The doctor icu training self-appraisal

Doctor icu refresher self appraisal

ICU ward is the intensive care unit of the hospital, is the most dangerous and critical place of the patient's life, the following is my compilation of doctor icu refresher self appraisal, welcome to read!

A short 2 weeks passed quickly, although 2 weeks in my 20 years of working life accounted for a very small amount of time, but it is a little time to give me a sense of feeling and gain is abundant, here I would like to thank the head nurse to give me 2 weeks of ICU training opportunity. Here I would like to thank the nurse manager for giving me 2 weeks of ICU training.

The ICU concentrates the best instruments and equipments in the whole hospital, and also concentrates the most critical patients in the whole hospital, and the work there is tense and busy, where not only do we need to have a solid theoretical foundation, rich clinical operation skills, but also a variety of ways of communication and general nursing knowledge, in the ICU, I have learned the theoretical knowledge and operation skills that are not available in the wards, or are seldom seen in the wards, or are more than the wards require higher thinking and judgment. I have learned theoretical knowledge and operational skills that are not available or rarely seen in the ward, or higher thinking and judgment skills than those required in the ward.

1. Resilience Clinical emergency, first aid nursing observation and treatment and characteristics and general clinical diagnosis, treatment work is very different. Life-threatening changes in the patient's condition is often sudden, in addition to a few cases can be predicted, most of them are random, so the nurse is required to not single wait for the doctor to confirm the diagnosis, the response to the strain to be fast, strong processing ability. Clinical emergency, first aid patients to take effective scientific emergency treatment measures, as well as emergency wisdom, seize the moment, do not hesitate to make a judgment ability, and take a series of specific contingency measures, in the nick of time to save the patient's life will play a practical and important role.

2. Nursing technology operation The serious teaching of the instructor and strict training, so that I initially mastered the resuscitation technology, such as: drugs, the performance of the rescue equipment, operation methods and indications, a variety of different diseases of nursing technology operation. I was mainly familiar with the establishment of artificial airway, the use of ventilator, the time of use and precautions, as well as how to provide deep sputum suction for patients, when to suction precautions and so on. They understood the process of indwelling PICC, mastered the points of attention of its nursing care, familiarized with the resuscitation of shock and participated in the cooperation, understood the working principle of blood flow machine, the cause of the alarm and the treatment, learned to use the vibration sputum expectoration apparatus, and turn over and pat the back to expectorate, and the use of pneumatic pressure therapeutic instrument, understood the use of electrocardiogram machine for the ECG monitoring of patients and the correct diagnosis of the ECG, and the use of defibrillator for the treatment of the critical patients (cardiopulmonary and cerebral resuscitation). The use of defibrillators for critical patients (cardiopulmonary resuscitation) and other techniques.

3. Medical and nursing cooperation In the premise of good nursing work, take the initiative to cooperate with the doctor's work. It is often thought that the nurse's job is to implement the doctor's orders, to complete a variety of nursing work, and diagnosis and treatment is the doctor's business, the nurse does not need to intervene or participate in the concept has been proved wrong. Nurses wait 24h in the patient's body, is the patient's guardian angel, is the condition of the direct observer, therefore, must have the ability to comprehensively, accurately and error-free reflection of the patient's condition. Nurses are no longer passive simple implementation of medical advice, in the work to be able to work closely with the doctor, communicate with each other, complement each other. *** with the sacred task of treating the sick and saving lives.

4 communication ability ICU patients are mostly intubated they will be temporarily restricted language ability, and their communication will have some difficulties, by seeing the teachers with their unique language communication really admire, there is writing, there is to look at the eyes, there is to observe the lips, there is to guess, and so on. I also learned a lot.

5 basic care ICU pay special attention to basic care, have lived in a coma for more than 2 years of patients did not occur on the skin of any problem, a week to wipe the bath 2 times, 2 hours to turn over once, timely replacement of unclean clothes, timely treatment of urine and feces, meticulous oral care, timely trimming of fingernails and whiskers, and so on, all to do very well.

In fact, the ICU needs us to learn a lot more.

A short three months of training and learning life soon came to an end, for me is a kind of training, but also a test. For me just work three years, technology theory are still shallow, this time in the ICU to learn, get a comprehensive exercise, undoubtedly the opportunity is very precious, harvest is also very rich. I would like to thank the hospital leadership and all the people who care about me for giving me this rare opportunity! It is this opportunity that has improved my professional skills, and I would like to share my learning experience with you.

Peace Hospital ICU *** set up 10 beds, including 8 open beds, isolation beds 2, 6 doctors, including 4 resident doctors, rotating doctors 2. More than 30 nurses, in addition to further training outside, as well as vacationers, there are about 7-8 nurses on duty per shift, usually the bed utilization rate of up to 100 %, mainly to admit and treat some patients who need respiratory support, so the staff is small, and every day's workload is very large. The director, Dong Zhang, is a student of Nanshan Zhong with a doctoral degree. The head nurse is a person who likes to research, has two inventions, and has published papers every year, so under their strict requirements, the department has a very strong learning atmosphere, and the work pressure is also quite high. I have the honor to study in this department and learned a lot of knowledge.

ICU is a set of medical, teaching, research in one of the departments, the technical force is relatively strong, advanced and complete professional diagnostic and treatment equipment, such as monitors, ventilators (including invasive and non-invasive), micro-pumps (infusion pumps and syringe pumps), hemofiltration machine, nutritional pumps, physical chest defibrillator, physical head cooling instrument, infusion system, infrared electrocardiography, defibrillation, blood gas analyzers, ciliopathy and so on.

With advanced equipment, there must be technologically advanced medical staff, so every

doctor in the department will be tracheal intubation, as well as deep vein puncture, the nurse in addition to good life care, to reduce the patient's rate of infection as well as family members are not around the sense of isolation, but also must be a general nurse, the rescue of critically ill patients (cardiopulmonary resuscitation), as well as the coordination of technology is the most basic, because every patient entering the ICU, the patient's heart, lungs and brain resuscitation. Because every patient who enters ICU is under the notice of critical illness, there are also some advanced nursing skills, such as inserting gastrointestinal tubes through the nose (nutrients are delivered directly to the small intestine and absorbed directly, and the retention time is much longer than that of gastric tubes, and once inserted it is not easy to be dislodged), nursing techniques of deep venous catheterization, collection of blood gases, interventional as well as extracorporeal physical therapy of the chest, and the management of the artificial airway, etc. At present, several of the above techniques are not available in the hospital. At present, the above technologies are not carried out in our hospital, according to the current level of technology in our hospital, chest physiotherapy and blood gas collection (this technology is a small investment, and reduces the time of specimen exposure to air, improving the correct rate of examination results), the use of nutritional pumps can be used for diabetic patients, hypoglycemic coma, or tumor malignant night patients.

ICU due to the special nature of the patient, some of the system is also more advanced, for example, the patient by the patient's attending physician and ICU doctors and nurses *** with the management, so the nurse is required to the patient's condition of the "all know", so the head nurse to implement the "recapitulation of the shift Therefore, the head nurse has implemented the "recapitulation shift", urging all nurses to understand the condition of all patients, and in the shift can correct some of the nurses on the patient's condition of the improper narration, reducing the patient and the patient's family members in the communication of misunderstandings, and conducive to the communication between nurses and patients. When working in the department, we can feel their self-protection awareness is very strong, and they can reasonably explain all kinds of questions raised by the patients and clearly inform the development of the disease and the prognosis.

During the study period in ICU, it has greatly broadened my . The strong learning atmosphere and exploratory spirit of the ICU have inspired me to master new theoretical knowledge and techniques as soon as possible. Through this rare learning opportunity, I have improved my skills in monitoring critically ill patients. I want to apply what I saw in the medical school and what is different from our hospital with the best choice of methods, and bring the good style and experience to the work to improve the quality of our work.

I am very grateful to the hospital to give me the opportunity to go outside to study, so that I can understand myself better, enrich myself, prove myself, and summarize my own shortcomings. It makes me more hesitant to face my life, to face my future, so that I have learned knowledge and friendship. I am grateful to the hospital, the head nurse and my colleagues for their support. During the period of further training, I was in the spirit of open-mindedness to ask for advice, serious study, hard work attitude, by the department of comrades unanimous praise. Through special training, my nursing theory knowledge and clinical nursing skills have been improved. Now the refresher training above is the content of my study.

First, serious study, careful notes, and constantly improve the theoretical knowledge

Third Military Medical University Hospital Daping Hospital is a tertiary hospital, advanced equipment, teaching faculty strength. ICU has 41 beds, more than 70 nurses, strict system, and accepts nurses from all levels of hospitals for further training. ICU attaches great importance to the work of further training, special arrangements for the hospital and the ICU senior nurse lectures, mainly taught basic clinical nursing theory and operation, common pipeline nursing knowledge, clinical update knowledge, mechanical ventilation patient care, etc. Lectures using multimedia slides, clinical demonstration, academic exchanges and seminars and other forms to enrich the teaching content. During the period, I can seriously participate in the study, actively participate in the lectures held in the hospital, humbly ask the teacher for advice, serious speculation, careful notes. In my spare time, I actively participate in the hospital lectures, and purchase related books to learn, and constantly improve the level of theoretical knowledge.

Second, hard work, repeated practice, and constantly improve the clinical nursing skills Daping Hospital ICU focus on the use of clinical practice in the way of further training, by the instructor on-site teaching. The nurses are cross optimized with the hospital nurses, divided into two shifts to work, *** with the clinical care. In nursing care, they experience the standard nursing model of ICU in large hospitals, strengthen communication and improve nursing skills. Through the study, I have seen that they have many aspects that we should learn from. We have gradually absorbed the essence of them. During the period, I can overcome difficulties and work pragmatically; for difficult problems, I ask for more advice from experienced teachers; for key equipment such as ventilators, monitors, various micro-pumps, etc., I use my spare time to practice operations repeatedly. Through intense standardized practice and operation exchange, my nursing skills have been improved rapidly, such as the friendly title makes the patient very comfortable, and the strengthening of hand disinfection of medical and nursing staff can reduce the chance of cross-infection. There is no previous contact with the central venous pressure monitoring, bladder pressure monitoring, urine specific gravity monitoring, tracheal intubation and tracheotomy to catch the voice under the door attraction care, picc, cystostomy, gastrostomy care cooling ice blanket care and so on have a further understanding.

Third, strengthen the exchange, broaden their horizons, so that the nursing concept of timely update in the spare time for training, I went to training with the other county hospital nurses extensive academic exchanges, exchanges of nursing tips, discuss the work of the experience and good practices, *** with the complementary strengths and weaknesses, in order to return to work in the post to better carry out the nursing work. If you want to make a good impression on your patients, you can do so by strengthening the hand sanitization of the medical staff to reduce the chances of cross-infection.

During the training period, the ICU environment is elegant, scientific partition (living area work area separate). The wards are divided into single rooms, double rooms and triple rooms. According to the condition of the reasonable arrangement of patients. Each ward is fully equipped: water and electricity are installed in place, power supply, attraction, oxygen, adjustable infusion and pump devices are all fixed on the shelf, there is a gap around the bed. In this way, there is no delay due to inconvenience when rescuing patients. The patient's meal and nutritional solution are placed in a special refrigerator, labeled with the bed number, which is effective in preserving freshness and differentiation. The system is rigorous, standardized management, through further training and personal experience, so that we have broadened our horizons, updated the concept of nursing, enhance the work of the confidence and sense of honor; the hospital ICU rules and regulations, operating norms and other aspects of the software, we are very guiding significance.

Through the special training, I have further enriched my theoretical knowledge of nursing, improved my clinical nursing skills, updated my nursing concepts, and improved my overall quality, which will play a positive role in promoting my future work.

According to the hospital arrangements I have the honor to Zigong First People's Hospital Intensive Care Unit (ICU) for a period of three months of work for further training, in the blink of an eye three months of further training has been successfully completed, through the three-month study, I am on the ICU's basic workflow, nursing characteristics, main equipment and the use of various aspects of the work of the ICU. Zigong First People's Hospital Intensive Care Ward **** there are 54 medical staff, including 13 doctors group, 41 nursing group, nursing group with a nurse manager, deputy nurse manager 1 (late has been transferred), shift nursing using 6 people a shift, using 5 shift rotation system.

The unit has 10 beds (30 after relocation), often in short supply, usually by a nurse responsible for 2-3 patients, very critical patients using one-to-one care.

The department is equipped with about 20 sets of major medical equipment, including ventilators, cardiac monitors, infusion pumps, syringe pumps, electric sputum aspirators, infrared therapeutic instrument, blood gas analyzers, defibrillators, blood purifiers, etc., of which the ventilators, cardiac monitors, infusion pumps, syringe pumps, electric sputum aspirators, each bed are equipped.

A hospital ICU charges are more expensive, ordinary care of the patient's charges a day total of more than a thousand dollars, the need to rescue care of the patient's charges are usually more than ten thousand dollars a day.

Second, the characteristics of intensive care unit ICU

Intensive Care Unit (Intensive Care Unit, ICU) as a kind of specialized ICU for the clinical treatment of critically ill patients to provide a better than ordinary treatment conditions. ICU is characterized by its unique intensive care and intensive care, or strengthened custody and strengthened treatment. ICU is characterized by its unique intensive care and intensive treatment, or intensive care and intensive treatment. The contents of intensive care should include consciousness, respiration, heart rate, blood pressure, oxygenation, body temperature, laboratory tests and special tests. The purpose of intensive care is twofold: first, to improve patient safety through timely detection and treatment of problems through monitoring; second, to evaluate the effectiveness of interventions and make timely adjustments through monitoring, which will help to further improve the success rate of treatment for critically ill patients. The content of critical care treatment should include: 1) airway management, respiratory management, and circulatory management in critical care procedures or cardiopulmonary resuscitation; 2) maintenance of internal environmental stability, including regulation and maintenance of water, electrolytes, acid-base balance, and blood glucose; 3) protection of organ function; 4) nutritional support and immune regulation; and 5) other therapeutic measures, including etiological treatment and infection control.

The use of major equipment in the ICU ward

The main equipment used in the ICU ward of Zigong No.1 Hospital are ventilators, electronic monitors, infusion pumps, syringe pumps, infrared therapeutic instrument, blood gas analyzers, defibrillators, blood purification equipment, etc.

1, ventilator

The need to use this type of equipment for the following conditions: severe malaise, severe hyperventilation, neuromuscular paralysis, cardiac surgery, increased intracranial pressure, neonatal tetanus, the use of large doses of sedation requires respiratory support, asphyxia, cardiopulmonary resuscitation, any reason for the respiratory cessation or will stop.

Connection to the patient: emergency or estimated intubation retention time will not be too long, neonates, preterm infants, usually intubated through the mouth, other cases can choose to intubate through the nose or tracheotomy.

Adjustment of the working parameters of the ventilator: four major parameters: tidal volume, pressure, flow, time (including respiratory frequency, inhalation and exhalation ratio). The process of use should be further adjusted according to the blood gas analysis: first of all, we should check whether the airway is smooth, the position of the tracheal tube, whether the air intake in both lungs is good, whether the ventilator sends the air normally, and whether there is any air leakage.

Adjustment method:

When PaO2 is too low: (1) Increase the oxygen concentration (2) Increase the value of PEEP (3) If ventilation is insufficient, you can increase the volume of ventilation per minute, prolong the duration of inhalation, and stay at the end of inhalation. When PaO2 is too high: (1) reduce the oxygen concentration (2) gradually reduce the PEEP value.

When PaCO2 is too high: (1) increase the respiratory frequency (2) increase the tidal volume: fixed-volume type can be directly adjusted, fixed-pressure type increase the pre-conditioning pressure, timed type increase the flow rate and raise the pressure limit. When PaCO2 is too low: (1) Slow down the respiratory rate. It can prolong the expiratory and inspiratory time at the same time, but it should prolong the expiratory time mainly, otherwise it will have the opposite effect. If necessary, switch to IMV mode. (2) Reduce the tidal volume: fixed-volume type can be directly adjusted, fixed-pressure type can reduce the pre-conditioning pressure, and timed type can reduce the flow rate and lower the pressure limit.

Ventilator evacuation: gradually reduce the oxygen concentration, PEEP gradually reduced to 3~4 cm water column, change IPPV to IMV (or SIMV) or pressure support, gradually reduce the IMV or support pressure, and finally transition to CPAP or complete evacuation of the ventilator, the whole process needs to be closely observed respiratory, blood gas analysis. Indications for extubation: With strong spontaneous breathing and coughing, good swallowing function, basically normal blood gas analysis results, and no laryngeal obstruction, extubation can be considered. Tracheal intubation can be pulled out at once, tracheotomy can be replaced by a thin tube, half blocked tube, full blocked tube order, gradually pull out.

2, cardiac monitor

Where the condition of the critical need for continuous uninterrupted monitoring of the heart rate, rhythm and temperature, respiration, blood pressure, pulse and transcutaneous oxygen saturation, etc., the general admission to the ICU ward patients need to use. Blood pressure monitoring:

1). Main function: it is divided into automatic monitoring, manual monitoring and alarm device. Manual monitoring is used at any time at any time to start the START key; automatic monitoring can be timed, manually set the interval, the machine can automatically monitor the set time.

2). The use of blood pressure monitor should pay attention to the following: First, it should be noted that the residual gas in the cuff should be exhausted each time the measurement is made, so as not to affect the measurement results. Second, choose the right cuff.

Transcutaneous oximetry monitoring:

1). The infrared probe of the transcutaneous oximetry monitor was fixed on the patient's finger tip, and the oxygenated hemoglobin as a percentage of hemoglobin was monitored to the patient's finger tip when the small arteries were pulsating.

2). Precautions: First, the probe should be fixed when using, try to make the patient quiet, so as not to alarm and not display the results. Second, severe hypotension, shock and other poor peripheral circulation perfusion, can affect the accuracy of its results.

3, micro syringe pump

Accurately control the speed of infusion, so that the speed of the drug is uniform, the dosage is accurate and safe into the patient's body to take effect. The main operation process: the micro fixed in the appropriate infusion frame; plug in the power supply, turn on the power switch, hear a beep that the internal circuit self-test is complete, the micro-pump is in standby charging state. Put the syringe (20ml or 50ml syringe) into the syringe holder, the edge of the syringe ring must be stuck into the syringe holder, move the pusher to the end of the syringe pusher, and push the syringe into the groove of the pusher. According to the medical advice and the patient's condition set the parameters, press the start button (START), and then press the fast-forward button (FAST), to be the scalp needle air exhaust after pressing the pause button (STOP), the needle will be connected to the infusion device on the heparin cap or trident tube or the patient's venous (arterial) puncture, and then start the micro-pump and start the infusion.

Fourth, a few suggestions

Through the other hospitals and related departments for further study, combined with the characteristics of our own hospitals to put forward a few points for the leadership reference.

1, the nursing operation practice to operational exercises, so that the operation process is more close to reality, to improve the actual nursing emergency capacity;

2, in the conditions of the situation: it is recommended that the ICU wards and the operating room only a channel between the convenience of nurses to the operating room to pick up and drop off the patient, but also to reduce the contamination of the ICU patients deterioration of the condition of the convenience of the operating room to the rescue;

3, in the ICU beds around the configuration of the power supply, left and right sides should be configured with power outlets, wards can be set up more power outlets to facilitate more equipment can be used at the same time;

4, between the wards can be set up to have interoperability between the door and the glass window with movable curtains, so that the patients will not interfere with each other, but also convenient for nurses to observe the condition of the disease

5, in the case of the conditions have It is suggested that the nurse station is set in the center of the ward, the center can have a monitor of the cardiac monitor of the whole patient, and the cardiac monitor of each ward can also display the cardiac situation of the whole patient, the modern high-tech for nursing management, greatly reducing the labor intensity of the medical staff, and improve the efficiency of the work

6, the oxygen can be used pipeline delivery, special management, shorten the first aid time, and improve the efficiency of nursing care, reduce safety hazards. efficiency and reduce safety risks.

In the ICU three months of further study has been the end of their own learning through this period of time in all aspects of the ability to get a certain amount of improvement, I would like to sincerely thank the hospital leadership and the nursing department to give me this opportunity to learn, but also thank the medical staff of the first hospital has given me a lot of support and help.