Model essay on nursing specialty: "On improving the level of nurses"
1 material
1. 1 Once a woman said, I was in pain and scared when I gave birth, but the two midwifery nurses talked and laughed endlessly. I'm afraid they're distracted, and they'll be angry if I miss my business and talk to them? .
1.2 About 12.5% of the intern nurses were confused about their improper use of language and habitual use of professional terms, which caused communication obstacles and even misunderstandings, affected their communication and communication, and laid a hidden danger for nurse-patient disputes.
1.3 Due to the imperfection of medical laws and regulations in China today, the understanding of the laws and regulations by intern nurses is not perfect, which has laid a hidden danger for medical accidents.
2 problems in nursing care
According to the above three materials, it reflects many problems faced by nursing practice nurses today, and also understands the shortcomings of nurses in nursing work.
2. 1 own comprehensive quality
2. 1. 1 Lack of sympathy and indifference.
Compassion is the foundation and one of the basic principles of interpersonal communication. Especially in hospitals, the good sympathy of nurse interns plays an important role in the establishment and development of nurse-patient relationship.
2. 1.2 There is too little information to communicate.
The first contact between patients and their families is the nurse. Patients and their families are very anxious, eager to know a series of problems related to hospitalization, such as illness, medication, treatment measures, prognosis, names of responsible doctors and nurses, professional level and so on.
2. 1.3 lack of excellent professional skills
Because the intern nurse has just left school, she rarely has face-to-face contact with patients. Nursing work is professional and common in nursing work. Although we are kind, our doubts about patients are ambiguous and unskilled, which also causes patients' distrust and even disgust, which affects the relationship between nurses and patients.
2.2 The understanding of laws and regulations is not comprehensive
2.2. 1 Legal issues in nursing documents
When nursing students use nursing documents for the first time, there are still many things they don't understand. For example, the medical records are different, the nursing handwriting is scrawled, the statement is not detailed, the contents of nursing records are inaccurate, the focus is not prominent, and the continuity is poor. The time when the doctor's order was issued was inconsistent with the time when the nurse carried it out, and the nursing records lost their authenticity and integrity because of random alteration, signature and traceability. This phenomenon has laid a hidden danger for medical disputes, resulting in the inability to prove and lose the case.
2.2.2 Legal issues of dereliction of duty
Internship nurses are seriously irresponsible in their work, do not implement various rules and regulations and nursing routines, and violate operating procedures, resulting in death or serious injury to patients. For example, the check system is not implemented, the patient's medication route is improper, and the liquid is changed by mistake. If the patrol system is not implemented, the oxygen catheter will be blocked, and the patient's body will swell due to liquid extravasation, and the patient's condition will not be found in time, which will make the patient lose the best rescue opportunity.
2.2.3 Tort legal issues
In the process of practicing as a nurse, due to improper nursing, low technical level or irresponsible work, patients' rights and interests are neglected, which brings harm and even death to patients' health and infringes on patients' right to life and health. At the same time, patients have the right to know the treatment and nursing plan of their diseases, and medical staff have the obligation to inform patients. For example, performing medical operations and some tests without the consent of patients and their families will constitute an infringement of the right to informed consent. If the majority of medical staff are not alert to this, its harm will greatly increase.
3 improvement measures
3. 1 Pre-job training
Through the planned, targeted and targeted pre-job training for new nurses. Cultivating the service consciousness of dedication and selfless dedication can help them adapt to the new environment as soon as possible, guide new nurses to love nursing specialty, carry out nursing practice according to professional standards and norms, and provide effective clinical nursing for patients.
3.2 improve the concept of nursing service
In daily work, we should pay attention to shaping the good image of nursing staff, cultivating comprehensive abilities such as appearance and aesthetics, beautifying the words and deeds of nursing staff, and adopting? Patient-centered? Specific measures are truly implemented. At the same time, improve the ability of nursing students to observe and solve problems, change passive nursing into active nursing, and deepen the understanding of? Three-part rule, seven-part protection? Understanding of the connotation [4].
3.3 Strengthen the awareness of the legal system and enhance the concept of the legal system.
Organize nursing staff to learn relevant laws and regulations, invite legal professionals to give lectures in the hospital, combine the legal knowledge they have learned with specific cases, strengthen management, standardize nursing behavior, analyze existing nursing errors, focus on the big picture and start with small things to prevent or reduce the occurrence of medical accidents.
3.4 Strengthen learning and standardize the writing of nursing documents.
The Regulations on Handling Medical Accidents stipulates: Nursing record is one of the important parts of medical records. ? In other words, nursing records will be used as court evidence like medical records. Nurses should improve their understanding of nursing records from the perspective of law enforcement, take corresponding measures for new problems encountered in writing nursing documents and standardize nursing records.
3.5 Strengthen the study of legal knowledge and enhance the concept of legal system.
In clinical work, nurses must know the law, understand the law and abide by the law, make clear their legal responsibilities in their work, fully realize that nursing behavior is always restricted by law, strictly abide by various laws, regulations and departmental rules and regulations, and minimize the occurrence of medical accidents.
3.6 Fulfill the obligation of informing
Patient's consent is a necessary condition for medical tort and a prerequisite for medical legality. Therefore, nurses should inform patients and their families of the purpose and risk factors of each operation. Patients' consent is required for special treatment, nursing and examination, and signature procedures should be performed if necessary. This is not only to respect the rights of patients, but also to meet the needs of nursing self-protection.
4 abstract
Nurses have a long way to go. It is the responsibility and obligation of every nurse to improve the nursing level and reduce the disputes between nurses and patients. Nurses should improve the quality of nursing, renew their concepts and improve their professional level; At the same time, strictly abide by various rules and regulations, operating procedures, conscientiously perform their duties, and truly implement relevant laws and regulations and departmental rules and regulations, so as to ensure the standardized and orderly development of nursing work.
Model essay II on nursing specialty: "On the nursing of postpartum hemorrhage"
First, analysis of the causes of postpartum hemorrhage
Postpartum hemorrhage is one of the important causes of maternal death. According to the analysis of clinical data in our hospital, postpartum hemorrhage mainly has the following reasons:
(a) uterine atony
Uterine atony is the main cause of postpartum hemorrhage. During normal delivery, it is common to have a small amount of bleeding when the placenta is stripped from the uterus, but when the placenta is completely stripped from the uterus, the amount of bleeding will decrease rapidly. However, due to excessive mental anxiety or fatigue during labor and delivery, some parturients have weak uterine contraction and poor vascular closure, which can lead to massive bleeding. Multiple pregnancy, giant fetus, prolonged labor, various pregnancy complications and complications, as well as uterine fiber injury after multiple abortions and excessive stretching of uterine muscle fibers caused by polyhydramnios. It is also prone to postpartum hemorrhage due to uterine contraction weakness.
(2) Placental factors
Postpartum hemorrhage caused by placental factors is commonly known as? Can't fit in? It is also a common cause of postpartum hemorrhage. There are mainly the following situations: the most common is incomplete placental detachment, that is, bleeding on the detachment surface due to partial placental detachment from the uterine wall; Second, the placenta can not be discharged in time after exfoliation, that is, the placenta has been completely exfoliated from the uterine wall, but the placenta can not be discharged due to weak uterine contraction, leading to bleeding; Third, women with a history of curettage have poor uterine decidua development, and placental villi are implanted into the myometrium of uterus, which leads to placental adhesion and placenta implantation, which often leads to bleeding; 4. Improper use of oxytocin can cause spasmodic contraction of uterus, embed detached placenta into uterine cavity, and also cause vaginal bleeding.
(3) tearing of birth canal
Most of them occur after vaginal delivery. Fetus is too large, forceps delivery, obvious edema or varicose veins in the birth canal, dystocia and emergency delivery will all increase the possibility of birth canal laceration. In recent 3 years, 8 patients in our hospital have different degrees of pregnancy-induced hypertension syndrome. Due to systemic arteriospasm, tissue hypoxia and increased vascular fragility, the soft birth canal tears during delivery, resulting in vaginal wall hematoma. Others include acute childbirth, vulvovaginitis and tenacity of cervical canal, leading to tissue damage and blood vessel tear. Improper operation of midwives is also a cause that cannot be ignored.
Coagulation dysfunction
If the parturient suffers from blood system diseases, the symptoms are thrombocytopenia, anemia, and lack of coagulation factors. And it is also easy to cause postpartum hemorrhage. Among 23 cases of postpartum hemorrhage in our hospital, 8 cases have anemia of different degrees.
Second, the prevention and emergency measures of postpartum hemorrhage
(a) adhere to the prevention first, take symptomatic preventive measures.
1 to prevent postpartum hemorrhage caused by uterine atony.
First, because postpartum hemorrhage mostly occurs in pregnant women with abnormal delivery timeliness and complications, high-risk pregnant women should be carefully screened out before delivery, monitored well, and prepared for postpartum hemorrhage rescue before delivery. Second, during childbirth, we should strengthen the monitoring, pay attention to the rest and nutritional supplement of the parturient, carry out nursing for the parturient, strengthen psychological nursing, empty the bladder, and prevent prolonged labor and postpartum uterine contraction caused by maternal failure. If antihypertensive and sedative drugs must be used, they should be used moderately to avoid excessive influence on uterine contraction. Third, pregnant women who are prone to postpartum hemorrhage, such as twins, polyhydramnios, delayed delivery, placenta previa, placental abruption, severe pregnancy-induced hypertension, and those who have a history of postpartum hemorrhage in the past, can use oxytocin to promote uterine contraction immediately after the delivery of the fetal front shoulder.
2. Prevention of postpartum hemorrhage caused by placental factors.
First, catch? Good morning. , combined with gynecological treatment, pregnancy examination and other extensive health education, to avoid multiple abortions, early detection of pregnancy complications and complications and other causes of postpartum hemorrhage, to mobilize women to be admitted to hospital in advance for labor, and to formulate targeted prevention and first aid measures before delivery. The second is to catch? Quasi? In the process of labor, accurately judge the signs of placental abruption, wait patiently before placental abruption, and avoid squeezing uterus and pulling umbilical cord prematurely. After the fetus is delivered, oxytocin can be injected intramuscularly, which can stimulate contractions and prompt placental abruption and timely discharge. Second, if the placenta is still not peeled off after half an hour of delivery, oxytocin should be injected intravenously to strengthen the contraction. If the placenta has not been peeled off, the perineum can be disinfected again, and the bladder can be emptied for manual peeling. Fourth, if there is bleeding caused by placenta incarceration, anesthesia can be implemented to relax the narrow ring and artificially remove the placenta. It should be noted that in any of the above cases, after the placenta is discharged or taken out manually, it is necessary to carefully check whether there is any placenta, fetal membrane or accessory placenta residue. If there is, it is necessary to clean the uterus in time and use antibiotics to prevent infection and avoid bleeding in the later period.
3. Prevention of postpartum hemorrhage caused by laceration of birth canal
Timely and accurate repair and suture is an effective measure to prevent postpartum hemorrhage caused by soft birth canal laceration. After the delivery of the fetus, carefully check the soft birth canal, including the cervix, vagina, perineum, especially the cervix, and suture it in time if there is any laceration. The first is the treatment of cervical laceration. Severe cervical laceration can extend to fornix and fissure, and even to adjacent tissues. Disinfect first, then expose the cervix. Oval pliers should be used to clamp the front lip of the cervix side by side and pull it toward the vaginal opening. Move the elliptic forceps clockwise step by step, and observe the cervical situation directly. If laceration is found, the first needle should start at a position slightly higher than the top of the fissure, and the last needle should stop at a distance of 0.5 cm from the lateral end of the cervix. If it is sewn to the outer edge, it may happen later. The second is the treatment of vaginal laceration. Vaginal lacerations should be stitched to the bottom to avoid leaving dead ends. After suture, the effect of tissue alignment and hemostasis should be achieved. In the process of suture, it is necessary to avoid the suture from passing through the rectum and take the direction perpendicular to the blood vessels in order to stop bleeding more effectively. The third is the treatment of perineal laceration. The muscularis and submucosa can be sutured according to the anatomical position, and finally the vaginal mucosa and perineal skin can be sutured.
4. Prevention of postpartum hemorrhage caused by coagulation dysfunction
First, the medical history should be asked in time before delivery. If there is an early admission, laboratory tests such as platelet, bleeding time and coagulation time should be carried out. Second, coagulation dysfunction is a rare cause of postpartum hemorrhage. Once postpartum hemorrhage occurs, it can be identified as suspected coagulation dysfunction after excluding uterine inertia, placental factors, soft birth canal laceration and other reasons. After a definite diagnosis, fresh whole blood, platelets, fibrinogen or prothrombin complex and coagulation factors should be actively infused. Thirdly, postpartum hemorrhage with coagulation dysfunction is the most difficult special type in the treatment of postpartum hemorrhage. In addition to the routine procedures and methods of postpartum hemorrhage treatment, we should also pay attention to protecting the functions of important organs in order to improve the success rate of rescue and reduce the maternal mortality.
(2) Adhere to the principle of nursing and take timely nursing measures.
Postpartum hemorrhage, especially fulminant hemorrhage, easily leads to maternal shock, so once postpartum hemorrhage occurs, nurses must be calm, take effective measures such as keeping warm, taking oxygen, actively promoting uterine recovery, and report to doctors for rescue work. First, quickly assist the doctor to rescue, stop bleeding in time and effectively, start to find the cause of bleeding, draw blood for emergency blood type examination, cross-match blood, prepare for blood transfusion and surgery when necessary, keep the respiratory tract unobstructed, and deliver oxygen in time to prevent hypoxia. In an emergency, a double vein channel can be quickly established to effectively supplement the blood loss of the parturient in a short time. Second, closely observe the maternal pulse, blood pressure, breathing, uterine involution, accurately measure the amount of bleeding, and make special nursing records in detail. Third, after the shock is corrected, the lying-in woman should be comforted to rest quietly, encouraged and assisted to eat, and at the same time, the blood pressure, pulse, fundus height, uterine recovery and vaginal bleeding of the lying-in woman should be closely observed, especially within two hours after delivery, and the lying-in woman can be sent back to the ward after her condition is normal. Fourth, after returning to the ward, women should be instructed to empty their bladder in time to prevent bladder swelling from affecting uterine contraction and involution. Within one day after delivery, we should still pay close attention to the general situation of the parturient, guide the parturient to keep the vulva clean, prevent infection, maintain a nutritious diet and prevent anemia symptoms caused by postpartum hemorrhage.
Model essay 3 on nursing specialty: Analysis on the causes of poor teaching effect of psychiatric nursing.
Nurse occupation is an important part of China's medical system. With the change of modern life style, the improvement of people's health awareness and the intensification of the aging trend of the population, the demand for nurses in society is increasing. At present, some of the nurse resources in China are supplemented by five-year nursing students. The learning process of students at school is the basis of becoming an excellent nurse. Psychiatric nursing is a specialized course of nursing specialty. Therefore, how to learn this course well is not only related to the teaching expectation of the school, but also related to the clinical work of students.
According to the spirit of the Nurses' Regulations, the Measures for the Administration of Nurses' Practice Registration and the Measures for the Examination of Nurses' Practice Qualification, nurses implement the admission system, and they must pass the examination of nurses' practice qualification before they can apply for practice registration. Since 20 1 1, the nurse qualification examination has been changed from four subjects to two subjects: professional practice and practical ability. The content of the examination involves the nursing of various common diseases that nurses may encounter in the early stage of clinical work, including the new disease of mental disorder. However, in the results of the nurse professional qualification examination, it was found that most of the five-year students in the test sites related to mental disorders did not score. This phenomenon has to make educators think deeply about what causes students' poor nursing effect in psychiatric department. Combining years of teaching experience and clinical practice, the author analyzes the reasons as follows:
First, the student groups are mixed.
Five-year nursing students enter vocational colleges after graduating from junior high school. Some students choose to study in vocational colleges, hoping to learn vocational skills and gain livelihood skills. Some students enter vocational colleges according to their parents' wishes, hoping to enter social work as soon as possible through school education. As far as society is concerned, the academic performance of students in vocational colleges may not be satisfactory. In the process of teaching, students' basic problems will appear. Nursing students should also study all basic medical courses, such as biochemistry, physiology, histology and embryology, microbiology and immunology. In junior high school courses, students have been exposed to chemistry, physics, biology and other courses, which is still helpful for the study of basic medical courses. If the foundation is not solid, there will be some problems in the study of specialized courses based on basic subjects. Psychiatric nursing is also one of the specialized courses, and it also needs biochemistry, physiology and other courses as the basis to master the knowledge related to mental illness.
Although students have different foundations, in the teaching process, each of our teachers should consider the needs of all students, constantly improve teaching methods and means, help each student understand and master the knowledge points needed in the work, and improve the teaching quality.
Second, the teaching method is relatively simple.
Modern life is changing with each passing day, and technology is also improving. Multimedia teaching methods are very common in both basic education and university education. Through the display of multimedia PPT and video materials, we can accurately tell students the key points and difficulties of each class, thus explaining the relevant knowledge of diseases to students, but at present, only a single traditional teaching method can not meet the requirements of modern nursing. The study of mental illness nursing needs not only theoretical knowledge, but also some training and internship courses like other professional courses such as internal medicine, surgery, pediatrics, obstetrics and gynecology nursing. Through training and internship, we can combine classroom knowledge with practical operation to improve students' comprehensive vocational skills. Mental illness is a special disease. Training courses can teach some common mental illness nursing skills and methods to deal with emergencies to avoid being overwhelmed by such diseases in the future. Probation courses can make students really get in touch with mental illness, intuitively understand mental illness, and deepen their study and mastery of mental illness. In addition, students' ideas are diverse, and teachers can also set up some teaching scenes so that students can learn the process of nursing mental patients in the form of short plays. In order to help students continue to learn related knowledge about mental illness in their spare time, we can also add some advanced teaching methods with the times, such as uploading teaching courseware or micro-lesson videos on the school website to show the knowledge gained in the learning process for everyone to learn. In addition, qualified teachers can establish a personal WeChat public platform and use the popular smart phones to help students solve learning problems anytime and anywhere.
With the continuous progress of society, the teaching methods of psychiatric nursing should be constantly updated to meet the learning needs of students and truly highlight the advantages of vocational education.
Third, the level of teachers is uneven.
The development of modern science leads to the continuous innovation of biomedical technology, which makes us have a more comprehensive and profound understanding of the biological problems of many diseases. People of insight put forward that the medical model should be? Bio-psycho-social? Trinity model transformation, a new medical model, is the most suitable, applicable and needed in psychiatry. At the same time, more and more people advocate that psychiatry not only studies mental diseases in the traditional sense, but also (or more importantly) pays attention to various psychological and behavioral problems; Psychiatry should not only serve mental hospitals, but also (or more importantly) pay attention to the mental health of the whole society. However, under our curriculum system, the knowledge of mental illness is relatively backward, there are few opportunities for going out for training, the library bibliography is relatively slow to update, and even some teachers are too lazy to continue their studies, resulting in the constant level of teachers related to psychiatric nursing all the year round. More seriously, many teachers who teach psychiatric nursing have never really been exposed to mental illness, and they can only explain the related knowledge of mental illness by book knowledge, lacking certain experience and practical skills.
For every teacher, if you don't update your knowledge structure and improve your teaching methods, it's like a stagnant pool, and there will never be life. Then students' enthusiasm for learning may be gradually exhausted because teachers are not enterprising. I hope that every teacher will not sit still and wait for death, but constantly improve his own quality in order to achieve the purpose of improving teaching quality.
Fourth, the school management system is backward.
Five-year nursing students are younger when they enter school and spend a relatively long time in school. This process is also an important process of their growth and transformation. The school believes that five-year students have no mature mind and self-discipline ability, and even their ability to distinguish right from wrong is relatively weak. Schools sometimes consider students and parents, and the management of five-year nursing students is generally strict or even rigid. Basically, according to the management mode of compulsory education, students study on time and at night, without going to the library, reading room and electronic reading room to expand their knowledge space, and even stifle students' ability to cultivate self-study. In life, five-year students may need the supervision and supervision of teachers and schools, but they should be given some space in their studies. Psychiatric nursing is also a difficult course. It is impossible to master the knowledge related to mental illness only by relying on the knowledge points taught by teachers in class, which requires students to consciously consult relevant materials to solve some problems. There is an old saying? It is better to teach people to fish than to teach them to fish. The teacher's duty is to teach, and the student's purpose is to learn. But how to learn is also something that teachers should infiltrate into students in the teaching process, which is the main purpose of education.
Under the current academic background, long live 60 points? The concept has fallen behind, and all the knowledge learned in vocational colleges needs to be transformed into skills and applied to practical work. How to improve the learning effect of five-year nursing students in psychiatric nursing is also an important part of teaching. Helping students to strengthen basic knowledge, enrich teaching methods, improve teachers and improve school management system are effective ways to improve the nursing effect of psychiatric department for five-year nursing students. I hope it will be helpful to improve the learning situation of mental nursing for five-year students and inspire the teaching reform of educators.
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