Tisch
After working for a month, I experienced the initial hesitation caused by unfamiliar environment. At this moment, I felt the joy of harvest, and pointed out the direction for my upcoming work-starting from myself, starting from now, starting from small things, reflecting my value in ordinary work and interpreting the meaning of "angel".
This is a place where everyone is "full of vigor and work hard". Everyone creatively faces work and life, willingly dedicates their enthusiasm and brings health, happiness and hope to patients. No one complains about hard work, and everyone finds their own value in work; Doctors and nurses express their trust and gratitude to the hospital with rigorous attitude, positive action and serious eyes.
In addition to my admiration for teachers' profound knowledge and professionalism, my heart is full of deep gratitude to the dean and head nurse! Thanks to this team, this positive, energetic and caring team!
At first, I just listened, looked and felt. Over time, everyone will drive me to gradually integrate into the culture of the hospital and into the team of orthopedics. A very United departmental team is not only reflected in the fact that colleagues are like a family, but also cares more for patients than relatives. Head nurses attach great importance to patients' psychological care, health education and standardized services, close nurse-patient relationship and improve patients' satisfaction rate with nursing work, which is an opportunity to test and exercise nurses' knowledge structure and comprehensive ability, enhance nurses' role in patients' rehabilitation, and enhance nurses' self-worth and enthusiasm for learning knowledge.
It also made me deeply like back therapy. In fact, every flower is the crystallization of sunshine and rain. I believe that although I have been here for a short month, I have learned a lot of knowledge and benefited a lot, because there are such lovely and respectable colleagues and teachers who always urge me to take every step.
Nurses are not disgusted and impatient with every patient. With their gentlest smiles, the most appropriate language and the most skilled operation, they provide patients with more humanized services, so that every patient who receives treatment here feels "at home". Working here, I was infected by their spirit. Let me gradually understand that our work is not a career, but a career, so that I can keep a positive heart no matter what problems I encounter in my future work.
Of course, I will talk about the current situation and existing problems of the department from my personal point of view.
First, the treatment room and dressing room insist on mopping the floor with disinfectant twice a day, the ward regularly mops the floor with disinfectant, and the sheets of discharged patients are disinfected at the end (clean the bedside table and wipe it with disinfectant).
Second, the application of warm tips and signs. Hanging various warm warning signs and signs in the ward can improve the quality of nursing. The illustrated warm warning signs reflect humanistic care. If warning signs and signs are hung in the dressing room, nurse station, ward corridor, sterile area and polluted area of treatment room, it is more conducive to establishing an interactive nurse-patient relationship and effectively avoiding nursing defects and errors.
Third, establish a management system for first-aid drugs. First-aid drugs must be placed in designated places, managed by special personnel and marked with eye-catching signs. It should be placed in different categories, supplemented and registered in time after use, and the validity period should be checked on time.
Finally, I thank the dean, the head nurse and all my colleagues for their concern. In the future, I will work harder to make my due efforts for the comprehensive quality nursing service and nursing development of hospitals and departments!
extreme
First of all, I would like to thank the leaders of the hospital for giving me this opportunity for further study. Through this special study of endoscopic surgery in the operating room of Fujian Provincial People's Hospital, I greatly broadened my horizons, enhanced my professional ability, realized the gap between us and the superior hospitals, and made clear my future study and development direction, laying a solid foundation for future study and professional skills training.
Now I will sum up what I have learned from my one-month further study as follows:
The cooperation of endoscopic surgery is a highly specialized technical knowledge, which requires operating room nurses to master the operation, use, loading and unloading, cleaning, disinfection and maintenance of endoscopic instruments, as well as the operating procedures, precautions and even the surgical habits of surgeons, and to predict possible problems in endoscopic surgery, understand the reasons and master the correct treatment methods. Only by mastering these can we better cooperate with the work of doctors and carry out safe and efficient auxiliary surgery smoothly. The indispensable premise is that the nurses in the operating room must have a high sense of responsibility and a positive and serious working attitude.
The preparation stage before operation is very important. This includes the preparation of the staff on duty the day before the operation and the preparation of the nurses around the table and on the stage on the day of the operation. Preoperative examination includes instruments and equipment (which must be turned on for inspection), whether co2 is sufficient (due to the large amount of operation, enough spare co2 cylinders must be placed at fixed points and hung with "empty" and "full" signs), sterile bags, disposable articles, operating tables, shadowless lamps, aspirators, etc. Through detailed examination, before the patient enters the room, we should ensure that the surgical materials are in good condition, and also consider the preparation of items that may be used during the operation (whether there are any and where to put them). Find problems in advance and solve them.
The patient should be carefully examined after entering the room, especially if there are many similar operations and it is necessary to pick up the operating table. Checklists can be used to standardize the contents of inspections. If the medical record indicates that there is organ resection, it must be confirmed to the surgical patient again to avoid irreparable serious consequences due to mistakes. At the same time, I am amiable, encouraging and comforting patients, answering patients' questions seriously, increasing patients' sense of security and reducing their tension and fear. (but pay attention to self-protection when answering patients' questions. )
The nurses on the stage came to the stage in advance to check whether the instruments are complete, such as whether the separation forceps can be tightened, whether the unipolar forceps can be used, whether the trocar is unobstructed, whether it is matched with the pneumoperitoneum tube, whether the lens can be connected with the light guide tube, and whether the aspirator switch is elastic and flexible. Pay attention during the operation, carefully observe the operation steps of the surgeon, try to keep up with the doctor's thinking, think of the doctor's next move one step ahead of time, and make preparations before the doctor opens his mouth. Minimize redundant steps and make the operation clean, efficient and smooth.
Nurses around the table should ensure that the patient's posture is safe and comfortable, which is conducive to the operation. Don't use the lithotomy position if you can use the supine position to reduce the pressure on the patient's limbs; When in the lithotomy position, your knees should be as flush as possible with your body. If you stand too high, it will not only increase physical oppression but also hinder the doctor's operation. Don't raise your hips and lower your head too much to reduce the occurrence of postoperative adverse reactions. According to the patient's physical condition, adjust the pneumoperitoneum pressure and inflation speed in time as appropriate to minimize co2 perfusion. (Generally, it is appropriate to set the pneumoperitoneum pressure at 65438±0.3 kPa, which is not more than 65438±0.5 kPa. It is not advisable to inflate suddenly and quickly, especially at the beginning. Ensure the safe and normal use of the instrument, and know how to carry out simple inspection and maintenance in case of emergency failure.
Pay attention to the potential safety hazards during the operation, such as the safe use of electrotome and electrocoagulation equipment, to prevent the patient's upper limbs from excessive abduction and falling off the bed and limbs, to prevent the skin or nerves and blood vessels from being compressed, to prevent burns, and to observe whether the patient has subcutaneous emphysema.
The establishment of co2 pneumoperitoneum sometimes leads to subcutaneous emphysema, so repeated puncture should be avoided as far as possible. Co2 gas can only be injected after the puncture is confirmed to be successful. Fix the trocar during the operation to prevent it from escaping from the abdominal wall and shorten the operation time as much as possible. If there is subcutaneous emphysema, it should be removed immediately, and vital signs should be closely monitored for symptomatic treatment.
Hand-pressurized inflatable infusion bag can be used instead of uterine expansion pump to prevent air from entering and forming air embolism due to excessive pressurization or failure to change fluid in time, which increases safety hazards.
After the operation, the doctor should be supervised to discharge residual gas in abdominal cavity to prevent co2 gas from remaining. In the awake stage of general anesthesia, it is necessary to protect the safety of patients and prevent accidents such as falling out of bed. Finally, fill in the record form carefully and escort the patient out of the ward.
All kinds of optical fibers and power cables connected to the platform can be protected by disposable sterile plastic protective sleeve. This method is quick and convenient, and the service life of optical fiber and power cord will not be shortened because of repeated disinfection. However, attention should be paid to sealing the protective sleeve during operation to prevent the connector from being polluted. Before cleaning and disinfecting the instruments, especially when the instruments are disinfected quickly, the instruments should be disassembled to the smallest unit to ensure the disinfection effect of the chamber.
After the operation on the same day, valuables such as lenses were checked by two people and collected at the designated place. All items should be put back to their original places for use at any time.
Compared with our hospital, the preoperative preparation of surgical patients in Provincial People's Hospital is more adequate. Endoscopic female patients tie their hair to one side and braid it. Don't wear underwear and pants, put on the surgical gown and coat backwards, and untie the straps when you go to the operating table. Ward nurses check the preparation items in detail on the checklist and sign it. The checklist is brought into the operating room with the case and signed by the nurses around the table for confirmation.
In addition, in the observation outside endoscopic surgery, I found that the teacher was very strict in counting the instrument gauze, twice before operation and once before and after suture, to prevent the possibility of instrument gauze left in the patient's body. The inventory of high-pressure packaging is also very careful to ensure that there is nothing missing in formal packaging. Signing your name means being responsible and cultivating good work habits. We also actively cooperate with doctors and strive to provide services for doctors within our own capabilities and conditions, thus shortening the operation time, saving the operation cost, reducing the pain of patients and serving them better.
Nurses in the operating room have a clear division of labor, unite and cooperate on the basis of performing their duties to people, and create a rigorous, serious, positive and harmonious working atmosphere.
Through this rare learning opportunity, I have a further understanding of laparoscopic surgery, especially gynecological laparoscopic surgery, and improved my theoretical knowledge and practical skills to some extent. More importantly, I have broadened my horizons, broadened my thinking and changed my ideas. Generally speaking, it has achieved the established goals, successfully completed the task of entering a higher school, and won unanimous praise from the majority of teaching teachers. In the future work, I will further improve my work by combining the income from further study, and strive to combine the good and advanced concepts and practices of other hospitals with the reality of our hospital and implement them in our hospital in a new way.