Thank you for the hospital leadership to give me the opportunity to study, through this training and learning, to a large extent, to open up my horizons, enhance their own business capacity, and recognize the gap between our hospitals and the domestic large-scale high-level hospitals on the existence of professional and technical, and clear the direction of their own future learning and development for the future of learning and business skills training has laid a solid foundation for the future.
The liberation of the army is the first step in the process.
PLA General Hospital is the largest comprehensive hospital in the military, set medical, health care, teaching, research in one, is one of the important national health care base, responsible for the central, the military commission and the headquarters of the health care work, bear the military regions, military types of difficult diseases diagnosis and treatment, the hospital also accepts from the country's local patients. The hospital has more than 4,000 beds and more than 150 clinical and technical departments.
The hospital has an annual outpatient capacity of 2.5 million, more than 80,000 admissions, and nearly 40,000 surgeries. At the same time, the hospital carries out a number of new businesses and new technologies every year, forming a clear technical characteristics and advantages, so that many difficult diseases have been effectively diagnosed and treated, many complex surgeries and major salvage success, some diagnostic and treatment techniques to reach the international advanced level.
First, the technical cooperation of advanced surgery
In the People's Liberation Army General Hospital for a period of seven months of further study, in the General Hospital of the majority of doctors and nurses under the care and help, the successful completion of the rotation of the groups. Through the study, he has been able to independently complete the orthopedic internal fixation of limbs, cervical anterior and posterior approach internal fixation, thoracolumbar internal fixation, percutaneous low-temperature plasma ablation nucleus pulposus vaporization surgery; general surgery of portacaval shunt, radical treatment of rectal cancer, total gastrectomy, retroperitoneal tumors; thoracic surgery of esophagus, lung surgery, and esophageal triple incision; neurosurgery of the cervical spine, anterior and posterior approach internal fixation, orofacial pituitary tumors, meningiomas, cervical artery aneurysms, clipping, and auditory neuroma excision. Clamping, auditory neuroma resection and other major surgery with surgical cooperation.
The advanced instruments and equipment
This time, we went to the General Hospital of the People's Liberation Army for further training and learning, and we saw and operated a lot of advanced instruments with our own hands. For example, ultrasonic knife, warm blanket machine, circuit electrodes, orthopedic and neurosurgery navigation system, neurosurgery craniotomy drill and pneumatic drill, nerve electrical stimulation instrument, rapid disinfection kettle, cryogenic disinfection kettle, instrument ultrasonic cleaning kettle, ethylene oxide disinfection kettle.
General Hospital operating rooms have eliminated the two chemical sterilization methods of glutaraldehyde immersion and formaldehyde re-steaming, and they usually choose autoclave sterilization, ethylene oxide sterilization, and low-temperature sterilization, so the disinfection kettle is also very complete, easy and safe to operate, which not only ensures the sterilization requirements of instruments, but also greatly saves the time to receive the table of surgery. The neurological group uses advanced navigation system to cooperate with the surgery, through the navigation can accurately locate the advantage can judge the position and size of the occupying lesion, whether the resection is complete or not during the operation, which greatly improves the quality of the operation. Orthopedics in the spinal internal fixation surgery using navigation systems can help doctors determine whether the nail is in the cone, there is no damage to the nerve, etc., increasing the coefficient of surgical safety.
Third, the management of the operating room
PLA General Hospital's logistics management, human resources management, instrument management, high-value items in the custody of a lot of advantages worthy of our learning and reference, the department has printed a detailed list of charges, each operation is completed by the charge collector unified checking, recording the account, the same day the cost of the same day to end, to put an end to the default, leakage of fees. The department has printed a detailed list of charges, and the charge collector will check and record the account after each operation. The department is responsible for the next day's supply of routine and special instruments for all surgeries, as well as the supply of emergency surgical instruments, and is responsible for the cleaning and maintenance of the instruments after the surgery is completed and sent to the hospital for disinfection. The General Hospital is very strict and standardized on the teaching of new nurses and trainees, and the training is unified by a teaching team leader. In order to avoid advanced trainees to eliminate blindness on the stage, first of all, the organization of advanced trainees to learn the rules and regulations of the hospital's operating room, workflow, for the advanced trainees of the later smooth cooperation with the operation to lay a solid foundation for each operation is unified training, to eliminate the personal habits in the operation. The training is based on a one-on-one approach, in which the instructor teaches all the trainees by example, so that they can understand the process of each operation, the habits of the operator, and the precautions to be taken during the operation, so that all the trainees can benefit from the process.
Fourth, the personal talk
Through the period of training comparison, found that we and the People's Liberation Army General Hospital, that is, there are gaps also have our advantages. For example, the hospital in the surgical notification form will indicate the intraoperative surgical position, special supplies, whether or not the need for autologous blood recovery instrumentation, the patient has a special infection in order to facilitate the head nurse to arrange the operation; our hospital in the instrument cleaning, maintenance and disinfection of this link in the very detailed, for the maintenance of the instrument is also very much in place in the hospital, basically eliminated the phenomenon of the strike of the instrument during the operation.
7 months of further study, in the PLA General Hospital operating room of the majority of doctors and nurses `help teach and personal initiative to learn, is my theoretical knowledge as well as professional skills have improved greatly, to achieve the established internship goals, the successful completion of the further study task, won the praise of the teacher. I will strive to further improve my work in the future by combining what I have learned from my training, and at the same time, I will implement the advanced management concepts and practices of the foreign hospitals in our hospitals.
General Surgery self appraisal of the secondFirst, the advanced technology with the PLA General Hospital for seven months of further study, in the General Hospital of the majority of doctors and nurses care to help, the successful completion of the rotation of the work of the groups. Through the study, he has been able to independently complete orthopedic internal fixation of limbs, cervical spine anterior and posterior approach, thoracic and lumbar spine internal fixation, and percutaneous low-temperature plasma ablation nucleus pulposus vaporization; general surgery of portacaval shunt, radical treatment of rectal cancer, total gastrectomy, and retropubic peritoneal tumors; thoracic surgery of esophagus, lung surgery, and esophageal three-incision; neurosurgery of cervical vertebrae anterior and posterior approach to internal fixation, oro-nasal pituitary tumors, meningiomas, carotid artery aneurysm Clamping, auditory neuroma resection and other major surgery with surgical cooperation.
Second, advanced instruments and equipment this time to the General Hospital of the People's Liberation Army for further study, to see and personally operate a lot of advanced equipment. For example, ultrasonic knife, warm blanket machine, circuit electrode, orthopedic and neurosurgery navigation system, neurosurgery craniotomy electric drill and pneumatic drill, nerve electrical stimulation instrument, rapid disinfection kettle, cryogenic disinfection kettle, instrument ultrasonic cleaning kettle, ethylene oxide disinfection kettle.
General Hospital operating rooms have eliminated the two chemical sterilization methods of glutaraldehyde immersion and formaldehyde re-steaming, and they usually choose autoclave sterilization, ethylene oxide sterilization, and low-temperature sterilization, so the disinfection kettle is also very complete, easy and safe to operate, which not only ensures the sterilization requirements of instruments, but also greatly saves the time to receive the table of surgery. Neurological group using advanced navigation system with surgery, medical teaching, education network | collection of navigation can accurately locate the advantage can determine the location of the occupying lesion, size, intraoperative resection is complete, greatly improving the quality of surgery. Orthopedics in the spinal internal fixation surgery using a navigation system can help doctors determine whether the nail in the cone, there is no damage to the nerves, etc., to increase the coefficient of surgical safety.
Third, the operating room management experience of the General Hospital of the People's Liberation Army logistics management, human resources management, instrument management, high-value items in the custody of a lot of advantages worth learning from us, the department has printed a detailed list of charges, each surgery is completed by the charge collector unified checking, recording the account, the day of the day the cost of the day to end, to put an end to the delinquency, leakage fee. The department is responsible for the next day's supply of routine and special instruments for all surgeries, as well as the supply of emergency surgical instruments, and is responsible for the cleaning and maintenance of the instruments after the surgery is completed and sent to the hospital for disinfection. The General Hospital is very strict and standardized on the teaching of new nurses and trainees, and the training is unified by a teaching team leader. In order to avoid advanced training personnel to eliminate blind on the stage, first of all, the organization of advanced training personnel to learn the rules and regulations of the hospital operating room, workflow, for advanced training personnel in the later stages of smooth cooperation with the operation to lay a solid foundation, medical teaching, education network | collection of each operation is through a unified training, eliminating the operation of the personal habits. The first step in the process is to teach all the trainees to understand the process of each operation, the habits of the operator, and the precautions to be taken during the operation, so that all the trainees will be benefited a lot.
Self-assessment of general surgery training part threeThe psychological characteristics of surgical patients are nervousness, anxiety, fear, irritability, unresponsiveness, insomnia, depression and so on. Surgery is a special experience for every patient, and most of the patients have a hopeless mindset when they enter the operating room. During surgical anesthesia, accidents can occur regardless of the type of anesthesia. Causing cardiac arrest is the most serious kind of anesthesia accident in anesthesia, and it is also the most difficult kind of anesthesia accident in resuscitation. The author will December 1998 ~ XX May to strengthen the psychological care before surgery, preoperative patient's anti-vision care, with the care of anesthesia accident retrospectively summarized, and reported as follows.
1, preoperative psychological care
1, 1 surgery, no matter how big or small, the patient in the psychological need to withstand a certain degree of pressure. The patient into the operating room, often have a kind of "life in the hands of health care workers," the psychological, health care personnel will directly affect the patient's complex. Therefore, the operating room nurses must be kind, neat instrumentation, demeanor. Attention to all aspects of cultivation is an important prerequisite for good psychological care.
1,2 continue to learn new medical theory and technology, summarize experience, enrich themselves, carry forward the spirit of dedication, improve the nurse's own quality, eliminate the patient's nervousness and fear of psychology, so that the patient can be in the best state of mind to cooperate with the operation.
2, preoperative anti-vision nursing
2, 1 solution to the patient. The first thing you need to do is to go to the hospital and see if you can find a doctor who can help you with the surgery.
2, 2 most patients are eager to understand the anesthesia and surgical methods, we went to the ward before surgery to prevent the patient, introduced to the patient surgery and anesthesia methods, demonstration of surgical position, so that their preoperative bed in the ward pre-training, into the operating room can stand up to active cooperation to improve the success rate of anesthesia, to ensure that the operation is carried out smoothly.
2, 3 read the medical record, ask for medical history, check the patient's general condition and laboratory documents and other auxiliary examination, the name of the operation, anesthesia methods, fully grasp the patient's condition, predict the possibility of intraoperative accidents, and timely preparation of measures to solve the problem.
2.4 Explain the time and importance of preoperative gastric tube, urinary catheter, fasting and drinking ban, and inform the relevant precautions, to obtain the patient's active cooperation.
3, intraoperative anesthesia accident with care
3.1 Standing instruments and medication preparation, such as anesthesia machine, tracheal intubation supplies, cardiac monitor, suction, etc.. Resuscitation drugs such as epinephrine, lidocaine, atropine, dopamine, mesylate, sodium bicarbonate and so on.
3,2 Close observation of the condition during anesthesia allows for early detection and resuscitation as soon as possible. Keep the airway open, if there is a foreign body in the mouth, assist the anesthesiologist to attract and remove it, if the airway is found to be blocked, prepare a tracheotomy kit and make a tracheotomy if necessary. When the anesthesiologist prepares for tracheal intubation, the nurse should first give mouth-to-mouth artificial respiration to avoid interruption of the patient's ventilation. Establish a viable intravenous channel to buy time for medication during resuscitation.
3.3 If cardiac arrest occurs during anesthesia before surgery, the nurse should first perform chest compressions, while speeding up the infusion of fluids, and applying resuscitation medications accurately and correctly according to the doctor's instructions. In the past, the resuscitation of patients with drugs with intracardiac direct injection, now advocate intravenous injection and tracheal drug delivery, the onset of time and drug effects and intracardiac injection of the same, to avoid intracardiac injection of myocardial damage to the adverse factors, early myocardial monitoring, and to provide accurate data to the doctor.
4, experience
4, 1 with the continuous development of the level of medical science, as an operating room nurses, not only in the surgical cooperation with a certain degree of knowledge and experience, but also have knowledge of psychology, to grasp the preoperative patient's various psychological state, summarize the experience, enrich their own, so that their own technical level. The first step is to make sure that you have a good understanding of the situation and the need for a good understanding of the situation.
4,2 Only with rich experience in preoperative nursing, can we make the operating room nursing work from passive to active, from indoor to outdoor, can we give a satisfactory answer to the patient's various questions, get the patient's trust, and do a better job in physical and mental care.
4,3 With the rapid development of medical science, anesthesia has become a genus used in modern medicine. Anesthesia accidents rely solely on the strength of the doctor is often not enough, there must be close cooperation with the operating room nurses. This requires us to study hard, updated knowledge, in the moment of the rescue of the patient, to save the life of the patient's critical moment, and the doctor with the tacit understanding, coordinated action, and compete to save the patient's life.