Functional duties of the nurse of the psychoneurological department
Psychiatric assistance to the population is provided by the work of a psycho-neurological dispensary and a psychiatric hospital. Patients who are registered with the psychoneurological dispensary and newly diagnosed patients are referred to the hospital if necessary. When hospitalization of patients in a hospital, medical personnel need to obtain their consent to hospitalization and treatment. Compulsory treatment is necessary only when the patient is inadequate, unable to critically treat his condition, if it poses a danger to himself and others.
The psychiatric hospital consists of a reception room, a general psychiatric ward, and specialized departments. The hospital for comprehensive examination and treatment is equipped with diagnostic laboratories, X-ray and physiotherapy rooms, specialists of various specialties work for advisory work. Also at the psychoneurological hospital there are places for occupational therapy, various workshops, a library for the rehabilitation and adaptation of psychiatric patients.
The simple separation of a psychiatric hospital includes two halves: restless and calm. The restless half contains patients with inadequate behavior in an acute condition: with delirium, hallucinations, psychomotor agitation, in a stupor. Such patients need constant supervision of medical personnel, as they can harm themselves and other people. Patients in need of special supervision and care are placed in a special ward - an observation room, where the nurse and the nurse are always present. In a calm half, patients are in recovery, when they have adequate behavior, when they can take care of themselves and are not dangerous to themselves and others. In the psychiatric hospital department, all doors are always locked, which is only for doctors and nurses. Windows should be barred or glass must be unbreakable. The windows on the windows should be placed so that the patients could not reach them.
The duties of medical personnel in the psychoneurological hospital have their differences from work in other somatic hospitals. Differences in work mainly depend on the contingent of patients being treated. Some patients can not critically evaluate their illness, or do not consider themselves to be sick. Often, mental patients have attacks of excitement and aggressive behavior, which is dangerous for medical personnel.
Therefore, there are several mandatory rules of conduct and care in the psychiatric ward for all medical personnel. Medical staff in psychoneurological hospitals should constantly display vigilance, patience, sensitivity, politeness, attention to the sick. Medical workers should avoid bright cosmetics, wearing ornaments( beads, earrings) that can be ripped off by patients with psychomotor agitation. Nurses wear a bathrobe and a hat. Hair must be removed under the hat. With patients, despite their behavior, even aggressive, it is necessary to communicate patiently, politely, benevolently. Quite often the behavior of psychiatric patients leads to tragedies, so the nurse must be vigilant, never turn to the sick back. Medical personnel must ensure that all doors are closed so that the keys do not fall into the hands of the sick. Regularly check the personal belongings of patients prone to suicide, for the presence of sharp, cutting objects, cuttings, chips, wire, pens, pins, matches, pins, what the patient can open the door or harm himself and others. Personal belongings of other patients are also periodically examined. It is better to conduct an audit of personal belongings at a time when the patient is not in the ward( the patient is in the dining room, bathroom, for a walk), this spares the feelings of the sick. If you want to immediately see the patient's things, he is called to the doctor's office or to another place outside the ward.
During the meal, patients are fed food, which can only be eaten with a spoon. The room where cutlery( knives, forks) and other items are located should always be closed so that patients can not get there freely.
In the organization of well-coordinated work of the psychiatric ward, the work of the nurse plays an important role, which not only prescribes the doctor, therapeutic manipulation, care for the sick, but also helps the patients in recovery and rehabilitation. The nurse should be well informed about the number of patients in the department for each day, know the sick by name, patronymic, surname, in which wards each of them lies, the reasons for the absence of some of them. She should know about the mental illness of each patient, the peculiarities of his current, about the condition at the moment, about the treatment that he has undergone. The nurse should know what appointments the attending physician has made and strictly follow them at a certain time. Communication of the nurse with patients should be equal, serious, patient, caring. You can not overly curry favor with the sick. It is impossible to distinguish among "sick" departments "pets" and pay attention only to them, forgetting about other patients. A nurse should strictly monitor the regime in the psycho-neurological department, since its maintenance is the key to the successful treatment of mental patients. Medical personnel are obliged to monitor their speech, in the presence of patients, even those who are in catatonia, one should not allow talking to extraneous topics, this can cause harm to the mental state of the patient. It is forbidden for a patient to talk about his health or the health of another patient, make any predictions. With patients you can not joke, laugh at them, talk with irony.
A nurse should always give clear, truthful answers to patient questions, when it is not possible, it is better to change the topic of the conversation. Patients with delirium require a more sensitive and patient attitude, often they doubt the correctness of treatment, speak about the dangers of being in the hospital for their health and even life. Such patients do not need to be strongly dissuaded, this can lead to the opposite effect, cause even greater distrust of the medical staff. The nurse should politely and calmly explain to the patient that he is wrong, that he is sick and needs treatment, that here no one will harm him. While working in the psychiatric ward, one should not be afraid of the sick, but they should not be underestimated either, since this can be dangerous for the health of the medical staff. Some patients show aggression towards others, and one can not show a negative attitude towards such patients, since this condition is due to illness. Quite often between patients flare quarrels and even fights, the nurse should not stand on the side of one patient. She is obliged to stop the fight, calling the orderlies and the doctor. Patients in severe arousal need special care. Excitation occurs in schizophrenia, manic-depressive psychosis. In the treatment of such patients, the use of medicines is effectively used: aminazine, hydrochloride, hexenal, barbamyl. All drugs are administered parenterally. When excited, patients rush, fight, swear, shout, often they have to be forcibly fixed in bed. The nurse must have the skills to fix the patient and be able to explain this to the orderlies. To keep the patient, they put him on the bed, and the orderlies press his hands and feet, while the nurse enters the preparations. If a prolonged fixation is necessary, soft elastic tapes are used, and the term for fixing the patient is determined by the doctor.
A patient with epilepsy usually falls during a seizure, loses consciousness, and has seizures. For the prevention of bruises such patients during an attack are placed on a low bed or on the floor. It is necessary to unbutton clothes, in order to avoid aspiration vomit, the patient's head is turned to the side. A spoon is placed between the molars in the mouth between the molars( if you place a spoon between the front teeth, this can cause them to break during a fit), wrapped in gauze, so that the patient does not injure the tongue with teeth. After the attack, the patient plunges into a long sleep, after which the patient has a bad mood, about the attack, he does not remember anything. The patient in this state must provide peace.
Weak and bed patients need constant care of a nurse. Such patients are nursed by a nurse or a paramedic, mostly by liquid food, taking care that the patient does not choke, carry out hygiene measures, change of bed linen and bed linen. Carry out prophylaxis of pressure sores, for this patient in bed it is necessary to constantly turn over, under the place of special squeezing put rubber circles, watch the cleanliness of the bed. Skin covers of the patient should be constantly examined, if there are places of hyperemia( redness), they need to be wiped with camphor alcohol. If the patient has incontinence, or he does physiological administration for himself due to his illness, it is necessary to regularly wash the patient, change linen, put an oilcloth and a vessel.
Vigilance The nurse should also apply to the numerous requests of patients - for this you must first weigh and think about all the possible consequences. It is necessary to know that psychiatric patients can hide some manifestations of their pathology, deceive, so even, at first glance, innocuous requests can cause significant harm to the patient himself and others.
The nurse also has to monitor, read letters written by the patients themselves and transmitted to them by their relatives. Letters from patients with clearly delusional content can not be sent, their nurse gives the doctor. Letters from relatives are also read by medical staff, because some news can harm a person's mental state and prevent treatment.
You need to check the products, things brought by relatives, since they can contain something that the patient can not or can do harm: alcoholic beverages, narcotic substances, razors, blades, knives, needles.
A nurse supervises not only patients in the ward, but she must supervise the work of the nurses and supervise their work. She must ensure that continuity is maintained between the different shifts in the work of the sanitary post, so that nurses will always be present in the ward. The nurse tells a new change of orderlies which patients require special attention and care.
The work of a nurse is a creative process, including the carrying out of a medical process, for which knowledge of the disease, its course, methods of treatment is necessary. The nurse is responsible for carrying out many vital procedures. The nurse of the psychiatric ward needs knowledge about the psychology of the patient, the features of the course of his illness, each patient should have an individual approach. This knowledge is necessary for the adequate performance of the medical work of a nurse, because it is very difficult to receive the consent of a psychiatric patient for a particular procedure, because of psychosomatic pathology, delusional symptoms, and hallucinations. For mental patients, care and supervision by the nurse always remains an important process in the treatment and convalescence. The nurse provides feeding, replacement of bed linen and bed linen, medical and hygienic measures. The nurse of the psychiatric ward is also the link between the patient and the doctor. She is in constant contact with patients and can note in such a category of patients as depressed patients, patients with catatonia, behavioral disorders, changes in their mood, appearance of suicidal moods. Working in close connection with doctors, the nurse, thus, influences the medical process.
In the psychiatric ward, there are: an insulin, an aminosine, a procedural nurse. The duties of a procedural nurse are therapeutic manipulations, the receipt and storage of medicines, and the provision of advice by other specialists. Medicines are given to patients under the strict supervision of a nurse who must check whether the patient has drunk the whole dose, as patients can accumulate medicines for suicidal attempts.
The duties of an insulin nurse include insulin therapy for the treatment of schizophrenia. The duties of an aminazine nurse are the distribution of psychotropic drugs. Distribution of psychotropic drugs takes place in a special aminazine cabinet, where the medicines are stored in a closet with a hood. A nurse, when working in such a room, should put on a rubber apron over the robe, then another robe and mask, after the distribution all this is removed and stored in a special place. A nurse should not turn away from the medicine tray, allow patients to take medicines on their own. An Aminozine Nurse also checks if the patient has drunk the entire single dose of medications, for this, the patient is opened with a mouth and checked with a spatula. After distributing the preparations, the cabinet should be well ventilated. The nurse must also ensure that patients do not enter this office in her absence.
The nurse should monitor the patients around the clock. It should control the time of sleep and wakefulness, the diet regime, and perform sanitary and hygienic procedures. In the psychiatric ward, a strict daily routine. Patients should sleep at night 8-9 hours, in the daytime -1 hours. Nutrition of patients occurs at certain hours 4 times a day. Patients placed in the observation room( patients with suicidal attempts, aggressive, prone to escape), need special care and supervision, as they show excessive ingenuity to implement their plans. Such patients are under the constant supervision of a nurse and nurses. If such a patient is closed with a blanket with his head, we must open his face, we must monitor the patient during the temperature measurement, so that the patient does not harm himself with the thermometer. The orderlies should watch such patients and when they visit the toilet. Quiet patients are shown daily walks under the supervision of medical staff. Daily lists of patients for walks are supervised by the doctor. The nurse is obliged to monitor the behavior of patients, especially those prone to escape and suicide. It is also necessary to know the exact number of walking patients. The greatest control over the sick is necessary in the morning hours, when the longing for them is the most difficult. In a calm half there are patients whose acute period of illness has already passed, they are not dangerous to themselves and others. These patients do not require constant care and supervision. The nurse should actively help the patients in their rehabilitation, stimulate the ability to self-service, adapt to the outside world. Such patients have a softer and extended regime, they are allowed to use a shaving kit, go to a hairdresser. They can meet more often with relatives, walk around the entire hospital. A nurse in communication with patients, caring for them, should behave so that the patient feels care and attention. In the psychiatric ward, you need to keep silence, you can not slam the doors, thunder tools, utensils. Night sleep is especially important for patients, so nurses should not disturb their rest. You can not raise the voice of the sick. A nurse must monitor her speech, especially with patients who have delusions of persecution, suicidal attempts.
A nurse must monitor the behavior of patients and note its changes. In psychiatric patients, due to the peculiarities of mental illness, there are sudden mood changes: a cheerful and sociable patient can quickly become gloomy, unsociable;calm - excited, aggressive. Patients often have attacks of unreasonable fear and anxiety. It is important to pay attention to the habits of the patient: he likes to lie in bed or walk, be silent or communicate. The nurse on duty observes the behavior of patients at night, reveals patients with sleep disorders: insomnia, anxious, superficial sleep. Changes in the behavior and habits of the patient may indicate an exacerbation of the psychotic state. In this case, the nurse must be able to help and call a doctor. Some patients do not eat, drink, or only drink, or take only certain foods. This condition can be due to various causes( catatonic stupor, delusions, hallucinations, depression), but the nurse should notice and know such patients. To such sick the nurse should be treated with patience, care and affection, this is of great importance in persuading the patient to eat. After much persuasion, patients can start eating. Sometimes patients agree to eat, if they are fed by the Goth, to whom they trust. Some intractable patients are given a small dose of insulin to stimulate appetite. In especially severe cases, the patient has to be fed through a probe.
In , the duties of the nurse include not only vigilant observation of the behavior of patients, but also control over the fact that patients do not have sharp, pricking, cutting objects. Since patients can pick up such items on the street, the nurse must monitor the patients during the walk. The medical staff should carefully clean the area adjacent to the hospital, where patients are walking. It is also necessary to monitor patients during occupational therapy, so that they do not hide working tools: scissors, needles, hooks.
Thus, the work of a nurse in the psycho-neurological department is an important component in the treatment and care of mental patients. It has a great responsibility not only for the medical process and patients, but also for the coordinated work of the department, all its employees. Careful, sensitive, attentive attitude of the nurse to the patients, professional approach - all this gives good results in the care and treatment of mental patients.