January 15, 2016
A person with secondary medical education and practical work experience is appointed to the position of nurse in the treatment room.
Order of the Ministry of Health and Social Development of the Russian Federation (Ministry of Health and Social Development of Russia) dated 1. N 5. 66, Moscow “On approval of the Procedure for providing medical care for mental disorders and behavioral disorders” Registered with the Ministry of Justice of the Russian Federation 1. Registration N 2.
Job description of a district nurse. Job description of a treatment room nurse Methods and means of hygienic education in protecting public health The following is available in the treatment and vaccination room. The psychiatric hospital consists of an emergency department and a general psychiatric department. When working in such an office, a nurse must wear over the gown the nursing staff of the dental clinic. and interior · Assortment and description of decorative flowering plants.
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In accordance with Article 3. Federal Law dated 2. N 3. 23-FZ "On the fundamentals of protecting the health of citizens in the Russian Federation" (Collection of Legislation of the Russian Federation, 2. N 4. 8, Art. 6. 72. Approve the Procedure for the provision of medical assistance for mental disorders and behavioral disorders according to the annex.
I. o. Minister T. Golikov. Application. The procedure for providing medical care for mental disorders and behavioral disorders. This Procedure defines the rules for providing medical care for mental disorders and behavioral disorders in medical organizations. Medical care is provided for mental disorders and behavioral disorders, including: organic (symptomatic), mental disorders; mental and behavioral disorders caused by the use of psychoactive substances; schizophrenia, schizotypal and delusional disorders; mood disorders (affective disorders); neurotic, stress-related and somatoform disorders; behavioral syndromes associated with physiological disorders and physical factors; personality and behavior disorders in adulthood; mental retardation; emotional and behavioral disorders that begin in childhood and adolescence. Medical assistance for mental disorders and behavioral disorders is provided in the form of: emergency, including specialized emergency medical care; primary health care; specialized medical care. Medical care for mental disorders and behavioral disorders is provided on a voluntary basis, except in cases regulated by the current legislation of the Russian Federation, and provides for the implementation of the necessary preventive, diagnostic, therapeutic and medical rehabilitation measures provided in accordance with established standards of medical care.
Medical assistance for mental disorders and behavioral disorders in conditions that pose a threat to the patient’s life is provided in an emergency manner. Within the framework of emergency, including emergency specialized medical care, medical care for mental disorders and behavioral disorders is provided by paramedic mobile ambulance teams, medical mobile emergency medical teams in accordance with the order of the Ministry of Health and Social Development of Russia dated November 1, 2. N 1. 79 “On approval of the procedure for providing emergency medical care” (registered by the Ministry of Justice of Russia 2. N 6. 13. 6) as amended by orders of the Ministry of Health and Social Development of Russia dated August 2, 2. N 5. 86n (registered by the Ministry of Justice of Russia 3. N 1. 82. 89 ), from 1.
N 2. 02n (registered by the Ministry of Justice of Russia on April 4, 2. N 2. 03. 90), from 3. N 6. 5n (registered by the Ministry of Justice of Russia 1. N 2. 34. 72). 7. When providing emergency medical care, medical evacuation is carried out if necessary. Primary specialized health care for mental disorders and behavioral disorders is provided by specialist doctors from medical organizations providing specialized care, in collaboration with other specialist doctors. After treatment and medical rehabilitation in a hospital setting, in accordance with medical indications, the patient is sent for further treatment and medical rehabilitation to medical organizations (and their structural units) that provide primary specialized health care for mental disorders and behavioral disorders. Specialized medical care for mental disorders and behavioral disorders is provided by psychiatrists in collaboration with other medical specialists and includes the diagnosis and treatment of mental and behavioral disorders that require the use of special methods and complex medical technologies, as well as medical rehabilitation.
Medical organizations and their structural units providing medical care for mental disorders and behavioral disorders include: a psychoneurological dispensary (dispensary department of a psychiatric hospital), operating in accordance with Appendices No. 1 - 3 to this Procedure; the office of a local psychiatrist, operating in accordance with Appendices No. 4-6 to this Procedure; an office for active dispensary observation and outpatient compulsory treatment, operating in accordance with Appendices No. 7-9 to this Procedure; a psychotherapeutic office operating in accordance with Appendices No. 1. Procedure; day hospital (department), operating in accordance with Appendices No. 1. Procedure; department of intensive psychiatric care, operating in accordance with Annexes N1. Order; medical rehabilitation department operating in accordance with Appendices No. 1.
Order; department of medical and psychosocial work in outpatient settings, operating in accordance with Appendices No. 2. Order; medical-industrial (labor) workshops of a psychoneurological dispensary (psychiatric hospital), carrying out their activities in accordance with Appendices No. 2. Procedure; a psychiatric hospital operating in accordance with Appendices No. 2 of the Procedure; a psychotherapeutic department operating in accordance with Appendices No. 3. Procedure; medical and rehabilitation department of a psychiatric hospital, operating in accordance with Appendices No. 3. of the Procedure; department of medical rehabilitation department for developing independent living skills in patients who have lost social ties, operating in accordance with Appendices No. 3.
Preventive advisory and therapeutic psychiatric, psychotherapeutic and medical-psychological assistance to patients, including victims of emergency situations, in order to prevent them from suicidal and other dangerous actions, is provided by: the “Helpline” department, operating in accordance with Appendices No. 4 .Order; office of medical, social and psychological assistance, carrying out its activities in accordance with Appendices No. 4. Procedure. Appendix No. 1 to the Procedure. Rules for organizing the activities of a psychoneurological dispensary (dispensary department of a psychiatric hospital)1. These Rules determine the procedure for organizing the activities of a psychoneurological dispensary (dispensary department of a psychiatric hospital) (hereinafter referred to as the psychoneurological dispensary).
A psychoneurological dispensary is an independent medical organization or a structural unit of a medical organization. The psychoneurological dispensary is intended to provide primary specialized health care and specialized medical care (if there are inpatient units in the structure of the psychoneurological dispensary).
The activities of the psychoneurological dispensary are carried out on a territorial basis. The organizational structure and staffing levels of a psychoneurological dispensary are determined taking into account the size of the population served, the structure of morbidity and other features and needs in the provision of psychiatric care to the population, and the volume of medical care provided.
For a psychoneurological dispensary of the state and municipal health care systems, the staffing number of medical and other workers is established taking into account the recommended staffing standards in accordance with Appendix No. 2 to the Procedure for providing medical care for mental disorders and behavioral disorders, approved by this order. If there are two or more psychoneurological dispensaries in a subject of the Russian Federation, each of them is assigned a serial number, while one of them may be assigned coordinating functions for the organizational and methodological management of psychiatric care and the collection of data on the subject of the Russian Federation for registers, the maintenance of which is provided for by law. The equipment of the psychoneurological dispensary is carried out in accordance with the standard of equipping the psychoneurological dispensary in accordance with Appendix No. 3 to the Procedure for the provision of medical care for mental disorders and behavioral disorders, approved by this order, depending on the volume and type of medical care provided.
Functional responsibilities of a nurse in the psychoneurological department. Home > Paramedic. Functional responsibilities of a nurse in the psychoneurological department. Psychiatric care to the population is provided by the work of a psychoneurological dispensary and a psychiatric hospital. Patients registered at a psychoneurological dispensary and newly identified patients, if necessary, are sent for treatment to a hospital. When hospitalizing patients in a hospital, medical personnel must obtain their consent for hospitalization and treatment. Compulsory treatment is necessary only when the patient is inadequate, unable to be critical of his condition, if he poses a danger to himself and others.
A psychiatric hospital consists of an emergency department, a general psychiatric department, and specialized departments. The hospital is equipped with diagnostic laboratories, X-ray and physiotherapeutic rooms for a full examination and treatment; specialists from various specialties work to carry out advisory work. Also, at the psychoneurological hospital there are places for occupational therapy, various workshops, and a library for the rehabilitation and adaptation of psychiatric patients. A simple psychiatric hospital ward has two halves: a restless one and a calm one.
The restless half contains patients with inappropriate behavior in an acute state: delusions, hallucinations, psychomotor agitation, and stupor. Such patients require constant supervision by medical personnel, as they can cause harm to themselves and other people. Patients who need special observation and care are placed in a special ward - an observation room, where a nurse and a nurse are constantly present. In the calm half there are patients during the recovery period, when they have adequate behavior, when they can take care of themselves and are not dangerous to themselves and others. In the department of a psychiatric hospital, all doors are always locked with a key, which is kept only by doctors and nursing staff.
Windows must be barred or glass must be unbreakable. Windows should be located so that patients cannot reach them. The responsibilities of medical personnel in a psychoneurological hospital differ from work in other somatic hospitals. Differences in work mainly depend on the number of patients being treated. Some patients cannot critically assess their illness, or do not consider themselves sick at all. Mental patients often experience attacks of agitation and aggressive behavior, which is dangerous for medical personnel. Therefore, there are several mandatory rules of conduct and care in a psychiatric ward for all medical personnel.
Medical staff in psychoneurological hospitals must constantly show vigilance, patience, sensitivity, politeness, and attention to patients. Medical workers should avoid wearing bright cosmetics and wearing jewelry (beads, earrings), which can be torn off by patients with psychomotor agitation. Nurses wear a gown and cap. Hair must be tucked under a cap. With patients, despite their behavior, even aggressive, it is necessary to communicate patiently, politely, and kindly. Often the behavior of psychiatric patients leads to tragedies, so the nurse must be vigilant and never turn her back on the patient. Medical staff must ensure that all doors are closed to prevent keys from falling into the hands of patients.
The personal belongings of patients prone to suicide should be regularly checked for the presence of sharp, cutting objects, cuttings, chips, wire, pens, hairpins, matches, hairpins, anything with which the patient can open the door or cause harm to himself and others. The personal belongings of other patients are also periodically inspected. It is better to carry out an inspection of personal belongings when the patient is not in the room (the patient is in the dining room, bathroom, on a walk), this spares the feelings of the patients. If it is necessary to immediately look through the patient's belongings, he is called to the doctor's office or to another place outside the ward.
During meals, patients are served food that can only be eaten with a spoon. The room where cutlery (knives, forks) and other items are located should always be closed so that patients cannot freely enter there. In organizing the coordinated work of a psychiatric department, the work of a nurse plays an important role, who not only carries out doctor’s appointments, medical manipulations, and care for patients, but also helps patients in recovery and rehabilitation. The nurse must be well aware of the number of patients in the department every day, know the patients by name, patronymic, surname, in which wards each of them lies, the reasons for the absence of some of them. She must know about the mental illness of each patient, the characteristics of its course, the current state, and the treatment provided to him. The nurse must know what orders the attending physician has made and strictly carry them out at a certain time.
Communication between a nurse and patients should be smooth, serious, patient, and caring. You cannot be overly ingratiating and liberal with the sick.
It is impossible to single out “favorites” among the patients of the department and pay attention only to them, forgetting about the other patients. The nurse must strictly monitor the regime in the psychoneurological department, since its maintenance is the key to successful treatment of mental patients. Medical personnel are obliged to monitor their speech; in the presence of patients, even those in catatonia, conversations on extraneous topics should not be allowed, as this can cause harm to the patient’s mental state. It is prohibited to talk about the state of his health or the health of another patient in front of a patient, or make any predictions.
You cannot joke with patients, laugh at them, or talk with irony. The nurse should always give clear, truthful answers to patients’ questions; when this is not possible, it is better to change the topic of conversation.
Patients with delirium require a more sensitive and patient attitude; they often doubt the correctness of treatment, and speak out about the dangers of being in the hospital for their health and even life. Such patients do not need to be strongly dissuaded; this can lead to the opposite effect and cause even greater distrust of the medical staff. The nurse must politely and calmly explain to the patient that he is wrong, that he is sick and needs treatment, that no one here will harm him. When working in a psychiatric department, you should not be afraid of patients, but you should not underestimate them either, as this can be dangerous to the health of the medical staff. Some patients show aggression towards others, and one should not show a negative attitude towards such patients, since this condition is caused by the disease.
Quarrels and even fights often break out between patients; the nurse should not take the side of one patient. She must stop the fight by calling paramedics and a doctor. Patients with severe agitation require special care. Excitement occurs in schizophrenia and manic-depressive psychosis. In the treatment of such patients, the use of drugs is effectively used: aminazine, hydrochloride, hexenal, barbamyl. All drugs are administered parenterally. When excited, patients rush around, fight, swear, scream, and often have to be forcibly restrained in bed.
The nurse must have the skills to fix the patient and be able to explain this to the orderlies. To restrain the patient, he is placed on a bed, and orderlies press his arms and legs while the nurse administers drugs. If long-term fixation is necessary, soft elastic tapes are used; the period of fixation of the patient is determined by the doctor.
A patient with epilepsy usually falls, loses consciousness, and has convulsions during a seizure. To prevent bruises, such patients are placed on a low bed or on the floor during an attack. It is necessary to unfasten clothes, to avoid aspiration of vomit, the patient’s head is turned to the side. A spoon is placed in the patient’s mouth between the molars (if you place a spoon between the front teeth, this can lead to them breaking during a seizure), wrapped in gauze so that the patient does not injure the tongue with the teeth. After an attack, the patient falls into a long sleep, after which the patient is in a bad mood and does not remember anything about the attack. The patient in this condition must be given rest.
Weak and bedridden patients need constant nursing care. Such patients are fed by a nurse or orderly, mainly with liquid food, being careful so that the patient does not choke, they carry out hygienic measures, change underwear and bed linen.
They carry out the prevention of bedsores; for this, the patient must be constantly turned over in bed, under places of particular compression. Skin. the patient must be constantly examined if areas of hyperemia appear. If the patient has.
The nurse must also be vigilant about the numerous requests of patients - for this, you first need to weigh and think about all the possible consequences. You need to know that psychiatric patients can hide some manifestations of their pathology and deceive, so even seemingly harmless requests can cause significant harm to the patient himself and those around him. The nurse must also monitor and read the letters that the patients themselves write and that their relatives give them. Letters from patients with clearly delusional content cannot be sent; the nurse gives them to the doctor.
Letters from relatives are also read by medical staff, because some news can harm the patient’s mental state and interfere with treatment. It is necessary to check the products and things brought by relatives, as they may contain something that is not allowed for the patient or may cause harm: alcoholic beverages, drugs, razors, blades, knives, needles.
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Sample job description for a ward nurse in a psychoneurological boarding house
Sample job description for a ward nurse in a psychoneurological boarding house, 1 votes
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On strengthening measures to prevent epidemiological typhus and combat pediculosis.” 6. Order of the Ministry of Health of the Russian Federation No. 36 of 02/03/1997 “On improving measures for the prevention of diphtheria.” IMPROVEMENT OF QUALIFICATIONS. Working as a nurse, I constantly improve my professional level and attend all nursing studies. Annual testing according to orders No. 408, according to OST, nosocomial infections, emergency care, OOI, test tasks for nurses in the infectious diseases department. To educate myself and improve my professional level, I constantly read medical literature. I systematically improve my qualifications by studying relevant literature, participating in conferences and seminars.
Job description of a neurological nurse
Responsibilities of the head nurse The main vocation of the head nurse is to use with maximum efficiency the professionalism of the department staff in order to provide medical care at a high level. The head nurse of the department is appointed in accordance with the recommendation of the head. This position is usually filled by a nurse with a high level of professionalism.
Important
She must have management skills. She has at least 5 years of experience working in a medical facility. As a financially responsible person, she monitors the equipment and equipment in the department. The head nurse takes part in all meetings held on the hospital ward.
A specialist of this level acts as an organizer of work for mid- and junior-level medical personnel, and is responsible for discipline in the team and maintaining order at work.
Info
A clinic nurse must constantly improve her professionalism. What are the responsibilities of a department nurse? The functional responsibilities of a department nurse are as follows:
- monitoring the general condition of the patient;
- implementation of patient care activities;
- fulfilling prescriptions given by the doctor;
- communication on a professional level with medical personnel, patients and their relatives;
- preparing patients for examinations;
- compliance with hygiene standards in the department;
- maintaining documents in the prescribed form.
A nurse working in the department must be able to do all types of injections and use a sterile table and tray. She is obliged to change the patient’s underwear, both underwear and sleeping.
Her responsibilities include measuring the patient's temperature, pulse and blood pressure.
Functional responsibilities of a nurse in the neurological department.
The functional responsibilities of the head nurse include drawing up reports for the supply of necessary equipment, medicines and instruments. The head nurse is responsible for occupational health and safety. She personally draws up the work schedule of her subordinates and allocates their vacation time. She maintains payroll records and issues sick leave certificates for temporarily disabled employees. A nurse of this profile keeps records of medications containing toxic, narcotic and potent substances and controls their use. Its functions include monitoring the cleanliness of dressings and sterilization of medical instruments.
Job Description for a Nurse in a Psychiatric Clinic
SAMPLE JOB RESPONSIBILITIES of a nurse in the neurological department (office) 1. A specialist with secondary medical education and special training is appointed to the position of nurse in the neurological department (office). 2. A nurse in the neurological department (office) is appointed and dismissed by the chief physician (head) of the clinic in the prescribed manner.
3. In her work, the nurse of the neurological department (office) is guided by the regulatory legal acts of the Republic of Belarus, the Regulations on the clinic, the Regulations on the neurological department (office), orders and instructions of the chief physician, orders of the chief nurse and neurologist, and job descriptions. 4.
Functional responsibilities of a nurse in a clinic and department
VYKOV I have professional skills in accordance with the requirements in the field of “Nursing”. I know: - theoretical foundations of nursing; — organization of nursing care for patients according to the stages of the nursing process; — psychology of professional communication; — basics of dietetics; — main causes, clinical manifestations, diagnostic methods, complications, principles of treatment, prevention of diseases and injuries; — main drug groups and their indications, contraindications, complications of drugs, regulatory documents regulating the pharmaceutical procedure in medical institutions; — infection control system, infectious safety of patients and staff of a medical institution; — main types of medical documentation; — safety precautions and labor protection in medical institutions; — health insurance system; — medicine of disasters and emergency situations.
Job description of a nurse in the pre-medical reception room
In my work, I pay great attention to: - the culture of relationships with colleagues, doctors and other nurses in the clinic and hospital - the attitude towards one’s own health. I try to maintain the authority and reputation of my profession. I observe the rules of personal hygiene - an integral quality of a person.
Attention
I pay due attention to my workplace and do not allow violations of the sanitary and hygienic regime. My work is proactive and creative. In my work, the following are not acceptable: ambition, raised tone, imposition of one’s own opinion, personal hostility. I accurately and skillfully provide medical care to patients who seek help.
The way I look plays an important role in communicating with subordinates and patients. A snow-white, starched robe is my visual characteristic.
403 forbidden
Responsibilities To perform her functions, the nurse in the neurological office is obliged to: 1. Prepare workplaces before an outpatient appointment with a neurologist, monitoring the availability of the necessary medical documentation, equipment, inventory, checking the serviceability of equipment and office equipment. 2. Prepare and submit patient self-registration sheets and doctor’s appointment vouchers for the current week to the reception desk. 3. Before the start of the appointment, bring from the card storage medical records of outpatients, selected by the registrars in accordance with the self-registration sheets. 4. Monitor the timely receipt of research results and paste them into the medical records of outpatients. 5. Regulate the flow of visitors by recording the appropriate time on self-registration sheets for repeat patients and issuing coupons to them. 6.
Abstract: acquisition of professional skills
In my work I use literature: Nurse's Directory, magazines: “Nursing”, “Nursing”. Health education is one of the important and effective methods of disease prevention and control. Propaganda of prevention issues consists of two main components: - hygienic training and education of the general population - preventive propaganda (primary prevention).
It is carried out in two directions - a) dissemination of knowledge about prevention among the general population. It is important that this work is carried out correctly methodically - only in terms of targeted information designed to ensure early detection of the disease and mass participation of the population in activities aimed at strengthening the body's defenses; -b) hygienic education of the patient and their family members.
The nurse of the neurological department (office) is responsible for failure to perform or improper performance of their official duties, non-compliance with labor and performance discipline, internal regulations, medical ethics and deontology. ^ SAMPLE REGULATIONS for the cardiology office of a city clinic 1. A cardiology office, as a structural subdivision of a city clinic, is created in the absence of a cardiology clinic on the territory of the city. If there is a cardiology clinic, a cardiologist from the clinic may work in the office.
2. The management of the cardiology office is carried out by a cardiologist, who is appointed and dismissed in the prescribed manner by the chief physician of the clinic. 3.
The main tasks of a cardiologist are the development and implementation of preventive measures, early identification and effective treatment of patients suffering from diseases of the cardiovascular system, living in the area where the clinic operates, 6. Evaluation of the work of a cardiologist is carried out by the deputy chief physician of the clinic for the medical department based on the results of the work for the quarter (year) based on taking into account the qualitative and quantitative indicators of his work, his compliance with the requirements of fundamental official documents, labor discipline rules, moral and ethical standards, and social activity. 7. In accordance with the tasks assigned to the cardiology office, the cardiologist: 7.1.
conducts outpatient appointments according to a schedule approved by the administration of the clinic, regulating the flow of visitors by rationally distributing repeat patients; 7.2.
Functional responsibilities of a nurse in the neurological office of the clinic
The obtained data is clearly recorded in the patient’s graphic sheet. The department nurse knows how to fill out all the necessary documentation. In addition, her responsibilities include:
- preparing bixes for sterilization;
- taking an ECG;
- applying compresses, cupping, enemas and heating pads;
- tying the limbs with an elastic bandage;
- implementation of preventive measures to prevent the occurrence of bedsores;
- gastric lavage;
- acceptance and handing over of duty.
District nurse The district nurse carries out diagnostic and treatment procedures in accordance with the doctor’s prescription. The functional responsibilities of a district nurse are quite broad. She must prepare the office to receive patients. Under the supervision of a doctor, certificates are issued, prescriptions are issued, referrals for examinations and other medical documentation is completed.
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Psychiatric nurse
1. The concept of psychosis
2. Nursing process in psychiatry
3. Nursing examination of the patient
Conclusion
List of literature
1. The concept of psychosis
Psychosis is a pronounced mental disorder, manifested entirely or predominantly by a sharp inadequate reflection of the surrounding reality with behavioral disturbances, changes in various aspects of mental activity, which is manifested by behavioral disturbances and the occurrence of phenomena not characteristic of the normal psyche (hallucinations, delusions, psychomotor, affective disorders, clouding of consciousness, etc. .).
There are acute and chronic psychoses.
Acute psychoses occur predominantly as acute exogenous reactions. The possibility of acute onset of endogenous psychoses remains controversial. It is believed that in most cases there is an exogenous provocation of an endogenous disease.
Chronic psychoses are characterized by a long-term, most often progressive course, with the formation of a mental defect in the first place.
turn in thinking and emotionally personal sphere.
Emergency medical care is required by acute (including suddenly developed) mental disorders (delusions, hallucinations, psychomotor agitation, etc.), accompanied by an incorrect assessment and interpretation of what is happening, ridiculous actions when the patient’s actions become dangerous for him and others.
myocardium, etc.).
2. Nursing process in psychiatry
The nursing process involves achieving certain goals in providing assistance to persons with mental disabilities and can be divided into 5 stages.
The first stage includes medical history, physical examination, and laboratory data. The nurse collects information about the patient, examining all areas of his life, and determines the need for care. An important aspect of the work of a psychiatric nurse is observation. When communicating, the nurse pays attention to the patient’s behavior (natural or simulated), his facial expression, intonation, posture, as well as psychopathological disorders of perception, thinking, emotions, consciousness, memory, and intellect. Collecting information will determine whether the patient can function as an independent person or whether he needs outside help.
At the second stage, the patient's problems are identified. There are existing problems that the patient is currently experiencing (anxiety, fear, pain) and potential ones that may arise due to improper treatment or care. An important task of this stage is the formulation of a nursing diagnosis, which is aimed at identifying the body's responses to the disease and can be recorded as pain, weakness, restlessness, anxiety, sleep disturbance and requiring nursing intervention.
At the third stage, the nurse draws up a nursing intervention plan, taking into account the individual characteristics of the patient. It is a detailed listing of the nurse's actions necessary to provide nursing care. The nurse must clearly understand the patient’s personality, his environment (family, relatives) and what goals and objectives she sets for herself in order to help the patient adapt to new conditions for him due to the disease.
The fourth stage is the implementation of the action plan. Its main goal is to provide appropriate care according to a plan to meet the patient's needs and speed up his recovery. It is carried out with the help of independent nursing interventions, when the nurse takes actions on his own initiative (teaching self-care skills, etc.), dependent (doctor's orders) and interdependent (joint activities of the nurse with other specialists, for example a psychologist).
Stage 5 - assessment of the results of care. It consists in determining the effectiveness of the work performed by the nurse herself, the patient and his relatives. When analyzing the results of care, the mental, somatic and social status of the patient is assessed and, if necessary, the nursing action plan is revised, taking into account the patient's feedback on the care received.
A psychiatric nurse, in comparison with other employees of a medical institution, spends the most time with the patient, knows perfectly his experiences, which are associated with both the disease and social and other problems. Quality nursing care is only possible through a partnership between the patient and the nursing staff. The basis of trust necessary for treatment arises when the nurse shows herself as a real person, accepts the patient as he is, without judgment, shows interest in the patient and tries to understand him. Problems may arise if the patient confides important information to the nurse that he has not told anyone else. In this case, the nurse should make it clear to the patient that such an exclusive relationship is not allowed.
According to the stages of the nursing process, the nurse has a framework for making decisions and resolving patient problems when providing nursing care. A nurse's diagnosis is an integral part of her work.
Possible nursing diagnoses for psychiatric patients:
1. Disturbed adaptation
2. Hopelessness.
3. Change in perception: visual, auditory, tactile,
olfactory.
4. Violation of self-esteem.
5. Impaired ability for introspection, introspection and
self-knowledge.
6. Broken communication.
7. Social isolation.
8. Stress syndrome, etc.
Caring for patients with mental disorders has a number of specific features. First of all, it is necessary to take into account that the nurse is dealing with a person who, due to illness, cannot control his emotions and actions. Therefore, caregivers of a mentally ill patient must be constantly alert to prevent the occurrence of possible violent episodes or seizures. It is also impossible to do without such qualities as patience, vigilance and resourcefulness, since in the treatment of mental illness it is very important to provide the necessary assistance in a timely manner and be able to react correctly in
the current situation. Caring for patients should consist not only of physical, but also of moral support. Therefore, a sister caring for a mentally ill person must be a polite, friendly, affectionate and sympathetic person. When caring for patients with mental illness, it should be taken into account that many of them cannot care for themselves. The patient needs constant assistance in solving seemingly simple issues: washing himself, getting dressed, eating, and even getting out of bed.
Eating should be done regularly. Since people with mental disorders spend a lot of energy, they need a varied diet. A sick person should be given food in small portions, making sure that
he didn't choke. For swallowing disorders, it is preferable to give liquid food.
You should monitor the patient’s meal schedule, the dispensing of medications, and monitor the condition of the skin. This is especially important in cases where the patient does not get out of bed. It is advisable to cut his hair short. It is necessary to change the patient’s underwear daily and help take hygienic baths. Nursing also includes routinely taking patients to the toilet.
Nursing care includes monitoring the administration of medications.
Care must be taken to ensure that the patient immediately takes the medications given to him. Some patients may collect medicine in order to
to drink everything at once, which can lead to poisoning. Be sure to remove and lock all sharp objects, medications and household chemicals from a person with mental disabilities. The nurse must keep track of the keys to the room and department. Particular attention should be paid to patients who are depressed, have suicidal tendencies, hallucinations or delirium tremens. Such people may try to commit suicide.
The psychiatric department has a mandatory daily routine for everyone with precisely fixed times for getting up in the morning, eating, taking medications and other medical procedures, walking, occupational therapy, cultural entertainment, and going to bed. Nurses pay close attention to organizing the medical and protective regime in the department. The regimen helps to normalize the behavior of patients and restore the rhythm of sleep and wakefulness that is often disturbed in them. Patients' night sleep should last 8-9 hours, afternoon rest should last at least 1 hour; Patients take food 4 times a day. The duration of medical work depends on the profile of the department and the condition of the patients. Patients take a weekly hygienic bath, after which their bed and underwear are changed. Patients in a state of psychomotor agitation, as well as somatically weakened, unkempt, and stuporous patients are prescribed bed rest. As a rule, such patients are placed in an observation ward or in a special ward for weak patients. Medicines are given by nursing staff strictly as prescribed by the doctor. A single dose of medication must be taken in the presence of a nurse. Otherwise, there is a danger of accumulating and taking medications for suicidal purposes. When applying bandages and compresses, it is also necessary to ensure that the patient does not collect
bandages and gauze, as they can also be used for suicide. If
There are no special contraindications, then patients are regularly, at least once a day, taken for a walk under the guidance and supervision of staff. The list of patients for the walk is endorsed by the doctor. The nurse must
know the number of patients taken out for walks. During the walk, special attention is paid to patients with a tendency to escape and suicide. The same rules are observed when accompanying patients to occupational therapy workshops, to outdoor work, to a club and other premises. An integral part of the nursing process is the prevention of the occurrence of psychosis in patients, measures to organize a clear regime, as well as the work and rest of patients, an important task of the nurse.
3. Nursing examination of the patient
Acute mental disorders are identified primarily during a conversation with the patient, during which the patient’s management tactics are determined.
The main objectives of such a conversation:
* establishing initial contact;
* establishing a trusting relationship between the health worker and
patient;
* determination of diagnosis at the syndromic level;
* development of a plan for the provision of medical care and further
The correct psychotherapeutic tactics carried out by a nurse in relation to a patient with acute psychosis can sometimes replace drug care or, in any case, be an extremely important addition to it. There are several conditions that must be adhered to:
* when talking with a tense, delirious patient, do not take any notes in front of him, do not be distracted by other patients, and under no circumstances show the patient your fear of him;
* behave kindly towards the patient, avoiding either rudeness or familiarity, which can cause a reaction of irritation; it is better to address him as “you” and maintain a “distance” that does not offend the patient;
* do not start the conversation with questions about the disease, it is better to ask a few formal or “calming” questions, talk “about this and that”;
* demonstrate to the patient your desire and readiness to help him; do not argue or dissuade him; One should not, however, recklessly agree with all his statements, much less suggest possible answers to questions that are delusional in nature;
* do not discuss his condition with others in the presence of the patient;
* do not lose “psychiatric vigilance” for a single minute, since the patient’s behavior at any moment can change sharply; there should be no objects suitable for attack or self-harm near him; he should not be allowed to go near the window, etc.
Conclusion
Nurses are the main curators of patients???. They provide basic care and accompany patients??? for walks, manipulations, teaching patients??? self-service skills, i.e. spend their working time with the patient in order to identify his problems, monitor the dynamics of his mental state, and provide assistance to patients in adapting to living conditions. That is, the functions of a nurse are not limited to performing nursing manipulations, but include elements of medical, social, psychological and pedagogical work. The nursing process brings a new understanding of the role of the nurse in practical healthcare, requiring from her not only good training techniques, but also the ability to creatively relate to patient care, the ability to work with him as a person, and not as a nosological unit. Constant contact with the patient makes the psychiatric nurse the main link between the patient and the outside world. The nurse's task is to clarify his concerns and help him eliminate his illness. Thus, when working with mental patients, constant vigilance, restraint, patience, resourcefulness, a sensitive, affectionate attitude and a strictly individual approach to patients on the part of the nurse are important. patient nosological nursing psychiatry
List of literature
1. Golenkov A.V., Averin A.V. Nursing process in psychiatry: Textbook. allowance. Cheboksary: Chuvash Publishing House. Univ., 2003. 200 p.
2. Golenkov A.V., Kozlov A.B., Averin A.V. etc. // Nurse. 2003. No. 1. P. 6-9.
3. Golenkov A.V., Kozlov A.B., Ronzhina L.G. and others. Nursing record of an inpatient with mental disorders: Method. instructions. Cheboksary, 2002. 44 p.
4. Kozlov A.B., Golenkov A.V., Averin A.V. and others. Modern technology of nursing care and its standards in a psychiatric clinic: Method. instructions. Cheboksary, 2002. 52 p.
5. Mental disorders: Textbook. allowance. /Trans. from English; Under general ed. G.M. Perfileva. M.: GEOTAR-MED, 2001. 72 p.
6. Nursing process: Proc. allowance. /Trans. from English; Under general ed. G.M. Perfileva. M.: GEOTAR-MED, 2001. 80 p.
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Certification work
I. Information about professional education and all forms of post-graduate training
VIII. Organizational and expert activities, participation in professional activities
IX. Evidence of public recognition
X. Carrying out professional activities from the perspective of basic legal documents
Information about professional education and all forms of post-graduate training
I, Fio, was born _______, in ______. Graduated from ________________ medical school, _________ department.
She began her career in _______________ (where by whom).
From 19___ to 19___ worked as a nurse in
List all places of work
From 19_____ to the present time I have been working in (place of work), (position) of the same department.
I have specializations: (list of specializations, if any)
In 19___ took a specialization course in “Nursing in Psychiatry”, and in 19______ she studied at advanced courses in the same specialty at (name of medical school).
In 20____, she took a specialization course in “Organization of Nursing” at the Secondary Professional Educational Institution of the Mining and Metallurgical Complex and was awarded the highest category.
In 20___ I studied at the advanced training courses “Nursing in Psychiatry” at the Secondary Professional Educational Institution of the Moscow Mining and Metallurgical Complex - confirmed the highest category.
In 20___ re-took the specialization course “Nursing in Psychiatry” - confirmed the highest category.
Total work experience ___ years. In psychiatry -- ___years
II. General characteristics of the healthcare institution
The name of the institution is located on the territory of .... district, city..... Located in …..
All divisions have a single management apparatus, which includes the following departments and divisions:
Administration, accounting and planning department
Statistics Department
Dispensary department, where outpatients are received and treated, dispensary observation, monitoring of patients at home,
social assistance is provided to patients.
Department of Borderline Neuroses
Day and night hospital
Narcology department
Two men's departments, two women's departments
Reception department where reception and “sorting” are carried out
patients admitted to inpatient departments
X-ray room
Department of Laboratory Diagnostics
Laundry
Catering department, housekeeping service
In addition there are:
Dental office
ECG rooms; EEG; physiotherapy room
Ophthalmologist's office
Psychotherapy room
Other support services.
2.1 Workplace organization
Acute psychiatric (male, female) department No. XX has XX beds. Served (men, women) and teenagers from the age of 15... and... districts of.... . with a population of...thousands of people
The department is divided into... posts.
At the first post there are: ... wards (for ... people), nursing, bathroom, head nurse's office, bathroom, box.
At the 2nd post there are ... wards (for ... people), a psychologist's office, the housewife's sister's office, a bathroom, a bathroom, a utility room for cleaning equipment.
The department also has a hall, a resident's room, an office for the head of the department, a treatment room, a dining room, and a bathroom. room for employees.
The department provides the following types of assistance:
emergency psychiatric care and treatment of patients with acute mental conditions and states of decompensation;
planned psychiatric care, hospitalization for social reasons;
military examination to resolve issues of suitability for military service of persons of military age;
labor examination to resolve issues of work ability;
compulsory treatment
treatment of drug addicts;
consultations with doctors of somatic specialties and therapy of concomitant diseases;
social rehabilitation measures.
Indicators of staffing with paramedical personnel
Table 1 Nursing staff
|
Reporting period |
Subdivision |
Number of staff positions |
Number of occupied positions |
Number of individuals |
Staffing of full-time positions with individuals (%) |
Staffing of regular positions with occupied positions (%) |
Part-time ratio |
|
The table shows that in 2013, the department hired... nurses. The nurse resigned of her own free will. All nurses have the highest qualification category. Low staffing level of nursing staff due to low wages and difficulty of work in the acute department.
Table 2 Main performance indicators of the department for the period 2011 - 2013
|
Indicator |
|||||
|
Average monthly number of beds |
|||||
|
Percentage of plan completion by bed days |
|||||
|
Actual bed turnover |
|||||
|
Average length of stay for a discharged patient |
|||||
|
Patients received |
|||||
|
Patients dropped out |
|||||
|
Of these, discharged |
|||||
|
% of repeat admission per year |
|||||
|
% of first-time admissions per year |
According to these indicators, it is clear that in 2013 the occupancy of the department increased and the plan for bed days was exceeded. The main group of patients admitted to the department are repeat patients. Repeated hospitalization is due to:
Arbitrary withdrawal of maintenance therapy by patients;
Lack of control over medication intake by relatives;
The presence of a pronounced psychopath-like defect in the patient;
The presence of unfavorable living conditions and various stressful situations.
In the department, up to 15% of the bed capacity is blocked by patients with long stays: patients with an unfavorable course of the disease, which does not allow the patient to stay at home; the presence of socially unsettled patients who have lost their housing, lost their guardian, their registration and are awaiting transfer to social protection institutions.
Noteworthy is the gradual increase in the number of initially admitted patients, which positively characterizes the dispensary diagnostic and treatment service. There has been an increase in the number of admissions of drug-dependent young patients, patients with alcoholic psychoses, and suicidal tendencies.
Treatment methods used
In 2013, the following were actively used:
Atypical antipsychotics and modern antidepressants due to their availability;
The level of consumption of traditional antipsychotics, antidepressants, and mood stabilizers remained almost the same, which indicates the relevance of these drugs in the provision of emergency psychiatric care;
Most of the "primary" patients were treated with "modern drugs";
The presence of “atypicals” and SSRIs in the department made it possible to more effectively treat patients who cannot tolerate typical antipsychotics and antidepressants.
Cholinesterase inhibitors have also been actively used; akatinol-memantine - in patients with organic damage to the central nervous system, mnestic disorders, depressive symptoms. In addition to “traditional” psychopharmacotherapy, treatment methods such as:
Cancellation method - 12 people
Zigzag method - 4 people
- “lacquer blood” - 21 people
Psychotherapy and psychocorrection - 15 people.
methods of changing the body's reactivity - 37 people
The department is constantly working on:
control of potent drugs (at least once a month);
organization of food and care for patients;
maintenance of medical equipment.
For this purpose, housekeeping rounds are regularly carried out with the manager. department, senior nurse (at least once a week). Logs of potent drugs are kept, and food from the catering unit is checked daily.
At least once a month, the department's senior nurse carries out maintenance. studies on topics:
Patient care and supervision;
Sanitary and epidemiological regime, clinical picture and tactics for HCAI, tuberculosis, pneumonia, acute intestinal infections, HIV infection, especially dangerous infections. Topics are discussed unscheduled in the event of emergencies, quarantines, violations of sanitary and epidemiological regulations, patient supervision, and conflict situations with patients and their relatives. The department maintains a technical log. study.
In 2013, there were no quarantines in the department for acute respiratory infections; there was one case of pneumonia in a newly admitted patient.
The department actively operates a treatment room, where intramuscular, intravenous, subcutaneous injections, drip infusions, vaccinations, and blood sampling are performed.
In 201, 1935 injections were made, of which:
IM injections - 1274;
IV injections - 340;
IV drip - 321.
The volume of work has increased compared to 2011 - 2012.
During the year: 117 people were examined for HIV. (5 results “+”); for HbsAg +C - 276 people. (12 results “+”); on RW - 17 people. (1 result “+”).
Approved medical documentation:
Patient intake log;
Patient observation log;
Journal of Physical Restraint Measures;
Home Leave Log;
Logbook for subject-quantitative preparations;
Emergency log;
Notebook for obtaining medications, medical instruments, dressings;
Treatment card, temperature sheet, surveillance grid, somatic observation sheet, seizure record;
Journal of infectious diseases (f.060/u);
Logbook of examination and identification of registration of head lice in patients in the department;
Journal of emergency situations during medical procedures;
Logbook for registration and control of operation of an ultraviolet bactericidal installation.
2.2 Responsibilities of the head nurse
The basis of the work of the head nurse is the organization of work of middle and junior medical staff, monitoring the performance of medical staff of their duties: the quality of sanitary treatment of patients, compliance by staff and patients with the established regime for the department, internal labor regulations, taking medications by patients, and carrying out therapeutic measures.
I ensure the correct placement of middle and junior staff with subsequent approval by the head of the department, and carry out timely replacement of nurses and orderlies who do not show up for work. I draw up a work schedule and timesheets, agreed upon with the manager. department. I draw up a staff vacation schedule for the year. I submit an application to the HR department for employee training and help with paperwork. I make lists for medical examinations of employees and monitor implementation.
I organize the necessary supervision of patients and monitor its implementation by medical staff. I monitor and regularly check the implementation of doctor’s orders by the procedural nurse and ward nurses. I am present and help during complex manipulations (feeding through a tube, sampling of cerebrospinal fluid, etc.), during medical procedures. procedures for weakened and agitated patients. I control the quality of the dignity. processing of all newly admitted patients and department patients (according to the bathing schedule).
I control the transfer of patients to other hospitals (preparation of clothing, documentation), provide an accompanying person and transport, organize individual posts in other hospitals (for agitated and weakened patients).
I ensure and monitor compliance with the rules of the sanitary and epidemiological regime by staff, compliance with the rules of asepsis and antiseptics, especially in the treatment room. I monitor the correct storage and use of disinfectants. funds.
I monitor the implementation of the principles of the medical and protective regime of the department.
I write out portion sheets. I control the receipt, delivery, and distribution of food. I participate in feeding weakened patients and patients with food refusal. I monitor food transfers to patients and their storage. I am present during meetings between patients and relatives.
I am a financially responsible person. I write out requirements for medications, honey. instruments, patient care items, receiving them, distributing them and monitoring their use and proper storage. I ensure the safety of property and medical care. inventory in the department and its timely repair. I provide doctors and nurses with the necessary forms and documentation.
I compile reports on the movement of patients for the statistical office, monitor the timely submission of medical histories of discharged patients and the timely receipt of documents from the archive for re-admitted patients.
I accept valuables and documents of admitted patients from the duty nurse of the emergency room, keep records of them, ensure their safety, and arrange for their issuance upon discharge.
I maintain documentation and am responsible for the correct documentation by nurses. I submit monthly and annual reports.
I'll see you off. studies with newly admitted employees: primary and at the workplace (through 5-7 shifts of work) and with all employees of the department twice a year (sanitary and epidemiological regime, job responsibilities, security regime, safety precautions, medical waste).
Under the leadership of the head. The department is developing a plan for improving the professional knowledge of secondary and junior medical staff. staff in the department for a year. Doctors, the head nurse and nurses of the department participate in conducting classes in the department.
I constantly improve my professional qualifications. I participate in the work of the hospital's Council of Nurses and scientific and practical conferences for nurses.
I am the curator of the catering department: I check the sanitary condition, the quality of products, the stocking and quality of ready-made dishes.
I participate in the work of a multidisciplinary team: restoration of lost documents of patients; preparation of documents for the transfer of patients who have lost housing and a guardian to social protection institutions; purchasing food, hygiene items, and necessary clothing for patients without relatives; instilling in patients the skills of personal hygiene and self-care.
2.3 Responsibilities of a nurse
The main responsibility of the ward nurse is to treat patients humanely; I must do everything in my power so that the patient and relatives do not have fear of the psychiatric hospital. When I go on duty, I see a number of patients. I accept the report from the previous duty shift on newly admitted patients. I check the sanitary condition of the entire department, introduce junior medical staff to patients who require special attention, and point out aggressive patients who are prone to escape and suicide. I make sure that the nurses do not leave their post. I take registered, potent and expensive medications. I sign for quantitative appointments in special journals, and I sign in the journal for the delivery of medical instruments. After receiving the shift and after the end of the planning meeting, I begin to prepare the patients for breakfast. I make sure that all patients get up on time, wash themselves, and put their bed in order. I help the barmaid set the tables for meals. During meals, I make sure that all patients eat. When refusing food, I try to persuade the patient; I myself feed weakened patients. After meals, I control the number of spoons handed over, which can be used by patients in case of suicidal behavior and escape.
After feeding, I begin distributing medications and check that the doors to the bathroom and toilet rooms are closed. When distributing medications, there must be a nurse nearby to ensure that pills are taken under strict control. After taking the medications, injections are given. On weekdays, procedures are carried out by a treatment nurse, and on weekends and in the evening by a ward nurse. During the shift, according to the entries in the consultation log of medical specialists, I send patients, accompanied by junior staff, to the above consultations. Must be present when doctors visit patients. During the rounds, care must be taken to ensure that all patients are near their beds; the toilet is closed during this time. After the round, I carry out, as directed by the doctor, the transfer of patients from one ward to another or to another post. I send patients on home leave, fill them with medications and schedule their appointments. I receive the valuables from the head nurse against signature and give them to the patient after he signs the medical history for his valuables. I register everyone who went on home leave in a log where their full name is indicated. patient, home address and duration of home leave. When the patient is discharged, the same measures are taken.
As prescribed by the doctor, I do cleansing enemas, remove urine with a catheter, make compresses, treat wounds, do various dressings, put drops in the eyes and ears, measure blood pressure and body temperature.
Together with junior medical staff, I wash patients once a week and, if necessary, cut nails once a week. I check for lice upon admission and once a week. All events are held under strict supervision. Every day, relatives give packages to patients and come for visits at the time established by the regime. I check everything that relatives bring, I monitor the sell-by date, expiration date and container. I supervise patients during the entire shift: I make sure that patients do not cover their heads with a blanket while sleeping, I accompany patients to the toilet and do not leave them alone. At the end of each shift, I describe the patients who have changed in behavior. I must always be prepared to provide emergency assistance or in case of suicide attempt or aggression. You must immediately inform your doctor about this, do not panic and remain calm.
Supervision helps prevent all kinds of emergencies in a psychiatric hospital. With its help the following tasks are solved:
the state in which the patient is located and its dynamics are clarified;
Possible dangerous actions are prevented.
The hospital carries out 5 types of strict supervision:
Depressive-suicidal;
Aggressive - impulsive;
For epileptic seizures;
By escape;
Somatic.
Depressive-suicidal supervision is prescribed to patients who are depressed in combination with anxiety, delusional disorders, auditory hallucinations (blaming, imperative) due to the presence of ideas of guilt and sinfulness. Such patients are at risk of making suicide attempts.
Monitoring the behavior of such patients requires especially close attention. A department employee accompanies the patient every time he leaves the room, controls the intake of food, medications, and the presence of foreign objects.
Aggressive-impulsive supervision is prescribed to patients prone to impulsive actions who are in a state of passion, anxiety, fear, psychomotor agitation or stupor. Patients with delirious or twilight disorder of consciousness, with dysphoric mood disorders, with hallucinatory disorders, especially imperative ones, delusional ideas, disinhibited.
Surveillance of patients suffering from seizures is assigned to patients suffering from various types of seizures in order to monitor, clarify the nature and frequency of seizures, correctly assess the condition, and select adequate treatment. They must know the clinical variants of epileptic seizures in order to promptly notice their onset, inform the attending physician, describe them in an observation diary, and provide assistance.
Escape supervision refers to patients with depressive disorders who seek escape to realize their morbid ideas; persons undergoing compulsory treatment and others.
Somatic supervision is for patients suffering from mental disorders in combination with somatic diseases: weakened depressive patients with refusal to eat, with weight loss, with eating disorders, patients who have developed side effects during treatment with antipsychotics, patients with febrile schizophrenia, catatonia, states of upset consciousness, etc. Such patients, as prescribed by the doctor, are given a somatic sheet, in which blood pressure, pulse, body temperature, skin condition, daily diuresis, and stool are monitored daily.
General observation also has significant differences. The presence of mental disorders requires closer attention to the behavior of patients and compliance with precautions to ensure their safety. At night, the nurse should be especially vigilant. Carrying out doctor's orders, caring for seriously ill patients, carrying out many, sometimes quite complex manipulations - all this is the direct responsibility of nursing staff. When communicating with patients and performing manipulations, often unpleasant and painful, the nurse must distract the patient from difficult thoughts and instill in him faith in recovery. A nurse must always be patient and friendly. Contribute to the creation of a normal working atmosphere in the medical institution. The behavior of a nurse should inspire respect for her and create confidence in patients that she knows and can do everything, that they can safely trust her with their health and life. The appearance of the nurse is of great importance: neat, smart, and inspires the patient’s trust. In her presence, he feels calmer and more confident. A mandatory quality of a nurse should be the desire to constantly improve their qualifications, deepen their knowledge, and acquire new skills.
2.4 Personal experience of introducing elements of modern technologies in practical activities
As a ward nurse, I have the highest category. I have good theoretical and practical training in the specialties of a ward nurse and procedural nurse. I am proficient in diagnostic and therapeutic procedures:
Taking various tests;
Carrying out various infusions (s.c., i.v., i.m., i.v., i.v. drip infusions);
Providing emergency assistance.
At night and on weekends, I perform the work of a procedural nurse independently. The treatment room uses:
Disposable instruments;
Paper hand towels;
Elbow taps;
Elbow dispensers;
Desar recirculator;
Vacutainers (for blood collection);
Iglotex (for used needles);
Yellow bags (for collecting used medical waste);
Containers.
The department also uses new generation disinfectants (UniDez, Denal).
The hospital has a storage room for medical waste.
III. Creating a favorable psychological climate
The best help for mentally ill people is provided when their condition is perceived by others only as an illness. This helps patients maintain the self-awareness necessary for their healing. Caregivers should not perceive the patient's personality, with its needs, desires and fears, only in terms of the diagnosis of the disease. Holistic care covers the person, illness, profession, family, relationships and more. A mentally ill person is not only an object for care. Actively involving the patient in solving his health problems is the main task of the nursing staff. In this sense, caring for a patient means not only performing the necessary medical procedures, it means much more: accompaniment, explanation, encouragement to action and attention to the patient's problems. The process of care is carried out in stages as follows: gathering information, identifying problems and resources, determining goals of care, planning care, implementing care, and evaluating results. Assessment of the effectiveness of care is based on the results of repeated collection of information about the patient's condition and makes it possible to monitor and make necessary adjustments to the care process. Quality care is possible through a partnership between the patient and the caregiver. Such interaction can only be achieved by establishing a relationship of trust between the patient and the caring staff. Therefore, the nurse must have communication skills, knowledge of medical psychology and certain personal qualities: respect for the individual, the ability to empathize, endurance and others.
The basis of trust necessary for treatment arises in the patient when three prerequisites are present, when the nurse:
1. shows himself as a real person;
2. accepts the patient as he is, without judgment;
3. shows interest in the patient and tries to understand him.
Problems may arise if the patient confides important information to the nurse that he has not told anyone else. In this case, the nurse should make it clear to the patient that such an exclusive relationship will not be tolerated. It is necessary to encourage the patient to independently report the content of the conversation to the attending physician or ask permission to convey the information to a specialist.
Psychiatric patients often have conditions where communication with them is impossible. In these cases, it is permissible to forcibly restrain the patient, “pharmacological restraint” by administering antipsychotics, or restraining by restraint. After each case of a violent solution to a problem, nursing staff need to discuss what happened with the patient and try to find out the possible reasons for the aggressive behavior.
Invaluable assistance in creating a favorable psychological climate is provided by hospital social workers and psychologists: patients of the department regularly attend film screenings, a “fine motor skills” group, and participate in the preparation and holding of holidays and other events. There is a labor instructor in the department, and morning exercises are carried out daily.
The department's psychologist carries out individual psychocorrectional work with patients and their relatives, which significantly reduces the workload and helps the department's doctors and nurses.
IV. Participation in the implementation of the regional healthcare modernization program
Our hospital is doing a lot of work to improve the quality of patient care. Major repairs have been made to the narcological department, department No. 1, and the hospital laboratory, and planned repairs are constantly being carried out in all departments. New functional beds were purchased for the entire hospital, a cardiograph was purchased, and new equipment was installed in the laboratory. All wards and toilet rooms are equipped with wall-mounted quartz lamps.
New furniture is purchased for employees. The offices of department heads, residents' rooms and the offices of senior nurses are computerized.
Air recirculators, containers for collecting medical waste are installed in the treatment rooms, special bags for waste disposal (gr B, gr V), and iglotex are used, and the hospital has a room for storing medical waste. Employees work with disposable tools and use disposable towels and napkins. Vacutainers are used to collect blood; when administering injections, special alcohol-based sterile wipes are used.
V. Work with newly arrived young specialists
When young nurses enter the workforce, I personally teach the work of a guard nurse, namely, how to properly handle medical instruments, observe the sanitary and epidemiological regime, and carry out the instructions of the attending or duty doctor clearly and in a timely manner.
I always help and suggest how to correctly perform various manipulations. Also, from the first hours of work, I explain how to communicate with mentally ill patients and observe safety precautions in the department.
I always help my work colleagues, maintain a friendly atmosphere in the team, based on trust, helping each other, helping young nurses.
I manage and supervise the work of junior medical personnel, checking their compliance with safety regulations.
I pay great attention to the appearance of myself and my colleagues.
ward nurse psychiatric
VI. Ethical principles of a specialist
In my work I am guided by the principles of nursing ethics and deontology. I show tact, restraint, patience, sensitivity and a friendly attitude towards the patient. I act in compliance with the norms of the Constitution of the Russian Federation. “Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens” from 1993, the Federal Law “On psychiatric care and guarantees of the rights of citizens during its provision” from 1993, as well as Order No. 1303 “On the non-disclosure of information about the mentally ill”.
When communicating with patients, I try to instill confidence in their recovery and create an optimistic attitude towards the future. I strive to constantly improve my qualifications, deepen my knowledge, acquire new skills by reading specialized literature, and attending training events organized for nursing staff.
VII. Information about self-education
On the basis of GBUZ SOPB No. 3, training events are held for hospital nurses twice a month.
Classes are taught by hospital doctors, chief nurses, and epidemiologists. During classes they conduct seminars, give lectures, and talk about innovations in our work.
To deepen my knowledge I use the relevant professional literature:
· Magazine "Nursing";
· Textbook: “Nursing in neurology and psychiatry with a course in narcology”;
· Large medical encyclopedia;
· The Internet provides an invaluable service in acquiring new knowledge.
I also use the experience of my colleagues.
I constantly participate in citywide professional conferences. In... the year I participated in 2 conferences based on.... regional medical college, in the seminars “Organization of medical waste management in medical institutions” (“Chem.Lab” from St. Petersburg) and in the All-Russian scientific and practical conference “Ethics and spiritual and moral culture in medicine”. Received a Certificate after completing a 2-week seminar on psychosocial rehabilitation under the Thorne program.
VIII. Organizational and expert activities
As the head sister of the department, I participate in the work of the Council of Senior Sisters. I am the curator of the food department. I participate in the work of commissions to check the work of departments and discuss the results. I participate in the preparation and conduct of in-hospital nursing conferences. In August 2014, she gave a presentation at a hospital nursing conference: “Hand hygiene. Indications for working with gloves." Like all senior nurses, I take part in the preparation of various competitions and festive events. She was a member of the jury in the competition for the best medical newspaper (our department took 2nd place), in the competition for the best hospital nurse (the nurse of our department took 1st place).
In the department, in addition to working with employees, I conduct health education work with patients and their relatives. Much attention is paid to the prevention of drug addiction, alcoholism, smoking, tuberculosis, personal hygiene, and the promotion of a healthy lifestyle.
IX. Public recognition of professional success
I have been working for... for... years. Of these... years as the head nurse of the same department. Over the years of work, she received a large number of thanks and five “Certificates of Honor” from the administration of the hospital and department. I have gratitude from patients and their relatives.
X. Sanitary-epidemiological, organizational and other measures
The fundamental sources for compliance with anti-epidemic measures for various infections are the orders of the Ministry of Health of the Russian Federation and the Ministry of Health of the USSR.
In September 2013, in accordance with Order of the Ministry of Health of Russia dated June 17, 2013 No. 378n, new requirements were introduced for the registration of transactions related to the circulation of medicines subject to subject-quantitative accounting.
Strict accounting and compliance with the storage conditions of medicines of the general group and those subject to subject-quantitative accounting are maintained.
Work in the department is carried out in accordance with the following regulatory documents and recommendations:
SP 2.1.3.2630-10 -- Sanitary and epidemiological requirements for organizations engaged in medical activities.
Order of the Ministry of Health of the Soviet Union dated February 16, 2012. No. 116-p -- Prevention of occupational HIV infection.
SP.3.1.2.1319-03 -- Prevention of influenza, introduced on June 25, 2003.
SP.3.1.1.1.1295-03 -- Prevention of tuberculosis, introduced on June 25, 2003.
S.P.2.1.7.2790-10 -- Sanitary epidemiological requirements for the management of medical waste (dated 12/09/2010)
S.P.3.1.3212-13 -- Prevention of viral hepatitis
OST 42-21-2-85
SP 3.1.1.3108-13 -- Prevention of acute intestinal infections
SP 3.1.2.1108-02 -- Prevention of diphtheria.
SP 2.1.3.2630-10 -- Prevention of HIV infection.
The department operates on the basis of the “Law of the Russian Federation on psychiatric care and guarantees of the rights of citizens in its provision” dated 01.01. 1993.
There is Order of the Ministry of Health and Social Development of the Russian Federation dated May 17, 2012 No. 566n “On approval of the Procedure for providing medical care for mental disorders and behavioral disorders,” which came into force on August 5, 2012.
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