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我在美国做RN注册护士:岗前培训

来源:中国护士网 作者:www.hushi512.com 人气: 发布时间:2015-09-24
摘要:我在美国做RN注册护士:岗前培训
培训第一天,填了无数的表格,读了无数的院方规则,看了若干的影视资料,答了好多试卷。最大的进步是打电话预约事情和办事儿不愁了,培训我的帅哥就两句话“这个需要你先打个电话预约一下,你约完了,我才能传真过去!”转身他就走了,俺也不敢说我实在是打怵打电话,于是只好硬着头皮打,连续打了几个电话之后,发现打电话的恐惧竟然没有了,你看,人就是怕逼不是!
 
培训第二天,早5:30起床,6:30就要上岗了,护理部主任说了,“你有12年的临床经验,应该没问题”,给我定工资的时候,她是这么说的“你尽管有12年的临床经验,但是那不是美国的临床经验,所以,我们只能按照新手RN来付工资!”钱是按照新手的价位给的,工作却是按照老护士的标准分配的,纯粹的剥削阶级资本家行为!好久没起的这么早了,闹表不屈不挠的响了好久,我才听见!直接就安排进病房工作了,跟在一个美国丫头后面,一上手就20个患者,全是术后复健的,我立刻就麻爪了。那个带教的丫头,手快,脚快,嘴快,叭叭叭的,不到30分钟我就脑袋疼了,一上午我就记住了三个患者的名字,中午饭我都没吃,上火了,不饿,吃不下去!最主要是没时间吃,我晕!
 
健康中心没有医生,病人出现病情变化,打电话报告医生,得到电话医嘱(telephone order)就成了护士工作中很重要的一项工作,而且是很常见的一项工作内容,也是中国护士最恐惧的一件事儿,接电话,怕听不懂药名,听不懂医嘱;打电话,怕说不清楚病人病情,可是,没人迁就我,因为我已经是注册护士了!临上岗之前,我特意找来医院里关于打电话给医生的这一部分的有关规定记录了一下,并且以一个自杀患者为例,让培训我的帅哥当成电话另一端的医生,我假装报告病情,让他纠正我的语序和发音!
 
下面我就把电话汇报SBAR report(situation, background, assessment, recommendations) 的规矩写下来,有关专业英语,药名,我没办法帮忙,的确我们都需要一段时间的努力和经验,每个人刚开始都要经历这些。但是打电话报告一些病情的常见用语,我倒是可以列举一些,仅供大家参考。
 
Before calling to physician, (在给医生打电话之前的注意事项)
 
1,Assess the patient (给病人做体检)
2,Review the chart for the appropriate physician to call. (再看一遍病人的病志,找到他的主治医生)
3,Know the admitting diagnosis. ( 知道病人的入院诊断)
4,Read the most recent progress note and assessment from the RN of the prior shift.(读一遍最新的上一个班次的RN 做的患者的护理记录和体格评估)
5,Konw the INTENSITY of care. (知道哪里需要加强护理)
6,Keep your information concise .( 保持你的信息简洁)
7,Have available when speaking with the physician. ( 在你同医生讲话的时候,所有的病人资料信息要在手边备好)。
 
这些东西都准备好之后,就开始给医生打电话了,一般接电话的应该是医生本人,所以,他在明里,你在暗处,你知道他是谁,他不知道你是谁。顺序如下,SBAR
一, S, Situation最一开始说的时候要介绍自己 Introduction
1, Dr,Narmen, this is Nurse Mia from West View Health care station 1,(很多医生做很多家医院,不止固定在一家)
2,I am calling about patient Ms,Kelley, Patty,
3,The problem I'm calling about is .........然后说病人什么情况situation
 
二,B, Background
1,State the admission diagnosis and date of admission. 介绍病人入院日期,以及诊断。例如:Ms, Kelley,Patty was admitted 4 days ago and has a diagnosis of borderline personality disorder.
2, State the pertinent medical history, 简要复述病人的相关病史
3,Give a brief synopsis of the pertinent treatment to date.
例如:Patients past history is ...and is on ... medication & on ...IV fluids
 
三, A, Assessment
1,Most recent vital signs, BP,P,R,T, Pain leven, Oxygen, O2 sats.
I have assessed vital signs as ... (任何情况,一定要先测生命体征再打电话,不一定报告,但是一旦问起没有数据,会被医生骂,被认为是很不专业的护士)
必要时报各种医疗数值
Observations Neurologically patient is ...
Patient is on ... amount O2 with SaO2 ...%
 
四,R, Recommendations
向医生提出合理化建议
The patient appears to be at risk of ... and needs ...
例如: I recommend you: come to see the patient when possible, or, I need an order o continue the observation. And is there anything else you would like us to address at this time? or,I would like you to review/require ICU consult.
总而言之,电话报告病人情况应该非常清楚,有重点性,而且报告的各种信息都要和病人情况相关,不要废话。也不要为了显示自己英语好用很专业的词汇叙述,应该在不丢失自己专业性的情况下,以最简单的语言表述出来。
 
下面我就抄一个,以精神病人要自杀为例的,完整的电话报告:
Dr.Narmen, this is Nurse Mia from West View Health Care Station1. I am calling about Ms.Kelley,Patty. At 3:15pm, she locked herself in the bathroom and threatened to drown herself in the toilet. She voluntarily opened the door when instructed to do so; her clothes, face, and hair were completely dry.
Ms, Kelley, Patty was admitted 4 days ago for suicidal gesture of self-inflicted cuts to the arms and has a diagnosis of borderline personality disorder. She did not verbalize suicidal intent before the incident, but this morning she had a verbal fight with another patient over a lipstick. She is currently alert, conversant,and uninjured.
Her blood pressure is 120/80mmHG, pulse rate is 82 beats/min, and respirator rate is 12 breaths/min. I talked to her and she is apologetic about causing a commotion,but she refuses to sign a no-suicide contract and she says that she'll probably try something else.
She is in her room, and we placed her on one- -on- -one observation. I need an order to continue the observation. And is there anything else you would like us to address at this time?
 
这些话要是用汉语说,一点都不费事儿,不外乎就是患者自己找死,整事儿弄景儿的。可是用英语说,还真得斟酌斟酌。很是想念国内的医疗环境,护士,医生办公室就对门,一吆喝就成了,根本就不用护士亲自去看,哪用这么费心啊!今天美国临床工作第一天,发口服药,测量血糖,给G-Tube feeding, 发传真给医生,药剂师,抄写了医嘱,翻看了好多又重又厚的病志。多亏这十几个月备考RN的学习,没白学,临床药匣子里的药,俺基本都认识,还好,还能勉强对付一阵子!
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