The nurse, in addition to performing medical work and caring for the sick, maintains medical records.

1. Journal, or notebook appointments.

2. Journal of reception and transfer of duty.

3. A sheet of records of the movement of patients and hospital beds.

5. Register of medicines of list A and B.

6. Summary of the condition of the patients of the help desk.

7. Journal of accounting for expensive and acutely scarce drugs.

8. Journal of dressings.

9. Journal of copying materials and alcohol.

10. Journal of disinfection treatment of instruments.

I. Journal of pre-sterilization treatment of instruments.

12. Journal of general cleaning.

13. Journal of quartzization.

14. Register of post-injection complications. In addition, she must be able to fill out a statistical coupon (form No. 30).

15. Journal of emergency tetanus prophylaxis.

Journal or appointment book. The nurse prescribes the prescribed drugs, as well as the studies that need to be performed by the patient, in the prescription book, which indicates the full name. patient, room number, manipulations, injections, laboratory and instrumental studies. It duplicates the entry data in the appointment sheet. Be sure to put the dates and the signature of the nurse.

Journal of reception and transfer of duties. Most often, the transfer of duty is done in the morning, but it can also be done in the afternoon, if one nurse works in the first half of the day, and the second in the afternoon and at night. The nurses receiving and handing over the duty go around the wards, check the sanitary and hygienic regime, examine the seriously ill and sign in the register of reception and transfer of duty, which reflects the total number of patients in the department, the number of seriously ill and feverish patients, the movement of patients, urgent appointments, the state of medical equipment, items care, emergencies. The journal must have clear, legible signatures of the nurses who accepted and passed the duty.

The nurse on duty in the morning fills out the “Patient Movement Record Sheet” (form No. 007y).

The ward nurse, checking the list of appointments, makes a "portion" every day (if there is no dietary sister). The portioner should contain information about the number of different dietary tables and types of unloading and individual diets. For patients admitted in the evening or at night, the portioner is made up by the nurse on duty. Information from ward nurses on the number of diets is summarized by the head nurse of the department, they are signed by the head of the department, then transferred to the catering unit.

Register of medicines of list A and B. Medicines included in list A and B are stored separately in a special cabinet (safe). On the inside of the safe there should be a list of these medicines. Drugs are usually stored in the same safe, but in a special compartment. The safe also stores extremely scarce and expensive funds. Handing over the keys to the safe is recorded in a special register. To account for the consumption of medicines stored in a safe, special journals are kept. All sheets in these magazines should be numbered, laced, and the free ends of the cord should be sealed on the last sheet of the magazine with a paper sheet indicating the number of pages. This sheet is stamped and signed by the head of the medical department. To account for the consumption of each drug from list A and list B, a separate sheet is allocated. This magazine is also kept in a safe. Annual records of drug consumption are maintained by the head nurse of the department. The nurse has the right to administer a narcotic analgesic only after the doctor records this appointment in the medical history and in his presence. About the injection made, a mark is made in the medical history and in the prescription sheet. Empty ampoules from narcotic analgesics are not thrown away, but are transferred along with unused ampoules nurse embarking on the next duty. When transferring duty, they check the correspondence of the entries in the accounting log (the number of used ampoules and the balance) with the actual number of filled used ampoules. When using the entire stock of narcotic analgesics, empty ampoules are handed over to the head nurse of the department and new ones are issued in return. Empty ampoules from narcotic analgesics are destroyed only special commission approved by the head of the medical department.

The journal of accounting for acutely scarce and expensive funds is compiled and maintained according to a similar scheme.

Summary of the status of patients for the reference table. This summary is compiled daily by the night nurse, most often early in the morning, before the shift. It contains the names of patients, the numbers of their wards, as well as their state of health.

The dressing journal indicates the date, types of dressings, the number of patients who received dressings, and also puts a daily signature.

The journal for writing off alcohol and dressings is located in the surgical room or in the dressing room. This journal is numbered and laced, signed by the senior nurse and head of the department. To the attention of the nurse - the consumption of alcohol by order No. 245 of August 30, 1991.

Surgical office - 1200 g per 1 thousand people (1 person - 1.2 g of alcohol).

Oncology room - 1000 g per 1 thousand people (1 person - 1 g of alcohol).

Urologist's office - 1200 g per 1 thousand people (1 person - 1.2 g of alcohol). To apply a compress, 20-30 g of alcohol is required. Burn treatment - 20-40 g of alcohol.

Similarly, the consumption of cotton wool, bandages, furacilin is taken into account. Logs of disinfection treatment of instruments, pre-sterilization treatment of instruments are compiled and maintained to control the relevant activities (table).

Orders for work in the surgical room

Instruction on labor protection for a nurse at school. AGREED APPROVED. Chairman of the trade union director. Order. General provisions health and safety instructions for nurses. An employee hired by a school as a nurse must necessarily undergo a medical examination, special training, introductory safety briefing, primary briefing for a nurse - at the workplace, repeated briefing - at least once every 6 months, unscheduled (if conditions change) work of a nurse, safety violations, accidents).

Employees with an average medical education by specialty. Persons who have studied the labor protection instructions for the school nurse, as well as the job description of the nurse at the school, are allowed to perform duties. The employee has the right to refuse the work entrusted to him if a situation has arisen that is dangerous for his personal health, or for the people who surround him, and the environment.

An employee is obliged to strictly comply with the requirements and internal regulations of a general educational institution: observe discipline; take care of equipment, tools, devices, medicines, materials and overalls; keep your workplace and territory clean; periodically undergo medical examinations. When performing the duties of a nurse at school, exposure to harmful production factors is possible: electric shock when turning on electric lighting, using faulty electrical outlets; electric shock when working with a bactericidal quartz lamp, medical or other electrical equipment; violation of visual acuity in case of insufficient illumination of the workplace of a nurse; damage to the mucous membrane of the eyes due to failure to comply with the instructions and requirements for the use of bactericidal quartz lamps; injections, cuts in the provision of medical care to victims. It is forbidden to smoke and drink alcohol in the workplace. Rules must be strictly followed fire safety. It is also necessary to observe the rules of personal hygiene: eat only in the dining room; perform work in perfectly clean overalls; when performing injections, use rubber gloves; one.

All employees of the department (office) are re-instructed at least as often as the knowledge of the personnel of the department (office) on safety measures according to the program. The results of the briefing are recorded in the appropriate journal, knowledge of this labor protection instruction for the nurse is checked. Maintaining the necessary sanitary and epidemiological regime in the surgical department is impossible without the following components They are contained in the RTM

The nurse is obliged to follow the instructions for labor protection in the medical office. The medical office of the institution must be equipped and equipped with tools in accordance with the approved list of equipment and tools for medical office. For violation of the requirements of this instruction on labor protection for a nurse, a medical worker working at a school is held liable in accordance with the legislation of the Russian Federation. Occupational safety requirements for a nurse before starting work.

Before starting work in the medical office of the school, the nurse must put on clean overalls: a medical gown, a cap or scarf, a gauze bandage-mask. The overalls of the nurse must be clean and ironed, fastened with all buttons or tied.

Inspect the premises, make sure that the electric lighting in the medical and treatment rooms of the school is working. Ventilate the room of the medical office, treatment room. Check the integrity of electrical outlets and the serviceability of other electrical appliances. It is necessary to carefully check the availability of all medicines and the serviceability of medical equipment.

Before starting work, the nurse of the educational institution must thoroughly wash their hands with soap and water. Safety requirements during the work of a nurse. The school nurse is obliged to: Accurately and promptly follow the instructions of the doctor; be sensitive and attentive to sick children, monitor the personal hygiene of students; use equipment and tools professionally, accurately and carefully; Report all technical malfunctions to the director of the educational institution. It is forbidden for the school nurse to use medical equipment and devices for other purposes. To avoid injury and the occurrence of dangerous situations, the nurse must comply with the following requirements: do not leave switched on and operating equipment unattended; do not allow persons who have not undergone appropriate training to work with medical equipment; work only on serviceable medical equipment and serviceable tools; constantly monitor the expiration date of the drugs used; observe the rules of electrical safety and fire safety; do not perform work that is not part of your duties. Sterilize medical instruments only in specialized rooms (treatment room). When working with medical equipment, observe safety measures: do not connect to electrical network and do not disconnect devices from it with wet and damp hands; do not violate the sequence of turning on and off the equipment, do not violate technological processes; strictly follow the instructions for using electrical appliances available in the medical office; do not leave unattended devices, quartz lamps, ovens, etc., turned on in the medical office;

Each student is required to undergo a safety briefing at the clinical base of the department, before starting training and conducting practical classes. Conducting practical classes at the clinical bases of the department, in the departments of the surgical profile. Safety instructions for working in the surgical department. File description: Added: 04/20/2016 Downloads: 1603 File status: available File public: Yes File uploaded: raulLAN44. Typical instruction on labor protection for personnel of operating units (approved. Job description of the nurse of the surgical department: This job description was developed and approved by them; - internal labor regulations; - rules and regulations of labor protection, safety and fire protection; - 1st and 2 -th surgical departments Standard safety instructions for working in sterilization rooms (Approved by the Ministry of Health of the USSR on 14.10. Each student is required to undergo a safety briefing in the hospital before starting to work in the hospital department, you must change clothes.

An instruction on labor protection for an obstetrician is urgently needed. To work in the gynecological department (hereinafter referred to as the "department"). Surgical instruments used in various HEALTH AND SAFETY INSTRUCTIONS Nursing post of the surgical department, Contents. Repeated briefing on labor protection should be carried out at least in time when working in the surgical department, in maternity, etc. Participates in surgical operations, provides members of the surgical team with the necessary tools, materials, equipment. Complies with internal regulations, fire safety and safety regulations.

This job description defines official duties, rights and responsibility (head of the department, deputy chief physician). Safety and fire safety rules at the workplace and in the department. Basic requirements, orders, instructions for infectious safety and prevention of nosocomial infections in a surgical hospital. Instructions for students on safety precautions when working in medical institutions in 2. Before starting work in the hospital department, you must change clothes. Dress code: medical gown, surgical suit, medical cap. All newly hired workers must undergo an introductory briefing on labor protection. The results are recorded in the entry log. My 422039-05 (technics for the collection and transport of surgical and biomaterials in microbiological laboratories) institutions). Instructions GBUZ SO *&SOKB N*.

The head of the department is obliged to develop safety instructions for each type of equipment, which must be approved by the administration of the health facility and agreed with the trade union committee.

Standard instruction on labor protection for staff of departments, labor protection for a ward nurse (reception-quarantine. The job description of a nurse (nurse) is local act, in which the activities of the department to which it is attached (surgical, radiological Compliance with safety precautions when working with equipment in the operating room. When working with electrical equipment, follow the operating rules and safety precautions set out in the instructions, which 9. Infections of the skin and subcutaneous tissue - only for obstetric and surgical hospitals, departments of neonatal pathology Instructions for safety precautions Obligations of the student in the surgical department: I. To ensure a safe environment for the patient in the hospital.

To protect yourself from injuries to your hands in the process of opening the ampoule, you must first file the ampoule with a nail file and then break off its nose with your fingers protected with gauze or cotton. Know the ways of evacuation in case of fire, the procedure for emergency situations, be able to use a powder fire extinguisher if necessary. During work, the nurse must observe the rules of personal hygiene, the requirements of the labor protection instruction for the school nurse, be careful with medicines. Occupational safety requirements at the end of the work of a nurse. Disconnect all electrical equipment from the electrical network.

Ventilate the medical office. Tidy up your workspace. Take off your overalls and hide them in the designated place. Tightly close the window, transom. Close the medical and treatment room with a key.

reachpriority.weebly.com

I.V.SHATKIN

Appendix No. 21
to the order of the Ministry
health care of the USSR
dated 23.09.1981 N 1000

www.zakonprost.ru

Organization of the work of the surgical department and the surgical room of the polyclinic

In our country, medical care is organized according to the territorial principle, however, with the development of insurance and private medicine, this principle, especially in relation to planned care, is beginning to change.

Organizations of surgical care

Feldsher-obstetric station - provides emergency first aid, carries out the prevention of diseases and injuries to residents of one or more rural settlements.

The district hospital provides emergency and emergency medical care for acute surgical diseases and injuries, carries out work on their prevention, and manages the work of feldsher-obstetric stations located in this area of ​​the district.

District hospital - provides surgical care to all patients with acute surgical diseases and trauma, conducts planned treatment of the most common surgical diseases (hernia, gastric ulcer, cholecystitis, etc.)

The regional hospital - in addition to the volume of care provided in district hospitals, provides specialized surgical care: urological, traumatological, oncological, etc.

City hospitals provide emergency and planned surgical care to residents of city districts.

Surgical departments of medical universities - in addition to providing surgical care, they conduct the scientific development of certain sections of surgery.

Scientific research institutes, in accordance with their profile, provide special surgical care, carry out the scientific development of surgical problems.

Inpatient surgical care is provided in surgical departments three types: general profile, specialized and highly specialized (centers).

General surgical departments are organized as part of district and city hospitals. They provide the main types of qualified inpatient surgical care to a large part of the country's population. Various diseases are treated here, among which more than 50% are acute surgical pathologies and 20-40% are injuries and diseases of the musculoskeletal system.

Specialized departments are opened in regional and city hospitals and serve from 50 thousand to 3 million people. They are intended to provide patients with surgical care in the relevant specialty. The organization of specialized departments is based on similar principles that contribute to the concentration of patients on a certain basis:

* · for a disease of one organ system - departments of vascular surgery, lung surgery, proctological, urological, etc.;

* By nosological forms, taking into account localization - burn departments, surgery for genitourinary and osteoarticular tuberculosis, etc.;

* by sections of surgical pathology - oncological departments, emergency surgery, purulent surgery, etc.;

* by the peculiarities of the methods of operations - plastic surgery;

* · on age characteristics- Pediatric surgery.

General surgical departments are opened, as a rule, for 60 beds or more, specialized departments for 25-40 beds. A significant part of city and regional hospitals are clinical, as surgical clinics of medical institutes operate on their basis. Surgical beds are also available in special clinics of medical institutes that are not part of the city network, in research institutes subordinate to ministries and departments, and in institutes of the Russian Academy of Medical Sciences.

Organization of emergency and urgent surgical care. In cities, it is carried out according to the scheme: emergency medical care (health center or clinic) - surgical hospital. In the countryside: feldsher-obstetric station, district hospital - surgical department district hospital. Surgical departments have round-the-clock duty of surgeons, anesthesiologists and operating nurses to provide emergency surgical care.

ORGANIZATION OF THE WORK OF THE SURGICAL DEPARTMENT

Departments of the surgical profile should be located in the same building with the emergency room, the operating unit, the intensive care unit and the intensive care unit, since they are functionally dependent on each other. Ward departments are organized for 60 or more beds. According to SNiP (Building Norms and Rules, 1971), departments in new hospitals are planned from two impassable sections, which are separated by halls. The section should have 30 beds. The ward section provides for: a post for a nurse on duty (4 m 2), a treatment room (18 m 2), a dressing room (22 m 2), a dining room (with at least 50% of the number of beds), a room for sorting and temporary storage of dirty linen , cleaning items (15 m 2), bathroom (12 m 2), enema (8 m 2), restroom (men's, women's, for staff). Along with this, the department needs: the head's office (12 m 2), the staff's room (10 m 2 for each doctor, in addition to one additional 4 m 2), the head nurse's room (10 m 2), the hostess (10 m 2). The clinics provide offices for professors, associate professors, assistants and study rooms for 10-12 people.

Chamber - the main place of stay of the patient in a medical institution. In the wards of the surgical department, 7 m 2 is allocated per bed. Most of the wards in the section are planned for 4 beds, 2 - two-bed wards, 2 - one-bed wards. The optimal number of beds in the ward is 3. Before entering the ward, a gateway is planned, which is provided as a small front room, where there are built-in individual wardrobes for patients and an entrance to the toilet, with a washbasin, bath or shower. The rooms are equipped with beds of a metal structure, to which a transfusion stand and a skeletal traction device can be attached. Most beds should be functional. The interior of the room is complemented by a bedside table, a common table, chairs, and a waste paper basket. The temperature in the room should be at 20°C. Optimum air humidity is 50-60%, air mobility is about 0.15 m/s. Chambers should be well lit by natural light, windows should not be oriented to the north. The ratio of the area of ​​​​windows and the floor should be 1:6. Provides general and local electric lighting. Each bed has a nurse call system.

The post of the ward sister is placed in the corridor so as to ensure good review chambers. The post is located in the center of the section. It is equipped with cabinets for storing medicines, tools, care items and documentation (lists of medical appointments, handovers, etc.).

When placing patients, it is necessary to take into account the characteristics of the contingent, so clean and purulent departments should be allocated. This will make the treatment more effective, and most importantly, prevent complications.

Surgical departments should be provided with forced ventilation, and separate rooms with supply and exhaust ventilation or conditioned air. The premises of surgical departments are subject to wet cleaning, using disinfectants, twice a day: in the morning after the patients wake up and in the evening before bedtime. Once a month it is necessary to carry out general cleaning, with wet disinfection of mattresses and pillows. Air samples should be taken monthly for bacteriological examination.

The organization of work of medical personnel is regulated by the “Model internal regulations”, on the basis of which rules are drawn up for various institutions, depending on their purpose. Each surgical department has a daily routine, which is aimed at creating rational working conditions for medical personnel and optimal conditions for the recovery of the sick.

Special requirements are imposed on the personnel of the surgical department: the human qualities of the personnel are no less important than their qualities as specialists. It is necessary to impeccably follow the principles of medical deontology and ethics. Deontology (Greek deon - due, logos - teaching) - a set of ethical and organizational norms for the fulfillment by health workers of their professional duties. The main elements of deontology are aimed at creating a special psychological climate in the surgical department. The main function of the psychological climate in a surgical facility is to create conditions for the speedy, high-quality and reliable recovery of patients. Two main goals follow from this:

* Minimize the effect of factors slowing down and qualitatively worsening the process of patients' recovery;

* Maximize the extent to which patients perceive a healthier lifestyle.

WORK ORGANIZATION

SURGICAL DEPARTMENT OF THE POLYCLINIC

The polyclinic provides reception of patients with surgical diseases and treatment of those who do not need inpatient treatment. Most patients visit the department repeatedly for dressings and medical procedures.

The surgical department of the polyclinic should be located, if there is no elevator, on the first or second floor. This facilitates visiting them by patients with diseases of the lower extremities and the delivery of stretcher patients. With one working surgeon, the department should include: a doctor's office, a dressing room, an operating room, a sterilization room, and material rooms. With a large number of working surgeons, the operating room, sterilization room, material room can be shared, but the office and dressing room should be separate for each doctor. The surgeon's office should have a table, 2 stools, a couch for examining patients, which is best placed behind a screen, a negatoscope, etc.

The walls must be smooth and in all rooms at least two meters high must be painted with oil paint, the walls of the operating room must be covered with tiles. All rooms in the surgical department must have wash basins. Premises of the surgical room must be especially carefully protected from pollution. The contingent of patients changing during the reception, the delivery of patients in clothes contaminated after injuries contributes to the introduction of dirt into the surgical room. Therefore, it is necessary to frequently wipe the floors of offices and dressing rooms with a wet method, using antiseptic liquids that are devoid of an unpleasant odor. Wet current cleaning of the premises (floor, walls) should be carried out after each appointment. At the end of the day's work, the office is completely cleaned.

The work of a surgeon in a clinic is significantly different from the work of a surgeon in a hospital. Unlike a hospital surgeon, an outpatient surgeon has significantly less time for each patient and often lacks the ability to accurately distribute his work hours, especially where there is no separate trauma room. Appeal of patients for emergency surgical care (dislocations, fractures, injuries) requires stopping the current appointment and providing first aid to the victim, however, this does not relieve the surgeon from providing assistance to all other patients scheduled for an appointment.

The surgeon participates in consultations with doctors of other specialties, resolves issues of planned and emergency hospitalization of patients, issues of working capacity, employment. In addition to medical, advisory work, a polyclinic surgeon conducts a medical examination of certain groups of patients (varicose veins, thrombophlebitis, osteomyelitis, hernia, after surgery for gastric ulcers, etc., as well as disabled WWII), participates in preventive work at the site, in work of engineering and medical teams. The polyclinic surgeon maintains contact with the hospital, where he sends patients, and also provides aftercare after discharge from the hospital. In some cases of emergency surgery, the doctor has to visit patients at home, where, in the absence of additional research methods, he is obliged to make the correct diagnosis and decide on the tactics of further treatment of the patient. An error in diagnosis and delay in providing the necessary assistance can lead to fatal consequences. To carry out this work, the surgeon must be the organizer of the medical and surgical process, implementing the principle of N.I. Pirogov on the importance of organization in medicine and surgery in particular.

The nature of the work of the surgical office requires that all personnel are well aware of their duties and master the methods of their work. The nurse of the surgical room should be knowledgeable in the field of asepsis and antisepsis, comply with her requirements in work and monitor compliance with them by other employees and patients, help the doctor in organizing the reception of patients. The nurse of the surgical department should be trained in the rules of cleaning, washing instruments, and the technique of preparing material for sterilization. She must skillfully help the doctor and nurse during certain manipulations (help with undressing, dressing, etc.). Be aware of the danger of violating the rules of asepsis (be able to open bottles with sterile linen, supply a sterilizer with instruments, a basin for washing hands, etc.).

When conducting a lesson in the surgical office of the polyclinic, students, together with the surgeon working in the office, receive primary and secondary patients, participate in their examination, get acquainted with the rules for filling out medical documents (outpatient card, dispensary card, coupons and referrals) and selecting patients for hospitalization. The most interesting and thematic patients are dealt with in more detail with the teacher. In the course of admission, students get acquainted with the procedure for issuing and extending sick leave.

Thus, in the classroom in the clinic, students get acquainted with the contingent of patients that they do not see in the hospital, and also consolidate practical skills (bandaging, immobilization, injections, etc.).

ORDER of the Ministry of Health of the USSR dated September 23, 1981 N 1000 (as amended on December 22, 1989) “ON MEASURES TO IMPROVE THE ORGANIZATION OF WORK OF OUTPATIENT AND POLYCLINIC INSTITUTIONS”

Annex N 20

1. Surgical, otolaryngological, ophthalmological and neurological departments (offices) are organized as part of the city polyclinic.

2. The head of the department (office) is a specialist who has received special training in the relevant specialty.

3. Control over the work of the department (office) is carried out by the management of the polyclinic.

4. Doctors of departments (offices) work in contact with doctors - specialists of a different profile and, first of all, with general practitioners - district (territorial and shop medical districts).

5. Doctors of departments (offices) in their work are guided by this regulation, orders, instructions and instructions of the Ministry of Health of the USSR and current legislation.

6. The main tasks of departments (offices) are to carry out disease prevention measures, early detection of patients and their effective treatment in a polyclinic and at home according to their profile.

7. In accordance with these tasks, doctors of departments (offices) carry out:

– regular outpatient appointments according to the schedule approved by the administration of the polyclinic;

- dynamic observation and active treatment of patients until their recovery, remission or hospitalization;

- control over the timeliness of the implementation of diagnostic and therapeutic procedures by patients under supervision in this department (office);

- timely referral of patients, if indicated, to VTEC;

- consultations of patients in the directions of other doctors - specialists, incl. at home;

- timely identification of persons subject to medical examination according to the profile of this department (office), and taking them for dynamic observation;

– conducting an examination of temporary disability with the issuance of sick leave in accordance with applicable law;

— carrying out sanitary-educational work and hygienic education of the population.

8. The department (office) has the necessary space for placement, in accordance with sanitary and hygienic standards and requirements, as well as medical equipment, tools and inventory.

Head of the Main Department
medical and preventive care
I.V.SHATKIN

Appendix No. 21
to the order of the Ministry
health care of the USSR
dated 23.09.1981 N 1000

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In intensive care units, as well as in the operating room, I strictly observe sanitary and epidemiological and hygienic conditions.

Sanitary-anti-epidemiological and hygienic regimes are a whole complex of organizational, sanitary-hygienic and anti-epidemic measures that prevent the occurrence of nosocomial infection (HAI), purulent-septic processes, viral hepatitis and other infectious diseases, as well as measures aimed at preventing injuries, and, respectively, the possible infection of medical workers (based on the system of accounting and registration of injuries and emergencies associated with blood). To carry out preventive measures in case of an emergency, the treatment room has an emergency first aid kit, which includes:

Ø Alcohol 70%-100.0 ml.,

Ø Iodine solution 5%.

Ø Bactericidal plaster.

Ø Dressing material.

Ø Fingertips.

Ø Sterile distilled water.

Ø Tanks for pointing solutions.

Ø Disposable syringes (pipettes).

Actions medical worker in an emergency:

Ø in case of cuts and punctures immediately remove gloves, wash hands with soap and water under running water, treat hands with 70% alcohol, lubricate the wound with 5% alcohol solution of iodine;

Ø in contact with blood or other biological fluids on the skin this place is treated with 70% alcohol, washed with soap and water and re-treated with 70% alcohol;

Ø when blood and other biological fluids of the patient get on the mucous membrane of the eyes, nose and mouth: oral cavity rinse with plenty of water and rinse with 70% ethanol solution , the mucous membrane of the nose and eyes are washed with plenty of water (do not rub);

Ø when blood and other biological fluids of the patient get on the dressing gown, clothes: take off work clothes and immerse in a disinfectant solution or in a bix (tank) for autoclaving;

Ø get started as soon as possible antiretroviral drugs for post-exposure prophylaxis of HIV infection.

Every Monday in our department general cleaning is carried out:

Daily routine cleaning is carried out twice a day.

After the transfer of the patient, all care items are processed: a tray, a vessel, bottles from under the drains. Processing of beds, mattresses, bedside tables, stools, oilcloths.

I disinfect used syringes, needles, systems in 2%

solution "Nick-Police" exposure 15 minutes. Stitching and cutting objects after processing are disposed of in a separate container;

I carry out disinfection and pre-sterilization treatment

instrumentation solution "Nika-Politsid" 2% exposure 15 minutes;

I carry out disinfection of anesthesia and respiratory equipment;

I carry out quartz treatment and ventilation of the wards;

I carry out a phenolphthalein and azopyram test for control

the quality of pre-sterilization cleaning of instruments with a record in the special. magazine.

Due to the high risk of occupational infection, in order to comply with the sanitary and epidemiological regime and safety regulations, we work in special clothes using a mask, gloves and goggles. modern technology hand treatment, all expendable materials disposable: this helps reduce the risk of developing nosocomial infections

In my work I am guided by the orders:

According to sanitary epidemiological mode:

1. Federal Law of March 30, 1999 No. 52-FZ “On the sanitary and epidemiological well-being of the population”.

2. Federal Law No. 157-FZ of September 17, 1998 “On Immunoprophylaxis of Infectious Diseases”.

3. Federal Law No. 38-FZ of March 30, 1995 “On Preventing the Spread of Disease Caused by the Human Immunodeficiency Virus (HIV) in the Russian Federation”.

4. Decree of the Government of the Russian Federation of July 15, 1999 No. 825 “On approval of the list of works, the implementation of which is associated with a high risk of contracting infectious diseases and requires mandatory preventive vaccinations”

5. SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities"

6. SanPiN 2.1.7.2790-10 "Sanitary and epidemiological requirements for the management of medical waste"

9. SP 3.1.5.282-10 "Prevention of HIV infection"

10. SP 3.1.958-00 “Prevention of viral hepatitis. General requirements to the epidemiological surveillance of viral hepatitis.

11. SP 3.1.1.2341-08 "Prevention of viral hepatitis B".

12. SP 3.1.2.1108-02 "Diphtheria prevention".

13. SP 3.1.1.1117-02 "Prevention of acute intestinal infections".

14. SP 3.1.1.2137-06 "Prevention of typhoid fever and paratyphoid fever".

15. SP 3.1.1381-03 "Prevention of tetanus".

16. SP 3.1.1295-03 "Prevention of tuberculosis".

17. SP 3.1.2.1319-03 "Influenza Prevention".

18. SP 3.1.3.2352-08 "Prevention of tick-borne viral encephalitis".

19. Order of the Ministry of Health of the USSR dated March 23, 1976 No. 288 “On approval of the instructions on the sanitary and anti-epidemic regime of hospitals”.

20. Order of the Ministry of Health of the USSR dated April 14, 1979 No. 215 “On measures to improve the organization and improve the quality of specialized medical care for patients with purulent surgical diseases”.

21. Order of the Ministry of Health of the Russian Federation dated August 16, 1994 No. 170 “On measures to improve the prevention and treatment of HIV infection in the Russian Federation”.

22. Order of the Ministry of Health of the Russian Federation dated September 30, 1995 No. 295 “On the Enactment of the Rules for Mandatory Medical Examination for HIV and the List of Employees of Certain Professions, Industries, Enterprises, Institutions and Organizations Who Undergo Mandatory Medical Examination for HIV”

23. OST 42-21-2-85 "Sterilization and disinfection of medical devices (Methods, means and modes)", approved by the Order of the Ministry of Health of the USSR dated 10.06.85 No. 770.

24. Order of the Ministry of Health of the Russian Federation of March 21, 2003 No. 109 “On the improvement of anti-tuberculosis measures in the Russian Federation”.

25. Order of the Ministry of Health of the USSR dated 16.08.89. No. 475 "On measures to further improve the prevention of AII incidence in the country."

26. Order of the Ministry of Health of the USSR dated July 12, 1989 No. 408 “On measures to reduce the incidence of viral hepatitis in the country”.

27. Order of the Ministry of Health of the Russian Federation dated November 26, 1998 No. 342 “On strengthening measures for the prevention of epidemic typhus and the fight against pediculosis”.

28. Order of the Ministry of Health of the Russian Federation dated April 24, 2003 No. 162 “On approval of industry standards. Patient management protocol. Scabies"

29. Order of the Ministry of Health and Social Development of the Russian Federation dated April 12, 2011 No. 302n “On Approval of Lists of Harmful and (or) Hazardous Production Factors and Works, During the Performance of which Mandatory Preliminary and Periodic Medical Examinations (Examinations) Are Conducted, and the Procedure for Conducting Mandatory Preliminary and Periodic medical examinations(surveys) of workers engaged in hard work and work with harmful and (or) hazardous conditions labor"

30. MU 3.1.2313-08 "Requirements for the disinfection, destruction and disposal of single-use injection syringes."

31. MU - 287-113 of December 30, 1998 "On disinfection, pre-sterilization cleaning and sterilization of medical devices"

32. Guidelines R.3.5.1904-04 "Use of ultraviolet germicidal radiation for disinfection of indoor air and surfaces".

33. Instructions for the use of disinfectants used in the work.

In the work of the surgical department, a fairly large volume is used drugs used to relieve pain in patients in the postoperative period. In my work, I use normative documents:

Ø Order of the Ministry of Health of the Russian Federation No. 330 dated 11/12/1997. “on measures to improve the storage, prescribing and use of narcotic drugs and psychotropic substances”;

Ø Order No. 1008n "on the invalidation of some annexes to order No. 330";

Ø FZ-No. 3 dated 08.01.98. "federal law on narcotic drugs and psychotropic substances";

Ø Decree of the Government of the Russian Federation of 06.08.98. No. 892 "on approval of the rules for the admission of persons to work with narcotic substances and psychotropic substances";

Ø order No. 785 "List of medicines subject to subject-quantitative accounting in pharmacies (organizations), organizations wholesale trade medicines, medical institutions and private practitioners”;

Ø order No. 703 "addition to order 785";

Ø order No. 127 of the Ministry of Health of the Russian Federation of 03.28.03. “on the approval of instructions for the destruction of narcotic drugs, psychotropic substances included in lists 2 and 3 of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation, the further use of which in medical practice is recognized as inappropriate”;

Ø order No. 110 of the Ministry of Health of the Russian Federation dated 12.02.07. “On the procedure for prescribing and prescribing medicines, medical devices and specialized products medical nutrition»;

Ø order No. 747 "on approval" of the "instruction for accounting for medicines, dressings and medical products in medical and preventive health care institutions, consisting of the state. budget";

Ø Order of the Ministry of Health of the Russian Federation No. 245 dated 30.08.91. "On the norms of consumption of ethyl alcohol for healthcare institutions, education and social security»;

Ø order No. 109 dated 12.02.07. “On making changes to the procedure for dispensing medicines approved by Order No. 785”;

Ø order No. 706n "Rules for the storage of medicines";

Ø p.p. No. 1148 "Rules for the storage of narcotic drugs and psychotropic substances"

Ø Government Decree No. 681 dated June 30, 1998 “on approval of the list of narcotic drugs, psychotropic substances and their precursors subject to control in Russian Federation».

Ø Decree of June 9, 2010 N 419 on the provision of information on activities related to the circulation of precursors of narcotic drugs and psychotropic substances, and the registration of operations related to their circulation

Ø By Decree of the Government of the Russian Federation of December 29, 2007 N 964, a list of potent substances for the purposes of Article 234 and other articles of the Criminal Code of the Russian Federation

All documents related to the circulation of narcotic drugs, psychotropic substances and their precursors, poisonous and potent substances must be filled out with the utmost care, corrections are not allowed.

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ORDER of the Ministry of Health and Social Development of the Russian Federation of December 24, 2010 1182n ON APPROVAL OF THE PROCEDURE FOR PROVIDING MEDICAL CARE TO SURGICAL PATIENTS ... Relevant in 2018

Annex N 5

1. This regulation determines the organization of the activities of the inpatient surgical department of medical organizations (hereinafter referred to as the Department).

2. The department is headed by the head, appointed to the position and dismissed by the head medical organization in which it was created.

3. A specialist with higher and postgraduate medical education in the specialty "surgery" is appointed to the position of the head of the Department, meeting the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by the Order of the Ministry of Health and Social Development of Russia dated July 7, 2009 N 415n ( registered by the Ministry of Justice of Russia on July 9, 2009 N 14292) without presenting requirements for work experience.

4. A specialist with higher and postgraduate medical education in the specialty "surgery" is appointed to the position of a surgeon of the Department, meeting the qualification requirements for specialists with higher and postgraduate medical and pharmaceutical education in the field of healthcare, approved by Order of the Ministry of Health and Social Development of Russia dated July 7, 2009 N 415n (registered by the Ministry of Justice of Russia on July 9, 2009 N 14292).

5. Specialists corresponding to the qualifications positions of workers in the healthcare sector, approved by Order of the Ministry of Health and Social Development of Russia dated July 23, 2010 N 541n (registered by the Ministry of Justice of Russia on August 25, 2010 N 18247) in the specialties: "ward nurse", "dressing nurse", "procedural nurse" , "operating nurse".

6. Structure of the Branch and headcount medical and other personnel are established by the head of the medical organization in which the Department was created, based on the number of beds and the number of people served, taking into account the recommended staff standards(Appendix N 5 to the Procedure for the provision of medical care to patients with surgical diseases, approved by this Order).

departments of anesthesiology - resuscitation.

The law is simple: electronic document the numbering of paragraphs corresponds to the official source.

9. The equipment of the Department (including the operating room) is carried out in accordance with the equipment standard in accordance with Appendix No. 6 to the Procedure for the provision of medical care to patients with surgical diseases, approved by this Order.

10. The department performs the following functions:

providing diagnostic, therapeutic and preventive care to patients with surgical diseases;

providing advice to doctors of other departments of a medical organization in resolving issues of diagnosis and provision of medical care to patients with surgical diseases;

development and implementation of measures to improve the quality of the medical and preventive work of the Department;

participation in the process of increasing professional qualifications personnel of a medical organization on the issues of diagnosis and provision of medical care to patients with surgical diseases;

implementation in clinical practice modern methods diagnostics, treatment and rehabilitation of patients with surgical diseases;

carrying out examination of temporary incapacity for work;

holding conferences on the analysis of the causes of deaths in the treatment of patients with surgical diseases in conjunction with the pathoanatomical department;

implementation of sanitary-hygienic and anti-epidemic measures to ensure the safety of patients and staff, prevent the spread of nosocomial infection;

maintaining accounting and reporting documentation, submitting reports on their activities in the prescribed manner, collecting data for registers, the maintenance of which is provided for by law.

10. In the structure of the Department, it is recommended to provide for the allocation of wards for patients with purulent-septic surgical diseases (conditions) with the organization of an anti-epidemic regime in accordance with the current sanitary rules and regulations.

11. The department can be used as a clinical base educational institutions secondary, higher and additional professional education, as well as scientific organizations.

Appendix No. 6
to the Procedure for rendering
medical care for the sick
surgical diseases,
approved by Order
Ministry of Health
and social development
Russian Federation
dated ___________ 2010 N ____

The surgical department of the polyclinic maintains the following medical documentation:

Outpatient card (form No. 025/U and form No. 025/U-04);

Research referral forms;

Journal of registration of patients;

Journal of referrals to the hospital;

Operations log;

Journal of dispensary patients;

Journal of registration of injuries and anti-tetanus vaccinations;

Journal of blood directions for Hbs-antigen and Wasserman reaction;

AIDS referral log;

Register of infectious post-injection complications;

Journal of dressing quartzing;

Journal of quartzization of the operating room;

Journal of quality control of pre-sterilization processing of instruments;

Journal of control of the autoclave;

Logbook for monitoring the operation of a dry-heat cabinet.

There are a lot of documents, but they are all necessary. In case of careless filling or not keeping records of a particular type of activity, complications may develop in patients, violations of the order of work in the clinic and hospital. We have already dwelled on the importance of filling out an outpatient card of the patient. Once again, it must be emphasized that this card is kept throughout the life of each patient of the polyclinic. It includes all types of examination and treatment of the patient, all identified intravital diagnoses. This is the basic legal document of an outpatient. According to its analysis, all types of examinations are carried out. Hence the importance of the correct formulation of the diagnosis of the patient, determining the timing of temporary disability. It should be emphasized that the doctor of the polyclinic can issue a sick leave personally for up to 30 days, then the patient, if necessary, is sent to the control and expert commission.

Research referral forms must be printed in a typographical manner. If the medical institution, for economic reasons, cannot do this, then they must be written by hand in advance. This will save time for patient care.

The patient register is necessary to compile a register of the provision of medical care, which is compiled monthly and sent to Insurance companies. The salary of a medical worker in a polyclinic directly depends on the volume and quality of treatment of patients. There were cases when the workers of certain rooms of the polyclinic were reduced wage due to the small number of patients treated.

The journal of referrals to the hospital is divided into two headings: referrals for emergency and planned patients. Once again, it should be emphasized that emergency patients in the clinic may not be examined in full. At the same time, all planned patients are subject to laboratory, X-ray and ultrasound examinations to reduce the length of stay in the hospital before surgery.

The transaction log must be filled out clearly. Each protocol of operations describes the nature of the intervention, the existing complications.

The journal of dispensary patients should show the dynamics of the treatment of registered patients. It should reflect the timing of follow-up examinations, therapeutic measures taken and their effectiveness.

The register of injuries and tetanus toxoid vaccinations is filled out individually for each patient. It is very important to reflect in it the volume of tetanus toxoid vaccinations, the need for revaccination.

Registers of blood referrals for Hbs-antigen, AIDS and syphilis are maintained to identify the incidence of the population, to prevent infection of others and medical personnel. It is desirable that all patients treated by the surgeon undergo these studies additionally.

The register of post-injection complications is necessary for the detection of iatrogenic diseases and the implementation of anti-epidemic measures in those medical institutions where a non-sterile injection was made. Each disease is reported to the epidemiological service.

Journals of quartzization of the dressing room, operating room, control of the operation of the autoclave, dry-heat cabinet, quality of pre-sterilization processing of instruments are necessary to comply with the basic rules of asepsis and antisepsis, and prevent the development of a hospital infection.

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 small planned operations. In such hospitals, there are special rooms for sterilization, operating room and dressing rooms.

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 hypochlorite 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. it large group 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, participating 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;

To take part in meetings (meetings) when discussing the work of the surgical office, to receive the necessary information to fulfill 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 assessment 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, 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 qualification category). The position on the specialist in nursing can be considered as the basis for compiling job description ward nurse.

Persons who have a completed medical education and are 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 admissions department of the hospital), assess the general hygienic condition of the patient (bathing, changing clothes, trimming 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 (medication);

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 to disinfect the hands of a doctor, to take a direct part in the bypass of patients by a doctor-intern or doctor on duty, to 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;

To 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 documenting, laying and transferring 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 the topics of sanitary and hygienic, patient care, disease prevention, healthy lifestyle life, 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 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 fasting department 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.

Responsibilities

The chief operating nurse distributes the work among the operating nurses. Practice shows that in order to increase responsibility and the best organization labor, 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 tool 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 intended bandwidth institutions.

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 to 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 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 sister's constant presence 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 state of health (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. There are physiological, psychological, social, as well as real (shortness of breath, cough, bleeding) and potential (risk of pressure sores) nursing diagnoses.

Currently, they use 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 to 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 down in simple words so that each sister 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 plan of care - 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;

Specific 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 cooperation 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 an emotional, intellectual and psychological help, which helps the patient prepare for present or future changes arising from stress, which is always present during an exacerbation 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 what kind of relationship is established 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 anesthetic 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 strong and weak sides in their 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.) -