Introduction
Chapter 1 nurse patient care
Chapter 2. Rights and responsibilities of a junior nurse for patient care
Chapter 3. Deontological aspects of nursing
Chapter 4
4.1. Sanitary and hygienic treatment of patients
4.2. Transportation of patients by junior nurses to the medical departments of the hospital
4.3. Change of hospital linen
4.4. Delivery of the vessel and urinal
4.5. Treatment of bedsores
4.6. Feeding seriously ill patients
Conclusion
List of sources used
Introduction
A decisive role in ensuring proper patient care is assigned to the middle and junior medical staff.
The junior medical staff is directly responsible for maintaining cleanliness in the wards, corridors, places common use and other premises, their regular wet cleaning. Junior medical personnel often deal with very serious patients with severe motor dysfunction, urinary and fecal incontinence, who have to change linen several times a day and carry out sanitary and hygienic treatment, and spoon-feed. Such patients are often a burden to others, and often to themselves. Caring for them requires great patience, tact, compassion.
Junior nurses assist in feeding seriously ill patients, changing their underwear and bed linen, serving, cleaning and washing vessels and urinals, sanitizing, accompanying patients to various examinations, and ensuring delivery of tests to the laboratory.
The purpose of this work: to study the main responsibilities of junior nurses in caring for the sick.
Tasks:
- To study the job responsibilities of junior nurses in the care of patients;
- Consider the rights and responsibilities of junior nurses;
- To study the technology of the main procedures carried out by junior nurses in the performance of their functional duties.
Chapter 1
A person who has a secondary (complete) general education and additional training in the courses of junior nurses in nursing without presenting requirements for work experience or secondary (complete) general education, additional training in junior courses nurses to care for patients and work experience in the profile of at least 2 years.
Appointment to the position of a junior nurse for patient care and dismissal from it is carried out in the established current labor law by order of the head of the health care institution.
The Nurse Nurse reports directly to the Chief Nurse.
The nursing assistant should know:
- laws Russian Federation and other regulatory legal acts regulating the activities of healthcare institutions;
– organizational structure healthcare institutions;
- techniques for conducting simple medical manipulations;
- rules of sanitation and hygiene, patient care;
– the basics of the treatment and diagnostic process, disease prevention, propaganda healthy lifestyle life;
- the main methods and techniques for providing pre-medical medical care;
- ethical standards of behavior when communicating with patients;
- internal rules work schedule;
– rules and norms of labor protection, industrial sanitation, safety and fire protection;
Nursing Assistant Nurse:
- Carries out simple medical manipulations, such as setting cans, mustard plasters and compresses.
- Monitors the cleanliness and order in the premises of the medical institution.
- Assists in the care of patients under the guidance of a nurse.
- Monitors compliance by patients and visitors with the internal regulations of the healthcare facility.
- Participates in the transportation of seriously ill patients.
- Makes a change of bed and underwear.
- Monitors compliance with the rules of the sanitary-hygienic and anti-epidemic regime when using and storing patient care items.
Chapter 2. Rights and responsibilities of a junior nurse for patient care
The nursing assistant has the right to:
- Make proposals to the management of the enterprise on the optimization and improvement of medical and social assistance, including on issues of their work activities.
- Require the management of the institution to assist in the performance of their duties and rights.
- Receive information from the company's specialists necessary for the effective performance of their duties.
- enjoy labor rights in accordance with Labor Code Russian Federation
The nursing assistant is responsible for:
- For the proper and timely performance of the duties assigned to him, provided for in this job description
- For the organization of their work and the qualified execution of orders, orders and instructions from the management of the enterprise.
- To ensure that subordinate employees comply with their duties.
- For non-compliance with internal regulations and safety regulations.
For offenses or omissions committed in the course of therapeutic measures; for errors in the process of carrying out their activities, which entailed serious consequences for the health and life of the patient; as well as for violation labor discipline, legislative and regulatory acts, a junior nurse for patient care may be brought in accordance with applicable law, depending on the severity of the misconduct, to disciplinary, material, administrative and criminal liability.
Chapter 3. Deontological aspects of nursing
Any specialty is characterized by the existence of its own specific ethical standards, rules of conduct. In this regard, medical deontology (from the Greek deon, deontos - duty, due; logos - teaching) is the science of the professional duty of medical workers. Close in meaning and concept medical ethics, sciences about moral aspects of medicine.
The deontological aspects of nursing are now becoming increasingly important. Unfortunately, callousness, rudeness, irritability, indifference, selfish motives have become common phenomena in the work of medical personnel.
Of no small importance is the decline in the prestige of the work of paramedical workers. Over the past 20 years, the category of junior medical personnel has practically disappeared in our country.
All this made the task of improving the care of the elderly, the seriously ill, the disabled, as well as raising the prestige of the profession of junior nurse and nurse, extremely urgent.
The range of problems that medical deontology deals with is extremely diverse. These are various questions concerning the relationship between the doctor and the patient, the doctor and the patient's relatives, medical workers among themselves. Many areas of medicine have, in addition, their own deontological features. Certain deontological problems arise in connection with the wider introduction of the results of scientific and technological progress in medicine.
Such human qualities as sensitivity, responsiveness, kindness, cordiality, care, attention are required from medical workers hourly in daily work and in caring for patients. Junior nurses often deal with very serious patients with severe motor dysfunctions, urinary and fecal incontinence, who have to change linen several times a day and carry out sanitary and hygienic treatment, spoon-feed. Such patients are often a burden to others, and often to themselves. Caring for them requires great patience, tact, compassion.
Deontological principles also determine certain requirements for appearance junior medical staff caring for patients. At work, it is necessary to use removable shoes, the dressing gown must be immaculately clean and ironed, the nails should be cut very short, it is recommended that the hair be neatly tucked under a cap or scarf. A stale bathrobe, street shoes, dirty hands, poorly trimmed nails are unacceptable from the point of view of sanitation and hygiene and, moreover, make a depressing impression. It is necessary to use cosmetics and perfumes very carefully and moderately, since in patients with allergies they can cause a deterioration in the condition - provoke an attack bronchial asthma, hives.
Care also implies certain rules for communicating with patients. It should be borne in mind that sick people often become excitable, irritable, quick-tempered, capricious, and sometimes, on the contrary, depressed, indifferent. When caring for them, it is important to show maximum attention, reassure, explain the need to comply with the regimen, regular intake medicines, to convince of the possibility of recovery or improvement of the condition.
Great care must be taken when talking with patients suffering from cancer, who are not usually informed of the true diagnosis, especially in cases of poor prognosis. Such patients often suspect that they have a malignant tumor and strive in every possible way to confirm their assumptions. Therefore, it is necessary to carefully monitor that the examination data indicating the diagnosis of the tumor and the medical history do not fall into the hands of patients. For the same reasons, the results of the examination of patients should not be reported by telephone.
The deontological aspects of patient care can also include the need for strict preservation of medical secrecy. Medical workers can sometimes become aware of information about the patient that is deeply personal, intimate in nature, which they do not have the right to disclose. This requirement in no way applies to those situations where, in the process of monitoring the patient, circumstances are revealed that may pose a danger to other people (information about infectious and venereal diseases, poisoning, etc.). In such cases, health workers, on the contrary, are obliged to immediately report the information received to the appropriate organizations.
Chapter 4
4.1. Sanitary and hygienic treatment of patients
Junior nurses are involved in the sanitization of patients. Sanitary and hygienic treatment is carried out in the sanitary inspection room of the admission department.
The sanitary checkpoint of the admission department usually consists of an examination room, a dressing room, a bath-shower room and a room where patients dress.
In the examination room, the patient is undressed, examined for pediculosis and prepared for sanitary and hygienic treatment.
If the linen is clean, it is put in a bag, and outerwear is hung on a coat hanger and handed over to the storage room. The list of things (admission receipt) is made up in two copies: one is handed over with things to the storage room, the other is glued to the medical history and, upon discharge, they receive things for the patient. Existing valuables and money on receipt are handed over to the senior nurse to store them in a safe.
If the patient is found infection, linen is placed in a tank with bleach or chloramine B for 2 hours and sent to a special laundry. If the linen is lice-ridden, it is pre-treated with a disinfectant solution and sent to the disinfection chamber for special treatment. On bags with such clothes there should be an appropriate inscription - "Pediculosis".
Stages of sanitary and hygienic treatment of patients.
- Examination of the skin and hair of the patient.
- Haircut, nails, shaving (if necessary).
- Washing in the shower or hygienic bath.
Examination of the skin and hair of the patient
Signs of pediculosis:
- the presence of nits (lice eggs, which are glued by the female to the hair or villi of the fabric; Fig. 2-2) and the insects themselves;
- itching of the skin;
- traces of scratching and impetiginous (pustular) crusts on the skin.
In case of detection of pediculosis, a special sanitary and hygienic treatment of the patient is carried out; the nurse makes an entry in the "Pediculosis Examination Log" and puts on title page history of the disease with a special mark (“P”), and also reports the detected pediculosis to the sanitary and epidemiological service. You can carry out partial or complete sanitary and hygienic treatment. Partial sanitary and hygienic treatment consists in washing the patient with soap and a washcloth in a bath or shower, disinfecting and disinsection of his clothes and shoes. Full sanitary and hygienic treatment means the treatment of bedding and living quarters.
All data on the processing of the incoming patient must be recorded in the medical history so that the ward nurse can re-process after 5-7 days.
Stages of sanitary and hygienic processing:
1) pest control (lat. des- a prefix denoting destruction, insectum- insect; destruction of arthropods that act as carriers of pathogens of infectious diseases);
2) hygienic bath (shower, rubdown);
3) cutting hair and nails;
4) dressing the patient in clean linen.
There are several types of disinfectant solutions. 20% benzyl benzoate emulsion solution. Special shampoos (for example, "Elco-insect"). Special lotions (for example, Nittifor).
The order of the procedure.
- Prepare for sanitization: lay out the necessary equipment and put on protective clothing.
- Lay an oilcloth on a stool (couch), seat the patient on it and cover his shoulders with a plastic diaper.
- If necessary, cut the hair over the prepared basin.
- Treat the hair with a disinfectant solution, tie the head with a plastic scarf and a towel on top, leaving it for a certain time indicated in the instructions.
- Untie the head and rinse with warm running water, then shampoo.
- Dry the hair with a towel and treat the hair with a heated 6% solution of acetic acid.
- Re-tie the head with a plastic scarf and top with a towel, leaving for 20 minutes.
- Untie the head and rinse with warm running water, dry with a towel.
- Tilt the patient's head over the white paper and carefully comb out the strands of hair with a fine comb, then re-examine the patient's hair.
- Burn the cut hair and paper in the basin.
- Put the patient's clothes and the nurse's protective clothes in an oilcloth bag and send them to the disinfection chamber. Treat the comb and scissors with 70% alcohol, the room with a disinfectant solution.
The use of disinfectant solutions is contraindicated during pregnancy, in women in labor and breastfeeding, children under 5 years of age, as well as in diseases of the scalp.
The procedure for disinsection in the presence of contraindications to the use of disinsecticidal solutions.
1. Prepare for sanitization: lay out the necessary equipment and put on protective clothing.
2. Lay an oilcloth on a stool (couch), seat the patient on it and cover his shoulders with a plastic diaper, if necessary, cut his hair over the prepared basin
3. Treat the hair (not the scalp) with a heated 6% vinegar solution, mechanically removing and destroying the lice.
4. Tie the head with a plastic scarf and top with a towel, leaving for 20 minutes.
5. Untie the head and rinse with warm running water, then shampoo, dry with a towel.
6. Tilt the patient's head over the white paper and carefully comb out the strands of hair with a fine comb, then re-examine the patient's hair.
7. Burn the cut hair and paper in the basin.
8. Put the patient's clothes and the nurse's protective clothes into an oilcloth bag and send them to the disinfection chamber. Treat the comb and scissors with alcohol (70%), the room with a disinfectant solution.
Haircut, nails, shaving
Haircut
Required equipment.
- Scissors, hair clipper.
- Basin for burning hair, matches.
- Alcohol (70%).
The order of the procedure.
1. Prepare for sanitary and hygienic treatment: lay out the necessary equipment.
2. Lay an oilcloth on a stool (couch), seat the patient on it and cover his shoulders with a plastic diaper.
3. Remove the hair with a hair clipper, in case of a skin disease of the scalp - cut the hair over the prepared basin
4. Burn your hair.
5. Treat scissors, razor with alcohol.
Shaving
Required equipment:
- Rubber gloves.
- Razor, brush and shaving cream.
- Napkin, towel, water container.
The order of the procedure.
one . Prepare for sanitary and hygienic treatment: lay out the necessary equipment, put on gloves.
2. Heat water (up to 40-45 ° C), soak a napkin in it, wring it out and cover the patient's face.
3. Remove the napkin, apply shaving cream with a brush.
4. Shave the patient, pulling the skin with the other hand in the opposite direction relative to the movement of the razor.
5. Wipe your face with a damp, then dry cloth.
6. Treat the razor with alcohol.
7. Remove gloves, wash hands
Nail cutting
Required equipment.
- Rubber gloves.
- Scissors and nail clippers.
- Warm water, liquid soap, hand and foot cream, alcohol (70%).
- Basin and tray for water, towels.
1. Prepare for sanitary and hygienic treatment: lay out the necessary equipment, heat water, put on gloves.
2. Add liquid soap to the tray with warm water and dip the patient's hands into it for 2–3 minutes (alternately as the nails are trimmed).
3. Alternately removing the patient's fingers from the water, wipe them and carefully trim the nails.
4. Treat the patient's hands with cream.
5. Add liquid soap to a basin with warm water and lower the patient's feet into it for 2-3 minutes (alternately as the nails are trimmed).
6. Put the foot on a towel (alternately as the nails are trimmed), wipe it off and cut the nails with special tweezers.
7. Treat the feet with cream.
8. Disinfect scissors and tweezers with alcohol.
9. Remove gloves, wash hands.
4.2. Transportation of patients by junior nurses to the medical departments of the hospital
Transportation - transportation and carrying of patients to the place of medical care and treatment.
The method of transporting the patient from the emergency room to the department is determined by the doctor conducting the examination.
Vehicles (wheelchairs, stretchers) are provided with sheets and blankets. The latter must be changed after each use. Patients who move on their own, from the admission department come to the ward, accompanied by junior medical staff (junior nurse, nurses or orderlies).
Patients who cannot move around are transported to the ward on a stretcher or in a wheelchair.
Transporting a patient on a stretcher manually
The patient should be carried on a stretcher without haste and shaking, moving out of step.
Down the stairs, the patient should be carried with his feet forward, and the foot end of the stretcher should be raised, and the head end should be slightly lowered. . At the same time, the person walking behind holds the handles of the stretcher on his arms straightened at the elbows, and the person walking in front - on his shoulders.
Up the stairs, the patient should be carried head first, also in a horizontal position. . At the same time, the one walking in front holds the handles of the stretcher on his arms straightened at the elbows, the one walking behind - on his shoulders.
Transferring a patient from a stretcher (wheelchair) to a bed
Translation order.
- Place the head end of the stretcher (wheelchair) perpendicular to the foot end of the bed. If the room area is small, place the stretcher parallel to the bed.
- Bring hands under the patient: one nurse brings her hands under the head and shoulder blades of the patient, the second - under the pelvis and upper thighs, the third - under the middle of the thighs and lower leg. If transportation is carried out by two orderlies, one of them brings his hands under the neck and shoulder blades of the patient, the second - under the lower back and knees.
- At the same time, with coordinated movements, lift the patient, turn with him 90 ° (if the stretcher is placed in parallel - 180 °) towards the bed and lay the patient on it.
- When the stretcher is located close to the bed, hold the stretcher at the level of the bed, together (three of us) pull the patient up to the edge of the stretcher on the sheet, slightly lift it up and transfer the patient to the bed.
Transferring the patient from bed to stretcher
Translation order.
- Position the stretcher perpendicular to the bed so that its head end is at the foot end of the bed.
- Bring hands under the patient: one orderly brings his hands under the head and shoulder blades of the patient, the second - under the pelvis and upper thighs, the third - under the middle of the thighs and lower leg. If transportation is carried out by two orderlies, one of them brings his hands under the neck of the patient's shoulder blades, the second - under the lower back and knees.
- At the same time, with coordinated movements, lift the patient, turn 90 ° together with him towards the stretcher and lay the patient on them.
The method of transporting and placing the patient on a stretcher depends on the nature and localization of the disease.
Features of transportation of patients
Moving the patient in bed
Moving the patient in bed is carried out in stages.
Stage 1. Assess the patient's ability to participate in the procedure, namely: his mobility, muscle strength, adequate response to words.
Stage 2 . Raise the bed to the most comfortable height for working with the patient.
Stage 3. Remove pillows and other objects from the bed that interfere with the movement of the patient.
Stage 4. If necessary, enlist the help of a nurse, a doctor.
Stage 5 Explain to the patient the meaning of the procedure in order to calm him down and encourage him to cooperate.
Stage 6 Give the bed a horizontal position, fix the wheels.
Stage 7. Wear gloves to reduce the risk of infection.
Stage 8. After moving the patient, lower the bed, raise the handrails to ensure patient safety.
Stage 9 Check the correct position of the patient's body. The back should be straightened, any curvature, tension are excluded. Find out if the patient is comfortable.
Moving helpless patient in bed
- Turn the patient on his back, check the correct position of the body.
- Lower the head of the bed to a horizontal position.
- Put a pillow at the head of the bed so that the patient does not hit his head on the headboard.
- Stand facing the foot of the bed at an angle of 45 0 and move the patient's legs diagonally to the head of the bed.
- The procedure begins with the movement of the legs, because. they are lighter than other parts of the body and easier to move.
- Move along the patient's thighs.
- Bend the legs at the hips and knees so that the arms are at the level of the patient's torso.
- Move the patient's hips diagonally to the headboard.
- Move along the patient's torso parallel to the upper part of his body.
- Put the hand closest to the headboard under the patient's shoulder, clasping his shoulder from below. The shoulder must be simultaneously supported by the hand.
- Place your other hand under your upper back. The head and neck support maintains proper alignment of the patient's body and prevents injury, while the torso support reduces friction.
- Move the torso, shoulders, head and neck of the patient diagonally towards the head.
- Raise the side rail of the bed to prevent the patient from falling off the bed and move to the other side of the bed.
- Moving from one side of the bed to the other, repeat the procedure until the patient's body reaches the desired height.
- Move the patient to the middle of the bed, in the same way manipulating the three parts of his body in turn, until the goal is achieved.
- Raise the side rails for patient safety.
- Remove gloves, wash hands.
4.3. Change of hospital linen
Hospital linen includes sheets, pillowcases, duvet covers, diapers, shirts, scarves, gowns, pajamas, etc.
Clean linen is stored in the linen located in the department, on shelves painted with oil paint and covered with medical oilcloth. Shelves for clean linen are regularly treated with disinfectant.
Dirty linen is stored in a special room in oilcloth labeled bags.
All linen must be labeled and stamped.
The junior nurse carries out a regular change of linen and timely sending of dirty linen to the laundry.
Once every 7-10 days, a bathing day is held with a change of linen, but if there are seriously ill patients with involuntary urination or defecation in the department, then the change of linen is carried out as it gets dirty.
Due to the fact that the patient spends most of the time in bed, it is important that it is comfortable and tidy, the mesh is well stretched, with a flat surface. A mattress without bumps and depressions is placed on top of the mesh. Depending on the season, flannelette or woolen blankets are used. Bed linen must be clean. Sheets should not have scars and seams, and pillowcases - knots and fasteners on the side facing the patient. At the same time with bed linen the patient receives 2 towels.
The bed of patients with involuntary urination and fecal secretions should have special adaptations. Most often they use a lining rubber vessel, and the mattress is sheathed with oilcloth. Bed linen for such patients is changed more often than usual, as it gets dirty.
If a sick woman has abundant discharge from the genitals, then to keep the bed clean, an oilcloth is placed under the patient and a small sheet is placed on top, which is changed at least 2 times a day, and if necessary more often, a pad is placed between the thighs, which is changed as needed. pollution.
The bed of the patient must be regularly remade - in the morning, before daytime rest and at night. The junior nurse shakes the crumbs off the sheet, straightens it, fluffs the pillows. The patient at this time can be put on a chair. If the patient cannot get up, then shift him together to the edge of the bed, then, straightening the mattress and sheet on the freed half, remove the crumbs from them and shift the patient to the cleaned half of the bed. Do the same on the other side.
Changing bed sheets for seriously ill patients requires a certain skill from the staff. If the patient is allowed to turn on his side, first, carefully raising his head, remove the pillows from under it. Then help him roll over on his side, facing the edge of the bed. On the vacated half of the bed, located behind the patient's back, they roll up a dirty sheet so that it lies in the form of a roller along his back. A clean, also half-rolled sheet is placed in the vacated place. Then the patient is helped to lie on his back and turn on the other side. After that, he will be lying on a clean sheet facing the opposite edge of the bed. Then the dirty sheet is removed and the clean sheet is straightened.
If the patient cannot make active movements, the sheet can be changed in another way. Starting from the head end of the bed, roll up a dirty sheet, lifting the patient's head and upper body. In place of a dirty sheet, they put a clean one rolled up in the transverse direction and straighten it in the vacant place. Then a pillow is placed on a clean sheet and the patient's head is lowered on it. Further, raising the patient's pelvis, the dirty sheet is shifted to the foot end of the bed, and a clean one is straightened in its place. After that, it remains to remove the dirty sheet.
The shirts of a seriously ill patient are changed as follows: having slightly raised the upper part of the body, they collect the shirt from the back to the neck. Raising the hands of the patient, they remove the shirt over the head, and then release the hands from the sleeves. If one arm of the patient is damaged, then the sleeve is removed first from the healthy arm, and then from the patient. They put on a clean one in the reverse order: first, starting with a sore arm, put on the sleeves, and then put on a shirt over the head and straighten it along the back.
4.4. Delivery of the vessel and urinal.
The vessel is one of the most necessary items of care for the seriously ill. Patients who are on strict bed rest, during the act of defecation, it is necessary to submit a vessel, and for men, when urinating, a urinal.
Vessels are made of faience, enameled metal, rubber, and various plastics. Vessels come in a variety of shapes with a large round opening at the top and a relatively small opening in a tube extending from one side of the vessel. The large opening is provided with a lid at the top. A clean vessel is stored in the toilet room, in a specially designated closet or under the patient's bed on a stand.
If the patient has a need to empty the intestines, it should, first of all, be fenced off from other patients with a screen. Before use, the vessel is rinsed with warm water and a little water is left in it. An oilcloth with a diaper is laid under the patient at an angle, throwing back the blanket, the patient is asked to bend his knees and help him, bringing his left hand under the sacrum, to raise the pelvis. Holding the open vessel by the tube with the right hand, bring it under the buttocks so that the perineum is above the large hole, and the tube is between the thighs towards the knees. Covering the patient with a blanket, leave the patient alone for a while. Then the vessel is taken out from under the patient, covered with a lid and taken to the restroom, where it is freed from the contents, thoroughly washed with a brush, disinfected, rinsed and put in place. The patient after the act of defecation must be washed.
The rubber vessel is often served to debilitated patients or patients with urinary or fecal incontinence to prevent the formation of bedsores. With a long-term setting of the vessel, it must be wrapped in a diaper or put on a cover (so that there is no skin irritation from contact with rubber). The rubber vessel is not tightly inflated using a foot pump. It is disinfected in the same way as an enamelled vessel. To eliminate the smell, the rubber vessel is rinsed with a weak solution of potassium permanganate.
Patients who are on strict bed rest are forced to urinate in bed. For this, there are special vessels - urinals. They are made of glass, plastic or metal and have an oval shape with a hole extended into a short tube. The shape of the tube - the openings of the female and male urinals are somewhat different. Women often use not a urinal, but a vessel. Urine bags, as well as vessels, must be individual. Serve them clean and warm, immediately free from urine. Disinfection of urinals is carried out in the same way as the vessel. Since urine is often a sediment that adheres to the walls in the form of plaque and emits an unpleasant ammonia smell, from time to time the urinals must be washed with a weak solution of hydrochloric acid, followed by rinsing with running water.
4.5. Treatment of bedsores.
Pressure sores are dystrophic ulcerative-necrotic processes that occur in debilitated patients who have been in bed for a long time. Most often, bedsores are formed in the area of the shoulder blades, the sacrum, the greater trochanter, on the elbows, the occipital region, the back surface of the heels.
The formation of bedsores is facilitated by poor skin care, uncomfortable bedding, and rare bedding. One of the first signs of bedsores is pale skin and wrinkling, followed by redness, swelling and flaking of the epidermis. Then blisters and skin necrosis appear. Attachment of infection can lead to sepsis and be the cause of death.
Prevention of bedsores:
- turn the patient on his side several times a day, if his condition allows (change the position of the patient);
- daily several times a day shake off the sheet so that there are no crumbs in the bed;
- make sure that there are no folds and patches on bedding and underwear;
- for seriously ill patients who are in bed for a long time, put an inflatable rubber circle on which a pillowcase is put on, so that the sacrum is above the opening of the circle;
- daily wipe the skin with a disinfectant solution: camphor alcohol, vodka, cologne, and in their absence, wipe the skin with a towel moistened with warm and soapy water and wipe dry, slightly rubbing the skin.
For wiping, the end of a clean towel is moistened with a disinfectant solution, squeezed lightly and wiped over the neck, behind the ears, back, buttocks, front of the chest and armpits. Special attention should be addressed to the folds under the mammary glands, where diaper rash can form in obese women. Then the skin is wiped dry in the same order.
These procedures are performed by junior nurses daily at night for patients who cannot take a weekly hygienic bath, as well as for patients who are in an unconscious state. Thus, at proper care the patient's skin should always be dry and clean.
4.6. Feeding seriously ill patients
Caring for seriously ill patients requires great patience, skill and mercy from the junior nurse. Such patients are very vulnerable, often capricious in their desires, impatient. All these changes do not depend on the patient himself, but are associated with the influence of the disease on the patient's psyche, his behavior. It is necessary to regard this as a symptom of a serious illness. For a sick person, food and drink are of particular importance, often determining either recovery or progression of the disease. Malnutrition several times increases the risk of developing bedsores, slows down recovery, and contributes to the progression of the underlying disease.
Before you start feeding, you need to do all the medical procedures, to carry out the physiological administration of the patient. After that, it is necessary to ventilate the ward and help the patient wash their hands. A nurse can help with this nurse. It is best, if the condition allows, to give the patient a semi-sitting position or raise the head. If this cannot be done, then it is necessary to turn the patient's head to one side. A great help in feeding a seriously ill patient is a functional bed, equipped with a special bedside table. If there is none, then instead of a table, you can use a nightstand. Cover the patient's chest with a napkin, if necessary. put on an oilcloth. Food should be semi-liquid and warm.
Conclusion
Every doctor is well aware of the importance of junior nurses in the care of patients.
Nursing Assistant Nurse
The duties of a junior nurse include:
- Regular wet cleaning of premises: wards, corridors, common areas, etc.
- Assistance to the nurse in caring for the sick: changing linen, feeding the seriously ill, hygienic provision of physiological supplies for the seriously ill - supplying, cleaning and washing vessels and urinals, etc.
- Sanitary and hygienic treatment of patients.
- Accompanying patients for diagnostic and therapeutic procedures.
- Transportation of patients. helps the ward nurse in caring for the sick, carries out a change of linen, ensures that the patients themselves and the hospital premises are kept clean and tidy, participates in the transportation of patients, and monitors patients' compliance with the hospital regime.
Junior nurses often deal with very serious patients with severe motor dysfunctions, urinary and fecal incontinence, who have to change linen several times a day and carry out sanitary and hygienic treatment, spoon-feed.
Caring for them requires great patience, tact, compassion.
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- Guidelines for paramedical workers / Ed. Yu.P. Nikitina, V.M. Chernyshev. – M.: GEOTAR-Media, 2007.
- Nursing Handbook. - M .: Eksmo Publishing House, 2006.
- Khetagurova A.K. "Problems of ethics and deontology in the work of a nurse" Supplement to the journal "Nursing" No. 1, 2008.
Qualification requirements. Secondary (complete) general education without presenting requirements for work experience.
General provisions:
Nursing assistant refers to junior medical staff.
A person who, depending on the pay category, has: - secondary (complete) general education and additional training in courses for junior nurses in nursing without presenting requirements for work experience;
Secondary (complete) general education, additional training in nursing courses for junior nurses and at least 2 years of work experience in the profile.
The junior nurse for patient care is appointed and dismissed by the chief physician (head of the medical institution).
Must know:
Techniques for conducting simple medical manipulations;
Rules of sanitation and hygiene, patient care;
Internal labor regulations;
Rules and norms of labor protection, safety measures, and fire protection;
Ethical standards of behavior when dealing with patients.
In her activities, the junior nurse for patient care is guided by the internal labor regulations, orders of the head, medical institution, this job description and reports directly to the head of the unit.
Patient Care Responsibilities:
Provides assistance in caring for patients under the guidance of a nurse;
Carries out simple medical manipulations (setting cans, mustard plasters, compresses);
Ensures cleanliness of patients, premises;
Monitors the proper use and storage of patient care items;
Makes a change of bed and underwear;
Participates in the transportation of seriously ill patients;
Monitors compliance by patients and visitors with the internal regulations of the healthcare facility.
Has the right to:
Submit proposals on issues related to their activities for consideration by their direct management;
Receive from the specialists of the institution the information necessary for the implementation of their activities;
Require the management of the institution to assist in the performance of their duties.
Responsible:
For improper performance or non-performance of their official duties provided for by this job description, to the extent determined by the labor legislation of the Russian Federation.
For offenses committed in the course of carrying out their activities - within the limits determined by the administrative, criminal and civil legislation of the Russian Federation.
For causing material damage- within the limits determined by the current legislation of the Russian Federation.
Job description of a nurse.
Job responsibilities:
Provides pre-hospital medical care, collects biological materials for laboratory research;
Provides patient care in medical organization and at home;
Performs sterilization of medical instruments, dressings and patient care items;
Assists in the doctor's treatment and diagnostic manipulations and minor operations on an outpatient and inpatient basis;
Prepares patients for various types of examinations, procedures, operations, for outpatient doctor's appointments;
Ensures the fulfillment of medical appointments;
Accounting, storage, use medicines and ethyl alcohol;
Maintains personal records, information (computer) database of the health status of the population served;
Supervises the activities of junior medical staff. Maintains medical records;
Carries out sanitary and educational work among patients and their relatives on health promotion and disease prevention, promotion of a healthy lifestyle;
Collects and disposes of medical waste;
Carries out measures to comply with the sanitary and hygienic regime, aseptic and antiseptic rules, sterilization conditions for instruments and materials, prevention of post-injection complications, hepatitis, HIV infection.
Must know:
Laws and other regulatory legal acts of the Russian Federation in the field of healthcare; theoretical basis nursing;
Fundamentals of the treatment and diagnostic process, disease prevention, promotion of a healthy lifestyle;
Rules for the operation of medical instruments and equipment;
Statistical indicators characterizing the state of health of the population and the activities of medical organizations;
Rules for the collection, storage and disposal of waste from medical organizations;
Fundamentals of the functioning of budget-insurance medicine and voluntary medical insurance;
Fundamentals of valeology and sanology;
Fundamentals of dietetics;
Fundamentals of clinical examination, social significance of diseases;
Fundamentals of disaster medicine;
Rules for maintaining accounting and reporting documentation of a structural unit, the main types of medical documentation;
medical ethics; psychology of professional communication;
Basics of labor legislation; internal labor regulations;
Rules on labor protection and fire safety.
Indispensable in medical institution The employee is a junior nurse. She has a huge responsibility. This employee takes care of the sick, takes care of them. What exactly is the job of a nurse? What does the junior nurse do? What manipulations can a junior nurse perform? How to get this position? We'll tell you in the article.
Responsibilities of a Junior Nurse
The job of a nurse is to help and care for patients. But this wording is too general. Let's try to clarify: what exactly is the junior nurse obliged to do? The answer to this question is contained in her job description.
Accounting for all medical staff can be kept remotely directly from a smartphone. Set the schedule, salaries, all necessary documentation in Clinic Online.
Functional duties of a junior nurse:
- Perform simple medical manipulations;
- Help patients to maintain hygiene, wash their hands, wash their faces, etc.;
- Keep the premises clean;
- Store the tools necessary for work in suitable conditions;
- Change bed;
- Collect and recycle medical waste;
- Transfer materials for analysis to the laboratory;
- Disinfect and sterilize instruments;
- Avoid complications after injections; development of diseases such as HIV and hepatitis.
A nurse assistant is an employee who helps the doctor. Its main functions are to assist the doctor and help patients. It depends on how high-quality services are provided in the clinic. The employee monitors whether the patients are on the mend. She controls whether they receive proper care.
This employee has the right to:
- Get the information she needs to do her job;
- Express your position to optimize the work of the institution;
- Suggest alternative ways to solve problems;
- Inform the head of the provision of all necessary equipment and materials;
- Engage in development, improve skills;
- Join an association of nurses.
What category of staff does the junior nurse belong to?
A nurse assists during an appointment with a dentist, therapist, pediatrician, surgeon, neurologist. It helps to carry out operations, put anesthesia and so on. The category of personnel to which it belongs is junior medical personnel. In addition to it, this category includes:
- Sanitary (ka), who also performs auxiliary functions;
- Sister-mistress, keeping order in the institution;
- A nurse taking care of patients in the wards.
The employee is appointed to the position by the head of the medical institution. A special order must be issued for this. Dismissal occurs in the same way. Her immediate supervisor is the head nurse. The junior nurse is subordinate to the senior nurse, as well as to the doctor, head of the department. These are her direct superiors.
Nursing Assistant Nurse: Her Responsibilities
The junior medical staff also includes the junior nurse for patient care. Her duties and rights are regulated by the job description. Such a document must be in any medical institution. It is quite universal, but it is adjusted taking into account the specifics of a particular organization.
Depending on the department in which the employee works, the tasks may vary. So the junior nurse in the intensive care unit will have their job responsibilities. As a rule, to her functional duties patient care includes:
- Assistance to those patients who cannot eat and move independently.
- Monitoring how the regime is observed.
- Moving documentation.
Responsibilities of a junior nurse during and after breakfast
There are many things to do in the morning. Breakfast starts at 8 o'clock and lasts for an hour. At this time, she can help the ward nurse, who feeds the patients with breakfast. To do this, she needs to change clothes and wash her hands. If help is not required, then you can start cleaning. Then by the end of breakfast and by the time the doctor goes to the wards, everything will be cleaned.
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Then the treatment of patients begins, they attend procedures, consult with a doctor. After the patients have had lunch, daytime sleep begins. At this time, silence must be observed. It is necessary to strictly monitor compliance with the sleep regimen, because it is very useful for restoring the body. Therefore, it is forbidden to make noise, you need to speak quieter. Patients who are awake should not disturb others. When patients wake up, the junior nurse pours tea for them, helping them drink it if necessary.
Cleaning as one of the duties of a junior nurse
Maintaining cleanliness in the room is possible only with the help of wet cleaning. According to the rules during the day it is held at least three times. Bleach is used to kill microbes. For washing, a solution of cold water and bleach is made: 10 to 1. The mixture can be stored in a dark glass vessel. The volume of the vessel is calculated depending on the number of chambers. Usually the maximum volume is 20 liters. The mixture needs some time to stand.
After 12 hours, it can be poured into smaller containers and used. But it should be stored only in a dark place, otherwise it will stop killing germs. The finished mixture can be diluted in water. 200 g of bleach solution is enough for a bucket of water. For cleaning, you can use the following tools: brushes, mops, rags. Hands during cleaning should be protected with rubber gloves. It is recommended to wash the floor in the ward with sweeping movements directed towards the exit. Small rubbish can be swept away and thrown away or destroyed.
Communication of a junior nurse with visitors
It is required to constantly monitor strangers who come to patients. Those who wish to visit the sick person can do so at a designated time. At the same time, strict rules are observed. Visitors should not bring germs into the department. Therefore, you can not sit on the bed with the patient or kiss him. Noise is also prohibited - loud conversations, laughter. To maintain a stable emotional background of the patient, he is not recommended to talk about something bad.
Visitors often bring food to the sick. In general, this is not prohibited, but there is a list of what cannot be brought. This must be controlled by employees. At the same time, you must remain polite and courteous. Their task is to protect the patient from the harm that a visitor can unintentionally inflict on him. For example, he can talk for a long time, not noticing that the patient is tired of talking and wants to rest.
Evening duties of a junior nurse
The patient's day ends with dinner and treatments. After the last meal, the third wet cleaning of the room is done. During cleaning, do not forget to ventilate the room. In addition to cleaning, the junior nurse must help her colleagues in performing the necessary medical and sanitary procedures. When patients fall asleep, she controls their sleep.
In order to maintain a restful sleep for patients, the ward must be quiet. Therefore, telephones are not placed next to the beds of patients. Sound sirens are replaced by light alarms. The furniture is equipped with rubber feet so that it can be moved silently. During sleep, no cleaning is carried out, and medical procedures, if they are not urgent, are postponed until morning. If something bothers the patient at night and you need to turn on the light, then he can turn on the nightlight.
Requirements for a candidate for the position of a junior nurse
In order to qualify, you need to have a secondary (complete) education and take courses. These may be refresher courses or retraining courses. The duration of the course is at least 16 hours. Work experience is not required. This is due to the fact that the necessary theoretical base and work skills are acquired already in the learning process.
The position of "junior nurse for patient care" is accepted by specialists who have completed one of two courses:
- advanced training courses, duration - 16 hours
- program professional retraining, duration - 250 hours.
Education in this specialty is impossible without working out in practice. At the end of the course, the student defends thesis and passes two state exams (written and oral).
How is the training for a junior nurse
Training for a junior nurse is regulated by the relevant professional standard. There are two options.
- the applicant has already received a complete secondary education. He can prepare for work in one academic year, which is 10 months.
- the applicant received basic general education. Then the training period will be 2 years 10 months.
The duration of training in the future may decrease or increase. It depends on how the general standard in education changes. For example, remote learning is now actively developing. Perhaps new technologies will significantly change the approach to training young professionals. The level of training when applying for a job can be different. Later, when moving along career ladder the person with the best level of education will have an advantage.
What knowledge should a junior nurse have
After preparation in educational institution During practice, a nurse learns some general norms. These are, in particular, the norms of labor protection and safety. Also important are the norms of communication and ethics when talking with patients and their visitors. In addition, she must know:
- What manipulations can a junior nurse perform;
- What methods are used to perform these manipulations;
- The structure of the human body and features of its functioning;
- How to care for a patient if it is: an old man, an adult, a child;
- How to provide first aid;
- How to observe the sanitary regime and hygiene rules;
- What to do with waste in a medical institution;
- What regime is observed in the organization;
- How to properly prepare documents.
Note that if a junior nurse has only a secondary education or an elementary medical education, she will not be able to qualify for a promotion to a ward nurse.
Approximate daily routine of patients of the therapeutic department and job responsibilities of a junior nurse
for patient care.
|
Times of Day |
Schedule |
Responsibilities of a junior nurse |
|
7.00 – 7.30 8.00 – 8.10
9.00 – 9.30
13.00 – 13.30 14.30 – 16.30
20.00 – 21.30
|
Rise, thermometry morning toilet Taking medicines Breakfast Fulfillment of doctor's orders afternoon rest Thermometry Visiting patients with relatives Taking medicines Dinner Evening toilet Preparation for sleep Night sleep |
Turns on the light in the wards (in winter), distributes thermometers, monitors the correctness of thermometry, writes down the data in the temperature sheet. Helps to wash seriously ill patients, remakes or straightens the bed, transports biological material to the laboratory, ventilates the wards. Participates in handover. Distributes medicines prescribed for taking before meals, distributes medicines for taking after meals. Participates in rounds, writes down appointments or prepares patients for examinations, accompanies patients to diagnostic rooms. Cares for seriously ill patients, puts compresses, performs other manipulations. Distributes medicines. He ventilates the wards, monitors the state of silence in the department, and the condition of the patients. Distributes thermometers, monitors the correctness of thermometry, writes data to the temperature sheet. Controls the composition of the transmissions. Distributes medicines, monitors their intake. Helps distribute food, feeds seriously ill patients. He puts enemas, jars, mustard plasters, distributes medicines, helps the nurse on duty to perform evening injections. Ventilate the rooms. Washes, washes the seriously ill, straightens the bed, creates a comfortable position in bed. Ventilate the rooms. Turns off the lights in the wards, covers the patients, monitors the silence in the department. Makes rounds of patients on an hourly basis. The joint venture is carried out continuously throughout the day. |
The nursing assistant provides the following types of care:
Accepts a patient from the admission department, participates in shifting him from a wheelchair to a bed or accompanies a walking patient to the bed, checks the quality of sanitization, introduces the regimen and internal rules of the medical department;
Monitors the cleanliness and order in the wards, the regularity of their ventilation, the air temperature in the ward, the observance of personal hygiene by patients and the regularity of changing bed and underwear;
Carries out the supply of the vessel and the urinal, hygienic care for a seriously ill patient, assistance with vomiting, change of underwear and bed linen in compliance with the principles of infectious safety;
Takes part in the distribution of food, feeding the seriously ill (Fig. 3), monitors the sanitary condition of the wards, bedside tables, refrigerators, sanitary and hygienic cleaning of the catering unit;
Measures body temperature, respiratory rate, pulse, conducts anthropometry, determines water balance, enters data on a temperature sheet, puts jars, mustard plasters, compresses, enemas, takes care of a permanent catheter and a removable urinal, distributes medicines, injects medicines into rectum, externally, in the eyes, nose, ears;
Collects biological material (feces, urine, sputum) and transports it to the laboratory;
Prepares patients for various examinations and transports them to diagnostic rooms (Fig. 4);
Carries out the nursing process in case of violation of meeting the needs of a seriously ill patient, preventive measures at the risk of developing bedsores, caring for stoma patients;
AT emergency cases provides first aid.
Fig.4 Transportation of a seriously ill patient
Fig.3 Feeding seriously ill patients
From the Order of the Ministry of Health and Social Development of the Russian Federation (Ministry of Health and Social Development of Russia) dated July 23, 2010 N 541n Moscow “On approval of the Unified Qualification Handbook for the positions of managers, specialists and employees, section “Qualification characteristics of positions of workers in the field of healthcare”:
.
Job Responsibilities . Assists in the care of patients under the guidance of a nurse. Carries out simple medical manipulations (setting cans, mustard plasters, compresses). Ensures cleanliness of patients and rooms. Ensures proper use and storage of patient care items. Makes a change of bed and underwear. Participates in the transportation of seriously ill patients. Monitors compliance by patients and visitors with the internal regulations of the medical organization. Collects and disposes of medical waste. Carries out activities to comply with the rules of asepsis and antisepsis, sterilization conditions for instruments and materials, prevention of post-injection complications, hepatitis, HIV infection.
Must know: techniques for conducting simple medical manipulations; rules of sanitation and hygiene, patient care; rules for the collection, storage and disposal of waste from medical institutions; internal labor regulations; rules on labor protection and fire safety.
Qualification Requirements . Primary professional education in the specialty "Nursing" without presenting requirements for work experience or secondary (complete) general education, additional training towards professional activity no requirement for work experience.
The junior nurse reports directly to the ward nurse, as well as to higher officials.
Job description nursing assistant also reflects the rights and responsibilities of a specialist.
Nursing Assistant Nurse has the right to :
Make proposals to the management of the enterprise on the optimization and improvement of medical and social assistance, including on issues of their work activities.
Require the management of the institution to assist in the performance of their duties and rights.
Receive information from the company's specialists necessary for the effective performance of their duties.
Enjoy labor rights in accordance with the Labor Code of the Russian Federation
For the proper and timely performance of the duties assigned to him, provided for in this job description
For the organization of their work and the qualified execution of orders, orders and instructions from the management of the enterprise.
To ensure that subordinate employees comply with their duties.
For non-compliance with internal regulations and safety regulations.
Infection control and prevention of nosocomial infection
Scale of the nosocomial infection (HAI) problem
Nosocomial infections are known to be actual problem modern healthcare.
More than 2000 years ago, Hippocrates proved that cleanliness is the prevention of disease. Modern doctors only confirm this idea, which is why the requirements for hygiene and cleanliness are so high in medicine.
The problem of nosocomial infections arose in ancient times with the advent of the first hospitals. Until the 19th century, one of the main functions of hospitals was the isolation of infectious patients, while the prevention of nosocomial infections was practically absent, and the conditions for keeping patients did not hold water. The frequency of wound infection reached 100%, about 60% of amputations ended in the death of patients. Mortality was extremely high among women who gave birth in a hospital: for example, during an outbreak of "puerperal fever" in 1765, 95% of puerperas died. Despite the fact that individual measures of treatment and prevention were known in antiquity. 
Fig. 5 I. Semmelweis observes the processing of the hands of doctors and obstetricians
In 1843, Oliver Wendell Holmes first concluded that medical staff, infecting their patients with "puerperal fever" through unwashed hands. After conducting examinations, Holmes came to the conclusion: "The disease known as puerperal fever is contagious, since doctors and nursing staff often transfer it from one patient to another." In 1847, the Hungarian obstetrician Ignaz Semmelweis proved that hand washing prevents nosocomial infections. From the very beginning of his obstetric practice, he was interested in the problems of puerperal fever, which was considered the "scourge" of European obstetrics in the 19th century. Great amount women had to pay for the birth of a child own life. The disease began on the third or fourth day after childbirth, a high temperature appeared and a few days later the woman died,
despite all the efforts of doctors to help get rid of the disease. The neonatal mortality rate was also high. Everyone considered this to be quite normal. For more than two years, Semmelweis was tormented by this issue, continuously monitoring the work of doctors and midwives. In May 1847, he found the reason and immediately suggested that all doctors, midwives and students, before starting work, thoroughly wash their hands and keep them in a solution of bleach for several minutes (Fig. 5). This decision initially provoked protests from the staff, but after a month the mortality rate dropped and out of a hundred women admitted, only two died.
The emergence of antibiotics in the 40s of the 20th century caused the emergence of antibiotic-resistant microorganisms. This led to the realization of the need integrated approach to solving the problems of HBI. Already in the middle of the last century, the first programs for epidemiological surveillance of nosocomial infections and documentary evidence of the need for infection control programs appeared.
Virginia Henderson made a great contribution to the prevention of nosocomial infections.
Prevention of nosocomial infection not only in Russia, but also in all countries of the world is the main task. In recent years, according to WHO, significantly more cases of nosocomial infections have been recorded.
As defined by the WHO Regional Office for Europe, nosocomial infection (HAI) is any clinically recognizable infectious disease that affects a patient as a result of his admission to the hospital or seeking medical care, or an infectious disease of an employee as a result of his work in this institution(regardless of the time of manifestation of clinical symptoms).
Nosocomial infections in some cases lead to death, and if the outcome is favorable, the length of the patient's stay in the hospital increases (on average by 10 days), and the cost of his treatment increases 4 times.
The structure of nosocomial infections in hospitals is specific and is determined by the bed capacity, the profile and nature of the treatment provided in the medical organization, as well as the nosology and age composition of the hospitalized. In most large multidisciplinary hospitals, purulent-septic infections, intestinal infections, hepatitis and HIV are more common.
Often there are so-called classic infections: measles, rubella, mumps, influenza, tuberculosis, diphtheria, dysentery.
Nosocomial infections are "superimposed" on the main diseases of the patient in the form superinfections or reinfections (superinfection- layering of a pathogen of a different type of infection on an already existing infectious disease; reinfection - This is a repeated infectious disease caused by the same pathogen), worsening the condition of the body, lengthening the time of recovery and treatment, and thereby bringing economic damage to both the patient and the medical organization. In addition, during the entire period of hospitalization, a patient with nosocomial infection, under certain circumstances, is a source of infection for other patients and staff.
In medical organizations, nosocomial infections pose a serious danger to patients and medical workers.
The concept, developed by the Federal Service for Supervision of Consumer Rights Protection and Human Welfare, defines the main directions for improving the national system for the prevention of infections associated with the provision of medical care. The strategic task of healthcare is to ensure the quality of medical care and create a safe environment for patients and staff in organizations that carry out medical activity. Healthcare Associated Infections (HAIs), are an important component of this problem due to the widespread negative consequences for the health of patients, staff and the economy of the state.
The general criterion for classifying cases of infections as HAIs is the direct connection of their occurrence with the provision of medical care (treatment, diagnostic tests, etc.). Therefore, HCAI includes cases of infection that not only join the underlying disease in hospitalized patients, but are also associated with the provision of any type of medical care (in outpatient clinics, sanatorium and health institutions, institutions social protection population).
Factors contributing to the spread of infections
related to medical careHCAI) :
The growth of HCAI is generated by a complex of factors, including:
Creation of large hospital complexes with a peculiar ecology: a high population density, represented mainly by weakened contingents and medical staff, constantly and closely communicating with patients; isolation environment, the originality of its microbiological characteristics (circulation of a number of strains, conditionally pathogenic microorganisms).
The presence of a constant large array of sources of infectious agents in a number of patients admitted to hospitals with unrecognized infectious diseases, persons in whom nosocomial infections are superimposed on the underlying disease in the hospital and medical staff (carriers with erased forms of infection).
Activation of the natural mechanisms of transmission of pathogens of infectious diseases, especially airborne and contact household, in conditions of close communication between patients, medical staff in the LU.
The unsystematic uncontrolled use of antimicrobial agents leads to the formation of resistant hospital strains of microorganisms that are resistant to the hospital environment (UV, the action of disinfectants and drugs).
An increase in the number of patients being cared for and cured due to the advancement of modern medicine, an increase in the number of elderly people and the presence of a large number of newborns and children with weakened immune systems.
Implementation of new diagnostic and therapeutic manipulations using complex techniques that require special processing methods.
Underestimation of the problems of nosocomial infections and economic difficulties in the country.
Sanitary condition medical institutions and hygiene culture, both of patients and staff, the effectiveness of disinfection measures and sterilization.
The state of catering and water supply.
Types of pathogens that cause nosocomial infection
Currently, about 100 nosological forms of nosological infections associated with more than 200 types of microorganisms have been described (bacteria - 90%; viruses, molds and yeast-like fungi, protozoa - 10%).
The causative agents of nosocomial infections, depending on the degree of pathogenicity for humans, are divided into two groups:
obligate pathogenic, which account for up to 15% of all nosocomial infections;
opportunistic pathogens, which are the cause of 85% of nosocomial infections.
Obligate pathogenic microorganisms have factors of active penetration into internal environment and suppression of the body's defenses, secrete exotoxins. The development of the epidemic process of nosocomial infection caused by obligate pathogenic microorganisms occurs more often as a result of the introduction of infection into the hospital from the outside due to non-compliance with the anti-epidemic regimen.
The bulk of the nosocomial infections at the present stage is called opportunistic pathogens. These include representatives of the following genera of microorganisms:
a) Gram-positive bacteria: aureus and epidermal staphylococci(up to 60% of all cases of nosocomial infections), streptococci and etc.; b) Gram-negative bacteria: Enterococcus, Escherichia, Klebsiella, Proteus, Citrobacter, Pseudomonas and others (Fig. 6).
Most types of opportunistic microorganisms are normal inhabitants of the skin, mucous membranes, intestines, and are observed in all or many people and in large quantities, without exerting a pathogenic effect on a healthy organism. They are often found in water, soil, food products, on objects and other objects external environment. Opportunistic pathogens cause disease in debilitated people when they enter normally sterile cavities and tissues in an unusually large infectious dose. The term "purulent-septic infections" is often used for them.
The emergence and spread of diseases caused by opportunistic microorganisms are entirely determined by causes that act only in hospital conditions. A pathogen of a certain type, adapted to the specific conditions of a hospital, resistant to therapeutic and disinfection-sterilization measures is called hospital strain.
Fig.6 Pathogens nosocomial infections
Characteristics of causative agents of nosocomial infectionsby localization
pathological process
VBI of the urinary tract. Most commonly caused by Gram-negative bacteria ( E. coli, Klebsiella, Proteus, Serration, Pseudomonas etc.), among gram-positive there are enterococci, staphylococci, group B streptococci. Urethral catheters are the main factor in urinary tract infection. The risk of infection increases with the length of time the catheter is in the urethra.
Respiratory infections. Previously, the main reason was considered streptococci and staphylococci, there is now a clear predominance Gram-negative bacteria, and nosocomial pneumonia caused by these pathogens is more severe than those caused by gram-positive ones, with a mortality rate of up to 50%. At present, there is no doubt that the causative agent of pneumonia is legionella. Sporadic outbreaks of nosocomial pneumonia can cause acinetobacter, pseudomonas. Pneumonia caused by Pseudomonas aeruginosa. A factor predisposing to pneumonia is endotracheal intubation. The risk of pneumonia after surgical interventions is high.
Surgical area infections. The leading role in the development of these infections (up to 15% of all nosocomial infections) is played by the banal cutaneous endoflora ( staphylococci, enterococci others); in debilitated and elderly patients, mixed infections are often observed (a combination of several pathogens of a specific infection). In burn hospitals, the leading causative agent of nosocomial infections also remains Staphylococcus aureus, In second place - Pseudomonas aeruginosa and enterobacteria.
Infections of the digestive tract. The causative agents of nosocomial gastroenteritis are salmonella, shigella, coli, aeromonads, campylobacter.
bacteremia and sepsis. Bacteremia is most often caused enterobacteria, These include: coli, klebsiella, enterobacter, serration, Proteus, Moreover, pseudomonads. The primary sources of infection are often the gastrointestinal tract, the genitourinary system and the skin. Predisposing factors are surgical interventions, medical manipulations.
Among gram-positive pathogens, the main one is Staphylococcus aureus, less often epidermal and saprophytic. The cause is abscesses of the skin. Contamination occurs through various medical instruments.
Methods of transmission of some causative agents of nosocomial infections
We bring to your attention a typical example of a job description for a junior nurse for patient care, a sample of 2019. A person can be appointed to this position without presenting requirements for education and work experience. Do not forget, each instruction of a junior nurse on patient care is issued on hand against receipt.
It provides typical information about the knowledge that a nursing assistant should have in caring for patients. About duties, rights and responsibilities.
This material is included in the huge library of our site, which is updated daily.
1. General Provisions
1. The junior nurse for patient care belongs to the category of workers.
2. A person is accepted for the position of a junior nurse for the care of patients without presenting requirements for education and work experience.
3. A junior nurse for patient care is hired and dismissed by _____________ (director, head) of the organization on the recommendation of ___________. (job title)
4. Nursing assistant to care for patients should know:
a) special (professional) knowledge of the position:
- rules for patient care;
- methods of cleaning and processing fixed premises with their equipment, inventory, utensils, etc .;
- rules for the operation of small-scale mechanization;
- safety regulations and compliance with the sanitary and hygienic regime in institutions (divisions).
b) general knowledge of the employee of the organization:
— rules on labor protection, industrial sanitation and fire safety;
- requirements for the quality of work (services) performed, for rational organization work in the workplace;
- production signaling.
5. In its activities, the junior nurse for patient care is guided by:
- the legislation of the Russian Federation,
- Charter (regulations) of the organization,
- orders and orders of _________ organization, ( CEO, director, leader)
- this job description,
- The internal labor regulations of the organization.
6. The nursing assistant reports directly to ___________ (a worker with more than highly qualified, head of production (section, workshop) and director of the organization)
7. During the absence of a junior nurse to care for patients (business trip, vacation, illness, etc.), her duties are performed by a person appointed by ___________ of the organization (position of the head) on the proposal of ____________ (position) in the prescribed manner, which acquires the appropriate rights, duties and is responsible for the fulfillment of the duties assigned to him.
2. Job responsibilities of a junior nurse for patient care
The duties of a nursing assistant nurse are:
a) Special (professional) duties:
- Nursing.
– Delivery of patients to medical diagnostic and other units.
- Providing assistance to doctors and paramedics medical workers during medical and diagnostic procedures.
- Helping a needy patient with dressing, undressing, washing, bathing, feeding, putting to bed.
- Giving the vessel to the patient, changing the patient's clothes and underwear.
— Wet cleaning of premises.
- Processing of tools, patient care items, utensils.
- Control over the implementation of internal regulations by patients.
b) General duties of an employee of the organization:
— Compliance with the Internal Labor Regulations and other local regulations of the organization, internal rules and norms of labor protection, safety, industrial sanitation and fire protection.
— Execution within employment contract orders of employees to which it is repaired in accordance with this instruction.
– Performing work on the acceptance and delivery of shifts, cleaning and washing, disinfection of serviced equipment and communications, cleaning the workplace, fixtures, tools, as well as keeping them in good condition.
- Maintaining established technical documentation.
3. The rights of a junior nurse to care for patients
The nursing assistant has the right to:
1. Submit proposals for management consideration:
– to improve the work related to the provisions of this responsibilities,
— on bringing to material and disciplinary responsibility employees who violated production and labor discipline.
2. Request from structural divisions and employees of the organization the information necessary for him to perform his duties.
3. Get acquainted with the documents that define his rights and obligations in his position, the criteria for assessing the quality of performance of official duties.
4. Get acquainted with the draft decisions of the organization's management regarding its activities.
5. Require the management of the organization to provide assistance, including the provision of organizational and technical conditions and the execution of established documents necessary for the performance of official duties.
6. Other rights established by the current labor legislation.
4. Responsibility of the junior nurse for patient care
The nursing assistant is responsible for the following:
1. For improper performance or non-performance of their official duties provided for by this job description - within the limits established by the labor legislation of the Russian Federation.
2. For offenses committed in the course of their activities - within the limits established by the current administrative, criminal and civil legislation of the Russian Federation.
3. For causing material damage to the organization - within the limits established by the current labor and civil legislation of the Russian Federation.
Job description of a junior nurse for patient care - a sample of 2019. The duties of a junior nurse to care for the sick, the rights of a junior nurse to care for the sick, the responsibility of the junior nurse to care for the sick.
Tags by material: Job description of a junior nurse for patient care.