Article 1

In order to further clarify the working ideas, working methods and key tasks of the "Quality Nursing Service Demonstration Project", promote the exchange of experience and promote the smooth development of various tasks. The Provincial Department of Health organized a special training for head nurses of high-quality nursing service demonstration wards. Taking advantage of the training opportunity, I was fortunate to visit Jiangsu Provincial People's Hospital. As one of the earliest hospitals in China to provide high-quality nursing services, Provincial People's Hospital has rich experience in implementing basic nursing care, improving specialty quality, and carrying out scientific management. Through visiting and studying, I gained a lot of insights.

1. Basic care reflected in services

As a century-old hospital, Provincial People’s Hospital has always attached great importance to the creation of service brands. From the humanized service in 2003 to the unaccompanied care in 2004 to the comfortable care in 2008, they all reflect the process of continuous innovation and improvement of the provincial medical hospital. It is this step-by-step improvement that has finally condensed into today's service brand strategy: humanization as the concept, holistic as the content, professionalism as the feature, unaccompanied as the requirement, and patient satisfaction as the goal. When it comes to the high-quality nursing services of the Provincial People's Hospital, we have to mention their "accompanying but not caring". This is something that many of us nurses think is impossible, but at the Provincial People's Hospital they are the first to apply it in their work. When I visited the gynecological ward of Hexi Branch, I truly understood its connotation. In order to ensure the patient's rest, the nurse will appropriately arrange visitors according to the patient's condition to meet the patient's family and psychological needs without intervening in any basic nursing work. The basic care of patients is provided by daily nurses according to the basic nursing instructions issued by the responsible nurses, assisting patients to complete various necessary daily nursing tasks from head to toe, including washing face, combing hair, wiping body, washing feet, etc. Here, the treatment cart has become a bond of affection between nurses and patients. When necessary, the nurse will immediately push the cart to the patient's bedside to solve the patient's difficulties in a timely manner. At the same time, their basic care is meticulous, and they even help the patient close the curtains during his lunch break. They think of every detail like this. They do what the patient thinks of, and they do what the patient doesn't think of. During the two days there, I watched the busy figures of the nurses. I deeply realized that the value of nursing is not only reflected in the technical aspects, but also requires our nursing staff to help every patient with sincerity, love and sincerity. It is precisely because of this heart that menial tasks such as washing faces and wiping feet, which may seem dazzling to ordinary people, bring a sense of accomplishment to our lovely nursing colleagues and extend the happiness of patients.

2. Rigorousness embodies professional connotation

After seeing the document of "Quality Nursing Service Demonstration Project", many of our nursing colleagues do not fully understand the life care included in it, and even To believe that quality care demeans the status of nurses is to abandon one's profession. While studying at the Provincial People's Hospital, while watching them deepen their basic nursing work, I also realized the professional connotation of nursing reflected in their rigorous work style. If nursing work is only about executing doctor's orders and completing nursing operations, then how can we blame the public for calling us nurses doctors' errands? The most important professional ability of nurses should be to observe the condition and use their own professional knowledge to judge Patient condition. The nursing staff of Provincial People's Hospital left a deep impression on me by assessing the muscle strength of post-operative patients before getting out of bed. Before the patient gets out of bed and moves around after the operation, the responsible nurse will conduct a muscle strength assessment on the patient. Based on the assessment, they will determine whether the patient can move after the operation, how long the activity will last, and what the range of activity will be. Through the combination of theory and practice, patients' activities are guided more scientifically. Many patients' activity time has been advanced and postoperative complications have been reduced. If we only stop at the doctor telling us that the patient can get out of bed in two days, and we tell the patient that he can only stay in bed within two days, then what is the use of our professional knowledge that requires continuous education? We should tell the patient why she can only stay in bed for a day and a half. He was able to get out of bed, while the patient in the next bed took two and a half days to get out of bed. I believe that only a rigorous work attitude and style can create the professional connotation and brand value of nursing.

3. Scientific management in high efficiency

As the saying goes, "management brings efficiency", how to achieve twice the result with half the effort through scientific management is also an important thing for me to study at the Provincial People's Hospital this time. Purpose. During the two days of study, I was exposed to many advanced management methods. Nowadays, technology is developing at a rapid pace, and all walks of life are using advanced information tools to improve work efficiency, and our nursing workers are also brave enough to try new things. Provincial People's Hospital has a very good nursing management information system. Managers can use the information system to schedule, assess, quality check, and collect statistics. In order to do the refined management we have always advocated, it is really important to carry out process management. Processing and standardizing everything not only speeds up the dissemination of information, saves manpower, but also improves management efficiency. They guide the nurses' work in a reasonable and precise manner by using various processes professionally and directionally in their work, including nursing operation processes, various job processes, key medication work processes, non-medication work processes, nursing management processes, etc. It realizes the standardization and formulaization of nurses' work, thereby reducing the occurrence of nursing errors and accidents.

Among them, their small innovations in management are also very eye-catching. For example, they express nursing routines in the form of pathways, which is to tell nurses very straightforwardly and clearly what kind of care should be provided to patients with the same disease on the first day after admission. Nursing, what is the focus of nursing the next day? This kind of out-of-the-box initiative can not only allow new nurses to quickly adapt to department work, but also provide a standard for judging nursing management work. Another example: conduct a work peer evaluation once a month, because nursing work is a collaborative work, and peer support plays a very important role in enhancing the atmosphere of the department and improving work enthusiasm. Therefore, through monthly peer evaluations, the head nurse understands each nurse's work performance and areas for improvement. The head nurse then communicates with the client in a timely manner, supervises the client to make corrections, and strengthens the building of the entire nursing team.

On the road to creating high-quality nursing services, the nurses of the Provincial People's Hospital have provided us with advanced service concepts and advanced service methods. In the future work, we must learn and summarize, learn from the advantages of others, combine with the actual situation of our hospital and department, continue to reform and innovate, adhere to the patient-centered approach, consolidate basic nursing, improve service quality, and fully implement the "high-quality nursing service" According to the relevant requirements of "Demonstration Project", we must do a solid job in nursing and truly make it possible to use stones from other mountains to attack jade.

Chapter 2

Director Song Mingsuo is the director of pediatrics at Shanxi Provincial Hospital of Traditional Chinese Medicine and has extensive clinical experience. When I was studying at the Provincial Hospital of Traditional Chinese Medicine, I was fortunate to listen to Dr. Song. The teacher’s lecture on the differentiation and treatment of warm and hot qi syndrome in children is summarized as follows based on his own experience:

(1) Syndrome characteristics of qi syndrome

Qi syndrome in children is very common in pediatrics. It is also the key to the outcome and prognosis of the disease. If treated in time and with appropriate medication, the condition will be cured. If not treated in time and with appropriate medication, the nutrient blood will be trapped and cause bad diseases. The condition is critical and the prognosis is poor, so it is crucial to grasp this stage of Qi syndrome in clinical practice to curb the development of the disease.

From the perspective of Ba Gang, Qi syndrome is definitely a syndrome of internal excess heat. Clinically, due to excessive evil Qi

, strong righteousness is not declining, and the evils compete fiercely with each other, the symptoms are as follows: It is a syndrome of excessive yang-heat, but the clinical manifestations vary due to the nature of the disease, the different organs affected, and the physical constitution of children. Moreover, after children become ill, they often have phlegm, food accumulation, and are prone to convulsions and convulsions. The climate is complex and diverse.

(2) Differentiation and treatment of common Qi differentiation syndrome

2.1 Evil heat obstructing the lung syndrome

Clinical manifestations: high fever, sweating, irritability (mostly in children) Crying a lot),

Thirsty and excessive drinking, red face and lips, or shortness of breath in severe cases (shortness of breath may be evidence of this). This symptom represents a change in syndrome, and its occurrence often indicates that children Pneumonia, wheezing and coughing (which is a symptom of "closing the lungs"), yellow and thick phlegm, constipation, red tongue, yellow or thick yellow tongue coating, weak pulse, or blue and purple fingerprints.

Treatment principles and methods: clearing away heat and clearing the lungs, resolving phlegm and relieving cough

Representative prescriptions: Maxing Shigan Decoction (often added with lung heat-clearing medicines Scutellaria baicalensis, Forsythia suspensa, Qi-lowering medicines Perilla, sore throat and phlegm-reducing medicine Tianzhuhuang, Dannanxing)

Clinical additions and subtractions: ① If phlegm heat is obvious and the tongue coating is thick and greasy, fresh bamboo drain liquid can be added to traditional Chinese medicine for use (bamboo drain liquid Dosage: Children aged 3 to 5 years old can take 10 ml each time, twice a day; older children can take 15 ml each time, twice a day.) ② In children with obvious asthma, ephedra should be roasted in honey and added with Dilong and Bombyx mori. ③ If you have a cough If the cough is even spasmodic at night, and the child is restless at night, crying, nausea, and vomiting, the whole insect can be added (the dosage is 1/2~1/3 of the dosage of Dilong and Bombyx), Polygala ④ When the cough is more obvious ⑤ Add Sichuan scallops ⑤ If the stool is dry, add rhubarb, and pay attention to ask about the characteristics of the stool. If it is spherical rhubarb, add Yuanming powder and add qi-moving medicine such as Citrus aurantium or Citrus aurantium husk ⑥ If the child has a high body temperature but has diarrhea down below and has diarrhea 5~ times a day 6 times, this may be due to a weak spleen and stomach in the child. You can add spleen and stomach-protecting medicines such as Poria and Jiaoshan hawthorn in the prescription. At this time, do not use radish seeds and Trichosanthes melon. 7. Yin deficiency in children or Yin damage caused by illness. Map Tongue, pay attention to the addition of Adenophora, Ophiopogon japonicus, and paeonol bark to the Guhu Yin Liquid. 8. People with nausea mostly have heat in the lungs and stomach, and gardenia can be added. 9. If the child's high fever does not go away after 1 to 2 days of taking the medicine, there are signs of convulsions. Add antelope horn powder (antelope horn is a commonly used medicine in pediatrics. Now it is often taken separately. Drink the antelope horn powder five minutes before drinking traditional Chinese medicine. The dosage is 3~

For children aged 5 years old, 0.6g each time, one serving Twice a day, it can be used to clear away heat, prevent convulsions and prevent the influx of nutrients, the so-called truncation therapy) ⑩ Regarding the use of raw gypsum: Traditionally, it is believed that gypsum should be fried first, but now it seems that the sequential decoction method does not affect its heat-clearing effect. , excessive use of gypsum will damage the spleen, and if combined with rhubarb, it will increase its purgative effect, so it is contraindicated in those with weak spleen and stomach, yin deficiency and heat

2.2 Heat disturbing the chest and diaphragm syndrome

< p>Clinical manifestations: Most of them are syndromes caused by heat disturbing the heart and heat accumulated in the spleen and stomach, manifesting as high fever and irritability, restless crying, thirst, red lips, gum swelling and pain, throat redness or ulceration, constipation, red tongue, Thick or yellow tongue coating or yellow and greasy coating is clinically more common in acute upper respiratory tract infection, scarlet fever, mucocutaneous lymph node syndrome, mumps, etc.

Treatment principles: Clear heat (qi) and cool the diaphragm

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Representative prescription: Liangge Powder combined with Shengjiang Powder (when using Shengjiang Powder, only silkworm, cicada, and rhubarb are used instead of turmeric)

Notes: Director Song’s experience in formula Liangge Qingqi liquid (gypsum 15g gardenia 10g skullcap 10g forsythia 10g yuanshen 10g paeonol 6~8g red peony root 10g silkworm 10g cicada 6g rhubarb 6g fried Citrus aurantium 6g fried radish seed 10g)

Clinical Modifications and subtractions: ① If the pharyngeal congestion is severe, add buffalo horn, decoct it first and the dosage should be large. ② If children have lymphadenopathy, add cat's claw, Fritillaria fritillary, canopy beads, oysters, and increase the dose of Radix Polygonatum spp. ③If the patient presents with mumps, it is necessary to distinguish between epidemic and purulent symptoms. Epidemic cases are characterized by high fever, diffuse swelling under the ears and cheeks, and the surface is neither red nor suppurative. They have lifelong immunity and are viral infections. Add Bupleurum on top; purulent cases often present with repeated infections, and the parotid duct in the mouth is It appears very red, and if you squeeze it with a cotton swab, pus will overflow. If the blood test shows bacterial infection, you can add winter melon kernels and dandelion on top. 4. If the child shows rash, pay attention to the clinical identification. Measles erupts in a certain order, first in front of the ears and behind the ears, then on the chest, back, and finally on the limbs. Although the rash is dense, there is normal skin between the rashes. The rash will increase as the heat increases, and the medication for its treatment is not suitable. If it is bitter and cold, it should be mainly pungent and cool. If the skin has a rash, which is dense and small and bright red, with no normal skin between the rashes, accompanied by throat redness, swelling and ulceration, pale rings around the mouth, and desquamation in the skin folds, it is scarlet fever. The treatment is to clear away heat, detoxify and cool blood, and the prescription is It is necessary to increase the dosage of paeonol bark and add rehmannia glutinosa and buffalo horn. Children with lip ulcers, body rashes, swollen lymph nodes, and joint pain are mostly mucocutaneous lymph node syndrome. Treatment should include blood-cooling medicine, cat's claw, oyster, ginseng, etc.

2.3 Heat such as Yangming's syndrome has different entry into the meridians and fu-organs in Treatise on Febrile Diseases. Baihu Decoction is used to enter the meridians, and Chengqi Decoction is used to enter the fu-organs. However, the pediatric meridians and fu-organs are often inseparable, so the two methods need to be used in combination.

(3) Conclusion

Qi syndrome is very common in pediatrics, so it is necessary to be familiar with its treatment ideas. The method taught by Director Song is practical and practical. It can be imitated in application.

Chapter 3

Henoch-Schonlein purpura is a common disease in clinical practice. Vasculitis is a disease characterized by changes in permeability and manifesting as skin bleeding spots on the skin. It is clinically divided into cutaneous type, renal type, joint type and abdominal type. Western medicine treatment mostly uses desensitization and improvement of vascular permeability. Sex is used to treat this disease. I also saw a lot of allergic purpura when I followed Dr. Li Fengxian in the outpatient clinic. Now I will summarize some of Dr. Li Fengxian’s clinical ideas for treating this disease based on the outpatient cases.

(1) Method of cooling blood to stop bleeding, tonifying kidney and removing blood stasis

This method is the first method that Teacher Li started. It mainly treats Shihui Powder combined with kidney-tonifying and blood stasis medicine. In the advanced stage, kidney-tonifying drugs such as Ligustrum lucidum, Eclipta, Cornus, raspberry, and gallnut are often used as cut-off therapy, because Henoch-Schonlein purpura can easily cause purpuric nephritis, causing hematuria and proteinuria to appear in urine tests. Change, early use of some kidney-tonifying and blood-cooling drugs is necessary to curb the progression of the disease. Furthermore, to stop bleeding, it is necessary to prevent the retention of blood stasis, so during treatment, blood-activating and blood-stasis-removing drugs such as Angelica sinensis, red peony root, Salvia miltiorrhiza, safflower, Puhuang, Panax notoginseng, Wangbuliuxing, and Passepartout are often used. Typical case: Li Moumou, male, 10 years old, first diagnosed on February 20, 2012. One month ago, I was treated with medication for an upper respiratory tract infection. Later, I developed pinpoint-sized bleeding spots with persistent pressure in both lower limbs, accompanied by migratory joint pain. I then went to the hospital for treatment to desensitize and improve vascular permeability, and also used After nearly one month of treatment with prednisone (6 tablets/day), the rash was significantly reduced. However, during the withdrawal of the drug (prednisone was reduced from 6 tablets/day to 4 tablets/day), the rash recurred, so he came to seek treatment with traditional Chinese medicine. When I came to the hospital, dark red pinpoint-sized bleeding spots were diffusely distributed in both lower limbs, which did not fade after being pressed. There was no joint pain or abdominal pain. The throat was red, the tonsils were not large, the tongue was red, and the fur was thin and yellow. When I came to the hospital, blood and urine tests were done at the outside hospital. All are normal. That is to treat by cooling the blood to stop bleeding, tonifying the kidneys and removing blood stasis. The prescription is as follows: Angelica sinensis 6g red peony root 6g salvia miltiorrhiza 6g safflower 3g Imperata root 6g Lithospermum 6g scutellaria baicalensis charcoal 6g blood residual charcoal 9g lotus root charcoal 9g notoginseng powder 3g paeonol bark Charcoal 6g buffalo horn 15g stir-fried cattail 6g ligustrum lucidum 9g cornus 9g gallnut 6g raspberry 6g stir-fried three immortals 9g each.

(2) Method of activating blood circulation, removing blood stasis, cooling blood and stopping bleeding

This treatment method is used to treat purpura in the chronic stage. Most of the rashes have subsided and only a few rashes remain. The rash is dim in color. Scattered spots may appear on the lower limbs due to exertion or excessive activity. At this time, methods should be used to activate blood circulation, remove blood stasis, and cool blood to stop bleeding. In clinical practice, Dr. Li often uses Huoxue Sanyu Decoction combined with cooling blood and hemostasis drugs for treatment. Composition of Huoxue Sanyu Decoction: Sappan wood 9g red peony root 9g white peony root 9g safflower 6g peach kernel 9g ghost arrow feather 15g triangular prune 9g zedoary 9g. This prescription is mainly based on warm blood-activating medicine. Taking the blood to warm it is the meaning of action. Promoting blood circulation and removing blood stasis is its main function.

Typical case: Su Moumou, male, 16 years old, first diagnosed on April 6, 2012. The dark red rash on both lower limbs lasted for more than a year and recurred for 7 days. A year ago, I developed a rash on both lower limbs after catching a cold. I went to a local hospital and was diagnosed with allergic purpura. I was given infusion of calcium and methylprednisolone for a week, and the rash subsided. I then switched to 6 tablets of prednisone/day and vitamin C 0.2 Tidpo. After nearly one month of treatment with rutin tablets 40 mg Tidpo, the hormone was slowly withdrawn, and vitamin C0.2 Tidpo was still given. After treatment with rutin tablets 40 mg Tidpo, I accidentally caught a cold 7 days ago and developed macules on both lower limbs. I came here for diagnosis and treatment today. When he came to the clinic, he had diffuse dark red macules on both lower limbs. Part of the rash subsided and left pigmented spots. There was no joint pain or abdominal pain. The patient had mild sore throat, dark tongue, ecchymosis, and thin yellow coating. He treated the patient with blood circulation, blood stasis, and cooling blood. To stop bleeding, the prescription is as follows: Huoxue Sanyu Decoction, add Imperata Root, Comfrey Lithospermum, Reed Root Silver Flower, 12g Forsythia suspensa, 12g Angelicae Sinensis, 10g Diyu Charcoal, 10g Fried Puhuang, 9g Oujie Charcoal, 10g Blood Remaining Charcoal, 10g Stir-fried Three Immortals, 10g each.