About emergency icu internship summary essay
Part 1: Emergency and ICU internship reflections
Through the apprenticeship in the two departments of the emergency and ICU, I have seen a lot, but also learned a lot. Both understand the importance of calmness and composure in the emergency room, but also in the intensive care unit to have a steady technical operation and clinical resilience, but also see the difference between clinical practice and theory and the classroom.
First we went to the emergency room, in the emergency room teacher first briefly introduced us to the department and triage system. Emergency medicine is an "emergency" word, most of the patients who come here are critically ill patients, so in order to save time and grab every minute and every second of the patient's death, the Emergency Department needs to have its own specialized pharmacy, laboratory, specimen collection window, so that the time is not wasted here; in addition, Dongzhimen's Emergency Department has a 1 to 4 retention room for further observation and examination of the patient. Observation rooms are used for further observation and examination of patients, and critical care observation rooms are used to monitor critically ill patients. Patients come to the emergency room, through the door of the triage desk nurse triage, mainly divided into internal and external, surgery, gynecology, pediatrics, and then proceed to the next step in the diagnosis and treatment. In this teacher talked about, as a good triage nurse should not only have a solid knowledge of triage, know the common types of acute diseases and characteristics, to triage for acute patients, but also should have a calm and collected heart, in the patient triage, do not panic.
Then the teacher and we talked about CPR, the use of simple breathing ball and the use of defibrillator. I was impressed by the use of a simple respiratory balloon. Simple respiratory ball for cardiopulmonary resuscitation, a variety of poisoning caused by respiratory depression, neuromuscular disease caused by respiratory muscle paralysis, a variety of electrolyte disorders caused by respiratory depression, a variety of large-scale surgery, with oxygen therapy for dissolution therapy, for mechanical ventilation patients for special checks in and out of the operating room and other cases, but also a temporary alternative to the ventilator, the respiratory machine in the event of obstacles, blackouts, and other special circumstances can not be used, can be temporarily applied to a simple respirator instead of a respiratory apparatus. It can also be used as a temporary substitute for the ventilator. Simple respiratory ball from the mask, check valve, ball, oxygen storage valve, oxygen storage bag, oxygen catheter composition. The patient should be supine, remove any visible foreign objects such as dentures in the mouth and throat, and insert the oropharyngeal airway to prevent tongue bite and tongue retraction. The resuscitator is located behind the patient's head, tilting the head back and holding the lower forehead firmly so that it faces upward to keep the airway open.
Hold the mask over the nose and mouth and press firmly with the thumb and forefinger, while the other fingers press firmly on the forehead to keep the airway open at all times. Squeeze the bulb with the other hand to deliver gas into the lungs. Regular squeezing of the bulb provides sufficient inhalation and exhalation time, 12-15 breaths/minute for adults and 14-20 breaths/minute for children. Rescuers can confirm that the patient is in a normal state of hyperventilation by using the following scenarios. First, observe whether the patient's chest rises and falls in response to balloon compression. Second, observe changes in the color of the patient's lips and face through the transparent portion of the mask. Third, through the transparent cover, observe whether the check valve is properly utilized. Fourth, during exhalation, observe whether there is a mist in the mask. Operation should pay attention to the mask should be fastened to the nose, otherwise it is easy to leak; if the patient has independent breathing, it should be synchronized with it, that is, the patient's inhalation at the beginning of the smooth extrusion of the respiratory capsule, to reach a certain amount of tidal volume, then completely release the airbag, so that the patient completes the exhalation action.
When the teacher talked about defibrillators, he told us about a common mistake on TV. On TV, we often see the metal surfaces of the two defibrillator handles touching and rubbing against each other before defibrillating the patient. This is a very dangerous maneuver and can easily result in electrocution. Because the switch to start defibrillation is not only on the handle, the defibrillator also has a start button on the console, and the console is not covered by the lid, other people are easy to touch the button directly, resulting in the start of defibrillation, if the defibrillator personnel happen to be in contact with each other on the metal surface of the two handles, which will lead to a large number of discharges, thus causing electrocution.
When talking about CPR, the teacher talked to us about a common phenomenon in the actual operation of the theory is different from our books, that is, in the hospital for artificial CPR, simply can not do a person five consecutive 30 cycles, and even 30 can not be done. The teacher said that when she first came to the emergency room, she could still do more than 10 standard chest compressions, but now she can only do 5 at a time, and no more, and if she can barely do it, she can't reach the standard of compressions, and it's not effective. In addition, in the thin elderly to do chest compressions, the patient is very easy to fracture, basically the patient is rescued, the ribs are almost broken.
ICU wards are transparent, which allows doctors and nurses to see the patient's condition through the glass at any time, to observe the patient's condition changes, and once the condition worsens, immediately carry out rescue. Before entering the ICU, the teacher asked us to change into slippers to enter the ICU, so as to reduce the germs into the ICU, thus preventing the ICU patients with weak immunity from getting infected. Therefore, after entering the ICU, we were observing the patients through the glass, and failed to go to the patient's bedside to have a close observation. The teacher also introduced us to the general situation of the department, which is equipped with respirator, monitor, oxygen, compressed air, first aid equipment, defibrillator and other instruments, storage room, treatment room, disinfection room and dirt room, nurses' and doctors' lounge, doctor's duty room and other facilities, as well as equipment and isolation beds for preventing infections, etc. The scope of the ICU includes patients with various kinds of circulatory failure, serious infections, acute hemorrhage and serious multiple trauma patients, as well as other patients with severe infections. hemorrhage and severe multiple trauma patients, patients with multiple organ failure, acute respiratory insufficiency must be managed respiratory patients, acute renal insufficiency patients, severe acid-base, water-electrolyte disorders and severe metabolic disorders patients, acute disorders of consciousness, especially frequent spasms patients, acute poisoning and drug intoxication patients, patients with severe myasthenia gravis crisis, organ and spinal cord transplantation, and other critical patients who are eager to recover from the short-term intensive treatment. The critically ill patients. But brain death, acute infectious diseases, no acute attacks of chronic diseases, advanced malignant tumors, the process of natural death of old age, and other patients who have no hope of salvation or give up treatment for some reason ICU is not admitted. The teacher also gave us the quality requirements of ICU nurses and the special techniques that should be mastered. As ICU nurses should master the establishment of a variety of venous access technology, invasive arterial blood pressure detection technology, the application of mechanical ventilation, first aid or resuscitation techniques, emergency pacemaker placement with the cooperation and nursing technology, the timely application of assisted circulation technology.
In these two departments of apprenticeship let me learn a lot of knowledge and textbooks are not the same, in the clinical operation can not be completely copied from the textbooks, need to be combined with the actual operating environment and the specific situation of the patient, we have to be flexible to use the knowledge learned from the textbooks, theory combined with practice, in order to go longer and farther on the road of nursing.
Part II: Emergency Department Internship
Dear Teacher:
I am your 303 internship group of Zhang Zhouquan, now I am in the Emergency
Department of the internship this month to summarize:
Emergency Department is the hospital to rescue emergency, critical, severe patients at the forefront of the work of the prominent feature is the "urgent"
The emergency department is the front of the work of the emergency, critical, serious patients. The outstanding characteristics of the work is "emergency", "critical", "heavy". Most of the patients are onset of acute, time-critical, complex conditions, need to be in a short period of time every second, go all out to give timely rescue and care, a slight delay will affect the patient's treatment, and even life-threatening, as an emergency doctor, not only to be familiar with the theory of the various disciplines of the profession, but also to master the operation of the first aid, but also have the patience of the ordinary people do not have the patience and love to see the teacher to the dead patient, wipe the blood off his face, and I will be able to see the patient, and I will be able to see his face, and I will be able to see his face. Seeing the teacher wipe away the blood on the face of the dead patient, I was y touched, to do this is not easy, I have to learn a lot; to be in an emergency, use their own ingenuity, to treat the patient with a sincere and honest attitude, seriously do a good job of communicating with the patient's family. These tasks may seem simple, but they can never be accomplished overnight. Through this period of time in the emergency internship, so that I have a further understanding of the work of doctors, I will remember the emergency rigorous and realistic, serious and cautious work style, down-to-earth and do a good job of every job, and strive to become a good clinician.
Emergency doctors are superhuman, this sentence is not too much. Just to the resuscitation room when I saw the patient bloody scene I stood on the side of the scared don't know what to do, the teachers calm and collected to the patient resuscitation, at the same time also didn't forget to stand next to the internship classmates, step by step to pull us into this scene, slowly I can basically adapt to this atmosphere, solemn and serious, but also rich in love to treat each of the living or the dead. I really admire the skillfulness and calmness of the teachers. In the emergency work under such a stressful environment, the teachers can work very calmly, these are what I have to learn.
Now I will not face some of the gruesome scene of the dumb stand, no longer in the child or elderly patients bedside with the family sad, and forget the operation of the hand. It is really good for the patient to put away his fear and pity and calmly finish what he has just finished. When the fear and unnecessary pity after the demise, I am more able to devote myself to the rescue of patients, in order to make the dying patient through the death of a new life.
During my internship in the emergency room, I took the initiative to comply with the rules and regulations of the emergency room, and mastered the skills of emergency nursing, and completed the nursing work, listened carefully to the teachings of the teachers, and worked hard to improve their own deficiencies. During the internship in emergency medicine, through the enthusiasm of the teachers' guidance, patience, teaching by example, so that I have a deeper understanding of the art of the doctor's work and professionalism. Emergency medicine is the first line to save patients' lives and take care of critically ill patients. As an emergency doctor, not only to be familiar with the theory of various disciplines, but also to master the operation of the first aid, but also have the common people do not have the patience and love; to be in an emergency, use their own ingenuity, to treat the patient in a sincere attitude, seriously do a good job of communicating with the patient's family. These tasks seem simple, but can never be accomplished overnight. Through this period of time in the emergency internship, so that I have a further understanding of the work of doctors, I will keep in mind the emergency rigorous and realistic, serious and cautious work style, down-to-earth and do a good job of every job, and strive to become a good clinician as soon as possible.
The 4-week emergency medicine internship began, respectively, in the rescue room and temporary observation room for 2 weeks. When I first arrived at the emergency room, I thought their uniforms were very nice. Instead of the traditional white coats, they had blue shirt-like tops and pants, unlike the wards. I liked the fact that they looked light and didn't feel like a chore to work in. I once saw someone was axed, the first time so close to the hemorrhaging patients, in the end one of them on the outpatient surgery can be, while one due to intracranial hemorrhage eventually died; one night I work, the rescue room lying three patients, one of them is a schizophrenic patient, a whole night talking to themselves, I do not know what to say, disturbing the patient next to the opinion of a lot, but also One of them is a schizophrenic who talks to himself all night long and doesn't know what to say. There was also a lung cancer patient who died in the middle of the night despite all the medication. I guess I'm still a man of the world. Thinking back to the clinical internship has been half past, have been in the inpatient wards work, very eager to see the emergency scene, this time to the emergency department, finally got what I wished for. The first thing I want to do is to get my hands on a new pair of shoes and a new pair of shoes for the first time.
Sure enough, on the first day of reporting to the department, I saw the teachers busy, moving quickly and cooperating well, but I was dumbfounded. I was looking around at the instruments and only knew the names but didn't know how to use them, so I could only mechanically follow the teacher's instructions to do some miscellaneous work. After a few rounds of chest compressions, the doctor let me go on the stage. This was my first time to press on a real person, at that time I was a little timid, but I did not dare to be negligent, and I was determined to save lives. I looked at the patient's face while pressing, how much I want him to wake up ah, but the data on the ECG monitor is a constant reminder of the patient's departure?
Emergency medicine is the first line to save patients' lives and take care of critically ill patients. After experiencing this, I more y appreciate to the doctor's work of art and professionalism. During the internship in emergency medicine, through the enthusiasm of the teachers to guide, patience and teach, I am familiar with the emergency medicine, learned the cardiac monitoring, CPR, automatic gastric lavage method, defibrillator, ventilator use process and other operations.
In this extremely short four-week period, the biggest experience is the emergency room doctor work characteristics:
"urgent", "busy", "miscellaneous". Emergency patients onset , urgent, rapid change, therefore, we must be every second, rapid processing, for rescue time. Emergency patients to time, number and critical degree of unpredictability, randomness, controllability, therefore, usually to do both division of labor, and cooperation, so that the work is busy but not chaotic.
Four weeks to the emergency room, the time is too short, I just familiar with the environmental structure of the emergency room, the work of the various classes of duties to go, really good to be sad ah!
All in all, I would like to thank my teachers for their careful teaching and the reasonable arrangement of each teacher. I will be more proactive work attitude, more solid and solid operating skills, more rich and deep theoretical knowledge, into the next all departments, improve clinical work ability, the medical cause of dedication and responsibility!
Zhang Zhouquan
December 9, 20XX
Part III: Summary of the internship in the Department of Emergency Medicine
Dujiangyan internship group summary (9.2~10.17)
Emergency Department is the hospital to rescue the emergency, critical, and serious patients. Most of the patients are onset of acute, urgent, complex conditions, need to be in a short period of time, go all out to give timely rescue and care, the slightest delay will affect the patient's treatment, and even life-threatening, as an emergency internship nurse, not only to be familiar with the theory of the various disciplines of professionalism, and more to master the operation of the first aid, but also with the patience of the ordinary people do not have and love, to see the teacher to dead Seeing the teacher wipe away the blood on the face of the dead patient, I was y touched, to do this is not easy, I have to learn a lot; to be in an emergency, use their own intelligence, to treat the patient with a sincere and honest attitude, seriously do a good job in communicating with the patient's family. These tasks may seem simple, but they can never be accomplished overnight. Through this period of internship in the emergency room, so that I have a further understanding of the work of nurses, I will remember the emergency room rigorous and realistic, conscientious and careful work style, down-to-earth and do a good job in every job, and strive to become an excellent clinical nurse.
Emergency nurses are superhuman, this sentence is not too much. Just to the resuscitation room when I saw the patient bloody scene I stood on the side do not know what to do, the teachers calm and collected to the patient resuscitation, at the same time did not forget to stand next to the internship classmates, step by step ` will pull us into this scene, slowly I can basically adapt to this atmosphere, solemn and serious, but also compassionate treatment of each of the living or the dead. I really admire the skillfulness and calmness of the teachers. In the emergency work under such a stressful environment, the teachers can work very calmly, these are what I have to learn.
Now I will not face some of the gruesome scene of the dumb stand, no longer in the child or elderly patients at the bedside accompanied by family members sad, and forget the operation of the hand. It is really good for the patient to put away his fear and pity and calmly finish what he has just finished. When the fear and unnecessary pity after the demise, I am more able to devote myself to the rescue of patients, in order to make the dying patient through the death of a new life.
During my internship in the emergency room, I took the initiative to comply with the rules and regulations of the emergency room, and mastered the skills of emergency nursing, and completed the nursing work, listened carefully to the teachings of the teachers, and worked hard to improve their own deficiencies. In the emergency internship period, through the enthusiasm of the teachers to guide, patience and teach, so that I more y appreciate to the nurse's work of art and professionalism.
When I came to the first day of reporting to the department, to see the teachers busy, quick action, with tacit understanding, but I was dumbfounded. I was surprised to see that I only knew the names of the instruments around me, but I didn't know how to use them, and I could only mechanically follow the teacher's instructions to do some miscellaneous work. After a few rounds of chest compressions, the doctor let me go on the stage. This was my first time to press on a real person, at that time I was a little timid, but I did not dare to be negligent, and I was determined to save lives. I looked at the patient's face while pressing, how much I want him to wake up ah, but the data on the ECG monitor is a constant reminder of the patient's departure?
Emergency medicine is the first line to save patients' lives and take care of critically ill patients. After experiencing this, I more y appreciate to the nurse's work of art and professionalism. During the internship in the emergency room, through the passionate guidance of the teachers, patience and teaching, I am familiar with the emergency medicine, learned the cardiac monitoring, CPR, automatic gastric lavage, defibrillator, the use of ventilators and other operations.
In this extremely short four-week period, the biggest experience is the emergency room nurses work special ? Emergency patients onset of acute, rapid change, therefore, we must be every second, rapid processing, for rescue time. Emergency patients to time, the number and critical degree of unpredictable, random, controllable small, therefore, usually to do both division of labor, and cooperation, so that the work is busy but not chaotic.
In conclusion, I would like to thank my supervising teachers for their careful teaching and the reasonable arrangement of each teacher. I will be more proactive work attitude, more solid operating skills, more rich and deep theoretical knowledge, into the next all departments, improve the clinical work ability, to the medical cause of dedication and responsibility!
Part IV: Summary of the emergency department internship
Clinical internship is the deepening and continuation of school education and teaching, the nature of the emergency department nursing work is more complex, emphasizing the "urgent, fast, accurate, live", the disease is urgent and heavy. The patient's condition changes quickly, the number of consultations, especially in the event of an accidental disaster, to undertake a large number of casualties of the rescue nursing work. So emergency nursing work is very busy, hard, must be busy but not chaotic, nervous and orderly, based on the characteristics of the work of the emergency department, the nursing clinical teaching problems and improvements are summarized as follows: internship nurses 1. theoretical knowledge mastery is not solid, the lack of theoretical basic knowledge and skills of responsibility, internship nurses in the lack of solid theoretical foundations before entering the clinical internship, there is no experience in the technical operation, but also Lack of due responsibility.
2. Nursing students role awareness fuzzy, part of the nursing students just entered the clinical internship on their own role to distinguish, most of the nursing students on their own "student" role is too dependent on the fear of operational failure, patients are not satisfied, not willing to hands-on nursing practice, a few students are too much to strengthen their role as nurses, for a variety of nursing practice. The majority of nursing students are too reliant on their "student" role for fear of failing to operate, and are unwilling to engage in nursing practice.
3. Nursing students' legal awareness is weak, safety awareness is not strong. Nursing students in school rarely receive legal knowledge education, their own legal responsibility is not clear, so in the internship does not pay attention to the relationship between nursing and the law, can not be viewed from the legal point of view of their own nursing work, speak and do things are not rigorous enough, easy to cause medical disputes.
Teaching teachers:
1. Teachers' own quality problems, teaching teachers lack of comprehensive knowledge accumulation and improvement of their own quality, part of the staff professional thinking is not stable, directly affecting the
students enthusiasm, creativity and initiative
2. Teaching time and energy is not enough, the hospital since the implementation of performance appraisal, the nurse staffing constraints To guide students to think differently, respect for the rights of patients, so that nursing students early to establish the legal concept of due diligence and prudence, to strengthen the sense of responsibility.
2. After entering the department, the teacher will lead the nursing students to familiarize themselves with the environment of the ward, observation room, injection room, rescue room, sterile treatment room, rescue medicines, goods, equipment and the location of the relevant requirements, to introduce the professional characteristics of the department, to explain the internship program, as well as the situation of the medical and nursing staff and patients, etc., to eliminate the unfamiliar feeling of the nursing students, to increase self-confidence, and to lay a good foundation for the work of the internship.
3. Theory combined with practice of clinical teaching to develop a detailed teaching plan, according to the requirements of the internship syllabus, combined with the characteristics of the emergency department to develop, arrange a practical teaching plan and nursing teaching room, as much as possible to provide practice opportunities, so that nursing students in the practice of the operation of the gradual completion of the process from unfamiliarity with the familiar and then to the accurate process.
4. Weekly for the emergency department of common diseases, frequent diseases, emergencies, nursing knowledge of small lectures, and the use of common emergency medicine and precautions to give guidance.
5. Combination of theoretical knowledge and clinical practice, the instructor from the nursing students into the department to lead them into the emergency nursing work, together for outpatient observation patients, emergency patients, do a good job of health education, counseling, guiding the direction of the injecting room, together for the injection room patients with intravenous, intramuscular, intradermal, hypodermic injections, do a good job of the three checks and eight, instructing the nursing students to practice hand-to-hand, the instructor hands off, not to let go of the eyes, in each of the work, to help the nursing students recall the work, and to help the students to practice, and to help the nursing students to practice. At the end of the work, to help nursing students to recall the knowledge learned on that day, and encourage them to record clinical notes to deepen the understanding and mastery of knowledge.
6. discharge assessment, nursing students out of the department a week before under the guidance of the instructor for emergency nursing knowledge theory and operation assessment, to understand the nursing students on the theory of emergency knowledge mastery, assessment of qualified to fill out the internship manual.
7. Nursing Department of internship teaching two-way assessment system, the monthly head nurse and teaching teacher meeting summarized, the teacher from moral, physical, ability, responsibility and diligence aspects of training and evaluation of students, students from the teacher's teaching attitude, business level, teaching ability, teaching lectures, teaching room and questioning aspects of the evaluation teacher. This allows nursing students to understand their own shortcomings, timely correction, and constantly improve, but also allows teachers to understand the teaching situation to find out the defects, and constantly improve the teaching program, improve the quality of teaching.
Part V: Emergency Department Internship Summary
Once upon a time, I liked to watch the film and television programs about the emergency department, and felt that the story of the doctors and nurses are so decisive and competent, charismatic, and make me envious. I didn't realize that after years of growing up, I now have the honor of becoming an emergency department nurse, from the beginning of the fumbling to gradually find the rules, which really appreciate how easy it is to do a good job as an emergency department nurse!
The emergency department is one of the most important windows of the hospital, my hospital township staff hospital, not only to receive normal emergency patients, but also to treat the transfer of critically ill patients from the county, there is an emergency, busy, miscellaneous characteristics. In the face of critical emergency patients first diagnosis and rescue, emergency patients and often diagnosis is not clear, the condition is not clear, rapid changes, if not handled properly, it is easy to medical disputes. And patients and their families are prone to impatience, anxiety, fear, emergency is different from the ward, medical staff have enough time to communicate with patients and their families, timely understanding of the needs of patients, and the establishment of a good nurse-patient relationship.
In the emergency, patients and their families in the short contact time with health care personnel, has not yet established a good sense of trust, health care personnel of every minute link is very sensitive, health care personnel's speech and behavior on the patient's psychology will have a great impact. Resulting in the rescue behavior of health care workers are not understood, patients and their families left "not valued", "emergency is not urgent" illusion. So I feel more and more that communication is the most important thing in the emergency room is the most easily ignored.
Florence Nightingale said: nursing not only requires excellent technology, but also requires art. First of all, to learn to observe, only good at finding the existence of problems, including the patient's condition, psychology, needs and family observation. For example: some patients' family members are very critical of the nurses' behavior, but they do not know that their patients' fluids are finished, like this family member, we should patiently remind him every time we change the fluids to what should be called the nurse when the fluids are transferred to what place, and at the same time, we should also visit the wards on time, and observe the progress of the fluids, so that we can avoid conflicts with the patients and their family members to a large extent because the fluids are not replaced in time. This can largely avoid conflicts with the patient because the fluids are not changed in time. Secondly, we should learn to communicate, mutual respect and trust is based on communication. For patients who come to the emergency room, we should proactively ask and enthusiastically guide them. For example: for patients with limited mobility, we can help or assist them with a cart to the clinic, measure their vital signs and hand them over to the clinic nurse; for patients who need and can go to the ward for treatment, we can indicate the location of the ward in detail, to avoid the patient to run "wrong way".
And for patients who have been ill for a long time and are not in critical condition, we can advise them to go to the outpatient clinic, patiently and carefully informing them of the location of the outpatient clinic and the time of the clinic, so as to facilitate the patient's arrangement. Although, a smile expression, a supporting action can not solve the patient's physical pain, but can quickly shorten the distance between the nurse and the patient, to effectively meet the patient needs to be taken care of psychological needs, so that we can carry out the following nursing work. Finally, through observation and communication to learn to judge the patient's condition and needs to have an accurate understanding and judgment, conducive to the development of medical staff to save the work, but also for the patient to buy time. For example: traumatized patients can be observed and roughly asked to understand the location and severity of their injuries, the first time for them to find a doctor for their treatment, and registration and other procedures can be made up later.
The above is just a brief overview of my work in the emergency room, and there is still a lot to learn. In the emergency everyone is my teacher, everything is my experience, teach me a lot of things, whether it is to do people or do things. Of course, to do a good job as a nurse in the emergency department, only communication is far from enough, but also need a solid theoretical foundation, rich experience in rescue, rapid response, sharp action, which is in the emergency when the test of the guarantee.
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