Date of creation: 2008
Introduction
About the author
I, Ekaterina Nikolaevna Dudko, graduated in 1970 from a two-year course for nurses of the Union of Red Cross and Red Crescent Societies of the USSR. She studied on the job while working as a nurse in the operating unit of the 1st surgical department 1st City Clinical Hospital of Novosibirsk. After qualifying nurse began working in the anesthesiology department of the 1st City Clinical Hospital.
In 1975, I went to work in the anesthesiology and resuscitation department of the 333 District Military Hospital of the Siberian Military District.
From the fall of 1996 to June 1999, she worked in the military sanatorium of the Siberian Military District "Eltsovka" as a ward nurse of the department rehabilitation treatment. Due to staff reductions, she was fired in July 1999 and was registered with the city employment center until 2002.
From August 2002 to the present, I have been working in the military sanatorium of the Siberian Military District “Eltsovka” as a ward nurse in the medical department.
Characteristics of the place of work
The military sanatorium "Eltsovka" is located in the resort area of Novosibirsk in a pine forest on the banks of the Ob River. The sanatorium has a capacity of 200 full-time beds. Vacationers are accommodated in a comfortable dormitory building in double rooms. At the service of vacationers: club; library; sauna and bath; gym with exercise equipment; sports grounds for playing volleyball, badminton, tennis; well-groomed paths for health paths; billiard room; playground; beach. In winter, a small skating rink is opened and skis and skates are available for rental.
The main methods of treatment used in the sanatorium: climatotherapy, hydrotherapy, physiotherapy, physical therapy and massage, aerosol and speleotherapy, therapeutic nutrition. The sanatorium has a dentist, a functional diagnostics room, and a clinical laboratory.
The main tasks of the medical department where I work are:
- Accommodation of patients in conditions that provide them with adequate rest and sanatorium treatment.
- Conducting timely and qualified treatment of patients.
- Maintaining constant readiness to provide emergency services medical care.
- Enforcement hygiene standards and rules of the anti-epidemic regime in the department.
To complete these tasks medical department provided with appropriate material resources, economic and medical equipment and staff.
The department has the following premises: wards for living with sanitary facilities, offices of doctors and the head of the department, the office of the nurse on duty, the treatment room, the room of the hostess, storage rooms and household rooms.
The nurse's office is located on the second floor of the dormitory building. It consists of two rooms and combines a medical station and a treatment room.
Nurse's post equipped with the necessary office furniture and telephone. There is a cabinet for storing medicines of group “B” and a folding cabinet with individual cells for placing medications prescribed by doctors. The office also stores medical documentation (case histories, work logs), various manuals and instructions (job responsibilities; occupational safety precautions; algorithms for providing emergency medical care; an action plan in case of diagnosis of particularly dangerous infections; instructions for disinfection and sterilization, etc.)
Treatment room equipped with a safe for storing group A medications. There are cabinets with a set of medicines for providing emergency care in the department and a special bag-box for emergency medical care outside the department. All medical equipment of the department is in working order and is aimed at providing emergency care. Available: a convenient automatic cardiograph, defibrillator, manual breathing bag, oxygen inhaler, mechanical suction. The treatment room is also equipped with a bactericidal irradiator, a couch, manipulation tables, a refrigerator, a stand for droppers, various bins (containing sterile dressings and injection balls, instruments, rags for general cleaning of the treatment room), containers for disinfection of used instruments and medical waste . The “Anaphylactic shock”, “Anti-AIDS”, “Demercurization” layouts have been created.
Activity analysis
Ward nurse's work
The work of the department's nurses is organized in the form of daily shifts. When I go on duty, in the presence of the head nurse, I take strong medications from the previous shift against signature medicines registered; keys to the safe and cabinets where medical records and department documentation are stored; I receive information about the number of patients in the sanatorium and patients requiring supervision by staff on duty; I check the availability of medications in the emergency kits. While on duty:
- I receive patients entering the department, introduce them to the internal regulations, conduct anthropometry and body thermometry for newly admitted patients and enter this data into the medical history, also fill out the passport part of the medical history and coordinate with the doctor the time of the first medical examination;
- I receive the necessary medications from the head nurse, record them in special journals and ensure proper consumption and storage;
- I am constantly in the department. In the case of visiting wards or other departments (for example, the catering department), I inform the doctor on duty and post a sign indicating my location;
- I devote Special attention patients requiring special monitoring (I am required to know the nature of their disease, specific therapeutic and diagnostic measures carried out for each of them, basic objective data - blood pressure, heart rate, respiratory rate, temperature); if the patient’s condition worsens, I provide emergency first aid until the doctor on duty arrives;
- I report to the doctor on duty and the head of the department about all emergency incidents, as well as about the dynamics of the condition of patients under observation;
- I make a selection of medical prescriptions from medical records, paste the data diagnostic examinations and results laboratory tests;
- at a time determined by the daily routine, I dispense tablets to patients, perform medication injections, dressings and other procedures;
- I refer patients to diagnostic and treatment rooms, ensure correct sampling biological material in patients and promptly send them for laboratory testing;
- 30 minutes before the food is given to the soldiers, I take a sample of the prepared dishes, make a conclusion about their quality, the sanitary condition of the canteen, and enter my data in the “sample book”;
- In accordance with the schedule, I disinfect the treatment room, care items and medical instruments;
- I periodically make rounds of the wards to check patients’ compliance with the established treatment and protective regime and rules of behavior, I do not allow the presence of unauthorized persons in the department;
- In the course of constant communication with patients, in accordance with the requirements of medical ethics and deontology, I observe tact, politeness, and patience;
- at the end of duty, I prepare the post for delivery;
- in the morning, when reporting for the past duty, I report on the condition of the patients, separately on the condition of the patients under the supervision of the doctor on duty, and on the work performed during the shift.
Mastered skills and manipulations
The beginning of work in the departments of anesthesiology and intensive care contributed to the acquisition of valuable practical experience. I am proficient in the following basic therapeutic and diagnostic procedures:
- preparing the patient for diagnostic tests;
- blood sampling for biochemical laboratory testing;
- measuring body temperature, blood pressure, calculating heart rate and respiratory rate;
- technique for placing cups, mustard plasters, compresses;
- administering injections (s.c., i.m., i.v.) and intravenous drips;
- immobilization of the injured limb; treatment of wounds and burn surfaces with the application of an aseptic dressing;
- temporary stopping of bleeding by all available means (application of tourniquets and bandages, finger pressure); stopping nosebleeds (except for posterior tamponade);
- tube gastric lavage, administration of enemas (siphon, cleansing, therapeutic);
- conducting major resuscitation measures: artificial ventilation, external massage hearts.
I can do it myself artificial ventilation lungs using the mouth-to-mouth method or using an Ambu bag through a mask, install an air duct, give oxygen, perform indirect cardiac massage for resuscitation measures.
I know how to record an electrocardiogram and in emergency cases I take ECGs for patients. I can prepare and use a defibrillator under the supervision of a doctor.
SAMPLE
I APPROVED
Chief physician
Name of health care facility
_________________
Report
about the work done for _________ year
local pediatric nurse
Ivanova Maria Petrovna
MUZ "City Children's Clinic No.»
To prepare a report on production activities for certification to the appropriate category
All certification material must be printed using Times New Roman No. 14 font, 1.5 spacing on one side of white A4 paper, with standard margins.
Tables, pictures, drawings, diagrams, graphs are made on standard sheets. Report pages, including illustrations and appendices, are numbered in order.
The report is signed by the person being certified, the head nurse, the head of the relevant department, and is certified on the title page by the signature of the head of the institution and official seal institutions.
Sample report on production activities for certification at 2 qualification category
I, Ivanova Maria Petrovna, graduated from Chitinsky Medical College in 20___, majoring in “Nursing”, specialization in “Nursing in Pediatrics”. After graduating from ChMK, she came to the children's clinic as a young specialist as a district nurse. The general experience is 3 years, in the specialty - 3 years.
Member of the association since 20___.
The children's clinic is an independent medical and preventive institution. In the area of its operation, the clinic provides outpatient treatment, diagnostic and preventive care to the child and adolescent population with a total population of 01/01/20 ______, of which children under one year of age ______, adolescents _______.
In the service area of the clinic there are ____ preschool educational institutions and _______ secondary educational schools.
The planned capacity of the clinic is ______ visits per year.
Structure of health care facilities
Pediatric department: ____ pediatric areas.
Children's school department: _____ preschool educational institution, _____ secondary school
Clinical diagnostic laboratory
Dental department
X-ray room
Functional diagnostics room
Massage room
Healthy child's office.
Vaccination room
Treatment room
CSO office
Physiotherapeutic office
The appointments are conducted by specialized specialists: neonatologist, neurologist, surgeon, ophthalmologist, ENT doctor, pediatric gynecologist, endocrinologist, infectious disease specialist, immunologist, cardiologist, adolescent therapist, psychologist, speech therapist, psychiatrist.
Two days a week (Tuesday and Thursday) reception of healthy children.
My working day starts at 8-00. The doctor's office is getting ready for a doctor's appointment.
in 30 min. before the start of the reception:
Ventilation and turning on the recirculator (or bactericidal lamp)
Replacement disinfectants for routine disinfection of the surface of tables, couches, scales, stadiometers
Delivery of sterile spatulas from the Central Dispensary Center
Delivery outpatient cards(form No. 112/у)
Preparation of prescription forms, various directions, certificates, etc.
Documentation
Site passport (site plan, main indicators of the site, lists of disabled children, socially disadvantaged, neglected and supervised children)
Work folder
Children's Census Journal by year
Children's household census register
Medical examination journal
Register of unorganized children in 2 copies (one is in the vaccination room)
Logbook of endangered tuberculosis cases
Register of pregnant women at the site and folder of prenatal visits.
Register of children of the first year of life by risk groups
Journal of reports on newborns, one-year-olds, unorganized children
Daily work plan of the district nurse
Plan preventive vaccinations for a month
Workplace equipment
Desk – 2 pcs.
Changing table – 1 pc.
Cabinet – 1 pc.
Chairs – 4 pcs.
Scales (electronic) for children up to 20 kg. - 1 PC.
Floor scales (electronic) for adults – 1 pc.
Height meter for infants – 1 pc.
Height meter for adults – 1 pc.
Couch – 1 pc.
Sink for washing hands – 1 pc.
Recirculator (or bactericidal lamp) – 1 pc.
Sterile spatulas, packed in kraft paper, 10-15 pcs.
Tray for sterile spatulas
Thermometers are clean, dry – 5 pcs.
Containers for disinfection (spatulas, thermometers, class B waste)
Disposable hand towels for staff
Brief description of the site and main indicators
The site is located in the area __________, where the following houses are located:
9-story, ______ 5-story, private sector with _____ one-story wooden houses. The area is extended (not extended), compact (not compact). Children attend preschool educational institution No., No., No.; secondary schools No., No., No.
The birth rate in the area has increased (decreased) compared to last year.
During the period of my work at the site there was no infant mortality (or there was, indicate in which year). Infant mortality rate
at the clinic for _______ year it amounted to _____ ppm of those admitted for observation. In the city, the infant mortality rate is _______ ppm, in the region ______ ppm.
A census of the children's population in the area is carried out 2 times a year
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Name |
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Total number of children in the area |
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Number of children under one year |
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Number of unorganized children |
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Number of children attending preschool educational institutions |
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Number of children attending schools |
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Number of disabled children |
Antenatal fetal care
Prenatal care.
In order to improve antenatal care of the fetus and newborn, an ATPC council operates on the basis of health care facilities, which is held once a month. Each precinct prepares lists of socially disadvantaged families for antenatal clinic, and the therapeutic service presents lists of women of childbearing age with extragenital pathology and a list of women with absolute contraindications.
Work to protect the health of the child in the area begins even before his birth. The antenatal clinic sends lists of pregnant women who have registered to the children's clinic.
For the first prenatal visit, a woman comes to the children's clinic for an appointment with a pediatrician herself in the first 10 days. If for some reason she does not come to the children's clinic within 10 days, the local nurse provides prenatal care at the woman's home. High-risk pregnant women receive 3rd prenatal care at home by a pediatrician.
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Number of pregnant women |
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Prenatal care |
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Complicated obstetric history |
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Anemia in pregnancy |
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Rh negative pregnant women |
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Permanently residing on the site |
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Working with newborns
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Number of newborns |
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SHOP injuries |
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Premature babies |
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After the newborn is discharged from maternity hospital During the first 2 days, primary medical and nursing patronage is provided to him. When providing patronage to a newborn, a special positioning of the district nurse is used.
Laying composition:
Ethyl alcohol 70% or 0.2% chlorhexidine solution
Hydrogen peroxide solution 3%
Sterile cotton balls
Sterile tweezers
Sterile pipettes – 2 pcs.
Disposable sterile gown
Medical sterile gloves
Disposable medical cap
Disposable medical mask
Disposable shoe covers
Class B waste collection container
At the first visit, we teach the mother how to care for her newborn, the technique of treating the umbilical wound, hygiene procedures, treating skin folds, as well as the technique of bathing and swaddling the baby. A conversation is held on the prevention of hypogalactia, a conversation about the rules of breastfeeding. Together with the doctor, a plan for monitoring the child up to one year is drawn up, taking into account perinatal risk groups. During the neonatal period up to a month, healthy children are visited by a nurse once a week, children in the 4th risk group - daily until 14 days, then 2 times a week until 4 months. Children in the 7th risk group from socially disadvantaged families up to one year old are visited individually, but at least 2-3 times a week.
Working with children 1 year of age
Observation of children 1 year of life
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Number of children under 1 year |
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Observed by a nurse |
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Inspection by specialists |
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Neurologist |
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Dentist |
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Traumatologist-orthopedist |
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Laboratory research |
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general blood analysis |
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general urine analysis |
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feces per i/chl |
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scraping e/w |
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Pneumonia |
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Healthy children |
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From one month to 6 months of life, children are visited by a nurse 2 times a month, children from 6 months to 1 year - once a month.
In a family where a premature baby was born, conversations are held with the mother about caring for the premature baby, preventing pneumonia, and malnutrition. Such children are provided with scales, and control weighing of the child is carried out at home. The data is recorded on an observation sheet.
Children in the first year of life are invited monthly to the clinic for an appointment with a pediatrician for anthropometric measurements, assessment of physical and neuropsychic development, and preventive vaccinations. Examinations are carried out by specialized specialists, general blood and urine tests are prescribed, and ultrasound examinations of the hip joints are performed.
When observing children in the first year of life, observation sheets developed as part of nursing innovations are used.
Work with disorganized children from 2 to 7 years old.
Children of the 2nd year of life are visited by a nurse once a quarter, children of the 3rd year of life - once every six months, unorganized children over 3 years old - once a year. In addition, they are invited according to the plan for preventive vaccinations. On their birthday, unorganized children are annually invited to the clinic for tests and a medical examination by specialized specialists. Their physical and neuropsychic development is assessed.
Immunoprophylaxis.
The children's clinic operates under the territorial program “Vaccine Prevention”. The priority national project “Health” provides for an increase in the number of people subject to vaccination against rubella, hepatitis B and influenza.
There is a filing cabinet in the structure of the vaccination room. The work is based on the basic principles: accurate and reliable accounting of all children (according to the census and the movement of children) and the availability of medical documentation for each of them. A preventive vaccination plan is drawn up monthly, and a vaccination analysis is carried out at the end of the month. A plan for each child is drawn up monthly using forms No. 63/u.
After vaccination with DPT, DPT-M, ADS, HBV, children are visited by a nurse the next day to assess their condition. Attention is paid to sleep, appetite, temperature, stool, etc.; OPV - on the 4th, 7th, 14th, 30th and 60th days - pay attention to temperature, stool, neurotic symptoms, rash; measles and mumps - on the 6th and 18th days, rubella - on the 6th and 12th days.
I monitor the presence of forms No. 63/u in the file cabinet, for determining the effectiveness of BCG scars and timely medical withdrawals.
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Standard indicator |
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clinic |
plot |
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Diphtheria |
up to 1 year V |
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up to 1 year V |
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Poliomyelitis |
up to 1 year V |
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2 years (18 m.) RV 1 |
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2 years (20 m.) RV 2 |
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Mumps |
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BCG (1 year) |
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If standard vaccination rates are reduced, indicate the reason for the decrease, for example, the lack of a particular vaccine.
Indicate (if any) the number of young mothers, what work is being done in this direction (lectures, conversations, and other events).
Visits to sick children at the site are carried out as prescribed by a doctor. When visiting such children, I check that the parents are complying with medical prescriptions, the availability of medications, administer prescribed injections to the child, check hospitalization, and monitor contacts in areas of various infections.
Working with a dispensary group of children.
Children registered at the dispensary are called to see a pediatrician 2 times a year (spring and autumn). They are given directions in advance for tests and consultations with specialists. At the appointment, anthropometry is carried out, blood pressure is measured, the physical development of the child is assessed, and according to indications, an additional examination is prescribed at the clinical diagnostic center for children. After all the examinations, the pediatrician prescribes anti-relapse treatment.
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Indicators |
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clinic |
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Total number of children registered as “D”: |
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Including the pediatrician |
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Completeness of coverage |
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Efficiency of medical examination: |
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No exacerbations |
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Deregistered due to recovery |
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Dispensary observation coverage per 1000 thousand population total: |
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Including the pediatrician |
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Structure of chronic diseases
Spa treatment
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Name of health care facilities |
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I work with disabled children according to a plan, and provide home visits once a quarter. Work is underway on DLO, I monitor the receipt of medications prescribed by the pediatrician, and the fulfillment of medical prescriptions by the patient.
R working with children from socially disadvantaged families.
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Indicators |
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plot |
clinic |
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Total child population: including up to a year |
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Total number of socially vulnerable families |
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In them children from socially disadvantaged families |
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Including up to 1 year |
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Children in need of health improvement: |
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improved |
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Number of pregnant women from socially disadvantaged families |
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Covered by contraception from socially disadvantaged families |
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Conducted door-to-door inspections and raids with inspectors |
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Children from socially disadvantaged families are under constant supervision of the OSZN and the children's clinic. The district nurse visits socially disadvantaged families weekly. Children under care at the site are visited by a nurse at home in order to familiarize themselves with the material and living conditions in which the child is, the psychological climate in his environment, and are invited to see specialists to undergo a medical examination and tests.
Working with teenagers
Children who have reached the age of 15 are transferred to the teenage room. At the beginning of the year, lists of teenagers at the site are compiled, according to which the child is called for transfer in the month in which he was born. The child is visited by a nurse at home. He is given directions for tests, a fluorographic examination of the chest organs, and a teenage card is opened for him.
The district nurse prepares in advance lists of boys and girls with an analysis of morbidity and prepares cards for undergoing a medical examination.
If there is a chronic disease or a newly diagnosed disease, the teenager is carefully examined and undergoes conservative or surgical treatment according to indications.
Introduction of innovative technologies into the work of a local nurse
Performing TPMU(list which TPMU are performed )
Analysis of the quality of a specialist’s work
Based on the ranking results for 20___, I take ___ place out of ___ district nurses. I am behind the ranking place by following criteria, For example:
low vaccination rate. Cause:
low coverage of antenatal care. Cause:
Based on the results of a survey of patients and their relatives at the site, the degree of satisfaction with the quality of care nursing care in general, it is quite high (or not high enough) and amounts to ___%. Parents receive a sufficient amount of information from the nurse on prevention issues, the operating hours of the institution, etc. According to the study, parents of young patients fully trust the professional skills and knowledge of the local nurse.
Every year, by order No. 549 of the Ministry of Health of the Trans-Baikal Territory “On improving the examination of the activities and quality of nursing care in the Trans-Baikal Territory”, I take a professional competency exam in the following disciplines:
readiness to provide emergency first aid
improvement of manipulation techniques as part of the implementation of TPMU standards
preparing patients for various research methods
knowledge and compliance with pharmaceutical regulations (medicine science)
knowledge and compliance with ethical and legal standards
compliance with infection safety
The exam results are entered into a personal record book and taken into account when ranking. According to the data for 20____, I have a final grade of ____.
I regularly improve my professional level. I attend nursing conferences held in health care facilities, seminars for district nurses, master classes, and take part in regional scientific and practical conferences in the specialty “Nursing in Pediatrics.” According to the credit-accumulation system I have ____ hour. I use scientific and methodological literature received from the Association
Conclusion: the nurse makes a brief conclusion about the results of the work done, notes problems and planned ways to solve them, the certified person’s proposals for improving the activities of the service in the institution, region
District nurse's signature
Signature of the head nurse
List of used literature(indicating authors, year and place of publication), published within the last five years
For the attention of specialists who prepare the report
for the 1st qualification category
The report is prepared according to the same requirements as for the 2nd quarter. category, but must additionally indicate:
-
For the attention of specialists who prepare the report
for the highest qualification category
The report is prepared according to the same requirements as for the 2nd quarter. category, but must additionally indicate
- responsibility for conducting any master class, indicating the number of specialists trained in this master class
Participation in the development of new TPMU standards (list which ones)
Mentoring young professionals
Presentations at regional and regional conferences in the specialty, articles in the media
Serving on the Nursing Council
Conclusion on the results of the work done, notes problems and planned ways to solve them, proposals of the certified person to improve the activities of the service in the institution, region
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Attestation case
ward nurse
purulent surgery department
MUZ "hospital" Saransk
Ivanova Irina Ivanovna.
I approve
Chief Physician of the Hospital
Petrov P.P.
Report
about the work of a ward nurse
department of purulent surgery of the Municipal Health Institution “Hospital”, Saransk
Ivanova Irina Ivanovna
Agreed with main
nurse Sidorova S.S.
Introduction
MUZ "Hospital" is a multidisciplinary treatment and preventive institution. According to the order, it is designed for 370 hospital beds.
On the basis of the hospital, educational and industrial practice is carried out for students of the medical college with training in practical skills in the workplace.
Main structural divisions of the institution:
Therapeutic department – 54 beds
Cardiology department – 60 beds
Heart attack department – 40 beds
Neurological department – 50 beds
Reanimation and Intensive Care Unit
Department of Anesthesiology-Resuscitation
Department of Pure Surgery – 65 beds
Department of purulent surgery – 21 beds
Department of Urology – 50 beds
On the basis of the hospital there are paraclinical departments:
- Operating unit;
Physiotherapeutic department;
X-ray Department;
Dental office;
Department of Functional Diagnostics;
Transfusion therapy room;
An emergency department through which 60-80 patients pass per day.
To examine patients, the hospital has an X-ray department, where examinations are carried out using the Siberia apparatus - a low-dose digital X-ray machine with computer control. The hospital recently acquired the latest Apollo X-ray diagnostic complex, which makes it possible to early diagnose various diseases. In the ultrasound room, diagnostics of blood vessels, parenchymal organs and bile ducts is carried out using the VIVID-7 expert class ultrasound system, as well as the ALLOKA-1700 device. For examination of ECHO CS, the ALLOKA-3500 device was purchased.
An emergency gastroscopy room has been opened, where diagnostics of diseases of the digestive tract (esogastroduadenoscopy, sigmoidoscopy, colonoscopy), respiratory tract (fibrobronchoscopy) is carried out using the latest devices: gastroscope GIF Q-40 "OLYMPUS", video gastroscope "OLYMPUS" OEK-A.
The clinical and laboratory diagnostics department carries out all the tests necessary to confirm the diagnosis. In 2010 the hospital purchased new equipment for the laboratory: a coagulometer analyzer “TS-4000” for determining APTT, prothrombin, fibrinogen, INR; hematological analyzer – automatic “BC-3000 PLUS.Mindray” for testing blood for leukocytes, erythrocytes, hematocrit, platelets. And intensive care units have their own specialized laboratory, where a quick clinical examination is carried out, which allows experienced resuscitation doctors to assess the patient’s health status and identify his problems.
Since January 2010 In our hospital there is a primary vascular department with 30 beds for the treatment of patients with acute cerebrovascular accident, myocardial infarction and acute coronary syndrome. Modern equipment was allocated for the implementation of the national project “Health”. IN In connection with this, a 16-slice computed tomograph TOSHIBA SCANNER Aguilion model TSX - 101A was installed, ultrasound diagnostics VIVID-5. From the first minutes of admission, the patient is examined on a computed tomograph, to clarify the nature of the stroke, a study of biochemical blood parameters is carried out, an ECG and ultrasound are performed. If the diagnosis of “acute cerebrovascular accident” is confirmed, patients are hospitalized in the intensive care unit of the vascular department. During the work of the vascular department, 234 patients were treated. Mortality decreased from 15.9% to 11.1% in 2010.
In our health care facility, to realize the potential capabilities of the CSC, the “Clean Tool” work system was chosen, which provides:
- strengthening the control and methodological functions of the sterilization service;
- collective and personal responsibility for the safety of tools and materials.
The system provides:
-performing therapeutic and diagnostic manipulations using an instrument or set of instruments and dressings individual for each patient;
- individualization of the composition of kits for each doctor and nurse, taking into account their wishes;
-exclusion due to the presence of such sets of intermediate preparatory manipulations with sterile products, which reduces the risk of contamination, reduces preparation time for procedures and creates maximum convenience when working with them.
Main tasks of the hospital
The main objectives of the hospital are:
- provision of highly qualified emergency medical services
helping patients with life-threatening conditions requiring
resuscitation and intensive care;
- implementation of organizational, methodological and advisory
assistance to treatment and preventive institutions of the regions in
activities regarding the organization of emergency medical
help;
- implementation of measures to ensure the constant readiness of the hospital for
work in emergency conditions with mass arrivals
victims in the city;
- ensuring effective continuity and relationship with all
medicinal - preventive institutions cities in rendering
emergency medical care in prehospital and hospital settings
stages;
- analysis of the quality of emergency medical care at various
stages of its provision and assessment of the effective performance of the hospital and its
structural divisions;
- analysis of the population's need for emergency medical care
all stages of its organization;
- carrying out health education and hygienic education
population to promote a healthy lifestyle, provide self- and mutual assistance in case of accidents and sudden illnesses,
timely seeking emergency medical care.
Characteristics of the department.
At the hospital, I work in the department of purulent surgery, as a ward nurse.
The main activity of the department of purulent surgery is the provision of emergency medical and diagnostic care to patients hospitalized in the hospital by ambulance and referrals from outpatient services.
Today the department has 21 beds and continues to be a unique part of surgical care for the city population. Here, emergency and planned treatment of patients with acute and chronic diseases associated with purulent processes of various localizations is carried out. Infections of soft tissues, bones and joints, lymphatic and blood vessels, purulent diseases of the abdominal cavity, extremities - all this variety of surgical pathology is observed among patients admitted to the department. A significant number of patients are patients suffering from diabetes mellitus and diabetic foot.
The department uses modern methods of treating patients with surgical infections, including various types surgical interventions, local effects on wounds and conservative therapy. Various methods are widely used physical impact on the wound process (cavitation with ultrasound of low and medium frequencies, laser and ultraviolet pulsed irradiation). A method of radical surgical treatment of purulent-septic diseases with active aspiration has been introduced into everyday practice. In the future, it is planned to create a city diabetic foot center.
Activities of the inpatient department of purulent surgery
Analysis of the assistance I provided in 2010. patients with various diseases
| Name of diseases | Number of persons |
| Diabetes. Diabetic foot | 17 |
| Acute gangrenous perforated appendicitis. Peritonitis | 190 |
| Various gangrenes | 20 |
| Abscesses | 35 |
| Atherosclerosis of the vessels of the lower extremities | 20 |
| Atherosclerosis of the vessels of the lower extremities with ischemic changes | 10 |
| Thrombophlebitis | 15 |
| Pancreatic necrosis | 7 |
| Colostomy | 37 |
| Trophic ulcers of the lower extremities | 25 |
| Infected wounds | 70 |
| Erysipelas | 3 |
| Osteomyelitis | 13 |
Many years of work by the hospital administration to introduce a program (protocol) for compliance with the rules of asepsis and sanitary-anti-epidemic regime into the work of the guard nurse gave a positive result. Clear knowledge and practical actions of medical personnel on high-quality, safe service and patient care helped raise the entire organization of diagnostic and treatment work in the hospital’s clinical departments to a higher level.
The department is constantly addressing issues of increasing the level of theoretical and practical knowledge of nurses. There is a mandatory system of advanced training for nursing staff. Upon entering the workforce, a nurse undergoes on-the-job training under the supervision of an experienced colleague.
. Staffing schedule of the purulent surgery department
| No. | Name | Quantity (units) |
| 1. | Head of department | 1 |
| 2. | Head nurse | 1 |
| 3. | Nurse | 7 |
| 4. | Sister-hostess | 1 |
| 5. | Ward nurse | 4 |
| 6. | Nurse-barmaid | 2 |
Distribution of nursing staff by length of service
Age composition of nursing staff
Number of members of the Association of Construction and Construction Works RME:
__6_____
people ____5____
% of total nursing staff.
Qualification
categories of nurses in the department of purulent surgery
The number of people with the highest qualification category has decreased due to nurses receiving preferential pensions (2 people).
The department of purulent surgery is relatively divided into 2 zones: clean and working. In the working area of the department there are 7 patient rooms, a distribution room, two treatment rooms, a dressing room, a bathroom, two toilets and an enema room. In the clean area there is the head nurse’s office, the resident’s room, the nurse’s room, the nurses’ rest room, and the housekeeper’s office.
Treatment room No. 1
| № | Name | Quantity |
| 1 | 1 PC. | |
| 2 | 1 PC. | |
| 3 | Desktop | 1 PC. |
| 4 | Containers for disinfection of honey. tools | 10 pieces. |
| 5 | quartz lamp | 1 PC. |
| 6 | Couch | 1 PC. |
| 7 | Safe storage narcotic drugs and psychotropic substances, as well as drugs of list “A” | 1 PC. |
| 8 | Cabinet for storing medicines. list "B" funds | 1 PC. |
| 9 | 8 pcs. | |
| 10 | 2 pcs. | |
| 11 | Trays for IM and SC injections | 4 things. |
| 12 | Chair | 1 PC. |
| 13 | Bedside table for storing medical products | 1 PC. |
Treatment room No. 2
equipped with the following items medical purposes
| № | Name | Quantity |
| 1 | Manipulation table for sterile material | 1 PC. |
| 2 | Rack for containers with disinfectants | 1 PC. |
| 3 | Desktop | 1 PC. |
| 4 | 10 pieces. | |
| 5 | quartz lamp | 1 PC. |
| 6 | Refrigerator for storing thermolabile drugs | 1 PC. |
| 7 | Cabinet for storing medicines of list “B” | 2 pcs. |
| 8 | Medical metal cabinet with a lock for storing medicines of list “A” | 1 PC. |
| 9 | Bixes for sterile material | 8 pcs. |
| 10 | Sterilizer for sterile instruments | 2 pcs. |
| 11 | Trays | 4 things. |
| 12 | Chair | 1 PC. |
| 13 | Bedside table for storing medical records | 1 PC. |
Dressing room
equipped with the following medical supplies
| № | Name | Quantity |
| 1 | Mobile hydraulic dressing table | 1 PC. |
| 2 | Mobile surgical lighting | 1 PC. |
| 3 | Manipulation table for covering a sterile table | 2 pcs. |
| 4 | Nightstand | 1 PC. |
| 5 | Container rack | 1 PC. |
| 6 | Containers for disinfection of medical instruments and waste material | 10 pieces. |
| 7 | Medical storage cabinet | 1 PC. |
| 8 | Bin for used diapers | 1 PC. |
| 9 | Bixes | 16 pcs. |
| 10 | Ultraviolet bactericidal air irradiator-recirculator “Dezar” | 1 PC. |
| 11 | Bactericidal irradiator | 1 PC. |
Medical equipment and furniture in treatment rooms and dressing rooms were placed taking into account the identification of a sterile zone and a disinfection zone and were used in strict accordance with safety and labor protection rules.
I am in charge of treatment room No. 1. It is divided into 2 zones. The sterile area contains:
- Manipulation table for performing procedures and storing small amounts of medications;
- Medical cabinet for storing medicines;
- Couch;
Safe;
When organizing our workplace, we took into account the requirements for medical support, aesthetic maintenance of the workplace, work with medical documentation and implementation of sanitary and anti-epidemic measures.
The post of the purulent surgery department is equipped with an alarm system for calling a nurse into the ward
I, as a guard (ward) nurse, accepted and handed over duty according to the inventory of the equipment of the medical post:
- chair,
cabinet for tablet medications;
cassette holder with a set of bottles for dispensing medicines;
rubber heating pads - 2 pcs.;
ice bubble - 2 pcs.
oxygen cushion - 1 PC.;
containers for disinfection of thermometers, bottles - 1 pc.
supply of bed linen for patients (at least 10-15 sets); thermometers - 22 pcs.;
tonometer - 1 pc.
phonedoscope - 1 pc.
At the nurse’s station there is a desktop on which there is all the necessary documentation:
1. Journal of admitted patients
2. journal of long-term febrile patients
3. Journal of medical prescriptions and consultations
4. Journal of IM and SC injections
5. Log of requests to the laboratory
6. Log book for the operation of the steam sterilizer Gk-100
7. forms for referrals for laboratory clinical diagnostic studies, appointment sheets, temperature sheets, inserts for medical records, daily patient registration sheets;
8. duty handover logs,
9. registration of the bactericidal lamp operation
10. Registration of general cleaning
11. log of the transfer of keys to the safe;
12. accounting for alcohol consumption;
13.examination of patients for pediculosis;
14. vaccination registration log;
15. log of transactions related to the trafficking of narcotic drugs and psychotropic substances;
16. journal of medications subject to subject-quantitative recording. Narcotic, poisonous, ethyl alcohol, and drugs in acute shortage are subject to subject-quantitative accounting and control, which is maintained in a special book, numbered, laced and sealed and signed by the head physician of the medical institution.
According to Order 330 “On the storage of narcotic and potent drugs,” they must undergo strict quantitative control, including empty ampoules. The room for storing narcotic drugs should be windowless, with double doors and metal bars. The thickness of the walls must comply with the requirements of Order No. 330, and also be equipped with an audible alarm.
The supply of narcotic drugs should not exceed the department's 3-day requirement, 5-day supply of toxic medications, and 10-day supply of potent medications. Medicines must be used within the established expiration dates. Such medicines are stored in a locked safe in a separate room designated for these purposes.
- When storing medicines, the rules for placing them into groups are observed:
- List A;
- List B.
At the post there is a folder on the sanitary epidemiological regime, where instructions are stored for guard and treatment nurses on compliance with the sanitary and anti-epidemic regime, routine and general cleaning of department premises, hand treatment, the regime for disinfecting surfaces and medical devices, quality control of disinfection and PSO, etc., and also an inventory of kits for sterilization, anti-shock kits and an emergency first aid kit "Anti-AIDS", "Requirements for sterilization of medical devices".
In addition, I, the guard nurse, filled out the logs stored in treatment room No. 2 during the absence of the treatment nurse:
-accounting for blood collection for biochemical studies;
-blood log on RW;
- accounting for blood collection for AIDS and viral hepatitis;
-accounting for intravenous infusions;
- accounting for blood transfusions and blood substitutes;
- taking into account the quality of pre-sterilization treatment (form No. 366/u);
- registration of temperature conditions and defrosting (disinfection) of the refrigerator;
- accounting for the operation of bactericidal irradiators.
Scope of work performed:
My responsibilities include organizing the work of the medical post. While on duty, I was on duty in a medical suit (blouse, trousers) or gown, cap and slippers. To perform work outside the department (delivery of blood samples to the laboratory, transportation of medical devices for sterilization at the Central Social Security Center, etc.), I used a “going out” robe. Leaving the post to perform patient manipulations or for other reasons objective reasons I locked the cabinets with medicines. and medical products.
I, as a guard nurse, checked and supported the sanitary
hygienic condition of the medical post, wards and other premises
branches in the post service area.
When going on each duty, I checked:
- filling out all documentation,
processing of used instruments,
supervised patients who had to undergo blood and urine tests;
marking temperatures in medical records for the previous duty;
Carrying out hygienic treatment of the face and body of seriously ill patients. She took shifts at the patient's bedside;
cleanliness and order in the rooms:
- it is prohibited to have boilers in the wards
- outerwear and street shoes should not be on
I passed the night duty at the morning meeting of the medical staff of the department at 8.00, with a report on the condition of the patients, the implementation of medical prescriptions, which took place according to the following scheme:
Summary: The number of patients admitted, departed, how many are currently enrolled, how many of our patients are in other departments, the number of patients in the day hospital.
Heavy: surname, diagnosis, what bothered the patient, complaints, what manipulations were performed, what treatment he was receiving. Bedridden patients (if any): condition of bedsores, timely feeding, whether morning and evening toilets were performed, change of linen.
Feverish: surname, diagnosis, what complaints he has made (if any), what treatment he is receiving. Who made complaints, what was done. (Which assignments were carried out on duty, unscheduled - names of patients, diagnosis). Separately, it is reported on those who receive anticoagulants, potent, poisonous, narcotic drugs.
Analyzes: who failed and for what reason.
Research: who is prepared for what research. The presence of violations of the regime in the department, the presence of patients in the department, timely dismissal. Report what medications were missing at the post and in the treatment room.
Problems: does everything work, the condition of electrical appliances, medical equipment; safety of property in the department.
She noted the work of junior nurses. Passed the shift (full name), accepted the shift (full name).
Admitted a patient to the department:
- I entered his data into the receipts log and the temperature log.
She reported the room number and full name of his attending physician.
Introduced me to the separation regime.
She told him the location of the dining room, treatment room, staff room, shower, and toilet.
She provided a list of things and personal hygiene items permitted for use.
She informed the attending physician, the catering department and the junior nurse about the admitted patient.
- Participated in patient visits by attending physicians and wrote down their prescriptions; informed the doctor about all detected severe complications and diseases of patients, complications arising as a result of medical procedures or cases of violation of the internal regulations of the department. I ensured proper storage, accounting and write-off of medications, and compliance with the rules for taking medications by patients.
- Checked the quantity and expiration dates of medications stored in a locked medicine cabinet.
Every morning, and also during the shift, she handed over to the head nurse of the department a list of medications, patient care items and other medical products required at the post. I compiled and updated the list of patients at my post as they were admitted and discharged; transferred to the emergency department in the morning and at the request of the department doctor on duty; received newly admitted patients and discharged treated patients, as well as transferred them to other departments of the hospital.
Introduced the admitted patients to the rules of internal routine, personal hygiene and daily routine.
She kept records of the patients' diets and reported to the head nurse of the department the number of patients and their distribution by diet. Each duty submitted to the catering department a portioned requirement for feeding patients on dietary tables (Order 330 of 2003): Department of Internal Affairs,
ShchD, tube feeding.
Recommended standard diets are distinguished by the quantitative and qualitative composition of the main nutrients, preparation technology, average daily set of products and includes five options for standard diets.
1. main version of standard diets –OVD -includes previously used diets 9, 10, 15, 6.7.
2.ShchD – diet option with mechanical and chemical sparing - all 1st and 5th tables.
3.UBI– with an increased amount of protein.
4.NBD– low protein diet – 7a, 7b.
5.NKD– reduced calorie diet -9a, 10c.
OVD dishes are indicated for chronic gastritis in remission. Diabetes mellitus without concomitant excess body weight. Diseases of the cardiovascular system, ischemic heart disease.
A diet with a physiological content of protein, fats, carbohydrates is enriched with vitamins and minerals. Dishes are prepared boiled or baked. Proteins 85-95 gr.
ShchD - peptic ulcer of the stomach and duodenum in the acute stage, acute gastritis, acute pancreatitis, severe exacerbation of chronic pancreatitis, after infectious infections. With the exception of spicy snacks, spices, seasonings, dishes are prepared boiled, pureed or unmashed. Proteins 85-90 gr.
IAP - after gastric resection 2-4 months later for peptic ulcer in the presence of hepatitis, cholecystitis, pulmonary tuberculosis, burn disease, anemia of various etiologies. Proteins 110-120 gr.
NBD is chronic glomerolonephritis with severe and moderate impairment of nitrogen excretory function of the kidneys. Dishes with a sharp restriction of salt, steamed, in flock form. Proteins 20-60 gr.
NCD - various degrees of obesity in the absence of severe complications from the digestive system. Diabetes mellitus type 2. Cardiovascular diseases in the presence of excess weight. A diet with a moderate restriction of energy value (up to 1300-1600k/cal per day) due to fats and carbohydrates. Proteins 70-80g.
Taking into account the average energy requirement of inpatients, the recommended levels of energy consumption established by the order range from 1340 to 2680 k/cal per day.
- Informed patients and relatives about the rules of transfer and storage food products.
I introduced them to the lists of prohibited and permitted products for donation (the lists are posted in places where food donations are received) and the rules for their storage (in refrigerators for storing patients’ food in individual plastic bags indicating the patient’s full name, room and time of transfer); checked daily compliance with the rules and expiration dates (storage) of food products in refrigerators. If food products were found to be expired, showing signs of spoilage, or stored in refrigerators in violation of the established range and quantity, the products were sent to food waste.
My responsibilities also included monitoring the procedure for visiting sick relatives (required in shoe covers, on ordinary days - daily from 17.00 to 19.00; on Sundays and holidays - from 11.00 to 13.00 and from 17.00 to 19.00).
Performed therapeutic and diagnostic procedures for patients in accordance with the doctor’s prescriptions in medical records (medical histories) and cared for patients: carried out a selection of medications according to sheets of medical prescriptions, laid out medications for each patient in cassettes (bottles) and distributed them to patients. She distributed medicines in individual packages (bottles) to the seriously ill patients in their wards. I monitored patients’ medication intake 3-4 times a day: in the morning (at 7.30-8.00), before lunch (at 13.00-13.30), before dinner (at 19.00-20.00). After feeding, she distributed tablets and monitored
so that they are immediately accepted.
- I checked the expiration date.
- I checked the production time of the medicine.
- I carefully read the name and dosage.
- I checked the name and dosage with the doctor’s prescription.
- Evaluated the drug by its appearance. She gave the patient a drink in the presence of the nurse on duty.
The dispensing of medications was noted on the doctor’s prescription sheets.
Compliance with the disinfection regime in the department
I, as a ward nurse, supervised the work of the nurse in carrying out routine cleaning and disinfection of the department premises in the morning and evening, as well as when they were contaminated. The ward of the purulent surgery department, where there are patients preparing for surgery and patients who have already undergone surgery, requires impeccable sanitary and hygienic condition. This was achieved by cleaning the wards.
Routine cleaning is carried out near the patient's bed. There are daily two-time scheduled cleaning, routine and general cleaning.
within the area that was contaminated. It is required after dressings, changing drains, bed linen, etc. spring-cleaning produced weekly. It includes cleaning the wards with the treatment of the floor, ceiling and walls with disinfectant solutions (for example, 0.1% Javel Solid solution or 2% Brilliant solution). Operating, preoperative and dressing rooms are treated especially carefully. During non-working hours, the premises are sterilized by ultraviolet radiation.
- I ordered and received from my sister-hostess, and also cooked using personal protective equipment,
- Immediately after each manipulation, reusable and disposable IMD was disinfected in marked containers, and the IMD was completely immersed in a disinfectant solution using a pressing (immersion) lid.
The IMI contaminated with blood was subjected to primary cleaning, removing residual blood from the outer surface of the products using a fabric (gauze) napkin when immersed in a working disinfectant solution; thoroughly washed the channels of the products with this solution using a syringe for 2-3 minutes.
Reusable medical products were subjected to disinfection combined with pre-sterilization cleaning (PSC) in a disinfectant solution with the exposure specified in the instructions. Quality control of pre-sterilization cleaning of clinical medical devices was carried out by performing azopyram tests. The control was carried out on 1% of simultaneously processed products of the same name. The control results were recorded in a journal using form No. 366/2. After that, it was dried in a drying cabinet until the moisture completely disappeared, placed in packaging material (boxes, packaging bags, etc.) according to standard sets and, together with the accompanying document ("Requirement for sterilization of IMI"), was submitted for sterilization to the Central Specialist Center. She received sterile sets of medical products from the central medical center according to the “Requirements for sterilization of medical devices”, then delivered them to the department on a special covered trolley.
Reusable products used for manipulations without violating the integrity of the skin and mucous membranes (thermometers, cassette holders or bottles with stands for dispensing medicines, bedpans, urinals, scissors for cutting nails, lining oilcloths, basins for used dressings, lining oilcloths and etc.), subjected to disinfection and drying combined with PSO. Heat-labile products (thermometers, optical parts, etc.) were dried by wiping with a clean cloth, then placed in clean containers (jars or trays) and stored until next use. Wheels, wheelchairs, carts for transporting sterilized medical devices, medicines, linen, food, external and internal surfaces of refrigerators, rubber mats, oxygen masks, an oxygen bag horn, a rubber heating pad, an ice pack, not contaminated with blood, a stethoscope, a mattress cover made of oilcloth or polymer film was wiped with a cloth soaked in a disinfectant solution 2 times with an interval of 15 minutes. Medical gowns, caps, underwear, stained with blood and other biological fluids, were soaked in a disinfectant solution before washing (exposure according to instructions).
Immediately after generation, medical waste was disinfected in containers, immersed in a disinfectant solution using a pressing lid, placed in yellow plastic bags and handed over to a nurse in the department for delivery to containers for medical waste. Before disinfection, disposable blood transfusion systems were cut in half with scissors, the hoses were cut into fragments 15-20 cm long. Disinfection is allowed various types medical waste of the same class in one container.
After the injection, without covering the needle with a cap, I carried out separate disinfection of the used needle and syringe using a chemical disinfection method, for which I drew a disinfectant solution into the syringe using a piston. then disconnected the needle from the syringe using a needle puller. After this, the body of the syringe with the piston was placed in a container with a disinfectant and the exposure time was maintained according to the instructions for the solution. Then the disinfectant solution was released from the syringe body, after which the disinfected syringes were placed in a single-use bag with color marking corresponding to medical waste class B or C.
All health care facilities, regardless of their profile, as a result of their activities generate waste of different composition and degree of danger. All waste is divided into five classes according to the degree of its epidemiological, toxicological and radiation hazard.
Class B. hazardous (risky) waste from healthcare facilities (yellow packaging)
Class B. extremely hazardous waste from healthcare facilities (red packaging).
Class G. Health care facility waste is similar in composition to industrial waste (black packaging).
Class D. radioactive waste from healthcare facilities.
Composition of waste by hazard class in the department.
As shown in diagram No. 1, the majority of the department’s waste is class A waste - 75%, 20% is class B hazardous waste and the smallest share of class B waste is 5%.
- Participated in the examination of patients for pediculosis upon admission to the department and thereafter once a week. When pediculosis was detected in the patient, she carried out sanitary treatment with handing over the linen, bedding and slippers for decontamination. Data on examination for pediculosis and anti-pediculosis treatment were entered into medical card inpatient;
participated in identifying patients or those suspected of an infectious disease, took measures for their timely placement in the diagnostic ward of the department. I allocated individual care items to patients with suspected infectious diseases (food and drinking utensils). Conducted current (while the patient was in the diagnostic ward) and final disinfection (after transferring the patient to the infectious diseases hospital) in the ward, bathroom, pantry and other areas of the department;
when identifying patients (suspicious for the disease) with quarantine infections and contagious viral hemorrhagic fevers (CVHF), immediately informed the doctor on duty, the head of the department and acted in accordance with functional responsibilities nurse when identifying a patient (suspicious of a disease) with particularly dangerous infections.
etc.................
Everyone can, without hesitation, say who a nurse is and what role she plays in medical institution. She is the mistress of any department of the hospital. How successful the treatment outcome will be depends on her; patients see her every day and she is the one who asks questions. Few patients pay attention to the nurse's certification. However, this is a direct confirmation of her professionalism. And hardly anyone thought about what role it plays in the healing process. Meanwhile, the work of a nurse, although not always noticeable, is difficult to overestimate.
Career growth as a nurse: myth or reality?
In vain, many people think that the profession does not allow development, and it is almost impossible to achieve career advancement. Today, the attitude towards her as a specialist has changed noticeably. And even if the opportunity to take the position of head nurse of a department or chief nurse remains rather illusory, you can always confirm and strengthen your professionalism if you wish. You just need to set goals and achieve them.
For many specialists the average professional education is only a stepping stone to a more important goal. It can be a step towards becoming a doctor. Many aspiring to obtain the title of doctor use this opportunity to test their strength and confirm their decision.
Why does a doctor need a nurse?
Of course, the doctor plays first fiddle in the hospital. He examines the patient, makes decisions, makes appointments, and supervises the work of nurses. He's in charge. However, the doctor will not always be able to carry out all his appointments, and meanwhile think about what to do next. Moreover, he has to think not about one, but about several patients at once who need treatment. And when the examinations are completed and the treatment is prescribed, the nurse’s work begins. And it can last for a long time, weeks or even months. And it depends only on the nurse, on her efforts, patience, and compassion, how effective the treatment will be.
Previously, a nurse was considered only a shadow of a doctor, but today she is independent. She performs the functions of a hostess in the department, while the doctor is busy with appointments and examinations. Everyone has their own important work and responsibilities.
What education should a nurse have?
Receive today vocational education not enough to be considered a professional. The educational institution provides good basic theoretical training and general knowledge. And gaining experience begins with practice. Therefore, junior and nursing staff regularly improve their skills. Certification of nurses has long been a regular procedure that allows assessing the level of theoretical knowledge and practical skills that they acquire as a result
Advanced training for nurses
The result of such periodic monitoring is certification work It is written personally by the nurse and contains detailed information about the applicant for the qualification category. In such works, in addition to information about the completed educational institution and qualifications usually describe the essential skills that a nurse has. As well as the specifics and features of the medical institution in which she performs her duties. One of the sections of such work is the characteristics of a nurse. For certification, this is an important section, which she writes herself and is signed by the department employees.
After passing the certification, which is repeated at certain intervals, the nurse is assigned a certain category. First the second, then the first and finally the highest. And even if a nurse has the highest qualification category, this does not mean that her training is over. The category will need to be confirmed. And if for some reason a nurse does not pass certification, she will lose it. And this, in turn, will affect her pay.
Therefore, the highest category is assigned to experienced employees who confidently perform their duties. However, they, like everyone else, should closely monitor all changes in the healthcare sector and new technologies. After all, a nurse of the highest category in a medical institution is one of the most highly qualified specialists.
Certification and work experience
Certification of nurses for a category is mandatory if there is a certain length of service by specialty. So, for example, a specialist who has worked for at least 3 years can apply for the 2nd category, for the 1st category - for at least 5 years, and for the highest - for at least 8 years. In exceptional cases and with appropriate recommendations, this period may be reduced. Subsequent confirmation of the category is carried out every 5 years. It should be noted that the certification procedure for nurses is regulated by law.
Certification is voluntary
Of course, the thought of constant study may be alarming to some. And therefore, certification of nurses to the highest category is not attractive to many. However, the decision to do so is made independently and voluntarily.
But not only formally obtaining a category is the goal for many workers in white coats. Such advanced training allows you to get an increase in wages, which is a completely different argument. This is a significant motivation for constant self-improvement and certification.
The procedure for certification of nursing staff
After the advanced training course has been completed, the nurse prepares a package of documents in certification commission, and then takes the final exam. To successfully pass such an exam, theoretical knowledge is not enough. Attention is also paid to regulations and legal acts that regulate the activities of nursing staff.
The package of documents for the commission includes a statement established for the last year and a nurse certification report must be signed by the head of the medical institution. After all, it contains a list of performed manipulations and lists specific skills. Patients can also provide a reference for a nurse. This will be a significant addition to her certification as a specialist. After all, many grateful patients for a long time remember your kind attitude and will gladly provide all the necessary feedback.
Certification work for nurses is written in accordance with the specialization of the medical institution in which they work. After all, the specifics, for example, of the surgical and physiotherapy departments are completely different. And different skills are required. Therefore, such work must contain a detailed description of all procedures and manipulations that the nurse knows. The execution technique, equipment and devices used in the work must be described in detail.
Nurse: profession or vocation?
In addition to mastering the basic manipulations that a nurse is required to perform, she must be able to assist a doctor when he provides first aid to a patient. A qualified nurse of mercy, having the highest category and rich, will be able to predict in advance what a doctor may need in a certain situation. She will not question or argue. She knows how to work correctly and effectively to help the patient overcome the disease.
Today, scientific and technological progress greatly facilitates the work of nurses. Various electronic equipment gives a timely signal when the attention of a health care worker is required, records the patient's vital signs and helps to perform a lot of different daily work. And in order to keep up with the development of medicine, certification work is needed.
nurses every year it becomes more and more. Today this specialty is as popular as, say, being an accountant. Anyone who has decided to devote himself to nursing the sick is aware of the importance and necessity of the profession. Doing such work should not only be an obligation or duty. Only one who is able to sympathize, empathize, help and support can become a real nurse. It’s not for nothing that they were previously called sisters of mercy.
Increasing popularity of the profession
The status of nursing staff in medical institutions is steadily increasing. This is precisely why certification work is carried out. Nurses, yesterday's graduates, who set themselves high goals, is getting bigger. And this indicates the growing popularity of the profession among young people.
Thus, constant professional development allows the nurse not only to confirm the status of a professional, but also satisfies her need for self-realization. And even though the patient often does not care what category the nurse has. At the moment when he needs help, she is the only one who is always there. Precisely because the nurse has long been considered a sister of mercy.
Medical unit of the Central Internal Affairs Directorate for the Chelyabinsk region
CERTIFICATION WORK
for 2009 ward nurse of the 1st therapeutic department of the hospital No. 1 Maria Fedorovna Makeeva for confirmation of the highest qualification category in the specialty “Nursing”
Chelyabinsk 2010
Professional route
Characteristics of the institution
Characteristics of the department, workplace
Main sections of work
Related professions
Emergency conditions
Sanitary and epidemiological regime in the workplace
Hygienic education of the population
Analysis of work for the reporting period
Professional route
I, Maria Fedorovna Makeeva, graduated from the Zlatoust Medical School of the Ministry of Railways in 1973 with a degree in Nursing - diploma No. 778717 dated June 29, 1973, registration No. 736. By distribution she was sent to the Second Road Clinical Hospital of Chelyabinsk South Ural Railway. Admitted by a nurse to the 3rd surgical department (oncology). Based on the principle of interchangeability, I mastered the work of a nurse in the treatment room and dressing room. In 1977, she was dismissed at her own request.
She was enrolled in the Hospital with a polyclinic of the Medical Department of the Internal Affairs Directorate of the Chelyabinsk Regional Executive Committee as a nurse in the therapeutic department in 1977.
In 1984, she was called up for military service in military unit No. 7438 as a company medical instructor. At the end of the contract in 1988, she was dismissed from the Soviet Army.
In 1988, she was hired as a nurse in the neurological department of the Hospital with a polyclinic of the Medical Department of the Chelyabinsk Regional Executive Committee. In 1990, she underwent certification at the medical department of the Internal Affairs Directorate of the Chelyabinsk Regional Executive Committee and by order of the medical department of the Internal Affairs Directorate of the Chelyabinsk Regional Executive Committee was awarded the first qualification category, certificate No. 53 dated June 21, 1990.
In August 1993, she was appointed to the position of senior nurse in the therapeutic department. On June 20, 1995, the certification commission at the medical subdepartment of the Internal Affairs Directorate of the Chelyabinsk Region and the order of the medical subdepartment dated June 22, 1995 No. 34 awarded the highest qualification category of a hospital nurse. In 2000, at the Chelyabinsk Regional Basic School for Advanced Training of Workers with Secondary Medical and Pharmaceutical Education, she attended a series of lectures on the program “Modern Aspects of Management and Economics of Health Care” - certificate No. 4876 dated November 24, 2000, protocol No. 49 - awarded the highest qualification category in the specialty "Nursing" In February 2003 at her own request she was transferred to the position of ward nurse of the therapeutic department. In 2005 improved her qualifications at the State Educational Institution of Additional Professional Education "Chelyabinsk Regional Center for Additional Professional Education of Health Care Specialists" in the cycle of improvement "Nursing in Therapy" - certificate No. 2690/05 dated October 18, 2005. No. 373l.
In 2010 improved her qualifications at the State Educational Institution of Higher Professional Education "Chelyabinsk State Medical Academy of Roszdrav" in the cycle of improvement "Nursing in Therapy" - certificate registration number 1946/122 dated 02/20/2010.
Work experience in a healthcare institution for 33 years.
Work experience in nursing for 37 years.
Characteristics of the institution
The medical and sanitary unit of the Central Internal Affairs Directorate for the Chelyabinsk Region was organized with the aim of providing medical, preventive and diagnostic assistance to employees working in the Ministry of Internal Affairs system, in accordance with Order No. 895 of November 8, 2006. “On approval of the regulations on the organization of medical care and sanitary-resort treatment in medical institutions of the Ministry of Internal Affairs of Russia.” The medical and sanitary unit is located in a typical five-story building, three floors of which are occupied by a clinic and two floors by a hospital. The clinic is designed for 650 visits per day, where medical care is provided by local therapists and specialized specialists: ophthalmologist, dermatologist, urologist, gynecologist, gynecologist, ENT, cardiologist, psychiatrist, surgeon, neurologist.
To conduct diagnostic examinations, the following services have been created in the clinic:
X-ray - conducts X-ray and fluoroscopic examinations of the chest, gastrointestinal tract, musculoskeletal system, skull, intravenous urography, irrigoscopy, fluorographic examinations.
Department of Functional Diagnostics - performs the following scope of examinations: ECG, HM-BP, HM-ECG, ECHO-cardiography, bicycle ergometry, transesophageal electrical stimulation, neurophysiology: EEG, REG; Ultrasound diagnostics of abdominal organs, organs pelvis, thyroid gland, mammary glands, lumbar spine, Doppler ultrasound of blood vessels; The endoscopic room performs FGDS of the stomach.
Laboratory department - conducts a full range of clinical, biochemical and bacteriological studies of blood, urine, feces, sputum and other biological media. All laboratories are equipped with appropriate equipment, including modern analyzers and reagents.
Physiotherapeutic department - provides treatment with high-frequency currents, inductotherapy, magnetic therapy, UHF, laser therapy, ultraviolet radiation. The department has a massage room, a physical therapy room, an inhalation room, and a massage shower.
Dental service.
Characteristics of the unit
The inpatient unit of the Medical and Sanitary Unit is located on the 4th and 5th floors of the building, designed for 100 beds: 40 beds in the neurological department and 60 beds in the therapeutic department.
Bed capacity of the therapeutic department:
Table No. 1
Therapeutic department staff
In the therapeutic department of the hospital there is the office of the head of the department, the office of the chief nurse of the Medical and Sanitary Unit, a treatment room, a resident's room, a manipulation room where patients are prepared for diagnostic examinations, shower rooms for patients and medical staff, men's and women's toilets, and a staff toilet. For patients' relaxation there is a lounge with upholstered furniture and a TV. The department has two medical posts with the necessary equipment: work tables with a set of documentation: job descriptions of the ward nurse, an algorithm for carrying out medical prescriptions, work logs; medical cabinet for storing medicines in accordance with standard requirements, cabinet for storing medical supplies, cabinet for storing disinfectants and containers for disinfection. The treatment room consists of two blocks: the first - for carrying out subcutaneous, intramuscular, intradermal and intravenous injections and blood sampling for biochemical and bacteriological analysis; the second is for infusion therapy. There are also cabinets for medicines, a refrigerator for storing thermolabile drugs (vitamins, hormones, chondroprotectors, insulins), a cabinet for storing sterile solutions, a bactericidal irradiator, containers for disinfecting disposable medical supplies that are subject to disposal (syringes, systems for infusion of infusion solutions ), couches, cleaning equipment. In the treatment room there are syndromic emergency kits and an Anti-AIDS first aid kit.
Main sections of work
In my work, as a ward nurse, I rely on regulatory documentation, orders of the Ministry of Health of the Russian Federation, resolutions of the Ministry of Health of the Russian Federation, Sanitary Regulations. I try to conscientiously and efficiently fulfill my job descriptions, which include:
Caring for and monitoring patients.
Timely and high-quality implementation of medical prescriptions.
Thermometry of patients with subsequent notes in the medical history.
Hemodynamic monitoring: blood pressure, heart rate, respiratory rate.
Compliance with the sanitary and epidemiological regime in the department, wards, and department premises.
Collecting material for laboratory tests (preparing directions, glassware, talking with patients about the purposes of the study, the correct preparation and technique for collecting tests).
Compliance with the medical and protective regime in the department.
Familiarization of newly admitted patients with internal regulations.
Preparing patients for X-ray, endoscopic and ultrasound examinations.
Maintaining documentation at the nursing station:
Log of patient movement in the department,
Journal of one-time medical prescriptions,
Journal of consultations of narrow specialists,
Log of diagnostic examination appointments,
Register of medicines subject to subject-quantitative accounting,
Shift delivery log,
Drawing up portion requirements according to the diet prescribed by the doctor, in accordance with the order of the Ministry of Health of the RSFSR No. 330 of 08/5/2003. “On measures to improve therapeutic nutrition in healthcare facilities of the Russian Federation.”
Obtaining the required amount of medications from the head nurse of the department. All medications are placed in groups in locked cabinets. All medicines must be in the original industrial packaging, with the label facing outwards and have instructions for use of this drug, according to the orders:
Order No. 377 of November 13, 1996 “On approval of requirements for organizing the storage of various groups of medicines and medical products.”
Order of the Ministry of Health of the RSFSR dated September 17, 1976. No. 471 “Memo for medical workers on the storage of medications in the departments of medical institutions.”
According to the order of the USSR Ministry of Health No. 747 dated June 2, 1987. “On approval of instructions for recording medicines, dressings and medical products in health care facilities” and the Ministry of Health of the Chelyabinsk region letter dated June 4, 2008. No. 01/4183 “On the organization of accounting of medicines and medical supplies”, strict accounting of medicines subject to subject-quantitative accounting is maintained.
Distribution of medicines. Carry out in accordance with the patient's prescription sheet, which indicates the name of the drug, its dosage, frequency and mode of administration. All appointments are signed by a doctor indicating the date of appointment and cancellation. At the end of treatment, the appointment sheet is pasted into the patient’s medical history. I distribute medications in strict accordance with the time of appointment and adherence to the regimen (during food Time, before or after meals, at night). The patient must take medications only in my presence. I distribute medicines to bedridden patients in the ward. Be sure to warn patients about possible side effects medicine, body reactions to taking the drug (change in color of urine, feces) containing iron, carbolene, bismuth. Narcotic drugs, psychotropic and potent drugs of list “A” are given to the patient separately from other medications in the presence of a nurse. To avoid mistakes, before opening the package and ampoule, you must read aloud the name of the drug, its dosage and check it with the doctor’s prescription.
Examination for pediculosis. Order of the Ministry of Health of the Russian Federation No. 342 dated November 26, 1998. “On strengthening measures to prevent epidemic typhus and combat lice.”
If the first signs of an infectious disease are detected in a patient, I immediately inform the attending physician, isolate the patient and carry out ongoing disinfection in accordance with San PiN 2.1.3.263010 dated 08/09/2010. “Sanitary and epidemiological requirements for organizations engaged in medical activities”
Transfer of the shift according to the instructions of the ward nurse: the number of patients on the list indicating the ward, case history number, diet; medical supplies: thermometers, heating pads, beakers; devices: nebulizer, glucometer, tonometer; medical preparations. If there are seriously ill patients in the department, shift retakes are carried out at the patient’s bedside.
Related professions
During her work, she mastered such related professions as a nurse in a therapeutic department, a neurological department, an emergency room and a treatment room. I am proficient in the technique of collecting material for research:
Clinical (blood, urine, sputum, feces),
Biochemical (blood),
Bacteriological (blood, sputum, urine, feces, nasal and throat swabs).
I know the technique of applying aseptic dressings, warming compresses, using an ice pack, catheterizing the bladder with a soft catheter, performing cleansing, hypertonic, oil and therapeutic enemas. I am proficient in the technique of taking an electrocardiogram using a portable electrocardiograph EK1T - 07. I am also proficient in the technique of chest compressions and artificial lung ventilation. She mastered the technique of blood transfusion and blood substitutes, conducting infusion therapy and administering injections: subcutaneous, intradermal, intramuscular and intravenous.
Emergency conditions
Diseases of the cardiovascular system and respiratory organs can be complicated by acute severe conditions:
Anaphylactic shock,
Acute myocardial infarction,
Hypertensive crisis,
Asthmatic status,
Pulmonary edema.
To provide emergency medical care, the treatment room has syndromic sets of medications and a nurse’s action algorithm. All kits are checked in a timely manner and replenished with the necessary drugs.
The technology for providing first aid in emergency conditions is as follows:
Anaphylactic shock
1. Information to suspect anaphylactic shock:
During or immediately after the administration of the drug, serum, or insect bite, weakness, dizziness, difficulty breathing, a feeling of shortness of breath, anxiety, a feeling of heat throughout the body appeared,
The skin is pale, cold, moist, breathing is frequent, shallow, systolic pressure is 90 mmHg. and below. In severe cases, depression of consciousness and breathing.
2. Nurse tactics:
3. Prepare equipment and tools:
Intravenous infusion system, syringes, needles for intramuscular and subcutaneous injections, ventilator, intubation kit, Ambu bag.
Standard set of drugs “Anaphylactic shock”.
4. Assessment of what has been achieved: restoration of consciousness, stabilization of blood pressure and heart rate.
Myocardial infarction (typical pain form)
1. Information to suspect an emergency condition:
Severe chest pain, often radiating to the left (right) shoulder, forearm, shoulder blades or neck, lower jaw, epigastric region.
Possible suffocation, shortness of breath, heart rhythm disturbances.
Taking nitroglycerin does not relieve pain.
Nurse tactics:
3. Prepare equipment and tools:
As prescribed by a doctor: fentanyl, droperidol, promedol.
System for intravenous administration, tourniquet.
Electrocardiograph, defibrillator, cardiac monitor, Ambu bag.
4. Assessment of what has been achieved: the patient’s condition has not worsened.
Bronchial asthma
1.Information: the patient suffers from bronchial asthma
Choking, shortness of breath, difficulty in exhaling, dry wheezing, audible at a distance, participation of auxiliary muscles in breathing.
Forced position - sitting or standing with support on your hands.
2. Nurse tactics:
3. Prepare equipment and instruments: intravenous system, syringes, tourniquet, Ambu bag.
4. Assessment of what has been achieved: reduction of shortness of breath, sputum discharge, reduction of wheezing in the lungs.
Sanitary and epidemic regime
In my work to implement the sanitary and epidemiological regime in the department, I am guided by the following orders:
Order No. 288 of the USSR Ministry of Health dated March 23, 1976. “On approval of instructions on the sanitary and anti-epidemic regime of hospitals and on the procedure for the implementation by bodies and institutions of the sanitary and epidemiological service of state supervision over the sanitary condition of health care facilities.”
Order No. 720 of July 31, 1978 Ministry of Health of the USSR “On improving medical care for patients with purulent surgical diseases and improving measures to combat nosocomial infections.”
Law of the Russian Federation No. 52 of March 30, 1997 “On the sanitary and epidemiological well-being of the population.”
OST 42-21-2-85 “Sterilization and disinfection of medical products.”
Order No. 342 of November 26, 1998 Ministry of Health of the Russian Federation “On strengthening measures to prevent epidemic typhus and combat lice.”
SaN PiN 2.1.7.728-99 dated January 22, 1992. “Rules for the collection, storage and disposal of waste from medical institutions.”
SaN PiN 1.1.1058-01 “Organization and conduct of production control over compliance with sanitary rules and implementation of sanitary and anti-epidemic (preventive) measures.”
SaN PiN 3.5.1378-03 “Sanitary and epidemiological requirements for the organization and implementation of disinfection activities.”
Order No. 408 of July 12, 1983 Ministry of Health of the USSR “On measures to reduce the incidence of viral hepatitis in the country.”
SaN PiN 2.1.3.2630-10 “Sanitary and epidemiological requirements for organizations engaged in medical activities.”
After performing the manipulations, all instruments must be processed. Single-use medical supplies are subject to disinfection and disposal, reusable items are subject to processing in 3 stages: disinfection, pre-sterilization cleaning and sterilization in accordance with OST 42.21.2.85. To use disinfectants in the department you must have the following document:
License,
Certificate of state registration,
Certificate,
Methodical instructions.
When disinfecting instruments and treating work surfaces, we use an oxygen-containing 30% solution of Peroximed, which is also used for pre-sterilization cleaning, state registration certificate No. 002704 dated January 18, 1996. When carrying out repeated bacteriological examinations of the treatment room (tank, air culture and washings from working surfaces), we received a negative result, so the disinfection work is based on the use of this disinfectant. Since the microflora has become more stable in the external environment, it is recommended to replace the disinfectant every 6 months. For this purpose, disinfectants such as Clorcept and Javelin are used.
Table No. 2
Disinfection modes
At the workplace, we use a 3% Peroximed solution to disinfect medical products (thermometers, beakers, spatulas, tips). All containers are clearly labeled indicating the disinfectant, its concentration and the date of preparation. I prepare solutions, guided by methodological instructions, using personal protective equipment. To treat hands when performing various manipulations in the department, antiseptics are used - Cutasept and Lizhen.
Infection safety of medical workers
Infection safety is a system of measures that ensures the protection of health workers from infectious diseases, which includes immunization, the use of protective clothing, compliance with instructions and rules when performing procedures, compliance with the rules of personal prevention, an annual medical examination in accordance with Order No. 90 of the Ministry of Health of the Russian Federation dated March 14, 1996. “On the procedure for conducting preliminary and periodic examinations of medical workers and medical regulations and permission to work.” In the context of the increasing spread of HIV infection among the population, all patients must be considered as potentially infected with HIV and other infections transmitted by blood contact, therefore, when working with blood and other biological fluids, 7 safety rules must be observed:
Wash your hands before and after contact with the patient.
Consider the patient's blood and other biological fluids as potentially infectious, so it is necessary to work with gloves.
Immediately after use and disinfection, place used instruments in special yellow bags - class “B” waste. SaN PiN 2.1.7.728-99 “Rules for the collection, storage and disposal of waste in health care facilities.”
Use eye protection (goggles, face shield) and masks to avoid contact of blood and other biological fluids with skin and mucous membranes of medical personnel.
Consider all linen contaminated with blood as potentially infected.
Use special waterproof clothing to protect the body from drops of blood and other body fluids.
Treat all laboratory samples as potentially infectious material.
In order to prevent infection with HIV infection and viral hepatitis, I am guided by the rules of infection safety recommended in the orders:
Order of the Ministry of Health of the Russian Federation No. 170 dated August 16, 1994. “On measures to improve the prevention and treatment of HIV infection in the Russian Federation.”
Order of the Ministry of Health of the Russian Federation No. 408 dated July 12, 1989. “On measures to reduce the incidence of viral hepatitis in the country.”
Order of the Ministry of Health of the Russian Federation No. 254 dated September 3, 1991. “On the development of disinfection in the country”
Order of the Ministry of Health of the Russian Federation No. 295 of October 30, 1995 “On the implementation of the rules for compulsory medical examination for HIV and the list of workers in certain professions, industries, enterprises, institutions and organizations who undergo compulsory medical examination for HIV.”
Instructional and methodological instructions of the Ministry of Health of the Russian Federation “Organization of activities for the prevention and control of AIDS in the RSFSR” dated 08/22/1990.
SaN PiN 3.1.958-00 “Prevention of viral hepatitis. General requirements for epidemiological surveillance of viral hepatitis."
If biological fluid comes into contact with exposed skin, you must:
Treat with 70% alcohol
Wash your hands with soap and water
Re-treat with 70% alcohol
If it comes into contact with the mucous membrane of the eyes, it should be:
treat (rinse copiously) with a 0.01% solution of potassium permanganate.
In case of contact with the nasal mucosa:
rinse with 0.05% solution of potassium permanganate or 70% alcohol.
For cuts and punctures you must:
Wash gloved hands with running water and soap
Remove gloves
Put a clean glove on the uninjured hand
Squeeze blood out of the wound
Wash your hands with soap
Treat the wound with a 5% iodine solution. Don't rub!
Table No. 3
Composition of the Anti-AIDS first aid kit
The Anti-AIDS first aid kit is located in the treatment room and is always available. Expired medications are promptly replaced. The algorithm for the action of a health worker in emergency situations during procedures is also located in the treatment room. Emergency situations, as well as preventive measures taken, are subject to registration in the journal “Emergencies for contamination with biological fluids.” In cases of contamination, the head of the department should be notified and immediately contact the AIDS Prevention and Control Center at Cherkasskaya, 2. There were no emergency situations during the reporting period.
Processing of medical instruments
Processing of medical instruments is carried out in 3 stages:
Processing stages
disinfection pre-sterilization sterilization
treatment
Disinfection– a set of measures aimed at destroying pathogenic and conditionally pathogenic microorganisms in the external environment in order to interrupt the transmission routes of infectious disease agents.
Disinfection methods
physical chemical
drying, exposure to high levels of disinfectants
temperatures, exposure to steam
With the chemical method of disinfection, disassembled used instruments are completely immersed in a disinfectant using a drowner for 60 minutes.
Pre-sterilization cleaning – This is the removal of protein, fat, medicinal contaminants and disinfectant residues from medical products.
Manual method of pre-sterilization treatment:
Stage 1 – rinsing the instrument under running water for 30 seconds.
Stage 2 – complete immersion of products in a 0.5% washing solution for 15 minutes. at a temperature of 50*
components of the cleaning solution:
Hydrogen peroxide
Synthetic detergent (Progress, Lotus, Aina, Astra)
Table No. 4
The ratio of components in the cleaning solution
The washing solution can be used during the day and heated up to 6 times if the solution has not changed color.
Stage 3 – wash each instrument in the same solution for 30 seconds.
Stage 4 – rinsing with running water for 5 minutes.
Stage 5 – rinsing each instrument in distilled water for 30 seconds.
Quality control of pre-sterilization treatment is carried out in accordance with the order of the Ministry of Health of the Russian Federation No. 254 dated 09/03/1991. “On the development of disinfection in the country.” 1% of the total number of instruments, but not less than 3-5 products of the same name, are subject to control.
Azopyram test – detects traces of blood and chlorine-containing oxidizing agents. A working solution consisting of equal proportions of azopyram and 3% hydrogen peroxide solution is applied to the instrument and the result is assessed after a minute. The appearance of a purple color indicates the presence of blood residues on the instrument.
Phenolphthaley test – allows detection of detergent residues. A 1% alcohol solution of phenolphthalein is evenly applied to the product. If a pink color appears, it means there are detergent residues on the product. In this case, the entire tool is reprocessed. If the test result is negative, the processed material must be sterilized. Pre-sterilization treatment of medical instruments is not carried out in our department, because... We work with disposable medical supplies, which are subject to disinfection and disposal in accordance with SaN PiN 3.1.2313-08 dated January 15, 2008. “Requirements for the disinfection, destruction and disposal of single-use injection syringes.”
Sterilization – This is a method that ensures the death of all vegetative and spore forms of pathogenic and non-pathogenic microorganisms.
All instruments in contact with the wound surface, in contact with blood or injectable drugs, as well as diagnostic equipment in contact with the patient’s mucous membrane are subject to sterilization.
Table No. 5
Sterilization methods
Sterilization control:
Visual – monitoring the operation of the equipment;
Thermal time indicators of sterility.
Temperature control using technical thermometers.
Biological - using biotests.
The chemical method of sterilization is the use of chemicals to prevent infectious diseases during endoscopic procedures. To sterilize endoscopes, use Lysofarmin 3000 8% solution at a temperature of 40*, exposure time is 60 minutes, then washed twice with sterile water, dried with a sterile napkin, and the channels are purged. Store endoscopes in a sterile napkin. To sterilize metal products (burs) and plastic (enema tips), use hydrogen peroxide 6%
At a temperature of 18* - 360 min.,
At a temperature of 50* - 180 min.
Then rinse twice with sterile water and store in a sterile container lined with a sterile sheet.
Hygienic education of the population
Hygienic education of the population is one of the forms of disease prevention. A healthy lifestyle: giving up bad habits and playing sports improves health, which allows you to avoid diseases of the respiratory system, cardiovascular system, and musculoskeletal system. Compliance with work, rest and nutrition regimens reduces the risk of exacerbation of gastrointestinal diseases. Compliance with and implementation of personal hygiene rules prevents infection with infections such as HIV, hepatitis B, C. I carry out work on hygienic education among patients during duty in the form of conversations.
Table No. 6
Topics of conversation
Analysis of work for the reporting period
Table No. 7
Indicators of preparing patients for x-ray examinations:
Table No. 8
Conclusions: in the structure of manipulations, the number of injections IM, SC, IV drip infusions increased due to an increase in bed turnover. The number of diagnostic examinations has increased, which makes it possible to identify the disease at an early stage.
Every month the department conducts classes on the following topics:
"Nurse tactics in emergency conditions"
"HIV infection",
“Sanitary and epidemiological regime in the department.”
Tests are held 2 times a year:
Accounting and storage of narcotic drugs,
Sanitary and epidemiological regime according to orders of the Ministry of Health of the Russian Federation No. 288, No. 408, No. 720, No. 338, OST 42-21-2-85,
First aid for emergency conditions (in the form of testing).
To improve my professional level, I regularly attend nursing conferences, lectures, classes on civil defense, general education, which are held in the Medical and Sanitary Unit. I apply all the acquired knowledge in practice in my work.
conclusions
The peculiarities of the work of a medical worker place high demands not only on theoretical knowledge and professional skills, but also on the moral and ethical character of a nurse, the ability to behave with dignity in a team, to be merciful with patients and polite with their relatives.
Professional knowledge and strict compliance with the orders of the Ministry of Health of the Russian Federation on compliance with the sanitary and epidemiological regime, aseptic rules and manipulation techniques helps prevent the occurrence of post-injection complications and nosocomial infections. Over the past period, there were no such cases in the department.
During the reporting period, I mastered the following techniques: determining the level of glucose in the blood with a ONE TOUCH VITRA glucometer, performing inhalations through the OMRON CX nebulizer, using a breathalyzer to determine the level of alcohol in the blood.
Knowledge of related professions and the principle of interchangeability of employees ensures a continuous treatment process.
Tasks
Improving professional level.
Confirm the highest qualification category.
Attend advanced training courses and study new medical literature.
Take part in conducting classes in the department and hospital conferences.
Train new employees in the specifics of working in the department.
