From the management point of view, the sick bay is both a humanistic environment of a special nature, but also a must comply with the medical and health principles, to meet the patient's physical and mental needs of the physical environment. They constitute the center of gravity of the environmental management of the ward.
To make the work of the ward can be orderly, efficient normal operation, it is necessary to ward people, money, materials, technology, equipment, time, information and other movement process organization, planning, coordination, supervision and control, with a view to achieving the intended goals (tasks), which is the task of the ward nursing management.
First, the management of the physical environment of the ward
The physical environment to enhance the medical effect, to help patients to adapt to the role of the patient can not be ignored, the focus of its management are some of the following aspects:
(a) clean. Tidy ward mainly refers to the spatial environment of the ward and all kinds of furnishings of uniform specifications, neat layout; all kinds of equipment and supplies set reasonable, clean and sanitary. To avoid the accumulation of dirt, to prevent the spread of bacteria, to the patient to fresh, comfortable, beautiful purpose. To maintain a clean environment measures; ① things have positioning, return to the position after use, to develop anytime, anywhere attention to clean up the environment, to maintain the habit of cleanliness. ② regular dusting of the walls inside the hospital, the ground and all items with wet cleaning method; ③ timely removal of treatment and care of waste and patient excreta; ④ non-necessary living supplies and non-medical care of patients are not allowed to bring the necessary goods into the hospital area.
(ii) quiet. Quiet environment can reduce the patient's agitation, so that the body and mind to rest and sleep, the same is also the patient (especially patients with serious illness) recovery, health care workers can focus on the important guarantee of orderly work. (1) According to the international noise standard, the daytime noise in the hospital area does not exceed 38Db. (2) Noise control medical staff should do; walking light, talking light, operating light, closing light. (3) Easy to send out loud chair feet should be nailed rubber pads, wheel axle of the trolley, door and window interlocking chain should be regularly dripping lubricant. (4) actively carry out the education and management of keeping the environment quiet.
(C) comfortable. Comfortable environment mainly refers to the patient can be in a quiet, suitable temperature and humidity, fresh air, sunshine, clean, easy to live in the environment, there is peace, cozy, relaxed feeling.
1. Temperature, humidity room temperature is too high nervous system is easily inhibited, affecting the body heat; room temperature is too low, so that the body muscle tension, cold air attack can lead to patients cold cold. Kidney disease room temperature is generally 18-23 ℃ in winter, 20-28 ℃ in summer, pediatrics room between 22-28 ℃, relative humidity of 50% -60% is appropriate. Humidity is too high, conducive to bacterial reproduction, and slow body heat dissipation, the patient feels uncomfortable wet; temperature is too low, the air is dry, the human body water evaporation fast, heat distribution easy to cause respiratory mucosal dryness, dry mouth and sore throat affecting the patient's recovery. Therefore, according to the season and conditions according to local conditions, the use of open windows and ventilation, ground sprinkler, air conditioners and other measures to regulate the indoor temperature and humidity, so that the patient feels happy, safe and sound.
2. Ventilation, air circulation can regulate indoor temperature and humidity, increase the oxygen content of the air, reduce carbon dioxide concentration and the density of microorganisms, so that the patient feels comfortable and pleasant, to avoid boredom, lethargy, dizziness, loss of appetite and other symptoms, conducive to the recovery of the disease body. Reasonable practice is: according to the climate change situation regularly open the windows to ventilate, winter ventilation is generally about 30 minutes each time; the sickroom should be a smoke-free area (no smoking indoors); timely removal of dirt and bad smell.
3. Sunshine, sunny rooms, not only to protect the patient's eyesight, increase vitality; and the use of ultraviolet rays in the sun, to play its bactericidal effect, purify the indoor air; appropriate "sunshine bath" can also enhance the patient's physical fitness, especially in the winter of the sun, so that the patient feels warm and comfortable, stimulate the interest. However, it must be noted: sunlight should not be directed at the eyes, so as not to cause dizziness; nap with curtains to block the sun, not to affect the patient's lunch break; indoor artificial light source, both to ensure that the night work, life lighting, but also can not affect the patient's sleep.
(D) safety. Ward management should make every effort to eliminate all obstacles to patient safety factors, safety and security, the patient's psychological relaxation, can avoid accidents, improve the cure rate, enhance the social effect of nursing. Avoid accidental injury caused by various factors. Such as bathing room floor wet, resulting in patients slipping and falling; coma patients did not add bed gear, protective gear and fall into bed or crash; delirious or agitated patients touching the power supply and burns and so on. ② to eliminate medical damage. Such as carelessness caused by nursing accidents, errors; poor service attitude, resulting in psychological imbalance of the patient. ③Prevent cross-infection in the hospital. All of the above unsafe factors can be avoided through scientific management, to receive satisfactory results. First of all, we should improve the service attitude, put the patients' interests in the first place in everything, and continuously improve the service level and quality; strive to improve the safety facilities in the ward, such as toilets, corridors with handrails, to give a sense of security to the patients with dysfunctions; power sockets are far away from the patients who are in delirium, and there is a small lamp at night for lighting, which is convenient for the patients to live; there is a strict system of environmental sweeping, cleaning and disinfection of goods; the wards and the treatment rooms are equipped with The water flow hand washing equipment that meets the requirements of hygiene.
(E) beautiful. Ward beautification including environmental beauty and the beauty of life in two aspects;
1. Environmental beauty mainly refers to the layout, facilities, supplies, neat beauty, color tone beauty. Generally more light blue, light green and other cold colors, can give a person a quiet, angry feeling; in the ward and ward corridor can also be set up green bonsai plants, flowers, murals, etc., to embellish the beautification of the environment, regulating the spiritual life of patients.
2. The beauty of life mainly refers to the patient's recuperative life involves various aspects such as nursing tools, tableware and other household items beautiful and suitable; nurses' hearts, language, behavioral beauty; patients and health care personnel of the dress beauty; medical and nursing care and operation of the art of design beauty and so on. All of these are done according to the laws of aesthetics, can inspire patients to love life, adjust the psychological distance between patients and nurses, to meet the spiritual and psychological needs of patients.
Second, the organization and division of labor ward nursing
Ward nursing division of labor is based on the duties of nursing staff at all levels and the ability to work in a combination of the design of the collaborative approach. Usually according to the nursing operation to organize the nursing staff division of labor form. The form of organization of nursing work according to the way nursing operates is expanded and evolved with the advancement of nursing and the connotation of nursing work. The quality of care is governed by the way in which care is organized, and different ways of organizing care produce different effects of care.
(a) according to the function of different ways of division of labor;
post-centered, segmented, categorized to complete the task. For example, treatment nurses are responsible for administering medication injections to patients; clinical nurses are responsible for clinical accountability care; office nurses are responsible for handling medical prescriptions, and so on. The advantage is to provide the most basic care with the least manpower, saving manpower, equipment and time, clear tasks, clear responsibility, easy to organize and implement, conducive to proficiency in skills and techniques. For each patient, there is a related fixed-post responsible nurse responsible for the patient's condition and physical and mental needs can have a comprehensive understanding of the convenience of collaborative work to achieve the effect of holistic care.
Accountable care is a modern nursing system adopted in recent years. After a patient is admitted to the hospital, a nurse (i.e., the charge nurse) is designated by the nurse manager to be responsible for the patient's holistic and continuous care. The responsible nurse has a clear scope of responsibility for the patient's care and has the right to autonomy, self-governance and decision-making. This nursing model is patient-centered, with nursing procedures as the core, planned care as the content, and aims to achieve a systematic and holistic nursing purpose by evaluating the effectiveness of nursing care. Responsible nursing can undoubtedly enhance nurses' sense of responsibility for patients, give full play to nurses' potential and professionalism, promote nursing research, and improve nurse-patient relationship, thus further reflecting the value of nursing. However, it requires a high level of knowledge, business skills and overall quality of the responsible nurses; at the same time, there must be enough nurses to fully cover the ward and effectively fulfill the heavy responsibility of responsible nursing.
(2) Group responsibility method;
There are two methods of group responsibility. By neighboring, related diseases with a group, responsible for a number of patients' medical and nursing care. Or according to the severity of the disease will be serious or major post-surgical patients are relatively centralized, by a group of nurses responsible for all their nursing work. The advantages of group responsibility are: conducive to the observation of the condition, timely understanding and to meet the needs of patients; conducive to improving the quality of care, but may need to be equipped with duplicated manpower and the corresponding equipment.
Three, nursing goods, equipment management
(a) goods, equipment management of the main tasks
1. Establishment of a sound management system
2. According to the nursing needs and use of the experience and the principle of economic and practical, for the hospital to provide reasonable advice and suggestions for material procurement
(b) nursing goods management
1. Establishment of a register to record the receipt, loan, damage, loss, etc.
2. Establishment of item cards according to the type of items, positioning, management, regular maintenance, strict handover procedures
3. Establishment of a property book to register the number of items, quality
4. Regular inventory of items
(3) Management of nursing equipment
1. Instrument manuals
2. Establishment of operating procedures
3. Establishment of equipment cards, equipment management
(d) Management of commonly used medicines
1. Ward medicine cabinets according to clinical diseases and needs, to determine the number of bases
2. Medicines should be dry, low temperature, and stored away from light,
3. The drugs should be dry, low temperature, and kept away from light,
3. All kinds of items should be clearly marked
4. Rescue drugs are fixed in the rescue car, fixed base, numbered rows of cases, and positioned in the storage
5. Prevention of nursing defects
1. Strengthen education, awareness raising
2. Cultivate legal awareness, management according to law
3. Strengthen professional theoretical and technical training
4. Establishment of a perfect monitoring mechanism
(2) Nursing error handling
1. After the occurrence of errors, the person concerned should immediately report to the head of the nurses and the leadership of the unit
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2. The department timely organization and discussion
3. The parties involved in the error treatment