Junior nurse for patient care. Job description of a junior nurse Who has the right to work as a junior nurse

1. This job description defines the functional duties, rights and responsibilities of a junior nurse in caring for patients.

2. A person who has primary vocational education in the specialty “Nursing” without requirements for work experience or secondary (complete) general education, additional training in the field of professional activity without requirements for work experience is appointed to the position of junior nurse for patient care. .

3. A junior nursing nurse should know: techniques for performing simple medical procedures; rules of sanitation and hygiene, patient care; rules for collection, storage and disposal of healthcare facility waste; internal labor regulations; labor protection and fire safety rules.

4. A junior nurse for patient care is appointed and dismissed by order of the head of the organization in accordance with the current legislation of the Russian Federation.

5. The junior nurse for patient care is directly subordinate to the head of his structural unit (head of the department) or the senior nurse.

2. Job responsibilities

Assists in patient care under the direction of a nurse. Performs simple medical procedures (placement of cups, mustard plasters, compresses). Ensures that patients and premises are kept clean. Ensures proper use and storage of patient care items. Changes bed and underwear. Participates in the transportation of seriously ill patients. Monitors compliance by patients and visitors with the internal regulations of the medical organization. Carries out the collection and disposal of medical waste. Carries out measures to comply with the rules of asepsis and antisepsis, conditions for sterilization of instruments and materials, and the prevention of post-injection complications, hepatitis, and HIV infection.

3. Rights

A junior nurse caring for patients has the right:

1. make proposals to management on the organization and conditions of their work activities;
2. use information materials and regulatory documents necessary to perform their official duties;
3. undergo certification in the prescribed manner with the right to receive the appropriate qualification category;
4. improve your skills.

A junior nurse caring for patients enjoys all labor rights in accordance with the Labor Code of the Russian Federation.

4. Responsibility

The junior nursing assistant is responsible for:

1. timely and high-quality implementation of the duties assigned to her;
2. timely and qualified execution of orders, instructions and instructions from management, regulations on its activities;
3. compliance with internal regulations, fire safety and safety regulations;
4. maintaining documentation provided for by current regulations;
5. promptly taking measures, including timely informing management, to eliminate violations of safety regulations, fire safety and other rules that pose a threat to the activities of the organization, its employees and other persons.

For violation of labor discipline, legislative and regulatory acts, a junior nurse caring for patients may be subject to disciplinary, material, administrative and criminal liability in accordance with current legislation, depending on the severity of the offense.

The functional responsibilities of a nurse, girl or woman, whose actions are directed by a doctor, include the implementation of the basic rule: caring for the patient as directed by the authorities and only by him. Other important instructions for her come from this.

What should the nurse know?

The nurse's knowledge must be quite broad. She should not only familiarize herself with the laws related to the health care system, but memorize them, as well as the rights related to her immediate work and the work in which she is engaged. Such a girl or woman should know the basics of fire safety, the tasks of a nurse and the organization of healthcare institutions very well. She should be guided in her activities by the law, orders of her immediate supervisor, materials related to medical issues, the charter of the institution, hygiene and labor regulations and job descriptions (exclusively this one).

This list basically includes the following: caring for patients and sick people, providing medical care before the doctor arrives; sterilization of instruments, dressings and other items for treatment; control over the storage, consumption and use of drugs and preparations, their accounting. The nurse is also involved in ensuring that the patient undergoes procedures exclusively correctly, as well as recording data on the patient’s condition. She administers IVs and injections in the hospital, takes a blood sample, prepares instruments and medications before surgery; measures blood pressure and temperature, gives injections, applies bandages, etc. This is especially true for representatives of this profession working in emergency rooms, schools and traumatology departments.

The functional responsibilities of a nurse in children's clinics also include patronage - monitoring the child's condition and special consultations with parents on how to care for him at home. The district nurse keeps records of people who come to see a doctor, as well as patients who go to the hospital. The nurse's responsibilities include filling out medical cards and checklists, and filling out certificates. In the operating room, a girl of this specialty monitors the integrity and completeness of drugs and instruments, helps the surgeon, giving him the necessary instruments at his request with the necessary efficiency. In schools and preschools, she is also responsible for seasonal and routine vaccinations.

Her responsibilities include carrying out simple medical procedures (related to cupping, compresses, heating pads); change of underwear and bed linen; assistance to a senior employee; transportation of seriously ill patients; monitoring patients' compliance with the rules of the institution, cleanliness, and order. In addition, the nurse's functional responsibilities include replacing the head nurse when she goes on vacation or is on sick leave.

Introduction
Chapter 1. Job responsibilities of a junior nurse for patient care
Chapter 2. Rights and responsibilities of a junior nurse in caring for patients
Chapter 3. Deontological aspects of nursing
Chapter 4. Techniques for performing the basic functional duties of a junior nurse
4.1. Sanitary and hygienic treatment of patients
4.2. Transportation of patients by junior nurses to medical departments of the hospital
4.3. Changing hospital linen
4.4. Supply of bedpan and urine bag
4.5. Treatment of bedsores
4.6. Feeding seriously ill patients
Conclusion
List of sources used

Introduction

The decisive role in ensuring proper patient care is given to nursing and junior medical personnel.

Junior medical personnel are directly responsible for maintaining cleanliness in the wards, corridors, common areas and other premises, and their regular wet cleaning. Junior medical staff often deal with very seriously ill patients with severe motor dysfunction, urinary and fecal incontinence, who have to change underwear several times a day, carry out sanitary and hygienic treatment, and spoon-feed. Such patients are often a burden to others, and often to themselves. Caring for them requires enormous patience, tact, and compassion.

Junior nurses assist in feeding seriously ill patients, changing their underwear and bed linen, serving, cleaning and washing vessels and urinals, carrying out sanitary treatment, accompanying patients to various studies, and ensuring the delivery of tests to the laboratory.

The purpose of this work: study the main responsibilities of junior nurses when caring for patients.

Tasks:

1. Study the job responsibilities of junior nurses in caring for patients;
2. Consider the rights and responsibilities of junior nurses;
3. To study the technology of basic procedures performed by junior nurses when performing their functional duties.

Chapter 1. Job responsibilities of a junior nurse for patient care

A person who has a secondary (complete) general education and additional training in courses for junior nurses in caring for patients without any work experience requirements or secondary (complete) general education, additional training in junior courses is appointed to the position of a junior nurse for patient care. nursing nurses and at least 2 years of experience in the field.

Appointment to the position of a junior nurse for patient care and dismissal from it is made in the manner established by the current labor legislation by order of the head of the healthcare institution.

The junior nurse for patient care reports directly to the chief nurse.

A junior nursing nurse should know:

– laws of the Russian Federation and other legal acts regulating the activities of healthcare institutions;

– organizational structure of the healthcare institution;

– techniques for performing simple medical procedures;

– rules of sanitation and hygiene, patient care;

– basics of the diagnostic and treatment process, disease prevention, promotion of a healthy lifestyle;

– basic methods and techniques for providing pre-medical care;

– ethical standards of behavior when communicating with patients;

– internal labor regulations;

– rules and regulations of labor protection, industrial sanitation, safety and fire protection;

Junior nurse for patient care:

1. Performs simple medical procedures, such as placing cups, mustard plasters and compresses.
2. Monitors cleanliness and order in the premises of the medical institution.
3. Assists in patient care under the direction of a nurse.
4. Ensures that patients and visitors comply with the internal regulations of the healthcare facility.
5. Participates in the transportation of seriously ill patients.
6. Changes bed and underwear.
7. Monitors compliance with sanitary-hygienic and anti-epidemic regulations when using and storing patient care items.

Chapter 2. Rights and responsibilities of a junior nurse in caring for patients

A junior nurse caring for patients has the right:

1. Make proposals to the management of the enterprise on the optimization and improvement of medical and social care, including on issues of their work activities.
2. Demand that the management of the institution provide assistance in the performance of their official duties and rights.
3. Receive information from company specialists necessary to effectively fulfill your job responsibilities.
4. Enjoy labor rights in accordance with the Labor Code of the Russian Federation

The junior nursing nurse is responsible for:

1. For the proper and timely performance of the duties assigned to him, provided for by this job description
2. For organizing your work and qualified execution of orders, instructions and instructions from the management of the enterprise.
3. For ensuring that employees subordinate to him comply with their duties.
4. For failure to comply with internal rules and safety regulations.

For offenses or inaction committed during the treatment process; for errors in the process of carrying out their activities that entailed serious consequences for the health and life of the patient; as well as for violation of labor discipline, legislative and regulatory acts, the junior nurse caring for patients may be subject to disciplinary, material, administrative and criminal liability in accordance with current legislation, depending on the severity of the offense.

Chapter 3. Deontological aspects of nursing

Any specialty is characterized by the existence of its own specific ethical standards and rules of behavior. In this regard, medical deontology (from the Greek deon, deontos - duty, due; logos - teaching) is the science of the professional duty of medical workers. Close in meaning is the concept of medical ethics, the science of the moral and ethical aspects of medicine.

Deontological aspects of nursing are currently becoming increasingly important. Unfortunately, callousness, rudeness, irritability, indifference, and selfish motives have become frequent phenomena in the work of medical personnel.

Of no small importance is the decline in the prestige of the work of paramedical workers. Over the past 20 years, the category of junior medical personnel has practically disappeared in our country.

All this has made it extremely urgent to improve the care of the elderly, the seriously ill, and the disabled, as well as to increase the prestige of the profession of junior nurse and nurse.

The range of problems that medical deontology deals with is extremely diverse. These are various issues relating to the relationship between the doctor and the patient, the doctor and the patient’s relatives, and medical workers among themselves. Many areas of medicine also have their own deontological characteristics. Certain deontological problems arise in connection with the wider introduction of the results of scientific and technological progress into medicine.

Such human qualities as sensitivity, responsiveness, kindness, cordiality, care, attention are required from medical workers every hour in their daily work and when caring for patients. Junior nurses often deal with very seriously ill patients with severe motor dysfunction, urinary and fecal incontinence, who have to change linens several times a day, carry out sanitary and hygienic treatment, and spoon-feed. Such patients are often a burden to others, and often to themselves. Caring for them requires enormous patience, tact, and compassion.

Deontological principles also determine certain requirements for the appearance of junior medical personnel caring for patients. At work, you must use replaceable shoes, your robe must be immaculately clean and ironed, your nails must be cut very short, and it is recommended that your hair be carefully tucked under a cap or scarf. A stale robe, street shoes, dirty hands, poorly trimmed nails are unacceptable from the point of view of sanitation and hygiene and, in addition, make a depressing impression. It is necessary to use cosmetics and perfumes very carefully and moderately, since in patients with allergies they can cause a worsening of the condition - provoke an attack of bronchial asthma, urticaria.

Nursing also requires certain rules for communicating with patients. It should be borne in mind that sick people often become excitable, irritable, hot-tempered, capricious, and sometimes, on the contrary, depressed and indifferent. When caring for them, it is important to show maximum attention, reassure them, explain the need to adhere to the regimen, regularly take medications, and convince them of the possibility of recovery or improvement of their condition.

Great care must be taken when talking with patients suffering from cancer, who are not usually told the true diagnosis, especially in cases of poor prognosis. Such patients often guess that they have a malignant tumor and strive to confirm their assumptions in every possible way. Therefore, it is necessary to carefully ensure that examination data indicating the tumor diagnosis and medical history do not fall into the hands of patients. For the same reasons, you should not communicate the results of patient examinations over the phone.

The deontological aspects of patient care also include the need to strictly maintain medical confidentiality. Medical workers may sometimes become aware of information about a patient that is of a deeply personal, intimate nature, which they do not have the right to disclose. This requirement in no way applies to those situations when, in the process of monitoring a patient, circumstances are revealed that may pose a danger to other people (information about infectious and sexually transmitted diseases, poisoning, etc.). In such cases, medical workers, on the contrary, are obliged to immediately report the information received to the relevant organizations.

Chapter 4. Techniques for performing the basic functional duties of a junior nurse

4.1. Sanitary and hygienic treatment of patients

Junior nurses take part in the sanitary treatment of patients. Sanitary and hygienic treatment is carried out in the sanitary inspection room of the reception department.

The sanitary inspection room of the emergency department usually consists of an examination room, a dressing room, a bath-shower room and a room where patients dress.

In the examination room, the patient is undressed, examined for lice and prepared for sanitary and hygienic treatment.

If the linen is clean, it is put in a bag, and outerwear is hung on hangers and put into a storage room. The list of things (receipt receipt) is made in two copies: one is handed over to the storage room, the other is glued to the medical history and upon discharge, things for the patient are received from it. Available valuables and money are handed over to the senior nurse against receipt to be stored in a safe.

If the patient is diagnosed with an infectious disease, the linen is placed in a tank with bleach or chloramine B for 2 hours and sent to a special laundry. If linen is infested with lice, it is pre-treated with a disinfectant solution and sent to a disinfection chamber for special treatment. Bags with such clothes should have the appropriate inscription - “Pediculosis”.

Stages of sanitary and hygienic treatment of patients.

• Examination of the patient's skin and hair.
• Hair cutting, nail cutting, shaving (if necessary).
• Washing in the shower or hygienic bath.

Examination of the patient's skin and hair

Signs of pediculosis:

• the presence of nits (lice eggs, which are glued by the female to the hair or fibers of fabric; Fig. 2-2) and the insects themselves;
• itching of the skin;
• traces of scratching and impetiginous (pustular) crusts on the skin.

If pediculosis is detected, the patient is subjected to special sanitary and hygienic treatment; the nurse makes an entry in the “Pediculosis Examination Journal” and puts a special note (“P”) on the title page of the medical history, and also reports the detected pediculosis to the sanitary-epidemiological service. Partial or complete sanitary and hygienic treatment can be carried out. Partial sanitary and hygienic treatment consists of washing the patient with soap and a washcloth in the bath or shower, disinfecting and disinfesting his clothes and shoes. Full sanitary and hygienic treatment means the treatment of bedding and living quarters.

All data on the processing of an admitted patient must be recorded in the medical history so that the ward nurse can re-process it in 5-7 days.

Stages of sanitary and hygienic treatment:

1) disinfestation (lat. des– a prefix denoting destruction, insectum– insect; destruction of arthropods that act as carriers of pathogens of infectious diseases);

2) hygienic bath (shower, wiping);

3) cutting hair and nails;

4) dressing the patient in clean linen.

There are several types of disinfectant solutions. 20% benzyl benzoate emulsion solution. Special shampoos (for example, Elko-insect). Special lotions (for example, Nittifor).

The order of the procedure.

1. Prepare for sanitary and hygienic treatment: lay out the necessary equipment and put on protective clothing.
2. Lay an oilcloth on a stool (couch), sit the patient on it and cover his shoulders with a plastic diaper.
3. If necessary, cut the hair over the prepared basin.
4. Treat your hair with a disinfectant solution, tie your head with a plastic scarf and top with a towel, leaving it for a certain time specified in the instructions.
5. Untie your head and rinse with warm running water, then with shampoo.
6. Dry your hair with a towel and treat your hair with a heated 6% acetic acid solution.
7. Tie your head again with a plastic scarf and a towel on top, leaving for 20 minutes.
8. Untie your head and rinse with warm running water, dry with a towel.
9. Tilt the patient's head over the white paper and carefully comb the hair strand by strand with a fine comb, then re-examine the patient's hair.
10. Burn the cut hair and paper in a basin.
11. Place the patient's clothing and the nurse's protective clothing in an oilcloth bag and send it to the disinfection chamber. Treat the comb and scissors with 70% alcohol, and treat the room with a disinfectant solution.

The use of disinfectant solutions is contraindicated during pregnancy, women in labor and breastfeeding, children under 5 years of age, as well as for diseases of the scalp.

The procedure for performing disinsection in the presence of contraindications to the use of disinfectant solutions.

1. Prepare for sanitary and hygienic treatment: lay out the necessary equipment and put on protective clothing.

2. Place an oilcloth on a stool (couch), sit the patient on it and cover his shoulders with a plastic diaper, if necessary, cut the hair over the prepared basin

3. Treat the hair (not the scalp) with a heated 6% vinegar solution, mechanically selecting and destroying lice.

4.Tie your head with a plastic scarf and a towel on top, leaving for 20 minutes.

5.Untie your head and rinse with warm running water, then with shampoo, and dry with a towel.

6. Tilt the patient’s head over the white paper and carefully comb the hair strand by strand with a fine comb, then re-examine the patient’s hair.

7.Burn the cut hair and paper in a basin.

8.Place the patient’s clothing and the nurse’s protective clothing in an oilcloth bag and send it to the disinfection chamber. Treat the comb and scissors with alcohol (70%) and the room with a disinfectant solution.

Hair cutting, nail cutting, shaving

Haircut

Necessary equipment.

• Scissors, hair clipper.
• Basin for burning hair, matches.
• Alcohol (70%).

The order of the procedure.

1. Prepare for sanitary and hygienic treatment: lay out the necessary equipment.

2. Place an oilcloth on a stool (couch), sit the patient on it and cover his shoulders with a plastic diaper.

3. Remove hair with a hair clipper; in case of skin disease of the scalp, cut the hair over the prepared basin

4. Burn your hair.

5. Treat scissors and razor with alcohol.

Shaving

Required equipment:

• Latex gloves.
• Razor, brush and shaving cream.
• Napkin, towel, water container.

The order of the procedure.

1 . Prepare for sanitary and hygienic treatment: lay out the necessary equipment, put on gloves.

2. Heat water (up to 40–45 °C), soak a napkin in it, wring it out and cover the patient’s face.

3.Remove the napkin and apply shaving cream with a brush.

4. Shave the patient, pulling the skin with the other hand in the opposite direction to the movement of the razor.

5.Blot your face with a damp, then dry cloth.

6. Treat the razor with alcohol.

7.Remove gloves, wash hands

Nail cutting

Necessary equipment.

• Latex gloves.
• Scissors and nail clippers.
• Warm water, liquid soap, hand and foot cream, alcohol (70%).
• Basin and tray for water, towels.

1. Prepare for sanitary and hygienic treatment: lay out the necessary equipment, heat the water, put on gloves.

2.Add liquid soap to a tray with warm water and soak the patient’s hands in it for 2–3 minutes (alternately as you trim the nails).

3. One by one, removing the patient’s fingers from the water, wipe them and carefully trim the nails.

4. Treat the patient’s hands with cream.

5.Add liquid soap to a basin of warm water and soak the patient’s feet in it for 2-3 minutes (alternately as the nails are trimmed).

6.Place the foot on a towel (alternately as you trim the nails), wipe it and cut the nails with special tweezers.

7. Treat your feet with cream.

8. Disinfect scissors and tweezers with alcohol.

9.Remove gloves, wash hands.

4.2. Transportation of patients by junior nurses to medical departments of the hospital

Transportation – transporting and carrying patients to the place of medical care and treatment.

The method of transporting the patient from the emergency room to the department is determined by the doctor conducting the examination.

Mobility aids (gurneys, stretchers) are provided with sheets and blankets. The latter must be changed after each use. Patients who move independently are admitted from the emergency department to the ward, accompanied by junior medical staff (junior nurse, orderlies or orderlies).

Patients who cannot move are transported to the department on a stretcher or in a wheelchair.

Transporting a patient on a stretcher manually

The patient should be carried on a stretcher without haste or shaking, moving out of step.

The patient should be carried down the stairs feet first, with the foot end of the stretcher raised and the head end slightly lowered . In this case, the person walking behind holds the handles of the stretcher on his arms straightened at the elbows, while the person walking in front holds the handles on his shoulders.

The patient should be carried up the stairs head first, also in a horizontal position. . In this case, the person walking in front holds the handles of the stretcher on his arms straightened at the elbows, and the person walking behind holds them on his shoulders.

Transferring the patient from a stretcher (gurney) to a bed

Transfer order.

1. Place the head end of the stretcher (gurney) perpendicular to the foot end of the bed. If the room area is small, place the stretcher parallel to the bed.
2. Place your hands under the patient: one nurse places her hands under the patient’s head and shoulder blades, the second - under the pelvis and upper thighs, the third - under the middle of the thighs and lower legs. If transportation is carried out by two orderlies, one of them places his hands under the patient’s neck and shoulder blades, the second - under the lower back and knees.
3. At the same time, with coordinated movements, lift the patient, turn with him 90° (if the stretcher is placed parallel - 180°) towards the bed and lay the patient on it.
4. When the stretcher is located close to the bed, hold the stretcher at the level of the bed, two (three) of you pull the patient to the edge of the stretcher on the sheet, slightly lift it up and transfer the patient to the bed.

Transferring the patient from the bed to a stretcher (gurney)

Transfer order.

1. Place the stretcher perpendicular to the bed so that its head end approaches the foot end of the bed.
2. Place your hands under the patient: one orderly places his hands under the patient’s head and shoulder blades, the second - under the pelvis and upper thighs, the third - under the middle of the thighs and lower legs. If transportation is carried out by two orderlies, one of them places his hands under the neck of the patient’s shoulder blade, the second - under the lower back and knees.
3. At the same time, with coordinated movements, lift the patient, turn 90° towards the stretcher and lay the patient on it.

The method of transporting and placing the patient on a stretcher depends on the nature and location of the disease.

Features of transporting patients

Moving the patient in bed

The patient is moved in bed in stages.

Stage 1. Assess the patient’s ability to participate in the procedure, namely: his mobility, muscle strength, adequate response to words.

Stage 2 . Raise the bed to the height that is most comfortable for working with the patient.

Stage 3. Remove pillows and other objects from the bed that interfere with the patient's movement.

Stage 4. If necessary, seek the help of a nurse or doctor.

Stage 5. Explain to the patient the meaning of the procedure in order to reassure him and encourage cooperation.

Stage 6. Place the bed in a horizontal position and secure the wheels.

Stage 7. To reduce the risk of infection, carry out the procedure with gloves.

Stage 8. After moving the patient, lower the bed and raise the handrails to ensure the patient's safety.

Stage 9. Check the correct position of the patient's body. The back should be straight, any curvature or tension should be avoided. Find out if the patient is comfortable.

Moving a helpless patient in bed

1. Turn the patient onto his back, check the correct body position.
2. Lower the head of the bed to a horizontal position.
3. Place a pillow at the head of the bed to prevent the patient from hitting his head on the headboard.
4. Stand facing the foot of the bed at an angle of 45 0 and move the patient's legs diagonally towards the head of the bed.
5. The procedure begins with moving the legs, because... they are lighter than other parts of the body and easier to move.
6. Move along the patient's thighs.
7. Bend your legs at the hips and knees so that your arms are level with the patient's torso.
8. Move the patient's hips diagonally towards the head of the bed.
9. Move along the patient's torso parallel to his upper body.
10. Place the hand closest to the head of the patient under the patient’s shoulder, clasping his shoulder from below. The shoulder must be supported at the same time with the hand.
11. Place your other hand under your upper back. Head and neck support ensures proper alignment of the patient's body and prevents injury, while torso support reduces friction.
12. Move the patient's torso, shoulders, head and neck diagonally towards the head of the bed.
13. Raise the side rail of the bed to prevent the patient from falling out of bed and move to the other side of the bed.
14. Moving from one side of the bed to the other, repeat the procedure until the patient’s body reaches the desired height.
15. Move the patient to the middle of the bed, in the same way alternately manipulating three parts of his body, until the goal is achieved.
16. Raise side rails to ensure patient safety.
17. Remove gloves, wash hands.

4.3. Changing hospital linen

Hospital linen includes sheets, pillowcases, duvet covers, diapers, shirts, scarves, gowns, pajamas, etc.

Clean linen is stored in the linen room located in the department, on shelves painted with oil paint and covered with medical oilcloth. Shelves for clean linen are regularly treated with a disinfectant solution.

Dirty laundry is stored in a special room in marked oilcloth bags.

All linens must have a department tag and stamp.

The junior nurse regularly changes linen and promptly sends dirty linen to the laundry.

Once every 7-10 days there is a bath day with a change of linen, but if there are seriously ill patients in the department with involuntary urination or defecation, then the linen is changed as it gets dirty.

Due to the fact that the patient spends most of his time in bed, it is important that it is comfortable and neat, that the mesh is well stretched and has a smooth surface. A mattress without bumps or depressions is placed on top of the mesh. Depending on the season, flannelette or wool blankets are used. Bed linen must be clean. The sheets should not have scars or seams, and the pillowcases should not have knots or fasteners on the side facing the patient. Along with bed linen, the patient receives 2 towels.

The bed of patients with involuntary urination and fecal discharge should have special devices. Most often, a rubber bed is used, and the mattress is covered with oilcloth. Bed linen for such patients is changed more often than usual - as it gets dirty.

If a sick woman has copious discharge from the genitals, then to keep the bed clean, an oilcloth is placed under the patient and a small sheet on top, which is changed at least 2 times a day, and if necessary, more often, a pad is placed between the thighs, which is changed as needed. pollution.

The patient's bed must be changed regularly - in the morning, before the day's rest and at night. The junior nurse shakes the crumbs off the sheet, straightens it, and fluffs the pillows. The patient can be seated on a chair during this time. If the patient cannot get up, then move him together to the edge of the bed, then, straightening the mattress and sheet on the vacant half, remove the crumbs from them and transfer the patient to the cleaned half of the bed. Do the same on the other side.

Changing bedsheets for seriously ill patients requires a certain skill from the staff. If the patient is allowed to turn on his side, first, carefully lift his head and remove the pillows from under it. Then they help him turn over on his side, facing the edge of the bed. On the vacant half of the bed, located behind the patient’s back, a dirty sheet is rolled up so that it lies in the form of a roll along his back. A clean, also half-rolled sheet is placed on the vacant space. Then the patient is helped to lie on his back and turn to the other side. After this, he will find himself lying on a clean sheet facing the opposite edge of the bed. Next, remove the dirty sheet and straighten the clean sheet.

If the patient cannot make active movements, the sheet can be changed in another way. Starting from the head end of the bed, roll up the dirty sheet, lifting the patient's head and upper torso. In place of the dirty sheet, place a clean one rolled up in the transverse direction and straighten it in the vacant space. Then a pillow is placed on a clean sheet and the patient’s head is lowered onto it. Next, lifting the patient’s pelvis, the dirty sheet is moved to the foot end of the bed, and a clean sheet is straightened in its place. After this, all that remains is to remove the dirty sheet.

Shirts for a seriously ill patient are changed as follows: slightly raising the upper part of the body, collect the shirt from the back to the neck. Raising the patient's arms, remove the shirt over the head, and then release the arms from the sleeves. If one of the patient’s arms is injured, the sleeve is removed first from the healthy arm, and then from the sick one. A clean one is put on in the reverse order: first, starting with the sore arm, put on the sleeves, and then put the shirt on over the head and straighten it along the back.

4.4. Supply of bedpan and urinal.

A vessel is one of the most necessary items for caring for seriously ill patients. Patients on strict bed rest must be provided with a bedpan when defecating, and men must be provided with a urinal when urinating.

Vessels are made of earthenware, enamel-coated metal, rubber, and various plastics. The vessels come in a variety of shapes, with a large round hole at the top and a relatively small hole in the tube coming off one side of the vessel. The large hole at the top is equipped with a lid. A clean vessel is stored in the toilet room, in a specially designated closet or under the patient’s bed on a stand.

If a patient has a need to empty the intestines, he should, first of all, be fenced off from other patients with a screen. Before use, rinse the vessel with warm water and leave a little water in it. An oilcloth with a diaper is laid under the patient at a corner, the blanket is thrown back, the patient is asked to bend his knees and help him, placing his left hand under the sacrum, to raise the pelvis. Holding the open vessel by the tube with your right hand, bring it under the buttocks so that the perineum is above the large hole, and the tube is between the thighs towards the knees. Covering the patient with a blanket, leave the patient alone for a while. Then the vessel is removed from under the patient, covered with a lid and taken to the restroom, where it is emptied of its contents, thoroughly washed with a brush, disinfected, rinsed and put back in place. The patient must be washed after defecation.

A rubber bedspread is often given to weakened patients or patients with urinary or fecal incontinence to prevent the formation of bedsores. When the vessel is parked for a long time, it is necessary to wrap it in a diaper or put a cover on it (to avoid skin irritation from contact with the rubber). The rubber vessel is not tightly inflated using a foot pump. It is disinfected in the same way as an enamel vessel. To eliminate odor, the rubber vessel is rinsed with a weak solution of potassium permanganate.

Patients on strict bed rest are forced to urinate in bed. For this purpose, there are special vessels - urinals. They are made of glass, plastic or metal and have an oval shape with a hole elongated into a short tube. The shape of the tube - the opening of the female and male urinals is somewhat different. Women more often use a bedpan rather than a urinal. Urinals, just like bedpans, must be individual. They should be served clean and heated, and immediately freed from urine. Disinfection of urinals is carried out in the same way as vessels. Since urine is often a sediment that adheres to the walls in the form of plaque and emits an unpleasant ammonia odor, from time to time the urinals must be washed with a weak solution of hydrochloric acid, followed by rinsing with running water.

4.5. Treatment of bedsores.

Bedsores are dystrophic ulcerative-necrotic processes that occur in weakened patients who remain in bed for a long time. Most often, bedsores form in the area of ​​the shoulder blades, sacrum, greater trochanter, elbows, occipital region, and back of the heels.

The formation of bedsores is promoted by poor skin care, uncomfortable bed, and infrequent re-bedding. One of the first signs of bedsores is pale skin and wrinkles, followed by redness, swelling and peeling of the epidermis. Then blisters and skin necrosis appear. Infection can lead to sepsis and cause death.

Prevention of bedsores:

• turn the patient on his side several times a day, if his condition allows (change the patient’s position);
• shake off the sheets several times a day so that there are no crumbs in the bed;
• ensure that there are no folds or patches on bed linen and underwear;
• for seriously ill patients who have been in bed for a long time, place an inflatable rubber circle with a pillowcase on it, so that the sacrum is above the hole in the circle;
• wipe the skin daily with a disinfectant solution: camphor alcohol, vodka, cologne, and in their absence, wipe the skin with a towel moistened with warm and soapy water, and wipe dry, lightly rubbing the skin.

To wipe, moisten the end of a clean towel with a disinfectant solution, wring it lightly and wipe the neck, behind the ears, back, buttocks, front surface of the chest and armpits. Particular attention should be paid to the folds under the mammary glands, where obese women can develop diaper rash. Then the skin is wiped dry in the same order.

These procedures are performed by nurses every day at night for patients who cannot take a weekly hygienic bath, as well as for unconscious patients. Thus, with proper care, the patient’s skin should always be dry and clean.

4.6. Feeding seriously ill patients

Caring for seriously ill patients requires enormous patience, skill and compassion from the nurse. Such patients are very vulnerable, often capricious in their desires, and impatient. All these changes do not depend on the patient himself, but are associated with the influence of the disease on the patient’s psyche and behavior. These should be regarded as symptoms of a serious illness. For a sick person, food and drink become especially important, often determining either recovery or progression of the disease. Poor nutrition several times increases the risk of developing bedsores, slows down recovery, and contributes to the progression of the underlying disease.

Before you start feeding, it is necessary to carry out all medical procedures and carry out the patient’s physiological functions. After this, it is necessary to ventilate the room and help the patient wash his hands. A nurse can help the nurse with this. It is best, if the condition allows, to give the patient a semi-sitting position or raise the head of the head. If this cannot be done, then it is necessary to turn the patient's head to the side. A great help in feeding a seriously ill patient is a functional bed equipped with a special over-bed table. If there is none, then instead of a table you can use a bedside table. Cover the patient's chest with a napkin, and if necessary. put some oilcloth on it. Food should be semi-liquid and warm.

Conclusion

Every doctor knows well how great the importance of junior nurses is in caring for patients.

Junior nursing nurse

The duties of a junior nurse include:

1. Regular wet cleaning of premises: wards, corridors, common areas, etc.
2. Assisting a nurse in caring for patients: changing linen, feeding seriously ill patients, hygienic provision of physiological functions of seriously ill patients - feeding, cleaning and washing vessels and urinals, etc.
3. Sanitary and hygienic treatment of patients.
4. Accompanying patients for diagnostic and treatment procedures.
5. Transportation of patients. helps the ward nurse in caring for the sick, changes linen, ensures that the patients and the hospital premises are kept clean and tidy, participates in the transportation of patients, and monitors patients’ compliance with the hospital regime.

Junior nurses often deal with very seriously ill patients with severe motor dysfunction, urinary and fecal incontinence, who have to change linens several times a day, carry out sanitary and hygienic treatment, and spoon-feed.

Caring for them requires enormous patience, tact, and compassion.

List of sources used

1. Kazmin V.D. “Handbook for nurses and aides” (in questions and answers), 2009.
2. Mukhina S. A., Tarnovskaya I. I. “Practical guide to the subject “Fundamentals of Nursing” Moscow Publishing Group “Geotar-Media” 2008.
3. Mukhina S.A. Tarnovskaya I.I. Theoretical foundations of nursing: Textbook. – 2nd ed., rev. and additional – M.: GEOTAR – Media, 2008.
4. Obukhovets T.P., Sklyarova T.A., Chernova O.V. Fundamentals of Nursing. – Rostov e/d.: Phoenix, 2002.
5. Petrovsky B.V. – “Deontology in medicine.” - M.: Medicine, 2010.
6. Order of the Ministry of Health and Social Development of the Russian Federation (Ministry of Health and Social Development of Russia) dated July 23, 2010 No. 541n “On approval of the Unified Qualification Directory of positions of managers, specialists and employees, section “Qualification characteristics of positions of workers in the field of healthcare”
7. Professional standard “Junior nurse for patient care” 2010.
8. Guide for paramedical workers / Ed. Yu.P. Nikitina, V.M. Chernysheva. – M.: GEOTAR-Media, 2007.
9. Nurse's Handbook. – M.: Eksmo Publishing House, 2006.
10. Khetagurova A.K. “Problems of ethics and deontology in the work of a nurse” Supplement to the journal “Nursing” No. 1, 2008.

\Typical job description for a junior nurse for patient care

Job Description of a Junior Nurse for Patient Care

Job title: Junior nursing nurse
Subdivision: _________________________

1. General Provisions:

Subordination:
• The junior nurse for patient care reports directly to....................................
• The junior nurse for patient care follows instructions.................................................... ..........

(the instructions of these employees are followed only if they do not contradict the instructions of the immediate supervisor).

Substitution:

• The junior nurse for patient care replaces.................................................... .......................................
• Replaces the junior nurse for patient care.................................................... ....................................

Hiring and dismissal:
A junior nurse for patient care is appointed and dismissed by the head of the department in agreement with the head of the department.

Must know:

• nursing rules
• methods of cleaning and processing assigned premises with their equipment, inventory, utensils, etc.
• rules for operating small-scale mechanization equipment
• safety rules and compliance with sanitary and hygienic conditions in institutions (divisions).

• Nursing.
• Delivery of patients to treatment, diagnostic and other units.
• Providing assistance to doctors and paramedical workers during treatment and diagnostic procedures.
• Maintaining cleanliness of assigned premises with their medical, special and household equipment, soft equipment and furniture.
• Assisting a patient in need with dressing, undressing, washing, bathing, feeding, and putting to bed.
• Providing a bedpan to the patient, changing the patient's clothes and linen.
• Wet cleaning of premises.
• Processing of instruments, patient care items, dishes.
• Monitoring patients' compliance with internal regulations.

4. Rights

• The junior nurse for patient care has the right to give instructions and tasks to employees subordinate to him on a range of issues included in his functional responsibilities.
• The junior nurse for patient care has the right to monitor the implementation of production tasks and the timely execution of individual assignments by employees subordinate to him.
• The junior nursing nurse has the right to request and receive the necessary materials and documents related to his activities and the activities of his subordinate employees.
• The junior nursing nurse has the right to interact with other services of the enterprise on production and other issues included in his functional responsibilities.
• The junior nurse for patient care has the right to get acquainted with draft decisions of the enterprise management concerning the activities of the Unit.
• The junior nursing nurse has the right to submit proposals for improvement of work related to the responsibilities provided for in this Job Description for consideration by the manager.
• The junior nurse for patient care has the right to submit proposals for the consideration of the manager on encouraging distinguished employees and imposing penalties on violators of production and labor discipline.
• The junior nurse for patient care has the right to report to the manager about all identified violations and shortcomings in connection with the work performed.

• The junior nurse for patient care is responsible for improper performance or failure to fulfill his job duties provided for in this job description - within the limits determined by the labor legislation of the Russian Federation.
• The nursing assistant is responsible for violating the rules and regulations governing the activities of the enterprise.
• When transferring to another job or being released from a position, the Junior Nursing Nurse is responsible for the proper and timely delivery of cases to the person taking up the current position, and in the absence of one, to the person replacing him or directly to his supervisor.
• The junior nursing nurse is responsible for offenses committed in the course of her activities, within the limits determined by the current administrative, criminal and civil legislation of the Russian Federation.
• The junior nurse caring for patients is responsible for causing material damage - within the limits determined by the current labor and civil legislation of the Russian Federation.
• The nursing assistant is responsible for compliance with current instructions, orders and regulations for maintaining trade secrets and confidential information.
• The junior nurse for patient care is responsible for compliance with internal regulations, safety regulations and fire safety.

Head of structural

Nursing care is provided by nursing and junior medical staff.

Nursing staff

A nurse is a specialist with secondary medical education (graduates from medical college). A nurse is classified as a nursing assistant; she acts as a doctor’s assistant in medical institutions, carries out medical appointments and carries out the nursing process. According to WHO definition, the essence of the nursing process lies precisely in the provision of patient care.

The responsibilities of a nurse depend on the type and profile of the medical institution where she works, her position and the nature of the work performed. The following nursing positions exist.

· Chief nurse. Currently, he is a specialist with a higher medical education, graduating from the Faculty of Higher Nursing Education of a medical university. She deals with issues of rational organization of labor, advanced training of middle and junior medical staff of the hospital and monitors their work.

· Senior nurse assists the head of a hospital (polyclinic) department in administrative and economic matters, organizes and controls the work of ward nurses and junior medical staff.

· Ward nurse carries out medical appointments for patients in the wards assigned to her, monitors the condition of patients, provides care for them and organizes their meals.

· Procedural nurse carries out medical prescriptions (intravenous injections and infusions), helps with manipulations that only a doctor has the right to perform, takes blood from a vein for biochemical studies.

· Operating room nurse assists the surgeon during surgical interventions, prepares surgical instruments, suture and dressing material, and linen for the operation.

· Community nurse assists the local doctor in the reception of patients living in his area, carries out medical procedures at home as prescribed by the doctor and participates in carrying out preventive measures.

· Nurses who see patients with specialized doctors (ophthalmologist, otorhinolaryngologist, neurologist, etc.).

· Dietic nurse (diet nurse) under the guidance of a nutritionist, he is responsible for the organization and quality of medical nutrition, draws up menus, controls the culinary processing and distribution of food, as well as the sanitary condition of the kitchen and dining room for patients.

Despite a certain division of the functions of nurses, there is a range of responsibilities adopted for the mid-level medical level as a whole.

1. Carrying out medical prescriptions: injections, dispensing medications, administering mustard plasters, enemas, etc.

2. Implementation of the nursing process, including:

1. Nursing examination - initial examination of the patient, measuring body temperature, counting respiratory rate (RR) and pulse, measuring blood pressure, monitoring daily diuresis, etc.;

2. Correct collection of material for analysis (blood, sputum, urine and feces);

3. Providing care for patients - care for the skin, eyes, ears, oral cavity; control over the change of bed and underwear; organization of proper and timely nutrition for patients.

3. Providing first aid.

4. Providing transportation of patients.

5. Reception of admitted patients and organization of discharge of patients.

6. Monitoring the sanitary condition of the departments.

7. Monitoring patients’ compliance with the internal regulations of medical institutions and their compliance with personal hygiene rules.

8. Maintaining medical records. Junior medical staff

Junior medical personnel include junior nurses, housekeepers and nurses.

· Junior nurse(nursing nurse) helps the ward nurse in caring for the sick, changes linen, ensures that the patients and hospital premises are kept clean and tidy, participates in the transportation of patients, and monitors patients’ compliance with the hospital regime.

· Sister-hostess deals with economic issues, receives and issues linen, detergents and cleaning equipment and directly supervises the work of nurses.

· Nurses: the range of their responsibilities is determined by their category (department nurse, barmaid, nurse, cleaner, etc.).

The general responsibilities of junior medical staff are as follows:

1. Regular wet cleaning of premises: wards, corridors, common areas, etc.

2. Assisting a nurse in caring for patients: changing linen, feeding seriously ill patients, hygienic provision of physiological functions of seriously ill patients - serving, cleaning and washing vessels and urinals, etc.

3. Sanitary and hygienic treatment of patients.

4. Accompanying patients for diagnostic and treatment procedures.

5. Transportation of patients.

Fundamentals of medical ethics (deontology)

Medical ethics (lat. ethics, from Greek ethics - the study of morality, ethics), or medical deontology (Greek. deon - duty; the term “deontology” has been widely used in the domestic literature in recent years) - a set of ethical standards and principles of behavior of medical workers when performing their professional duties.

According to modern ideas, medical ethics includes the following aspects:

· scientific - a section of medical science that studies the ethical and moral aspects of the activities of medical workers;

· practical - an area of ​​medical practice, the tasks of which are the formation and application of ethical norms and rules in professional medical practice.

Medical ethics studies and determines solutions to various problems of interpersonal relationships in three main areas:

· medical worker - patient,

· medical worker - relatives of the patient,

· medical worker - medical worker.

Any medical worker should have such qualities as compassion, kindness, sensitivity and responsiveness, caring and attentive attitude towards the patient. Ibn Sina also demanded a special approach to the patient: “You should know that each individual person has a special nature inherent to him personally. It is rare or even impossible for anyone to have the same nature as him.” The word is of great importance, which implies not only the culture of speech, but also a sense of tact, the ability to lift the patient’s mood, and not to injure him with a careless statement.

Of particular importance in the medical profession are such universal norms of communication as the ability to respect and listen carefully to the interlocutor, demonstrate interest in the content of the conversation and the patient’s opinion, and correct and accessible construction of speech. The neat appearance of the medical staff is also important: a clean gown and cap, neat replacement shoes, well-groomed hands with short-cut nails.

Even in ancient Indian medicine, the doctor told his disciples-followers: “Now leave your passions, anger, greed, madness, vanity, pride, envy, rudeness, buffoonery, falsehood, laziness and all vicious behavior. From now on you will wear your hair and your nails short, dress in red clothes, and lead a clean life.” It is always necessary to remember that it is unacceptable for a physician to use perfumes and cosmetics without measure. Strong and pungent odors can cause undesirable reactions: from nervous irritation of the patient and various manifestations of allergies to an acute attack of bronchial asthma.

PRIMUM NON NOCERE (Latin) - FIRST OF ALL, DO NO HARM - this statement is the main ethical principle in medicine.

The moral responsibility of a medical worker implies compliance with all principles of medical ethics. Incorrect diagnosis, treatment, and behavior of the doctor, representatives of nursing and junior medical personnel can lead to physical and moral suffering of patients. Such actions are unacceptable honey. employee, such as disclosure of medical confidentiality, refusal of medical care, violation of privacy, etc.

Caring for a patient involves, among other things, also observing certain rules of communication with him. It is important to pay maximum attention to the patient, reassure him, explain the need to adhere to the regimen, take medications regularly, and convince him of the possibility of recovery or improvement of his condition. Great care must be taken when talking with patients, especially those suffering from cancer, who are not usually told the true diagnosis. And today the statement of the great physician of antiquity, the father of medicine, Hippocrates, remains significant: “Surround the patient with love and reasonable consolation, but, most importantly, leave him in the dark of what threatens him.” In some countries, the patient is still informed about the seriousness of the disease, including the possible death (lat. le-talis- fatal), based on socio-economic considerations. Thus, in the USA, a patient even has the right to initiate legal proceedings against a doctor who hid the diagnosis of a cancerous tumor from him.

Iatrogenic diseases

Violation of the deontological principles of communication with a patient can lead to the development of so-called iatrogenic diseases (Greek: iatrogenic diseases). -iatros- doctor, -gepes - generated, arising). Iatrogenic disease (iatrogenics) is a pathological condition of a patient caused by careless statements or actions of a doctor or other medical worker that create in a person the idea that he has a disease or the particular severity of his disease. Inappropriate, wounding and harmful verbal contacts for the patient can lead to various psychogenic iatrogenies.

However, more than 300 years ago, the “English Hippocrates” Thomas Sydenham (1624-1689) emphasized the danger for the patient not only of the actions of a medical worker, which traumatize the patient’s psyche, but also of other possible factors - undesirable consequences of medical manipulations. Therefore, at present, any diseases the occurrence of which is associated with certain actions of medical workers are considered iatrogenic.

So, in addition to the psychogenic iatrogeny (iatropsychogeny) described above, there are:

· iatropharmacogenia: a consequence of drug effects on the patient - for example, side effects of drugs;

· manipulation iatrogenics: adverse effects on the patient during his examination - for example, complications during coronary angiography;

· combined iatrogenies: a consequence of the influence of several factors;

· so-called silent iatrogenies - a consequence of the inaction of a medical worker.