one
This summer vacation, I came to the hospital for a 1 month nursing internship. I went deep into the daily work of nurses and experienced the ups and downs of being a nurse, only to find that being a nurse is not as easy as I thought. Being a nurse is really difficult. For a while, transfusion and blood drawing, injection and administration, and enema with traditional Chinese medicine. If the patient is unwell, he will think of the nurse first. If the patient has any problems, he will still call the nurse. If the patient wants to change medicine and infusion, he must call the nurse ... there is always a busy nurse in the ward.
The most profound feeling is that clinic is a solid foundation of theoretical basic knowledge. Clinical field experience and field practice have enabled me to concentrate on thinking about all kinds of questions when learning those boring and stubborn knowledge in this school. For example, why should I read these pharmacology and pathology? What's the use of my back to me? After reading it, it seems that there is no benefit at all, and the knowledge is all-encompassing, but after learning it, the general feeling is that I have been studying only for the exam, and there is nothing for me. At school, no one asked me what adverse reactions I would have if I took these drugs. Even though I knew about these adverse reactions, I never really saw them. I don't understand how serious the medical mistake is. No one has asked me what the clinical manifestations of this disease are, and I have never really seen these clinical manifestations. What's it like? Is it the same as in the book? etc ......
This 1 month internship is also very helpful for me to realize the cooperation between doctors and nurses in my future work. Doctors and nurses have the same responsibilities, both to solve the patients' physical and psychological pain. Only close cooperation between doctors and nurses can bring benefits to patients. To do this, we must first understand our own work and each other's work. As a future nurse, I must understand the work of nurses, so I think this internship not only plays a bridge role in early clinical contact, but also enhances the potential of clinical thinking, cultivates the potential of practice and enhances confidence.
First of all, re-recognize the loftiness of the profession of nurses.
In my previous impression, nurses were synonymous with patience and carefulness. I have always felt that their work is very simple, just follow the doctor's advice and take medicine according to the prescription, and other work is also very trivial. This time, through nursing practice, I went deep into the daily work of nurses for the first time, and experienced the ups and downs of being a nurse, only to find that being a nurse is not as simple as I thought. The job of a nurse is a word "tired". Running with them every day makes me exhausted. They not only have to walk around the ward, but also give patients injections and dressing changes. In fact, they are much more tired than doctors, but they don't complain. Nurses are full of energy as long as they are working. They threw themselves into a battle: at this moment, they fully demonstrated their vitality inside and outside the ward; Give the patient your energy and smile without reservation.
The shift is usually at 8 o'clock in the morning, and all nurses and doctors should attend. Of course, I am no exception. The dean of the department stood in the front. Last night, the night nurses began to give their nursing pathology shift report, and then the doctor on duty. In addition, doctors also talked about the situation of critically ill patients under their jurisdiction. Finally, the two directors and the head nurse summed up the shift that must be done every day. Personally, I think change is very important. It is a discipline for doctors and nurses, so that our medical staff can understand that the life of patients is in our hands. Be organized and disciplined, and be a serious and responsible medical worker.
Second, broaden your horizons and increase your knowledge.
During my internship, I followed my teacher, listened carefully to the teacher's explanation and guidance, learned a lot about the basic operation of medical equipment, and observed and practiced a variety of medical operations, such as measuring weight, blood pressure, breathing, pulse and temperature. There are many professional musical instruments that I saw for the first time. There are many seemingly simple nursing operations, and it is not the case until you really do it. In the short five weeks in the hospital, new things came one after another, which always brought me an exciting impact. I am full of curiosity, pay attention to observation, ask questions attentively, and the nurse patiently explained to me, which made me understand the use of some medical devices and basically mastered the essentials and precautions of nursing operation. They vividly analyzed the seemingly simple operations and gave me many practical opportunities under the premise of rules and regulations, which gave me the opportunity to use these instruments and equipment and practice nursing operations. All these have given me the necessary perceptual knowledge of the work to be done in the future.
Thirdly, it is necessary to understand the holistic nursing of medical cooperation.
This is extremely important for my future work, and it is also one of the most important purposes of this internship. Through understanding, I realize that the responsibilities of doctors and nurses are highly unified, and the goal is to alleviate or relieve patients' physical and psychological pain. Only close cooperation between doctors and nurses can bring benefits to patients. To do this, we must first understand our own work and each other's work. This knowledge accumulation is also the harvest of my nursing practice. Specifically, I learned that:
1. Holistic nursing needs a high degree of cooperation between doctors and nurses, among which the close cooperation between department directors and head nurses is the key. Before carrying out holistic nursing in the ward, the director of nursing department should contact the director of the department to introduce his work plan and implementation plan to the director of the department and win the support of the director. The head nurse must consult with the department director when formulating and implementing the overall nursing work plan, system, responsibilities, division of labor and scheduling methods. The director of the department attached great importance to this work. At the handover meeting, he emphasized the benefits and specific work plan of implementing holistic nursing with medical care, and asked the doctors to support and cooperate attentively. When the department organizes nurses to carry out holistic nursing knowledge training, department directors and doctors must also take part in the study.
2, medical care must be clear responsibilities, cooperation, * * * with management. Every patient in the ward has a small card at the bedside with the names of the doctor in charge and the nurse in charge written on it. When a new patient is admitted to the hospital, the nurse in charge should introduce the doctor and nurse in charge to the patient, so that the doctor and nurse can clearly define their respective responsibilities and bring all-round services to the patient, thus making the cooperation between the doctor and nurse closer.
3, medical * * * with rounds. This is conducive to solving the medical and nursing problems of patients. The nursing department stipulates that the nurse in charge of the ward must attend the doctor's rounds every day and make records. The nursing department does not regularly check the status of the ward round records. Nurses' participation in doctors' rounds can further understand the patient's condition and treatment plan, help nurses find problems and improve the quality of nursing service.
4. The cooperation between doctors and nurses can help doctors understand new nursing concepts. The reform of nursing system has transformed functional nursing centered on diseases into holistic nursing centered on patients, which has changed the simple and passive situation of nurses carrying out medical orders for many years. The new nursing mode, such as nursing patients according to nursing procedures, needs to collect patient data, write nursing medical records, make nursing plans, make health education plans, carry out psychological nursing and communicate with patients. It should be understood by doctors to get support and help.
5, completes the patient's psychological care is the responsibility of medical care * * *. The patient's mood and psychological state have great influence on the prognosis of the disease. Doctors and nurses have the responsibility to treat patients according to biological, psychological, social and medical models. Change the past simple biomedical model of seeing a doctor but not seeing a person. When patients are sick, they will have various negative emotions, such as tension, fear, anxiety, pessimism and disappointment. When the nurse in charge finds the above negative emotions, she can cooperate with the doctor in charge to do a good job of psychological care for the patients, so that they can understand the treatment in a psychological state.
6. Health education is also the responsibility of medical care. Health education is an important function of the hospital, a treatment method and important information for implementing holistic nursing. Health education runs through all stages of patients from admission to discharge. The formulation and implementation of health education plan is completed by medical staff, including: determining the educational needs of patients and their families, establishing educational goals, selecting educational methods, implementing educational plans, and discharging education. At the same time, health education should be clearly defined as a skill that nurses should master, and health education materials should be added to the formulation of nursing routine and diagnosis and treatment routine, which doctors and nurses must follow.
7, timely exchange of information, to solve various problems for patients. Nurses walk around patients all day, spend more time in contact with patients, and report patients' condition changes, drug reactions and treatment problems to doctors in time so that doctors can deal with them in time. Good nurse-patient relationship makes patients willing to tell their thoughts and concerns to nurses. The nurse will pass this information to the doctor, who will explain the patients one by one during the rounds, so as to eliminate the patients' worries in time.
two
The two-week nursing practice has come to an end, and we have benefited a lot from it. During this period, we abide by the intern rules, work hard, study hard and obey the instructions of our superiors.
First of all, let me briefly introduce our work. On the morning of July 9th, we decided to choose tongji hospital as the internship site, and then arrived at the Department of Integrated Traditional Chinese and Western Medicine. Because it is our own major, head nurse Yan quickly agreed to let us put on white coats and report at 7: 30 on Monday.
On the morning of July 1 1, I reported to the Department of Integrated Traditional Chinese and Western Medicine in tongji hospital. Through the head nurse's explanation, I learned that nurses are divided into different classes: nursing, responsible for infusion and dressing change. Class 83, it is a continuous shift at noon, but it gets off work at 3 pm. Night shift, go to work at 3 pm and get off work at 8 pm. The head nurse divided us into three groups, followed by different nursing teachers; Subsequently, we received disposable masks, gloves and badges for us, and told the relevant matters and introduced the hospital workflow. After that, we followed the teacher to make the bed in the ward, then took part in the shift at 8 am and made rounds with the doctor. After rounds, the nurse will give the patient injections, dressing changes and other tests. In the rest of my spare time, I read the medical records in the doctor's office, listened to the doctor discuss the illness, and watched the interns copy the will. 1 1 In the afternoon, the hospital admitted a new patient. We chose to follow a newly hospitalized patient and finally chose the patient in bed 6. All afternoon, I read the medical records in the office and occasionally went to the ward.
For the remaining few days, I went to the hospital at 7: 30 every morning, basically repeating the first day's things and eating something else in the afternoon. In this process, I followed the teacher, listened carefully to the explanation and guidance, learned a lot about the basic operation of medical equipment, observed and practiced many medical operations, such as vital sign measurement (blood pressure, breathing, pulse, temperature, blood sugar), ECG monitoring and so on. Atomization inhalation, intravenous drip, intramuscular injection, instrument disinfection and so on. There are many professional musical instruments that I saw for the first time. There are many seemingly simple nursing operations, and it is not the case until you really do it. I also learned the classification of hospital trash cans. Not only that, when accompanying patients for examination, I learned about ct, color Doppler ultrasound, thoracic puncture, pleural effusion, moxibustion, debridement and other examination and treatment methods; During the injection with the nurse, I also learned about indwelling needles and filters. All these have broadened our knowledge.
Ten days' work is not static. On July 14, I went to the clinic to take part in the treatment of winter disease in summer. Under the leadership of all the brothers and sisters, we learned several acupoints and put plaster on the patients. 15 in the afternoon, I learned a lot from Professor Hu's lecture on the basic principles of treating tumors with traditional Chinese medicine, and understood the importance of thinking in the process of treating diseases.
For interns, it is more important to get in touch with the clinic as soon as possible. Through interns, they can understand the important position of hospital and hospitalization environment, hospital management, doctor's work, nursing methods, medical cooperation and communication between doctors and nurses in the process of disease diagnosis and treatment, and lay a good foundation for future clinical study.
Let's talk about the hospital work problems learned from several aspects:
First, the hospital environment
The first floor of the Department of Integrated Traditional Chinese and Western Medicine has a doctor's office, a doctor's lounge, a nurse's workstation, a dining room, a disinfection room, an instrument room and a 10 ward. Among them, there are 2 large wards with 8 people each; Eight small wards, each with four people. Male patients and female patients are separated in different wards. There are curtains between beds, and the ward is equipped with TV and toilet. When the ward is full, you can add beds in the corridor.
Second, the normal working procedure
At half past seven, the nurse began to make the bed; At 8: 00, the doctors and nurses handed over, and the nurses on duty at night read out the vital signs and conditions of each patient, which were supplemented by the doctors on duty at night, explained some conditions by the doctors on duty, and finally summarized by the director and the head nurse; At 8: 30, doctors make rounds, headed by professors, followed by doctors, interns and trainee doctors; At 9 o'clock, the doctor went to the office to see the medical record and write the doctor's order, and the nurse began to give the patient an injection; 10: 00, take the temperature, blood sugar and blood pressure, and the patient will do other tests; 1 1 point, lunch care. We attended the afternoon work program, so I won't list it here. )
Third, the work of doctors and nurses.
Doctors are responsible for patient rounds, talking with patients, diagnosing diseases and writing long-term and temporary medical orders; Nurses are responsible for all kinds of basic nursing work, such as making beds, dispensing medicines, sending and receiving medicines, injections, dressing changes, measuring blood sugar, blood pressure and body temperature. Doctors and nurses are generally very serious and responsible in their work: doctors are always smiling and affable when asking patients' questions, and doctors take pains to make their self-descriptions easy to understand when patients and their families can't clearly describe their illness; When nurses give injections to patients, they will also double-check the names of people and medicines. Every time a patient comes, the nurses will call his name until he answers, so as to avoid unnecessary mistakes. Doctors and nurses are very tired at work, and only when they really enter the hospital can they deeply understand it. In my previous impression, nurses were synonymous with patience and carefulness. I have always felt that their work is very simple, just follow the doctor's advice and take medicine according to the prescription, and other work is also very trivial. This time, through nursing practice, I went deep into the daily work of nurses for the first time, and experienced the ups and downs of being a nurse, only to find that being a nurse is not as simple as I thought. The job of a nurse is a word "tired". I remember the first day, we walked around with doctors and nurses in the morning and didn't sit there much. When we got home, our feet hurt and we were tired, so we fell asleep. Even people like us who don't have much work are like this. Nurses not only have to keep walking around the ward, but also give patients injections and dressing changes. Their fatigue can be imagined. But they didn't complain.
It's a pity to come. Nurses are full of energy as long as they are working. They threw themselves into a battle: at this moment, they fully demonstrated their vitality inside and outside the ward; Give the patient your energy and smile without reservation.
Fourth, the basic nursing operation
Make the bed: the teacher said that the bed must be flat so that the patient can sleep comfortably; The bed is not changed every day, but cleaned every day, also for the sake of patients' health. Sometimes some seriously ill patients can't turn over, so nurses should try their best to turn them over and clean their beds.
Measuring blood pressure: Grade 07 seniors taught us to measure blood pressure. There are two different sphygmomanometers, one is electronic and convenient, and the other is traditional. Taking blood pressure seems simple, but it must be taken seriously.
Temperature measurement: The head nurse said to dry the sweat under the armpit before measuring blood pressure. These explanations are simple, but they are crucial.
Blood sugar measurement: Some diabetic patients in the hospital should measure their blood sugar before and after meals. The method of measuring blood sugar is relatively simple, but there are many problems in the operation process, such as the method of fingertip disinfection. It is important that the blood sugar measurement should be sharp and neat, otherwise the patient will be very painful. They have to measure their blood sugar at least six times a day. Their nails are only 10, and their fingertips are full of needles. If the blood volume is not enough for the first time, it has to be re-measured, which undoubtedly increases the pain of the patient.
Verb (abbreviation for verb) The importance of communication and communication.
1, between nurses and patients and their families: Sometimes patients' requirements conflict with nurses' duties, such as the fifth patient's breast was removed because of breast cancer, and her chest was covered with scars. The nurse must turn over and make his bed. What should a nurse do? You can't leave everything to the patient, which will cause more serious consequences.
2. When a family member quarrels, the nurse's handling method: silence. I remember that once the family members taught the teacher to be silent and shouted at the nurse because the nurse ignored the patient's pain. At that time, I thought the teacher was worthless. But they may be used to it. The patient is God.
3. Between doctors and patients: Grandma Bed 52 refused to continue treatment because of pain. What should doctors do? Obey grandma's wishes? Or compulsory treatment? The best way is to try our best to persuade grandma to understand the treatment, neither forcing nor letting go. This of course requires excellent communication skills.
4. Between patients: 60 patients with extra beds in the corridor couldn't sleep because of neglect of injections at night, while 6 1 patients played music in the corridor because of boredom during the day, and 60 patients clamored for rest. What should I do at this time? At that time, I went to talk to 6 1 bed, and he understood, although he showed an unhappy expression.
5. Between patients and interns: Patients don't trust interns, think their blood pressure and blood sugar are incorrect, and even have a unfriendly attitude. At this time, interns should understand criticism.
In a word, there will be many contradictions in this process, and how to solve them is very important. We must always practice that the patient is God, understand the teachings with an open mind and communicate with each other in a friendly way, so as to gain the trust of patients. Although sometimes patients and their families are fierce, sometimes they are friendly. Once I helped an old woman move a stool, and the old woman repeatedly said thank you.
Of course, communication between doctors and nurses is also very important. I remember when I was testing the blood sugar of 46 patients, I had a conflict with a classmate and turned my face in front of the patients. This is our extreme immaturity. No matter what happens, keep calm in front of patients and continue to do what you should do. The unity and cooperation between doctors and nurses is also very important.
Six, the doctor told the patient's condition principle
Some patients can't tell them the truth, which is not just the case in TV dramas. Take patient 34 as an example. He has advanced gastric cancer and was implanted with omentum. The doctor told him that it was a tumor, and the patient could eat and drink with confidence and look forward to life.
Seven, the difference between clinical and textbooks.
Many times, what we learned in textbooks was far from enough, and our understanding at that time was not thorough enough. One day, a classmate and I argued about afp in the office. Patients with liver cancer are afp positive, so what about liver metastasis of gastric cancer? Is afp positive or negative? For another example, is the pulse of patients with yin deficiency floating or sinking? If you don't understand thoroughly in class, you will be helpless when you encounter examples. This also inspires us that studying medicine should be used in clinic, not just for exams. We should remember some knowledge so that we can apply it freely in clinic. Clinical practice is an effective supplement to theory.
Eight, talk to patients
Talking with patients is a pleasure. They will tell us some truths about life and warn us to study hard, cherish our health and pay attention to our health. Sometimes they will recall some extraordinary past events. I believe that in this process, patients will also be very happy because someone is listening. We are little apprentices who can only watch but not do. However, our sense of hearing comfort is a warm seasoning that people who are in a hurry lack. Chatting with my uncle in bed 34, who was in moxibustion at that time, I told him that I just had to visit Zusanli, and he agreed. Then make fun of him and say don't be too face-saving and go back and drink less. A smile appeared on his thin face, despite his illness. Perhaps, at this moment, I have a deeper understanding of the sentence "Sometimes for healing, often for helping, always for comfort". My favorite professor always chats happily with patients. Even the words of exhortation can make the patient understand, because it is his sincere concern.
Nine, the problem of difficult and expensive medical treatment
It is difficult to see a doctor, but expensive is a big problem. It costs about 1500-2000 yuan a day in the hospital, and patients without medical insurance simply can't afford it. I remember that there were eight good patients who stayed in the hospital for many days, but they had a fever to be investigated. Finally, the cause was not found, because the medical expenses were too expensive, and they were discharged from the hospital. So are patients with good beds. What moved me most was what Professor * * said. The endurance of rural women in China is very strong. A rural woman came to check up. She had terminal cancer. It is said that she has been suffering for more than ten years. The root of his patience is that he has no money. Who is sick and doesn't want treatment? Although there is cooperative medical care in rural areas at present, according to the family members with 60 beds, the proportion of reimbursement for cooperative medical care is still very small, and most of the expenses are paid by patients themselves. One patient quipped: "Unless you open a bank at home, who can afford it!"
Ten, medical strength beyond.
There are many diseases that can't be treated for life, and even many diseases have not been found out. At present, medicine is not omnipotent, and there are very few real cures. In more than 50 beds of Chinese and Western medicine patients, most of them are cancer, cerebral infarction, hypertension and so on. Every day, patients have injections to take medicine, and their arms are full of needles. What doctors expect is to relieve patients' pain and prolong their lives.
The above aspects are the problems I understand and think about during my internship.
On July 22nd, we bid farewell to the ward, and 10-day internship life officially ended. Anyway, we will still be a little disappointed. After all, I have dealt with doctors, nurses and patients, and I have made rounds with doctors again and again, and I have a little understanding of their illness. When I leave, I will also be noticed. Especially my uncle in bed 34, where I sit every morning. And * * nurse, only he let us test blood sugar alone, but also take care of us novices.
In a word, this internship has taught us a lot, from basic nursing operation to hospital management system, from medical care to the treatment of doctor-patient relationship, which has given me the necessary perceptual knowledge for future work and laid a solid foundation for future work.
three
Next semester, we finally ushered in a five-day off-campus internship. We came to the Second People's Hospital affiliated to Fujian University of Traditional Chinese Medicine with curiosity and enthusiasm for serious work and study. Under the arrangement of the head teacher, Yuping, Yaqiong and Meng Jie and I were assigned to the Department of Nephrology. In this warm and caring department, we spent an extraordinary internship time.
Probation is a kind of training, a kind of social practice to feel the hospital environment and understand the normal work of nurses, and a preparation and understanding of the dream of self-care.
The daily work of nurses seems to be regular and simple, but it is so difficult. Dispensing, injection and infusion. These seemingly simple tasks can't be done well without necessary care and responsibility. Three checks and eight pairs. Before, during and after the operation, the patient's name, bedside card, drug name, usage, concentration and dosage should be checked. These make me understand that no matter how small things are, we must not relax at all, and we must do them seriously. This is responsible for the patients and ourselves.
My teachers are Rong Shu and Qin Zhao. They are both very experienced teachers. I learned a lot from them. After going to work every morning, you should first follow the nurse teacher who has handed over the shift to make rounds to prepare for the next day's nursing work. Usually at nine o'clock, I will follow the teacher to give the patient infusion and push the needle. I'll push the car and go to the wards. When the teacher operates, I will stay and observe carefully, paying attention to every detail of the teacher's operation, how to inject the needle, where the needle is suitable and so on. Similarly, the teacher will also take the initiative to tell me some professional knowledge and precautions: how to exhaust the infusion, how to speed up the infusion, how to push the needle quickly, and keep the needle. In the same way, I will consult my teacher if I have any questions, and the teacher will give me answers carefully, so that I can learn a lot of knowledge that I didn't learn in school under the teacher's indoctrination. But in this process, what I want to learn most is not these, but communication and communication. Communication with patients can not only help our work, but also enhance our communication potential and expand our social circle, which is also a kind of exercise and improvement for ourselves.
In the practice these days, I think there is another useful thing, that is, recognizing and distributing drugs. Of course, dispensing here does not mean how many milliliters of medicine, how much salt water and how much sugar water are needed, but the simplest way is to find out the medicine that a patient should use in a day according to the instructions and put it in the prescribed frame. It seems simple, but it can't be done in a day or two at all. There are many kinds of medicines, and we also find that we can't recognize the names of many medicines, but with an indomitable heart, we decided to do it well. Two days before the internship, we searched one by one according to the drug list, but we still found that some drugs could not be found, but in the end, with the help of the teacher, we were all able to find drugs, but we were still a little unfamiliar. In the next two days, we got faster and faster. The following is the prescription, which requires strict compliance with the doctor's advice and accurate dosage. All this can only be done quickly and qualified if you are familiar with drugs. But in the process, I still found a mistake, that is, I ignored the glucose sugar in my will and thought it was sugar water. As a result, I didn't do it, but the teacher finally gave me a good evaluation. One thing, if you work hard, you will get something, no matter how much.
In five days' time, I can say that I really integrated myself into the nurses' masses and thought about the vital interests of nurses. At present, there are really subtle relationships between doctors and patients, doctors and nurses, and nurses and patients. Once, an uncle's bottle hung up, and his family rang the doorbell for the nurse to pick it up. But at that time, it seemed that the teachers were busy with something, and after half an hour, no one finally answered the bottle. Finally, the family got angry and patted the table of the nursing station. They were very angry. Finally, under the explanation and mediation of the head nurse, the family members were relieved, and the most important thing was that the patient was fine. Another time, because of the doctor's advice, our deputy head nurse had some objections and had an argument with the doctor. Judging from this matter, I think our deputy head nurse is right. We can't trust all the doctors' advice. We should focus on the patient's life and have the potential to find the rationality and mistakes of the doctor's advice. This is what we must have. This is our duty!
The internship week is very short, but in just five days, I learned a lot, thought a lot, and learned a lot. I have my own views on the sacred profession of nurses. If I want to do it, I must do it well, I must!