Job Responsibilities of a Nurse in Resuscitation. What is included in the functional duties of a nurse, junior nurse

CHAPTER 4 DUTIES OF JUNIOR AND MEDIUM MEDICAL PERSONNEL

CHAPTER 4 DUTIES OF JUNIOR AND MEDIUM MEDICAL PERSONNEL

In hospitals, there is a two-stage (doctor, nurse) and three-stage (doctor, nurse, junior nurse) patient care system. Since 1968, in children's hospitals, instead of a nurse, the position of a junior nurse (nursing nurse) has been introduced. In a two-stage system, the nurse not only fulfills the doctor's orders and performs procedures, but also provides care for the sick. With a three-stage system, the junior nurse cleans the premises, monitors the timely change of linen, the cleanliness of care items, helps the sick and cares for them.

In charge junior nurse includes:

Wet cleaning of wards, offices, operating rooms, corridors, common areas;

Change of underwear and bed linen;

Sanitary treatment of patients;

Daily toilet, care for skin, hair, ears, eyes, oral cavity of patients, etc.;

Delivery of the vessel, urinal, their disinfection;

Prevention of bedsores;

Swaddling and washing children;

Control over the sanitary condition of bedside tables. The training of junior nurses is carried out directly in hospitals, as well as in short courses organized by the Union of Red Cross and Red Crescent Societies

(SOCC and KP).

Nurse- a representative of the middle medical level. This is a doctor's assistant in medical and preventive, preschool and school institutions, an independent medical worker within the framework of his competence (care, manipulation, etc.).

Persons who have graduated from medical schools with a period of study of at least 2 years and have received a certificate of conferment of medical qualifications are appointed to the position of a nurse.

Nurses. Medical students who have successfully completed three full-time courses can work as nurses.

Department nurse. To perform their duties, a nurse must possess a variety of skills. The nurse carefully and strictly fulfills all the appointments of the attending physician, and in emergency cases - the doctor on duty. She is obliged to make sure that the child takes the medicines prescribed for him, and, if necessary, help to drink them with water, etc. At the same time, the nurse takes care of the sick, psychologically helps the sick child and his parents to overcome the difficulties of the period of illness. She monitors the sanitary condition of the wards assigned to her, makes the necessary entries in the medical records of inpatients about the fulfillment of medical and hygienic appointments.

The nurse is present at the medical round of patients, informs the doctor about the state of health of children, receives further instructions for caring for patients and follows them. The nurse's duties include measuring the patient's body temperature and registering it in the temperature sheet of the inpatient's medical record, counting the pulse, respiratory rate, determining blood pressure, body weight, filling out specialist consultation logs, etc. As prescribed by the doctor, the nurse (with the help of a junior nurse ) measures the daily amount of urine and sputum.

As prescribed by the doctor, the nurse collects materials for analysis (urine, feces, sputum, etc.), delivers them to the laboratory, receives the results of the studies and sticks the answer forms to the medical records of inpatients. Accompanies children from one department to another (as prescribed by a doctor) for x-ray, endoscopic, radiological and other studies, transports patients (when transferring from department to department, etc.).

The nurse monitors the cleanliness, silence and order in the wards; teaches children and their parents the rules of personal hygiene; takes care of the timely supply of patients with everything necessary for treatment and care, conducts hygienic baths, as well as a change of underwear and bed linen.

The duties of a nurse include monitoring medical nutrition, and, if necessary, personal participation in the distribution of food,

feeding the seriously ill and young children; control over transfers to patients and their proper storage. Based on the doctor's prescriptions, the nurse draws up portion requirements for the nutrition of patients in 2 copies and transfers them to the catering unit and to the buffet.

The nurse is responsible for monitoring the implementation by patients, as well as junior medical staff, parents and visitors of the established internal rules of the hospital. During night duty, these duties are not duplicated by anyone.

The nurse is responsible for the exemplary maintenance of the nursing post, the good condition of medical and household equipment; complies with the rules for the storage of medicines; draws up requirements for medicines, dressings and child care items; monitors the timely return of medical records of inpatients from specialists, enters the results of research into them.

By appointment of the head of the department or the attending physician, the nurse calls specialists from other departments for consultation, orders a car to transport the child to another medical institution.

The nurse accepts children newly admitted to the department, examines the skin and scalp of the child to exclude infectious diseases and pediculosis, places sick children in the appropriate wards, reports the newly admitted patients to the doctor. Her responsibilities include familiarizing newly arrived children with the internal regulations, daily routine and rules of personal hygiene, sanitary and educational work.

The distribution of the work of a ward nurse during the day is presented in Table 9.

Table 9An approximate work plan for a ward nurse during

days

The nurse in the pediatric ward of the hospital must

to be able to perform the following manipulations:

1) feed the child, including through a tube, wash the stomach;

2) put enemas of all kinds (cleansing, siphon, etc.);

3) insert a gas outlet tube;

4) catheterization of the bladder with a soft catheter (in children older than 1 year);

5) put mustard plasters, banks, compresses;

6) give medicines by mouth;

7) rub medicines;

8) instill medicinal solutions in the eyes, nose, ears;

9) apply a patch;

10) conduct intradermal, subcutaneous, intramuscular and intravenous (the latter - with the permission of the doctor) infusions;

11) measure blood pressure;

12) to carry out an indirect heart massage;

13) carry out artificial ventilation of the lungs (ALV);

14) take smears from the throat;

15) collect material for laboratory research (urine, feces, sweat, vomit, etc.);

16) to carry out physiotherapeutic procedures (as prescribed by a doctor);

17) monitor the patient and notice deviations on the display;

18) to carry out gastric and duodenal sounding.

The work of a nurse is carried out according to the schedule approved by the head of the department. During duty, a nurse without the permission of a doctor does not have the right to leave her post and leave the department.

Senior nurse. The head nurse organizes the work of middle and junior medical personnel, in addition, her duties include compliance with the sanitary and epidemic regime in the department, training new employees, organizing classes to improve their skills. Its role in the proper organization of child care, storage of baby food and strict implementation of all medical (medical) prescriptions is extremely important. She draws up a duty schedule for nurses and payroll sheets, controls the availability of medicines in the pharmacy, orders the missing ones, monitors the replenishment of the department with the necessary tools and items for child care. In case of illness, the nurse finds a replacement for duty in a timely manner. In the department of newborns, the head nurse examines the staff and mothers every day before the start of work (measurement of body temperature, examination of the pharynx and skin).

Treatment room nurse. The staffing table of the department provides for the position of a nurse in the treatment room, who performs the most complex medical manipulations; it helps the doctor in carrying out those manipulations that only a doctor has the right to perform (blood transfusion, puncture, administration of contrast agents, etc.). In addition, there is also a position mistress sisters, responsible for household equipment, general cleaning of all premises, change of linen.

Reception and delivery of duties- the most crucial moment of the work of a nurse. The nurse does not have the right to leave the post on her own, even if her shift has not appeared.

The reception and transfer of duty by nurses is carried out on a bed-by-bed basis with visual control of the presence of each sick child. The nurse giving up the post acquaints the nurse accepting the post with sick children, transmits the necessary information about the individual characteristics of their treatment and care. At the morning conference, the nurse makes a report on the work done.

When taking up duty, nurses (giving and receiving a post) jointly conduct rounds of patients, while paying special attention to seriously ill patients, the sanitary condition of the wards, and observing the rules of personal hygiene. The duty log records the volume of work not completed for the previous shift for a particular patient, as well as medical appointments of the doctor on duty, data on the distribution of potent drugs, preparing children for laboratory and instrumental studies, etc. The nurse on duty takes thermometers, syringes, medicines, care items (drinkers, heating pads, bedpans, urinals, etc.), inventory, keys to medicine cabinets of the general list. She receives a pre-compiled list of research appointments and referrals to various laboratories and specialized rooms. Checks that there is enough clean linen for the entire shift.

Nurses should pay special attention to patients who are on bed and strict bed rest. If an individual post is not organized, then it is necessary to constantly approach and monitor a sick child, to prevent him from staying in the same position for a long time (for example, on his back), for which the patient should be turned over from time to time from one side to another. It is necessary to change the position of a sick child in bed with great care and without sudden movements. Sometimes you have to keep the child in bed, because children do not always realize the need to keep calm or are agitated.

At the end of the shift, the nurse compiles a summary of the movement of patients: the number of patients in the department at the beginning of the day, the number of admitted, retired (separately: discharged, transferred to

other departments or medical institutions, deceased) and consisting at the beginning of the next day. This information is transmitted daily to the admissions department of the hospital.

medical post- workplace of a nurse (Fig. 4).

Rice. 4.Nursing medical post

The medical post is located near the wards so that children, especially seriously ill children, are under constant visual control. For this purpose, the walls of the chambers or the partitions between them are made of thick-layer or organic glass. The nurse must have the following items:

Table with lockable drawers for storing medical records of inpatients, forms, medical instruments, etc.;

Cabinet for storage of medicines;

Telephones of city and local networks;

Fridge;

Computer (with a computerized data processing system) or monitor for communication with patients;

Drinking water;

Table lamp.

The workplace of a nurse must be kept clean and equipped with the necessary items. The effectiveness of the work of a nurse largely depends on the state of the workplace. The senior nurse of the department, finishing the working day, supplies nursing posts with everything necessary for the next day.

Medical documentation approved by the Ministry of Health and Social Development of the Russian Federation and used in medical institutions in the form of unified forms.

Medical record of an inpatient(f. ? 003 / y) (case history) - the main primary medical document that is filled out for each patient who is in the hospital of a medical institution. All data about the patient, including the results of dynamic observation and treatment, are entered into the medical record of the inpatient. The results of laboratory, instrumental and other studies are pasted into it, daily indicators of morning and evening body temperature, pulse and respiratory rate, blood pressure, and, if necessary, the daily amount of urine (diuresis) are recorded. In the medical record of an inpatient patient, the nurse notes the time of admission of the patient to the department and the results of the examination for the presence of pediculosis, signs. In the list of prescriptions, he notes the time of dispensing the drug, in the temperature sheet - the body weight and height of the child upon admission, the patient's body temperature in the morning and evening, then once every 7-10 days marks the days of taking a bath and changing clothes, daily - the child's stool.

The inpatient medical record is a legal document. It is stored for 25 years and therefore must be kept strictly in accordance with the established form. It does not allow any corrections; it is forbidden to glue, erase, cross out previously written, add. The nurse is responsible for the safety of the medical records of inpatients, which are stored in a box or cabinet, locked with a key, out of the reach of children and their parents.

Referrals to the laboratory are filled out by a nurse. They note the last name, first name and age of the child, the number of the medical record of the inpatient, the name of the department and a list of indicators that should be determined.

IN sister sheets the nurse makes medical appointments for each patient from the medical records of inpatients

mu. The form of filling is arbitrary. It is better to draw up individual nursing sheets for each child separately, but you can fill them out according to the type of manipulations, diets, medicines, listing the names of the children.

IN change log(reception and transmission) on duty note the number of children on duty, the names of newly admitted and retired patients with an indication of the diagnosis. In addition, they list febrile children with an indication of body temperature, assess the dynamics of clinical symptoms in seriously ill patients, list all unscheduled manipulations and measures taken to help performed by the doctor on duty and according to his appointment. Separately, they provide a list of children prepared in accordance with medical prescriptions for diagnostic and therapeutic procedures (endoscopic, x-ray, ultrasound, etc.).

IN journal of the movement of patients of the department information about the movement of patients is noted: the number of those who left and those who arrived.

IN register of infectious patients record the last name, first name, age of the child delivered with an infectious disease, diagnosis, date, contacts and measures taken.

In the journal of accounting and expenditure of narcotic drugs the nurse enters the necessary information about the drugs available and used during the shift. The same applies to accounting funds (this journal is sometimes filled out by a senior nurse).

emergency notice about an infectious disease, food, acute occupational poisoning, an unusual reaction to vaccination (form? 058 / y) is compiled by a medical worker (sister) and sent to the center for sanitary and epidemiological surveillance.

Admissions Nurse fills in:

Title page of the inpatient medical record

(form? 003/y);

Journal of hospitalization of patients (form? 011 / y);

Hospitalization denial log;

Register of hospitalized patients (listed in alphabetical order for the reference service);

Magazine of free places in branches (movements);

Register of infectious patients (plus emergency notifications);

Journal of hospitalization of patients arriving unaccompanied with a description of the main external signs (neglected and homeless children).

Working with medicines. One of the most important duties of a nurse is participation in the treatment process, which is manifested primarily in the distribution of medicines. Medicines have a variety of effects on the body, including local and general. However, in addition to the main therapeutic, they can cause side or unwanted effects. The latter are reduced and even completely eliminated after dose reduction and drug withdrawal. There may be cases of intolerance to drugs, leading to severe complications (for example, anaphylactic shock). The nurse must not only be aware of all possible adverse reactions to the administration of a particular drug, but also be able to provide emergency first aid.

Storage of medicines carried out in special lockers under the control of the guard nurse. In the cabinet, medicines are placed in groups on separate shelves with the appropriate inscription: sterile, internal, external, eye drops, injections. Larger dishes are placed at the back wall, small ones are placed in front. This allows, without rearranging the drugs, to read the label, to select the desired drug. In addition, each shelf must be divided: for example, "internal" - into compartments for powders, tablets, potions. You can put powders, tablets, capsules on one shelf, potions, solutions, etc. on the other. This is how medicines of the general list are stored. Medicines should not be stored without labels.

Particularly stringent requirements apply to poisonous and potent drugs. For them, small safes or metal cabinets are allocated, which are constantly under lock and key.

In the safe (cabinet) with the inscription "A" there are poisonous and narcotic drugs, and in the safe (cabinet) with the inscription "B" - potent drugs. On the inner surface of each of the safes, a list of poisonous and potent medicines is placed with an indication of the highest single and daily

doses (depending on the age of the child). There should also be tables of antidotes. Stocks of poisonous and narcotic drugs should not exceed 5-day needs, potent - 10-day.

To account for the receipt and consumption of poisonous and potent medicines, a specially numbered, laced and sealed with a wax seal journal of a medical institution is kept in the following form:

The journal, as well as the requirements for receiving and dispensing poisonous and potent drugs, are kept in the department for 3 years. Then these documents are destroyed in the presence of the commission, about which they draw up an act.

The keys to the safes (cabinets) "A" and "B" are kept only by persons appointed by order of the medical institution. This is usually the head sister of the department. Responsible persons are criminally liable for non-compliance with the storage rules and theft of medicines, especially for poisonous and potent medicines.

Nurses should be instructed on the timing and methods of storage of each product used in the department.

Medicines with a strong odor (iodoform, lysol, ammonia, etc.) and flammable (ether, ethyl alcohol) are stored in a separate cabinet. Coloring medicines (iodine, brilliant green, etc.) are also stored separately.

The shelf life of factory-made medicines, as a rule, is 2-5 years, but can be longer. The shelf life is determined by the label. Each industrial batch of produced medicines is assigned a factory series, which is marked with at least five digits. The last two digits

va - the year of manufacture, the previous two - the month of manufacture, the rest - the factory series.

Pharmaceutical products have shorter expiration dates. All containers (boxes, jars, vials) containing medicines manufactured in a pharmacy are provided with appropriate labels indicating the name, date of manufacture and shelf life.

The terms of storage and sale of medicines prepared in pharmacies have been established: 2 days - for injection solutions, eye drops, infusions, decoctions, mucus; 3 days - for emulsions; 10 days - for other medicines. Sterile solutions in bottles (not in ampoules) can be stored for no more than 3 days. Signs of damage to medicines are a change in appearance, in particular the appearance of plaque, flakes, spots on tablets, additional odor, discoloration.

There should not be expired or unusable medicines at the medical post.

When storing medicines, certain temperature and humidity should be observed, the degree of illumination, the safety of packages, etc. should be controlled. Liquid medicines, such as infusions and decoctions, perish quickly and should therefore be stored in a refrigerator at 2 to 10°C. The same requirements apply to the storage of emulsions, some antibiotics (penicillin, etc.), serums, solutions containing glucose, insulin, etc. Drugs that rapidly decompose in the light (bromine, iodine) should be stored in dark glass containers and in a dark room.

When storing medicines, it is forbidden to place them together with disinfectant solutions and means for technical purposes. The nurse does not have the right to pour the drug from one container to another, peel off and re-stick labels, randomly combine drugs (for example, tablets with powders, etc.).

Distribution of medicines carried out by a nurse in strict accordance with the appointment of a doctor who indicates in the medical record of the inpatient the dates of prescription and withdrawal of medicines. Medicines are taken before, during, after meals and at bedtime. The most common, simple and convenient way to administer the drug

is the enteral route, i.e. taking medication by mouth or by mouth. This method is well controlled. Inside, solid dosage forms are mainly taken: tablets, dragees, powders, capsules (Fig. 5). Powders in sachets are designed to be diluted with water. Less often, liquid dosage forms are prescribed inside: solutions, decoctions, potions, etc. It should be remembered that the younger the child, the more widely the use of liquid dosage forms is used.

Rice. five.Solid dosage forms:

a - tablets; b - dragee; c - powders (in a sachet); d - powders or microspheres with an enteric coating in gelatin capsules

When dispensing drugs, the nurse should wash their hands with soap and water, change their gown if necessary, and put on a mask. In order to avoid errors, it is necessary to be able to identify drugs by shape, color, smell, taste. The child should take medicines only in the presence of medical personnel - a nurse, a doctor.

There are several ways to distribute medicines in the children's department. You can use the trays, divided into cells with the names of patients. Medicines are laid out in them in advance. Before putting the drug in the cell, you should check the name indicated on the package

forging, with the name of the drug in the medical record of an inpatient or a nursing list. Then the nurse goes around all the rooms with a tray. Another way is to use a mobile table on which medicines for oral administration, a decanter of water, beakers, spoons, and clean pipettes are laid out. The nurse rolls this table into the ward and moves it in turn to the bed of each patient, if he is on bed rest. Walking patients independently approach the table, where, under the supervision of a sister, they take medicines.

When distributing powders, the paper in which the powder is packed is unfolded and, giving it the shape of a trough, the powder is poured onto the child's tongue, then they are offered to drink it with water. You should not give out medicines to the child on hand, especially several tablets at once. It is important to follow the sequence of taking medications. After swallowing the tablet, it is necessary to drink it with liquid, making small but frequent sips. This is explained by the fact that the tablet passes through the esophagus within 2-5 minutes. If you take a big sip, then the water quickly passes by the pill and the latter can stop in the esophagus. Frequent small sips of water or lumps of food contribute to the faster passage of the drug into the stomach.

Currently, a large number of medicines in syrup are produced. Children, especially younger ones, are very willing to accept them. Tablets are difficult for children to swallow, and children under 3 years of age almost never swallow them. Therefore, the tablets are crushed before taking. A tablet or powder sometimes has to be dissolved in sweet water, syrup, give the powder along with food, etc. In infants, the prescribed dose of the drug in liquid form is often administered in fractions so that the child does not choke. If the child does not want to take the medicine, then you have to forcefully open your mouth as follows: 1) gently press on the cheeks with two fingers; 2) pinch the nose and at this moment the child opens his mouth. Some potions (not irritating to the mucous membrane of the mouth) can be given to children in the first months of life from the nipple.

Potions, decoctions are given in graduated cups with divisions of 5, 10, 15, 20 ml. In the absence of graduated dishes, it is taken into account that the aqueous solution in a teaspoon is about 5 ml, in a dessert -

10 ml, in the dining room - 15 ml. Alcoholic infusions, as well as liquid extracts, are measured using clean disposable pipettes. The use of the same pipette for dispensing different medicines is prohibited.

Some heart drugs (validol, nitroglycerin) are taken under the tongue. If it is impossible to administer drugs through the mouth, they are administered in the form of suppositories into the rectum. Candles for children are administered only by nurses. In the treatment of respiratory diseases, the inhalation method of administering drugs is actively used, which has numerous options in the form of aerosols and sprays, providing for the presence of special packaging and a valve-distribution system.

Features of the technique of drug administration in infants. Usually, a measuring spoon is used, which is placed on the edge of the child's lower lip and tilted so that the medicine gradually flows into the mouth. The medicine can be administered using a special syringe. To do this, the tip of the syringe is placed in the corner of the mouth and the syrup is directed to the inside of the cheek, but not into the throat. The procedure is performed slowly so that the child has time to swallow the contents. In addition, the medicine can be administered through a special nipple. Such a device allows you to simultaneously treat the child and soothe.

According to the indications, the nurse has to use external methods of administering drugs: instillation of drops, administration of ointment or inhalation of powder into the nose, instillation of drops into the ear, instillation of drops into the conjunctival sac of the eyes or laying ointment behind the lower eyelid, applying ointments to the skin. All these manipulations are performed individually and are usually separated in time from the distribution of drugs, as well as parenteral procedures associated with drug injections. However, their implementation is strictly regulated and requires constant attention and control from the nurse.

It is necessary to warn patients and their parents that when taking certain drugs (bismuth, iron, quinoline, etc.), the color of urine and feces may change.

Responsibilities of a Nurse in a Clinic. The middle and junior medical staff in the children's clinic has a special role. Less time is devoted to direct work with a sick child, as in a hospital, and more medical

The nurse performs the functions of a doctor's assistant, clerical work. The functional responsibilities of the work of a nurse are largely determined by the characteristics of the work of a doctor of a particular profile.

District nurse. The main form of work of a nurse is preventive monitoring of the health of children. The method of dispensary control is used. The possibility of dispensary observation and assistance at its various stages is provided by the structure of the organization of the children's polyclinic.

The district nurse (under the supervision of a doctor) conducts prenatal patronage of a pregnant woman, the purpose of which is to provide medical advice to the expectant mother (parents) in pediatrics: preparing the breast for lactation, rational nutrition, fighting bad habits, ensuring optimal living conditions, creating a favorable psychological environment, the availability of child care items, the formation of a new family lifestyle when a child appears, etc. The first visit to the pregnant woman is carried out immediately after she is registered upon receipt of information from the antenatal clinic (12-23 weeks). The second patronage is carried out at a gestational age of 32 weeks (during maternity leave), taking into account its normal course. The address where the young family will live after the birth of the child, the presence of a children's room (a corner of the newborn) is specified.

Newborn care. According to the regulations, the pediatrician, together with the patronage nurse, visits the newborn at home in the first three days after discharge from the maternity hospital. If the child is the firstborn in the family, then the visit falls on the first day. An extract from the maternity hospital is studied, a thorough examination of the child is carried out with an assessment of his state of health. The nurse assesses the state of lactation in a woman, conducts a detailed briefing on breastfeeding techniques and child care. Carefully find out how the child sucks the mother's breast, what breaks take between feedings, whether there is vomiting, regurgitation, anxiety, whether the night break can withstand. An anthropometric study is carried out: the length and weight of the body, the circumference of the head and chest are measured. At the end of the examination, an individual plan for the management of the newborn is drawn up (the number and timing of patronages, consultations with specialists, a set of recreational activities). Follow-up care for a newborn baby is carried out by a doctor and a nurse

pour in succession. Medical (patronage) the sister during the first week visits the newborn in 1-2 days, and then during the first month - weekly, alternating visits with the pediatrician.

Dispensary supervision. When the child reaches the age of 1 month, the local doctor and nurse monthly evaluate the dynamics of physical development, give the necessary advice on the care and prevention of “controlled” diseases (rickets, anemia, iodine deficiency, etc.), and carry out preventive vaccinations.

Children of the second year of life are examined once a quarter. Physical and neuropsychic development is assessed, according to indications, general urine and blood tests are prescribed, feces are examined once a year for eggs of worms. From the age of three, children are examined once every six months, and from four years old - once a year. The doctor identifies groups of children at increased risk for the development of a number of diseases and sick children who need special supervision, entrusting control over them to the district nurse. The nurse monitors the actual place of residence of the child.

Outpatient reception. The district nurse prepares the workplace for receiving patients, prepares forms, selects outpatient and dispensary cards for the doctor, and ensures that all test results are entered into the outpatient card. Under the supervision of a doctor, a nurse writes various certificates, referrals for research, fills out statistical coupons (“Outpatient Coupon”, f. ? appointment with a doctor, performs the necessary measurements (anthropometry, measurement of blood pressure), etc.

The work of nurses in other offices (neurologist, cardiologist, endocrinologist, hematologist) has a significant similarity with the work of a district nurse. In some cases, for example, at the appointment of an ophthalmologist, a special nursing area is allocated for a nurse, where she, according to a special program, examines children who come to see an ophthalmologist: she checks visual acuity, measures intraocular pressure according to indications, etc. The nurse of the otolaryngological office is usually entrusted with the study of whispered and colloquial speech, olfactometry, taking smears from

pharynx, nose, external auditory canal, etc. Nurses of surgical and applied specialties (surgical, dental, physiotherapy, balneological, otolaryngological rooms) pay great attention to the preparation of tools.

Patient care at home. The main reason for visiting a sick child by a nurse at home is the fulfillment of medical prescriptions, mainly injections. District nurses are provided with special bags with a set of necessary supplies. During a visit to the patient at home, the nurse is engaged in sanitary and educational work, gives the necessary recommendations for caring for the child. If it is necessary to organize a "hospital at home" and prescribe complex treatment, the nurse performs intramuscular injections and intravenous infusions, visiting the patient several times a day.

Delivery of medicines to children in the clinic. If a sick child needs medicines, then the local doctor writes out regular or preferential prescriptions (for children under 3 years old, disabled since childhood, disabled due to illness), with partial or full payment. Nurses should be aware of the main drugs used in pediatric practice, indications and contraindications for their use, rules of use (medication forms, connection with food intake), and possible side effects. In addition, over-the-counter forms of medicines are on sale in domestic pharmacies, which allows the population to independently use certain dosage forms.

TEST QUESTIONS

1. What is the 2- and 3-tier system for children in the hospital?

2. List the duties of a junior nurse.

3. List the duties of a ward nurse.

4. What is an approximate work plan for a ward nurse during the day?

5. What manipulations should a nurse have?

6. What is the delivery and acceptance of duty in the children's department of the hospital?

7. How is the nurse's post equipped?

8. What types of medical documentation are used in the therapeutic department?

9. What data is entered in the temperature sheet?

10. What are the requirements for storing medicines in the department?

11. Name the features of the distribution of medicines taken by mouth to children of different ages.

12. How are the shelf life of certain medicines regulated?

General childcare: Zaprudnov A.M., Grigoriev K.I. allowance. - 4th ed., revised. and additional - M. 2009. - 416 p. : ill.

Many do not know what rights and responsibilities a nurse has. On the basis of what normative document this specialist carries out his work.

The nurse is the main assistant to doctors. The rights and duties of a nurse should be based on a willingness to help, respect for other people. Their actions should be directed to care, assistance in rehabilitation, and health promotion. In addition, care must be taken that other diseases do not appear in the future. The nurse must be present at the appointment of doctors in such hospital rooms: dental, therapeutic, children's, surgical, operating, procedural, anesthetist, reception, resuscitation.

It is imperative to follow the rules of normal communication with patients.

A nurse can begin to hold her position and be relieved of it on the basis of an order issued by the head of the medical organization.

The specialist must comply with:

• senior nurse;
• department head.

Junior medical staff include:

• a nurse;
• sister-mistress;
• a nurse who performs general ward care for patients.

To be able to hold this position, you need to get an education in the field of health with a specialty - nursing. Middle level education. The position of a nurse is included in the class - specialist. In cases where a nurse needs to be absent from the workplace (for example, due to illness), rights and obligations are transferred to the appropriate specialist. To transfer rights and obligations, it is necessary to prepare an order by the management of the organization. It is imperative that a specialist holding the position of a nurse must know the norms of legislative acts that regulate relations in the field of health protection. It is also necessary to know the document containing the composition and hierarchy of the departments of the medical institution. In addition, you should familiarize yourself with the materials that contain a list of measures, means that can prevent exposure of workers to hazardous factors. Carrying out her labor activity, a nurse must be based on the Constitution of the Russian Federation, the laws of Russia, the Charter of the institution, the Job Description.

The rights of a nurse

The rights of duty and responsibility of a junior nurse are provided for in the Job Description.

The rights of a nurse include:

1. For the performance of duties, expect to receive information that may be required for this.
2. In order to improve the activities of the medical staff to express their opinions and make their suggestions.
3. Demand from higher officials that the workplace be equipped with everything necessary for the proper performance of their duties.
4. Attend courses to improve your skills. Pass recertification to get the highest qualification categories.
5. Participate in the activities of nursing associations. At the same time, such work should not be prohibited by Russian law.

When performing their duties in the surgical department, in addition to the listed rights, there are other rights of a junior nurse. For example, controlling the antiseptic level at the time of the surgical intervention.

Responsibilities of junior and senior nurses

The Job Description describes the responsibilities of junior and senior nursing staff.

In accordance with this regulatory document, in practice, the list of responsibilities includes:

1. Carrying out evaluation activities to determine the patient's condition.
2. Making a care plan.
3. Performing functional procedures for treatment, prevention, which were prescribed by the doctor.
4. Performing auxiliary actions during the doctor's operations, medical manipulations. These actions can be carried out in an outpatient clinic or in a hospital.
5. Creation of conditions for fulfillment of medical appointments.
6. Assistance until the arrival of a doctor. This duty is fulfilled when the disease is acute or a catastrophe has occurred.
7. Ensuring the safety of medicines. It must also keep records, and in the event of termination of the validity period, take actions to write off the drugs.
8. Maintain accounting and reporting records. The procedure and rules are established by legislative acts and the management of the hospital.
9. Entering medications. This should be done in accordance with the doctor's prescription and the established order of necessary actions, based on the patient's condition.
10. In case of detection during the absence of a doctor of the onset of complications in the state of health of the patient. This may be due to the drugs that were prescribed for treatment.
11. Collect and dispose of medical waste.
12. Conduct physical therapy.
13. Sterilize medical instruments.
14. Ensure hygiene in the medical facility.

The duties of the head nurse also include monitoring the performance of their duties by junior medical personnel.

Responsibility of nurses

In certain cases, a nurse may be held liable. Such cases include non-fulfillment, as well as untimely fulfillment of the duties assigned to her by the Job Description. If a specialist treats his duties negligently, he can be held liable. In addition, liability arises when a specialist does not comply with the norms of the Job Description and other documents in force on the territory of a medical institution.

The nurse must not violate the following rules:

• labor discipline;
• fire safety;
• labor regime;
• safety technology.

Violations are qualified according to the civil, administrative and criminal legislation of the Russian Federation. In cases where the medical staff caused material damage to the employer by their violations, they can be held liable within the limits of civil and labor legislation.

Examples from judicial practice

The head physician of the medical institution reprimanded the nurse by signing the order. This decision was based on the fact that during the preparation of the annual report, the woman remained at work after the end of the working day. When she left, she closed the office and the department. The woman did not pay attention to the fact that the patient remained in the department. The man could not get out, he called for help. The aggravation of the situation was due to the fact that he had to be at the workplace on time (he took over the night shift), and in the hospital he wanted to get a certificate. The man filed a complaint. The nurse, after receiving a reprimand, went to court. Having considered the case, the judge made a decision on the satisfaction of the stated requirements. He based his decision on the lack of duties of a nurse to inspect the hospital grounds.

Qualification requirements. Secondary (complete) general education without presenting requirements for work experience.

General provisions:

Nursing assistant refers to junior medical staff.

A person who, depending on the pay category, has: - secondary (complete) general education and additional training in junior nurses' courses for patient care without presenting requirements for work experience;

Secondary (complete) general education, additional training in nursing courses for junior nurses and at least 2 years of work experience in the profile.

The junior nurse for patient care is appointed and dismissed by the chief physician (head of the medical institution).

Must know:

Techniques for conducting simple medical manipulations;

Rules of sanitation and hygiene, patient care;

Internal labor regulations;

Rules and norms of labor protection, safety measures, and fire protection;

Ethical standards of behavior when dealing with patients.

In her activities, the junior nurse for patient care is guided by the internal labor regulations, orders of the head, medical institution, this job description and reports directly to the head of the unit.

Patient Care Responsibilities:

Provides assistance in caring for patients under the guidance of a nurse;

Carries out simple medical manipulations (setting cans, mustard plasters, compresses);

Ensures cleanliness of patients, premises;

Monitors the proper use and storage of patient care items;

Makes a change of bed and underwear;

Participates in the transportation of seriously ill patients;

Monitors compliance by patients and visitors with the internal regulations of the healthcare facility.

Has the right to:

Submit proposals on issues related to their activities for consideration by their direct management;

Receive from the specialists of the institution the information necessary for the implementation of their activities;

Require the management of the institution to assist in the performance of their duties.

Responsible:

For improper performance or non-performance of their official duties provided for by this job description, to the extent determined by the labor legislation of the Russian Federation.

For offenses committed in the course of carrying out their activities - within the limits determined by the administrative, criminal and civil legislation of the Russian Federation.

For causing material damage - within the limits determined by the current legislation of the Russian Federation.

Job description of a nurse.

Job responsibilities:

Provides pre-hospital medical care, collects biological materials for laboratory research;

Provides care for patients in a medical organization and at home;

Performs sterilization of medical instruments, dressings and patient care items;

Assists in the doctor's treatment and diagnostic manipulations and minor operations on an outpatient and inpatient basis;

Prepares patients for various types of examinations, procedures, operations, for outpatient doctor's appointments;

Ensures the fulfillment of medical appointments;

Carries out accounting, storage, use of medicines and ethyl alcohol;

Maintains personal records, information (computer) database of the health status of the population served;

Supervises the activities of junior medical staff. Maintains medical records;

Carries out sanitary-educational work among patients and their relatives on health promotion and disease prevention, promotion of a healthy lifestyle;

Collects and disposes of medical waste;

Carries out measures to comply with the sanitary and hygienic regime, the rules of asepsis and antisepsis, the conditions for sterilizing instruments and materials, the prevention of post-injection complications, hepatitis, HIV infection.

Must know:

Laws and other regulatory legal acts of the Russian Federation in the field of healthcare; theoretical foundations of nursing;

Fundamentals of the treatment and diagnostic process, disease prevention, promotion of a healthy lifestyle;

Rules for the operation of medical instruments and equipment;

Statistical indicators characterizing the state of health of the population and the activities of medical organizations;

Rules for the collection, storage and disposal of waste from medical organizations;

Fundamentals of the functioning of budget-insurance medicine and voluntary medical insurance;

Fundamentals of valeology and sanology;

Fundamentals of dietetics;

Fundamentals of clinical examination, social significance of diseases;

Fundamentals of disaster medicine;

Rules for maintaining accounting and reporting documentation of a structural unit, the main types of medical documentation;

medical ethics; psychology of professional communication;

Basics of labor legislation; internal labor regulations;

Rules on labor protection and fire safety.

Responsibilities of a doctor in the organization of patient care

Organization of patient care

Patients are cared for by all medical workers of the surgical department: doctors, senior and ward nurses, nurse assistants (nurses), barmaid.

determines the hospital and motor modes for the patient, the need to use a functional bed and various devices to create a comfortable position for the patient in bed;

determines the method of transporting the patient to diagnostic and therapeutic manipulations and surgery;

appoints a diet and a way of food;

determines the need and nature of therapeutic exercises;

Controls the timeliness and correctness of the fulfillment of appointments for diagnostic procedures and treatment of the patient.

Direct care of patients in accordance with medical appointments is carried out by a nurse.

reception of newly admitted patients;

organization of discharge of patients;

transportation of patients for diagnostic and treatment procedures;

Feeding bed patients;

control over the storage of products of patients and the quality of transmissions;

Timely and correct fulfillment of medical prescriptions (injections, enemas, banks, etc.);

monitoring the patient's condition (counting the pulse, measuring blood pressure, daily diuresis, etc.);

Proper collection of the patient's secretions for laboratory testing (sputum, urine, feces);

In the event of clinical death, she should be able to carry out artificial ventilation of the lungs and closed heart massage, assist with drug anaphylactic shock, apply a tourniquet for external arterial bleeding;

Carrying out hygienic measures to care for the body of a bed patient;

control over the sanitary condition of the department, change of bed and underwear;

Monitoring compliance by patients with the internal regulations of the department and personal hygiene;

Maintaining the necessary medical documentation: filling out temperature sheets, a journal of appointments, receiving and passing on duty, issuing requirements for medicines, compiling a portion.

Responsibilities of Nursing Nursing Personnel:

regular sanitary and hygienic cleaning and maintenance of cleanliness in the wards, corridors and common areas (toilet, hygiene room, bathroom, dining room, etc.);

assistance to the nurse in changing underwear and bed linen;

Assistance to the nurse in feeding bed patients;

Assistance in the supply of the vessel, urinal, their washing and sanitization;

Accompanying patients for various examinations;

· delivery to the laboratory for the study of urine, feces, sputum, and other secretions.

Patient care items:

urinals;

bedpans;

· spittoons;

gastric probes;

· Esmarch's irrigator;

rubber cans in the form of a pear;

gas pipes;

· putty knife;

forceps;

cotton wool, bandages;

heating pads, jars, ice packs;

basins for washing the head and feet in bed patients with appropriate markings;

washcloths;

buckets or basins for wet cleaning of premises with appropriate markings - “for wards”, “for toilets”, etc.;

rags.

Chapter 4. MEDICAL ETHICS AND DEONTOLOGY IN CARE

Medical ethics is the science of morality and morality in the activities of medical workers. Medical deontology is an integral part of medical ethics. Deontology (from the Greek words "deon" - duty, due and "logos" - teaching) - the science of the professional duty of medical workers, about how they should behave among themselves (doctor - nurse), in relation to the patient, his relatives, friends and colleagues.

The first acquaintance of patients, their relatives with medical workers begins with the registry of polyclinics, emergency departments of hospitals, nurses and nurses. Hence the need to improve the general culture of medical institutions and their employees.

Basic deontological principles:

· "Do no harm";

“Everything that is applied must be useful.”

Personal qualities necessary for a medical worker when caring for a patient:

· high professionalism;

care and attention to patients;

· patience;

· politeness and tact;

high sense of responsibility for the fate of patients;

Ownership of your feelings.

Basic principles of relationships between medical workers:

subordination (a system of subordination of the junior to the senior). Medical appointments nurse must strictly comply with the dosage of medicinal substances, the time and sequence of their administration. Negligence and error can be life-threatening for the patient and lead to irreparable consequences. It is unacceptable for a nurse to cancel doctor's appointments herself, to make them at her own discretion. She should not take the responsibility of diagnosing and treating a patient without a doctor's prescription. If changes occur in the patient's condition that require the abolition of drugs or the appointment of new drugs, the doctor should be informed about this, who will give appropriate orders. In emergency situations, in the absence of a doctor, the order is given by the nurse of the corresponding unit. The middle and junior medical personnel of other divisions of the department must fulfill them immediately and unquestioningly;

tact, courtesy. It is unacceptable to criticize your colleagues in the presence of patients and visitors. This undermines the authority of the criticized, deprives further confidence of patients who can exaggerate the significance of the mistake made.

friendliness, mutual assistance and mutual assistance. If a doctor or nurse feels inadequately prepared to perform some therapeutic or diagnostic procedures, they should seek help and advice from more experienced colleagues. At the same time, more trained medical workers should help less experienced colleagues master the technique of various manipulations. Arrogance and arrogance in relations between medical workers are not acceptable.

The functional duties of a nurse, a girl or a woman, whose actions are led by a doctor, include the implementation of the basic rule: caring for the patient at the direction of the authorities and only him. Other important instructions for her come from this.

What should a nurse know?

The knowledge of the nurse should be broad enough. She should not just become familiar with the laws related to the health system, but learn them by heart, as well as the rights relating to her direct work and the work in which she is engaged. Such a girl or woman should know the basics of fire safety, the tasks of a nurse and the organization of health care institutions very well. She should be guided in her activities by the law, orders of the immediate supervisor, materials related to medical issues, the charter of the institution, the rules of hygiene and labor regulations and the job description (exclusively this one).

This list basically includes the following: care for patients and the sick, the provision of medical care before the doctor arrives; sterilization of instruments, dressings and other items for treatment; control over the storage, consumption and use of medicines and preparations, their accounting. The nurse is also engaged in ensuring that the patient undergoes the procedures exclusively correctly, as well as recording data on the patient's condition. She puts droppers and injections in the hospital, takes a blood sample, prepares instruments and preparations before the operation; measures pressure and temperature, makes injections, applies bandages and the like. This is especially true for representatives of this profession who work in emergency rooms, schools and traumatology departments.

The functional duties of a nurse in children's clinics also include patronage - monitoring the condition of the child and special advice to parents on how to care for him at home. The district nurse keeps a record of people who come to see a doctor, as well as patients who go to the hospital. The duties of a nurse include filling out medical cards and checklists, filling out certificates. In the operating room, a girl of this specialty monitors the integrity and completeness of preparations and instruments, helps the surgeon, giving him the necessary instruments at his request with the necessary efficiency. In schools and preschool institutions, she is also responsible for seasonal and routine vaccinations.

Her duties include carrying out simple manipulations of a medical nature (associated with banks, compresses, heating pads); change of underwear, as well as bed linen; assistance to a senior employee; transportation of seriously ill patients; monitoring compliance by patients with the rules of the institution, cleanliness, order. In addition, the functional duties of a nurse include replacing the head nurse when she goes on vacation or is on sick leave.