MANUAL AND DIARY
of on-the-job practical training as assistant to a ward nurse, treatment room
nurse and dressing room nurse
for 2nd year General Medicine students
(in surgery)
VOLGOGRAD STATE MEDICAL UNIVERSITY
A.A.POLYANTSEV GENERAL SURGERY DEPARTMENT
MANUAL AND DIARY
of on-the-job practical training as assistant to a ward nurse, treatment room
nurse and dressing room nurse
for 2nd year General Medicine students
(in surgery)
Compiled by:
A.A.Polyantsev,
Head of General Surgery Department
of Volgograd State Medical University
P.V.Mozgovoy, Assistant Professor
O.Y.Bosko, Associate Professor
V.A.Ievlev, Assistant Professor
Volgograd, 2009
1.
2.
3.
4.
GOALS OF ON-THE-JOB PRACTICAL TRAINING
Familiarising the students with the work of a patient care institution.
Learning the care of patients.
Learning nursing manipulations and some doctor’s manipulations.
Learning to observe the rules of deontology and ethics.
OBJECTIVES OF THE PRACTICAL TRAINING
1. The basic rules and methods of patient care in various diseases.
2. technique of nursing procedures
3. technique of basic doctor’s manipulations
FORMAT OF THE PRACTICAL TRAINING
On-the-job practical training of second-year students as nurse’s assistant takes place in
extracurricular time, amounting to 72 hours. The students work 4 hours weekly. The practical
training is supervised by the General surgery department of VolSMU. The immediate
supervisors are head nurses of surgical departments.
The students keep diaries where they enter the description of work done on that day. The
nurse supervising the student’s work certifies it with her signature.
To account for the practical training the student should submit the diary and a report. The
supervising teacher talks with the student on the range of problems given in the appendix and
gives the student his mark for the practical training.
THE CONTENT OF WORK IN SURGICAL AND RESUSCITATION
DEPARTMENTS
During his on-the-job practical training each student should familiarize himself with the
work of patient care institution, acquire practical skills of nursing surgical patients and giving
first aid, and to learn the sanitary standards of surgical service.
I. ADMISSION OF PATIENTS AT THE ADMISSION ROOM OF A SURGICAL INPATIENT DEPARTMENT
The admission room of a hospital is intended for admission, registration, examination and
cleansing of patients. It consists of 9 subdivisions:
1. Waiting-room
2. Office of the nurse on duty
3. Surgery and dressing room
4. Examination rooms
5. Treatment room
6. Sanitary inspection room
7. Clinical laboratory
8. Personnel office
9. Pre-hospitalisation ward.
The duties of the nurse include: accompanying the patient to the office, doing the
registration paperwork, examination and cleansing of the patient, transportation to a hospital
department. The nurse explains to the scheduled patients what they can take to the ward: toilet
articles, slippers, a gown. Personal things of admitted patients are listed in an inventory, 2 copies
of which are made. One copy is kept with the patient’s belongings; the other is handed to the
patient. The clothes are put on hangers and transferred to the storage room.
The patients are admitted by the head of admission department of by the doctor on duty.
The patient is examined in the examination room on a couch covered with an oilcloth and
sheet or disposable diaper. After each patient the oilcloth should be wiped with 1% chloramine
solution. The patient’s skin integument and fauces are examined, body temperature should e
taken. The used spatulas are washed in running water and boiled for 15 minutes. Thermometers
are kept submerged in 0.5% chloramine solution. While examining the patient in the admission
room attention should be paid to any skin diseases if present. A hospital stamp with the date and
the nurse’s signature is put to the patient’s case history.
After the examination room the patient is taken to the bathroom. The average duration of
a warm hygienic bath is 20-30 minutes, water t0 – 35-360C. If the bath is contraindicated in the
patient’s condition, he takes a shower. If the patient’s condition is serious, the junior nurse wipes
his body with a towel sponged in alcohol.
Then the patient is taken to a hospital department: he walks there or is transported in a
wheel chair or on a stretcher.
Admission department includes a minor surgery room to give surgical aid. To disinfect
the air a bactericidal lamp is used. The surgery is cleaned twice a day with a detergent and
hydrogen peroxide.
The patient signs a form stating that he was familiarized with the regulations of an inpatient department and binds himself to observe them.
The head of the department and head nurse checks the compliance with sanitation
requirements at he change of shift and during the day.
II. CARE OF PATIENTS IN A SURGICAL DEPARTMENT
1. Learning the basic duties and work conditions of junior and senior medical personnel.
2. Familiarising the students with the basics of medical psychology, ethics and
deontology.
3. Learning the general rules of nursing and differentiated care in a surgical clinic.
4. Teaching medical procedures and manipulations to students.
The duties of the ward nurse include: doing doctor’s round together with the attending
doctor, observing the patient’s condition, thermometry, control of dressings in operated patients,
distribution of drugs, giving injections, preparing patients for surgery or investigation, sending
blood and other samples for tests, control of test results, keeping medical records, ordering and
collecting drugs from the pharmacy, care of bedridden and grave patients together with junior
personnel, control of compliance with sanitary requirements.
The students should learn the design of wards, hospital furniture (beds, bedside tables,
chairs), care of grave and bedridden patients: care of the skin, washing the feet and head, care of
the oral cavity.
Students learn to give enemas, learn the types of enemas, the mechanism of their action,
technique of administering.
Students learn the technique of gastric intubation, indications; they prepare patients for
radiographic and endoscopic examination.
Students give subcutaneous and intramuscular injections.
III. DRESSING ROOM. CARE OF PATIENTS DURING DRESSING
Dressing is the process of removing the dressing, therapeutic manipulations in the wound,
application of a new dressing.
Indications for dressing: if the dressing has shifted, soiled, or got wet, a need for
therapeutic intervention.
The main objective of work in the dressing room: prevention of infection in the wound.
During the practical training students should note that patients are divided into “clean”
and “purulent” cases with separate dressing rooms for each category.
Students should transport patients into the dressing room in wheel chairs, on stretchers;
help walking patients. Note should be made of careful handling with patients, especially upon
transporting grave bedridden patients to the dressing room. Students should learn the technique
of relaying patients and changing beds. While in the dressing room students should stringently
observe the requirements of aseptics and antiseptics.
Students take part in the dressing, learning the technique of instrumental dressing.
After the dressing the patient has to be taken back to the ward. During the dressing
students assist in undressing the patient learning to do it painlessly.
In the clean dressing room students take part in surgical manipulations: taking out
stitches, abdominal paracentesis, pleuracentesis, puncture of large joints.
Between dressings students should prepare instruments for sterilization, treat them after
sterilization, disinfect the dressing table, take part in routine cleaning of the dressing room.
IV. TREATMENT ROOM. CARE OF PATIENTS
Students should familiarize themselves with the equipment of the treatment room, learn
the methods of instrument sterilization, paracentesis of peripheral veins, storage of sterile
instruments, drugs and blood samples.
Students will familiarize themselves with the structure and different types of syringes and
needles used in the treatment room; they learn to determine if the needles are usable, how to care
for them and store them.
Special attention is paid to sterilization of syringes and needles, careful observation of
instructions.
Students familiarize themselves with intramuscular, intravenous, subcutaneous injections,
with duodenal and gastric tubes. They take part in duodenal intubation, learn the technique of
introducing duodenal and gastric tube for taking gastric juice or gastric lavage.
V. CARE OF PATIENTS IN RESUSCITATION DEPARTMENT
In the resuscitation department students familiarize themselves with the equipment of
intensive care unit, learn the indications for resuscitation procedures, note the course of
postoperative period, learn to characterize the pulse, respiration, to take BP.
In early postoperative period the patient’s respiration should be watched, especially in
weak patients after anesthesia as respiratory failure can develop or airways can be blocked (by
the tongue or emetic masses).
Students should learn to give first aid upon loss of consciousness, acute mental
disturbances, acute hemorrhage, acute respiratory disorder, vomiting, regurgitation and
aspiration of gastric contents, collapse, terminal conditions.
After surgery you should stay with the patient until he wakes completely if he was
anesthetized, monitor his respiration, pulse, arterial pressure, prevent the arrival of gastric
contents into the esophagus and mouth. Learn to prevent and treat hiccups, vomiting, belching.
Upon doctor’s instruction you will intubate the stomach, introduce the flatus tube into the
rectum.
Students learn the technique of oxygen inhalation, respiratory exercises.
Students monitor the condition of the tube, care for it, monitor the urine flow. Upon
doctor’s instruction the bladder is catheterized.
VI. SURGERY UNIT
In the surgery unit students will familiarize themselves with:
- sterilization of materials, gloves and instruments
- scrubbing
- work of operation theatre taking part in surgery as assistant to scrub nurse.
1.
2.
3.
4.
5.
THEMES FOR REPORTS
Specifics of patient care in postoperative period.
Specifics of patients with abdominal surgery
Specifics of patients with thoracic surgery
Specifics of patients with urinary surgery
Specifics of patients with surgery of magistral vessels of extremities
6. Specifics of care for trauma patients
7. Cleansing enema (indications, technique of administration, possible complications
and their prevention).
8. Siphon enema. (Indications, technique of administration, possible complications and
their prevention).
9. Postoperative paresis of the intestine. Its prevention and treatment.
10. Respiratory arrest. Ways of its prevention, first aid.
11. Cardiac arrest, first aid.
12. Medical deontology and doctor’s ethics.
13. Medical secrecy. Ethical and legal aspects of medical secrecy.
14. Deontology in surgery.
15. Cupping glasses, mustard plaster, contraindications. Complications and their
prevention.
16. Gastric intubation. Indications and contraindications. Complications and their
prevention.
17. Prevention of hospital infection.
18. Personal hygiene as foundation of health.
19. Hardening the body with cold water as a way of preventing inflammatory diseases.
20. Ways of preventing the spread of AIDS.
21. The use of antibacterial medium in surgical practice.
22. Oxygen therapy. Its use in surgical practice.
23. The layout and regulations of medical care institutions.
24. Daily routine and nutrition of inpatients.
25. Ways of affecting blood circulation.
26. First aid in terminal conditions.
27. Defibrillation (indications, technique of administration).
28. Tracheostomy (indications, technique of administration, complications).
QUESTIONS FOR A CONCLUDING TALK
The notion of clinical hygiene.
Basic components of nursing care in surgery.
The notion of general and differentiated care.
The basics of medical personnel’s hygiene.
The specifics of care for surgical patients.
First aid upon contact of disinfectants with the skin, mouth, nasopharynx, eyes or
stomach.
7. The main objectives of admission department at a surgical clinic.
8. Sanitary cleansing of a patient in the admission department.
9. Hygienic preparation of a patient for urgent surgery.
10. Disinfection of bathtubs, sponges, scissors.
11. Hygiene of air at a surgical inpatient department.
12. Prevention of hospital infection at a surgical inpatient department.
13. Temperature, ventilation and disinfection of air at a surgical department, dressing
room and operation theatre.
14. Nutrition of bedridden patients, enteral feeding, feeding through a gastrostoma.
15. Sterilisation of air in the operation theatre.
16. Putting the patient onto the operation table, taking him off it, transportation to the
department.
17. Zones of the surgery unit, their difference, the “rule of the red line”.
18. The therapeutic and conservative regimen at the department.
19. Preparation of a patient for surgery.
20. The notion of regimen of a surgical patient. Types of regimen.
1.
2.
3.
4.
5.
6.
21. Bedsores, their cause, prevention, treatment.
22. Change of bed linen for a surgical patient. Ways of sanitary cleansing.
23. Aid upon vomiting, aspiration of gastric contents.
24. Care of unconscious patients.
25. Handling a dead body.
26. Postoperative wound, its observation, signs of complications.
27. Drains, their care.
28. Specifics of care for patients after abdominal surgery.
29. Specifics of care for patients after urinary surgery
30. Specifics of care for patients after thoracic surgery.
31. Prevention of pulmonary complications.
32. Enema, types of enema.
33. Technique of administering cupping glasses, mustard plaster.
34. Catheterisation of the bladder.
35. Flatus tube, its introduction.
36. Taking body temperature.
37. Deontology in surgery.
38. Closed-chest and open-chest cardiac massage.
39. Artificial ventilation.
40. Ways of transporting the patient in the department.
41. The layout of treatment room, its equipment.
42. Pre-sterilisation treatment of syringes.
43. Technique of giving subcutaneous, intramuscular, intravenous injections.
44. Prevention of wound infection in the dressing room.
45. The notion of dressing, indications.
46. Taking the pulse rate, arterial pressure and respiration rate.
LIST OF PRACTICAL SKILLS AND MANIPULATIONS
During the on-the-job training the student consolidates and deepens his knowledge and
mastery of practical skills and manipulations. In the diary a note should be made of the type of
skill and of the student’s progress in mastering it.
№
List of therapeutic and diagnostic skills
knowledge
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
I. CARE OF PATIENTS
A. AT THE ADMISSION DEPARTMENT
Transportation of patients from the ambulance
car to the admission department
Medical records, filling out the front page of
case history
Entering the patients into the register
Anthropometry
Examination of hair and skin integuments
Sanitary cleansing of patients (trimming the hair
and nails, a bath, shower or wiping)
Entering the temperature in the register
Storage and use of thermometers
Filling out temperature sheets
Preparation of 0.5%, 1%, 10% solution of
chlorinated lime
Catheterisation of the bladder
Transportation of patients from the admission
Quality of
skills
attainments
1.
2.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
1.
2.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
department to the inpatient department
B. IN THE WARD
Familiarisation with the layout, organization of
work, and regimen of medical care institutions
Familiarisation with the medical records, rules
of admitting and discharging patients
WARD HYGIENE:
Wet cleaning of wards:
Preparation of 0.5-1% solution of chlorinated
lime
Control of the sanitary condition of bedside
tables
Airing the wards
Control of visiting and food brought by visitors
Disinfection and storage of spittoons
Transportation of patients with a drip stand or
drain
Making the bed
Change of linen and bed clothes
Placing the rubber ring or bedpan
Transportation and relaying of patients
Administering mustard plasters and cupping
glasses
NUTRITION OF PATIENTD
Feeding the patient. Notion of dietotherapy.
Nutrition regimen
Feeding grave and bedridden patients
II. TECHNIQUE OF MANIPULATIONS
Transporting the patient to and from the dressing
room
Methods and techniques of changing a dressing
Applying various types of dressing
Sterilization of instruments
Cleaning of the dressing room
Care of skin in the presence of a fistula
Taking the temperature, entering it into the t0
sheet; types of temperature curves. Storage of
thermometers. Care of patients in different
periods of fever
Affecting blood circulation: indications,
contraindications, administering cupping
glasses, mustard plasters, hot water bottles, heat
compresses, ice packs; bloodletting; applying
the tourniquet
Oxygen therapy: operating the oxygen
installation
Prescription, storage, use of drugs; monitoring
the use of poisonous and powerful drugs;
distribution of drugs for internal use
Indications, contraindications, technique of
administering enemas (cleansing, nutrient
12.
13.
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
1.
2.
3.
4.
a.
b.
5.
a.
b.
c.
6.
7.
a.
b.
c.
1.
2.
3.
medicinal, siphon enema)
Preparation of patient for x-ray examination of
gastrointestinal tract, gallbladder and biliary
ducts, kidneys and urinary tracts
Injections:
Sterilization of syringes and needles
Filling the syringe from a vessel with sterile
solution, from ampoules
Taking a blood sample from the vein
Giving intravenous injections
Indications, contraindications, technique of
subcutaneous and intramuscular injections
Treatment of needles and syringes after use
Checking the sterility of needles and syringes
Filling a system for infusion therapy
Preparing tubes for drawing gastric juice and
duodenal intubation
Performing gastric lavage
Shaving the operation field
Sanitary cleansing of the patient
III. LABORATORY TESTS
Urine: doing Zimnitskiy’s test
Feces: physical properties, occult bleeding test
Gastric contents: methods and technique of
gastric intubation
Duodenal contents:
Methods and technique of duodenal intubation
Participating in duodenal intubation
Blood:
Drawing blood from the finger for a large drop
Drawing blood from the finger for agglutination
time test
Participation in blood grouping, Rhesus
compatibility
Sputum: technique of sputum collection (general
test, for atypical cells, for microflora and
antibiotic sensitivity, daily amount)
Pleural fluid:
Preparing instruments for pleurocentesis
Pleurocentesis: indications, contraindications,
technique, participation in performing
pleurocentesis
Determining physical properties of pleural fluid
IV. BASIC DOCTOR’S MANIPULATIONS
Counting respiratory movements, entering them
onto the temperature sheet
Properties of the pulse. Their graphic
representation of pulse rate in the temperature
sheet.
Registering BP
1.
2.
3.
4.
5.
6.
7.
V. URGENT CONDITIONS
Applying tourniquet to the extremities (acute
cardiac insufficiency)
Technique of external cardiac massage
Technique of artificial ventilation
Principles of defibrillation
Preparation of a catheter, participation in
catheterisation of bladder with a plastic catheter
Administering a flatus tube
Indications, contraindications, technique of
gastric lavage, participation in gastric lavage
VI. BASIC SURGICAL SKILLS
Nursing
Clinical hygiene of medical personnel in surgery
DIARY
of on-the-job practical training
of student _____________________________________________________
of the second year of training of General Medicine department
of Volgograd State Medical University
Dates of practical training
from ______________ to _____________
Teaching hospital ______________________________________
Supervisor of practical training _________________________________________
Supervisor of practical training at VolSVMU ______________________________
Date of
duty
Work accomplished
Signature of nurse
on duty
REFERENCE
of student ___________________________________________________
Signature of supervisor
of the on-the-job practical training
Signature of head nurse
at the department
Examination mark obtained