting general medical examination population."
• Order of the Ministry of Health and Social Development of the Russian Federation No. 1006-N dated December 3, 2012 “On approval of the procedure for conducting clinical examination of certain groups of the adult population.”
• Order of the Ministry of Health and Social Development of the Russian Federation No. 302-n dated April 12, 2011 “On approval of lists of harmful and dangerous production factors and work during which mandatory preliminary and periodic medical examinations are carried out.”
• Order of the Ministry of Health and Social Development No. 51-n dated January 31, 2011 “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications.”
• Order No. 869, as well as Order of the Ministry of Health of Russia dated November 20, 2002 Мя 350 (as amended on May 18, 2012) “On improving outpatient care for the population of the Russian Federation"(including the "Regulations on the organization of activities of a general practitioner nurse") contains requirements for a general practitioner nurse (family doctor).

The job responsibilities of a general practitioner (family doctor) nurse include the following:

• organizing an outpatient appointment with a general practitioner (family doctor), providing him with individual outpatient cards, prescription forms, referrals, preparing devices and instruments for operation;
• maintaining personal records, information (computer) database of the health status of the population served, participation in the formation of groups of dispensary patients;
• implementation of preventive, therapeutic, diagnostic, rehabilitation measures prescribed by a general practitioner (family doctor) in the clinic and at home, participation in outpatient operations;
• providing the general practitioner (family doctor) with the necessary medications, sterile instruments, dressings, and special clothing;
• accounting for the consumption of medications, dressings, instruments, special accounting forms;
• monitoring the safety and serviceability of medical equipment and equipment, the timeliness of their repair and write-off;
• conducting pre-medical examinations, including preventive examinations, recording the results in the individual outpatient card;
• identification and solution within the competence of the patient’s medical and psychological problems;
• provision and provision of nursing services to patients with the most common diseases, including diagnostic measures and manipulations (independently and together with a doctor);
• conducting classes (using specially developed methods or a plan drawn up and agreed upon with the doctor) with various groups of patients;
• accepting patients within their competence;
• carrying out preventive measures:
  • - performing preventive vaccinations for the assigned population according to the vaccination calendar;
  • - planning, organization, control of preventive examinations of the contingents subject to examination for the purpose of early detection of tuberculosis;
  • - carrying out measures to prevent infectious diseases;
• organizing and conducting hygienic training and education of the population;
• providing first aid in case of emergencies and accidents to sick and injured people;
• timely and high-quality maintenance of medical records;
• obtaining information necessary for the high-quality performance of functional duties;
• supervising the work of junior medical personnel, monitoring the volume and quality of work performed by them;
• collection and disposal of medical waste;
• implementation of measures to comply with the sanitary and hygienic regime in the premises, rules of asepsis and antisepsis, conditions for sterilization of instruments and materials, prevention of post-injection complications, hepatitis, HIV infection.

A general practitioner (family doctor) nurse should know:

• laws and other regulatory legal acts of the Russian Federation in the field of healthcare;
• theoretical foundations of nursing;
• the basics of the diagnostic and treatment process, disease prevention, promotion of a healthy lifestyle, as well as family medicine;
• rules for operating medical instruments and equipment;
• rules for the collection, storage and disposal of waste from medical institutions;
• statistical indicators characterizing the state of health of the population and the activities of medical organizations;
• the basics of the functioning of budgetary insurance medicine and voluntary health insurance;
• basics of medical examination;
• social significance of diseases;
• rules for maintaining accounting and reporting documentation of a structural unit;
• main types of medical documentation;
• medical ethics;
• psychology of professional communication;
• basics of labor legislation;
• internal labor regulations;
• labor protection and fire safety rules.

Qualification requirements: secondary vocational education

in the specialty “General Medicine”, “Midwifery”, “Nursing” and a specialist certificate in the specialty “General Practice” without presenting requirements for work experience.

The reorganization of medical care along the lines of a general practitioner gives the nurse a much more significant role than before. She cannot remain just a doctor’s assistant, an executor of his orders. Promoting a healthy lifestyle, vaccinating the population, actively identifying people with risk factors, constantly monitoring chronic patients, including those with an unstable course of the disease, teaching patients to independently monitor their condition - all this work is the responsibility of nurses, who are thus actively participate in primary and secondary prevention. It is the prevention of the diseases themselves and their complications that makes it possible to reduce the costs of all types of medical services, especially such expensive ones as ambulance calls and hospital treatment. She must take on a certain amount independent work and perform it professionally and with full responsibility.

The family doctor and nurse must be an expression of a high level of professionalism in diagnosing, treating diseases and caring for their patients. The pedagogical focus of a family nurse involves teaching patients and their families basic methods of mutual assistance. The nurse should provide first aid in case of emergency conditions of the patient, such as traumatic injuries, different kinds shock, respiratory and cardiac arrest.

Expansion of the functional duties and responsibilities of general practice nurses occurs in several forms. First, the nurse performs some of the functions traditionally performed by the primary care physician. For example, he independently sees patients in specially equipped clinic rooms, where there is an electrocardiograph, a tonometer, and a kit for determining intraocular pressure, tables for determining visual acuity, scales, stadiometer, etc. The nurse conducts an appointment in parallel with the doctor’s appointment.

Persons who are registered at the dispensary, as well as those with risk factors, who are in the period of selection of drug therapy, and other patients are invited to the appointment for dynamic monitoring, issuing referrals for examination, conducting conversations on a healthy lifestyle, consultations on diet and regimen for various diseases, training in methods of self-monitoring of one’s condition. If necessary, patients can independently make an appointment with a general practitioner nurse at the reception.

Secondly, the nurse plays a leading role in the development of hospital-substituting methods of providing medical care: patronage of patients and hospitalization at home. The selection of patients for patronage is carried out by the doctor. First of all, these are chronic patients with an unstable course or exacerbation of the disease, as well as those who are in the period of selecting drug therapy. These patients require constant, but not round-the-clock monitoring, and they often require emergency medical care.

When transferring a patient under patronage supervision, the general practitioner examines the patient together with the nurse. At the same time, they determine the severity of the condition, discuss the main syndromes of the disease, monitoring parameters, prescribed treatment, the mechanism of action of drugs, the expected result of therapy, possible side effects and complications, the nurse’s tactics in certain cases and the boundaries of her independent actions.

The task of the nurse during patronage includes monitoring the dynamics of the patient’s condition, his compliance with diet and regimen, and the correctness of medications. The introduction of patient monitoring standards made it possible to systematize the approach to outpatient care by nurses of patients with arterial hypertension, coronary heart disease, diabetes mellitus, peptic ulcer, cerebrovascular accidents and diseases of the urinary system. The standards also made it possible to differentiate the functions and responsibilities of a nurse and a doctor. High-quality patronage is the best evidence of good work in a team of doctors and nurses: the patient is under the close supervision of a nurse, receiving timely consultations from a doctor.

A very important component of nursing care is teaching the patient to independently monitor his condition and provide self-help when it worsens. Family members of the patient are taught the techniques and rules of care, performing simple medical procedures and providing first aid if the condition worsens. At the same time, risk factors for diseases in family members can be identified using questionnaires, and health education work is carried out.

The work of family nurses at home involves solving another important social problem - creating conditions for the longest and most successful stay of a disabled person at home with the help of a variety of care products and technical devices. In this case, a number of problems must be solved.

• 1. Ensuring patient safety, including:
  • fire safety;
  • electrical safety;
  • removing obstacles along the way;
  • installing railings, handles, strengthening rugs, etc.;
  • safe storage of cleaning products, bleaches, dyes, etc.;
  • reliability of shutters on windows and doors;
  • safe storage of medications, control over the contents of home first aid kits;
  • matching the height of chairs, beds, etc. patient's growth.
• 2. Respect for human dignity, respect for human rights.
• 3. Maintaining confidentiality (secrecy of personal affairs, diagnosis, content of negotiations, etc.).
• 4. Ensuring the quality of communication with the patient (availability for conversation, emotional support).
• 5. Expanding the patient’s social circle, creating an environment for this (telephone availability, availability of addresses, writing materials, encouragement to expand communication).
• 6. Encouraging the patient's independence and independence, allowing him to do as much as he can.
• 7. The use of means that promote the expansion of self-service and greater independence (equipment of premises, use of devices - support sticks, crutches, strollers, etc.).
• 8. Approval of the patient's actions.
• 9. Prevention and diagnosis of disorders in various areas (mental, sexual, physical, etc.).
• 10. Providing assistance in eating, moving around, caring for nails and hair, washing, dressing, delivering and preparing food, performing hygiene procedures, cleaning premises, etc.
• 11. Ensuring patient infection safety.

The family nurse should teach not only the patient the rules and methods to expand the level of self-care, but also his immediate environment - caring for this family member. Often this work is psychologically quite difficult.

Knowing the social status of the family, the level of health of each of its members, the characteristics of the development and course of diseases, using the trust and authority of their patients, the family nurse can more effectively engage not only in coordinating activities, but also in the development and implementation of specific preventive measures necessary for each family , in accordance with the living conditions of a given family, as well as the development and implementation of nursing care plans for patients.

A hospital at home is organized for seriously ill patients who are not hospitalized for various reasons(usually due to the refusal of the patient himself or his relatives), or for patients whose condition allows adequate treatment at home. If a hospital is organized at home, the clinic provides the patient with medications. In a hospital at home, in contrast to conventional nursing care, a nurse provides and coordinates more intensive care, including consultations with specialists, intravenous drips and other injections, collection of biomaterial for research, ECG readings, etc.

The third most important area of ​​activity of a general practice nurse is sanitary and hygienic training of patients and their relatives, including conducting classes with patients in the form of “schools” organized according to nosological principles (for patients suffering from diseases such as bronchial asthma, diabetes mellitus, diabetes, arterial hypertension). These diseases, which can be disabling and fatal, are potentially controllable. However, this is possible subject to the conscious participation of the patient, who must have a certain amount of information about his illness, methods and prospects for its treatment. But the most important thing is that the patient must be ready to follow the doctor’s recommendations. It is the low motivation of patients and their lack of understanding of their condition that often nullifies all the doctor’s efforts. Training at the school takes place in the form of alternating theoretical and practical classes, in which the nurse plays the role of a mentor.

As an example illustrating the topics and main directions of work of different patient schools, we give the following. At the “School for Diabetes Patients,” patients should receive information about what diabetes mellitus is and what its complications are; why and how to monitor glucose levels in blood and urine using a glucometer and test strips; what are the signs of hyper-, hypoglycemia, ketoacidosis; how to regulate blood glucose levels through diet (the concept of bread units) and proper intake hypoglycemic drugs; how to care for your limbs and prevent the development of diabetic foot and other complications.

During classes at the School of Arterial Hypertension, patients receive information about risk factors, development mechanisms and complications arterial hypertension, principles of prevention and treatment, methods of self-monitoring of one’s condition, self-help techniques when it worsens. Students are told about diet, physical therapy, acupuncture, occupational therapy, and promote a healthy lifestyle; carry out one practical lesson where they learn the rules for measuring blood pressure; Give instructions on how to keep a diary. During classes, patients exchange impressions, express their own opinions, and share experiences, which has a positive effect on the assimilation of the material and stimulates patients to follow the recommendations.

Paramedical workers in the family medicine service, spending significant time with the patient and his family, must form in the patient and his environment a clear conviction of the importance of preserving and maintaining health, and teach skills primary prevention, form an understanding of the existing disease, the possibilities of ensuring an acceptable quality of life if it is present, and teach basic techniques of care and self-care.

There are a number of theoretical considerations that should be taken into account when conducting patient education. The first of these is the correct assessment of the patient’s psychological status at different periods of the course of his disease. After the patient has learned about his diagnosis, he psychologically goes through several stages. The first stage - anxiety - is characterized, on the one hand, by the desire to know the truth about the disease, on the other, by an unwillingness to accept what happened. Patients struggle with conflicting desires to remain independent, on the one hand, and the need to receive assistance and care, on the other. This is a time of depression. The second stage takes the person back to childhood, interacting with caregivers as parents rather than as equals. This is a position of need for protection. At this time, a person becomes self-focused and dependent, can stop relationships with the outside world, and thinks only about his feelings. The sense of time becomes limited, the future seems uncertain. The third stage is the need to find a new existence in the face of illness. The result depends largely on social support, family relationships and the support that medicine can provide.

After diagnosis chronic disease is finally confirmed, a meeting with the patient should be held immediately. Before this, it is necessary to find out his educational level, social affiliation, life and professional activity, the nature of relationships in the family, as well as the general mood of the patient (how much he understands the need for constant treatment, changes in lifestyle, monitoring his condition, for example, is he able to constantly measure blood pressure or perform peak flow measurements). Next, you should determine an action plan for sanitary and hygienic education and training of the patient (in what form is it best to present him with the necessary information, its volume, frequency, etc.).

The ultimate goal of patient schools is awareness of the mutual social responsibility of medical personnel and the patient in treatment, care, rehabilitation and prevention, the development of mutually beneficial cooperation of both parties, the creation of trusting relationships, improving the culture of communication, maintaining and improving health. It is necessary to teach the patient to fight and take responsibility for his health. Active monitoring of one’s condition and awareness of positive aspects encourage the patient to change some habits and lifestyle. To do this, the nurse should have not only knowledge in terms of patient care, but also awareness of basic issues of philosophy and psychology. Because a nurse devotes a significant portion of her work to teaching patients, she requires pedagogical competence.

During the training, the patient and/or his relative must master the following information:

• information about the diagnosis and causes (factors) of the disease; about the nature of diagnostic procedures (non-invasive, invasive, significance, preparation, risks, consequences, etc.);
• about treatment, rehabilitation, prevention (application regimens medications, procedures and manipulations, risks, effectiveness);
• about the peculiarities of lifestyle in the presence of a particular disease (restrictions, regime, nutrition, interaction with nature, with others).

It is necessary to establish long-term, trusting relationships with patients and their families. Providing the patient with complete information helps create an atmosphere of trust and strengthens the relationship with the patient.

Effective patient education may be hindered by a number of reasons.

• 1. Physical condition. Exercises are inappropriate when the patient is in pain, weak, has a fever, or has another acute condition.
• 2. Financial circumstances. You need to know the material and economic capabilities of the family. Advice on nutrition, lifestyle, and purchasing medications should be given taking into account these circumstances.
• 3. Lack of support. It is necessary to help the patient gain family support by explaining to his loved ones the nature of the disease, possible consequences, features of care, and the need for behavior change.
• 4. Misconception about the disease and treatment, low level of literacy in general. Overcoming this obstacle requires the ability to adapt the content of recommendations and consultations to the patient's educational level.
• 5. Cultural, ethical, language barriers. Sometimes these obstacles are insurmountable, for example, if the patient has difficulty understanding the language you speak, or his religious principles prohibit him from following the doctor's recommendations. In this case, you should not interfere too actively and change the patient’s life circumstances.
• 6. Lack of motivation. As a rule, the doctor helps the patient find motivation to change behavior or learning; sometimes the patient himself finds an incentive to change behavior. The nurse must help the patient understand the essence of what is happening, demonstrate the connection between his behavior and the danger to health, and indicate the need for ongoing treatment and diet to avoid complications. Perhaps after such a conversation, the patient himself will gain motivation.
• 7. The environment very often pushes patients who want to change their behavior to breakdown or failure to follow recommendations. It is necessary to discuss this obstacle with the patient and suggest ways to overcome it.
• 8. Negative past experiences. Often patients, in response to an offer to change behavior or give up bad habits, recall past failures. In such cases, it is important to determine the cause of failure, help the patient understand and realize it, and suggest ways to solve the problem of factors that reduce their ability to self-care.

Thus, a general practitioner nurse is an equal participant, along with a general practitioner, in all types of treatment and preventive work at the site. According to global standards, the general practitioner nurse should treat patients as unique individuals; be able to identify their problems, including those within the family, and coordinate medical care throughout the life of patients. Good, friendly tandem work: a doctor and a general practitioner nurse is the key to reducing morbidity and increasing family health indicators.

A ward nurse is a specialist with a secondary medical education who must care for patients, record data on 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 sets out the basic responsibilities 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 required to read the job description when hired and sign in the journal, thereby certifying that he has studied the document and agrees with the requirements presented in it.

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

IMPORTANT! If the procedural nurse is absent for some reason, the ward nurse takes over her functions. Therefore, she must be fluent in medical manipulation techniques: 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 responsibilities of the ward nurse are as follows:

• care for patients and monitor their condition;
• carry out the doctor’s prescriptions and make notes about this in the relevant documents;
• supervise junior medical staff (for example, require timely cleaning, changing bed linen, washing weakened patients, etc.);
• ensure that order is maintained in the department, for example, to prevent violation of the regime by both patients and visiting relatives;
• while working, be constantly with patients, leaving only to take necessary medications or take notes;
• accompany the doctor during the rounds and report on the patient’s condition and its changes;
• familiarize patients entering the department with the internal regulations;
• examine patients once a week to identify head lice;
• if the patient’s condition worsens, immediately notify his attending physician (or, in his absence, the doctor on duty);
• monitor compliance with the quartz schedule of the wards and the cleanliness and order in them;
• report violations by junior medical staff to the senior nurse or head of the department.

Job responsibilities

The ward nurse has the following responsibilities:

• monitors patients while observing medical ethics;
• when receiving patients, places them in wards;
• in children's hospitals, the nurse must ensure that the children's parents comply with the sanitary and epidemiological regime;
• checks packages from relatives to prevent patients from getting products that could be harmful to their health;
• makes reports to the attending or duty doctor on the condition of patients;
• organizes examination of patients in diagnostic rooms;
• deals with the isolation of patients who are in a terminal condition. If necessary, calls the resuscitation team;
• prepares the bodies of the deceased for transportation to the appropriate department;
• ensures that the premises assigned to her have the necessary equipment for work;
• monitors the cleanliness of the wards assigned to her, 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 products in order to prevent infectious diseases (HIV, hepatitis, etc.).

Rights

The ward nurse has the following rights:

• to provide first aid to the patient until the doctor arrives. In some cases, the lives of patients depend on the nurse's qualifications and knowledge of basic resuscitation techniques;
• to supervise the work of junior medical staff;
• to receive information about the patient's health status. 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 relating to her work;
• for the issuance of protective clothing and personal protective equipment;
• for assistance from management in the performance of their functional duties.

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

IMPORTANT! The ward nurse often communicates with patients' relatives. She can give advice on the care of the patient or his diet, list the therapeutic and diagnostic measures that were carried out with the patient. However, only the attending physician can report on a person’s health status.

Responsibility

The ward nurse's job responsibilities include a section on her responsibilities. The nurse is responsible for:

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

Qualification Requirements

A specialist with a secondary medical education in the specialties “Nursing” and “General Medicine” can become a ward nurse. Some institutions require the nurse to have experience in a related position.

Each department has its own specifics, so nurses may be required to obtain certificates for completing additional advanced training courses.

Necessary psychological qualities

The ward nurse has more contact with patients than other specialists. The psychological mood of the sick person depends on her participation, sympathy and attentiveness. The ward nurse must be able to prepare the patient for the upcoming unpleasant manipulations and reassure him 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 empathize, kindness, the ability to understand people and well-developed communication skills. Patients exhausted by the disease and tired from prolonged hospitalization may show irritability and even aggression. A doctor must be able to listen to a suffering person, cheer him up, and explain the need for painful manipulations.

The functional responsibilities of a nurse in a therapeutic department involve performing a number of medical interventions. Some manipulations (enemas, bladder catheterization) may affect the patient’s sense of modesty. To gain respect and win over patients, the nurse must always remember the feeling self-esteem patients and respect their right to privacy.

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

IMPORTANT! The ward nurse must be very observant. She should notice any changes in the patients’ condition: sometimes seemingly insignificant symptoms are harbingers of the development of life-threatening conditions. For example, restlessness and the desire to sit down may indicate the development of pulmonary edema.