Tthực hành cộng đồng 1 phần 2

TO CHlfc HOAT DONG CUA TRAM Y TE XA MUC TIEU Sau hoc xong bai nay, sinh vien co khd nang: Phan tich diidc tinh hinh nhan liic va thiic hien nhiem vu cua tram y te ndi sinh vien den thUc tap So sanh diidc thiic trang cd sd tang va trang thiet bi chu yeu cua tram y te xa vdi chuan quoc gia ve y te xa Phan tich diidc cac nguon kinh p h i va sii dung kinh p h i cho hoat dong cua tram N han xet diidc cong tac quan ly diidc d tram y te xa Nhan lire va nhiem vu cua tram y te xa/phudng 1.1 Bwdc 1: gidi thieu ve nhan liic va nhiem vu cua tram Sinh vien se difdc nghe can bo tram gidi thieu ve nhan life va nhiem vu cua tram y te xa - Tinh hinh nhan life cua tram y te bao gom: + S6' lifdng can bo + Trinh va sii tham gia cac ldp dao tao nghiep vu chuyen mon + Chute nang va nhiem vu cua tifng nhan vien y te + Moi quan he cong tac cua cac vien vdi cong dong va cac nhan vien khac cua tram - Tinh hinh thiic hien nhiem vu cua tram y te xa: + Ke hoach hoac nhiem vu cua tram y te va ke hoach cong tac nam ve cham soc sifc khoe cho ngifdi dan trdng cdng dong + Cac loai dich vu y te dang cung cap cho cong dong bao gom kham chifa benh va cac dich vu dii phdng + Tinh hinh siic khoe chung cua cong dong d thdi diem hien tai + So lifdng va dac diem doi tifdng sii dung cac dich vu y te cua tram (vi du dan so cong dong, mot sd dac diem nghe nghiep, van hoa, phong tuc tap quan cua cong dong cd anh hiidng den sdc khoe va hanh vi sii dung dich vu v te) 79 1.2 Bifdc 2: quan sat cac hoat dong cua tram y te va cua tiing can bo thdi gian thac hanh - Dia diem lam viec: tram y te, cong dong dan cii, triidng hoc - Thdi diem tien hanh cac hoat dong, vi du truyen thong giao due siic khoe to chiic vao buoi toi hoac sau gid an trifa ; tiem chung tien hanh vao mot co dinh thang, chiidng trinh nha hoc diidng tien hanh buoi/1 tuan triidc gid vao 16p - Hoat dong chinh cua tiing nhan vien y te, vi du bac si cung cap cac loai dich vu lien quan den kham va chiia benh hang ; can bo phu trach tiem chung md rong quan ly cac loai sd sach co lien quan den tiem chung, dii tru vacxin, linh vacxin tif Trung tam Y te, phan cong nhiem vu cho cac can bo khac de chuan bi cho tiem chung, td chiic buoi tiem chung, ghi chep va bao cao buoi tiem chung ; can bo phu trach chiidng trinh dinh diidng thiidng ket hdp vdi cong tac vien dinh diidng d cong dong de td chiic theo doi can nang cho tre, truyen thong ve dinh diidng cho cong dong, quan ly cac loai sd sach va bao cao lien quan den chiidng trinh dinh diidng - Xac dinh vai tro, nhiem vu, sii dong gop cua can bo tram viec dap ling nhu c lu cham soc siic khoe cho ngiidi dan cua tram y te xa 1.3 Biroc Neu danh sach cua can bd tram y te, phan tich ro nhiem vu cua tiing chiic danh theo bang: nhan liic va thiic hien nhiem vu cua Tram y te TT Ho va ten Trinh chuyen mon Tran A BS 80 Churc danh Tram Nhiem vu -Kham benh -Phu trach TCMR Hoat dong cu the Hoat dong hoan - Kham, ke ddn Dii tru vacxin - LTnh Vaccin - To chiic buoi tiem chung md rong - Bao cao tiem chung md rong - Ke ddn - Da dii tru vacxin nhi/ng chiia du NhCmg diem can cai thien Lap hoach ke 1.4 Budc 4: sinh vien thao luan nhom cac cau hoi sau: - Bien che cua tram y te ve so' liidng va phan co gi giong va khac so vdi bien che quy dinh cua Nha nifdc? Can dieu chinh, bo sung khong? Neu phai dieu chinh co tinh kha thi khong? - Viec sap xep va phan cong cong viec co phu hdp k h 'n g ? Tai sao? Sinh vien tim hieu cach thiic hien nhiem vu chung cua tram gom bai phan chinh kham chiia benh tai tram va trien khai cac chiidng trinh y te quoc gia Dua tren sii phan tich ve: cO sd phan cong nhiem vu cho tiing vien, trinh chuyen mon, kha nang lam viec, khoi liidng cong viec cua moi vien ma de thao luan ve ti'nh phu hdp giao nhiem vu cua triidng tram y te - Tram y te co hoan nhiem vu theo quy dinh khong? B^ng chiing la gi? De tra ldi phan sinh vien do'i chieu ket qua dat diidc vdi muc tieu cua cac chiidng trinh/hoat dong y te va nhiem vu chung cua tram - Tram y te co thuan ldi va kho khan gi thiic hien nhiem vu? Tram da lam gi de kh&c phuc nhiing kho khan? Nhiing diem nao ho can cai thien de lam viec co hieu qua hdn? Nen phan tich den khia canh nhan liic cua tram, kinh phi hoat dong, sii tham gia cua cac vien tram vao cac hoat dong y te, sii ung ho cua chinh quyen dia phifdng va ngifdi dan thiic hien cac chiidng trinh y te, cac chinh sach lien quan den y te dang trien khai tai dia phifdng, dieu kien dia ly, kinh te va xa hoi cua cong dong C a s tang va trang thiet bj 2.1 So sanh thuc trang co so tang va trang thiet bi vdi chuan quoc gia v e y te xa Danh muc Co Khong Cd sd tang Tram d gan true giao thong, trung tam xa Dien tich dat tren 500 m2 Tong the cong trinh: - Khoi nha chinh, cong trinh phu trd - San phdi, vi/dn mau cay thuoc - Cay xanh bong mat chiem tren 30% dien tich khu dat - Co hang rao bao ve, co cong, bien tram Khoi nha chinh: - Cap cong trinh toi thieu cap III - Dien tich toi thieu: tren 90m2 - So phong chiic nang chinh 8-9 phong: + Tuyen truyen tii van + Don tiep va quay/tu thuoc + Kham benh va so cuu + Dich vu ke hoach hoa gia dinh 81 + Dd de + Sau de + Liru benh nhan + Rira, tiet trung + Kham chCra benh bang y hoc co truyen Khoi phu trd bao g6m: nha bep, nha kho, be nifdc, nha ve sinh, nha de xe He thong ky thuat tang: - Difdc noi vdi dien lifdi hoac co may phat dien - Co mot thue bao dien thoai trifc tiep - Co ngucn nude sinh hoat dam bao ve sinh va on djnh Duy tu, bao difdng: cd sd tang di/dc tu, bao difdng djnh ky m6i nam lan vao quy IV hang nam Trang thiet bj Trang thiet bj cd ban cho can bo y te de thifc hien kham, dieu tri benh nhan d tuyen dau tien: ong nghe, huyet ap, nhiet ke, bdm kim tiem va cac trang thiet bj cap cifu thong thifdng ban dau Bo dung cu kham chuyen khoa cd ban: mat, tai mui hong, rang ham mat Tai cac tram y te co bac sT lam viec: may dung, kinh hien vi, may xet nghiem ddn gian Trang thiet bj chc kham, dieu trj san phu khoa, ke hoach hoa gia dinh, dd de, cap cCru sd sinh va cham soc tre Trang bj ve sd che, bao quan thuoc dong y: chao thuoc, can thuoc, tu thuoc dong y, dao cau, thuyen tan, kim cham cifu Trang thiet bj phuc vu cho chifdng trinh y te quoc gia, chong mu loa, cham soc rang mieng, nha hoc dudng va cac chifdng trinh CSSK khac Trang thiet bj de thifc hien cong tac truyen thong giao due sifc khoe cong dong Thiet bj va dung cu tiet khuan: noi hap, tu say, noi luoc dung cu Thiet bj noi that: tu, ban ghe, giifdng benh, tu dau giifdng Thiet bj theng dung: den dau, den pin, may bdm nifdc Tui y te thon ban: moi thon tif 1-2 tui de thifc hien cac djch vu cd ban nhif: tiem , sd cifu, truyen thong giao due sifc khoe Tui de sach doi vdi cac xa mien nui, vung sau, vung xa 2.2 Thao luan nhom Sinh vien thao luan nhom de tra ldi cac cau hoi sau: - Cd sd tang va trang thiet bi co dap ilng difdc yeu cau thifc hien nhiem vu cua tram khong? - 82 Loai trang thiet bi nao can bo sung de dam bao chu&n quoc gia? - Nguon kinh phi nao de nang cap tram y te xa? - Sinh vien phan tich khi'a canh kinh te viec sii dung trang thiet bi, tram y te co nhat thiet phai bo sung mcfi trang thiet bi khong hay chi can sda chda va nang cap thiet bi, sii tiidng xdng ve mdc sd dung trang thiet bi so vdi nhu cau kham chiia benh cua ngifdi dan cong dong - Tram y te sd dung cd sd vat chat va trang thiet bi co hieu qua khong? Neu khong thi lam the nao de sd dung tot hdn? - Sinh vien thao luan, phan tich ve tan suat sd dung cac loai trang thiet bi lien quan den cung cap dich vu so vdi so lifdng ngifdi dan den sd dung de tim cau tra ldi Kinh phi hoat dong cua tram y te 3.1 Budc Lang nghe can bo y te trinh bay ve nguon kinh phi va sd dung kinh phi cua tram y te, bao gom so liiOng cua cac nguon thu va so lifdng cua cac khoan chi cho hoat dong cua tram y te 3.2 Budc Liet ke theo bang kinh phi cua Tram y te xa Cac nguon kinh phi So tien /nam Ghi chu - Trung tam Y te - Lifdng can bo - Phu cap dien nifdc - Kham, chCfa benh - Cac chifdng trinh y te - Chifdng trinh a,b - Thu phi kham benh - Ngan sach cua xa - Cac nguon thu khac 3.3 Budc 3: thao luan nhom Sinh vien thao luan nhom de tra ldi cac cau hoi sau: - Ngan sach Nha nifdc cap co dam bao cho cac hoat dong cua tram y te xa khong? - Cac nguon kinh phi bo sung cho hoat dong cua tram la gi? - Co dap dng difdc cho hoat dong cua tram khong? - Tram y te sd dung kinh phi co hdp ly khong? co hieu qua khong? - Chinh sach tai chinh ap dung cho ngifdi ngheo, dien chinh sach, che hifdng ldi cua nhan vien y te cong dong la nhdng gi va lam nhii the nao? 83 - De thao luan pnan dtfdc de dang sinh vien nen phan tich ve cac nguon thu, so liidng so vdi cac khoan muc, so' ludng chi cua tram y te xa hang ky Cong tac quan ly duoc tai tram y te 4.1 B udc L in g nghe can bo phu trach diidc gidi thieu ve cong tac diidc cua tram y te: - Nguon kinh phi de mua thuoc va quay vong von thuoc tai tram - Cd sd de liia chon thuoc de mua thuoc cho tram - Nguon cung cap thuoc cho tram y te xa va phiidng thiic toan - Danh muc thuoc hien co cua tram v te xa - Bao quan thuoc tai tram - PhiiOng thiic cap - Cac loai so sach iien quan tdi cong tac diidc cua tram phat va ban thuoc cua tram y te xa 4.2 BUOC Sinh vien thao luan n’n ung van de sau: - Tram co quay thuoc khong? - Co du thuoc theo danh muc thuoc thiet yeu khong? - Thuoc co diidc bao quan theo yeu cau ghi tren nhan khong? - Tu thuoc co ngan chua thuoc doc va thuoc gay nghien rieng theo quy che khong? - Co du thuoc cap ciiu n en g tai piiong Kham va iuon co du cd so thuoc cap ciiu thong thiidng tren dia ban va thuoc chong soc khong? - Thuoc co dap ling nhu cau chiia benh cua nhan dan xa? co tinh trang thuoc thiia thieu hoac qua han khong? - Nhiing diem can bo sung, dieu chinh de dam bao ch u ln quoc gia ve thuoc thiet yeu va sii dung thuoc an toan hdp ly tai tram v te xa la gi ? TL/LirO NG GIA Cau hoi luong gia Nhan liic cua tram y te co dat so vdi tieu chuln quy dinh cua Bo Y te khong9 Sii phan cong cong viec cho cac vien co phu hdp khong9 tai sao9 Nhiing nhiem vu nao tram y te da hoan thanh? Nhung nhiem vu nao chiia hoan thanh? Nhiing diem thuan ldi va kho khan cua tram v te thuc hien nhiem vu la gi? 84 Cd sd tang va trang thiet bi y te co dat chuan quoc gia khong? Nhiing diem can bo sung de dat diidc chuan quoc gia? Cac nguon kinh phi cung cap cho tram y te xa hoat dong? Cac khoan chi cua tram y te la gi? Viec sti dung nguon kinh phi co hieu qua khong? Quan ly thuoc cua tram co dat chuan quoc gia khong? Nhiing giai phap nao can dUdc thuc hien de k h lc phuc nhiing diem ton tai cua tram y te ve quan ly thuoc? Danh gia hoat dong cua Tram y te xa theo cac phan sau: - Quan ly nhan liic: + So vdi thong tii lien bo so 08/TTLB 20/4/1995 hiidng dan mot so" van de ve to chiic va che chinh sach doi vdi y te cd sd bien che va cd cau co phu hdp khong ? + Tram co du phong lam viec can thiet khong ? + Tram co phong cho benh nhan san khoa va phu khoa khong ? + Tram co phong lam viec hanh chinh, phong diidc khong ? + Moi thon co it nhat mot y te thon ban lam viec khong ? + Y te thon ban co hoat dong deu dan khong ? - Xa hoi hoa cong tac y te + Co ban chi dao cham soc siic khoe khong ? + Ban hoat dong co deu dan, co hieu qua khong ? + Co ke hoach y te diia vao nghi quyet Dang Uy khong ? - Hieu qua cua chiidng trinh + Giao due va nang cao siic khoe + Xay diing goc truyen thong va nang cao siic khoe + To chiic noi chuyen, tii van siic khoe + Noi chuyen qua he thong truyen cua xa may thang/1 lan - Hoat dong ve sinh phong benh + Co phat hien sdm cac vu dich, ngo doc thiic pham kip thdi khong? + Co bien phap de phong va khong che kip thdi khong? + Ty le ho gia dinh co ho xi hdp ve sinh? + Ty le ho gia dinh xii ly rac va phan xuc vat dung cach? - Kham chiia benh: + Binh quan so liidt ngiidi den kham tren 0,6 lan/ngiidi/nam khong? + Hoc sinh co diidc kham siic khoe hang nam tren 80% khong? + Ty le ngiidi tan tat diidc hudng dan va phuc hoi chiic nang tren 20% khong? 85 - Y hoc co truyen: + Ty le kham chiia benh b&ng y hoc co truyen tren 20%/nam khong? + Co ap dung cac bien phap chiia benh khong dung thuoc khong? - Cham soc siic khoe tre em: + Ty le tiem chung dat tren 95% khong? + Tre em diicfi tudi diidc theo doi tang triidng hang nam tren 90% khong? + Chan doan dung va dieu tri dung phac cho tre diidi tudi va nhiem khuan ho hap dat tren 90%)/ nam khong? - Cham soc siic khoe sinh san + Tat ca cac phu nii co thai diidc kham thai it nhat lan triidc sinh khong? + Ty le phu nii kham thai du lan thdi ky thai dat tren 75% khong? + Ty le san phu sinh co can bo y te dd co dat tren 95% khong? + Ty le sii dung bien phap tranh thai dat tren 65%> khong? + Ty le phu nii tudi sinh de diidc kham phu khoa tren 35%? - Thuoc diidc quan ly dung quy che va co it nhat tren 60% loai thuoc thiet yeu? - Thu chi dung quy dinh, ngiidi ngheo va doi tiidng chinh sach dtfdc kham chiia benh mien phi tai tram y te? Truong tram y te co hoan nhiem vu khong? Phan sinh vien tirtra ldi qua cac bang kiem sau? Nhiem vu Nam ro tinh hinh kinh te, vSn hoa, xa hoi, dan sd Co cac chi so tinh hinh siic khoe va benh tat d thdi diem hien tai Trao doi vdi chinh quyen, doan the ve benh tat Xac dinh van de iru tien de giai quyet Xay dung ke hoach giai quyet van de siic khoe Lap ke hoach djnh ky cho toan tram y te Phan cong cong viec cu the cho cac vien va uy quyen can thiet Quy dinh hop tram va bao cao dinh ky Thu’c hien cac hoat dong de tao nguon kinh phi, kiem soat thu chi tai tram Co theo doi vat tu’, trang thiet bi, hi/dng dan kiem tra, tong hdp, dii tru thuoc men Phan cong trifc tai tram y te xa va kiem tra Co di xuong cac thon va tham ho gia dinh Co triic tiep hiidng dan, giam sat, kiem tra y te thon ban lam viec Co ke hoach djnh ky danh gia hoat dong cua Tram y te Co ke hoach tap huan chuyen mon, nghiep vu cho can bo tram va y te thon ban Huy dong sir tham gia cua cong dong thong qua chinh quyen dja phifdng Thiet lap cac mdi quan he cua Tram vdi chinh quyen dja phudng To chiic lull trufva quan ly hd sd tai Tram 86 Co Khong Hudng dan sinh vien tu luong gia Qua ket qua thao luan nhom, sinh vien tim cau tra ldi Trinh bay nhiing diem chua ro hoac khong the tii tra ldi vdi can bo tram hoac giao vien de difdc giai dap (khong co dap an chung cho tat ca cac tram y te) HUONG DAN TU HOC, TU NGHIEN CLTU, VAN DUNG THUC TE Phuong phap hoc B u d c 1: sinh vien on tap cac p h ln ly thuyet co lien quan den quan ly nhan life, vat tif, trang thiet bi, kinh phi, thuoc va nhiem vu cua tram y te xa, chuan quoc gia ve y te xa giai doan 2001-2010 bang cach on tap cac tai lieu co lien quan Budc 2: thu thap nhiing thong tin lien quan den cac van de sinh vien quan tam b in g cach quan sat, phong van, xem xet sd sach bao cao lien quan de co difdc thong tin can thiet Budc 3: so sanh giiia ly thuyet va thifc te de co nhan xet cua ca nhan, sau thao luan nhom de tra ldi cac cau hoi/hifdng dan thao luan Budc 4: tra ldi cac cau hoi liidng gia; do'i chieu nhiing kien thutc/ky nang da hoc difdc vdi muc tieu bai hoc de tii rut nhiing kinh nghiem/bai hoc thiic te ve td chdc hoat dong cua tram y te xa Van dung thuc te Qua nhiing nhan xet ve tram y te xa ndi sinh vien thiic tap, rut nhiing bai hoc kinh nghiem ve td chifc hoat dong cho mot tram y te xa; phan dau de tram y te ndi sinh vien se lam viec dat diidc chuan quoc gia b in g cach sii dung co hieu qua nguon liic (con ngifdi, kinh phi, cd sd vat chat, trang thiet bi ) Tai lieu tham khao Bo Y Te C huan quoc gia ve y te xa giai doan 2001-2010 Ban hanh kem theo quyet dinh so' 370/2002/Q D -B Y T , thang nam 2002 cua Bo trifdng Bo Y te Pham Tri Dung Quan ly y te Bo Y te, To chiic Y te The gidi, Dii an phat trien he thong y te Y hoc 2001 125-131 Tai lieu dpc them Bo mon Y Xa Hoi Hoc To chdc va quan ly y te Trifdng Dai hoc Y khoa Thai Nguyen 2004 Trifdng Dai hoc Y khoa Thai Nguyen Tai lieu hifdng dan thiic hanh CBE 2004 87 PHAN TICH HE THONG SO SACH, BAO CAO TAI TRAM Y TE XA MUC TIEU Sau hoc xong bai nay, sinh vien co khd nang: Mo td ditdc he thong so sach bao cao tai tram y te cd sd Thitc hanh ghi chep thong tin y te tai cd sd Thong ke ditdc thong tin deviet bao cao dinh ky tai cd sd Sinh vien thiic hanh theo cac bii6c sau: Budc 1: gidi thieu cac d lu sd sach, bang bieu, bao cao Sinh vien se diidc nghe va quan sat cac quyen sd chinh dang stf dung de quan ly thong tin tai tram y te, bao gom: - Cac loai sd theo quy dinh cua Bo Y te: tii sd A l den sd A12 - Cac sd theo quy dinh cua Sd y te + Kham phu khoa + Kiem nhap thuoc + So nhap thuoc ngiidi ngheo + Theo doi benh nhan tam than: cap phat thuoc, cap nhat thuoc + Theo doi phat trien the chat tre em