To assign or confirm your qualification category. To pass this procedure, it is necessary for the last year of practical activity at the main place of work. For specialists with higher education, the report should reflect the activities for the last 3 years.

The report of a specialist applying for the assignment or confirmation of a qualification category is a work reflecting a comparative analysis of the work activity of a medical worker over the past year.

You should not approach writing an attestation report formally and expect that the attestation commission will not go into its detailed study. Recently, the number of nurses whose reports are being returned for revision has been growing. The absence of uniform reporting requirements approved at the federal level is not a reason for frivolity in this work. Particularly serious should be approached to compiling a report for nurses applying for the assignment of the first, and even more so, the highest qualification category.

Consider nurse certification report by sections. Usually, when compiling a report, medical professionals are guided by recommendations developed and proposed by specialists in a particular region. However, tentatively nurse certification report complies with the same rules of drafting and formatting.

1. Introduction

• milestones of the labor path;
• information about the improvement;
• information about previous certifications (if the nurse is not certified for the first time).

1.2 Brief description of the medical institution:

• material and technical base;
• the number of divisions;
• the total number of beds in hospitals;
• staffing;
• personnel and other information.

1.3 Characteristics of the unit:

• the number of beds in the hospital;
• material and technical equipment;
• staffing;
• staffing;
• division features.

2. Main body of the report

2.1 Patient population:

• sex, age, nosological forms of diseases;
• features of patient care in the unit;
• description of the creation of a safe hospital environment and a favorable socio-psychological atmosphere for the patients of the unit;
• description of examples of difficult situations with patients from their own nursing practice.

2.2 Scope of work performed:

• description of the workplace and job responsibilities;
• a description of the preparation for the work of medical equipment, medical instruments available and used in the unit;
• description of the preparation of patients for diagnostic and therapeutic procedures and manipulations;
• description of the rules for sampling biomaterial for laboratory research;
• a description of the patient care process, as well as care items, including new ones;
• a description of the rules for accounting, storage and dispensing of drugs in the unit, indicating the benefits of using new drugs;
• a description of the maintenance of medical records in the unit;
• description of care in emergency conditions, give examples from practice.

2.3 Qualitative and quantitative indicators of the work of a nurse for the reporting period:

• name and number of performed nursing manipulations in the form of tables.

2.4 Development and implementation of new modern nursing technologies, rationalization work:

• describe the benefits of using new nursing technologies in care, treatment, prevention and rehabilitation;
• description of the achievement of a therapeutic and diagnostic effect from the use of innovative nursing technologies and techniques.

2.5 Compliance with measures to prevent occupational diseases:

• use of personal protective equipment by employees of the unit at the workplace;
• timely medical examinations;
• immunization of personnel through vaccination (mandatory vaccinations).

3. Infection control

3.1 Infection control system:

• compliance with the rules of asepsis and antiseptics, the use of modern and sterilization in the unit;
• Key quality indicators for the reporting period:

• the number of sanitary and bacteriological complications during manipulations and the use of medical equipment;
• infection of patients after procedures;
• infectious safety of the medical personnel of the unit;
• cases of nosocomial infection, the timeliness of their analysis.

All indicators should be presented in comparison with indicators for the entire medical institution, as well as (preferably) for the district, region (krai). It is necessary to analyze the indicators of a specialist for the reporting period, determine the causes of complications and show ways to prevent their occurrence. An analytical explanation of digital data will demonstrate the ability of the certified specialist to evaluate his own activities, as well as the activities of the unit in which he works and the medical institution as a whole.

4. Participation in the activities of professional associations, pedagogical and sanitary-educational work, professional development

4.1 Social activities:

• participation in the work of professional associations.

4.2 Pedagogical activity:

• control and guidance when working with junior medical staff (for senior nurses - and with middle staff);
• training in the skills of nursing manipulations, methods of providing emergency care to students of medical colleges and schools;
• conducting technical classes with young nursing professionals;
• exchange of experience with colleagues from other departments and medical organizations.

4.3 Health education work:

• participation in the work of schools of patients on various nosological forms of diseases;
• conducting nursing patronage of patients;
• thematic conversations with patients, their relatives and visitors;
• issue of sanitary bulletins;
• participation in the organization and work of schools to promote a healthy lifestyle.

4.4 Medical ethics issues and :

• knowledge of the Code of Ethics for Russian nurses;
• knowledge of the Charter of Nurses of Russia;
• the importance of observing the principles of medical ethics and deontology on an example from practice.

5. Conclusions, tasks for the future, proposals

5.1 Conclusions:

• summing up the results of work for the reporting year;
• identification of problems and ways to solve them;
• summarizing the results and drawing conclusions based on the given data.

5.2 Challenges for the future:

• planning activities for further professional growth and improvement.

5.3 Offers:

• on the basis of the conducted analytical studies, recommendations are offered to improve the labor process.

6. Literature

6.1 Specialist's own publications:

• list of publications or photocopies of articles;
• titles of reports, presentations, with which the specialist spoke at conferences, symposiums and other forums.

6.2 Literature used to compile the report:

• list of bibliographic descriptions: official documents, books, periodicals, dissertations, abstracts, standards and electronic publications.

7. Applications

• Tables, diagrams, graphs, photographic documents, drawings.

We hope that compiled in the manner described nurse certification report will allow you to adequately pass an important professional test.

SAMPLE

APPROVE

Chief Physician

Name of health facility

_________________

Report

about the work done for _________ year

district pediatric nurse

Ivanova Maria Petrovna

MUZ "City Children's Polyclinic No.»

On the preparation of a report on production activities for certification for the appropriate category

All certification material must be in printed form using Times New Roman No. 14, spacing 1.5 on one side of A4 white paper, with standard margins.

Tables, figures, drawings, diagrams, graphs are made on standard sheets. The pages of the report, including illustrations and appendices, are numbered sequentially.

The report is signed by the certified person, the head nurse, the head of the relevant unit, on the title page it is certified by the signature of the head of the institution and the official seal of the institution.

A sample report on production activities for certification for the 2nd qualification category

I, Ivanova Maria Petrovna, graduated from the Chita Medical College in 20___ with a degree in Nursing, and passed a specialization in Nursing in Pediatrics. At the end of the CMC, she came to the children's clinic as a young specialist for the position of a district nurse. The total experience is 3 years, in the specialty - 3 years.

Member of the association since 20___.

The children's polyclinic is an independent medical and preventive institution. In the area of ​​its operation, the polyclinic provides outpatient medical, diagnostic and preventive care to the children and adolescent population with a total number of 01/01/20 ______, of which children under one year old ______, adolescents _______.

There are ____ preschool educational institutions and _______ secondary educational schools in the service area of ​​the polyclinic.

The planned capacity of the polyclinic is ______ visits per year.

Structure of healthcare facilities

Pediatric department: ____ pediatric areas.

Department of Children's School of Education: _____ preschool educational institution, _____ secondary school

Clinical diagnostic laboratory

Dental department

X-ray room

Cabinet of functional diagnostics

massage room

Office of a healthy child.

vaccination room

treatment room

CSO office

Physiotherapy cabinet

Narrow specialists conduct appointments: a neonatologist, a neurologist, a surgeon, an ophthalmologist, an ENT doctor, a pediatric gynecologist, an endocrinologist, an infectious disease specialist, an immunologist, a cardiologist, an adolescent therapist, a psychologist, a speech therapist, and a psychiatrist.

Two days a week (Tuesday and Thursday) reception of healthy children.

My working day starts at 8:00 am. Doctor's office getting ready

in 30 min. before admission:

Airing and turning on the recirculator (or bactericidal lamp)

Replacement of disinfectants for current disinfection of the surface of tables, couches, scales, height meters

Delivery of sterile spatulas from the CSO

Delivery of outpatient cards (form No. 112/y)

Preparation of prescription forms, various directions, certificates, etc.

Documentation

Site passport (site plan, main indicators of the site, lists of disabled children, socially disadvantaged, neglected and guarded children)

Work folder

Child population census log by year

Household Census of Children Log

Medical examination journal

Register of unorganized children in 2 copies (one is in the vaccination room)

Tuberculosis Threatened Register

A register of pregnant women at the site and a folder for prenatal patronage.

Register of children of the first year of life by risk groups

Journal of reports on newborns, one-year-olds, unorganized children

The daily work plan of the district nurse

Monthly vaccination plan

Workplace equipment

Desk - 2 pcs.

Changing table - 1 pc.

Cabinet - 1 pc.

Chairs - 4 pcs.

Scales (electronic) for children up to 20 kg. - 1 PC.

Scales (electronic) floor for adults - 1 pc.

Height meter for infants - 1 pc.

Height meter for adults - 1 pc.

Couch - 1 pc.

Sink for washing hands - 1 pc.

Recirculator (or bactericidal lamp) - 1 pc.

Sterile spatulas, packed in kraft paper, 10-15 pcs.

Tray for sterile spatulas

Thermometers clean, dry - 5 pcs.

Disinfection containers (spatulas, thermometers, class B waste)

Disposable hand towels for staff

Brief description of the site and main indicators

The site is located in the __________ area, where the following houses are located:

9-storey, ______ 5-storey, private sector with _____ one-storey wooden houses. The plot is extended (not extended), compact (not compact). Children attend preschool №, №, №; secondary schools no., no., no.

The birth rate at the site increased (decreased) compared to last year.

During the period of my work at the site, there was no infant mortality (or was, indicate in which year). Infant mortality rate

in the polyclinic for _______ year amounted to _____ ppm from among those admitted under observation. In the city, the infant mortality rate is _______ ppm, in the region ______ ppm.

The census of the child population in the area is carried out 2 times a year

	Name
	The total number of children in the area
	Number of children under one year old
	Number of unorganized children
	Number of children attending preschool
	Number of children enrolled in schools
	Number of children with disabilities

Antenatal protection of the fetus

Prenatal care.

In order to improve the antenatal protection of the fetus and newborn, an ATPK-council operates on the basis of the medical facility, which takes place once a month. Each precinct prepares lists of socially disadvantaged families for women's consultations, and the therapeutic service provides lists of women of childbearing age with extragenital pathology and a list of women with absolute contraindications.

Work on protecting the health of the child on the site begins even before his birth. The antenatal clinic sends lists of registered pregnant women to the children's polyclinic.

For the first antenatal care, a woman comes to the children's polyclinic for an appointment with a pediatrician herself in the first 10 days. If for some reason she did not come to the children's polyclinic within 10 days, the district nurse provides prenatal care at the woman's home. Pregnant women with a high degree of risk are given the 3rd antenatal care at home by a pediatrician.

Number of pregnant women
prenatal care
Burdened obstetric history
Anemia in pregnancy
Rh negative pregnant women
Residents permanently on the site

Working with newborns

Number of newborns
SHOP injuries
premature babies

After a newborn is discharged from the maternity hospital, primary medical and nursing patronage is carried out for him during the first 2 days. When carrying out patronage for a newborn, a special packing of the district nurse is used.

Styling composition:

Ethyl alcohol 70% or 0.2% chlorhexidine solution

Hydrogen peroxide solution 3%

Sterile cotton balls

Sterile forceps

Sterile pipettes - 2 pcs.

Dressing gown disposable sterile

Sterile medical gloves

Disposable medical cap

Mask medical disposable

Shoe covers disposable

Class B waste collection container

At the first patronage, we teach mothers how to care for a newborn, how to treat the umbilical wound, hygiene procedures, how to treat skin folds, as well as how to bathe and swaddle a baby. There is a conversation on the prevention of hypogalactia, a conversation about the rules of breastfeeding. Together with the doctor, a plan is drawn up for monitoring a child up to one year old, taking into account perinatal risk groups. During the neonatal period up to a month, healthy children are visited by a nurse once a week, children in the 4th risk group - daily up to 14 days, then 2 times a week up to 4 months. Children in the 7th risk group from socially disadvantaged families under one year old are visited individually, but at least 2-3 times a week.

Working with children of the 1st year of life

Observation of children of the 1st year of life

Number of children under 1 year
Observed by a nurse
Inspection by specialists
Neurologist
Dentist
Traumatologist-orthopedist
Laboratory research
general blood analysis
general urine analysis
feces per i/hl
scraping e/b
Pneumonia
healthy children

From one month to 6 months of life, children are visited by a nurse 2 times a month, children from 6 months to 1 year - 1 time per month.

In a family where a premature baby was born, conversations are held with the mother on caring for a premature baby, preventing pneumonia, malnutrition. Such children are provided with scales, a control weighing of the child is carried out at home. The data is recorded in the observation sheet.

Children of the first year of life are monthly invited to the clinic for an appointment with a pediatrician for anthropometric measurements, assessment of physical and neuropsychic development, and preventive vaccinations. Examinations are carried out by narrow specialists, they are appointed for the delivery of general blood and urine tests, ultrasound of the hip joints.

When observing children in the first year of life, observation sheets developed as part of nursing innovations are used.

Working with unorganized children from 2 to 7 years old.

Children of the 2nd year of life are visited by a nurse 1 time per quarter, children of the 3rd year of life - 1 time per six months, unorganized children over 3 years old - 1 time per year. In addition, they are invited according to the plan for preventive vaccinations. By the day of their birth, unorganized children are annually invited to the polyclinic for testing, undergoing a medical examination by narrow specialists. Their physical and neuropsychic development is assessed.

Immunoprophylaxis.

The children's polyclinic works according to the territorial program "Vaccinal Prevention". The priority national project "Health" provides for an increase in the number of people to be vaccinated against rubella, hepatitis B and influenza.

A file cabinet functions in the structure of the vaccination cabinet. The work is based on the main principles: accurate and reliable registration of all children (according to the census and movement of children) and the availability of medical documentation for each of them. A preventive vaccination plan is drawn up monthly, and at the end of the month, an analysis of vaccination is carried out. A plan for each child is drawn up monthly according to Forms No. 63 / y.

After vaccination with DTP, ATP-M, ATP, HBV, children are visited by a nurse the next day to assess their condition. Attention is paid to sleep, appetite, temperature, stool, etc.; OPV - on the 4th, 7th, 14th, 30th and 60th days - pay attention to temperature, stool, neurotic symptoms, rash; measles and mumps - on the 6th and 18th day, rubella - on the 6th and 12th day.

I control the presence of forms No. 63 / y in the file cabinet, for the removal of the effectiveness of BCG scars and timely medical withdrawals.

		Standard indicator
			polyclinic	plot
Diphtheria	up to 1 year V
	up to 1 year V
Poliomyelitis	up to 1 year V
	2 years (18 m.) RV 1
	2 years (20 min.) RV 2
Mumps
BCG (1 year)

If normative vaccination rates are reduced, indicate the reason for the decrease, for example, the absence of a particular vaccine.

Indicate (if any) the number of young mothers, what work is being done in this direction (lectures, conversations, and other events).

Visiting sick children at the site is carried out according to the doctor's prescription. When visiting such children, I check the fulfillment by the parents of medical prescriptions, the availability of medicines, I arrange the prescribed injections for the child, check hospitalization, and monitor contacts in the foci of various infections.

Working with a dispensary group of children.

Children registered at the dispensary are called to see a pediatrician 2 times a year (spring and autumn). In advance, they are given referrals for testing, for consultation with narrow specialists. At the appointment, anthropometry is performed, blood pressure is measured, the physical development of the child is assessed, according to indications, an additional examination is assigned to the clinical diagnostic center for children. After all the examinations carried out by the pediatrician, anti-relapse treatment is prescribed.

Indicators
		polyclinic
The number of children on the "D" account in total:
including the pediatrician.
Completeness of coverage
Efficiency of medical examination:
No exacerbations
Deregistered for recovery
Dispensary observation coverage per 1000 thousand population total:
including the pediatrician.

Structure of chronic diseases

Spa treatment

Name of health facilities

I work with disabled children according to the plan, I carry out patronage at home once a quarter. Work is underway on DLO, I control the receipt of medicines prescribed by the pediatrician, the fulfillment of medical prescriptions by the patient.

R work with children from socially disadvantaged families.

	Indicators
		plot	polyclinic
	Total child population: including up to a year
	Total number of socially vulnerable families
	They include children from socially disadvantaged families
	Including up to 1 year
	Children in need of recovery:
	improved
	Number of pregnant women from socially disadvantaged families
	Covered by contraceptive method from socially disadvantaged families
	Carried out door-to-door rounds, raids with inspectors

Children from socially disadvantaged families are under constant supervision of the OSZN and the children's polyclinic. Weekly district nurse visits socially disadvantaged families. Children under guardianship at the site are visited by a nurse at home in order to get acquainted with the material and living conditions in which the child is located, the psychological climate in his environment, are invited to an appointment with narrow specialists for medical examination and testing.

Working with teenagers

Children who have reached the age of 15 are transferred to a teenage room. At the beginning of the year, lists of adolescents are compiled at the site, according to which the child is called for transfer in the month when he was born. The child is visited by a nurse at home. He is given referrals for tests, for a fluorographic examination of the chest organs, and a teenage card is entered for him.

The district nurse prepares in advance lists of boys and girls with an analysis of morbidity and prepares cards for undergoing a medical examination.

In the presence of a chronic disease or a newly diagnosed disease, the teenager is carefully examined, he is given conservative or surgical treatment according to indications.

Implementation of innovative technologies in the work of the district nurse

Implementation of TPMU(list which TPMS are performed )

Analysis of the quality of the work of a specialist

According to the ranking results for 20___, I take ___ place out of ___ district nurses. I lag behind the ranking place according to the following criteria, for example:

low vaccination rate. Cause:

low rate of antenatal care coverage. Cause:

According to the results of a survey of patients and their relatives at the site, the degree of satisfaction with the quality of nursing care is generally quite high (or not high enough) and amounts to ___%. Parents receive a sufficient amount of information from the nurse on prevention issues, the working hours of the institution, etc. According to the study, the parents of young patients fully trust the professional skills and knowledge of the district nurse.

Every year, by order No. 549 of the Ministry of Health of the Trans-Baikal Territory “On improving the examination of the activities and quality of nursing care in the Trans-Baikal Territory”, I pass an exam for professional competence in the following disciplines:

readiness to provide emergency first aid

improvement of manipulation technique in the framework of the implementation of TPMU standards

preparation of patients for various research methods

knowledge and compliance with the pharmaceutical order (drug science)

knowledge and compliance with ethical and legal standards

compliance with infectious safety

The results of the exam are recorded in a personal record book and taken into account when ranking. According to the data for 20____, I have a final grade of ____.

I regularly improve my professional level. I attend nursing conferences held in medical facilities, seminars for district nurses, master classes, I take part in regional scientific and practical conferences in the specialty "Nursing in Pediatrics". According to the credit-accumulative system, I have ____ hour. I use the scientific and methodological literature received from the Association

Conclusion: the nurse makes a brief conclusion about the results of the work done, notes the problems and the planned ways to solve them, the proposals of the certified person to improve the activities of the service in the institution, region

Signature of the district nurse

Head nurse's signature

List of used literature(indicating the authors, year and place of publication), published in the last five years

To the attention of the experts who prepare the report

for the 1st qualification category

The report is prepared according to the same requirements as for the 2nd quarter. category, but additionally must specify:

-

To the attention of the experts who prepare the report

for the highest qualification category

The report is prepared according to the same requirements as for the 2nd quarter. category, but additionally must specify

- responsibility for conducting a master class, indicating the number of specialists trained in this master class

Participation in the development of new TPMU standards (list in which ones)

Mentorship work with young professionals

Presentations with reports at regional and regional conferences in the specialty, articles in the media

Work in the board of nurses

The conclusion about the results of the work done, notes the problems and the planned ways to solve them, the proposals of the person being certified to improve the activities of the service in the institution, region

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Creation date: 2003

"I approve"
Chief Physician
Maryanovsky boarding house
L.P. Alysheva

Certification work of a nurse of the department of mercy
Sotnik of Elena Vladimirovna
for 2003

Maryanovsky boarding house, 2004

Sections 12, 13, 14 and 15 are missing.

1. Production plan and professional development.
2. Acquisition of professional skills.
3. Characteristics of the department (service) - workplace, working conditions.
4. Features of work (by specialty). Introduction of modern nursing technologies.
5. Organizational and methodological work.
6. Organization of emergency care.
7. Infectious safety of patients, prevention of occupational infections.
8. Statistical performance indicators of the department. Analysis of work for the last year.
9. Ethics and deontology of medical workers. Implementation of articles of the ethical code in the work of nurses.
10. Work to provide "disaster medicine".
11. Sanitary and educational work.
12. Safety and fire safety.
13. Omsk professional nursing association - goals, objectives.
14. Health insurance.
15. Conclusions and offers.

1. Production path and professional development

I, Sotnik Elena Vladimirovna, born in 1981, graduated from the Omsk Republican College in 2001 with a degree in nursing.

After graduating from college, she was hired at the Maryanovsky boarding school for the elderly and disabled. I currently work in the charity department. I didn’t take advanced training courses, I don’t have a category.

2. Acquisition of professional skills

I have professional skills in accordance with the requirements for the specialty "Nursing".

I know:

• theoretical foundations of nursing;
• organization of nursing care for patients at the stages of the nursing process;
• psychology of professional communication;
• basics of dietology;
• main causes, clinical manifestations, diagnostic methods, complications, principles of treatment, prevention of diseases and injuries;
• main drug groups and their indications, contraindications, complications of drugs, regulatory documents regulating the pharmaceutical order in medical institutions;
• infection control system, infection safety of patients and staff of a medical institution;
• main types of medical documentation;
• safety and labor protection in medical institutions;
• health insurance system;
• disaster and emergency medicine.

I possess manipulations and practical skills:

• technique for preparing disinfectant solutions;
• technique for disinfecting hands, gloves, covering a sterile table;
• the technique of laying bandages, laying with tools and dressings, their design;
• disinfection technique for medical instruments and equipment;
• technique for performing injections (intramuscular, intravenous, subcutaneous, intradermal) and intravenous drip infusions);
• setting cans, mustard plasters, compresses, all types of enemas, vent tubes, heating pads, ice packs, the introduction of catheters;
• an algorithm for setting samples for the quality of the disinfection and pre-sterilization treatment;
• the imposition of an aseptic bandage, tire immobilization, the imposition of a plaster splint;
• technique for determining blood pressure, pulse, respiratory rate, temperature, blood group;
• methods of providing emergency care in emergency situations, poisoning, emergency conditions;
• preparation of patients for diagnostic studies;
• therapeutic and prophylactic and hygienic care for patients, disinfection of care items for them.

3. Characteristics of the service - workplace, working conditions

Our boarding school is located in the district center, in a separate residential building with central heating, water supply, sewerage. On the territory of the boarding school there are: garages, a mortuary, a vegetable store, a bath and laundry plant, a boiler room, a locksmith shop, a clothing warehouse. The boarding school refers to a social stationary public institution serving the population and is a separate structural unit.

The boarding school is designed for 330 beds, it includes 4 departments of mercy and 4 general types, in which elderly citizens (who have reached the age established by the legislation of the Russian Federation) who are entitled to medical and social assistance in social protection institutions live.

There are 5 medical posts in the boarding school, 4 of them in the mercy departments are deployed for 200 people and 1 post for general type departments is deployed for 130 residents. In addition, there is a separate treatment room, a reception and quarantine department, an isolation ward with separate entrances and a division into a female and male half. The following rooms also function: a laboratory, a physiotherapy room, a pharmacy, a dental room, a physiotherapy room, a health room, a massage room, a disinfector's room, an intern's room (where doctors of narrow specialties are received: ENT, ophthalmologist, surgeon, neurologist, gynecologist, dermatovenereologist ), a psychological relief room, where a qualified psychologist works with residents.

Supervision and control over the departments is carried out by the head of the department (therapist) and the head nurse. Once a year, an in-depth medical examination of all residents is carried out with the involvement of narrow specialists and once a quarter a preventive examination by a general practitioner. Each department of mercy has a medical post located in a separate office, equipped with everything necessary for work:

• manipulation table;
• storage cabinet for medicines;
• safe for storage of potent and narcotic (psychotropic) medicines;
• couch;
• Desktop;
• bactericidal lamp;
• fridge;
• table with disinfectant solutions.

The post also has the relevant documentation:

• nurse folder;
• folder of medical recommendations;
• register of reception and delivery of duty;
• register of procedures;
• register of disposable systems and syringes;
• bactericidal lamp operation log;
• journal of general cleaning at the post;
• register of potent and toxic substances;
• log of delivery of keys from the safe;
• technical passport of the cabinet;
• journal of examination of residents for pediculosis;
• dressing material accounting log;
• body weight log;
• log book of ethyl alcohol 70 degrees;
• register of work on hygienic education and upbringing of the population and promotion of a healthy lifestyle;
• medical history.

Also in the mercy departments there is a distribution room, a bathroom, a bathroom, a hall, a staff room, a smoking room.

The work of the mercy department is regulated by the order of the Ministry of Social Protection of the Population of the Russian Federation No. 170 dated July 28, 1995 - “On approval of instructions on the organization of medical care, anti-epidemic and sanitary-hygienic measures in nursing homes for the elderly and disabled.”

4. Features of the work of a nurse in the department of mercy

Work in the department of mercy requires great patience and attention, as the elderly and disabled people who have the right to medical and social assistance in social protection institutions live there. Therefore, the nurse is the first assistant in the treatment of the patient, since accurate and timely medical appointments, attentiveness and participation in the compassion and problems of the residents facilitate their well-being, and therefore the attitude of the staff towards the residents should be purely individual.

My working day begins with taking duty at the bedside of the patient, if he is in serious condition. Counting up the rest of the potent drugs. After taking duty, a morning planning meeting: familiarization of the medical staff with the work of the department over the past day, familiarization with the condition of patients, planning work for the day. After that, I go around the department, monitor the health of patients and, if necessary, call a doctor to provide medical assistance. The doctor makes appointments, and if necessary, patients are hospitalized in medical institutions, accompanied by medical personnel.

I carry out the alignment and distribution of medicines. By order of the doctor, I measure the heart rate, respiratory rate, blood pressure and body temperature of patients; I prepare patients for diagnostic manipulations.

I carry out the reception of newly admitted to the department, introduce them to the medical and protective regime of residence in the department, check the prescription lists, write out the requirements to the pharmacy of the missing medicines. I strictly follow the technology of all procedures: intravenous, intramuscular, subcutaneous, intradermal injections, intravenous drip infusions. After staging injections, I carry out pre-sterilization processing of instruments.

Patients are individual and the approach to each should be appropriate. With prolonged bed rest, I clean the patient's bed for the prevention of bedsores (inflatable ring, camphor alcohol, soap, powder), change the position of the patient every three hours, and also carry out sanitary and hygienic treatment of the eyes, mouth, nose, ear. I follow the change of bed and underwear at least 1 time in 7 days, but as needed and more often. I participate in a bath or bath, which is carried out once every 7 days, but also as needed and more often.

I supervise the distribution of food and its preparation. Food should be distributed no later than 2 hours after it is prepared. I control the sanitary condition of the dispenser.

I strictly observe the sanitary and anti-epidemiological regime, the basics of asepsis and antisepsis. I carry out a set of measures to prevent nosocomial infections (Order of the Ministry of Health of the USSR No. 720 of 07/31/1978). When working with blood, I put on a mask, gloves, an apron, and in emergency situations I use a first-aid kit for the prevention of "HIV infection". Sanitary treatment of instruments, catheters, syringes, systems for intravenous drip infusions is carried out in accordance with the requirements of the order of the Ministry of Health of the USSR No. 408 of 07/12/1989. Control over the sterility of instruments is carried out using thermal indicators.

I carry out explanatory work for residents and staff about the proper organization of nutrition, shelf life, sales of products stored by residents. I am talking about hygiene standards.

I improve my professional level by attending conferences, seminars. I take part in the preparation of statistical data on the work of the department on a monthly and quarterly basis.

5. Organizational and methodological work

In order to accurately fulfill my duties, I am guided by the job description, the hourly work schedule approved by the director of the boarding school, and methodological recommendations.

1. Professional development:

• Order of the Ministry of Health and MP of the Russian Federation No. 131 of May 23, 1995 "Regulations on the certification of secondary medical and pharmaceutical workers"
• Order of the Ministry of Health and the Ministry of Health of the Russian Federation No. 221 dated March 2, 1995 “On the certification of medical workers”
• Order of the Ministry of Health and the Ministry of Health of the Russian Federation No. 100 dated 03/25/1996 "On amendments to the regulation on certification of paramedical and pharmaceutical workers, approved by order Order of the Ministry of Health and the Ministry of Health of the Russian Federation, etc. No. 1131 dated 05/23/1995"
• Order of the Ministry of Health and MP of the Russian Federation No. 249 dated August 19, 1997 "On the nomenclature of specialties of nursing and pharmaceutical personnel"
• Instruction letter of the Ministry of Health and Ministry of Health of the Russian Federation No. 16-8-364 dated 05/03/1995 "On the advanced training of the secondary medical and pharmaceutical level in the forms and terms of training in institutions of post-medical education"

2. Sanitary and epidemiological regime

• Industry standard 42-21-2-85 "Sterilization and disinfection of medical devices"
• Order of the Ministry of Health of the USSR No. 720 dated July 31, 1978 "On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infection."
• Sanitary and epidemiological rules SP 3-1-958-00 “Prevention of viral hepatitis. General requirements for the epidemiological surveillance of viral hepatitis.
• Order of the GUZAO No. 30 dated February 24, 1998 “On improving the effectiveness of preventive work on HIV infection in health facilities in the Omsk region”.
• Order of the Ministry of Health of the Russian Federation No. 342 dated November 26, 1998 "On strengthening measures to prevent epidemiological typhus and combat pediculosis."
• Order of the Ministry of Health of the USSR of March 5, 1987 "On the fight against pediculosis and the prevention of typhus."
• Order of the Ministry of Health of the Russian Federation No. 36 of 03.02.1997 "On the improvement of measures for the prevention of diphtheria."

3. Therapeutic and protective regime

• Order of the Ministry of Health of the USSR No. 1204 dated 11/16/1986 "On the medical and protective regime of medical institutions."

4. Medical support

• Order of the Ministry of Health of the USSR No. m245 of August 30, 1991 "On the standards for the consumption of ethyl alcohol for healthcare, education and social security institutions."
• Order of the Ministry of Health of the USSR No. 1145 of August 28, 1995 "On the approval of temporary standards for the consumption of dressings in medical institutions."
• Order of the Ministry of Health of the USSR No. 471 dated September 17, 1976 "Memo to a medical worker on the storage of medicines in the department, medical institutions."
• Order of the Ministry of Health of the USSR No. 747 dated 06/02/1987 "On the accounting of medicines, dressings and medical products in medical and preventive health care institutions that are on the state budget of the USSR."
• Order of the Ministry of Health of the Russian Federation No. 377 dated November 13, 1996 “On approval of instructions for organizing the storage of various groups of medicines and medical products in pharmacies”.
• Order of the Ministry of Health of the USSR No. 673 of December 22, 1978 "List of medicines subject to subject-quantitative accounting in medical institutions"
• Order of the Ministry of Health of the Russian Federation No. 330 dated November 12, 1997 "On measures to improve the accounting for the storage, prescribing and use of narcotic drugs."
• Order of the Ministry of Health of the USSR No. 523 "On the procedure for storing, issuing and accounting for toxic and potent substances."
• Order of the Ministry of Health of the Russian Federation No. 328 “On the prescription of medicines, the rules for issuing prescriptions for them and the procedure for dispensing them by pharmacies, on some aspects of working with narcotic and psychotropic substances.

5. Sanitary and educational work

• Order of the Ministry of Health of the USSR No. 98 of July 15, 1993 "On measures to further improve hygienic education and education of the population of the Omsk region."
• Instructional-methodical letter of the Ministry of Health of the USSR dated April 10, 1980 “On filling out and using F 038 / u-4 - a register of sanitary and educational work.”

6. Organization of emergency care

In the process of working in the department, various emergency conditions may arise that require immediate action to provide assistance. Such as:

1. Fever

Fever is a protective and adaptive reaction of the body, manifested by an increase in body temperature. With an increase in body temperature, the patient should be put to bed, covered warmly, warmed with heating pads, given a hot drink, monitor the pulse rate, breathing, and if the body temperature rises to maximum numbers, call a doctor and apply drug therapy.

2. Shortness of breath

Shortness of breath - a violation of the rhythm, depth and frequency of breathing. Choking is a sharp, sudden shortness of breath. The patient may have bronchial asthma. Under these conditions, nursing care is as follows: seat the patient and raise the head end of the bed; unfasten tight clothing; provide fresh air; call a doctor. Further actions should be carried out under the guidance of a doctor without fuss and continue to monitor the patient's condition and his breathing.

3. Hypertensive crisis

Hypertensive crisis - a sharp deterioration in the condition, due to a sudden increase in blood pressure. An urgent need to call a doctor; raise the head end of the bed, measure blood pressure; provide complete rest to the patient; setting mustard plasters on the occipital region, calf muscles or a heating pad to the legs; cold compress or ice pack to the head; prepare the necessary ampouled medicines: dibazol, lasix, clonidine, syringes. Continue monitoring the patient's condition, blood pressure, bed rest.

4. Pain in the region of the heart

Heart pain is the most common symptom of heart disease. Angina pectoris is characterized by paroxysmal, constricting pain in the region of the heart or behind the sternum lasting up to 30 minutes. Myocardial infarction - the pain syndrome is more intense and prolonged. Nursing care is as follows: limit the patient's physical activity, ensure complete rest; seat or lay the patient with a raised head end; call a doctor; give the patient a tablet of nitroglycerin under the tongue, if there is no effect, repeat the intake of nitroglycerin; calm the patient, unfasten tight clothes; measure blood pressure, determine the properties of the pulse; follow the doctor's recommendations.

5. Nosebleeds

Nosebleeds occur more often when the vessels of the nasal mucosa are damaged. It is necessary to seat the patient without tilting his head back, to give a tray for collecting blood in his hands in order to judge the size of blood loss. Nasal tamponade: insert a sterile gauze bandage or a long gauze napkin deep into the nose with tweezers, each subsequent layer should fit snugly against the previous one so that the entire half of the nose is tamponed. Pre-lubricate the swab with vaseline oil. The tampon can be in the nasal passages during the day.

6. Anaphylactic shock

Anaphylactic shock is a life-threatening condition of an acute allergic reaction. First aid is provided only where shock has developed. The patient can be transported only after stabilization of blood pressure. It is necessary to stop the administration of the drug; urgently call a doctor through an intermediary; prick the injection site with a solution of adrenaline (1 ml + 9 ml of saline solution); lay the patient down with the head end down, fix the tongue; inject a solution of adrenaline 0.1% - 1 ml intravenously, prednisone 120 mg or 125 mg hydrocortisone. The nurse has the right to introduce these drugs before the arrival of the doctor and prepare: 2% solution of suprastin, 1% solution of diphenhydramine; 2.1% aminophylline; 0.5% strophanthin solution or 0.06% korglucon solution; tongue holder, mouth expander; syringes 10, 20, 5, 2 ml, systems for intravenous infusions; cotton wool, bandage, tourniquet, alcohol 70 degrees.

7. Injuries (fractures)

In case of fractures, first aid consists in ensuring the immobility of the fracture site and delivering the patient to the hospital. In case of injury to the upper limbs, apply a Cramer splint, lower - Dieterichs and fix the limb. In case of spinal injury, splint immobilization is carried out on a shield.

7. Infectious safety of patients, prevention of occupational diseases

The professional activity of nurses is associated with a high risk of infection with infectious diseases, as well as infection of patients in any medical institution. Therefore, the main task of nurses is to prevent infection. Hence the need for active prevention of nosocomial infection.

A hospital-acquired infection is any clinically recognizable disease that affects a patient as a result of his admission to the hospital or seeking treatment, or illness of an employee as a result of his work in this institution, regardless of the time of onset of symptoms of the disease (after or during the stay in the hospital).

Therefore, elementary security measures cannot be neglected:

• protective equipment (gloves, gowns, goggles, respirator mask) when working with disinfectants;
• use of universal precautions when working with biological fluids (gown, mask, gloves, apron).

In order to prevent infection with viral hepatitis, HIV infection, disposable instruments should be used, separate for each patient, after which the instruments are disinfected in accordance with OST 42-21-2-85.

Medical instruments in contact with people's blood must be thoroughly disinfected, then disassembled, washed and rinsed strictly with rubber gloves. Timely clean the surfaces of tables and floors from blood with rags soaked in a 3% solution of chloramine, carefully carry out preliminary and final cleaning of the premises and carry out general cleaning once a week.

Personal hygiene should be strictly observed, since many microorganisms are transmitted through the hands, it follows that hand washing is a serious measure for the prevention of hospital-acquired infection. Frequent use of disinfectants should be avoided when cleaning hands, as they can cause skin irritation and dermatitis, which facilitates the penetration of the pathogen.

Nurses in the treatment room and operating room are suspended from work if they have violations of the integrity of the skin on their hands. During operation, all damage must be covered with a fingertip or adhesive tape. In cases of blood getting on the skin, mucous membranes, injections or cuts, you should use a first-aid kit for the prevention of HIV infection, which contains: 5% iodine solution (storage 1 day after opening); adhesive plaster; potassium manganese solution 0.05% (shelf life 10 days); bandage; cotton wool; tweezers for eyes and nose 4 pcs.

When an injury is received, it must be recorded (documented in a medical institution within 12 hours). Healthcare workers who come into contact with blood are subject to screening for the presence of the Australian antibody at least once a year. Persons with the presence of the Australian antibody are not allowed to work with blood and its preparations. They must observe the rules of personal hygiene aimed at preventing infection of the patient.

8. Statistical indicators of the activities of the department

Table 1

It can be seen from the table that in 2003 the number of dropouts increased, since increased mortality and transfer of patients to other departments (as a result, the number of patients admitted to the department increased). Among the deceased, patients over 70 years of age with severe neurological and somatic pathology predominated.

table 2

Characteristics of the dead by age

Age	40-49	50-59	60-69	70-79	80-89	90-99
As of January 1, 2003	0	0	2	7	7	1
As of January 1, 2004	1	1	4	13	12	0

In the first place (53%) among the causes of death are diseases of the cardiovascular system (chronic cardiovascular insufficiency). In second place (42.5%) are acute cerebrovascular accidents, of which 17% are repeated strokes. In third place are oncological diseases (1.5%), acute cardiovascular insufficiency (1.5%), hereditary neuromuscular diseases (1.5%).

Table 3

Nosological structure

Nosological forms	2002	2003
Cardiac ischemia	24	21
Hypertonic disease	13	16
Bronchial asthma	10	8
Chronical bronchitis	10	8
Diseases of the gastrointestinal tract	17	6
Diabetes	3	3
Rheumatoid arthritis	4	6
Encephalopathy	9	10

Considering the table data on nosological forms, we see that patients with diseases of the cardiovascular system predominate, in 2nd place - the nervous and respiratory systems, in 3rd place - diseases of the gastrointestinal tract, in 4th place - diseases of the endocrine system.

Table 4

This table shows the predominance of intramuscular injections, since a significant percentage of people with exacerbated chronic diseases live in the department and the main types of treatment are anti-inflammatory and restorative therapy.

9. Ethics and deontology of medical workers. Implementation of the articles of the ethical code in the work of nurses

The history of domestic nursing shows how, with the development and improvement of methods of treatment and diagnostics, the role of the work of nurses increases. In this regard, nurses need ethical and deontological knowledge. Therefore, there are general deontological norms that are mandatory for nurses and patients at all stages of the treatment and diagnostic process. Among them is the use in the work of the basic ethical elements of humanity, mercy.

To be merciful means to be able to sympathize, pity and desire to help. The act of kindness in the work of a nurse includes:

• the ability to show delicacy, to say a kind word in time;
• negative attitude to disgust and indifference;
• respect for the feelings of believers;
• the ability to respond to patient requests;
• professionalism in work, because as a result of the poor preparation of the nurse, the patient's mood worsens, the pain in the course of the disease worsens;
• high culture of medical care, and not the formal performance of their duties;
• humble appearance.

According to the code, the responsibility of nurses has 4 main aspects: the promotion of health, the prevention of disease, the restoration of health, and the alleviation of suffering. In addition, these codes will define the responsibility of nurses to society and colleagues. First of all, the code reflected modern ideas about the rights of the patient, which determine the formulas for the moral duty of a nurse. The Code also reflects the features of today's medicine, which are the result of scientific and technological progress in the industry.

According to the Code of Ethics, a nurse is obliged to provide high-quality medical care that meets the principles of humanity and professional standards; she also bears a moral responsibility to the patient.

10. Work to provide "Disaster Medicine"

A catastrophe is an emergency caused by the forces of nature or human activity and accompanied by a massive defeat of people with all the features of pathology, the disabling of medical institutions and the elimination of the consequences of which will require the help of forces and means from outside the disaster areas.

In Russia, the emergence of the term "disaster medicine" appeared with the Decree of the Council of Ministers of the RSFSR Order No. 339 of 04/07/1990 "On the establishment of an emergency service in emergency situations in the country".

An emergency situation is a situation caused by a natural or psychological disaster, in which there is a sharp disproportion between the victims and emergency medical care and its provision with available forces and means.

A catastrophe and an accident can occur in peacetime anywhere. In our area, the source can be enterprises that have explosive potent poisonous substances in their production, fires, hurricanes, frosts, floods, outbreaks of infectious diseases, accidents on the railway, highway.

In our district, the headquarters for emergency assistance is deployed on the basis of the Central District Hospital, which is staffed with: an emergency team of 6 people and transport; specialized toxic-therapeutic team of 6 people and transport.

It is planned to bring the hospital to readiness to receive victims and provide qualified medical care, for which 70 beds have been deployed. Created a group of 9 people. A medical supply group has been completed, a blood transfusion doctor has been approved, a group for the construction of protective structures and logistics has been established, an operational group has been completed, a stock of medical equipment and medicines has been created - a responsible chief nurse. In case of emergencies, we will help the staff of the Central District Hospital to provide assistance to the victims.

I own:

• dressing technique;
• the technique of splinting limbs in case of injuries;
• methods of assisting with: bleeding, burns, frostbite, poisoning, traumatic shock.

11. Sanitary and educational work

Health education is a complex of medical and social measures aimed at promoting a healthy lifestyle.

The tasks of health education are: promotion of a healthy lifestyle, physical culture, rational nutrition, combating bad habits, familiarizing the population with disease prevention.

Health education is an obligatory duty of paramedical workers. One of the main tasks of a nurse is to convince a person to consciously adopt a healthy lifestyle and be a personal example for them.

When working with patients, the main form of sanitary and educational work are: conversations, lectures, posters. Since we have people with different diseases and inclinations, the topics of conversations are varied, such as:

• About the dangers of alcohol and nicotine
• Prevention of SARS and influenza
• Prevention of cardiovascular diseases
• Nutrition in old age
• Motor mode

The following sections are missing

12. Safety and fire safety.

13. Omsk professional nursing association - goals, objectives.

14. Medical insurance.

15. Conclusions and suggestions.

(Document)

Certification work of an anesthetist nurse in the intensive care unit (Document)

Cheat sheet - Collection of clinical tasks for the final state certification in the specialty Nursing with response standards (Crib sheet)

Nursing in Pediatrics (Document)

Myshkina A.K. Nursing: A Handbook (Document)

Cheat sheet - A collection of clinical tasks with illustrations for the final state certification in the specialty Nursing with answer standards (Crib sheet)

Khvoshcheva S.E. The standard of professional activity of a nurse in a therapeutic department of a hospital. part 1 (therapeutic ward nurse) (Document)

Cheat sheet - Tests with answers to the Gos on nursing in therapy, surgery and pediatrics (Crib sheet)

Presentation - Personal qualities of a nurse and her main functions (Abstract)

Report - analysis of the work of the ward nurse of the infectious department for 1 year (Document)

n1.doc

I approve

Commander of the military unit 49529

Lieutenant colonel m / s B. Vdovenko

"___" November 2004

Attestation work

Nurse of the surgical department of the military unit 49529

Specialties Nursing Bezginova Anna Alexandrovna.
Komsomolsk-on-Amur-31

Nursing work report

1. 
   Passport part
2. 
   Material and technical equipment of the place of work
3. 
   Scheme of quantitative indicators for 2003 compared to 2004
4. 
   Normative acts and orders used in the work
5. 
   Conclusions on their work and proposals for the organization

Bezginova Anna Alexandrovna graduated from the Perm State Medical School No. 2 in 1995. From 1997 to the present, she has been working in the military hospital of military unit 52015 as a ward nurse in the surgical department. On the territory of military unit 52015 there is a military hospital, military unit 49529.

The whole complex of medical institutions is conveniently located. The territory of the medical facility is separated from the administrative and residential territory of the town by a fence. It organizes and functionally separates the areas of buildings for infectious and non-infectious patients, administrative and utility buildings, clinics and a landscape gardening area. Distances between buildings and other buildings provide optimal conditions for insolation, illumination and ventilation. Pedestrian and access roads with a hard surface are conveniently arranged to the territory and on the territory of the medical facility. There are separate entrances to the areas of buildings for infectious and non-infectious patients. In front of the main entrance to the medical facility there is a platform for temporary parking of vehicles. To collect garbage and household waste, a platform with a concrete surface, tightly closed containers and a water supply for cleaning and disinfection has been arranged.

All departments and functional subdivisions of health care facilities are equipped with supply and exhaust ventilation, cold and hot water supply systems, sewerage systems, and have centralized water heating. Premises where patients and staff permanently stay for treatment and diagnostic procedures and corridors of ward sections have natural and artificial lighting. As artificial lighting, daylight fluorescent lamps are used, placed on the ceilings and covered with diffusers.

The interior decoration of the premises is made in accordance with their functional purpose. In 2002, a major overhaul of the military hospital was carried out. In October 2003, the hospital was inspected by representatives of the licensing and accreditation commission. The hospital was issued a license from the Ministry of Health of the Khabarovsk Territory, allowing the implementation of medical activities under No. G879472, registration No. 02-3 / 000603 dated 10/14/2003. The license is valid for 5 years.

In October 2000, a medical insurance office was opened in the hospital. The specialists of the cabinet conduct explanatory work among the residents of the garrison about the conditions and procedure for providing free medical care in state and municipal medical and preventive institutions. The staff of the cabinet includes a lawyer - a consultant, a doctor and an economist.

The admission department is located in the main building of the military hospital. It has a separate entrance and access for ambulances. The spacious entrance and wide doors make it convenient to transport the sick and the injured.

The department has:

• 
  examination room (for examining patients who applied to the hospital);
• 
  sanitary checkpoint (for sanitary treatment of patients);
• 
  pantry (for change of clothes, linen, slippers, inventory, stretcher);
• 
  shower room;
• 
  toilet;
• 
  treatment room (for emergency care).

There is a laboratory and an X-ray room next to the reception department.

On the second floor of the main building there is a surgical and therapeutic department. On the basis of the therapeutic department, neurological and children's departments are deployed.

The therapeutic, neurological and children's departments are united by one post, where the employees of the departments provide qualified medical care.

Each department has a treatment room, an intern's room, a functional diagnostics room, a head nurse's office, a place for patients to rest, a bathroom, a manipulation room, patient wards, a disinfection area, toilets and utility rooms. The departments have a large and bright corridor with a hall in which there is a TV, a radio station, comfortable chairs, a small library with medical, journalistic and fiction literature, a living corner. The floors of the corridor are covered with linoleum, the walls are painted with light paint. Throughout the corridor there are fluorescent lamps. The department is equipped with emergency lighting.
II.

In the corridor, in a place convenient for the nurse, there is her post. At the workplace there is a table with a lockable drawer (for storing patient histories, documentation, magazines, forms).

The post is equipped with a sound and light alarm system for communication with seriously ill patients, as well as means of communication. Opposite the post there is a stand with the documentation of the department, where patients can get acquainted with the daily routine, the rules for visiting patients, the evacuation plan in case of fire, the composition of the fire brigade, instructions on safety measures.

The nurse's office has the following documents:

• 
  reference documentation of the nurse on duty;
• 
  VMP training log;
• 
  log of delivery and acceptance of duty;
• 
  a list of patients by ward indicating the regimen and body temperature;
• 
  fire fighting calculation;
• 
  magazine on combat readiness;

• 
  registers of narcotic drugs of group "A" and "B";
• 
  dry-heater work log;
• 
  register of operation of bactericidal lamps;
• 
  work time log med. department staff.

Procedural the office is equipped with everything necessary for the qualified work of a procedural nurse: a couch, a work table, a sterile table, a cabinet for storing medicines, solutions for intravenous infusions; a refrigerator where medicines are stored, an emergency cabinet, an ECG machine, containers for processing medical instruments; dry-heat cabinet bactericidal lamp.
The department has wards for the sick and convalescents. Most of the windows of the wards face the southeast, so the wards are bright and warm. Depending on the profile, there are from 2 to 5 people in the wards. The chambers are spacious, well ventilated, with wide doorways. The walls are painted with light green oil paint, the floors are covered with linoleum. The rooms are equipped with:

• 
  beds with box springs and bedside rugs;
• 
  tables;
• 
  chairs (according to the number of beds);
• 
  bedside tables;
• 
  sinks for washing;
• 
  mirror shelves;
• 
  thermometers (to control the air temperature in the ward);
• 
  an emergency call system for a nurse on duty, general and individual lighting.
  In the wards, twice a day, wet cleaning is carried out with the addition of a disinfectant solution (1% chloramine), airing (at least 4 times a day), quartz treatment for 30-60 minutes.

STRUCTURE OF BEDS

№ p/n	Bed Profile (branches)	Number of branches	Number of deployed beds
1	Therapeutic	1	14
2	neurological	1	3
3	Children's	1	4
4	Surgical	1	15
5	Obstetrics and Gynecology	1	3
6	infectious	1	11

The department has a bathroom with showers. At least once every 7-10 days, if there are no contraindications, patients take a hygienic shower. They change their underwear and bed linen (the collection of dirty linen from the patient is carried out in a sealed labeled container).

The department has a canteen. Proper organization of therapeutic nutrition contributes to the successful treatment of patients. The dining room is provided with cold and hot water, two-section washing baths connected to the sewer, special nets for drying dishes, cabinets for storing cutlery and cutlery, a table with a hygienic coating for serving food, a microwave oven for heating food, tanks for soaking and boiling dishes, washing and disinfectants, a cabinet for cleaning equipment, as well as an elevator for lifting food from the kitchen.

After eating, the dining room is ventilated and wet cleaning is carried out with the addition of disinfectants (1% chloramine solution).
Working as a nurse on duty, I fulfill the requirements of the "Guidelines for the Medical Support of the SA and the Navy", Order No. 64 of 1989, which outlines the functional duties of a nurse. I report to the head of the department and the head nurse, I bear full responsibility for the timely and correct implementation of medical prescriptions, the sanitary and anti-epidemic state, I take care of the sick, control the feeding of the patients.

I start with reception duty:

• 
  I check the quantity and safety of the property of the department (keys, household equipment, documentation and medical records);
• 
  I check the sanitary condition of the wards;
• 
  I check the quantity and availability of medicines according to the list "A" and "B", the safe and the operation of the alarm system;
• 
  I check the sanitary and hygienic condition of severe and bedridden patients, the cleanliness of bed and underwear;
• 
  I check and carry out the preparation of patients going for diagnostic examinations and consultations.

After taking duty, I go to a five-minute session, which takes place daily, where they report on the number and severity of patients, prescribed tests, and consultations.

I begin my duties:

I am present at doctor’s rounds of patients, fixing doctor’s appointments, informing about the condition of patients (BP, T, diuresis) and their compliance with the hospital regimen.

Accompanying patients for consultations with specialists (with i/b.).

I distribute tablets and medicines to patients according to the doctor's prescription.

The drugs are taken 3-4 times a day under the supervision of a nurse individually for each patient.

Tablets from the main label do not come off, but are laid out in a beaker so as not to violate the integrity of the package.

Medicines are poured into individual beakers.

After taking the medicine, the beakers are soaked in a 0.5% solution of chloramine for 1 hour, and then washed with running water and dried.

Beakers are stored in a separate, labeled container.

I accompany patients for diagnostic tests (ECG, ultrasound of internal organs, fluorography, etc.). At the same time, the patient should have a towel, a sheet and a medical history with a referral.
In the treatment room I:

1. I take blood samples for the following tests: RW, HIV, biochemical study.

Blood sampling is carried out in clean, dry test tubes with a thick needle, in an amount of at least 5.0 blood for each analysis.

On the directions I write: department number, full name. patient, diagnosis, year of birth, № and / b, name of the study, number.

2. I do i/m, s/c, i/v injections.

I supervise the distribution and intake of food by patients. When there is no waitress, I get the diets myself, distribute and then process the dishes.

3. I make a portion requirement.

In our department, a greater number of patients eat according to diet No. 15 - a complete diet 4-5 times a day.

Medical nutrition in military institutions is organized in accordance with Pr. MO No. 400 of 2000 and is prepared from products provided for by Norm No. 5 of medical rations;

bread - 500 gr. (400 g - white, 100 g - black)

cereals - 20 g

rice - 30g

Macaroni - 40 g

Meat - 175g. grows. oil - 20g.

Bird - 50g. cow's milk -400g.

Fish - 125g.

Butter-45g.

Sour cream - 30g.

Cottage cheese - 30g.

Tea - 2g.

Cheese - 10g.

Coffee - 1g.

Sugar - 70g.

Potatoes and vegetables - 900g.

Fruits: fresh - 200g.

Dried fruits - 20g.

Juices - 100g. if not,

Jam - 5g. then 300 g of milk

In addition, some underweight patients receive additional nutrition, which is taken at the rate of 0.5 daily rations.
I perform intramuscular administration of antibiotics (gentamicin, lincomycin, cefazolin, ampicillin) after a sensitivity test.

Intradermal test.

Purpose: used for allergy testing.

Equipment: single-use syringe or tuberculin syringe, with a capacity of 1 ml. needle 15 mm long, section 0.4 mm, sterile needle in a package for a drug kit, drug, ethyl alcohol 70%, 3 three sterile balls, a tray, a mask, latex gloves, containers for disinfecting used syringes, needles and cotton balls .

Preparation for the procedure:

Establish a positive relationship with the patient;

Explain to the patient the purpose and course of the procedure, obtain consent, make sure that there are no contraindications for the use of this remedy;

Put on a mask, prepare your hands for work, put on gloves;

Check the suitability of the medicinal product (read the name, dose, expiration date on the package, determine by appearance);

Check doctor's orders

Treat the neck of the ampoule (bottle cap) with a swab moistened with alcohol;

Open the package, collect the syringe;

Draw the required amount of the drug into the syringe;

Change the needle, put a needle for intradermal injection on the syringe cone, leave the syringe at the specified dose, put on the cap;

Put the syringe on a sterile tray.

Performing a procedure

Seat the patient, put the hand with the front surface of the forearm up;

Take the syringe in your right hand with the needle cut up, remove the cap;

Treat the skin in the region of the middle third of the anterior surface of the forearm twice with different tampons;

Pull the skin in place with the fingers of the left hand, insert the cut of the needle into the skin at an angle of 5 0 to the surface of the patient's body;

Fix the needle with the second finger, pressing it against the skin;

Enter the drug;

Remove the needle;

With a cotton ball moistened with alcohol, treat the injection site;

Check for bleeding at the puncture site.

End of procedure:

Explain to the patient that water should not enter the injection site until a reaction is determined;

Disinfect the syringe, needles, cotton balls;

Remove gloves, place in a disinfectant solution;

Wash and dry hands;

Record the completion of the procedure on the assignment sheet.

Test for sensitivity to novocaine:

• 
  inject 0.1 - 0.5% solution of novocaine intravenously on the anterior surface of the forearm.

I read the reaction after 20-30 minutes, if the papule has not changed color, the reaction is considered negative. If the papule is hyperemic, then the reaction is considered weakly positive, and can cause the development of an allergic reaction and further anaphylactic shock.

Help with anaphylactic shock:

• 
  stop the administration of the drug;
• 
  inject 1.0 - 0.1% adrenaline solution s / c into the injection area, lay the patient down, raise his legs, head on his side;
• 
  IV prednisolone 90-120 mg per 15.0-5% glucose solution;
• 
  after 10-15 minutes, repeat the introduction of adrenaline 0.3-0.1% for 5.0 saline intravenously;
• 
  i / m 2.0 -1% solution of diphenhydramine (after normalization of blood pressure);
• 
  if the collapse lasts more than 20-30 minutes, then intravenously inject 5.0–2% norepinephrine solution in 500.0–5% glucose solution under the control of blood pressure;
• 
  oxygen inhalation;
• 
  if there is no breathing - IVL;
• 
  if there is no cardiac activity - ZMS.

In parallel with the events, call the resuscitation team.
Five times a day I submit a summary of the number of patients and their presence in the department, before that a variable composition is built.

I supervise visits of patients by relatives on the days and hours allotted for this.

I check the transfers for the presence of alcohol, drugs and other products and things that are not allowed to be brought to the transfer.

I measure body temperature and record the data in the temperature sheet (temperature is measured twice a day, in the morning and in the evening).

After use, thermometers are soaked in a 0.5% chloramine solution for 1 hour, then washed with water, dried and stored in a dry place.

For seriously ill patients and as prescribed by a doctor, I measure blood pressure and record the result in the medical history. In the evening I start checking the case histories, make a selection of appointments, write out referrals for tests, consultations and examinations of patients.

When preparing patients for an X-ray examination, as prescribed by a doctor, I do a cleansing enema:

Equipment: Esmarch's mug, tip, vaseline, oilcloth, vessel.

Cleansing enema technique.

I pour 1.0-1.5 liters of water at room temperature (20°C) into a mug. With anatomical constipation + 12С, and spastic constipation + 42С. To thin the feces, I add oil. I close the valve on the rubber tube and hang it on the rack, lubricate the tip with petroleum jelly. On the couch, which is covered with oilcloth hanging into the pelvis, I lay the patient on his left side, while one leg is bent and brought to the stomach. I push the buttocks apart, insert the tip into the anus, moving it into the rectum towards the navel, then parallel to the spine to a depth of 8-10 cm. I open the valve a little. After the introduction of water into the intestines, I close the valve and remove the tip. It is necessary to retain water in the intestines for several minutes. I ship quickly.

I warn patients about upcoming studies (analysis of gastric and duodenal sounding, blood biochemistry, ultrasound, etc.) and prepare for them:

During the day I monitor the condition of seriously ill patients: I control blood pressure, pulse, temperature, diuresis, change bed and underwear, prevent the development of bedsores (treatment with camphor alcohol), control the patient's stool.

Also, if the patient cannot urinate on his own, I do bladder catheterization:

Equipment: catheter and tweezers in a sterile tray, 0.02% furacillin solution, 0.1% rivanol solution, sterile glycerin, vaseline oil, cotton balls, tray, urinal.

Technique:

• 
  move the foreskin and expose the head of the penis;
• 
  grab the head between 3 and 4 fingers of the left hand, and 1 and 2 push the opening of the urethra;
• 
  treat the head of the penis with a cotton ball soaked in an antiseptic solution with your right hand;
• 
  lubricate the catheter with vaseline oil;
• 
  grab the catheter from the tray near its tip with tweezers at a distance of 5-6 cm from the side hole;
• 
  insert the end into the opening of the urethra, constantly moving it further;
• 
  when urine appears, lower the outer end into the urinal;
• 
  pull out the catheter.

After using disposable instruments, I disinfect them:

• 
  I soak in a 3% chloramine solution for 1 hour, then rinse under running water and hand it over for disposal.

I accept a patient from the admission department, check the sanitization, introduce the regimen and rules of conduct in the department. I participate in shifting patients from a stretcher to a bed, I walk walkers to bed. I draw up a medical history, file all the sheets, a referral for hospitalization, a temperature sheet. I record data on the height, weight, chest circumference of the patient.

I supervise the cleaning of the department by junior nurses and the quartzization of the wards.

I know how to provide emergency care to patients with:

Cardiac asthma and pulmonary edema;

angina pectoris;

Hypertensive crisis;

Fainting and collapse;

An attack of bronchial asthma;

Convulsive epileptic syndrome

Acute appendicitis;

Hypoglycemic coma;

Bleeding: nasal, gastric;

brain injury;

traumatic shock;

Frostbite;

Electrical injury, etc.

III. Schemes of quantitative indicators for 2003 compared to 2004.

Blood sampling in 2003.

- blood sampling in 2004.

- intravenous injections in 2003.

- intravenous injections in 2004.

I/M, S/C and I/C injections in 2003.

- I/M, S/C and I/C injections in 2004.

250,510,510

67, 310, 310

Feeding seriously ill patients in 2003

Feeding seriously ill patients in 2004

Prevention and treatment of bedsores in 2003

- prevention and treatment of bedsores in 2004

Preparation of antiseptic solutions in 2003

- preparation of antiseptic solutions in 2004

All my work is in stages

Nursing process.
Stage I - nursing examination of the patient. When a patient enters the department, I measure the physical data: height, weight, blood pressure, t, and write it down in the medical history. I examine the patient for the presence of skin defects: rashes, scratching, bruising. I evaluate the ability to move: on my own or with the help of strangers. I evaluate the emotional state, consciousness: conscious, unconscious, coma, stupor, etc. After the initial assessment of the patient's condition and recording the information received, I summarize it, analyze it and draw conclusions that become problems that are the subject of nursing care.
Stage II - diagnosis. First, I determine the patient's state of health, taking into account 14 functional needs: breathing, drinking enough food and fluids, excretion of waste products, movement, sleep and rest, personal hygiene, etc. I identify the real problems of the patient; not being able to take care of themselves, etc. Both the patient himself and I must anticipate the deterioration of health associated with any change in the usual rhythm of life. After evaluating the stage parameters, I provide the patient with full information about actual and potential problems.
Stage III - planning nursing interventions. I acquaint the patient with an assessment of his condition and need for care, listen to the patient's opinion, determine the goals of care for each problem together with the patient. By timing, there are two types of goals: short-term - achieved within one week and long-term - over a long period of time. I then identify the family's opportunities to participate in the nursing process.
Stage IV - implementation of the plan of nursing interventions. I inform the patient about the nursing intervention: injection, blood sampling, etc. Nursing interventions are divided into doctor-prescribed and independent actions that I carry out on my own initiative. I coordinate with the actions of other medical professionals. employees, relatives, taking into account their plans and capabilities.
Stage V - assessment of nursing interventions. I determine the effectiveness of nursing intervention, evaluate changes in the patient's health, take into account the patient's opinion on the implementation of the care plan and its effectiveness. If the patient's health status has improved, physical and emotional parameters have risen to normal levels, then we can assume that the goal has been achieved.
Working as a nurse on duty, I fulfill the requirements of the "Guidelines for the Medical Support of the SA and the Navy", Order No. 64 of 1989, which outlines the functional duties of a nurse. I report to the head of the department and the head nurse, I bear full responsibility for the timely and correct implementation of medical prescriptions, the sanitary and anti-epidemic state, I take care of the sick, control the feeding of patients

VI. Normative acts and orders used in the work.

1. 
   OST-42-21-2-85.

Sterilization and disinfection of medical devices.

The industry standard provides methods, means and modes of disinfection, pre-sterilization cleaning and sterilization.

1. 
   Disinfection.

- 1 container - 0.6% calcium hypochlorite solution. We clean the medically used one by injecting a solution into it.

2 container -0.6% r.r. calcium hypochlorite. Immerse medical instruments for 60 minutes.

Rinse under running water until the smell of the disinfectant disappears.

II. Pre-sterilization cleaning.

Immerse medical instruments in a washing solution for 15 minutes at t 50.

The composition of the washing solution: 3% H2O2 - 200 ml. detergent - 5 g, H2O - 795 ml.

Rinse under running water; distilled water.

Bag of medical products.

III. Sterilization. exposition

1. 
   Steam method:

- pressure 1.1 atm. –t 120 s 45 minutes.

Pressure 2 atm. – t 132 C 20 minutes.

2. Chemical method:

6% H2O2 (hydrogen peroxide) t+18 C 360 minutes.

6% H2O2 t+50 C 180 minutes.

3. Exposure to high temperatures:

Dry oven t 180 C 60 minutes.
Sterilization is carried out by one of the methods. It depends on the quality of the medical device.

To control pre-sterilization cleaning, an azopyram test is performed. It reveals residual traces of blood, rust, chlorine oxides on products.

Azopyram solution can be stored in a refrigerator at t +4 C in a tightly closed vial. The working solution is used within 1-2 hours. 1% of all working tools are being studied. Products must be at room temperature 25 C.

If the staining of the reagent occurs later than 1 minute after the sample was placed, then the reaction is not taken into account. In the presence of rust and chlorine-containing oxides on the studied products, a brownish coloration of the reagent is observed, and in other cases - pinkish-lilac. Sterilization control is carried out with the Vinar indicator.

1. 
   Order No. 720 of the Ministry of Health of the USSR dated 07/31/78.

"On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections."

According to this order, the sanitary and epidemic regime of the department is maintained.

Twice a month, the dressing material and instruments are monitored; take swabs for conditionally pathological microflora from the connecting parts of anesthesia and respiratory equipment. Once a quarter, the department's employees are tested for staphylococcus aureus. Air seeding is carried out once a month.

3. Order No. 330 of the Ministry of Health of the USSR dated 11/12/97.

"On measures to improve the accounting, storage, prescribing and use of narcotic drugs."

The order requires justification for the introduction of narcotic drugs, their introduction in the presence of a doctor, the delivery of empty ampoules, the registration of drug injections in the medical history, and the storage of drugs in safes with built-in alarms.

1. 
   Order No. 408 of the Ministry of Health of the USSR dated 12.07.88.

"On measures to reduce the incidence of viral hepatitis in the country"

The order provides for the use of disposable syringes, IV infusion devices, and personal protective equipment. Regulates the processing of tools; disposal of disposable products. In the event of an injury with skin damage, blood getting on the skin, mucous membranes, use AIDS styling.

5. Order No. 170 of the Ministry of Health of the MP RF dated 16.08.94.

"On measures to improve the prevention and treatment of HIV infection in the Russian Federation".

6. Order No. 295 of the Ministry of Health of the RSFSR dated 10.97.

"On the Enactment of the Rules of Conduct for Mandatory Medical Examination for HIV Infection and the List of Employees of Certain Professions, Organizations Undergoing Mandatory Medical Examination for HIV Infection."

7. Order No. 135 of the Ministry of Health of the RSFSR

"AIDS Prevention"

Every year, the number of HIV-infected people in the world is growing. In this regard, it is necessary to strictly observe all the rules of prevention. All manipulations associated with damage to the integrity of the skin, mucous membranes should be carried out using personal protective equipment. Before work, check the integrity of the skin. In case of injury, use the contents of the anti-AIDS pack.

Laying for personal anti-AIDS prevention:

Alcohol 70% - 50.0

Iodine tincture 5% - 20.0

Sulfacyl sodium 22% - 5.0

Hydrogen peroxide 6% - 10.0

Potassium permanganate 5.0

Distilled water 10.0

Bactericidal plaster

Pipettes - 3 pcs.

gauze balls

Gloves

Observe the rules for processing medical instruments and equipment. Employees of a medical institution are obligatorily examined once a year for HIV - carriage.

The systematic and competent use of these orders allows us to achieve good results in the prevention of nosocomial infections, there is no viral hepatitis in the department, there are no post-infection processes, postoperative complications.

V. Conclusion

I think that the surgical department meets all the necessary requirements. It is timely and fully supplied with the necessary medicines, tools and disinfectants. solutions, as well as gloves, disposable syringes and IV systems. Timely and high-quality measures are taken to prevent the spread of diseases both inside the hospital and outside it.
Surgical ward nurse

A. Bezginova

Head of the surgical department

Lieutenant Colonel A. Marenkov

Medical Unit of the Main Internal Affairs Directorate for the Chelyabinsk Region

CERTIFICATION WORK

for 2009 ward nurse of the 1st therapeutic department of the hospital of Hospital No. 1 Makeeva Maria Fedorovna for confirmation of the highest qualification category in the specialty "Nursing"

Chelyabinsk 2010

Professional route

Characteristics of the institution

Characteristics of the department, workplace

The main sections of the work

Related professions

Emergency conditions

Sanitary and epidemiological regime at the workplace

Hygienic education of the population

Analysis of work for the reporting period

Professional route

I, Makeeva Maria Fedorovna, in 1973 graduated from the Zlatoust Medical School of the Ministry of Railways with a degree in Nurse - diploma No. 778717 dated June 29, 1973, registration No. 736. According to the distribution, she was sent to the Second Road Clinical Hospital of the city of Chelyabinsk, South Ural Railway. Admitted by a nurse in the 3rd surgical department (oncology). According to the principle of interchangeability, she mastered the work of a nurse in a procedural and dressing room. In 1977, she was dismissed of her own free will.

In the Hospital with a polyclinic of the Medical Department of the Internal Affairs Directorate of the Chelyabinsk Regional Executive Committee, she was enrolled as a nurse in the therapeutic department in 1977.

In 1984, she was called up for military service in military unit No. 7438 as a company medical instructor. At the end of the contract in 1988, she was dismissed from the ranks of the Soviet Army.

In 1988, she was accepted as a nurse in the neurological department of the Hospital with a polyclinic of the Medical Department of the Chelyabinsk Regional Executive Committee. In 1990, she passed certification at the medical department of the Internal Affairs Directorate of the Chelyabinsk Regional Executive Committee and by order of the medical department of the Internal Affairs Directorate of the Chelyabinsk Regional Executive Committee, she was awarded the first qualification category, certificate No. 53 of 06/21/1990.

In August 1993, she was appointed to the position of senior nurse of the therapeutic department. On June 20, 1995, the certification commission at the medical subdivision of the Internal Affairs Directorate of the Chelyabinsk region and the order for the medical subdivision of June 22, 1995 No. 34 awarded the highest qualification category of a hospital nurse. In 2000, at the Chelyabinsk Regional Basic School for Advanced Studies of Workers with Secondary Medical and Pharmaceutical Education, she attended a series of lectures under the program "Modern Aspects of Health Management and Economics" - certificate No. 4876 dated November 24, 2000, protocol No. 49 - awarded the highest qualification category in the specialty "Sisterhood". In February 2003 voluntarily transferred to the position of ward nurse of the therapeutic department. In 2005 improved her qualifications at the State Educational Institution of Additional Professional Education "Chelyabinsk Regional Center for Additional Professional Education of Healthcare Professionals" in the cycle of improvement "Nursing in Therapy" - certificate No. 2690/05 dated 10/18/2005. No. 373l.

In 2010 improved her qualifications at the Chelyabinsk State Medical Academy of Roszdrav in the advanced training cycle "Nursing in Therapy" - certificate registration number 1946/122 dated 20.02.2010.

33 years of experience in healthcare.

37 years of nursing experience.

Characteristics of the institution

The medical and sanitary unit of the Central Internal Affairs Directorate for the Chelyabinsk region was organized to provide medical, preventive and diagnostic assistance to employees working in the system of the Ministry of Internal Affairs, in accordance with order No. 895 dated November 8, 2006. "On approval of the regulation on the organization of medical care and sanitary-resort treatment in medical institutions of the system of the Ministry of Internal Affairs of Russia." The medical unit is located in a typical five-story building, three floors of which are occupied by a polyclinic and two floors by a hospital. The polyclinic is designed for 650 visits per day, where medical care is provided by local therapists and narrow specialists: an oculist, a dermatologist, a urologist, a gynecologist, a gynecologist, an ENT specialist, a cardiologist, a psychiatrist, a surgeon, and a neurologist.

The following services have been established in the polyclinic to conduct a diagnostic examination:

X-ray - conducts x-ray and fluoroscopic examinations of the chest, gastrointestinal tract, musculoskeletal system, skull, intravenous urography, irrigoscopy, fluorographic examinations.

Department of functional diagnostics - performs the following examinations: ECG, HM-BP, HM-ECG, ECHO-cardiography, bicycle ergometry, transesophageal electrical stimulation, neurophysiology: EEG, REG; Ultrasound diagnostics of the abdominal organs, pelvic organs, thyroid gland, mammary glands, lumbar spine, ultrasound of blood vessels; Endoscopy room performs EGD of the stomach.

Laboratory department - conducts a full range of clinical, biochemical and bacteriological studies of blood, urine, feces, sputum and other biological media. All laboratories are equipped with appropriate equipment, including modern analyzers and reagents.

Physiotherapy department - carries out treatment with high-frequency currents, inductotherapy, magnetotherapy, UHF, laser therapy, UFO. The department has a massage room, a physiotherapy room, an inhalation room, a massage shower.

Dental service.

Subdivision characteristics

The hospital of the Medical and Sanitary Unit is located on the 4th and 5th floors of the building and is designed for 100 beds: 40 beds in the neurological department and 60 beds in the therapeutic department.

Bed fund of the therapeutic department:

Table No. 1

The staff of the therapeutic department

In the therapeutic department of the hospital there is an office of the head of the department, an office of the chief nurse of the Medical and Sanitary Unit, a treatment room, an intern's room, a manipulation room, where patients are prepared for diagnostic examinations, shower rooms for patients and medical staff, men's and women's toilets, a toilet for staff. There is a lounge with upholstered furniture and a TV for patients to relax. The department deployed two medical posts with the necessary equipment: desktops with a set of documentation: job descriptions of a ward nurse, an algorithm for fulfilling medical appointments, work journals; a medical cabinet for storing medicines in accordance with standard requirements, a cabinet for storing medical supplies, a cabinet for storing disinfectants and containers for disinfection. The treatment room consists of two blocks: the first - for subcutaneous, intramuscular, intradermal and intravenous injections and blood sampling for biochemical and bacteriological analysis; the second - for infusion therapy. There are also cabinets for medicines, a refrigerator for storing thermolabile drugs (vitamins, hormones, chondroprotectors, insulins), a cabinet for storing sterile solutions, a bactericidal irradiator, containers for disinfecting disposable medical items that are to be disposed of (syringes, systems for infusion of infusion solutions ), couches, cleaning equipment. In the treatment room there are syndromic emergency kits and an Anti-AIDS first aid kit.

The main sections of the work

In my work, as a ward nurse, I rely on regulatory documentation, orders of the Ministry of Health of the Russian Federation, resolutions of the Ministry of Health of the Russian Federation, San PiNy. I try to conscientiously and efficiently fulfill my job descriptions, which include:

Caring for and monitoring patients.

Timely and high-quality execution of medical appointments.

Thermometry of patients with a subsequent mark in the medical history.

Observation of hemodynamics: blood pressure, heart rate, respiratory rate.

Compliance with the sanitary and epidemiological regime in the department, wards, department premises.

Sampling of material for laboratory research (preparation of referrals, utensils, conversation with patients about the objectives of the study, about the correct preparation and technique for collecting tests).

Compliance with the medical and protective regime in the department.

Familiarization of newly admitted patients with the internal regulations.

Preparation of patients for X-ray, endoscopic and ultrasound examinations.

Nursing records management:

Journal of the movement of patients in the department,

Journal of one-time medical appointments,

Magazine of consultations of narrow specialists,

Journal of appointments of diagnostic examinations,

Journal of registration of medicinal products subject to subject-quantitative accounting,

shift log,

Drawing up a portion requirement, according to the diet prescribed by the doctor, in accordance with the order of the Ministry of Health of the RSFSR No. 330 of 08/05/2003. "On measures to improve therapeutic nutrition in healthcare facilities of the Russian Federation."

Obtaining the necessary amount of medicines from the head nurse of the department. All medicines are arranged in groups in lockable cabinets. All medicinal products must be in the original industrial packaging, with the label facing outward and have instructions for the use of this drug, according to the orders:

Order No. 377 of November 13, 1996 "On approval of requirements for the organization of storage of various groups of medicines and medical devices."

Order of the Ministry of Health of the RSFSR dated September 17, 1976 No. No. 471 "Memo to a medical worker on the storage of medicines in the departments of medical institutions."

According to the order of the Ministry of Health of the USSR No. 747 of 2.06.1987. "On the approval of the instructions for accounting for medicines, dressings and medical devices in health facilities" and the Ministry of Health of the Chelyabinsk Region letter dated 04.06.2008. No. 01/4183 “On the organization of accounting for medicines and medical supplies”, a strict accounting of medicines subject to subject-quantitative accounting is maintained.

Distribution of medicines. Carried out in accordance with the patient's prescription sheet, which indicates the name of the drug, its dosage, frequency and mode of administration. All appointments are signed by the doctor with the date of appointment and cancellation. At the end of treatment, the appointment sheet is pasted into the patient's medical history. I distribute medicines in strict accordance with the time of appointment and adherence to the regimen (during meals, before or after meals, at night). The patient must take medication only in my presence. I distribute medicines to bedridden patients in the ward. Be sure to warn patients about possible side effects of the drug, body reactions to taking the drug (discoloration of urine, feces), containing iron, carbolene, bismuth. Narcotic drugs, psychotropic and potent drugs of list “A” are given to the patient separately from other medicines in the presence of a nurse. In order to avoid mistakes, before opening the package and ampoule, it is necessary to read the name of the drug, its dosage aloud and check with the doctor's prescription.

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

If the first signs of an infectious disease are found in a patient, I immediately inform the attending physician, isolate the patient and carry out current disinfection in accordance with San PiN 2.1.3.263010 of 08/09/2010. "Sanitary and epidemiological requirements for organizations engaged in medical activities"

Transfer of the shift according to the instructions of the ward nurse: the number of patients on the list indicating the ward, case history number, diet; medical supplies: thermometers, heating pads, beakers; devices: nebulizer, glucometer, tonometer; medical preparations. If there are seriously ill patients in the department, the changeover is carried out at the patient's bedside.

Related professions

During her work, she mastered such related professions as a nurse in a therapeutic, neurological department, emergency room and treatment room. I know the technique of taking material for research:

Clinical (blood, urine, sputum, feces),

Biochemical (blood),

Bacteriological (blood, sputum, urine, feces, swab from the nose and throat).

I know the technique of applying aseptic dressings, warming compresses, using an ice pack, catheterization of the bladder with a soft catheter, setting cleansing, hypertonic, oil and therapeutic enemas. I know the technique of taking an electrocardiogram on a portable electrocardiograph EK1T - 07. I also know the technique of indirect heart massage, artificial lung ventilation. She mastered the technique of blood transfusion and blood substitutes, infusion therapy and injections: subcutaneous, intradermal, intramuscular and intravenous.

Emergency conditions

Diseases of the cardiovascular system, respiratory organs can be complicated by acute severe conditions:

Anaphylactic shock,

acute myocardial infarction,

Hypertensive crisis,

status asthmaticus,

Pulmonary edema.

To provide emergency medical care in the treatment room, there are syndromic sets of medicines and a nurse's action algorithm. All kits are checked in a timely manner and replenished with the necessary drugs.

The technology for providing first aid in emergency conditions is as follows:

Anaphylactic shock

1. Information to suspect anaphylactic shock:

Against the background or immediately after the administration of the drug, serum, insect bite, weakness, dizziness, shortness of breath, a feeling of lack of air, anxiety, a feeling of heat in the whole body appeared,

The skin is pale, cold, moist, breathing is frequent, superficial, systolic pressure is 90 mm Hg. and below. In severe cases, depression of consciousness and breathing.

2. Tactics of a nurse:

Actions	justification
Provide a doctor's call	To determine the further tactics of providing medical care
2. If anaphylactic shock has developed with intravenous administration of the drug, then: 2.2 to give a stable lateral position, remove dentures 2.3 raise the foot end of the bed 2.4 give 100% humidified oxygen 2.5 measure blood pressure and heart rate	Allergen Dose Reduction Asphyxia prevention Improving blood circulation in the brain Reduced hypoxia Condition control
3. When administered intramuscularly: Stop drug administration Put an ice pack on the injection site Provide venous access Repeat standard steps 2.2 to 2.4 for intravenous administration	Slowing down the absorption of the drug

3. Prepare equipment and tools:

Intravenous infusion system, syringes, needles for intramuscular and subcutaneous injections, ventilator, intubation kit, Ambu bag.

Standard set of drugs "Anaphylactic shock".

4. Evaluation of what has been achieved: restoration of consciousness, stabilization of blood pressure, heart rate.

Myocardial infarction (typical pain form)

1. Information to suspect an emergency:

Severe retrosternal pain, often radiating to the left (right) shoulder, forearm, shoulder blades or neck, lower jaw, epigastric region.

Perhaps suffocation, shortness of breath, heart rhythm disturbance.

Taking nitroglycerin does not relieve pain.

Nurse tactics:

3. Prepare equipment and tools:

As prescribed by the doctor: fentanyl, droperidol, promedol.

System for intravenous administration, tourniquet.

Electrocardiograph, defibrillator, heart monitor, Ambu bag.

4. Evaluation of what has been achieved: the patient's condition has not worsened.

Bronchial asthma

1.Information: the patient suffers from bronchial asthma

Choking, shortness of breath, difficulty exhaling, dry whistling rales, audible at a distance, participation in breathing of auxiliary muscles.

Forced position - sitting or standing with support on hands.

2. Nurse tactics:

3. Prepare equipment and tools: intravenous system, syringes, tourniquet, Ambu bag.

4. Evaluation of what has been achieved: reduction of shortness of breath, consolidated sputum discharge, reduction of wheezing in the lungs.

Sanitary and epidemic regime

In my work on the implementation of the sanitary and epidemiological regime in the department, I am guided by the following orders:

Order No. 288 of the Ministry of Health of the USSR dated March 23, 1976. "On the approval of instructions on the sanitary and anti-epidemic regime of hospitals and on the procedure for the implementation by the bodies and institutions of the sanitary and epidemiological service of state supervision of the sanitary condition of health care facilities."

Order No. 720 dated 31.07.1978 Ministry of Health of the USSR "On improving medical care for patients with purulent surgical diseases and improving measures to combat nosocomial infections."

Law of the Russian Federation No. 52 dated March 30, 1997 "On the sanitary and epidemiological well-being of the population."

OST 42-21-2-85 "Sterilization and disinfection of medical devices".

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

San PiN 2.1.7.728-99 of 01/22/1992 "Rules for the collection, storage and disposal of waste from medical institutions."

San PiN 1.1.1058-01 "Organization and implementation of production control over compliance with sanitary rules and the implementation of sanitary and anti-epidemic (preventive) measures."

San PiN 3.5.1378-03 "Sanitary and epidemic requirements for the organization and implementation of disinfection activities."

Order No. 408 dated 12.07.1983 Ministry of Health of the USSR "On measures to reduce the incidence of viral hepatitis in the country".

San PiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities."

After performing the manipulations, all instruments are subject to processing. Disposable medical items are subject to disinfection and disposal, reusable items are processed in 3 stages: disinfection, pre-sterilization cleaning and sterilization in accordance with OST 42.21.2.85. for the use of disinfectants in the department, you must have the following document:

License,

Certificate of state registration,

Certificate,

Methodical instructions.

When disinfecting instruments and treating working surfaces, we use an oxygen-containing 30% Peroximed solution, which is also used for pre-sterilization cleaning, state registration certificate No. 002704 dated 18.01.1996. during repeated bacteriological examination of the treatment room (tank, air inoculation and washings from working surfaces), a negative result was obtained, therefore, disinfection work is based on the use of this disinfectant. Since the microflora has become more stable in the external environment, it is recommended to replace the disinfectant every 6 months. For this purpose, disinfectants such as Clorsept, Javelin are used.

Table number 2

Disinfection modes

At the workplace for the disinfection of medical devices (thermometers, beakers, spatulas, tips) we use a 3% solution of Peroximed. All containers are clearly labeled with the disinfectant, its concentration and date of preparation. I prepare the solutions, guided by the guidelines, using personal protective equipment. For the treatment of hands when performing various manipulations in the department, antiseptics are used - Cutasept and Lizhen.

Infection safety of medical workers

Infectious safety is a system of measures that ensures the protection of health workers from infectious diseases, which includes immunization, the use of protective clothing, compliance with instructions and rules when performing procedures, compliance with the rules of personal prevention, annual medical examination in accordance with order No. 90 of the Ministry of Health of the Russian Federation dated 14.03.1996. "On the procedure for conducting preliminary and periodic examinations of medical workers and medical regulations and admission to work." In the context of the increasing spread of HIV infection among the population, all patients must be considered as potentially infected with HIV and other infections transmitted by blood contact, therefore, when working with blood and other biological fluids, 7 safety rules must be observed:

Wash hands before and after patient contact.

Consider the patient's blood and other body fluids as potentially infectious, so it is necessary to work with gloves.

Immediately after use and disinfection, place the used instrument in special yellow bags - Class B waste. San PiN 2.1.7.728-99 "Rules for the collection, storage and disposal of waste in healthcare facilities."

Use eye protection (glasses, protective screen) and masks to avoid contact of blood and other biological fluids with the skin and mucous membranes of the medical staff.

Treat all linens contaminated with blood as potentially infectious.

Use special waterproof clothing to protect the body from droplets of blood and other body fluids.

Treat all laboratory specimens as potentially infectious material.

In order to prevent infection with HIV infection and viral hepatitis, I am guided by the infection safety rules recommended in the orders:

Order of the Ministry of Health of the Russian Federation No. 170 dated 16.08.1994 "On measures to improve the prevention and treatment of HIV infection in the Russian Federation."

Order of the Ministry of Health of the Russian Federation No. 408 dated 12.07.1989 "On measures to reduce the incidence of viral hepatitis in the country."

Order of the Ministry of Health of the Russian Federation No. 254 dated September 3, 1991. "On the development of disinfection in the country"

Order of the Ministry of Health of the Russian Federation No. 295 dated October 30, 1995 “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”.

Guidelines of the Ministry of Health of the Russian Federation "Organization of measures for the prevention and control of AIDS in the RSFSR" dated 22.08.1990.

San PiN 3.1.958-00 “Prevention of viral hepatitis. General requirements for epidemiological surveillance of viral hepatitis”.

In case of contact with biological fluid on open areas of the skin, it is necessary:

Treat with 70% alcohol

Wash hands with soap and water

Re-treat with 70% alcohol

In case of contact with the mucous membrane of the eyes, it should be:

treat (wash abundantly) with a 0.01% solution of potassium permanganate.

In case of contact with the nasal mucosa:

rinse with 0.05% potassium permanganate solution or 70% alcohol.

For cuts and injections, you must:

Wash gloved hands with soap and running water

Remove gloves

Put on a clean glove on an uninjured hand

Squeeze out the blood from the wound

Wash your hands with soap

Treat the wound with 5% iodine solution. Don't rub!

Table No. 3

The composition of the first-aid kit "Anti-AIDS"

№ p/n	Name	Quantity	Type of packaging	Shelf life	Appointments
1	Alcohol 70% -100 ml.	1	Bottle with tight stopper	Not limited	For rinsing the mouth, throat, skin treatment
2	Potassium permanganate (2 weighings of 0.05 mg.)	3	Pharmacy, penicillin bottle	Indicated on the packaging	To prepare a solution of potassium permanganate to the norm in order to wash the eyes, nose, throat
3	Purified water (distilled)	1			For dilution of potassium permanganate for washing eyes, nose
4	Capacity 2 pcs. (100ml and 500ml)	1			For dilution of potassium permanganate
5	glass rod	1			To stir the solution
6	5% alcohol solution of iodine 10 ml.	1	Factory packaging	Indicated on the packaging	Treatment of damaged skin
7	Scissors	1			For opening vials and other uses
8	Bactericidal adhesive plaster	12	Factory packaging	Indicated on the packaging	Taping the injection site of the cut
9	Sterile gauze tampons or sterile gauze wipes 14*16	32	Laminated packaging	Indicated on the packaging	For leather, gown, gloves, surfaces
10	Eye pipettes	4	Case		For washing eyes (2pcs), nose (2pcs)
11	Beakers medical 30 ml.	2			For a 0.05% solution of potassium permanganate for washing eyes, nose
12	Cup	2			For rinsing the mouth, throat
13	Sterile gloves (pair)	2	Factory packaging	Indicated on the packaging	Instead of damaged

The Anti AIDS first aid kit is located in the treatment room and is always available. Expired medicines are replaced in a timely manner. The algorithm for the action of a health worker in emergency situations during procedures is also in the treatment room. Emergencies, as well as preventive measures taken, are subject to registration in the journal "Emergency situations on contamination with biological fluids". In cases of contamination, the head of the department should be informed and immediately contact the center for the prevention and control of AIDS at Cherkasskaya, 2. During the reporting period, there were no emergencies.

Processing of medical instruments

Processing of medical instruments is carried out in 3 stages:

Processing steps

disinfection pre-sterilization sterilization

treatment

Disinfection- a set of measures aimed at the destruction of pathogenic and opportunistic microorganisms in the external environment in order to interrupt the transmission routes of pathogens of infectious diseases.

Disinfection methods

physical chemical

drying, exposure to high use of disinfectants

temperatures, exposure to steam

With the chemical method of disinfection, the disassembled used instruments are completely immersed in a disinfectant using a drowner for 60 minutes.

Pre-sterilization cleaning this is the removal of protein, fat, medicinal contaminants and residues of disinfectants from medical devices.

Manual pre-sterilization treatment:

Stage 1 - rinsing the instrument under running water for 30 seconds.

Stage 2 - complete immersion of products in a 0.5% washing solution for 15 minutes. at a temperature of 50*

cleaning solution ingredients:

Hydrogen peroxide

Synthetic detergent (Progress, Lotus, Aina, Astra)

Table No. 4

The ratio of components in the cleaning solution

The washing solution can be used during the day, heated up to 6 times, if the solution has not changed color.

Stage 3 - washing each instrument in the same solution for 30 seconds.

Stage 4 - rinsing with running water for 5 minutes.

Stage 5 - rinsing each instrument in distilled water for 30 seconds.

Quality control of pre-sterilization treatment is carried out in accordance with the order of the Ministry of Health of the Russian Federation No. 254 of 09/03/1991. "On the development of disinfection in the country." Control is subjected to 1% of the total number of tools, but not less than 3-5 products of the same name.

Azopyram test - reveals the remains of blood and chlorine-containing oxidizing agents. A working solution consisting of equal proportions of azopyram and a 3% hydrogen peroxide solution is applied to the instrument and the result is evaluated in a minute. The appearance of purple coloration indicates the presence of blood residues on the instrument.

Phenolphthaleic test - allows you to detect detergent residues. A 1% alcohol solution of phenolphthalein is evenly applied to the product. If a pink coloration appears, it means that there are detergent residues on the product. In this case, the entire tool is re-machined. If the test result is negative, the treated material must be sterilized. Pre-sterilization processing of medical instruments in our department is not carried out, because. we work with single-use medical supplies that are disinfected and disposed of in accordance with San PiN 3.1.2313-08 dated 15.01.2008. "Requirements for the disinfection, destruction and disposal of single-use injection syringes."

Sterilization - This is a method that ensures the death of all vegetative and spore forms of pathogenic and non-pathogenic microorganisms.

All instruments in contact with the wound surface, in contact with blood or injectable drugs, as well as diagnostic equipment in contact with the patient's mucosa, are sterilized.

Table No. 5

Sterilization Methods

Sterilization Methods	Sterilization Mode	Sterilization material	t* mode	Type of packaging	Sterilization time
Steam	Autoclave	Textile, glass, corrosion-resistant material	132*	Bix	20 minutes.
Steam	Autoclave	Rubber, polymer products	120*	Bix, kraft package	45 min.
Air	Dry fat cabinet	Medical instruments	180*	open container	60min
Air	Dry fat cabinet	Medical instruments	160*	Open container, kraft bag	min.

Sterilization control:

Visual - at the work of the equipment;

Thermotemporal indicators of sterility.

Temperature control with technical thermometers.

Biological - with the help of biotests.

The chemical method of sterilization is the use of chemicals for the prevention of infectious diseases during endoscopic manipulations. For sterilization of endoscopes, Lysofarmin 3000 8% solution is used at a temperature of 40 *, exposure for 60 minutes, then washed twice with sterile water, dried with a sterile napkin, and the channels are purged. Store endoscopes in a sterile napkin. For sterilization of metal products (burs) and plastics (enema tips), hydrogen peroxide 6% is used.

At a temperature of 18 * - 360 min.,

At a temperature of 50 * - 180 min.

Then they are washed twice with sterile water and stored in a sterile bix lined with a sterile sheet.

Hygienic education of the population

Hygienic education of the population is one of the forms of disease prevention. A healthy lifestyle: giving up bad habits, playing sports improves health, which helps to avoid diseases of the respiratory system, cardiovascular system, and the musculoskeletal system. Compliance with the regime of work, rest and nutrition reduces the risk of exacerbation of diseases of the gastrointestinal tract. Compliance with and implementation of personal hygiene rules prevents infection with infections such as HIV, hepatitis B, C. I work on hygienic education among patients while on duty in the form of conversations.

Table No. 6

Conversation Topics

№ p/n	Topic	Reporting year 2010	Previous year 2009
1	Personal hygiene of patients	80	60
2	Mode of stay in the hospital	100	65
3	FOG and its importance in the prevention of tuberculosis	90	80
4	Healthy lifestyle. Fight bad habits	110	90
5	Prevention of acute intestinal infections	95	80
6	Prevention of HIV infection and viral hepatitis	80	65
7	Risk Factors for Cardiovascular Diseases	40	30
8	Health food	70	64

Analysis of work for the reporting period

Table number 7

№ p/n	Name
1	Made s / c injections	250	202
2	Made in / m injections	800	748
3	Made in/in injections	400	450
4	Performed in / in drip infusions	300	250
5	Distribution of medicines	240	200
6	Thermometry	250	200
7	Setting up a cleansing enema	70	50
8	Measurement of blood pressure, heart rate, respiratory rate	60	50
9	Applying a compress	30	25
10	Preparing for an ultrasound	120	100
11	Preparation for FGDS	80	50
12	Inhalation through a nebulizer	50	40

Indicators of preparing patients for X-ray examinations:

Table No. 8

Conclusions: in the structure of manipulations, the number of intramuscular injections, s / c, intravenous drip infusions increased due to an increase in bed turnover. The number of diagnostic examinations has increased, which makes it possible to detect the disease at an early stage.

The department conducts monthly classes on the following topics:

"Tactics of a nurse in emergency conditions",

"HIV infection",

Sanitary and epidemiological regime in the department.

Tests are held 2 times a year:

Accounting and storage of narcotic drugs,

Sanitary and epidemiological regime according to the orders of the Ministry of Health of the Russian Federation No. 288, No. 408, No. 720, No. 338, OST 42-21-2-85,

First aid in emergency conditions (in the form of testing).

To improve my professional level, I regularly attend nursing conferences, lectures, classes on civil defense, OOI, which are held in the Medical and Sanitary Unit. I apply all the knowledge gained in practice in my work.

conclusions

The peculiarities of the work of a medical worker place high demands not only on theoretical knowledge and professional skills, but also on the moral and ethical character of a nurse, the ability to behave with dignity in a team, to be merciful with patients and polite with their relatives.

Professional knowledge and strict implementation of the orders of the Ministry of Health of the Russian Federation on compliance with the sanitary and epidemiological regime, the rules of asepsis and the technique of performing manipulations can prevent the occurrence of post-injection complications and nosocomial infections. There were no such cases in the department during the past period.

During the reporting period, I mastered the following methods: determining the level of glucose in the blood with a ONE TOUCH VITRA glucometer, conducting inhalations through an OMRON CX nebulizer, using a breathalyzer device to determine the level of alcohol in the blood.

Possession of related professions and the principle of interchangeability of employees ensures a continuous treatment process.

Tasks

Improving the professional level.

Confirm the highest qualification category.

Attend advanced training courses, study new medical literature.

To take part in conducting classes in the department and hospital conferences.

Train new employees on the specifics of working in the department.

Reception department as an independent structural unit of the hospital, the main goals of its organization and the functions it performs. General characteristics and specific features of the work of the children's admissions department, the duties of nurses.

Studying the work of a nurse in the treatment room of the inpatient department of the Republican Dermatovenerological Dispensary. Cabinet equipment, disinfection regimes and the procedure for general cleaning. Basic measures for injections.

Features of the work of a midwife in the postpartum department of an obstetric clinic. Obstetric clinic as a specialized hospital for pregnant women with extragenital pathology. Tasks of the midwife in the postpartum department. Working day in the postpartum ward.

late maturity period. The usefulness of discussing with patients their condition, based not on a pessimistic review of the past, but on a life-affirming experience of the present. Features of medical and social assistance in a boarding school for the elderly and disabled.

Organization of the workplace of the senior nurse of the dispensary department of the regional clinical anti-tuberculosis dispensary. Preventive actions. First aid to the patient, diagnosis and inpatient treatment of open pneumothorax.

The system of infection control and infection safety of patients and medical personnel. Qualitative and quantitative indicators of work for the year, advanced training. Methods, means of hygienic education in the protection of public health.

Brief description of the republican clinical hospital. Working with medical supplies and equipment. Compliance with the sanitary and epidemiological regime in the department. Providing first aid for acute illnesses and accidents.

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General documentation for the treatment room. Functions of a nurse in a treatment room. Regulatory documents regulating the accounting, storage and distribution of medicines of various groups. Sterilization and disinfection of medical devices.

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Maryanovsky boarding house Certification work of a nurse of the mercy department Sotnik of Elena Vladimirovna 2004 Report on the work Contents

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Organization of the work of the department of medical statistics of the Regional TB dispensary, regulatory and accounting documents regulating its activities. Statistical analysis of the main quantitative and qualitative indicators of the work of medical facilities.

Brief description of the workplace. The amount of work performed. System of infection control, infectious safety of patients and medical personnel. Qualitative and quantitative performance indicators for the year.

Reception appointment. Primary documentation, which is filled in the admissions department for incoming patients. Organization of anti-pediculosis measures in the hospital. Measures for the sanitation of the patient. Types of room disinfection.

Characteristics of the regional clinical anti-tuberculosis dispensary. The main points of patient care, disease prevention. Functions of a ward nurse. Documents for the organization of the pharmaceutical order. Basic insurance program.