Hospitals and inpatient environments
I. Overview
(a) The mission of the hospital
The National Regulations on the Work of Hospitals, issued by the Ministry of Health, suggests that the mission of the hospital is ? To focus on medical work, on the basis of improving the quality of medical care, to ensure the completion of teaching and scientific research tasks, and constantly improve the quality of teaching and scientific research. At the same time do a good job of expanding the technical work of prevention, guidance at the grassroots level and family planning?
(B) Types of hospitals
1. Divided according to hierarchical management According to the "Hospital Hierarchical Management Standards" put forward by the Ministry of Health, hospitals can be divided into one, two and three levels according to different functions and tasks, as well as the level of technical quality and the level of management, and the condition of facilities. Each level is subdivided into A, B, C, etc., and the third-level hospitals are added to the special class, *** divided into three levels of ten.
(1) first-class hospitals: refers to the community directly to a certain population to provide medical and health services to the grass-roots hospitals. Such as rural townships, township health centers, urban street health centers.
(2) second-level hospitals: refers to the provision of health care services to multiple communities and undertake certain teaching and research tasks of regional hospitals. Such as general city and county hospitals, provinces, municipalities directly under the Central Government district hospitals and a certain scale of factories, mines, enterprises and institutions of the staff hospital.
(3) three hospitals: is to provide health care services to several regions or even the country's hospitals, guiding the first and second level of hospital business and mutual cooperation. Such as national, provincial and municipal hospitals directly under the municipal hospitals, hospitals affiliated with medical schools.
2. According to the scope of treatment
(1) General hospitals: a larger proportion of all types of hospitals, refers to a certain number of beds, various types of clinical specialties (such as internal medicine, surgery, pediatrics, obstetrics and gynecology, ophthalmology, otorhinolaryngology, dermatology, etc.), medical and technical departments (such as pharmaceuticals, testing, imaging, etc.) and the corresponding personnel and equipment of the hospital.
(2) Specialized hospitals: hospitals set up for the diagnosis and treatment of various types of specialized diseases, such as maternity hospitals, children's hospitals, stomatological hospitals, infectious disease hospitals.
3. Divided by specific tasks refers to hospitals with specific tasks and service objects, such as military hospitals, corporate hospitals.
4. According to the division of ownership can be divided into national, collective, individual ownership of hospitals, joint venture hospitals, joint-stock hospitals.
5. According to the purpose of business division into non-profit hospitals and for-profit hospitals.
Two, outpatient
(a) outpatient nursing
1. Pre-screening and triage Pre-screening and triage nurses should have rich practical experience and good professional quality. When receiving should be enthusiastic and active, first briefly asked about the history of the disease, after observing the condition, to make a preliminary judgment, and then give a reasonable diagnosis, so that the first pre-screening and diagnosis, and then guide the patient to register for treatment.
2. Arranging waiting and consultation
(1) Before the opening of the clinic, check the waiting and consultation environment, ready for a variety of inspection instruments and supplies.
(2) After the opening of the clinic, according to the order of registration to arrange for consultation. Collecting and organizing initial and follow-up cases and test reports.
(3) Measure temperature, pulse, respiration, etc. according to the condition, and record them in the outpatient case. If necessary, he/she should assist the doctor in the diagnosis and examination.
(4) Observe the condition of waiting patients at any time, such as high fever, severe pain, respiratory distress, bleeding, shock and other patients, should take immediate measures to arrange for early consultation or sent to the emergency room; the more serious condition, the elderly and frail, can be adjusted to the order of consultation.
(5) After the end of the outpatient clinic, the recovery of outpatient cases, organize and disinfect the environment.
3. Carry out health education Make full use of the waiting time for patients to carry out health education. The content can be flexibly mastered according to different seasons, different
Departments, the characteristics of different diseases; the form should be diversified, such as boards, lectures, videos, the distribution of pamphlets and so on. The patient's inquiries should be answered patiently.
4. Implementation of treatment Implementation of the need for outpatient treatment, such as a variety of injections, drug exchange, enema, catheterization, puncture. The treatment must strictly implement the operating procedures to ensure timely, safe and effective treatment.
5. Strict disinfection and isolation The outpatient clinic has the characteristics of patient concentration and mobility, the complexity of the disease, easy to cross-infection, so we must do a good job of cleaning and disinfection of the air, floor, walls, all kinds of supplies, for infectious diseases or suspected infectious diseases, should be assigned to the isolation of the outpatient clinic and do a good job of outbreaks of disease reporting.
6. Do a good job of health care clinic nursing Nurses can be trained to participate directly in the health examination, disease screening, vaccination, health education and other health care work.
(B) emergency nursing
1. pre-screening triage patients arrive at the emergency department, there should be a person responsible for the welcome. Pre-screening nurses should master the emergency room consultation standards, through a question, two see, three check, four diagnosis order, the initial judgment of the severity of the disease, and timely diagnosis to the specialty clinics. In the case of critical patients should immediately notify the doctor on duty and rescue room nurses; in the case of legal disputes, traffic accidents, criminal cases, etc. should immediately notify the hospital's security department or public security department, and ask the family or accompanying people to stay; in the case of catastrophic events should immediately notify the head nurse and the relevant departments.
2. Rescue work
(1) first aid items to prepare: first aid items include general supplies, sterile items and first aid kits, first aid equipment, first aid medicines and communication equipment. First aid items should do? Five? That is to say, the number of varieties, the location, the person to keep, the regular disinfection and sterilization and regular inspection and maintenance, so that the first aid goods intact rate reaches 100%. Nurses should be familiar with the performance and use of first aid items, and be able to eliminate general failures.
(2) with the rescue
1) the implementation of rescue measures: before the arrival of the doctor, the nurse should be based on the condition of the rapid analysis, judgment, emergency treatment, such as blood pressure, hemostasis, oxygen, sputum, the establishment of intravenous channels, chest compressions and artificial respiration. After the doctor arrived, immediately report the rescue situation, actively cooperate with the rescue, the correct implementation of medical advice.
2) make a good record of the rescue: the record includes the time (the patient and the doctor's arrival time, the time of the implementation of rescue measures), the implementation of the contents of the medical advice and the dynamic changes in the condition. Records should be timely, accurate, clear handwriting.
3) strict implementation of the checking system: in the rescue process, such as oral medical advice, the nurse must be repeated to the doctor, when both sides to confirm that there is no error before the implementation of the rescue is completed, the doctor to make up for the doctor's orders and prescriptions in a timely manner. Empty ampoules of all kinds of emergency medicines should be checked by two people, and then discarded after recording. Infusion bottles, blood bags, etc. should be placed uniformly after use, in order to check.
3. observation room Emergency department (room) should be set up in the emergency observation room, there are a certain number of observation beds, the main admission of some of the need for further observation, treatment of patients. Observation time is generally 3 to 7 days. Nursing work in the observation room:
(1) registration, establishment of medical records, writing reports.
(2) to take the initiative to visit the patient, close observation, the correct implementation of the medical advice, conscientiously complete the nursing work, pay attention to the patient's psychological response, good psychological care.
(3) Good management of patients and their families.
Three, ward
(a) the setup and layout of the ward
Each ward is set up with a sick room, critical care room and rescue room, treatment room, doctor's office, nurse's office, dietary room, washroom, bathroom, washroom, toilets, storage, medical lounge, show classroom, etc., if necessary, can be set up for patient If there are conditions, patients can be provided with recreation rooms and meeting rooms. Each ward has 30-40 beds, and each ward has 1-6 beds. Between the two beds should be set up curtains, conducive to treatment, care and maintenance of patient privacy; the distance between the two beds is not less than 1m.
(B) environmental management of the ward
The ward is a hospitalized patient to receive diagnosis and treatment, care and rehabilitation of the place, a good hospitalization environment is to ensure that the patient's physiological and psychological comfort is an important factor. To provide patients with a safe, comfortable, clean, quiet physical environment and a good social environment is one of the important responsibilities of the nurse.
1. Physical environment
(1) quiet: the ward should avoid noise, keep quiet. According to the provisions of the World Health Organization, the ideal sound intensity in the daytime area should be maintained at 35 ~ 40dB. 50 ~ 60dB, the patient can feel tired and restless, affecting rest and sleep. Prolonged exposure to 90dB or more can lead to fatigue, agitation, irritability, headache, dizziness, tinnitus, insomnia, and elevated blood pressure. When sound intensity reaches or exceeds 120dB, it can cause hearing loss or permanent deafness. In order to better control the noise, nursing staff in the work should do: ① four light: talk light, walk light, operation light, open and close the door light; ② sickroom doors, windows, tables, chairs and chairs should be nailed to the feet of the rubber mat; ③ trolley axle should be injected with lubricating oil and regular checks; ④ to the patients and their families to publicize the importance of keeping the sickroom quiet, *** with the creation of a good environment for recuperation.
(2) neat and tidy: keep the nursing unit neat and tidy, such as timely replacement of contamination, and timely removal of excreta, contaminated dressings. Keep patients clean. Staff should be dignified instrument, neat and generous clothing.
(3) temperature and humidity: appropriate temperature, humidity, can make the patient feel comfortable, conducive to the patient's rest, treatment and care work. The patient room should always have a thermometer, hygrometer, in order to assess and adjust the indoor temperature and humidity at any time. General room temperature is 18 ~ 22 ℃; baby room, operating room, delivery room, etc., the room temperature to 22 ~ 24 ℃ is appropriate. Room temperature is too high, the body heat is affected, not conducive to the recovery of physical strength, the patient feels irritable, breathing, digestion are disturbed. Room temperature is too low, cold . Stimulation can make the patient muscle tension, and easy to get cold. The relative humidity of the room is 50% to 60%. When the humidity is too high, the moist air is conducive to the propagation of bacteria, which can increase the incidence of hospital-acquired infections; at the same time, the body's evaporation is weakened, sweating is inhibited, the patient feels hot and stuffy, and the urinary excretion is increased, which aggravates the burden on the kidneys. When the humidity is too low, the air is dry, and water evaporates in large quantities, which can lead to dry mouth, sore throat, thirst, etc. It is particularly unfavorable for patients with tracheotomy, respiratory tract infections, and acute laryngitis.
(4) Ventilation: the sick room should be opened regularly to ventilate, each time about 30 minutes. Ventilation in winter should pay attention to warmth and avoid convective wind. Ventilation can reduce the density of microorganisms in the indoor air, reduce the concentration of carbon dioxide, increase the oxygen content, keep the air fresh, regulate the temperature and humidity, which can make the patient feel happy and refreshed, and increase the sense of comfort.
(5) Light: Indoor light can affect the patient's comfort. Sufficient light can make the patient feel comfortable, happy, and conducive to the observation of the condition and diagnosis, nursing work. Insufficient light can appear eye fatigue, headache, impaired vision, affecting the patient's activities, and even accidents. Lighting is divided into natural light source and artificial light source. The use of natural light, should avoid direct sunlight irradiation of the eyes, to prevent dazzling; nap time curtains should be used to block the light. At night when you sleep, you can open the floor lamp or cover wall lamps, both to ensure that the inspection work, but does not affect the patient's sleep.
(6) Decoration: patient room decoration should be simple, beautiful, beautiful environment can make people produce a pleasant, comfortable feeling. Color affects people's emotions, behavior, health. Such as green makes people quiet, comfortable; light blue makes people open-minded, emotional stability; white makes people feel cold, monotonous, reflective, easy to stimulate the eyes to produce fatigue; cream color gives a soft, pleasing to the eye, a sense of serenity. Hospital decoration should be based on the needs of different colors, such as pediatrics ward, the walls can be used soft warm colors, with some cute cartoon patterns, so that children feel warm and sweet, reduce the fear of psychology; operating room can choose blue or green; try not to choose all white walls. Room, the corridor can be properly placed flowers, green plants, both beautiful, but also add vitality (except allergic diseases room).
(7) safety: take effective measures to prevent and eliminate all unsafe factors.
1) avoid all causes of physical injury: ① avoid mechanical injury: corridors, bathrooms, toilets should be set up railings; rooms, bathrooms, toilets, the ground should be non-slip, to reduce obstacles and set up a call system; unclear consciousness, restlessness, infants and young children, hemiplegia, and other patients, should be used to protect the bed stalls, restraining belts, etc., in order to prevent the fall of the bed; on the first time for the first time to get out of bed for the long term bed-ridden and activities of the patient should pay attention to assist, in order to avoid falling into bed. Patients should pay attention to assist, in order to prevent falls. ② avoid temperature damage: application of cold, hot therapy, should be carried out in accordance with operational requirements, if necessary, need to be guarded; attention to the safe use of flammable, explosive substances and storage, fire prevention facilities and emergency evacuation measures. ③ Avoid biological damage: there are measures to exterminate mosquitoes, flies, cockroaches and so on.
2) Prevention of hospital-acquired infections: Strict implementation of the hospital to prevent and control infection of various systems, such as patient admission health disposal system, disinfection and isolation system, aseptic technology principles of operation, disinfection and sterilization effect monitoring system.
3) Avoid medical injury: Due to the carelessness of medical personnel's speech and behavior, it causes psychological and physiological injuries to patients, which is called medical injury. Such as disrespect for the patient, talk with improper words, care rough action, not according to the operating procedures for the operation, the sense of responsibility is not strong, etc., can cause psychological and physiological damage to the patient. Therefore, we should strengthen the professional ethics education of medical personnel, respect and care for the patient, standardize the language when talking, operate with light and steady movements, and strictly implement the operating procedures and strengthen the sense of responsibility to avoid medical injury.
2. Social environment The hospital is a part of society, the hospital district is a special social environment, nurses have the responsibility to help patients change their roles as soon as possible to adapt to changes in the environment, to establish and maintain good interpersonal relationships, and to promote recovery.
(1) to establish a good nurse-patient relationship: the nurse-patient relationship is a special interpersonal relationship, in which the nursing staff occupies a dominant position. Therefore, nursing staff should do: ① respect for the patient, so that the patient feels welcome and cared for, in the implementation of nursing activities, regardless of the patient's age, gender, position, beliefs, cultural background, economic status and proximity to the same; ② good use of language to play a positive role, to help the patient to establish confidence in overcoming the disease; ③ operating techniques to be skilled, stable, accurate, light, fast, reduce the patient's psychological burden, increase the sense of security, increase the security of the patient, and the patient's confidence in the patient's ability to overcome the disease. The psychological burden of the patient to increase the sense of security, trust; ④ good control of their emotions, cheerful, optimistic mood infected patients, so that they take the initiative to cooperate with the treatment and care, and strive for early recovery.
(2) to establish a good group relationship: patients in the same room constitute a group, a positive group atmosphere can promote patients to adapt to the hospital environment as soon as possible, conducive to recovery. Nurses should: ① guide patients to care for each other, help each other, encourage each other, help patients to establish a good emotional exchange, correctly eliminate bad emotions, so that the room presents a pleasant, harmonious atmosphere; ② guide patients *** with the hospital rules and regulations, and actively cooperate with the treatment and care, to promote the recovery of the disease; ③ to strengthen the communication with family members, to obtain the support and cooperation, to lift the patient's worries *** with good physical and mental care of the patient. With the patient's physical and mental care.