護(hù)士崗位職責(zé)與護(hù)理記錄范例一、引言護(hù)士是醫(yī)療團(tuán)隊(duì)中連接患者、醫(yī)生與家屬的核心橋梁，其崗位職責(zé)涵蓋病情觀察、護(hù)理干預(yù)、患者教育、跨團(tuán)隊(duì)協(xié)作等多個(gè)維度，直接影響患者的治療效果與就醫(yī)體驗(yàn)。而護(hù)理記錄作為護(hù)理工作的文字載體，不僅是臨床決策的重要依據(jù)，更是醫(yī)療糾紛中的法律證據(jù)。本文結(jié)合《護(hù)士條例》《醫(yī)療護(hù)理文書(shū)書(shū)寫(xiě)規(guī)范》及臨床實(shí)踐，系統(tǒng)梳理護(hù)士崗位職責(zé)，并提供標(biāo)準(zhǔn)化護(hù)理記錄范例，旨在為臨床護(hù)士提供可操作的參考指南。二、護(hù)士核心崗位職責(zé)護(hù)士的職責(zé)以“患者為中心”，圍繞“護(hù)理程序”（評(píng)估-診斷-計(jì)劃-實(shí)施-評(píng)價(jià)）展開(kāi)，具體可分為以下五大類(lèi)：（一）病情觀察與評(píng)估職責(zé)核心要求：及時(shí)、全面、動(dòng)態(tài)地觀察患者病情變化，為醫(yī)生診療提供依據(jù)。1.生命體征監(jiān)測(cè)：按醫(yī)囑或護(hù)理級(jí)別（如一級(jí)護(hù)理每1小時(shí)測(cè)一次生命體征）監(jiān)測(cè)體溫、脈搏、呼吸、血壓、血氧飽和度，重點(diǎn)關(guān)注異常值（如體溫＞38.5℃、血壓＞140/90mmHg）。2.癥狀與體征觀察：觀察患者的主訴（如疼痛、胸悶、乏力）、體征（如皮膚黏膜顏色、傷口滲液、引流管情況）及心理狀態(tài)（如焦慮、抑郁），尤其注意急危重癥患者的病情變化（如心肌梗死患者的胸痛性質(zhì)改變、腦出血患者的意識(shí)障礙加重）。3.功能狀態(tài)評(píng)估：對(duì)老年患者、術(shù)后患者進(jìn)行跌倒風(fēng)險(xiǎn)評(píng)估（如Morse跌倒評(píng)分）、壓瘡風(fēng)險(xiǎn)評(píng)估（如Braden評(píng)分）、日常生活能力評(píng)估（如ADL量表），制定個(gè)性化護(hù)理計(jì)劃。（二）護(hù)理干預(yù)與執(zhí)行職責(zé)核心要求：嚴(yán)格遵循護(hù)理規(guī)范，落實(shí)各項(xiàng)護(hù)理措施，確?；颊甙踩?.基礎(chǔ)護(hù)理：完成口腔護(hù)理、皮膚護(hù)理、翻身拍背、導(dǎo)尿、灌腸等基礎(chǔ)操作，預(yù)防并發(fā)癥（如壓瘡、肺部感染）。2.醫(yī)囑執(zhí)行：準(zhǔn)確執(zhí)行醫(yī)生醫(yī)囑（如給藥、輸液、輸血），嚴(yán)格遵守“三查七對(duì)”（查藥品名稱(chēng)、劑量、濃度、有效期、用法、時(shí)間、患者姓名；對(duì)床號(hào)、姓名、藥名、劑量、濃度、用法、時(shí)間），杜絕用藥錯(cuò)誤。3.專(zhuān)科護(hù)理：根據(jù)患者病情實(shí)施專(zhuān)科護(hù)理（如糖尿病患者的血糖監(jiān)測(cè)與胰島素注射指導(dǎo)、腦卒中患者的肢體功能鍛煉、重癥患者的機(jī)械通氣護(hù)理）。（三）患者與家屬教育職責(zé)核心要求：個(gè)性化指導(dǎo)患者及家屬掌握自我護(hù)理技能，提高治療依從性。1.疾病知識(shí)教育：用通俗易懂的語(yǔ)言講解疾病病因、治療方案（如高血壓患者的降壓藥作用機(jī)制）、注意事項(xiàng)（如冠心病患者避免劇烈運(yùn)動(dòng)）。2.用藥指導(dǎo)：告知患者藥物的用法（如阿司匹林需飯后服用）、不良反應(yīng)（如頭孢類(lèi)藥物可能引起過(guò)敏）及漏服處理（如降糖藥漏服后不要隨意補(bǔ)服）。3.生活方式指導(dǎo)：根據(jù)患者病情制定飲食（如腎病患者低蛋白飲食）、運(yùn)動(dòng)（如術(shù)后患者早期下床活動(dòng)）、休息（如失眠患者的睡眠衛(wèi)生指導(dǎo)）計(jì)劃。4.應(yīng)急處理指導(dǎo)：教會(huì)家屬常見(jiàn)緊急情況的處理方法（如患者突發(fā)心絞痛時(shí)含服硝酸甘油的方法、嗆咳時(shí)的海姆立克急救法）。（四）跨團(tuán)隊(duì)協(xié)作與溝通職責(zé)核心要求：主動(dòng)與醫(yī)生、藥師、康復(fù)治療師等團(tuán)隊(duì)成員溝通，協(xié)調(diào)患者治療與護(hù)理。1.醫(yī)生溝通：及時(shí)向醫(yī)生匯報(bào)患者病情變化（如患者出現(xiàn)呼吸困難、血壓下降），提出護(hù)理建議（如需要調(diào)整輸液速度）。2.家屬溝通：定期向家屬反饋患者病情（如術(shù)后恢復(fù)情況），解答疑問(wèn)（如患者為什么需要留置尿管），爭(zhēng)取家屬配合（如協(xié)助患者翻身）。3.其他科室溝通：如需轉(zhuǎn)科（如術(shù)后患者轉(zhuǎn)康復(fù)科），做好交接工作（如攜帶患者病歷、引流管情況、護(hù)理記錄）。（五）法律與倫理職責(zé)核心要求：遵守法律法規(guī)與護(hù)理倫理，保護(hù)患者權(quán)益。1.隱私保護(hù)：不泄露患者的個(gè)人信息（如病歷、檢查結(jié)果），避免在公共場(chǎng)合討論患者病情。2.知情同意：實(shí)施侵入性操作（如導(dǎo)尿、輸液）前，向患者及家屬解釋操作目的、風(fēng)險(xiǎn)與注意事項(xiàng)，取得同意并簽字。3.護(hù)理記錄真實(shí)性：如實(shí)記錄護(hù)理過(guò)程，不偽造、篡改記錄，確保記錄與實(shí)際操作一致。三、護(hù)理記錄范例與書(shū)寫(xiě)要點(diǎn)（一）新入院患者護(hù)理記錄（PIO格式）記錄時(shí)間：____09:00患者信息：張三，男，65歲，診斷“2型糖尿病伴周?chē)窠?jīng)病變”，步行入院。主訴：“多飲、多尿10年，雙下肢麻木1個(gè)月”。既往史：高血壓病史5年，服用硝苯地平控釋片；無(wú)藥物過(guò)敏史。P（問(wèn)題）：1.知識(shí)缺乏：缺乏糖尿病飲食與用藥知識(shí)；2.舒適改變：雙下肢麻木（VAS評(píng)分3分）；3.跌倒風(fēng)險(xiǎn)：Morse跌倒評(píng)分45分（中風(fēng)險(xiǎn)）。I（干預(yù)）：1.知識(shí)教育：向患者及家屬講解糖尿病飲食原則（如控制碳水化合物攝入、避免高糖食物）、胰島素注射方法（如皮下注射部位選擇腹部）；2.舒適護(hù)理：指導(dǎo)患者用溫水泡腳（水溫＜40℃），按摩雙下肢；3.跌倒預(yù)防：在床頭掛“跌倒風(fēng)險(xiǎn)”標(biāo)識(shí)，告知患者起床時(shí)緩慢起身，避免突然改變體位，家屬陪伴。O（結(jié)果）：1.患者及家屬能復(fù)述糖尿病飲食要點(diǎn)，掌握胰島素注射方法；2.患者雙下肢麻木緩解（VAS評(píng)分2分）；3.患者及家屬了解跌倒預(yù)防措施，同意家屬陪伴。書(shū)寫(xiě)要點(diǎn)：主訴用患者原話，避免主觀判斷（如“患者訴雙下肢麻木”而非“患者雙下肢很麻”）；風(fēng)險(xiǎn)評(píng)估需記錄具體評(píng)分（如Morse跌倒評(píng)分45分），而非僅寫(xiě)“中風(fēng)險(xiǎn)”；干預(yù)措施要具體（如“溫水泡腳水溫＜40℃”），避免泛泛而談（如“給予護(hù)理干預(yù)”）；結(jié)果要可衡量（如“VAS評(píng)分從3分降至2分”），而非“患者感覺(jué)好轉(zhuǎn)”。（二）住院期間病情變化記錄（SOAP格式）記錄時(shí)間：____14:30患者信息：李四，女，50歲，診斷“急性胰腺炎”，一級(jí)護(hù)理。S（主觀）：患者訴“上腹部疼痛加劇，惡心、嘔吐1次，嘔吐物為胃內(nèi)容物”。O（客觀）：體溫38.2℃，脈搏98次/分，呼吸22次/分，血壓130/85mmHg；上腹部壓痛（+），反跳痛（±）；血清淀粉酶1200U/L（參考值____U/L）；胃腸減壓管引流出淡黃色液體50ml。A（評(píng)估）：急性胰腺炎病情加重（疼痛加劇、淀粉酶升高）。P（計(jì)劃）：1.立即通知醫(yī)生；2.禁食、禁飲，持續(xù)胃腸減壓；3.遵醫(yī)囑給予生長(zhǎng)抑素靜脈泵入（250μg/h）；4.每30分鐘監(jiān)測(cè)生命體征，觀察腹痛性質(zhì)與程度；5.做好患者心理護(hù)理，緩解焦慮。書(shū)寫(xiě)要點(diǎn)：病情變化要記錄時(shí)間（如“14:30患者訴上腹部疼痛加劇”）；客觀指標(biāo)要具體（如“血清淀粉酶1200U/L”），而非“淀粉酶升高”；評(píng)估要結(jié)合主觀與客觀信息（如“疼痛加劇+淀粉酶升高”提示病情加重）；計(jì)劃要針對(duì)問(wèn)題（如“禁食、禁飲”針對(duì)胰腺炎的治療要求）。（三）出院護(hù)理記錄記錄時(shí)間：____08:30患者信息：王五，男，70歲，診斷“慢性阻塞性肺疾病（COPD）急性加重期”，出院。出院時(shí)病情：體溫36.5℃，脈搏78次/分，呼吸18次/分，血壓120/75mmHg；咳嗽、咳痰緩解（痰量從每日50ml降至10ml）；活動(dòng)后氣短改善（步行100米無(wú)明顯氣短）。出院指導(dǎo)：1.用藥：繼續(xù)吸入型糖皮質(zhì)激素（如布地奈德福莫特羅粉吸入劑），藥粉深吸氣至深部氣道，屏氣10秒，藥粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉粉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