Organization of the work of a nurse
The clinic belongs to outpatient-type outpatient facilities that provide out-of-hospital medical care and carry out preventive measures aimed at reducing the incidence of the population.
At present, children's polyclinics, dental polyclinics, outpatient clinics, polyclinic departments in hospitals and dispensaries are distinguished. Student polyclinics exist for medical assistance in secondary and higher educational institutions. At industrial enterprises, polyclinic care is also provided. Regional and large-scale multi-profile hospitals have consultative and diagnostic polyclinics. In large cities, polyclinics are organized for preventive medical examination( preliminary and periodic).
There are self-supporting polyclinics( dental, gynecological, multidisciplinary) providing paid services. Health-care unit( MSU) is a city polyclinic, which serves only workers of transport, construction, industrial organizations.
Recently, due to the construction of high-rise residential buildings, the service radius of the population has decreased noticeably. The term "polyclinic capacity" includes the number of visits per shift, in addition to dental clinics, where the capacity is determined by the number of dentists. According to the capacity and tasks, the structure of different types of polyclinics is not the same. An average norm of the population's need for out-patient care has been established: it is 12.9 visits per inhabitant per year, which makes 250 visits per shift per 10 thousand inhabitants. In polyclinics, the required number of specialists is calculated, which takes into account the load norm for 1 h of work.
The medical section is the main link of the polyclinic, which includes 1700 people, served by the district therapist. The activity of the polyclinic implies the provision of medical assistance to construction workers and industry, for which the shop therapeutic departments are organized on its territory.
The layout of premises, determined by the tasks, scope and nature of the polyclinic, can be different. Polyclinics are constructed as stand-alone buildings, and unite with the hospital. In the second case they are connected by a block in which diagnostic and treatment units are located( X-ray, physiotherapeutic, functional diagnostics, laboratories, etc.).
Thus, the above-mentioned examinations can take place both in polyclinic and inpatients. It is established that polyclinics per 1000 visits per shift are economically profitable.
The main departments of the polyclinic are the registry, the prevention department, the pre-hospital reception room, the specialized doctors' offices, the medical and diagnostic departments, the laboratories, the rehabilitation department, the health education and hygiene education office, the accounting and medical statistics office, and the pharmacy information cabinet.
The main function of the registry is to distribute doctors' visits throughout the day evenly. For this purpose, the registrars form a queue and write the patient to the doctor for a certain time. In the polyclinic at the place of residence, an outpatient patient card( form No. 025 / y) is issued for each patient. Here you will find all the necessary information about the results of the examination, appointments of doctors, recommendations on diet and nutrition, etc. Medical outpatient cards are in the registry, their placement is based on the precinct principle. The structure of the registration unit includes the information desk, the department of the preliminary and the next record, the department of registration of documents. There is also a home care unit and an archive where medical outpatient cards have been kept for 25 years. The reception area should be between 85 and 125 m2.
The Preventive Department consists of a pre-hospital reception room, a women's examination room, a health and education office. There is also an office, whose employees organize and supervise!carrying out prophylactic medical examination of the population. Anamnestic cabinet of this department reveals patients with increased morbidity.
To ensure that the patients stay in the clinic is minimal, a pre-hospital reception is organized. In addition, doctors are freed from their unusual functions. There are three nurses and two paramedics with at least three years of work experience. In accordance with the power of the clinic, the mode of the cabinet is determined. For example, in polyclinics, which serve more than 40 thousand residents, the work of the cabinet is carried out in two shifts. The functions of the pre-hospital care cabinet are the reception of patients who re-visit the clinic, but do not have a coupon to the doctor;measurement of temperature, blood pressure. In addition, there is a reception of patients who need medical documents. Employees of the cabinet issue directions for laboratory research, fill out the passport part of medical documents, which are then signed by the attending physician or the head of the department. If necessary, employees of the office provide the patient with a doctor's appointment. The inventory of the pre-hospital room includes: a work table, a couch for patients, a heightometer, a medical scales, a set of spatulas, thermometers, a blood pressure measuring device, an emergency aid kit. The main document of the cabinet is the "Journal of registration of outpatients", in which, in addition to passport information, in the column "Diagnosis" there is an occasion for treatment of the patient, and in the column "Appointments" - the treatment measures and recommendations. The staff of the pre-hospital reception should systematically keep a diary of the activities of the average health workers of the polyclinic. The area of the cabinet should be from 15 to 20 m2.Admission of patients in specialized offices should be carried out during the whole period of work of the clinic to ensure the admission of employees of production organizations working with shifts( the characteristics of some other departments of the polyclinic will be stipulated in the future).
One of the main links in the work of the polyclinic is the activity of district physicians-therapists. There are two types of posts of a doctor-therapist: district and shop. The first is assigned to the territorial site in the area of the polyclinic, for the second - the guild, organized at construction, industrial, transport enterprises, which do not have their medical and sanitary unit. The working time of the district therapist is strictly distributed. Thus, 6.5 hours are allocated for the admission of patients, 3.5 hours of which the doctor works in a polyclinic, and 3 hours of assistance at home. For each patient, the district therapist spends an average of 35 minutes. In accordance with the regime of the polyclinic patients are pre-recorded to the doctor to visit them at home. A district therapist can provide assistance on calls no later than 21 hours. This function is then performed by the ambulance service. If the patient's place of residence is significantly removed from the polyclinic, the district doctor is delivered by special transport. The doctor has a blood pressure monitor( a tonometer) and a universal first-aid kit. The appointment of a district therapist is performed by a nurse. At the enterprise, the preventive work of the doctor of the shop area is carried out in a specially designated room. Most of the time, the shop therapist conducts in the clinic, where he receives patients. For each enterprise, the health center must be assigned, in which the medical assistant works, whose activities are supervised by the doctor of the shop area.