Part I: Reflections on emergency and ICU probation.
Through my internship in emergency department and ICU, I have seen a lot and learned a lot. I not only understand the importance of being calm in the emergency department, but also understand the need for steady and steady technical operation and clinical adaptability in the intensive care unit, and also see the difference between clinical practice and classroom theory.
First, we went to the emergency room. The teacher in the emergency department first briefly introduced the situation of the department and the triage system. The word "emergency" means "emergency". Most of the patients who come here for treatment are seriously ill. Therefore, in order to save time and seize every minute of the dead patients, the emergency department needs its own special pharmacy, laboratory and specimen collection window, so that time will not be wasted here. In addition, the Dongzhimen Emergency Department has observation rooms 1 to 4 for further observation and examination of patients, and the intensive care observation room is used for monitoring critically ill patients. Patients came to the emergency department and were divided into internal medicine, surgery, gynecology and pediatrics by the nurses at the triage desk at the door, and then further diagnosis and treatment were carried out. The teacher said that as an excellent triage nurse, we should not only master solid triage knowledge and know the types and characteristics of common emergency diseases to triage emergency patients, but also have a calm heart and be in no hurry when triaging patients.
Then the teacher told us about cardiopulmonary resuscitation, the use of simple breathing balls and the use of defibrillators. What impressed me was the use of simple breathing balls. Simple breathing ball is suitable for cardiopulmonary resuscitation, respiratory depression caused by various poisoning, respiratory muscle paralysis caused by neuromuscular diseases, respiratory depression caused by various electrolyte disorders, and various large-scale operations. It is suitable for mechanical ventilation patients to go in and out of the operating room for special examination. It can also temporarily replace the ventilator. When the ventilator cannot be used due to obstacles, power failure and other special circumstances, it can be temporarily replaced by a simple ventilator. The simple breathing ball consists of a mask, a one-way valve, a ball, an oxygen storage valve, an oxygen storage bag and an oxygen delivery catheter. During the operation, the patient should lie on his back, remove any visible foreign bodies such as dentures in the mouth and throat, and insert them into the oropharyngeal airway to prevent tongue biting and leaning back. The rescuer is located behind the patient's head. He tilted his head back and his forehead up to keep his respiratory tract unobstructed.
Fasten the mask on the nose and mouth, press it tightly with your thumb and forefinger, and press your other fingers tightly on your forehead to keep the airway unobstructed. Squeeze the ball with the other hand and send gas into the lungs. Squeeze the ball regularly to provide enough inhalation and exhalation time. Adults 12- 15 times/min, children 14-20 times/min. Rescuers can confirm whether the patient is in a normal ventilation state through the following situations. First, observe whether the patient's chest fluctuates with the squeezing of the ball. Second, observe the color changes of the patient's lips and face through the transparent part of the mask. Third, through the transparent cover, observe whether the check valve is used correctly. Fourth, observe whether the mask fogs when exhaling. Pay attention to the mask tightly on the nose when operating, otherwise it will leak easily; If the patient has spontaneous breathing, it should be synchronized with it, that is, the patient squeezes the breathing sac at the beginning of inhalation, and when the tidal volume reaches a certain level, the airbag is completely released, allowing the patient to complete the exhalation action by himself.
When the teacher was talking about defibrillators, he told us a common mistake on TV. On TV, we often see the metal surfaces of the handles of two defibrillators touching and rubbing against each other before defibrillating patients. This is a very dangerous action, and it is easy to get an electric shock. Because the switch to start defibrillation is not only on the handle, but also on the operating table of the defibrillator, and there is no cover on the operating table, it is easy for others to touch the button directly, which leads to defibrillation. If the defibrillator only touches the metal surfaces of the two handles, it will cause a large amount of discharge and make people get an electric shock.
When talking about cardiopulmonary resuscitation, the teacher told us a phenomenon that is common in practice and different from the theory in our books, that is, when doing artificial cardiopulmonary resuscitation in a hospital, it is impossible for a person to do five 30 cycles or even 30 cycles in a row. The teacher said that when she first came to the emergency department, she could still do the standard chest compressions above 10. Now she can only do it five times at a time, and no more will do. If she manages to do it, she can't meet the compression standard and get no effect. In addition, patients are prone to fracture when chest compressions are given to thin old people. Basically, after the patient was rescued, his ribs were almost broken.
The ICU ward is transparent, and doctors and nurses can see the patient's condition through the glass at any time.
Observe the changes of the patient's condition, and rescue him immediately if it worsens. Before entering the ICU, the teacher asked us all to wear slippers, which can reduce the entry of germs into the ICU and prevent patients with weak immunity from being infected. Therefore, after entering the ICU, we all observed the patients through the glass, and failed to go to the patient's bedside for close observation. The teacher also gave us an overview of the department. ICU is equipped with ventilators, monitors, oxygen, compressed air, first-aid appliances, defibrillators and other instruments, storage room, treatment room, disinfection room and dirt room, nurses' and doctors' lounge, doctor's duty room and other facilities, as well as anti-infection equipment and isolation beds. ICU has various types of circulatory failure, severe infection, acute massive hemorrhage and severe multiple injuries, multiple organ failure, acute respiratory insufficiency requiring respiratory management, acute renal insufficiency, severe acid-base imbalance, water-electrolyte disorder and severe metabolic disorder, acute disturbance of consciousness, especially frequent spasms, acute poisoning and drug poisoning, myasthenia gravis crisis, organ spinal cord transplantation, and other critically ill patients who are eager to recover after short-term intensive treatment. However, patients with brain death, acute infectious diseases, non-acute chronic diseases, advanced malignant tumors, natural death in old age and other patients who have no hope of treatment or give up treatment for some reason will not be admitted to ICU. The teacher also told us about the quality requirements and special skills that ICU nurses should master. ICU nurses should master the establishment of various venous channels, the detection of invasive arterial blood pressure, the application of mechanical ventilation, first aid or rescue, the coordination of emergency pacemaker placement, the timely application of nursing technology and auxiliary circulation technology.
Internship in these two departments, let me learn a lot of knowledge different from textbooks. It is impossible to completely copy the teaching materials in clinical operation. We need to combine the actual operating environment with the specific situation of patients. Only by flexibly using the knowledge learned in textbooks and combining theory with practice can we go further and further on the road of nursing.
Part II: Experience of emergency department practice.
Dear teacher:
I'm Zhang Zhouquan from the practice group of Guihang 303, and I'm in the emergency department now.
Summary of this month's internship:
The emergency department is the front line of the hospital to rescue acute, dangerous and serious patients, and its outstanding characteristics are "urgency", "danger" and "severity". Most of the patients who come to see a doctor have acute onset, short time and complicated conditions, which require timely rescue and nursing in a short time. A slight delay will affect the treatment of patients and even endanger their lives. As emergency doctors, they should not only be familiar with the theories of various disciplines, but also master the emergency operation skillfully, and have patience and love that ordinary people do not have. I was deeply moved to see the teacher wiping the blood from the dead patient's face, so I had to do it. In case of emergency, we should give full play to our intelligence, treat patients with sincerity and communicate with their families seriously. These tasks seem simple, but they can't be completed overnight. Through my internship in the emergency department, I have a better understanding of the doctor's work. I will keep in mind the rigorous and realistic work style of the emergency department, be careful and do every job well, and strive to become an excellent clinician as soon as possible.
The doctors in the emergency department are all superhuman, which is no exaggeration. When I first arrived in the emergency room, I stood aside in fear and didn't know what to do. While calmly rescuing patients, the teachers did not forget the interns who stood by and pulled us into this scene step by step. Slowly, I can basically adapt to this working atmosphere and treat everyone alive or dead seriously and lovingly. I really admire the teachers' skillful skills and calm mentality. Teachers can work calmly under urgent work pressure, which is what I should study hard.
Now I will not stand still in front of some tragic scenes, nor will I grieve with my family at the bedside of children or elderly patients, nor will I forget my own surgery. It's really good that the patient can put away my fear and pity properly and finish what I just finished calmly. When fear and unnecessary pity disappear, I will be more able to devote myself wholeheartedly to saving patients and let dying patients get a new life through death.
During my internship in the emergency department, I took the initiative, observed various emergency rules and regulations, mastered various emergency nursing operation skills, earnestly completed various nursing work, listened carefully to the teacher's teaching, and strived to improve my own shortcomings. During the emergency practice, I deeply realized the artistry and professionalism of doctors' work through the enthusiastic guidance and patient words and deeds of all teachers. Emergency is the first line to save patients' lives and take care of critically ill patients. As an emergency doctor, you should not only be familiar with the theories of various disciplines, but also master the first aid operation skillfully, and have patience and love that ordinary people do not have; In case of emergency, we should give full play to our intelligence, treat patients with sincerity and communicate with their families seriously. These tasks seem simple, but they can't be completed overnight. Through my internship in the emergency department, I have a better understanding of the doctor's work. I will keep in mind the rigorous and realistic work style of the emergency department, be careful and do every job well, and strive to become an excellent clinician as soon as possible.
The four-week emergency internship began, two weeks in the emergency room and two weeks in the temporary observation room. When I first arrived in the emergency room, I thought their work clothes were very nice. Different from wards, they are not traditional white coats, but blue shirt-style tops and trousers. I like this kind of clothes. It looks very light and doesn't feel cumbersome to do things. I once saw someone cut by an axe. It was my first 1 close contact with a bleeding patient. One night I went to work, and there were three patients lying in the emergency room. One of them is a schizophrenic. He talked to himself all night and didn't know what to say. The patient next to him has great opinions, but he is also very helpless. Another patient was a lung cancer patient, but in the middle of the night, despite all the rescue drugs, he finally died. It seems that I am still full of sunshine. Recall that I spent half my clinical internship in the inpatient ward. Of course, I am also worried that my knowledge is not comprehensive and I can't cope with unexpected situations.
Sure enough, on the first day of reporting to the department, I was blindsided when I saw the teachers busy, quick and tacit cooperation. Looking around, I only know the name of the instrument, but I don't know how to use it. I can only listen to the teacher's instructions mechanically and do some chores. After several rounds of chest compressions, the doctor asked me to press on the stage. This is the first time I've pressed on a real person. Although I was a little timid at that time, I didn't dare to neglect, and I was bent on saving my life. I looked at the patient's face while pressing, hoping that he would wake up, but the data on the ECG monitor kept reminding everyone that the patient was leaving.
Emergency is the first line to save patients' lives and take care of critically ill patients. After this experience, I deeply realized the artistry and professionalism of doctor's work. During the emergency practice, through the enthusiastic guidance of the teacher and the example of the patient, I became familiar with the first-aid drugs and learned the operation of ECG monitoring, cardiopulmonary resuscitation, automatic gastric lavage, defibrillator and ventilator.
In this extremely short four weeks, the biggest experience is the working characteristics of emergency room doctors:
"urgent", "busy" and "miscellaneous" Emergency patients are seriously ill, their condition is urgent and changes rapidly. So we must race against time, deal with it quickly, and strive for rescue time. The time, number and severity of emergency patients are unpredictable, random and controllable. Therefore, there should be both division of labor and cooperation in peacetime, so as to keep the work busy and not chaotic.
It's too short to come to the emergency room. I'm just familiar with the environmental structure of the emergency room, and the duties of each class are about to leave. I really don't want to give it up!
In short, I would like to thank the tutor for his careful teaching and the reasonable arrangement of each teacher. I will go into the following departments with a more proactive working attitude, more solid operational skills and more profound theoretical knowledge to improve my clinical work ability and contribute to the medical cause!
Zhangzhouquan
20xx65438+February 9th
Chapter III: Practice summary of emergency department.
Summary of Dujiangyan Practice Team (9.2~ 10. 17)
The emergency department is the front line of the hospital to rescue acute, dangerous and serious patients, and its outstanding characteristics are "urgency", "danger" and "severity". Most of the patients who come to see a doctor have acute onset, short time and complicated conditions, which require timely rescue and nursing in a short time. A slight delay will affect the treatment of patients and even endanger their lives. As students majoring in emergency nursing, they should not only be familiar with the theories of various disciplines, but also be proficient in emergency operation, and have patience and love that ordinary people do not have. I was deeply moved to see the teacher wiping the blood from the dead patient's face. In case of emergency, we should give full play to our intelligence, treat patients with sincerity and communicate with their families seriously. These tasks seem simple, but they can't be completed overnight. Through my internship in the emergency department, I have a better understanding of the work of nurses. I will keep in mind the rigorous and realistic work style of the emergency department, do every job conscientiously and practically, and strive to become an excellent clinical nurse as soon as possible.
It is no exaggeration to say that the nurses in the emergency department are all superhuman. When I first arrived in the emergency room, I stood aside and didn't know what to do. While calmly rescuing patients, the teachers did not forget the interns who stood by and pulled us into this scene step by step. Slowly, I can basically adapt to this working atmosphere and treat everyone alive or dead seriously and lovingly. I really admire the teachers' skillful skills and calm mentality. Teachers can work calmly under urgent work pressure, which is what I should study hard.
Now I will not stand still in front of some tragic scenes, nor will I grieve with my family at the bedside of children or elderly patients, nor will I forget my own surgery. It's really good that the patient can put away my fear and pity properly and finish what I just finished calmly. When fear and unnecessary pity disappear, I will be more able to devote myself wholeheartedly to saving patients and let dying patients get a new life through death.
During my internship in the emergency department, I took the initiative, observed various emergency rules and regulations, mastered various emergency nursing operation skills, earnestly completed various nursing work, listened carefully to the teacher's teaching, and strived to improve my own shortcomings. During the emergency practice, I deeply realized the artistry and professionalism of nursing work through the enthusiastic guidance and patient words and deeds of all teachers.
On the first day of reporting to the department, I was blindsided when I saw the teachers busy, quick-moving and tacit cooperation. Looking around, I only know the name of the instrument, but I don't know how to use it. I can only listen to the teacher's instructions mechanically and do some chores. After several rounds of chest compressions, the doctor asked me to press on the stage. This is the first time I've pressed on a real person. Although I was a little timid at that time, I didn't dare to neglect, and I was bent on saving my life. I looked at the patient's face while pressing, hoping that he would wake up, but the data on the ECG monitor kept reminding everyone that the patient was leaving.
Emergency is the first line to save patients' lives and take care of critically ill patients. After this incident, I deeply realized the artistry and professionalism of nursing work. During the emergency practice, through the enthusiastic guidance of the teacher and the example of the patient, I became familiar with the first-aid drugs and learned the operation of ECG monitoring, cardiopulmonary resuscitation, automatic gastric lavage, defibrillator and ventilator.
In this extremely short four weeks, the biggest experience is the special work of emergency room nurses. Points: urgent, busy and miscellaneous. Emergency patients have rapid onset and great changes. So we must race against time, deal with it quickly, and strive for rescue time. The time, number and severity of emergency patients are unpredictable, random and controllable. Therefore, there should be both division of labor and cooperation in peacetime, so as to keep the work busy and not chaotic.
In short, I would like to thank the tutor for his careful teaching and the reasonable arrangement of each teacher. I will go into the following departments with a more proactive working attitude, more solid operational skills and more profound theoretical knowledge to improve my clinical work ability and contribute to the medical cause!
Chapter IV: Practice summary of emergency department.
Clinical practice is the deepening and continuation of school education and teaching. The nature of nursing work in emergency department is complex, emphasizing "urgency, quickness, accuracy and liveliness", and the illness is urgent and serious. The patient's condition changes rapidly, and the number of patients is large, especially in case of sudden disasters, and it is necessary to undertake the rescue and nursing work of a large number of wounded people. Therefore, the emergency nursing work is very busy and arduous, and it must be busy and orderly. Combined with the characteristics of emergency department, the problems existing in clinical nursing teaching and the improvement measures are summarized as follows: 1. The theoretical knowledge of practical nurses is not solid, they lack basic theoretical knowledge and skills, and their sense of responsibility is not strong. Nurse interns lack solid theoretical foundation, technical operation experience and due sense of responsibility before entering clinical practice.
2. The role of nursing students is vague, and some nursing students are not clear about their roles when they first enter clinical practice. Most nursing students rely too much on their "student" role, fearing that the operation will fail and the patients will be dissatisfied, and they are unwilling to start nursing practice. A few students over-emphasize their role as nurses and dare to try all kinds of operations, whether they have done it or not.
3. Nursing students have weak legal awareness and safety awareness. Nursing students seldom receive legal knowledge education at school, and their legal responsibilities are unclear. Therefore, in practice, they do not pay attention to the relationship between nursing and law, can't look at their own nursing work from the legal point of view, and their words and deeds are not rigorous enough, which may easily lead to medical disputes.
Teaching teachers:
1. The problem of teachers' own quality, the lack of comprehensive knowledge accumulation and the improvement of their own quality, and the unstable professional thinking of some personnel directly affect it.
Students' enthusiasm, creativity and initiative
2. Lack of teaching time and energy. Since the implementation of performance appraisal in our hospital, the establishment of nurses has been tightened, the workload of basic nursing in neurology department has been heavy, and various new businesses and technologies have been continuously developed.
Improvement measures in future teaching work;
1. Strengthen the pre-job training of nursing students and cultivate their awareness of legal safety. Before the nursing students enter the clinic, the nursing department will train them in nursing technical operation, professional quality, psychological knowledge and legal knowledge. In the process of clinical practice, teachers should guide students to put themselves in other's shoes, respect patients' rights, make nursing students establish legal concepts as soon as possible, be serious and independent, and enhance their sense of responsibility.
2. After entering the department, the teaching teacher will lead the nursing students to be familiar with the ward environment, observation room, injection room, rescue room, sterile treatment room, the location and related requirements of rescue drugs, articles and equipment, introduce the professional characteristics of the department, and preach the internship plan, medical staff and patients. So as to eliminate the strangeness of nursing students, increase their self-confidence and lay a good foundation for internship.
3. Combine clinical teaching theory with practice, and make a detailed teaching plan. According to the requirements of the internship program and the characteristics of the emergency department, the internship teaching plan and nursing teaching rounds are arranged, and internship opportunities are provided as much as possible, so that nursing students can gradually complete the process from unfamiliar to familiar and then to accurate.
4. Give lectures on nursing knowledge every week, and give guidance on the use and precautions of common emergency drugs for common diseases, frequently-occurring diseases and emergencies in the emergency department.
5. Combining theoretical knowledge with clinical practice, the teaching teacher should lead the nursing students into emergency nursing work from the moment they enter the department, observe with outpatients and emergency patients, do a good job in health education, consultation and guidance, do a good job in intravenous, intramuscular, intradermal and subcutaneous injections of patients in the injection room, guide the nursing students to practice hand-to-hand and help them remember after each work.
6. In addition to the examination, the nursing department conducted an examination on the theory and operation of first-aid nursing knowledge under the guidance of the teaching teacher a week ago to understand the mastery of first-aid theoretical knowledge by nursing students, and the practice manual can only be filled in after passing the examination.
7. Two-way evaluation system of nursing practice teaching. Head nurses and teachers hold monthly meetings to summarize. Teachers cultivate and evaluate students from the aspects of morality, physique, ability and diligence, and students evaluate teachers from the aspects of teachers' teaching attitude, professional level, teaching ability, teaching lectures, teaching rounds and questions. This will not only let the nursing students know their own shortcomings, correct them in time and improve them continuously, but also let the teaching teachers know about the teaching situation, find out the shortcomings, constantly improve the teaching plan and improve the teaching quality.
Chapter 5: Practice summary of emergency department.
I used to like to watch stories about the emergency department in film and television programs. I think the doctors and nurses in the story are so decisive, capable and charming that I envy them. Unexpectedly, when I grew up many years later, I was lucky enough to become an emergency nurse. From the initial anxiety to gradually finding the law, I really realized that it is not easy to be a good emergency nurse!
The emergency department is one of the most important windows in the hospital. The staff hospital in my township not only accepts normal acute and severe patients, but also accepts critically ill patients transferred from prefectures and counties, which has the characteristics of urgency, busyness and miscellaneous. Facing the first diagnosis and rescue of critical emergency patients, emergency patients often have unclear diagnosis, unclear condition and rapid changes. If it is not handled properly, it is easy to have medical disputes. However, patients and their families are prone to impatience, anxiety and fear. The emergency room is different from the ward. Medical staff have enough time to communicate with patients and their families, understand the needs of patients in time, and establish a good nurse-patient relationship.
In the emergency department, patients and their families have not yet established a good sense of trust in their brief contact with medical staff, and they are very sensitive to every nuance of medical staff. The speech and behavior of medical staff will have a great influence on patients' psychology. As a result, the treatment behavior of medical staff is not understood, leaving patients and their families with the illusion of "being ignored" and "being urgent and not urgent". Therefore, the more I feel that communication is the most easily overlooked and important thing in an emergency.
Nightingale said: Nursing needs not only exquisite skills, but also art. First, you must learn to observe, so that you can be good at discovering the existence of problems, including observing the patient's condition, psychology, needs and family members. For example, some patients' families are critical of nurses' behavior, but they don't fully understand patients' fluids. For such family members, we should patiently remind them where to call a nurse when changing fluids. At the same time, we should also patrol the ward on time to observe the progress of the liquid, so as to avoid conflicts with the patients' families to a great extent because the liquid was not replaced in time. Second, learn to communicate. Mutual respect and trust between people is based on communication. For patients who come to the emergency department, we should actively ask and guide them enthusiastically. For example, we can help patients with mobility difficulties, or help them take them to the clinic with carts, measure their vital signs and give them to the nurses in the clinic; For patients who need and can go to the ward for treatment, the location of the ward can be pointed out in detail to prevent patients from "running wrong".
For patients who have been ill for a long time but their condition is not critical, we can advise them to go to the outpatient clinic for medical treatment, and patiently and carefully inform them of the location and time of medical treatment, so as to facilitate patients' arrangements. A smiling expression and a hand gesture can not solve the physical pain of patients, but can quickly shorten the distance between nurses and patients, effectively meet the psychological needs of patients who need care, thus facilitating our follow-up nursing work. Finally, through observation and communication, learn to judge, and have an accurate understanding and judgment of the patient's condition and needs, which is conducive to the rescue work of medical staff and buys time for patients. For example, trauma patients can know the location and severity of their injuries through observation and general inquiry, and seek medical treatment at the first time. Registration procedures can also be prepared.
The above is just a brief talk about my short work in the emergency department, and there are still many things to learn. Everyone is my teacher in the emergency department, and everything is my experience, which has taught me a lot, whether it is being a person or doing things. Of course, being a good emergency nurse is not enough. It also needs a solid theoretical foundation, rich rescue experience, quick response and quick action. This is a guarantee to stand the test in an emergency.
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