VOLGOGRAD STATE MEDICAL UNIVERSITY
CHAIR OF PROPEDEUTIC OF INTERNAL DISEASE
MANUAL AND DIARY
of on-the-job practical training as a nurse assistant
in therapeutic departments
«GENERAL MEDICAL CARE. THERAPY»
for the 1st year General Medicine students
(English Medium)
Compiled by:
D.N.Emelyanov,
The Head of the Chair of Propedeutic of Internal Disease
of the Volgograd State Medical University
Volgograd, 2013
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GOALS OF ON-THE-JOB PRACTICAL TRAINING
1. Familiarizing the students with the work of a patient care institution.
2. Patient’s care.
3. The principles 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
FORMAT OF THE PRACTICAL TRAINING
Students work as nurse’s assistant takes place in extracurricular time, amounting to 72
hours. The students work 6 hours daily. The immediate supervisors are head nurses of therapy
departments.
The students keep diaries where they enter the description of work done every 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 explains students technique of medical manipulations, given in the appendix
and at the end of practice gives students marks for the practical training.
THE CONTENT OF WORK AT THE THERAPEUTICAL DEPARTMENTS
During the practical training each student should familiarize himself with the work of
patient care institution, acquire practical skills of nursing and giving first aid, and learn the
sanitary standards of therapy service.
I. ADMISSION OF PATIENTS TO THE THERAPEUTIC DEPARTMENT
The reception of a hospital is intended for admission, registration, examination and
cleansing of patients. It consists of several subdivisions:
1. Waiting-room
2. Office of the nurse on duty
3. Examination rooms
4. Treatment room
5. Sanitary inspection room
6. Clinical laboratory
The duties of the nurse include: accompanying the patient to the office, filling in 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.
The patients are admitted by reception department to reception doctor or 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 antiseptic
solution. The patient’s skin integument and oral cavity are examined, body temperature should
be taken. Thermometers are kept submerged in antiseptic solution. While examining the patient
in the examination room attention should be paid to any skin diseases. If they are present
examine the changes in day light, and 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, if it is necessary. The
average duration of a warm hygienic bath is 20-30 minutes, water t0 – 35-360C. If the bath is
contraindicated, 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, or on a stretcher cart.
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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 check the compliance with sanitation
requirements.
II. CARE OF PATIENTS AT THE THERAPY DEPARTMENT
1. The basic duties and work conditions of junior and senior medical personnel.
2. The basics of medical psychology, ethics and deontology.
3. The general rules of nursing and differentiated care at the therapy department.
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, measuring temperature chart, distribution of drugs,
preparing patients for investigations, sending blood and other samples for tests, control of test
results, keeping medical records, 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 insert enemas, learn the types of enemas, the mechanism of their action,
technique of the procedure preparing.
Students learn the technique of gastric and duodenal intubation, indications; they observe
patients for radiographic and endoscopic examination.
III. PROCEDURE ROOM. CARE OF PATIENTS
Students should familiarize themselves with the equipment of the procedure room. They
work 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.
In the procedure room students learn to characterize the pulse, respiration, to take blood
pressure.
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.
Students learn the technique of oxygen inhalation, respiratory exercises in wards.
Students learn the catheterization the urine bladder, monitor the condition of the catheter,
care for it, monitoring the urine flow. Upon doctor’s instruction the bladder is catheterized.
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The List of Nursing Skills (working as a Nurse Assistant):
1. Evaluating hygienic and sanitary conditions of wards;
2. Changing underwear and bedclothes;
3. Cleansing patients;
4. Using bed-pans, urinals; disinfecting them;
5. Watching the appearance and general condition of a patient;
6. Feeling the pulse on the radial artery, determining its character;
7. Counting the number of respirations per minute. Giving aid in breathlessness;
8. Giving first aid to patients suffering from cough. Taking sputum for analysis;
9. Feeding severely ill patients;
10. Transporting severely ill patients;
11. The rules of keeping drugs. Giving drugs to patients;
12. Estimation of antibiotic dose, dilution of antibiotics;
13. Application of an ice pack on the patients;
14. Using different forms of oxygen therapy;
15. Introducing a soft catheter into the urinary bladder;
16. Administering cleansing, retention, flush and medical enemas. Introducing a flatus tube;
17. Measuring body temperature and registering the results. Nursing patients with fever;
18. Anthropometric measurement;
19. Taking blood pressure and feeling the pulse. Recording the received data;
20. Taking sputum for analysis;
21. Applying a tourniquet on the arm;
22. Cleansing the stomach using a thick elastic tube. Performing gastric intubation using a thin
elastic tube. Making fractional analysis of gastric juice;
23. Performing duodenal intubation;
24. Giving first aid in nasal bleeding, blood spitting and pneumorrhagia;
25. Giving first aid in gastro-intestinal bleeding;
26. Giving first aid in cardiac pains;
27. Making artificial lung ventilation and closed-chest cardiac massage.
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LIST OF PRACTICAL SKILLS AND MANIPULATIONS
During the on-the-job training the student consolidates and deepens his knowledge and
master practical skills and manipulations. In the diary a note should be made on the type of skills
and the student’s progress.
№
List of therapeutic and diagnostic skills
I. CARE OF PATIENTS
A. AT THE RECEPTION DEPARTMENT
Transportation of patients from the ambulance car to the reception 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
Catheterization of the bladder
Transportation of patients from the reception department to the inpatient department
B. IN THE WARD
Familiarization with the layout, organization of work, and regimen of medical care
institutions
Familiarization with the medical records, rules of admitting and discharging patients
Wet cleaning of wards
Control of the sanitary condition of bedside tables
Airing the wards
Control of 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
Feeding of the patient. Notion of dietotherapy. Nutrition regimen
Feeding grave and bedridden patients
II. TECHNIQUE OF MANIPULATIONS
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
medicinal, siphon enema)
Preparation of patient for x-ray examination of gastrointestinal tract, gallbladder and
biliary ducts, kidneys and urinary tracts
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III. LABORATORY TESTS
Doing Zimnitskiy’s test
Feces: physical properties, occult bleeding test
Gastric contents: methods and technique of gastric intubation
Methods and technique of duodenal intubation
Participating in duodenal intubation
Drawing blood from the finger for a large drop
Drawing blood from the finger for agglutination time test
Detecting blood group and rhesus factor
Sputum: technique of sputum collection (general test, for atypical cells, for microflora
and antibiotic sensitivity, daily amount)
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 blood pressure.
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 catheterization of bladder with a plastic catheter
Administering a flatus tube
Indications, contraindications, technique of gastric lavage, participation in gastric lavage
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Table:
Example: Model of filling the daily work at the department:
Attendance
Date of Duty
Time of Duty
Surname and Name of the Nurse On Duty
Work plan
1.1 Instructions on occupational safety and
health.
1.2 Studying the work of the in-patient
therapeutic department.
1.3 Studying the arrangement of work of a ward
nurse.
1.3.1 Layout of workplace
1.3.2 Medical records, documents.
1.3.3 Functions.
1.4 Performed Work.
Signature of the nurse on duty
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DIARY
of on-the-job practical training
of student _____________________________________________________
of ___________________________________
Dates of practical training
from ______________ to _____________
Teaching hospital ______________________________________
Supervisor of practical training _________________________________________
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Date of
duty
Work accomplished
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Signature of nurse
on duty
CHARACTERISTIC
of the student ______________________________________________________________
Signature of head nurse
of the department
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