Selected practical experience of outpatient guidance

The course of outpatient medical guidance in the past three months has ended, which is different from the previous learning experience in clinical departments. Two and a half hours of outpatient service every week will have different experiences and feelings, and there are also many feelings when I understand the hospital process. I want to write down my feelings and gains in the process of guiding doctors.

First, the warmth under the hard and cold rules

I once saw a classic oil painting in which a sick child was lying in a hospital bed, and the doctor was sitting by the bed, looking at the sick child with great concern. On the other hand, the parents of the sick child are looking at the doctor with sharp eyes. This painting shows that when the doctor is seeing the patient, the patient and his relatives are also seeing the doctor; The patient doesn't say how the doctor treats the patient, but every time the doctor disposes, he will weigh it in his heart. In this context, medical staff need to ensure that their medical specialty is on the one hand, and whether their work is orderly and rigorous is a concern of patients and their families.

When I first stood at the nurse's information desk, the crowd and the noisy voice immediately caught my eye. Before I realized it, after the teacher gave me a brief explanation, I began to work. After a few minutes, I had an intuitive feeling about the work of the outpatient nurse station: the work itself is not complicated, but the communication with patients is complicated. Too many people and too few numbers is the most common phenomenon in large hospitals. In view of this phenomenon, there will naturally be corresponding rules and regulations, such as queuing for registration, waiting for medical treatment, and restrictions on signing. Every patient hopes to solve his own problems and demands in the shortest time, and hopes that the hospital can give priority. Of course, we explain and convince unreasonable demands beyond these rules over and over again. At this time, the hospital is rational, and doctors and nurses will inevitably give people an unreasonable feeling. At first, I thought that work should be done in strict accordance with the rules and there should be no privileges. But in fact, a patient I met in a class made me realize that hospitals are not only rational, but also human.

The thing is this: a mother came to the nurse's desk with her 1 month-old child and asked for priority access to the clinic. The sick child cried because of his discomfort. At that time, I patiently explained and refused. Unexpectedly, our conversation was carefully listened to by the nurse teacher next to me. She called her mother and gave her priority. After the whole process, the teacher just gave me a gentle look and said nothing. It was this glimpse that impressed me deeply. The hospital is a place to talk about rules, but it is definitely not a cold machine. Even if other patients see this scene, they will not only accuse the teacher of bias, but will only recognize and support it after understanding the specific situation. I think this is also a kind of positive energy.

Second, be sincere and enthusiastic, and learn to communicate.

Good doctor-patient communication has always been emphasized and advocated by us. The relationship between doctors and patients in outpatient service, especially in the nurse information desk.

The communication process is more prominent and important. Here, nurses and teachers have to go to work every day, and the same question may need to be answered hundreds of times, and the questions they have to face are more basic, more complicated, repetitive and monotonous than those of doctors in outpatient clinics. I have participated in some volunteer activities, and I have concluded that a qualified volunteer should be "patient, caring and responsible". Now facing patients directly, I think what needs to be done is "careful, enthusiastic and confident". First of all, no matter how to treat patients or colleagues, sincerity is the first. Every nurse and teacher I met in the clinic taught me how to respect others, how to be considerate of others, and how to handle details better in communication. Secondly, enthusiasm and confidence are indispensable. It is enthusiasm that makes us passionate about our work and willing to fight for the same goal. Besides, we should treat our work with confidence. Although we are not professional nurses and have not received the most professional training, we should also show our confidence as medical students, try our best to solve patients' problems and share teachers' work with our new mental outlook. Finally, be patient. As mentioned earlier, the work of the information desk is monotonous. Keep standing or sitting for a long time every day, and sometimes face the patient's incomprehension and deal with the patient's unfriendly emotions. But we know that the doctor-patient relationship is often between words and deeds. We need patience and hope that patients or their families can understand us and their feelings at the same time. Most importantly, we should improve our communication ability through constant practice. Being good at communicating with patients is the embodiment of doctors' basic ability, which is helpful to improve the relationship between doctors and patients and help doctors to know more about patients' condition. In fact, not only in the treatment of diseases, but also in all aspects of life, we are required to be good at communicating with people around us, which is conducive to the understanding between people and to our better integration into society and our own environment.

I often think that if I were a patient, I would be scared every time I came to a hospital like Huaxi. On the one hand, I am worried about my physical condition, on the other hand, I am troubled by complicated and even difficult medical procedures, and I am also worried about the time and money I have to pay for the clinic. Such empathy will naturally bring more patience and a slight smile to show relief when communicating with them.

There may be nothing I can do. I just hope that what I have done can erase some anxiety and sadness for patients.

Third, pass positive energy!

For interns and nurses who have just arrived at work or come into contact with patients in the hospital, their words and deeds are influenced by older and experienced teachers. After the first class, I just explained to a patient and breathed a sigh of relief. The teacher elder sister next to her said earnestly, "You just came here now, and you can explain patiently every time. After waiting for a long time, sometimes patients don't listen to you carefully and ask the same question repeatedly, so you will lose patience and don't want to communicate with them more. " Looking at her slightly tired face and admiring the helplessness in her words, her peaceful mood became somewhat depressed. It's not that there is anything wrong with what Senior Xue said, but the fact is just as she said. I just think that people's emotions are contagious, and negative or happy emotions will soon be passed on to people around them, which will have a great impact on the words, deeds and cognition of new workers. I think, instead of warning with my less smooth and negative experiences and experiences.

A new classmate who is still full of enthusiasm, why not choose to encourage his enthusiasm so as to make it last longer? I hope I can face all kinds of work with a peaceful attitude even if the novelty and passion have passed away.

Let's pass positive energy. Even if life is unhappy occasionally, happiness or peace should be the theme of life, shouldn't it?

Fourth, write it at the end.

First of all, I would like to thank the hospital leaders, department directors and head nurses for their training and colleagues' support in my work, so that I have the honor to participate in the fifth "Rehabilitation Specialist Nurse Training Course" in west china hospital. I am also very grateful to every teacher, who has done everything for us. You have worked hard. After two months of training, I benefited a lot and felt a lot. Now I will report my learning experience as follows:

In the theoretical study, the teacher explained with profound knowledge and humor, which not only enabled me to obtain the nursing routine and key points of common diseases in rehabilitation department (such as stroke, spinal cord injury, craniocerebral injury, diabetes, neck, shoulder, back and leg pain, etc.), but also improved my understanding of rehabilitation nursing of common orthopedic diseases, and also learned the knowledge of rehabilitation evaluation content and methods, physical therapy, occupational therapy and prosthetic orthopedic.

For me, this study is the promotion of theory and skills, and the baptism of thought, height and technology. First of all, we should update our concept: if we have a new understanding of rehabilitation, it is not recuperation, late treatment of patients or Chinese medicine plus physical therapy, but through training, compensation, enhancement and other methods to improve the quality of life of patients, return to their families, return to society and so on. Secondly, I realized the importance of early rehabilitation and mastered new techniques, such as clean intermittent catheterization, neurogenic bladder/rectum function training, good limb placement and so on. And have a certain understanding of the new concept of cardiopulmonary rehabilitation.

Clinical practice not only consolidated professional theoretical knowledge and technology, but also taught me how to manage patients, how to establish a good relationship with patients, how to do a good job in teaching and how to become an excellent manager. The clinical practice stage is also the most tense stage, and each of us needs to complete the theoretical graduation exam, operation skill exam, PPT production and report; 20142014129 October, a community practice activity with the theme of "having a healthy old age with rehabilitation nursing" was organized by Du Chunping, head nurse of Sichuan Rehabilitation Specialist Training Base, and Jiang, deputy head nurse of the spinal cord injury ward of Rehabilitation Medical Center.

This study also made me know my nursing colleagues from all corners of the country. We help each other in study and care about each other in life. From them, I deeply felt a medical professional's modest and rigorous spirit, practical work attitude, care for patients and care for colleagues.

If the previous study is compared to the change of "quantity", then this training is a "qualitative" leap for me. We feel, experience and understand with our own hearts.

This is the last winter vacation in college, and it may also be the last winter vacation in my life. One of the most meaningful things in winter vacation is to go to the people's hospital for internship. Although it was a month ago, I decided to write it down. It's nice here, too. Nobody knows me, and nobody cares about me. I can speak freely. I suddenly fell in love with such a quiet and pure place.

The probation period is not long, only about ten days. During these ten days, I took my sister-in-law to rest for a few days. I am not a trainee in the full sense, but I have gained a lot. The first is injection technique, the second is attitude, and the third is self-reflection.

First of all, the injections are mainly skin test, intramuscular injection and intravenous injection. I didn't give people a skin test this time, not because I didn't have a chance, but because I didn't have the courage. Intramuscular injection is what people usually call a spanking needle. After a few injections, I suddenly felt very scared. Intravenous injection was the most successful in general, although it failed once, hehe. Sometimes I laugh at myself unconsciously. As a nurse, I am afraid of giving injections to others and giving up many opportunities to practice needles. Although I am really afraid of causing pain to patients, I still have a psychological cowardice and dare not face it. I am afraid to face the reality in my bones, just like facing my future. I was intimidated by my father and chose a major that I didn't like so much. Forget it. Let's talk about injections.

Muscle injection is a weakness, so weak that I dare not give it to others later, for fear of causing too much pain to others. I was not mentally prepared for the first injection, and I didn't have time to recall the details and scenes taught in the book when I called my classmates for the first time. My brain is blind and my hands are shaking badly. I only remember that my sister-in-law told me to bring a curved cotton swab and alcohol, as well as a syringe full of potions, so I crustily skin of head. As a result, I was nervous enough to choose the right injection position. Fortunately, the first step succeeded. Then it was disinfected. During disinfection, my sister-in-law told me that the disinfection scope should be larger, with a diameter of about five centimeters. It is not allowed to disinfect the same cotton swab repeatedly, and the cotton swab should be used in rotation during disinfection. Although I know this, it is still not good enough in practice. Hey. The last step is injection. I only remember that my head was blank, my mood was very complicated, my hands were not tight enough, and I couldn't hold my muscles, so I gave an injection directly without drawing blood. After the injection, I felt the urge to run away. I can see that the patient is in pain. I'm really sorry. This is the first time to give an injection to a patient.

When she walked out of the ward, Xiao Ling, an intern, laughed very hard. My sister-in-law told me seriously that I made two big mistakes. First of all, I didn't tighten my muscles, which will increase the pain. The second is that I didn't put my hand on the patient's muscle when I injected, which is also commonly known as flying needle. This is very inappropriate. I looked at them with a sorry face and felt really failed and helpless. After all, I only moved my hand once when I was studying at school, and most of the knowledge taught at school was divorced from practice and theory. However, I will keep my sister-in-law's suggestion in mind and try to avoid making similar mistakes. After a few injections, it was a little better, but it was still not ideal. Since then, I have been afraid of intramuscular injection, and I don't know how to overcome this psychological obstacle. Let's overcome it when the school really arranges internships, and look down on yourself who is so timid and afraid to face difficulties from the heart.

Intravenous injection is relatively smooth, although the number of injections is small, but overall it is successful. Once I failed, I gave an injection to an old man. When it comes to the elderly, blood vessels are generally fragile and it is difficult to return blood. I was the same that time. When I went for an injection, he had an indwelling needle in his hand. When I inserted the intravenous syringe into the indwelling needle, I found that there was no liquid drop in Murphy's dropper, and I knew I had to remove the obstacle. I tried the method used by my sister-in-law and Xiaoling there for a while, and found it useless, so I called an experienced old nurse. Later, the old nurse came over and said that the indwelling needle was blocked and I had to pull out the needle for intravenous injection, so I pulled out the indwelling needle for him and changed it for intravenous injection. No vein was selected during intravenous injection, and no blood returned after insertion. It's no use folding it back. There is still no drop of liquid when it is opened. This means that the injection failed, so I changed the needle again, but I dare not continue to inject him for fear of failing again. I called an experienced intern to see how she did it. Fortunately, she succeeded, or grandpa would suffer again.

I think there are two main reasons for this failure. One is psychological failure, fear of failure and indecision. After selecting the blood vessels, my grandparents said that the blood vessels were often injected, so I changed them for fear of swelling. In fact, this is the most direct cause of failure. Later, the successful blood vessel of the intern was the one I chose at the beginning. If I, as a professional, stick to my own ideas and thoughts, I may be able to eliminate interference. Secondly, the operation was unsuccessful. Injections for the elderly should be disinfected with alcohol to identify blood vessels. I disinfected them with iodophor, and the tourniquet was not fastened. I didn't even put down the tourniquet when I called someone. Another time, when I hung the potion, I was so nervous that I didn't hang it properly and the bottle fell. The patient told me not to open it. Afraid of being held accountable, I put the needle back and hung it back. In fact, it is really an inappropriate mistake to change the needle this time, although there is no great pollution. Sometimes I really hate myself, I am timid and afraid of failure. Worst of all, I am afraid that facing the responsibility will affect the interests of patients. Fortunately, he is fine and has no adverse reactions, otherwise I will be condemned by my conscience and system.

There are also many mistakes in the common operations in the usual nursing work, mainly including dispensing, checking the liquid medicine, replacing the liquid medicine, eliminating the injection obstacles and so on.

Dispensing: unskilled, not paying attention to aseptic operation. Inexperience directly leads to the failure of aseptic operation. The lack of theoretical knowledge leads to the lack of basic knowledge of drug use. Although there is a doctor's advice, if the doctor makes a major mistake, he can't find the problem himself. It seems that if he doesn't study hard, he will pay it back sooner or later, and mainly practice more and pay more attention to details.

Check the potion and change it: carelessness. This is a very simple operation, that is, check the liquid medicine according to the doctor's advice, and check the patient clearly when changing the liquid medicine or injecting. I remember I made two mistakes. First, I was too busy during the middle shift. I changed two bottles of potions in the same ward, and the result was reversed. Fortunately, the patient's family promptly reminded him that it was a big mistake. Second, I have made temporary medical orders. Generally, old nurses are responsible for adding and mixing medicines, which can't be wrong. I added medicine to others as usual and didn't check the doctor's advice again. It turned out to be wrong this time. The human albumin originally prescribed for bed 16 hit bed 6. Fortunately, it was a tonic, otherwise it would be finished. Although the main responsibility is not mine, I just added the medicine according to the arrangement, but once something goes wrong. Be really careful in the future, don't harm others and yourself.

Remove obstacles: unfamiliar, afraid to face. I remember my sister-in-law and Xiaoling both taught me how to remove obstacles and get rid of air, but I didn't master it well and I didn't feel embarrassed to ask questions because of my face. There are many times when I can squeeze the air back by twisting the dropper, but I chose to put the medicine directly, which wastes medicine and time. But I only know this, and I am embarrassed to ask for a better method, because my sister-in-law and Xiaoling have already taught it. I'm most sorry for an uncle who forgot to fold the dropper when he was venting air. As a result, when air is released, blood gushes out through the injection tube. I was so anxious there that I folded it in a hurry. Fortunately, my uncle and aunt are both fine. Not only did they not blame me, but they also told me to wipe the blood off my hands with paper and comforted me not to tie it tightly. After that, the air has been lined up and I am still in shock when I come back. Later, I finally watched others exhaust and mastered the method of extrusion. There is no need to put potions when there is a lot of air. The most shameful thing here is that I am not clear but dare not ask others because of my face, which has caused tension and influence to patients. I'm really sorry about that uncle. Every time I pass his ward, I look inside and tell him I'm sorry.

Let me talk about my attitude first. There are good and bad. Although I don't want to learn nursing, I still have a sense of responsibility when I get to the hospital, and my attitude towards patients is very good and gentle. There is also a good relationship with my sister-in-law and Xiaoling. But on the other hand, as I said above, I am a person who is afraid of failure and faces problems. I really shouldn't. It hurts to think about it. I was afraid that others would know, so I didn't change the needle to increase the risk of infection. I am afraid of failure, so I dare not take another injection. I take an evasive attitude towards this problem. This is irresponsible, and I want to change it. I chose to escape blindly, so I simply didn't go to the hospital after the year. Such a timid person dare not even think about it.

Finally, we should reflect on ourselves. First, dare not face the problem and dare not solve it. The second is fear of taking responsibility; The third is serious psychological escape. It needs to be changed, and it needs to be changed.

I also want to say one thing, that is, when pulling out a catheter for an old man, a drops of urine sprayed on my lips, so I worked hard all day and regretted not wearing a mask. I still remember walking around the wards and corridors on the first day of work, which was more tiring than climbing mountains. Nursing is really not done by people. It's really hard. I was forced to study a major I didn't like. I didn't read many books in the university, and my grades were cleaned up every year, but I didn't find a way to change the status quo.

What can I do to save myself? I am not qualified to be a nurse. What else can I do?