A ward nurse is a specialist with a secondary medical education who must take care of patients, record data about their condition in a special journal and perform a number of other duties, which will be discussed in this article.
What is job description
A job description is a document that spells out the basic duties and rights of an employee. Job descriptions can be standard or they are developed in a specific institution, depending on the specifics of its work.
The employee is obliged to familiarize himself with the job description when applying for a job and sign the magazine, thereby ensuring that he has studied the document and agrees with the requirements presented in it.
If the employee's actions do not comply with the job description, he may receive a reprimand, lose his bonus or be fired.
IMPORTANT! If the procedure nurse is absent for some reason, the ward nurse takes over her functions. Therefore, she must be fluent in the techniques of medical manipulation: be able to place intravenous catheters, do all types of injections, etc.
General Provisions
A ward nurse works in all departments of hospitals (psychiatric, gynecological, gastroenterological, cardiological, etc.), in sanatoriums and in other medical and preventive institutions. The duties of a nurse of the ward are as follows:
- to care for the sick and monitor their condition;
- fulfill the appointments made by the doctor and make entries about this in the relevant documents;
- supervise junior medical personnel (for example, demanding timely cleaning, changing bed linen, washing weakened patients, etc.);
- to ensure that the order is observed at the department, for example, to prevent violations of the regime by both patients and visiting relatives;
- during work, to be constantly with patients, leaving only in order to take the necessary drugs or make notes;
- accompany the doctor during the round and report on the patient's condition and its changes;
- to acquaint patients entering the department with the internal regulations;
- examine patients once a week to detect head lice;
- if the patient's condition worsens, immediately notify his attending physician (or, in his absence, the doctor on duty);
- monitor compliance with the schedule for quartzing the chambers and the cleanliness and order in them;
- report violations by the junior medical staff to the head nurse or the head of the department.
Job responsibilities
The ward nurse has the following responsibilities:
- monitors patients, while observing the norms of medical ethics;
- when receiving patients, places them in wards;
- in children's hospitals, the nurse must ensure that the parents of the children comply with the sanitary and epidemiological regime;
- checks transfers from relatives in order to prevent patients from getting products that could harm their health;
- makes reports to the attending physician or doctor on duty about the condition of patients;
- organizes examination of patients in diagnostic rooms;
- is engaged in the isolation of patients who are in a terminal state. If necessary, call the resuscitation team;
- prepares the bodies of the deceased for transportation to the appropriate department;
- makes sure that the premises assigned to it have the equipment necessary for work;
- monitors the cleanliness in the wards assigned to it, as well as the hygiene of patients, the timely change of underwear and bed linen;
- collects and disposes of medical waste in accordance with the hazard class;
- monitors the correct processing of medical devices in order to prevent infectious diseases (HIV, hepatitis, etc.).
The rights
A ward nurse has the following rights:
- to provide first aid to the patient before the arrival of the doctor. In some cases, the lives of patients depend on the qualifications of the nurse and her knowledge of basic resuscitation techniques;
- to supervise the work of junior medical personnel;
- to receive information about the patient's health. This allows not only to provide proper care, but also to protect against infection in the event that the patient has infectious diseases;
- to receive information about changes in orders related to her work;
- for the issue of overalls and personal protective equipment;
- help from management in the performance of their functional duties.
Also, a nurse has the right to demand that the management create conditions for the quality performance of her professional duties.
IMPORTANT!The ward nurse often interacts with the patients' relatives. She can give advice on caring for the patient or his diet, list the therapeutic and diagnostic measures that were carried out with the patient. However, only the attending physician can report a person's health status.
Responsibility
The duties of a ward nurse include a section on her responsibilities. The nurse is responsible for:
- for failure to properly fulfill their duties prescribed in the job description;
- for compliance with the sanitary and epidemiological regime and fire safety rules in the chambers entrusted to her;
- for causing material damage to the employer;
- for the safety and proper storage conditions of medicinal products (including narcotic and potent) and medical products;
- for the timely assistance to the patients of the department.
Qualification requirements
A specialist with secondary medical education in the specialties "Nursing" and "General Medicine" can become a ward nurse. Some institutions require nursing experience in the relevant position.
Each department has its own specifics, therefore, nurses may be required to receive certificates of completion of additional training courses.
Necessary psychological qualities
The ward nurse is more likely than other professionals to be in contact with patients. The psychological mood of a sick person depends on her participation, sympathy and attentiveness. The ward nurse should be able to prepare the patient for the upcoming unpleasant manipulations, to cheer up if the condition does not improve or the treatment does not bring results.
To become a ward nurse, you need to have not only an interest in medicine, but also the ability to empathy, kindness, the ability to understand a person and well-developed communication skills. Patients who are exhausted by illness and tired of prolonged hospitalization may be irritable and even aggressive. The physician must be able to listen to the suffering person, to cheer him up, to explain the need for painful manipulations.
The functional duties of a nurse in the internal medicine department involve the implementation of a number of medical interventions. Some manipulations (enemas, bladder catheterization) may affect the patient's feeling of bash. In order to gain respect and win over patients, a nurse must always be aware of patients' dignity and respect their right to privacy.
The ward nurse must be ready not only for gratitude, but also for the fact that patients will take out the accumulated resentment on her, so she must have a high level of emotional stability. Otherwise, she will experience a quick emotional burnout.
IMPORTANT! The ward nurse should be very observant. She should notice any changes in the condition of patients: sometimes symptoms that are insignificant at first glance are harbingers of the development of life-threatening conditions. For example, restlessness and the urge to sit up may indicate the development of pulmonary edema.
Persons who have received a higher medical education in the specialty "Nursing" or secondary medical education, a diploma in the specialties "Nursing", "General Medicine", "Obstetrics" are admitted to professional activities as a nurse in the ward department of newborns; certificate in the specialty "Nursing in Pediatrics";
Appointment and dismissal of a ward nurse is carried out by the head physician on the proposal of the head of the department, the head nurse of the department and in agreement with the chief midwife of the maternity hospital and the head nurse of the hospital; - the ward nurse is directly subordinate to the attending neonatologist and the senior nurse of the department;
The ward nurse is directly subordinate to the ward nurse;
A ward nurse in her activities is guided by the position, qualification characteristics of specialists with secondary medical and pharmaceutical education in the specialty "Nursing in Pediatrics", this instruction, hourly work schedule, standards for the organization and performance of work by ward nurses of newborn departments, legislative and regulatory documents Of the Russian Federation on public health issues;) also by orders and instructions of higher authorities and officials.
11.1 Responsibilities
Organization of work in accordance with this instruction, hourly work schedule, standards for the organization and performance of work by ward nurses of the newborn department;
Carrying out professional activities in accordance with the ethical code of a nurse in Russia;
Strict adherence to the schedule of interaction with colleagues and employees of the departments of the maternity hospital (physiological, observation, CSO), treatment and diagnostic departments of the hospital (MGK, physio, laboratory departments) in the interests of the newborn;
Organization of the workplace according to the standard;
Compliance with the rules of internal labor regulations, labor discipline requirements, medical and protective regime, ethics and deontology standards when communicating with staff and women in childbirth;
Compliance with the requirements of labor protection, safety, industrial sanitation, labor hygiene, fire safety during the operation of premises and equipment;
Compliance with the requirements for the labeling of medical supplies;
Clear and timely maintenance of medical records in accordance with the nomenclature of cases and the requirements of the standard. Analysis of their activities;
Clear and timely registration of forms and directions for medical and diagnostic studies;
Keeping records of performed procedures, manipulations per day, month, quarter, half year, year. Analysis of identified complications, timely submission of a report;
Timely and high-quality gluing of research results into the history of the development of the newborn;
Control over the work of the ward nurse and the performance of her job duties, the volume and quality of the work performed;
Economical, rational use and safety of material values \u200b\u200band resources.
Leaving the department with the obligatory notification of the senior nurse of the department or the neonatologist on duty, without leaving the front door on the side of the passenger elevators unlocked. Non-admission of unauthorized persons to the department;
Reception and delivery of duty at the cribs of newborns, reconciliation of passport data with the bracelets of the newborn; workplace, checking the availability of care items, medical tools, medicines to an unspecified list;
Timely preparation of newborns and wards for bypassing the attending neonatologist;
Perfect knowledge of the methods of carrying out preventive, therapeutic, diagnostic, sanitary and hygienic procedures and manipulations prescribed by a doctor;
Planning and implementing neonatal nursing care prioritized by need. Teaching new mothers to care for healthy and sick children, feeding and nursing mothers. Providing newborns with individual care items;
Assistance to a neonatologist during examination of newborns and surgical excision of the umbilical remains;
Reception of newborns at the midwife of the delivery room, assessing the general condition, the state of the umbilical stump and checking the data of the bracelets with the passport data. Control over the conduct of the primary toilet of the newborn in the delivery room;
Monitoring the condition of newborns with the registration of any change, making decisions in accordance with the level of their competence and authority.
Implementation of timely sampling from the development histories of prescriptions of a neonatologist and high-quality implementation of recommendations and prescriptions;
High-quality and timely preparation of newborns for laboratory, instrumental research methods and collection of material from newborns for laboratory examination;
Strict adherence to algorithms for performing all types of manipulations and procedures;
Participation in nursing, preparation for feeding and feeding newborns and wards of joint
stay "Mother and Child" and in the department;
Transportation of newborns for feeding and monitoring the feeding of the puerperas, assistance in attaching children to the mammary gland and teaching the rules of feeding;
Control over the quality and conformity of the transmissions brought to the puerperas to the permitted range;
Preparing newborns for discharge or transfer to the second stage of nursing. Discharge of the newborn in the discharge room with obligatory reconciliation of passport data. Strict adherence to the rules for the flow of discharge depending on the department (physiological, observation);
Timely message to the attending physician and the head of the department, and in their absence, to the neonatologist on duty:
· About the deterioration of the condition of the newborn;
· Complications resulting from medical procedures;
· About cases of emergency in the department;
Ensuring the availability and staffing of the first aid kit for the provision of emergency care, according to the standards;
Providing first aid to newborns in case of emergencies and complications of diseases in newborns;
Ensuring infectious and environmental safety for newborns in the maternity hospital (compliance with the rules of sanitary and hygienic and sanitary and epidemiological regimes);
Carrying out a set of measures for the prevention of nosocomial and especially dangerous infections;
Carrying out a set of measures to prevent post-injection complications, serum hepatitis and HIV infection;
Strict adherence to the rules of personal hygiene, uniforms;
Regular and timely medical examination, examination for RW, HbsAg, HIV infection, pathogenic staphylococcus carriage according to epidemiological indications;
Strict adherence to safety precautions when working with biological fluids;
Control of the sterility of the material and instrumentation obtained, compliance with the shelf life of sterile products. Sterilization of breathing apparatus;
Control over all types of cleaning of the department premises, according to the schedule. Airing and quartzing chambers in accordance with the requirements of the sanitary-hygienic and anti-epidemiological regimes;
Ensuring proper order and sanitary condition of the medical post, sanitary room, wards and staff room;
Timely receipt from the hostess sister of soft equipment, disinfectants, detergents and cleaning agents. Compliance with safety measures when working with them;
Clear and timely prescription and receipt from the senior nurse of medications, alcohol, care items, forms necessary for work;
Timely discharge and receipt of dressing material, styling for hygienic care of newborns at the Central Social Service;
Ensuring correct accounting, storage, use of medicines, alcohol, dressings, care items, medical equipment and instruments;
Ensuring correct accounting, storage and use of psychotropic and potent drugs;
Conducting sanitary and educational work among puerperas on issues of a healthy lifestyle, nutrition, breastfeeding;
Continuous improvement of the professional level of knowledge, skills and abilities through self-education, mastering related specialties, participation in general hospital and general hospital nursing conferences, certification at the workplace, technical studies and conferences in the department;
Timely completion of the improvement program on the basis of the OCPK once every 5 years and obtaining a certificate in the specialty "Nursing in Pediatrics".
11.2 Rights
Obtaining the necessary information for the clear fulfillment of their professional duties;
Making proposals to the management to improve the work of the ward nurse and the organization of nursing in the maternity hospital;
Requiring the senior nurse to provide timely medications, nursing items, and forms necessary for work;
The requirement from a nurse with the performance of the duties of a senior nurse of the CSO to provide timely dressing material, hygienic care products;
Requirement of puerperas to comply with the internal regulations of the maternity hospital, based on the norms of medical ethics and deontology;
The requirement from the hostess sister to provide the necessary soft equipment, disinfectants, detergents and cleaning agents in a timely manner;
Improving their qualifications in the prescribed manner, passing certification, re-certification in order to assign qualification categories;
Participation in the social life of the department, maternity hospital and hospital;
Participation in the work of professional medical associations.
My workplace is a medical post and a manipulation room.
The manipulation room is designed for the following procedures:
S / c and i / m injections;
Throat processing;
Instilling drops in the eyes, nose, ears;
Inhalation;
Applying compresses;
Storage and distribution of medicines.
The manipulation room is equipped with:
Cabinets for storing medicines used for the treatment of patients, as well as for the provision of emergency medical care in case of emergency.
Refrigerator for thermolabile medicines.
Manipulation table;
Work table;
Table for the distribution of medicines inside;
A couch;
A bedside table for storing disinfectant solutions;
Safe for storing ethyl alcohol and accounting preparations.
The post contains the following documentation required for my work in the department:
1. Medical card of an inpatient.
2. List of appointments.
3. Patient movement log.
4. Journal of registration of movement of patients in intensive care units.
5. Journal of transfer of patients to the intensive care unit and from the intensive care unit.
6. Journal of transfer of patients to the infectious diseases department
7. Log of registration of the terms of quarantine.
8. Journal of medical instruments.
9. Journal of delivery and reception of shifts.
10. Requirements for the discharge of medicines, registration medicines, ethyl alcohol.
11. Log book for the consumption of ethyl alcohol.
12. The register of the temperature regime of the refrigerator for storing medicines.
13. Journal of quality control of pre-sterilization cleaning of medical instruments and medical products.
14. Log book of expensive and dressings.
15. Register of procedures.
16. Register of keeping hygienic training and education of the population, promotion of a healthy lifestyle.
17. Journal of accounting of classes "school of mothers"
18. Log of control of sterilizers operation by air and steam method
19. Register of febrile patients.
20. Register of laboratory research.
21. X-ray examination log.
22. Journal of sanitation of chambers, treatment room.
23. Register of general cleanings of the manipulation room, wards, treatment room.
24. Journal of examination for head lice.
25. Log book of examination for dysgroup and salmonellosis of children under 2 years of age and mothers for childcare.
26. Register of taking smears on Bl.
All magazines are numbered, laced, sealed and signed by the head of the institution.
As a ward nurse of the pediatric department, I perform the following functional duties:
1. Carry out the care and supervision of patients.
2. Timely and accurately fulfill the doctor's prescriptions.
3. Organize timely examination in the laboratory, diagnostic rooms, consultations.
4. I observe the patient's condition.
5. I provide sanitary and hygienic services to physically weakened and seriously ill patients;
6. I accept and place in patients' wards;
7. I check the transmission of sick children;
8. I rent and take a shift in wards, at the patient's bedside;
9. I control the implementation of the treatment and protective regime of the department by patients and their relatives;
10. I supervise the work of junior medical personnel and control their compliance with the internal regulations;
11. If a patient detects signs of an infectious disease, immediately inform the doctor;
12. I watch over the sanitary maintenance of wards, personal hygiene of patients, change of bedding and underwear;
13. I take care of the timely supply of patients with everything necessary for treatment and care;
14. I make sure that the sick take medicine in my presence;
15. I improve my professional qualifications;
16. Maintain the necessary accounting and reporting documentation;
17. Accompany the attending physician during the round;
18. In the absence of the hostess sister, together with the nurse, I am responsible for the safety of linen for patients;
19. I provide emergency first aid medical assistance;
20. I am prescribing and receiving necessary medications from the head nurse.
21. I strictly follow the shelf life of medicinal products;
22. I carry out all work during the shift according to the schedule developed in the department.
An integral part of the treatment process is compliance with the medical and protective regime in the children's department. Create properly medical and protective regime in the department - the primary task of all employees headed by the administration. The organization of the work of the staff should be built in such a way as to provide the patient with the most gentle change in his lifestyle. As a ward nurse, I adhere to the following principles of the conservative regime:
Optimal microclimate (adherence to the principles of deontology) and the creation of a pleasant interior.
Reducing the effect of negative emotions caused by procedures and other irritants - I calm the child, explain the purpose of the procedure, its necessity, etc.
The combination of the rest regime with the patient's physical activity and raising his neuropsychic tone - for this purpose, in the department I strictly follow the rules of the internal daily routine to create optimal conditions for the recovery of patients.
Elimination of unfavorable influences of the external environment and conditions of hospital stay (loud conversations, noise, slamming doors, knocking heels, etc.)
Attentive and friendly staff.
Compliance with the daily routine.
Conversations with the patient are part of the therapeutic and protective regime. Nurses should instill confidence in the patient's recovery, encourage him, celebrate progress. In this case, sincerity and goodwill are important.
Output: Correct organization of the nurse's work, clear, impeccable performance of their functional duties, continuity in work is a necessary and most important component of the treatment process aimed at the speedy recovery of the patient.
Similar information.
Inpatient (hospital, hospital) medical care is currently the most resource-intensive health sector. The main material assets of the industry (expensive equipment, apparatus, etc.) are concentrated in hospital institutions, on the maintenance of which an average of 60-70% of all resources allocated to health care are spent. Hospitals provide the largest volume of inpatient care in the country (Figure 10.1).
Figure: 10.1.Approximate organizational structure of a city hospital
In 2008, more than 6,000 hospitals operated in Russia with a total number of beds of about 1.5 million. At the present stage, new inpatient technology is gaining importance.
logics that can significantly save available resources without compromising the quality of medical care (see section 10.3).
10.1. ORGANIZATION OF THE WORK OF THE MEDICAL PERSONNEL OF THE CITY HOSPITAL FOR ADULTS
The hospital is headed by the chief physician, who is responsible for all treatment and prophylactic, administrative, economic and financial work. The chief nurse is in charge of the activities of the nursing and junior medical personnel. A person with higher medical education in the specialty "Nursing" or with secondary medical education, having a diploma in one of the specialties: "Nursing", "General Medicine", "Obstetrics" and a certificate in the specialty " Organization of nursing ”, possessing organizational skills. The chief nurse is appointed and dismissed by the chief physician of the hospital, and is directly subordinate to the deputy chief physician for medical affairs. The orders of the head nurse are mandatory for the nursing staff of the hospital.
The main responsibilities of the head nurse:
Development of long-term and current plans for the professional development of hospital nurses;
Formation of a reserve and training of nurses for promotion to the position of senior nurses;
Organization of receipt, storage and distribution to departments in accordance with their requirements of medicines, including narcotic, poisonous and potent drugs;
Control of the timely and accurate implementation of medical appointments by nursing staff, the correctness of accounting, distribution, consumption and storage of medicines (including narcotic, poisonous and potent) and dressings;
Control over compliance with the requirements of the sanitary-anti-epidemic regime, the quality of the preparation of medical documentation by nurses.
To fulfill her duties, the head nurse of the hospital has the right:
Give orders to nursing and junior medical personnel and monitor their implementation;
Make proposals to the chief physician of the hospital on the encouragement and imposition of penalties for the middle and junior medical personnel;
Submit proposals to the attestation commission on the assignment of the next qualification category to nursing staff;
To instruct nurses to check the work of the middle and junior medical personnel of the hospital departments.
The patient's first acquaintance with the hospital begins with admission department.It can be centralized and decentralized. Patients can get to the admission department of the hospital in different ways: by the direction of doctors from outpatient institutions (planned hospitalization), on an emergency basis (when they are delivered by an ambulance team), by transfer from another hospital, who independently applied to the admission department ("drift" ).
The tasks of the admission department include:
Reception of patients, making a preliminary diagnosis and resolving the issue of the need and profile of the department for hospitalization;
Providing emergency medical care if necessary;
Sanitary treatment of patients;
Acting as a reference and information center on the condition of patients.
The work of the middle and junior medical personnel of the admission department is organized by senior nurse of the admission department.A person with a higher medical education in the specialty "Nursing" or with a secondary medical education, having a diploma in one of the specialties: "Nursing", "General Medicine", "Obstetrics" and a certificate in specialty "Organization of nursing", with organizational skills. The senior nurse of the admission department is appointed and dismissed by the head physician of the hospital on the recommendation of the head of the department, to whom she
directly submits. The orders of the senior nurse are mandatory for the middle and junior medical staff of the department.
In the admission department, the possibility of urgent X-ray, endoscopic examinations, express analyzes, etc. should be provided. To provide emergency medical care, the admission department must have a constant set of necessary medicines, medical instruments, etc. At the admission department of large hospitals, intensive care and temporary isolation wards are organized.
For the position admissions nursea person with a secondary medical education who has a certificate in the specialty "Nursing" is appointed. The nurse of the admission department is appointed and dismissed by the chief doctor of the hospital and reports directly to the head of the admission department (doctor on duty) and the senior nurse of the admission department. The nurse's orders are binding on the junior medical staff of the admission department.
The admissions nurse has a wide range of responsibilities:
Acquaints with the referral of the patient and accompanies him to the office of the doctor on duty;
Listens to the complaints of the patient who entered "by gravity" and directs him to the doctor on duty;
Fills in the passport part of the "Medical card of an inpatient" (form 003 / y);
Keeps the "Register of patients admission and hospitalization refusals" (f. 001 / y);
Examines the patient for head lice and measures body temperature;
Performs procedures and manipulations prescribed by the doctor on duty;
Carries out, at the direction of the doctor on duty, call consultants and laboratory assistants to the admission department;
Monitors the condition of patients in the isolation ward, and timely fulfills all the doctor's instructions for their examination and treatment;
Timely transmits telephone messages to the police station, active calls to city polyclinics, emergency notifications
for infectious diseases to the appropriate territorial body of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare (Rospotrebnadzor);
Carries out a sampling of feces, urine, vomit and wash water for laboratory research;
Receives medicines from the senior nurse and ensures their storage;
Monitors the sanitary condition in the department and controls the work of junior medical personnel;
Timely hands over to the sister-owner of the department equipment and tools for repair.
From the admission department, the patient enters the inpatient department. The head of the medical department is in charge. The work of the middle and junior medical personnel of the department is organized by senior nurse of the department.
A person with a higher medical education in the specialty "Nursing" or with a secondary medical education, having a diploma in one of the specialties: "Nursing", "General Medicine", "Obstetrics" and a certificate in the specialty " Organization of nursing ”, possessing organizational skills. The senior nurse of the department reports directly to the head of the department. She is a financially responsible person, her orders are mandatory for the nursing and junior medical personnel of the department.
The main figure of the department is the attending physician (resident), he is helped ward nurses,who are directly subordinate to the head nurse of the department and perform the following duties:
Timely and accurate fulfillment of the prescriptions of the attending physician;
Organization of timely examination of patients in the laboratory, diagnostic rooms, with consulting doctors;
Monitoring the patient's condition: physiological functions, sleep, weight, pulse, respiration, temperature;
Immediate information to the attending physician (in his absence - to the head of the department or the doctor on duty) about a sudden deterioration in the patient's condition;
Providing emergency first aid;
Sanitary and hygienic services for the physically weakened and seriously ill (washing, feeding, rinsing the mouth, eyes, ears, etc.);
Isolation of patients in agonal state, calling a doctor to ascertain death, preparing the corpses of the dead for transfer to the morgue.
Work in the department in the morning begins with a morning conference, the so-called "five-minute". Every day, the department resident receives information from the night duty medical staff about the condition of patients and changes in their health, about newly admitted patients, gets acquainted with the results of laboratory, X-ray and other studies, conducts a round of patients. Patients are visited accompanied by a nurse. At the patient's bedside, the resident checks the fulfillment of the previously given appointments.
There are two systems for organizing patient care: two-stage and three-stage. In the two-stage system, doctors and nurses are directly involved in patient care. In this case, the junior medical staff helps in creating an appropriate sanitary and hygienic regime in the department (cleaning the premises, etc.). In a three-level system, nurses are involved in direct patient care. For the position junior nursing nursea person who has graduated from nursing nursing courses is appointed. She reports directly to the ward nurse.
The hospital must strictly adhere anti-epidemic and medical-protective regimes.
Control over the observance of the anti-epidemiological regime is carried out by specialists of the territorial bodies of Rospotrebnadzor.
Medical and protective regimeis a system of measures aimed at creating optimal conditions for patients to stay in the hospital. Nurses play an important role in adherence to the medical and protective regime. The main elements of the medical and protective regime include:
Rational layout, placement and equipment of wards and departments (isolation of operating blocks, dressing rooms, organization of 1-2-bed wards, etc.);
Elimination or maximum reduction of the impact of unfavorable environmental factors (uncomfortable beds, poor lighting, low or excessively high temperature in the wards, bad smells, groans or cries of patients, noise, tastelessly cooked and untimely served food, etc.;
Fighting pain and fear of pain (psychological preparation for operations, the use of anesthetics for painful dressings, the use of effective pain relievers, high skill of injection technique and other manipulations, proper sharpness of needles and scalpels, refusal from aimless research);
Measures to prevent the possibility of a patient leaving for illness and exaggerated perceptions of adverse consequences (fiction, favorite music, fascinating conversations, painting, television, the opportunity to do any favorite thing, walking around the hospital for walking patients, occupational therapy in wards for chronic patients , educational and pedagogical work in children's hospitals, etc.);
Organization of the patient's daily regimen (lengthening of physiological sleep, combination of rest with acceptable physical activity, communication of the patient with relatives and friends);
Reasonable use of the word - one of the strongest conditioned stimuli that can have a significant impact on the course of the pathological process and its outcome (avoiding iatrogenies);
Compliance by the personnel with the principles of medical ethics (high culture of medical personnel, sensitive, attentive attitude to the patient, his relatives, adherence to medical secrecy, friendly relations between medical personnel.
The patient is discharged from the hospital in the following cases: with his full recovery; if necessary, transfer to other medical institutions; with a persistent improvement in the patient's condition, when further hospitalization is no longer needed; in the chronic course of the disease, not amenable to treatment in this institution.
10.2. ORGANIZATION OF WORK MEDIUM
MEDICAL STAFF
CHILDREN'S CITY HOSPITAL
(CHILDREN'S DEPARTMENT OF THE CENTRAL
DISTRICT HOSPITAL)
The organization of the work of a children's hospital has much in common with the work of a hospital for adults, but there are also differences that determine the specifics of the work of nurses.
Sick children, like adults, are admitted to the inpatient department of a children's hospital in the direction of doctors of children's polyclinics, ambulance stations, children's institutions, "by gravity". Planned hospitalization of the child is carried out through the children's clinic.
The structure of the children's hospital includes an admission department, medical departments (pediatric and specialized: surgical, infectious, etc.), departments of laboratory and functional diagnostics, and others.
The admission department of a children's hospital should be boxed (boxes make up 3-5% of the total number of hospital beds). The most convenient for work are the individual boxes of Meltzer-Sokolov, which include an anteroom, a ward, a sanitary unit, a gateway for personnel. In small hospitals, in the absence of boxes for receiving children, at least 2-3 isolated examination rooms and 1-2 sanitary inspection rooms should be provided.
In case of admission of children without the knowledge of their parents, the latter are immediately notified of this by the employees of the admission department. In the absence of such an opportunity, information about the child is entered into a special book and reported to the police.
Departments (wards) of the hospital are formed according to age, sex, nature and severity of diseases, date of admission. Depending on age, departments (wards) are allocated for premature babies, newborns, infants, young children, and older children. By the nature of the diseases, departments (wards) can be: pediatric general, surgical, infectious, etc. It is advisable to have small rooms - for 2-4 beds, which makes it possible to fill
them taking into account the age of children and the disease. It is advisable to have glazed partitions between the wards so that the staff can observe the condition of the children and their behavior. It is necessary to provide for the possibility of staying in the hospital with the mother's child.
Tasks ward nursechildren's hospital:
Reception and placement in wards, care and supervision of a sick child;
Accurate and timely fulfillment of the prescriptions of the attending physician;
Emergency notification of a doctor about cases of changes in the condition of a sick child that require urgent action, and the provision of first aid in his absence;
Maintenance of the sanitary condition of the wards.
An important feature of the organization of the work of children's departments is the need for educational work there. For this purpose, positions of teacher-educators are being introduced in children's hospitals. Educational work is carried out with sick children who are treated for a long time in a hospital. A very important element of creating a medical and protective regime for children is the organization of their leisure time, especially in the evening. At the end of a sick day, manual labor, sculpting, drawing, and reading aloud improve children's mood and promote restful sleep. Ward nurses play an important role in the proper organization of children's leisure time.
Properly organized nutrition is of particular importance in the complex of therapeutic measures. To this end, breastfed babies are hospitalized with their mothers or provided with breast milk. Children of the first year of life receive all other food products from the children's dairy kitchen. For children over one year old, meals are organized at the hospital's catering unit.
In children's hospitals, more than in hospitals for adults, nosocomial infections should be feared. If a child with an acute infectious disease is identified in the department, quarantine is established for the incubation period for this disease. It is necessary to keep records of children in contact with the sick, which during the incubation period cannot be moved to other wards. In these cases, depending on the diagnosed acute infectious disease, special anti-epidemic measures are also taken (vaccinations, studies on bacterial carriers, etc.).
Anatomical and physiological characteristics of newborns, the peculiar nature of the course of the disease determine the need to create special departments for newborns and premature babiesas part of children's hospitals. The main task of these departments is to provide qualified diagnostic and therapeutic assistance to full-term and premature newborn sick children, to create optimal conditions for nursing children.
Children born with a mass of at least 2300 g and sick in the neonatal period are sent to the department for newborns. Newborns weighing less than 2300 g, having signs of immaturity and sick in the neonatal period are sent to the department for premature babies. Transfer of newborns and premature babies from maternity hospitals is carried out subject to the transportability of the child and the obligatory agreement with the head of the specialized department where the child is transferred. The transportation of newborns is carried out on a self-directed basis in a specialized resuscitation machine with a resuscitator or pediatrician well-trained in resuscitation of newborns and premature babies. Nursing staff accompanying children should also have special training in resuscitation and neonatal intensive care.
In the work of the department for newborns and premature babies of children's hospitals, a close relationship and continuity with maternity hospitals and children's polyclinics should be maintained.
10.3. ORGANIZATION OF WORK MEDIUM
MEDICAL STAFF
DAY STATIONARY
Taking into account the high cost of inpatient care, new inpatient technologies are gaining importance, allowing significant savings in available resources without compromising the quality of medical care. These organizational forms include:
Day hospitals in outpatient clinics;
Day hospitals in hospitals;
Home hospitals.
Day hospitalintended for carrying out preventive, diagnostic, therapeutic and rehabilitation measures for patients who do not require round-the-clock medical supervision
(fig.10.2).
Figure: 10.2.Approximate organizational structure of a day hospital with a surgical profile
The main forms of primary medical records of day hospitals:
"Journal of registration of patients admission and refusals of hospitalization", f. 001 / y;
"Medical card of an inpatient", f. 003 / y;
"Temperature sheet", f. 004 / y;
"Sheet of daily registration of the movement of patients and the bed fund of a 24-hour hospital, day hospital at a hospital", f. 007 / y-02;
"Sheet of daily registration of the movement of patients and the bed fund of a day hospital at an outpatient clinic, a hospital at home", f. 007ds / u-02;
"Consolidated statement of movement of patients and beds in the hospital, department or profile of hospital beds for round-the-clock stay, day stay at the hospital", f. 016 / y-02;
"Extract from the medical card of an outpatient, inpatient patient", f. 027 / y;
"Journal of accounting procedures", f. 029 / y;
"Book of registration of certificates of incapacity for work", f. 036 / y;
"Card of a patient being treated in the physiotherapy department (office)", f. 044 / y;
"Journal of recording of X-ray studies", f. 050 / y;
"Statistical card of a 24-hour stay in a hospital, a day hospital at a hospital, a day hospital at an outpatient clinic, a hospital at home", f. 066 / y-02;
"Journal of records of outpatient operations", f. 069 / y;
"Medical certificate of death", f. 106 / y-98.
In practice, day hospitals for therapeutic, surgical, obstetric-gynecological, neurological, dermatological and other profiles are most widespread.
Medical nutrition for patients in the day hospital is organized based on local conditions. Usually, if the hospital is part of the structure of a hospital, patients use two meals a day in accordance with the current hospital standards.
It should be noted that day hospitals in hospital and outpatient clinics have some differences. In the conditions of day hospitals on the basis of hospitals, as a rule, it is possible to carry out more complex laboratory and diagnostic examinations, it is easier to organize food. The advantage of day hospitals based on outpatient clinics is the possibility of using a wide range of rehabilitation treatment.
Home hospitalscan be organized in cases where the patient's condition and home conditions (social, material) allow organizing medical assistance and home care.
The purpose of the organization of hospitals at home is the treatment of acute forms of diseases, aftercare and rehabilitation of chronic patients, medical and social assistance to the elderly, observation and treatment at home of persons who have undergone simple surgical interventions, etc. Home hospitals in pediatrics and geriatrics have proven themselves well.
The organization of a hospital at home involves the daily supervision of the patient by a doctor and a paramedical worker, laboratory diagnostic examinations, drug therapy (intravenous, intramuscular injections, etc.), various procedures (banks, mustard plasters, etc.).
If necessary, the complex of treatment of patients includes physiotherapy, massage, exercise therapy, etc.
Treatment in hospitals at home is not associated with isolation, impaired microsocial adaptation, it is easier for patients to perceive, and is economically beneficial. Treatment in a hospital at home is several times cheaper than in a 24-hour hospital, and in terms of efficiency it is not inferior to treatment in a 24-hour hospital.
10.4. ORGANIZATION OF THE WORK OF THE SECONDARY MEDICAL PERSONNEL OF THE MATERNITY HOSPITAL, PERINATAL CENTER
The main institution providing inpatient obstetric and gynecological care is the maternity hospital (Fig. 10.3). Its tasks include the provision of inpatient qualified medical care to women during pregnancy, childbirth, the postpartum period, with gynecological diseases, as well as the provision of qualified medical care and care for newborns during their stay in the obstetric hospital.
The head physician is in charge of the maternity hospital. The work of middle and junior medical personnel is organized by chief (senior) midwife,whose tasks include:
Regularly conduct rounds of wards, offices and other premises of the maternity hospital;
Ensure the timeliness of discharge, the correctness of accounting, distribution, consumption and storage of medicines and medical products;
To instruct middle and junior medical personnel on the implementation of a complex of sanitary and anti-epidemiological measures in a maternity hospital;
Develop measures to improve the business qualifications of middle and junior medical personnel (holding nursing conferences, lectures by doctors, etc.);
To systematically carry out work to educate personnel in the spirit of a conscientious attitude towards fulfilling their duties, observing the principles of medical deontology;
Figure: 10.3.Approximate organizational structure of a maternity hospital
To systematically improve your professional qualifications.
Pregnant women (if there are medical indications), women in labor, as well as women in labor in the early postpartum period (within 24 hours after delivery) in case of childbirth outside the hospital are subject to hospitalization in the maternity hospital. Upon admission to the maternity hospital, the woman in labor or postpartum is sent to admission and examination block of the obstetric department,where he presents his passport and "Exchange card" (f. 113 / y). The reception of women in the admission and examination block is carried out by a doctor (in the daytime - by the doctors of the departments, then by the doctors on duty) or by a midwife who, if necessary, calls a doctor. It is advisable to have one filter room and two observation rooms in the receiving and inspection block. One examination room is provided for admitting women to the physiological obstetric department, the other is an observational one.
The doctor (or midwife) assesses the general condition of the applicant, gets acquainted with the "Exchange card", finds out whether the woman has suffered infectious, inflammatory diseases before and during pregnancy, paying special attention to the diseases transferred immediately before admission to the maternity hospital, establishes the presence of chronic inflammatory diseases, the duration of the anhydrous period.
As a result of collecting anamnesis, examination, acquaintance with documents in the filter room, women are divided into two streams: with the normal course of pregnancy, who are sent to physiological obstetric department,and representing an "epidemiological danger" to others who are sent to observational obstetric department.
In addition, women are sent to the observational department if there is no “exchange card of the maternity hospital”, as well as women in the early postpartum period in case of childbirth outside the hospital.
In the examination physiological and observational departments, an objective examination of the woman is carried out, her sanitization is carried out, a set of sterile linen is issued, blood and urine are taken for tests. From the examination room, accompanied by nursing staff, the woman moves (if indicated, is transported on a gurney) to the birth block or the department of pathology of pregnant women.
The midwife and junior medical staff of the obstetric department are directly subordinate to the senior midwife. The head midwife of the department is subordinate to the head of the department and the head midwife. The duties of a senior midwife are very similar to those of a senior nurse in a hospital.
The direct assistant to the obstetrician-gynecologist of the obstetric department is midwife,whose responsibilities include:
Preparing women for the upcoming medical examination;
Providing assistance to a doctor in carrying out medical diagnostic and surgical procedures;
Providing medical care during childbirth and carrying out primary treatment of newborns;
Monitoring compliance with the sanitary and hygienic regime in the department;
Supervision of the work of junior medical personnel;
Ability to carry out simple laboratory tests (urine for protein, blood group, hemoglobin and erythrocyte sedimentation rate);
Carrying out some obstetric interventions in situations that threaten the life of a woman in labor or postpartum women (isolation of the placenta by external methods, manual examination of the postpartum uterus, separation and isolation of the placenta, examination of the cervix with bleeding);
Suturing of I and II degree perineal tears.
Maternity hospital central unit - birth block,which includes prenatal wards, birth wards, intensive care ward, nursery, small and large operating rooms, sanitary rooms. In the prenatal ward, a woman spends the entire first stage of labor. The midwife or doctor on duty constantly monitors the mother's condition. At the end of the first stage of labor, the woman is transferred to the birth ward (delivery room).
If there are two delivery rooms, the delivery is carried out alternately. Each delivery room works for 1-2 days, then a general cleaning is carried out in it. If there is one delivery room, delivery is carried out alternately on different Rakhmanov beds. General cleaning of the delivery room is carried out twice a week. A midwife takes care of a normal delivery.
After the baby is born, the midwife shows the baby to the mother, paying attention to gender and the presence of congenital malformations (if any). Then the child is transferred to the nursery. The postpartum woman must be in the delivery room under supervision for at least 2 hours.
After washing hands under running water and processing them, the midwife carries out secondary treatment of the umbilical cord, primary treatment of the skin, weighing the child, measuring body length, chest and head circumferences. Bracelets are tied to the child's hands, and after swaddling, a medallion is placed over the blanket. They indicate: last name, first name, patronymic, birth history number of the mother, gender of the child, weight, height, hour and date of birth. After finishing the treatment of the newborn, the midwife (doctor) fills in the necessary fields in the "History of childbirth" (f. 096 / y) and "History of the development of a newborn" (f. 097 / y).
In the normal course of the postpartum period, 2 hours after childbirth, the woman is transferred on a gurney with the child to postpartum ward,which is part of the physiological obstetric department.
When filling the wards of the postpartum department, it is necessary to observe a strict cyclicality - one ward is allowed to be filled within no more than three days. When the first signs of disease appear in women in labor or newborns, they are transferred to obstetric departmentor to another specialized institution.
In the obstetric department are placed: sick women with a healthy child; healthy women with a sick child; sick women with a sick child.
Wards for pregnant women and women in childbirth in the observational department should be profiled if possible. It is unacceptable to accommodate pregnant women and women in childbirth in the same room.
In the wards of the newborns of the observational department there are children: those born in this department, born outside the maternity hospital, transferred from the physiological department, born with severe congenital anomalies, with manifestations of intrauterine infection, with a body weight of less than 1000 g. For sick children in the observational department, an isolator is allocated for 1-3 beds. If indicated, children can be transferred to the neonatal unit of the children's hospital.
During the first days after birth, each child is under intensive supervision of the medical staff. Pediatricians conduct daily examinations of children. If one pediatrician works in the maternity hospital, then during his absence, the children are examined by the obstetrician-gynecologist on duty. In necessary cases requiring emergency intervention, the obstetrician-gynecologist calls the pediatrician. At the end of the examination of newborns, the pediatrician (obstetrician-gynecologist) informs the mothers about the condition of the children and conducts sanitary and educational work with them.
In a modern maternity hospital, at least 70% of beds physiological obstetric departmentshould be allocated for the joint stay of the mother and child. Such a joint stay significantly reduces the incidence of diseases of puerperas in the postpartum period and the incidence of diseases in newborns. The main feature of such maternity hospitals or obstetric wards is
active participation of the mother in the care of the newborn child. The joint stay of the mother and the child limits the contact of the newborn with the medical staff, reduces the possibility of infection of the child. With this mode, early attachment of the newborn to the breast is ensured, the mother is actively taught the skills of practical care of the newborn.
When the mother and child stay together, they are placed in boxes or semi-boxes (for 1-2 beds).
Contraindications to the joint stay of the mother and the child on the part of the postpartum woman: severe gestosis of pregnant women, extragenital diseases in the stage of decompensation, fever, rupture or incisions of the perineum of the II degree. From the side of the newborn: prematurity, prematurity, long-term intrauterine fetal hypoxia, intrauterine hypotrophy of II-III degree, birth trauma, asphyxia at birth, developmental anomalies, hemolytic disease.
The joint stay of a mother and a child in a maternity hospital requires the strictest adherence to the anti-epidemic regime.
In order to reduce perinatal mortality, organize constant monitoring of the state of vital functions of newborns, timely conduct corrective and diagnostic measures in obstetric institutions, special resuscitation and intensive care wards for newborns are being created. The creation of such wards in maternity hospitals with a capacity of 80 or more beds for newborns is mandatory. At a lower capacity of the maternity hospital, intensive care posts are organized.
The main criteria for the discharge of a woman from the maternity hospital: satisfactory general condition, normal temperature, pulse rate, blood pressure, breast condition, uterine involution, normal laboratory results.
In case of exacerbation of extragenital diseases, women in childbirth can be transferred to the appropriate hospital, and in the event of complications in the postpartum period - to the observational department.
With an uncomplicated course of the postpartum period in a postpartum woman and the early neonatal period in a newborn, with a dropped umbilical cord and a good condition of the umbilical wound, positive
the dynamics of body weight, a mother with a child can be discharged 5-6 days after childbirth.
Discharge is carried out through special discharge rooms, which should be separate for postpartum women from the physiological and observational departments. The discharge rooms should have 2 doors: from the postpartum department and from the visitor's room. Reception rooms should not be used for the discharge of puerperas.
Before being discharged, the pediatrician, while still in the ward, conducts a conversation with the puerperas about the care and feeding of the child at home. The nurse (in the ward) must additionally process and swaddle the child. In the discharge room, the nurse of the neonatal department swaddles the child in the brought home linen, teaches the mother how to swaddle, draws her attention to the recording of the surname, name and patronymic on bracelets and a medallion, the condition of the child's skin and mucous membranes, once again talks about the peculiarities of care at home ...
In the "History of the development of a newborn", the nurse notes the time of his discharge from the maternity hospital and the condition of the skin, mucous membranes, introduces the mother to the record, which is certified by the signatures of the nurse and the mother. The nurse issues the mother a "Medical certificate of birth" (f. 103 / y-98) and the "Exchange card of the maternity hospital, maternity ward of the hospital" (f. 113 / y).
On the day the child is discharged, the head nurse of the neonatal department informs the children's clinic at the place of residence by phone the basic information about the discharged child.
Pregnancy pathology departmentsare organized in large maternity hospitals with a capacity of 100 beds or more. The department of pregnancy pathology hospitalizes women with extragenital diseases, complications of pregnancy (gestosis, threat of termination, etc.), with an abnormal fetal position, with a burdened obstetric history. The department employs obstetricians-gynecologists, maternity hospital therapists, midwives and other medical personnel.
The planning of the pregnancy pathology department should provide for its complete isolation from other departments, the possibility of transporting pregnant women to the physiological and observational obstetric departments (bypassing other departments), as well as an exit for
pregnant women from the department to the street. In the structure of the department, it is necessary to provide: a functional diagnostics room with modern equipment (mainly cardiological), an examination room, a small operating room, a physiopsychoprophylactic preparation room for childbirth, covered verandas or halls for walking pregnant women.
From the department of pathology of pregnancy, women can be transferred in connection with the improvement of their condition under the supervision of an antenatal clinic, as well as for delivery to the physiological or observational obstetric departments. The transfer of women to one of these departments is carried out necessarily through the reception and examination block, where they undergo complete sanitization.
Gynecological departmentsthere are three types of maternity hospitals:
1) for hospitalization of patients in need of surgical treatment;
2) for patients in need of conservative treatment;
3) for termination of pregnancy (abortion).
The structure of the department should include: its own admission unit, dressing room, manipulation room, small and large operating rooms, physiotherapy room, discharge room, intensive care unit. In addition, other medical and diagnostic units of the maternity hospital are used for the diagnosis and treatment of gynecological patients.
In general, the work of the gynecological department, as well as the duties of the nursing staff, is in many ways similar to the activities of a regular department of a general hospital.
In recent years, departments of artificial termination of pregnancy have been trying to withdraw from obstetric hospitals, organizing them in the structure of gynecological departments of multidisciplinary hospitals or on the basis of day hospitals.
Since 2005, in order to manage the quality of medical care provided to women during pregnancy and childbirth, as well as to improve the financing of antenatal clinics and maternity hospitals, “Birth certificates” have been introduced, the procedure for filling them out is determined by the corresponding order of the Ministry of Health and Social Development of the Russian Federation ...
In recent years, in order to improve the efficiency and quality of medical care for pregnant women, women in labor, maternity
perinatal centers are being established in the Russian Federation for women and newborns.
The main tasks of perinatal centers:
Provision of consultative and diagnostic, therapeutic and rehabilitation assistance mainly to the most difficult contingent of pregnant women, women in labor, postpartum women, newborn children;
Prevention of long-term consequences of perinatal pathology in children (retinopathy of prematurity, hearing loss from childhood, infantile cerebral palsy, etc.);
Provision of a system of rehabilitation measures and rehabilitation therapy, medical, psychological and social and legal assistance to women and young children;
Implementation of statistical monitoring and analysis of maternal, perinatal, infant mortality;
Organization of information support for the population and specialists on perinatal care, reproductive health and safe motherhood.
The main tasks of nursing staff in perinatal centers are in many ways similar to the tasks of nurses in antenatal clinics, maternity hospitals, intensive care units and intensive care units for newborns in children's hospitals.
The approximate organizational structure of the perinatal center is shown in Fig. 10.4.
10.5. HOSPITAL STATISTICS
The main forms of primary medical records of hospital institutions:
A sheet of daily registration of the movement of patients and the bed fund of a 24-hour hospital, day hospital at a hospital, f. 007 / y-02;
Statistical card of those who left the hospital for round-the-clock stay, day hospital at a hospital institution, day hospital at an outpatient clinic, hospital at home, f. 066 / y-02.
The main indicators of the hospital's medical activity:
The indicator of the provision of the population with hospital beds;
Indicator of the frequency (level) of hospitalization;
Figure: 10.4.Approximate organizational structure of the perinatal center
Average number of days a bed is occupied per year (function of a hospital bed);
Indicator of the average duration of the patient's stay in bed;
Hospital mortality rate.
Indicator of provision of population with hospital bedsthe most common in assessing the satisfaction of the population with hospital care.
As a result of the introduction of new hospital-replacing technologies [day hospitals based on outpatient clinics (APU), day hospitals based on hospitals, hospitals at home], this indicator for the period 1995-2008. decreased from 118.2 to 92.4 per 10 thousand population.
Hospitalization rate (level) indicatoris used to analyze the satisfaction of the population in hospitalization and to calculate the standards for the need for inpatient care.
The value of this indicator in 2008 in the Russian Federation was 22.4%. Taking into account the priority of the development of outpatient care, as well as the introduction of new hospital-replacing technologies, the level of hospitalization of the population in the future should decrease.
Average number of days a bed is occupied per year (function of a hospital bed)characterizes the effectiveness of the use of financial, material, technical, human and other resources of hospital institutions.
Indicator of the average length of stay of the patient in bed-
it is the ratio of the number of bed-days spent by patients in the hospital to the number of patients treated.
Hospital mortality rateallows to comprehensively assess the level and quality of the organization of medical and diagnostic care in the hospital, the use of modern medical technologies.
* The indicator is calculated for individual nosological forms and age-sex groups of patients.
For the period 2004-2008 the value of this indicator has some downward trend: from 1.40 to 1.32%, respectively.
In the analysis of the activities of the maternity hospital, the perinatal center, statistical indicators characterizing the qualitative aspect of the activities of the obstetric and gynecological service are of particular importance:
Indicators of the frequency of operational benefits during childbirth;
Indicators of the incidence of complications in childbirth;
Indicators of the incidence of complications in the postpartum period;
An indicator of the frequency of use of pain relief during childbirth. Indicators of the frequency of operational benefits during childbirth(overlay
forceps, vacuum extraction, cesarean section, manual separation of the placenta and others). Over the past 10 years in obstetric institutions of the Russian Federation, there has been a 2-fold increase in the use of caesarean section in childbirth, a 2-fold decrease in the frequency of applying obstetric forceps (Fig. 10.5).
* The indicator is calculated for certain types of operational benefits for childbirth.
Figure: 10.5.Surgical interventions in obstetric institutions of the Russian Federation (1998-2008)
The rate of complications in childbirth (perineal tears) and the rate of complications in the postpartum period (sepsis).
These indicators in the Russian Federation in 2008 were 0.17 and 0.58 per 1000 births, respectively.
** The indicator is calculated for certain types of complications.
An important characteristic for assessing the use of modern medical technologies for managing childbirth is an indicator of the frequency of use of pain relief during childbirth.This indicator in maternity hospitals in Veliky Novgorod in 2008 was 800 per 1000 deliveries, which indicates the possibility of expanding anesthetic benefits during childbirth.
The ability to correctly fill out the forms of primary medical records and, on their basis, collect data, calculate and analyze statistical indicators, is of paramount importance in the practical activities of the chief nurse (midwife), head of the feldsher-obstetric station, medical statistics and other medical workers.
test questions
1. List the main tasks of the city hospital for adults.
2. List the functional responsibilities of the head nurse of the city hospital for adults.
3. What are the main tasks of the admission department of the city hospital for adults?
4. Explain the responsibilities of the senior nurse in the admission department of the city adult hospital.
5. What are the responsibilities of the admissions nurse at the City Adult Hospital?
6. List the main responsibilities of a senior nurse in the City Adult Hospital ward.
7. Expand the functional responsibilities of the ward nurse of the city hospital for adults.
8. List the main responsibilities of a nurse at the City Adult Hospital.
9. What is a curative-protective regime and what are its main elements?
10. List the main tasks of the children's city hospital.
11. Expand the features of the admission department of the children's city hospital.
12. List the tasks and reveal the features of the work of the departments for newborns and premature babies in the children's city hospital.
13. List the main tasks of the maternity hospital.
14. What are the responsibilities of the head nurse of the maternity hospital?
15.How is the work of the admission department of the maternity hospital organized?
16. List the main responsibilities of a senior midwife in the midwife of a maternity hospital.
17. Explain the responsibilities of a midwife in the midwife department of a maternity hospital.
18.How is the work of the delivery unit of the maternity hospital organized?
19.How is the work of the physiological postpartum department of the maternity hospital organized?
20. How is the work of the observational department of the maternity hospital organized?
21. How is newborn care in the maternity hospital?
22. Expand the order of work of the pregnancy pathology department of the maternity hospital.
23. How does the gynecological department of the maternity hospital work?
24. List the main tasks of the perinatal center.
25. What is the organizational structure of the perinatal center?
Working on the post requires me to clearly and competently fulfill the entire list of functional duties presented below, while strictly following the principles of medical deontology and ethics in my work
- provide proper care and supervision of patients;
- accurately carry out all medical appointments with an accurate mark in the journal;
- supervise the work of junior medical personnel;
- ensure that the department maintains proper order, cleanliness and compliance with the established regimen by patients;
- while on duty, constantly be among patients, entering the office only for medicines, to record, fill out a diary of observation of patients;
- accompany during the round of the doctors, the head of the department and the doctor on duty who visited the department, report on the condition of patients, enter all comments and instructions in the journal;
- in the absence of a procedural nurse, perform all appointments (staging all types of injections and intravenous infusion therapy);
- receive newly admitted patients, acquaint them with the internal regulations;
- when admitting a patient admitted to the department, especially an agitated one, pay attention to bodily injuries, bruises, dislocations, and so on. Get acquainted with the mental and physical condition, pay attention to painful signs. The patient should not have objects with which he can harm himself and others. Check the quality of the previous sanitization of patients in the emergency room;
- regularly at least 1 time in 7 days, examine patients for head lice. Sauna and change of bed and underwear is held once a week.
- examine the patient's pharynx and, for prophylactic purposes, take BL swabs from the pharynx and nose;
- while working as a day ward nurse, note all the features of the condition, behavior of patients, states of aggression towards other patients and staff, their unusual statements, change or deterioration of the condition - in the observation log and report to the attending physician;
- in the absence of the attending physician and the head of the department, notify the doctor on duty;
- the nurse makes sure that all patients are neat, washed, shaved on time, and when going for a walk - dressed for the weather;
- in the department, the schedule for quartzing wards and premises assigned to the post, bathing patients must be observed;
- the nurse makes sure that patients lie down only on their own beds, so that underwear and bedding are clean;
- special attention is paid to weakened patients, severe in mental and somatic conditions. At the same time, explaining to junior staff the peculiarities of an individual approach to such patients, paying attention to their condition, behavior, especially careful care of them;
- supervise the work of the junior shift personnel, monitor the implementation of the relevant instructions, correcting the corresponding violations in the course of work;
- report all violations to the head of the department and the older sister;
- all comments, instructions to junior staff should be made in the absence of patients;
- the ward nurse on duty is obliged to know all patients by name, features of their condition and behavior, regime;
- promote the involvement of patients in work processes;
- make sure that during the duty in the department there are only personnel employed in the shift;
- twice a day to measure the body temperature of patients under control - blood pressure, NPV, PS;
- send for a walk only those patients for whom there is an appropriate doctor's order;
- to issue and ensure the administration of medications, for which purpose in a timely manner to submit to the head nurse a list of medications required for the post;
- transfer information about the availability of patients to the admission department (summary per day);
- observe that all rooms not intended for permanent use are locked and opened only during use;
- carefully monitor patients during and after visits, so that items that are not allowed to be transferred to the department do not get into the department;
- correctly take all analyzes and control their delivery to the laboratory;
- know and follow safety regulations;
- to treat patients who violate the regime strictly, do not give indulgences. Maintain the regime and status of the department.
- the duty personnel on duty should not be distracted, discuss patients, talk among themselves about treatment, about their personal affairs - patients catch everything;
- to carry out individual care for severe patients - to treat the oral cavity, eyes, monitor diuresis, feeding, stool, temperature, blood pressure, patient hygiene.
All functional duties of a ward nurse are included in the scope of my work and I try to fulfill them in good faith, clearly and quickly.
