Treatment of surgical patients is carried out in specially equipped and equipped surgical departments. With the correct organization of work in small district hospitals (for 25-50 beds), where there may not be a surgical department, it is possible to provide emergency surgical care and conduct minor elective operations. In such hospitals, there are special rooms for sterilization, operating room and dressing room.

One of the main tasks of deploying the department is to ensure the prevention of nosocomial infection ( VBI).

The surgical department usually consists of patient rooms; operating block; "clean" and "purulent" dressings; treatment room (for performing various injection procedures and decentralized sterilization of surgical instruments, syringes and needles); manipulation room; sanitary unit (bath, shower, toilet, hygienic room for women); pantry for distribution of food and dining room for patients; the office of the head of the department; staff room; linen, etc.

Halls are equipped with upholstered furniture designed for patients to relax.

In large hospitals or clinics, several surgical departments are created, each with at least 30 beds. The profiling of surgical departments should be based on the medical principle, i.e. features of the contingent of patients, diagnostics of the treatment of diseases and equipment of the wards. Usually there are clean, "purulent" and traumatic departments. Specialized surgical departments (oncological, cardiological, urological, etc.) can be allocated.

Depending on the profile of the surgical department, rooms for medical and diagnostic services are allocated in it.

Wet cleaning of the premises is carried out at least 2 times a day. The second cleaning is carried out after the end of dressings and other manipulations using one of the disinfectants (0.75% chloramine solution and 0.5% detergent, 1% chloramine solution, 0.125% sodium hypochloride solution, 1% aqueous solution of chlorhexidine bigluconate , 1% perform solution).

The wards of the medical department should be spacious, bright, based on no more than 6 people, with an area of ​​6-7 m 2 per one regular bed. More comfortable are wards with 2-4 beds.

The walls of the wards are painted with oil paint, the floors are covered with linoleum, equipped with functional beds, bedside tables, chairs. For seriously ill patients there are bedside tables. A refrigerator is installed in the ward to store products given to patients by relatives. All hospital furniture should be easy to clean.

Surgical departments should be equipped with water supply, central heating, sewerage and supply and exhaust ventilation.

Seriously ill patients and patients suffering from urinary and fecal incontinence, emitting fetid sputum, are placed in small (for 1-2 people) wards.

For every 25-30 beds in the department there is a nursing station, equipped accordingly. Arrange it so that the nursing staff can see all the chambers. The post should have a connection with the seriously ill, as well as a list of telephone numbers of all hospital departments, including the locksmith on duty, electrician, etc.

Particularly important in the work of the surgical department is the separate placement of patients with purulent-septic processes and patients who do not have inflammatory processes (prevention of nosocomial infections).

Surgical activity of a nurse

Work in the clinic. The surgical nurse of the polyclinic carries out her activities in the surgical room (surgical department), where patients with surgical diseases are treated that do not require their stay in the hospital. This is a large group of patients with mild purulent-inflammatory diseases. The majority of patients with surgical diseases are examined in a polyclinic and sent for surgical treatment to a hospital. Here, the treatment of the operated patients is also carried out and their rehabilitation takes place.

The main tasks of the nurse of the surgical office are to fulfill the treatment and diagnostic appointments of the surgeon in the clinic and participate in the organization of specialized medical care for the population living in the area of ​​the clinic, as well as workers and employees of attached enterprises. The appointment and dismissal of a nurse in a surgical office is carried out by the chief physician of the polyclinic in accordance with applicable law.

The nurse of the surgical office reports directly to the surgeon and works under his supervision. In her work, the nurse is guided by the job description, as well as methodological recommendations for improving the activities of the nursing staff of an outpatient clinic.

The work of a nurse in a polyclinic is diverse. Surgical Nurse:

Prepares workplaces before an outpatient appointment with a surgeon, controlling the availability of the necessary medical instruments, inventory, documentation, checking the serviceability of equipment and office equipment;

Receives from the Central Sterilization Department (CSO) the necessary surgical material for work in the operating room and dressing room;

Covers a sterile table for instruments and dressings for 5-10 dressings and emergency operations;

Transfers to the registry the self-recording sheets of patients, coupons for an appointment with a doctor for the current week;

Brings before the start of the reception from the card depository the medical cards of outpatients, selected by the registrars in accordance with the self-recording sheets;

Receives research results in a timely manner and pastes them into the medical records of outpatients;

Regulates the flow of visitors by fixing the appropriate time in self-registration sheets for repeat patients and issuing coupons to them;

Reports to the card storage on all cases of transfer of medical records of outpatients to other offices for making an appropriate entry in the substitute card;

Takes an active part in the reception of patients, if necessary, helps patients prepare for a doctor's examination;

Assists the surgeon in outpatient operations and dressings. In this regard, she must be fluent in desmurgy, make dressings, injections and venipunctures, possess the skills of an operating nurse, know the methods of preventing surgical infection (strictly observe asepsis and antisepsis);

Explains to patients the methods and procedure for preparing for laboratory, instrumental and hardware studies;

By issuing a request for medicines and dressings, he receives them from the head nurse in the polyclinic;

After receiving and performing operations and dressings, the nurse puts the operating room, dressing room in order, washes and dries surgical instruments, replenishes stocks of medicines;

Draws up medical documentation under the supervision of a physician: referrals for consultations and auxiliary rooms, statistical coupons, sanatorium cards, extracts from medical records of outpatients, sick leave certificates, certificates of temporary disability, referrals to the control and expert commission (CEC ) and medical and social expertise (MSEC), journals of outpatient operations, daily static reports, a diary of the work of nursing staff, etc .;

Participates in the conduct of sanitary and educational work among patients;

Systematically improves his skills by studying the relevant literature, participation in conferences, seminars.

The surgical nurse has the right to:

Present requirements to the administration of the polyclinic to create the necessary conditions at the workplace to ensure the high-quality performance of their duties;

Take part in meetings (meetings) when discussing the work of the surgical office, receive the necessary information to perform their functional duties from the surgeon, the head nurse of the department (responsible for the office), the head nurse;

Require visitors to comply with the internal regulations of the polyclinic; master a related specialty;

Give instructions and supervise the work of the junior medical staff of the surgical room;

Improve their qualifications at the workplace and improvement courses in the prescribed manner.

The evaluation of the work of a nurse in a surgical office is carried out by a surgeon, a chief (senior) nurse based on the performance of her functional duties, compliance with internal regulations, labor discipline, moral and ethical standards, and social activity. The nurse in the surgical room is responsible for the performance of their duties. Types of personal responsibility are determined in accordance with the current legislation.

Work in a surgical hospital

Ward (post) nurse - the name of the position of a paramedical worker. In accordance with the Order of the Ministry of Health of the Russian Federation of August 19, 1997 No. 249, a person with the specialty "Nursing" and "Nursing in Pediatrics" can be appointed to this position.

It contains the Regulations on the Nursing Specialist. The knowledge, skills and manipulations listed in it constitute a training program for a specialist in this specialty, as well as his certification (an exam for the right to work independently) and attestation (checks for assigning a qualification category). The regulation on a nursing specialist can be considered as the basis for compiling the job description of a ward nurse.

Persons with a completed medical education and admitted to medical activities in this position in accordance with the established legal procedure are accepted for the position of a ward nurse. They are accepted and dismissed by the chief physician of the hospital on the proposal of the chief nurse. Before starting work, a nurse undergoes a mandatory medical examination.

The ward nurse is directly subordinate to the head of the department and the head nurse of the department. Works under the direction of the resident of the department and the head nurse, and during their absence - the doctor on duty. Directly subordinate to the ward nurse are nurses - cleaners of the wards she serves.

The ward nurse of the department works according to the schedule drawn up by the head nurse, approved by the head of the department, deputy chief physician of the relevant profile and agreed with the trade union committee. Changing the work schedule is allowed only with the consent of the head nurse and the head of the department.

The ward nurse should be a model of discipline, cleanliness and tidiness, treat patients with care and sensitivity, supporting and strengthening their morale; accurately and clearly follow all the instructions of the doctors and the medical manipulations assigned to her (permitted to be performed by the average medical worker); constantly improve their medical knowledge by reading specialized literature, attending and participating in industrial training at the department and in the hospital, studying at least 1 time in 5 years at advanced training courses for paramedical workers in the profile of the work performed, master all related specialties departments to ensure full interchangeability of nurses; adhere strictly to the principles medical deontology, ethics, keep medical secrets.

In the evening, report all emergencies to the responsible doctor on duty at the hospital, know his phone number, he is located.

The keys to the fire escapes must be kept in a designated place at the nurse's post. The passage to the stairs must be free.

Sister should know phone numbers:

Doctor on duty in the admissions department;

Head of the department (home phone);

Head nurse of the department (home phone).

The ward nurse of the department is obliged to:

To carry out the reception of newly admitted patients in the department;

Conduct an examination for the presence of pediculosis (monitoring the work of the admission department of the hospital), assess the general hygienic condition of the patient (bathing, changing clothes, cutting nails, etc.);

Transport or accompany the patient to the ward, provide him immediately upon admission with individual care items, a glass, a spoon for taking water (medicine);

To acquaint with the location of the premises of the department and the internal regulations and daily routine, the rules of personal hygiene in the hospital;

Collect material from patients for laboratory tests (urine, feces, sputum, etc.) and organize their timely sending to the laboratory: timely receipt of the results of the study and pasting them into the medical history;

To prepare case histories, refer patients as prescribed by doctors for clinical diagnostic, functional studies, to operating rooms, dressing rooms and, if necessary, their transportation, together with the junior medical staff of the department, control over the return of case histories to the department with the results of the study ;

Prepare towels, special means for disinfection of the doctor's hands, take a direct part in the bypass of patients by the resident doctor or the doctor on duty, inform them of information about changes in the state of health of patients;

To measure the body temperature of patients in the morning and evening, and, as prescribed by the doctor and at other times of the day, keep a record

temperature in the temperature sheet, counting the pulse and respiration; measure the daily amount of urine, sputum, enter these data into the medical history;

Carry out planned monitoring, organization of care for bedridden and seriously ill patients, prevention of bedsores;

Conduct active monitoring of cleanliness and order in the wards, personal hygiene of patients, timely bathing, change of linen - underwear and bedding;

Make a personal appearance to the patient at his first call;

Monitor the patient's compliance with the diet established by the doctor, the compliance of the products brought to the sick relatives with the permitted assortment, daily monitoring of the condition of bedside tables, refrigerators in the wards;

To carry out the preparation of portion requirements for diet tables to the head nurse for their transfer by her for the preparation of diets;

Distribute food to patients of the department, feeding patients;

Monitor the implementation of the rules of work by junior service personnel;

Make notes in the sheet of medical appointments about their fulfillment with a signature for the fulfillment of each appointment;

To be humane, to behave tactfully in the presence of agonizing patients, to carry out the correct documentation, packing and transfer of the body of the deceased for transportation to the pathoanatomical department; patient care during this period is entrusted to medical personnel of another post;

Take a direct part in sanitary and educational work among patients and the population on sanitary and hygienic topics, patient care, disease prevention, a healthy lifestyle, etc.;

To receive and transfer patients only at the bedside of the patient;

Carry out regular (at least 1 time in 7 days) examination of patients for the presence of pediculosis (with a note about this in the relevant document), as well as the organization (if necessary) of anti-pediculosis measures;

Every morning, transfer to the head nurse the list of medicines required for fasting, patient care items, and also do this during the shift;

Compile at night a list of patients of your post, information about them according to the scheme approved in the hospital, transmit the information received in the morning to the hospital's emergency department for information desk (8.00);

Conduct quartzization of the wards assigned to the post, as well as other premises according to the schedule developed by the head nurse of the department together with the epidemiologist of the hospital;

Work without the right to sleep and not leave the department without the permission of the head nurse or the head of the department, and during their absence - the doctor on duty;

Know and ensure readiness to provide first-aid medical care in case of deterioration of the patient's condition, emergency conditions, ensure correct and prompt transportation.

The ward nurse must be able to:

Monitor the patient's condition and assess it correctly;

Proper work and fulfillment of the duties of the nurse assigned to the post;

Preservation of medical and household equipment of the post;

Compliance with internal regulations by patients and visitors.

Rights

The ward sister has the right:

Make comments to the patient of the wards served by her about non-compliance with the recommendations of the doctor and the regime of the institution;

Make proposals to the head of the department, the head nurse on encouraging the post nurse or imposing a penalty on her;

Receive the information necessary for the accurate performance of their duties;

Require the head nurse of the department to provide the post with the necessary inventory, tools, patient care items, etc .;

Make proposals for improving the work of nurses of the department;

Pass certification (re-certification) in order to assign qualification categories;

Participate in events held for paramedics of the hospital.

The work of an operating nurse

A person with a secondary education who has undergone special training in working in the surgical dressing unit is appointed to the position of an operating nurse. Appointed and dismissed by the head doctor of the hospital on the proposal of the head nurse in accordance with the current legislation. Directly reports to the senior operating nurse, in the process of preparing for the operation during its implementation - to the surgeon and his assistants, during the period of duty - to the doctor on duty of the department (hospital). In his work, he is guided by the rules of the instruction for the section of work being performed, orders and instructions from higher officials.

Duties

The chief operating nurse distributes the work among the operating nurses. Practice shows that in order to increase responsibility and better organize work, it is advisable to allocate a certain area of ​​work to each nurse, for example, one nurse is responsible for the quality of sterilization, the other for the order in instrument cabinets, etc. In the most critical operations, the senior operating nurse can take part herself.

Each operating room nurse must:

To be fluent in the technique of preparing both suture and dressing material;

To be able to help the doctor with endoscopic and laparoscopic studies, master the technique of hemotransfusion, as well as other manipulations;

Ensure full equipment of the operation;

Be in constant readiness for planned and emergency operations;

Submit to the responsible surgeon and not leave work without the permission of the senior in the duty team (if the operating sister is part of the duty team, consisting of different specialists);

Responsible for the aseptic preparation of the patient entering the operation, as well as for the asepsis of the operating unit - everyone who is in the operating room is subordinate to it,

Own the technique of pre-sterilization preparation and sterilization of all types of materials;

Know all typical operations, monitor their progress and provide the necessary qualified assistance to the surgeon;

Be able to correctly and timely submit instruments to the surgeon;

Keep a strict count of instruments, wipes, swabs before, during and after the operation;

Ensure that the records of the operation performed are timely and made in the generally accepted form in a special operational journal;

Monitor the safety and serviceability of equipment, take care of the replenishment and repair of faulty equipment, as well as the absolute cleanliness of the operating unit and the dressing room, the serviceability of conventional and emergency lighting;

Systematically replenish the operating room with the necessary medicines, dressings and surgical linen, select the necessary sets of instruments;

The senior operating nurse conducts monthly sterility checks using the bacteriological control method.

Work in the treatment room

The treatment room is designed for taking blood for various studies, performing all types of injections, intravenous administration of medicinal substances, preparing for transfusion of blood, its components, blood substitutes.

The sequence of actions of a nurse:

Prepare containers for disinfection of used tools and materials;

Hand over the prepared biks with the material to the CSO the day before;

Deliver sterile bixes from the CSO;

Prepare labeled trays for intravenous and intramuscular injections;

Prepare sterile bixes for work;

Put on a mask, carry out hygienic hand antisepsis, put on sterile gloves;

Cover the sterile trays with a sterile diaper using sterile tweezers and divide the tray into three conditional zones:

1 - the area on which, with the help of tweezers, put sterile balls, - under the top layer of a sterile diaper;

2 - area for sterile syringes filled with injection solutions and closed with a needle with a cap;

3 - the area in which to place the sterile forceps to work on the tray.

After the end of blood sampling from all patients, throw the diaper into a bag for dirty linen,

Close the sterile tray.

Note. Perform all procedures and manipulations only with sterile gloves, except for cleaning the office. Work not related to injections must be performed in another medical gown (stored separately). Cleaning of the treatment room is carried out using disinfectants. Current cleaning is carried out during the working day. Final cleaning - at the end of the working day, general cleaning - once a week, cabinet quartzization - every 2 hours for 15 minutes.

The work of a dressing nurse

Dressing room - a specially equipped room for the production of dressings, examination of wounds and a number of procedures performed in the process of treating wounds. In the dressing room, injections, transfusions and minor operations (primary surgical treatment of small wounds, opening of superficially located abscesses, etc.) can also be performed.

Modern dressing rooms are deployed both in hospitals and outpatient clinics.

The number of dressing rooms and tables is determined by the number of beds in ZhGU and its profile. The area of ​​the dressing room is calculated at the rate of 15-20 m 2 per dressing table.

The dimensions of the outpatient dressing room are determined depending on the estimated throughput of the institution.

In dressing rooms, walls, floors and ceilings should be suitable for mechanical cleaning during cleaning.

The dressing room is equipped with an appropriate set of items, equipped with the necessary surgical instruments, medications and dressings.

The dressing nurse is responsible for maintaining asepsis in the dressing room, and directs her work during dressings. The working day begins with an inspection of the dressing room. After that, the nurse receives a list of all dressings for the day, sets their order.

After making sure that the dressing room is ready, the nurse covers the sterile instrumental and material dressing table.

Sequencing:

The nurse puts on a mask, having tucked her hair under a cap before that, washes and disinfects her hands, puts on a sterile gown and gloves;

By pressing the pedal, he opens the bix with sterile linen, takes out a sterile sheet, unfolds it so that it remains two-layered, and covers the mobile table with it;

A grid with sterile instruments and other items removed from the sterilizer is placed on this table;

The dressing table is first covered with a sterile oilcloth, then in 4 layers with sheets so that the edges hang 30-40 cm down;

The upper two-layer sheet is thrown back to the back of the table and pins or hemostatic clamps are attached to it at the corners;

With a sterile forceps, the nurse transfers the instruments from the grid to the dressing table and lays them out in a certain order according to their intended purpose;

On the table there should be tweezers, hemostatic forceps, nippers, needle holders, forceps, button-shaped and grooved probes, kidney-shaped basins, syringes, glasses for solutions, catheters, drains, scissors, Farabef hooks, three-four-pronged hooks, ready-made stickers, napkins, turundas and balls;

With a sheet folded in half, the nurse closes the dressing table;

The edges of the lower and upper sheets are fastened with toes at the back and sides;

A tag is attached in the far left corner, on which the date, time of setting the table and the name of the nurse are indicated. The table is considered sterile for 1 day.

An approximate layout of instruments and material on the dressing table is shown in fig. one.

Organization of dressings

The ward nurse and nurse help the patient take off their outer clothing and lie down on the dressing table, then cover it with a clean sheet. When dressing, the attending physician must be present - he does the most responsible dressings personally.

After each dressing, the medical staff washes their hands with soap and water, wipes them with a sterile towel or sheet and treats them with alcohol using an alcohol ball.

Each dressing is carried out with the help of tools.

Sequencing:

Remove the old bandage with tweezers; along the wound, holding the skin with a dry ball and preventing it from reaching for the bandage, remove its surface layers; it is recommended to peel off a dried bandage with a ball dipped in a 3% hydrogen peroxide solution; it is better to remove a firmly dried bandage on the hand and foot after a bath from a warm 0.5% solution of potassium permanganate;

Examine the wound and its surrounding area;

The skin around the wound is freed from purulent crusts with sterile gauze balls, then the skin around the wound is treated with alcohol from the edge of the wound to the periphery;

Change tweezers; make a wound toilet with sterile wipes (removal of pus by blotting, washing with hydrogen peroxide, furacilin solution and other antiseptics);

The wound is dried with sterile wipes;

Treat the skin around the wound with a 5% iodine solution;

With the help of tweezers and a probe, wounds are drained with rubber tubes (tampons and turundas moistened with antiseptics or water-soluble ointments);

Apply a new bandage;

Fix the bandage with a sticker, bandage, etc.

After removing the old dressing and finishing the dressing, the nurse washes her hands (with gloves) with soap, soaping them twice, rinsing them with running water and wiping them with an individual towel. During dressings of patients with suppurative processes, the nurse puts on an additional oilcloth apron, which is disinfected after each dressing by wiping with a rag moistened with a 3% solution of chloramine, 0.05% solution of neutral anolyte, 0.6% solution of neutral sodium hypochlorite.

Used gloves are thrown into a container with a disinfectant solution, and hands are hygienically processed. Instruments after dressings are also disinfected in solutions. The couch (table for dressings) is disinfected after each dressing with rags moistened with disinfectant. The used dressing material before destruction is subjected to preliminary disinfection for two hours with one of the disinfecting solutions: 3% chloramine solution, 0.5% activated chloramine solution, etc.

When treating surgical patients with drainages in hollow organs or purulent cavities, the drainage tube and the wound around it are taken care of by the doctor during dressing. Once a day, the guard sister changes all connecting tubes, which are subjected to disinfection, pre-sterilization cleaning and sterilization. Banks with discharge are changed to sterile. The contents of the cans are poured into the sewer. After emptying, the jars are immersed in a disinfectant solution, washed and sterilized. Banks for the drainage system can not be placed on the floor, they are tied to the patient's bed or placed next to the stands.

In the structure of the surgical department, it is necessary to have two dressing rooms (for "clean" and "purulent" dressings). If there is only one dressing room, the treatment of purulent wounds is carried out after clean manipulations, followed by a thorough treatment of the room and all equipment with disinfectant solutions.

During the dressing of patients with suppurative processes, the nurse puts on an oilcloth apron, which, after each dressing, wipes with a rag soaked in 0.25% sodium hypochlorite solution, with an interval of 15 minutes, followed by an exposure time of 60 minutes, and treats the hands. 80% ethyl alcohol, 0.5% solution of chlorhexidine bigluconate in 70% ethyl alcohol, 0.5% (with 0.125% active chlorine) solution of chloramine are used as hand disinfectants. The working solution of these drugs is prepared by the pharmacy of the healthcare facility. A container with a solution is installed in the dressing room.

When disinfecting hands with ethyl alcohol or chlorhexidine, the drug is applied to the palmar surfaces of the hands in an amount of 5-8 ml and rubbed into the skin for 2 minutes. Hands are treated with chlorhexidine solutions in the pelvis. Pour 3 liters of solution into the basin. Hands are immersed in the preparation and washed for 2 minutes. The solution is suitable for 10 hand treatments.

dressing room cleaning

Well-coordinated work in the dressing room is ensured by a clear daily routine, a strict sequence of manipulations. Provides ongoing cleaning in the course of dressings.

After dressings are completed and dressings are collected in specially allocated containers, a final wet cleaning is carried out using disinfectants. Infected dressings are subject to disinfection and disposal. General cleaning is carried out at least once a week. Cleaning in the dressing room is carried out similarly to cleaning in the operating room (p. 494).

Preparation of the dressing room for further work

After cleaning, the dressing nurse, together with the nurse, prepare and put dressing material, underwear and kits for venesection, tracheostomy, etc. into the biks. The nurse hands over biks to the sterilization room.

For round-the-clock readiness of the dressing room for urgent dressings, the nurse sterilizes the necessary set of instruments in a dry-heat cabinet and covers the instrumental dressing table, creates the necessary stock of instruments. In addition, at night and on weekends, the dressing nurse leaves biks with sterile material and underwear in a conspicuous place. An inscription is made on each bix indicating when to spend its contents.

Before leaving work, the dressing nurse should take steps to ensure that:

Jars filled with antiseptic and disinfectant solutions;

There was a sufficient number of bandages, sterile material;

At any time it was possible to sterilize the necessary tools.

In addition, the nurse should check whether the dressing room has the necessary medicines for the next day and, if necessary, prescribe them at the pharmacy. At the end of work, the dressing nurse turns on the bactericidal lamps and leaves the dressing room, locking the door with a key. The keys to the cabinets and to the dressing room in the absence of a dressing nurse should be kept by the duty nurse of the surgical department, who must turn off the bactericidal lamps 8-9 hours after they are turned on.

NURSING PROCESS IN PATIENTS WITH SURGICAL DISEASES

Nursing reform has begun in Russia.

Today, there are many models of nursing care. In many countries of the world, practicing nurses use several of them at the same time.

It is necessary to comprehend the already developed models and choose those that are necessary for a particular patient. The model helps to focus the examination of the patient on its goals and interventions.

When planning care, individual elements can be selected from various models.

In our country, nurses planning to apply the nursing process within the WHO Regional Office for Europe are recommended to use a model that takes into account the physiological, psychological and social needs of the patient and his family. The use of the WHO model is to carry out the transfer of nursing care from a state of illness to a state of health. To provide assistance, the sisters assess a person’s health and find out his needs for self-help, home help, and professional help. As part of the nursing reform in Russia, it is necessary to approve the professional ideology of nursing. This is possible when the nursing staff masters a new type of activity - the implementation of the nursing process.

The nursing process is understood as a systematic approach to the provision of nursing care, focused on the needs of the patient. Its purpose is to prevent problems and emerging difficulties. Nursing examination concerns the physical, psychological, social, spiritual, emotional needs of the patient.

The purpose of the nursing process for the surgical patient is to prevent, alleviate, reduce or minimize the problems and difficulties that arise in him.

Such problems and difficulties in surgical patients are pain, stress, dyspeptic disorders, disorders of various body functions, lack of self-care and communication. The constant presence of the sister and contact with the patient makes her the main link between him and the outside world. When caring for surgical patients, the nurse sees the feelings that they and their families experience and expresses sympathy. The sister should alleviate the patient's condition, help in recovery.

The ability of self-care in patients with surgical pathology is severely limited, so timely attentive nursing care to perform the necessary elements of treatment will be the first step towards recovery. The nursing process enables the nurse to professionally and professionally solve the patient's problems related to his recovery.

The nursing process is a method of organizing and delivering nursing care. The essence of nursing is caring for a person and how the sister provides this care. This work should not be based on intuition, but on a thoughtful and formulated approach, designed to meet the needs and solve the problem of the patient.

At the heart of the nursing process is the patient as a person requiring an integrated approach. One of the indispensable conditions for the implementation of the nursing process is the participation of the patient (members of his family) in making decisions regarding the goals of care, the plan and methods of nursing intervention. Evaluation of the result of care is also carried out jointly with the patient (members of his family).

The word "process" means the course of events. In this case, this is the sequence undertaken by the nurse in providing nursing care to the patient, aimed at meeting the physical, mental, social, spiritual, emotional needs of the patient.

The nursing process consists of five successive steps:

1. Nursing examination of patients.

2. Diagnosis of his condition (determination of needs) and identification of the patient's problems, their priority.

3. Planning nursing care aimed at meeting the identified needs (problems).

4. Implementation (implementation) of the nursing intervention plan.

5. Evaluation of the effectiveness of the results of nursing intervention and new care planning.

Nursing examination concerns the various needs of the patient, his assessment and the relationship of information, which is then recorded in the nursing history.

Since information about the patient can be subjective and objective, the nurse should conduct a survey of the patient and a conversation with him, his family, roommates, other medical workers (attending physician), etc., as well as an examination of the patient (to assess the state of his tissues and organs), use the data of his medical history, outpatient card, the results of consultations of specialists and additional research methods (ECG, EEG, ultrasound, X-ray and endoscopic examination, etc.).

Analyzing the data obtained, the nurse at the second stage of the nursing process formulates a nursing diagnosis (to establish existing and potential problems that arise in the patient in the form of body reactions to his condition (disease), factors contributing to or causing the development of these problems; personal characteristics patient, contributing to the prevention or resolution of these problems).

When a nurse identifies a patient's problem, she decides which health care provider can help the patient.

Problems that a nurse can resolve or prevent on her own are a nursing diagnosis.

Nursing diagnosis, unlike medical diagnosis, is aimed at identifying pain, hyperthermia, weakness, anxiety, etc., as an identification of the body's response to the disease. The nurse needs to formulate diagnoses very precisely and establish their priority and significance for the patient.

The medical diagnosis may remain unchanged throughout the illness. Nursing diagnosis can change every day and even during the day as the body's response to illness changes. Nursing diagnosis involves nursing treatment within the competence of a nurse.

The medical diagnosis is associated with the pathophysiological changes that have arisen in the body, while the nursing diagnosis is associated with the patient's ideas about his state of health.

A nursing diagnosis is a clinical diagnosis made by a professional nurse that characterizes the patient's existing or potential health problems, which the nurse, due to her education and experience, can and has the right to treat. So, for example, pain, bedsores, fear, difficulties in adaptation are different types of nursing diagnosis. In 1982, a definition appeared: “Nursing diagnosis is a patient’s health condition (current or potential), established as a result of a nursing examination and requiring intervention on her part.”

For the first time, an international classification of nursing diagnoses was proposed in 1986 and supplemented in 1991. In total, the list of nursing diagnoses includes 114 key items, including hyperthermia, pain, stress, social self-isolation, insufficient self-hygiene, lack of hygiene skills and a nurse conditions, anxiety, reduced physical activity, reduced individual ability to adapt and overcome stress reactions, overnutrition, high risk of infection, etc.

Terminology and a classification system for nursing diagnoses have been developed, following the example of medical ones, otherwise nurses will not be able to communicate in a professional language that is understandable to everyone.

There are several classifications of nursing diagnoses. Physiological, psychological, social, as well as real (shortness of breath, cough, bleeding) and potential (risk of bedsores) nursing diagnoses are distinguished.

Currently, they use the diagnoses developed at the level of a medical facility or an educational institution.

There can be several nursing diagnoses, so the sister highlights the diagnoses to which she will respond first. These are the problems that the patient is currently concerned about. For example, a 30-year-old patient with acute pancreatitis is under observation. The patient is on strict bed rest. The patient's problems that are bothering him at this time are girdle pain, stress, nausea, indomitable vomiting, weakness, lack of appetite and sleep, lack of communication.

With the passage of time and the progression of the disease, potential problems may appear that currently do not exist in the patient: infection, the risk of developing purulent peritonitis, necrosis and purulent fusion of the pancreas. In these cases, the patient will require emergency surgery. Priorities are needed to prioritize nursing interventions and rationally allocate a sister's effort, time, and resources. There should not be many priority problems - no more than 2-3.

Let's look at them in terms of our patient's priorities. Of the existing problems, the first thing that a nurse should pay attention to is pain, indomitable vomiting, and stress. Other problems are secondary. Of the potential problems that will first need to be addressed when they arise, the priority is the fear of the upcoming operation.

The order of problem solving should be determined by the patient himself. It is quite obvious that in cases of life-threatening situations, the sister herself must determine which problem she will solve in the first place.

Initial problems can sometimes be potential problems. If the patient has several problems, it is impossible to satisfy them at the same time. Therefore, when developing a care plan, the nurse should discuss with the patient (his family) the priority of problems.

In the third stage, the nurse should plan care for each priority problem, she forms the goals and plan of care.

Goals should be:

Real, achievable (you can not set unattainable goals);

With specific deadlines for achieving each goal (short-term and long-term);

In the formulation of the term patient, not sister (the patient will demonstrate the ability to use the inhaler by a certain date).

Each goal includes three action components, a criterion (date, time, distance), a condition (with the help of something or someone). Thus, the goal is what the patient and nurse want to achieve as a result of the implementation of the care plan. Goals should be patient-centered and written in simple terms so that each nurse understands them unambiguously.

Goals provide only a positive result:

Reduction or complete disappearance of symptoms that cause fear in the patient or anxiety in the sister;

Improved well-being;

Expanding the possibilities of self-care within the framework of fundamental needs; changing attitudes towards their health.

After setting the goals, the nurse draws up a plan for the implementation of the goals (providing medical care - caring for the patient) so that the patient and his family can adapt to the changes that are possible due to health problems. The plan must be specific; general phrases and reasoning are unacceptable.

In particular, a sample individual care plan for our patient with acute pancreatitis might look like this:

The solution to existing problems is to administer an anesthetic, relieve the patient's stress by talking, give a sedative, administer an antiemetic, talk more often with the patient, give sleeping pills, etc.;

Solving potential problems - hunger, cold and rest, the introduction of antibiotics, treatment of peritonitis, if necessary, surgery to convince the patient that it is the only way to treat peritonitis, instill confidence in her successful outcome.

Planning is carried out on the basis of nursing intervention standards. It is impossible to take into account all the variety of clinical operations in the standard, so they cannot be applied thoughtlessly.

The care plan is necessarily recorded in the nursing history of the disease, which ensures its continuity, control, and consistency.

The sister is obliged to coordinate her plan with the patient, who must actively participate in the treatment process.

Having planned all the activities, the nurse puts them into practice. This will be the fourth step in the nursing process, the implementation of the nursing intervention plan. Nursing interventions recorded in the care plan - a list of actions that the nurse takes to solve the problems of a particular patient.

A care plan may list several possible nursing interventions for the same problem. This allows both the nurse and the patient to feel confident that different actions can be taken to achieve the set goals, and not just a single intervention.

Nursing interventions should be:

Based on scientific principles;

Concrete and clear so that any sister can perform this or that action;

Real for the allotted time and qualifications of the sister;

Aimed at solving a specific problem and achieving a set goal.

Nursing actions imply three types of nursing interventions: dependent, independent, interdependent.

With dependent intervention, the actions of the sister are carried out at the request or under the supervision of a doctor. However, the sister in this case should not automatically follow the instructions of the doctor. She is obliged to determine the correct dose, take into account contraindications to prescribing the drug, check whether it is compatible with others, etc. Clarification of appointments is within the competence of the sister. A nurse who performs an incorrect or unnecessary prescription is professionally incompetent and equally responsible for the consequences.

With independent intervention, the actions of the sister are carried out on their own initiative. This is assisting the patient in self-care, teaching the patient various methods of treatment and self-care, organizing leisure activities, advising the patient about his health, monitoring the patient's reactions to illness and treatment.

In interdependent intervention, the nurse cooperates with other medical professionals, the patient and his relatives, taking into account their plans and possibilities. Nursing intervention is carried out by the sister in accordance with the established nursing diagnosis in order to achieve a certain result. Its purpose is to provide appropriate patient care, i.e. rendering assistance to him in the fulfillment of vital needs; training and counseling, if necessary, for the patient and his family.

The patient's need for assistance can be temporary, permanent, rehabilitating, depending on the type and severity of the injury. Temporary assistance is designed for a short period of time, when there is a lack of self-care during exacerbations of diseases and after surgical interventions, etc. Constant assistance to the patient is required throughout life during reconstructive operations on the esophagus, stomach, intestines, etc.

It is known that rehabilitation should begin immediately after surgery in order to prevent possible complications and help the patient and his relatives to function normally in a new difficult life situation for them. Rehabilitation is a long process, sometimes lasting a lifetime. An important role in this process is assigned to the nurse, acting as a nurse, working as part of a patient care team, in collaboration with his relatives, in order to meet all the needs of the patient.

An example of rehabilitation assistance is massage, exercise therapy, breathing exercises, and conversation with the patient. Among the methods for implementing measures to care for a patient with surgical diseases, a conversation with the patient and advice that a nurse can give in a particular situation play an important role. Advice is emotional, intellectual and psychological help that helps the patient prepare for present or future changes arising from the stress that is always present during an aggravation of the disease. Nursing care is needed to help the patient solve emerging health problems, prevent potential problems and maintain his health.

At the final (fifth) stage of the process, the result of nursing intervention (care) is evaluated. Its purpose is to assess the quality of the assistance provided, evaluate the results obtained and summarize.

Important at this stage is the patient's opinion about the conducted nursing activities. During evaluation, the nurse judges the success of the care steps by testing the patient's response and comparing it to the expected response.

The evaluation shows whether the final goal has been achieved. An assessment of the entire nursing process is carried out if the patient is discharged, if he was transferred to another medical institution, or if he was exported.

Evaluation is performed continuously, in non-emergency patients - at the beginning and at the end of the shift. If the goal is not achieved, the nurse must find out the reason, for which she analyzes the entire nursing process to identify an error. As a result, the goal itself can be changed, the criteria (terms, distances) can be revised, the nursing intervention plan can be adjusted.

Thus, the nursing process plays an important role in the care and treatment of a patient with surgical diseases.

It helps the nurse to understand the importance and significance of her activities in the process of treating the patient. Most of all in this process, the patient wins. The more information the nurse collects, the more she will know about her ward both in terms of the disease and in terms of psychological. This helps her to more accurately identify the patient's problems and facilitate the relationship with him. The outcome of the disease often depends on the relationship between the nurse and the patient, on their mutual understanding.

The effectiveness of nursing care can be determined, first of all, by establishing whether the goals set jointly with the patient have been achieved, if they are measurable and realistic. They are recorded in the form of the patient's behavioral reactions, his verbal reaction, and the sister's assessment of certain physiological parameters. The time or date of the assessment is indicated for each problem identified. For example, when evaluating the effect of an analgesic drug, the evaluation is carried out after a short period of time, when performing other problems, after a long time; in the formation of bedsores and assessment of their condition - daily. The nurse, together with the patient, predicts when they will be able to achieve the expected result and evaluate it.

Distinguish between objective assessment (the patient's response to nursing care) and subjective assessment (the patient's opinion about achieving the goal). As a result of the assessment, the achievement of the goal, the lack of the expected result, or the deterioration of the patient's condition, despite ongoing nursing interventions, can be noted. If the goal is achieved, a clear entry is made in the care plan: "Goal achieved."

In determining the effectiveness of nursing intervention, the patient's own contribution, as well as the contribution of his family members, to the achievement of the goal should be discussed with the patient.

A care plan is only worthwhile and successful if it is corrected and revised when necessary. This is especially true when caring for the seriously ill, when their condition changes rapidly.

Reasons for changing the plan:

The goal is achieved, the problem is removed;

The goal has not been reached;

The goal has not been fully achieved;

A new problem has arisen or the old one has ceased to be so relevant.

The nurse, when conducting an ongoing evaluation of the effectiveness of nursing care, should constantly ask herself the following questions:

Do I have all the necessary information?

Have I correctly prioritized existing and potential problems?

Can the expected result be achieved?

Are the right interventions chosen to achieve the goal?

Does the care provide positive changes in the patient's condition?

Does everyone understand what I write in terms of care?

The implementation of the planned action plan disciplines the nurse and the patient. Evaluation of the results of nursing intervention enables the nurse to establish strengths and weaknesses in her professional activities.

So, the final assessment, being the last stage of the nursing process, is just as important as the previous stages. Critical evaluation of a written care plan can ensure that high standards of care are developed and maintained.

With regard to medical activities, the standard is a developed purposeful regulatory document of an individual plan for the implementation of the appropriate type of qualified surgical nursing care for a specific patient, for the performance of medical manipulations by her - a model of an algorithm for sequential nurse actions that ensure safety and quality nursing procedures.

At present, at the initiative of the Association of Nurses of Russia, work has begun on the regulation of the professional activities of paramedical workers in accordance with the “Basic Provisions for Standardization in Healthcare”. For the first time, an attempt was made to develop comprehensive standards for the specialty "Nursing". These standards contain a mandatory minimum requirement for the quality of medical services provided by nursing personnel with a basic level of secondary vocational education in their specialty. These standards need to be introduced into the practice of performing the nursing process and approbation in various regions of Russia.

Methodological approaches to making nursing diagnoses

When organizing a workflow, a working version of the classification of nursing diagnoses is needed. It is based on violations of the basic processes of the body's vital functions (already existing or possible in the future), which made it possible to distribute various nursing diagnoses into 14 groups.

These are diagnoses associated with disruption of processes:

Movements (decrease in motor activity, impaired coordination of movements, etc.);

Breathing (shortness of breath, productive and non-productive cough, suffocation, etc.);

Blood circulation (edema, arrhythmia, etc.);

Nutrition (nutrition, significantly exceeding the needs of the body, deterioration in nutrition due to a violation of taste sensations, anorexia, etc.);

Digestion (impaired swallowing, nausea, vomiting, constipation, etc.);

Urinary excretion (urinary retention acute and chronic, urinary incontinence, etc.);

All kinds homeostasis(hyperthermia, hypothermia, dehydration, decreased immunity, etc.);

Behavior (refusal to take medication, social self-isolation, suicide, etc.);

Perceptions and sensations (impaired hearing, vision, taste, pain, etc.);

Attention (arbitrary and involuntary);

Memory (hypomnesia, amnesia, hypermnesia);

Thinking (decrease in intelligence, violation of spatial orientation);

Changes in the emotional and sensitive areas (fear, anxiety, apathy, euphoria, negative attitude towards the personality of the medical worker providing assistance, to the quality of the manipulations, loneliness, etc.);

Changes in hygiene needs (lack of hygiene knowledge, skills, lack of care for one's health, problems with medical care, etc.) -

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

What is a job description

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

The employee is obliged to familiarize himself with the job description when hiring and sign in the journal, thereby certifying 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 be reprimanded, lose his bonus or be fired.

IMPORTANT! If the procedural nurse is absent for some reason, the ward nurse takes over her functions. Therefore, she must be fluent in the techniques of medical manipulation: be able to put intravenous catheters, make all kinds of injections, etc.

General provisions

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

• 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, demand timely cleaning, change of bed linen, washing of weakened patients, etc.);
• ensure that order is observed at the department, for example, to prevent violations of the regime by both patients and visiting relatives;
• during work, constantly be with patients, leaving only 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 pediculosis;
• if the patient's condition worsens, immediately notify the attending physician (or, in his absence, the doctor on duty);
• monitor the observance of the schedule of quartzization of the chambers and the cleanliness and order in them;
• report violations on the part of junior medical staff to the senior nurse or head of the department.

Job Responsibilities

The ward nurse has the following responsibilities:

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

Rights

The ward nurse has the following rights:

• to provide first aid to the patient until the doctor arrives. In some cases, the lives of patients depend on the qualifications of a nurse and her knowledge of basic resuscitation techniques;
• to manage the work of junior medical personnel;
• to receive information about the health status of the patient. This allows not only proper care, but also protection from infection if the patient has infectious diseases;
• to receive information about changes in orders relating to its work;
• for the issuance of overalls and personal protective equipment;
• assistance from management in the performance of their duties.

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

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

A responsibility

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

• for failure to properly perform their duties prescribed in the job description;
• for compliance with the sanitary and epidemiological regime and fire safety rules in the wards entrusted to her;
• for causing material damage to the employer;
• for the safety and proper storage conditions of medicines (including narcotic and potent) and medical products;
• for providing timely care to patients.

Qualification Requirements

A specialist with a secondary medical education in the specialties "Nursing" and "General Medicine" can become a ward nurse. In some institutions, the nurse is required to have experience in a relevant position.

Each department has its own specifics, so certificates of completion of additional advanced training courses may be required from a nurse.

Necessary psychological qualities

The ward nurse has more contact with patients than other specialists. 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 empathize, kindness, the ability to understand a person and excellent communication skills. Patients exhausted by the disease and tired from prolonged hospitalization may show irritability and even aggression. A physician should be able to listen to a suffering person, cheer him up, explain the need for painful manipulations.

The functional duties of a nurse in the therapeutic department involve the implementation of a number of medical interventions. Some manipulations (enemas, bladder catheterization) may hurt the patient's sense of shame. In order to win respect and win over patients, the nurse must always be mindful of the patients' self-esteem and respect their right to privacy.

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

IMPORTANT! The ward nurse must 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 desire to take a sitting position may indicate the development of pulmonary edema.

RECEPTION AND DELIVERY OF DUTY

medical post- the workplace of a ward nurse, who performs round-the-clock work to carry out activities to care for patients, monitor their health, provide first and emergency medical care and conduct planned drug treatment.

For better control over the movement of patients, employees and visitors through the department, the post should be placed in the hall, not far from the wards. To call a nurse to the patient, there must be a sound and light alarm that connects the post with the wards.

The medical post should be organized according to uniform methodological recommendations in accordance with sanitary standards: an area of ​​​​at least 20 m 2, post lighting of two types - natural and artificial. Natural lighting should be uniform, sufficiently intense. Artificial lighting used in the evening and at night should not be too bright. This requires ceiling lights, a table lamp or a sconce.

The equipment of the medical post includes: medical furniture, medical equipment, electrical equipment, stationery, visual information, disinfectant and cleaning solutions, medical instruments, care items necessary for work.

Visual information is located in a conspicuous place. Particular attention should be paid to the organization of the workplace of the ward nurse. When organizing the desktop, it is necessary to rationally place the main documents, the standards that the ward nurse is guided by in her work. Under the glass on the desktop should be:

Hourly work schedule of ward nurses;

Monthly duty schedule for nurses

List of patients;

List of phone numbers in case of emergency;

The calendar.

The nurse's workplace must be kept clean. The effectiveness of the work of a nurse largely depends on the preparedness and staffing of the workplace. A separate place is allotted for storing accounting and reporting documentation and forms.

Medical documentation is approved Ministry of Health and Social Development and is used in medical institutions in the form of unified forms and cards.

In a hospital, the main and legal document is inpatient medical record (disease history). It is given to each patient admitted to the hospital. It notes the path of the patient's admission to the hospital (by ambulance, by referral, on his own, etc.), the number, hour and minutes of hospitalization are noted. In the admission and diagnostic department, the nurse very carefully fills out all the columns of the passport part of the medical record. Performs a mark on the volume of sanitization and the method of transporting the patient to the medical department, on the fulfillment of the appointments of the doctor of the admission and diagnostic department. The doctor of the medical department enters all the data about the patient into the medical history, including the results of observation in dynamics and treatment of the patient. Nurses paste the results of laboratory, instrumental and other studies, daily record the values ​​of morning and evening temperature, pulse, respiratory rate, blood pressure, and, if necessary, daily diuresis. In the history of the disease, the nurse notes the time of admission of the patient to the department, the results of examination for pediculosis, scabies, viral hepatitis, in the list of prescriptions notes the time of dispensing drugs, the date of the selection of medical prescriptions, in the temperature sheet - the weight and height of the patient upon admission, then 1 time per 7-10 days registers the days of the patient's sanitization and change of linen.

The medical history is a legal document. It is stored for 25 years and therefore must be strictly filled in according to the established form. It does not allow any corrections; it is forbidden to glue, erase, cross out previously written, add. The nurse is responsible for the safety of the medical records, it is not allowed to familiarize the patient with the data of the medical history, the results of the examination, it is strictly forbidden to familiarize relatives and visitors with the medical record of the inpatient. These questions are the responsibility of the attending physician and the head of the department. After the patient is discharged, the medical record is handed over to the statistical department for processing, and then transferred and stored in the archive.

Referrals to the laboratory are filled out by a nurse, they indicate the surname, name and age of the patient, the number of the medical history, the name of the department, as well as a list of indicators that should be determined.

In sister sheets (magazine of medical appointments) the nurse makes medical appointments for each patient from the medical history.

V log of delivery (transfer) of duty note the number of patients who were on duty, the names of newly admitted and retired patients, patients with fever, an assessment of the dynamics of clinical symptoms in seriously ill patients is given, all types of unscheduled manipulations and measures taken to help performed by the doctor on duty and according to his appointment are listed. Separately, a list of patients prepared for special research methods according to medical prescriptions, as well as patients who have violated the regimen, is given.

V patient movement log departments note information on the number of patients admitted, those who left, the total number of patients on treatment at the end of the shift, the number of non-transportable patients.

Acceptance and delivery of duty is the most crucial moment in the work of a nurse in the implementation of continuity in the treatment of patients. When starting a shift, the nurse, together with the sister who is handing over the shift, goes around the wards, examines the seriously ill and notes in a special journal the amount of work outstanding, indicating the patient's name, ward number, checks the sanitary condition of the wards, halls, public places, and the patient's compliance with the rules of personal hygiene . The nurse takes thermometers, syringes, medicines, keys to cabinets and safes with medicines, checks the presence and compliance of narcotic and potent drugs and signs in the journal. At the end of the shift, the nurse compiles a summary of the movement of patients, how many were at the beginning of the shift, how many arrived and how many left (transferred to other departments, discharged, died) and how many are at the end of the shift, also makes up a portioner - a requirement for a food unit for treatment tables. The handover of duty ends at the morning medical and nursing conference, where the ward nurse reports on the work done, on the condition of patients under special supervision, deterioration in their condition, on newly admitted patients, additional need for medicines, and emergency situations.

The nurse in the medical department should perform the following medical manipulations:

Carry out tube feeding, probe and wash the stomach;

Conduct duodenal and gastric sounding;

To put enemas of all kinds;

Insert a gas outlet tube;

Perform catheterization of the bladder with a soft catheter;

Put mustard plasters, jars, plasters;

Own local ways of administering drugs;

Bury medicinal solutions in the nose, eyes, ears;

Own methods of setting all types of compresses;

Perform intradermal, intramuscular, subcutaneous and intravenous injections;

Measure blood pressure, count the number of breaths and heartbeats;

Perform indirect heart massage and artificial ventilation of the lungs;

Take smears from the pharynx;

Collect biological material for laboratory research;

Carry out the simplest physiotherapy procedures as prescribed by the attending physician;

Prepare the patient for planned and emergency surgical operations;

Monitor the patient.

The staff of the department is allocated a nurse in the treatment room, who performs the most complex manipulations. One of the experienced nurses with at least five years of experience in the hospital, who has a completed secondary medical education, preferably a paramedic, is appointed to the position of a nurse in the treatment room.

In accordance with the assigned functional duties, the procedural nurse is obliged to:

Observe the sanitary-hygienic and anti-epidemic regime at the workplace;

Process and hand over for sterilization to the centralized sterilization medical instruments, dressings;

Provide the treatment room with the necessary medicines and observe their proper storage;

Take blood samples for laboratory testing;

Perform intravenous, intramuscular and subcutaneous injections;

Under the supervision of a doctor, determine the blood type, Rh factor, conduct blood transfusions and tests for individual sensitivity and Rh compatibility;

Once a month, carry out bacteriological control of sterility;

Keep records of manipulations and medicines;

Safely and safely maintain the medical and household property, tools and equipment that are under the jurisdiction of the treatment room;

Strictly observe the rules of asepsis and antisepsis in the treatment room during the procedures;

Provide the treatment room, depending on the profile of the department, with a set of tools, dressings, sera for determining blood groups, syringes for injections and infusions, as well as the necessary set of drugs, sera, canned blood and blood substitutes.

Necessary documentation of the treatment room:

♦ register of general cleaning;

♦ register of blood sampling for biochemical analyzes;

♦ register of operation of the bactericidal lamp;

♦ register of intravenous infusions and drips;

♦ register of i/m, s/c, i/c injections and antibiotics;

♦ register of blood transfusions and blood substitutes;

♦ journal of delivery of syringes to the central sterilization department;

♦ journal of delivery of syringes by shift;

♦ register of patients with hepatitis;

♦ refrigerator temperature log;

♦ a register of blood sampling for the Wasserman reaction and for HIV infection.

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

Rice. 10.1. Approximate organizational structure of a city hospital

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

technologies that make it possible to significantly save available resources without compromising the quality of medical care (see Section 10.3).

10.1. ORGANIZATION OF THE WORK OF THE AVERAGE MEDICAL STAFF OF THE CITY HOSPITAL FOR ADULTS

The hospital is headed by the chief physician, who is responsible for all medical, preventive, administrative and financial work. The activities of the middle and junior medical staff are led by the chief nurse. A person with a higher medical education in the specialty "Nursing" or with a secondary medical education who has a diploma in one of the specialties: "Nursing", "General Medicine", "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 directly reports to the deputy chief physician for medical affairs. The orders of the head nurse are obligatory for the middle and junior medical staff of the hospital.

Key Responsibilities of the Chief Nurse:

Development of long-term and current plans for advanced training of hospital nurses;

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

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

Monitoring the timely and accurate fulfillment of medical prescriptions by paramedical personnel, the correctness of accounting, distribution, spending and storage of medicines (including narcotic, poisonous and potent) and dressings;

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

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

Give orders to the middle and junior medical staff and monitor their implementation;

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

Make proposals to the attestation commission on the assignment of the next qualification category to paramedical personnel;

Instruct nurses to check the work of the middle and junior medical staff of the hospital units.

The first acquaintance of the patient with the hospital begins with reception department. It can be centralized and decentralized. Patients can get to the admission department of the hospital in different ways: by referral from doctors from outpatient clinics (scheduled 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 (“spontaneous” ).

Receptionist duties include:

Receiving patients, making a preliminary diagnosis and deciding on the need and profile of the department for hospitalization;

Providing emergency medical assistance if necessary;

Sanitary treatment of patients;

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

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

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

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

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

The Admissions Nurse performs a wide range of duties:

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

He listens to the complaints of the patient who came "by gravity" and sends him to the doctor on duty;

Fills in the passport part of the "Medical record of an inpatient" (f. 003 / y);

Maintains a "Journal of registration of admission of patients and refusals in hospitalization" (f. 001 / y);

Examines the patient for pediculosis and measures body temperature;

Performs procedures and manipulations prescribed by the doctor on duty;

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

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

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

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

Carries out the collection of feces, urine, vomit and washings for laboratory research;

Receives medicines from the head nurse and ensures their storage;

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

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

From the emergency department, the patient enters the inpatient department. The head of the medical department is in charge of the work. The work of the middle and junior medical staff of the department organizes senior nurse of the department.

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

The main figure of the department is the attending physician (resident), they help him ward nurses, who report directly to the head nurse of the department and perform the following duties:

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

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

Isolation of patients in an agonal state, calling a doctor to 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 minutes". Every day, the intern of the department receives information from the night duty medical staff about the condition of patients and the changes that have occurred in their health, about newly admitted patients, gets acquainted with the results of laboratory, x-ray and other studies, conducts rounds of patients. Bypassing patients is carried out accompanied by a nurse. At the bedside of the patient, the resident checks the fulfillment of the previously given appointments.

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

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

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

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

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

Elimination or maximum reduction of the impact of adverse environmental factors (uncomfortable beds, poor lighting, low or excessively high temperature in the wards, bad smells, groans or cries of patients, noise, tasteless 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 painkillers, high skill in injection techniques and other manipulations, due sharpness of needles and scalpels, the rejection of aimless research);

Measures to prevent the possibility of the patient going into illness and exaggerated ideas about adverse consequences (fiction, favorite music, exciting conversations, painting, television, the opportunity to do some favorite thing, walking around the hospital for walking patients, occupational therapy in the departments for chronic patients , educational and pedagogical work in children's hospitals, etc.);

Organization of the patient's day 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 (prevention of iatrogeny);

Compliance with the principles of medical ethics by the staff (high culture of medical personnel, sensitive, attentive attitude to the patient, his relatives, observance of 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 THE WORK OF THE SECONDARY

MEDICAL STAFF

CHILDREN'S CITY HOSPITAL

(CHILDREN'S DEPARTMENT OF THE CENTRAL

DISTRICT HOSPITAL)

The organization of the work of a children's hospital has much in common with the work of a hospital for adults, however, there are also differences that determine the specifics of the work of nursing staff.

Sick children, like adults, are admitted to the in-patient department of a children's hospital on the direction of doctors from children's clinics, 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 a reception department, medical departments (pediatric and specialized: surgical, infectious diseases, etc.), departments of laboratory and functional diagnostics, and others.

The admission department of the inpatient department of the 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, and 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 the 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 in a special book and reported to the police.

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

them taking into account the age of the children and the disease. It is advisable to have 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 child of the mother.

Tasks ward nurse children's hospital:

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

Accurate and timely fulfillment of the appointments of the attending physician;

Emergency notification of a doctor about cases of changes in the condition of a sick child requiring urgent measures, and 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 to conduct educational work there. For this purpose, positions of educators are being introduced in children's hospitals. With sick children who are treated for a long time in a hospital, educational work is carried out. A very important element in creating a medical and protective regimen for children is the organization of their leisure time, especially in the evening. Handicraft, modeling, drawing, reading aloud at the end of the hospital day improve the mood of children and contribute to a restful sleep. Ward nurses play an important role in the proper organization of children's leisure.

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

In children's hospitals, to a greater extent than in adult hospitals, nosocomial infections should be feared. If a child with an acute infectious disease is detected in the department, quarantine is established for the duration of the incubation period for this disease. It is necessary to keep a record of children who have been in contact with the sick, who cannot be moved to other wards during the incubation period. In these cases, depending on the diagnosed acute infectious disease, special anti-epidemic measures are also taken (vaccinations, tests for bacteriocarrier, etc.).

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

Children who were born with a weight of at least 2300 g and fell ill in the neonatal period are sent to the departments for newborns. Newborns weighing less than 2300 g, with signs of immaturity and ill in the neonatal period, are sent to the departments for premature babies. The transfer of newborns and premature babies from maternity hospitals is carried out subject to the transportability of the child and the obligatory coordination with the head of the specialized department where the child is transferred. Transportation of newborns is carried out according to the principle “on oneself” in a specialized resuscitation vehicle with a resuscitator or pediatrician well trained in resuscitation of newborns and premature babies. Nursing personnel accompanying children should also have special training in resuscitation and intensive care of newborns.

In the work of the department for newborns and premature babies of children's hospitals, close interconnection and continuity with maternity hospitals and children's polyclinics should be carried out.

10.3. ORGANIZATION OF THE WORK OF THE SECONDARY

MEDICAL STAFF

DAY HOSPITAL

Taking into account the high cost of inpatient care, new hospital-replacing technologies are of great importance, which make it possible to significantly save available resources without compromising the quality of medical care. These organizational forms include:

Day hospitals in outpatient clinics;

Day hospitals in hospitals;

Stations at home.

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

(Fig. 10.2).

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

The main forms of primary medical records of day hospitals:

"Journal of registration of admission of patients and refusals in hospitalization", f. 001/y;

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

"Temperature sheet", f. 004/y;

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

"A sheet of daily records of the movement of patients and bed fund of a day hospital at an outpatient clinic, a hospital at home", f. 007ds/y-02;

“Summary statement of the movement of patients and bed capacity in a hospital, department or profile of beds in a round-the-clock hospital, day stay at a hospital”, f. 016/y-02;

"Extract from the medical record of an outpatient, inpatient", 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 treated in a physiotherapy department (office)", f. 044/y;

"Journal of records of X-ray studies", f. 050/y;

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

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

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

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

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

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

Stations at home can be organized in cases where the patient's condition and home conditions (social, material) allow organizing medical care 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 for people who have undergone simple surgical interventions, etc. Hospitals at home have proven themselves well in pediatrics and geriatrics.

The organization of a hospital at home involves the daily observation of a 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, physiotherapy exercises, etc.

Treatment in hospitals at home is not associated with isolation, impaired microsocial adaptation, is easier for patients to accept, and is cost-effective. Treatment in a hospital at home is several times cheaper than in a round-the-clock hospital, and in terms of efficiency it is not inferior to treatment in a round-the-clock hospital.

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

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

The head physician manages the activities 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, correct accounting, distribution, spending and storage of medicines and medical products;

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

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

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

Rice. 10.3. Approximate organizational structure of a maternity hospital

Systematically improve your professional qualifications.

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

The doctor (or midwife) assesses the general condition of the applicant, gets acquainted with the “Exchange Card”, finds out whether the woman suffered from infectious, inflammatory diseases before and during pregnancy, paying special attention to diseases that were 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 taking an anamnesis, examination, acquaintance with documents in the filter room, women are divided into two streams: with a 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 in the absence of an "Exchange card of the maternity hospital", as well as puerperas in the early postpartum period in case of childbirth outside a medical institution.

In the examination rooms of the physiological and observational departments, an objective examination of the woman is carried out, her sanitization, a set of sterile linen is given out, and blood and urine are taken for analysis. From the examination room, accompanied by paramedical personnel, a woman goes (if indicated, is transported on a gurney) to the birth unit or department of pathology of pregnant women.

The middle and junior medical staff of the obstetric department is directly subordinate to the senior midwife. The senior midwife of the department is subordinate to the head of the department and the main midwife. The duties of a chief midwife are in many ways similar to those of a chief 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 examination by a doctor;

Assistance to the doctor during medical diagnostic and surgical manipulations;

Providing medical care during childbirth and conducting primary treatment of newborns;

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

Monitoring the work of junior medical staff;

Ability to conduct simple laboratory tests (urine for protein, blood type, hemoglobin and erythrocyte sedimentation rate);

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

Stitching of ruptures of the perineum I and II degree.

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

If there are two delivery rooms, delivery is performed in them alternately. Each delivery room is open for 1-2 days, then it is cleaned. In the presence of one delivery room, delivery is carried out alternately on different Rakhmanov beds. Twice a week, general cleaning of the delivery room is carried out. A normal birth is handled by a midwife.

After the birth of the child, the midwife shows him to the mother, paying attention to the sex and the presence of congenital anomalies (if any). Next, the child is transferred to the nursery. The puerperal must be in the delivery room under supervision for at least 2 hours.

After washing hands under running water and processing them, the midwife conducts secondary processing of the umbilical cord, primary processing of the skin, weighing the child, measuring body length, chest and head circumferences. Bracelets are tied to the child's hands, and after swaddling over the blanket - a medallion. They indicate: surname, name, patronymic, birth history number of the mother, gender of the child, weight, height, hour and date of his birth. After the treatment of the newborn is completed, the midwife (doctor) fills in the necessary columns in the "History of childbirth" (f. 096 / y) and the "History of the development of the 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 cycle - one ward is allowed to be filled for no more than three days. When the first signs of disease appear in women in labor or newborns, they are transferred to observational obstetric department or other specialized agency.

In the observational obstetric department are placed: sick women with a healthy child; healthy women with a sick child; sick women with a sick child.

Chambers for pregnant women and puerperas in the observational department should be profiled if possible. It is unacceptable to place pregnant women and puerperas in the same room.

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

During the first day after birth, each child is under intensive supervision of medical staff. Pediatricians conduct daily examinations of children. If there is one pediatrician working in the maternity hospital, then during his absence, the examination of children is carried out 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 mothers about the condition of the children and conducts sanitary and educational work with them.

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

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

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

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

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

In order to reduce perinatal mortality, organize continuous monitoring of the state of vital functions of newborns, timely 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. With a lower capacity of the maternity hospital, intensive care posts are organized.

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

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

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

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

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

Before discharge, the pediatrician, while still in the ward, talks 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 record of the last name, first name and patronymic on the bracelets and medallion, the condition of the skin and mucous membranes of the child, once again talks about the features of care at home .

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

On the day of the discharge of the child, the head nurse of the department of newborns reports by telephone to the children's polyclinic at the place of residence basic information about the discharged child.

Departments of Pathology of Pregnancy organized in large maternity hospitals with a capacity of 100 beds or more. Women with extragenital diseases, pregnancy complications (preeclampsia, threat of miscarriage, etc.), with an abnormal position of the fetus, with a aggravated obstetric history are hospitalized in the pregnancy pathology department. The department employs obstetrician-gynecologists, maternity hospital therapists, midwives and other medical personnel.

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

pregnant women from the department to the street. 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 room for physio-psychoprophylactic preparation for childbirth, covered verandas or halls for pregnant women to walk.

From the department of pathology of pregnancy, women can be transferred in connection with the improvement of the condition under the supervision of the 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 observation unit, where they undergo a complete sanitization.

Gynecological departments There are three profiles of maternity hospitals:

1) for hospitalization of patients requiring surgical treatment;

2) for patients requiring conservative treatment;

3) for termination of pregnancy (abortion).

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

In general, the work of the gynecological department, as well as the duties of the nursing staff, are 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, “Maternity Certificates” have been introduced, the procedure for filling which is determined by the relevant order of the Ministry of Health and Social Development of the Russian Federation .

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

Perinatal centers are being set up for mothers and newborns in the Russian Federation.

The main tasks of perinatal centers:

Provision of consultative and diagnostic, medical and rehabilitation assistance mainly to the most severe contingent of pregnant women, women in childbirth, puerperas, newborns;

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

Providing a system of rehabilitation measures and rehabilitation therapy, medical, psychological and socio-legal assistance to women and young children;

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

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

The main tasks of the paramedical staff of perinatal centers are in many ways similar to the tasks of paramedical workers of antenatal clinics, maternity hospitals, resuscitation and intensive care units for newborns in children's hospitals.

An 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:

Sheet of daily records of the movement of patients and the bed fund of a round-the-clock hospital, a day hospital at a hospital institution, f. 007/y-02;

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

The main indicators of the medical activity of the hospital:

The indicator of provision of the population with hospital beds;

Indicator of the frequency (level) of hospitalization;

Rice. 10.4. Approximate organizational structure of the perinatal center

An indicator of the average number of days of bed occupancy per year (function of a hospital bed);

The indicator of the average duration of the patient's stay in bed;

Hospital mortality rate.

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

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

Rate (rate) of hospitalization is used to analyze the satisfaction of the population in hospitalization and 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 development of outpatient care, as well as the introduction of new hospital-replacing technologies, the level of hospitalization of the population should decrease in the future.

Average number of bed occupancy days per year (hospital bed function) characterizes the effectiveness of the use of financial, logistical, human and other resources of hospitals.

The indicator of the average duration of the patient's stay in bed-

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

Hospital mortality rate allows a comprehensive assessment of the level and quality of the organization of medical and diagnostic care in a hospital, the use of modern medical technologies.

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

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

In the analysis of the activities of a maternity hospital, a perinatal center, statistical indicators characterizing the qualitative side 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 frequency of complications in childbirth;

Indicators of the frequency of complications in the postpartum period;

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

forceps, vacuum extraction, caesarean 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 decrease in the frequency of applying obstetric forceps by 2 times (Fig. 10.5).

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

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

An indicator of the frequency of complications in childbirth (perineal tears) and an indicator of the frequency of complications in the postpartum period (sepsis).

These figures 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 evaluating the use of modern medical technologies for childbirth is an indicator of the frequency of use of anesthesia during childbirth. This figure in the maternity hospitals of Veliky Novgorod in 2008 amounted to 800 per 1000 births, which indicates the possibility of expanding anesthetic benefits during childbirth.

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

Control questions

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

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

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

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

5. What are the duties of a nurse in the admission department of the adult city hospital?

6. List the main duties of the head nurse of the department of the city hospital for adults.

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

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

9. What is a medical and 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 work of the admission department of the children's city hospital.

12. List the tasks and reveal the features of the work of 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 duties 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 duties of the senior midwife of the obstetric department of the maternity hospital.

17. Expand the functional responsibilities of the midwife of the obstetric department of the maternity hospital.

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

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

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

21. How are newborns cared for in the maternity hospital?

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

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

24. List the main tasks of the perinatal center.

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