January 14, 2009

Greetings to all!!

I have just completed my first three days at the Victor Horsley Ward, third floor, National Hospital for Neurology and Neurosurgery! The shifts are from 745 am to 815pm, and my first impression is that they are quite grueling. I get myself up at 6am, take a hot bath, and brace myself for the day. It is about a 10-15 min. walk to the hospital. I have found these 3 days to be mentally and physically exhausting. I now have a day off, and I am feeling like I am on vacation! Slept in, walked to the electronic store and exchanged my TV antennae, went to a coffee shop for a mocha and a free croissant if purchased before 12pm (they weren’t paying attention, it was 1203pm!), bought some room food, and returned to my room. I was excited to connect my new 15 pound antennae, as it is “amplified”, but was disappointed, as it is no better than the 5 pounder!!! Oh well, more trouble shooting to be done.
More about the hospital. The ward consists of 4 bays, each consisting of 6 beds, and 3 private rooms. The private rooms are designated for patients who are in isolation because of antibiotic resistant infections. This totals 27 patients. I have not quite figured out the staffing, as daily I keep hearing about staff shortages for that day. Of all the questions that I have to ask, I figure this is one can wait, but generally, the assignments seem to be 6-7 patients per nurse, and optimally one health care assistant for 12 patients.
I have been told that this ward is a step-down from intensive care, and I believe that, as the acuity is higher than what I would expect for a medical/surgical unit. Let me share a patient situation that I had the last two days. Patient is a 60 year old gentleman post stroke, who has a tracheostomy (trachy), tube feeding, left side deficits, and is total care. I have seen friends visit, and his wife is present through most of the day. He has pulled out his feeding tube multiple times, and now has his right hand bound up in an ace-like bandage. Physical therapy worked with him taking off the right hand bandage, and did not replace it. His wife and I agreed as long as she was there, we would give him a break from it, as he seemed pleased to have it unbound. He has been on the unit for a couple of weeks. The wife appeared frustrated with his attempts to communicate, so I suggested we give him a pen and paper. He promptly wrote that he wanted the toilet and to sit!! She was so excited that he had communicated! We lifted him in the hoyer, placed him on the bedside commode with good results (he “bowel opened”), and put him back in his bed. He then wrote he wanted a lager! Shortly thereafter, he pulled out his nasogastric tube!!!! Darn, double darn!! I replaced the tube and verified it with auscultation and a gastric content ph test. Needless to say, his hand was rebound (his hand is placed around a roll, positioned into a fist, then bound). Another patient on the unit also has this done, as this is done rather than our technique of restraint.
I have not yet picked up my uniform, and have been wearing scrubs in the meanwhile. I have yet to get my id and computer access, but that will be coming on Friday. I am not able to do many clinical procedures, i.e., pass medications, until I have been assessed and signed off. I have been told that nursing students never pass medications!
The following information will probably be more interesting for my American nursing colleagues. Two nurses sign out narcotics from the locked cupboard and the patient’s chart at the bedside, so needless to say, this is frequently done. Tylenol (paracetemol) is the most commonly given pain medication, followed by oromorph, a liquid morphine. No draw sheets are used, which is probably the item I miss the most. Rather, a tubular plastic slider is placed under the bottom sheet each time a patient needs to be pulled up in bed. The bottom sheet is not fitted.
Ok, let me try to describe the ward. It is one large room with the bays divided with partial walls. Each bay has 6 patients. They try to keep it even with women and men. The beds have approximately 4 feet between each other, with a curtain that is pulled around them when privacy is needed, but the curtains are left open the rest of the time. (I feel like the Wizard of Oz, as I go in and out of the curtains!) Visitors can come at 11am, and it can become very crowded, and loud, especially when families come with small children!
Two of the bays are for lower acuity patients, and therefore, has one TV at the end of it, for all of the patients. It frequently has a Jerry Springer-like show going. Some of the patients have brought in their own TV as well as their own food. Two of the bays are for higher acuity, and have no television at all. Cell phones are allowed, and one 83 year old gentleman frequently calls his significant other, and reminds her frequently how precious she is to him. For those who do not have a cell phone, the phone on a rolling cart is broken. I have seen patients use the nurses’ station to receive personal calls.
Now, questions have come up about hand washing between patients. I can assure you, infection control is very impressive. Hand sanitation, gowning, and gloving is required before accessing each patient. Nurses wear a bottle of sanitizer clipped to their tunics, and a bottle of sanitizer is attached to every bed. Attached to the wall is a dispenser (much like a role of saran wrap) that contains thin, plastic aprons, and you put one on before going to your patient, each and every time, along with gloves, almost regardless of the task you are performing.
In my induction, there was a presentation related to garbage wastes, and the need to put them in the appropriate container. This I am finding to be a challenge for me, as I am constantly needing to stop to make sure I am using the proper container, as there are three (this does not include laundry). I am still working on what the criteria is for each container! The room that gives me a chuckle in my head is the “sluice”. This translates somewhat into our soiled utility, but encompasses much more, bedside commodes, bedpans, various items, and housekeeping. The bedpan system is interesting to me, as you take it with its contents, open up a door on a dishwasher like appliance, slide it into a holder, then turn on the machine that washes it!! Urinals are also put into this machine!!
I have been very impressed with the nurses who I have been working with, and they are top notch! Their clinical skills and knowledge are very thorough and they are very patient centered. I am learning more and more about the “band” system that nurses progress through. It seems to start with housekeepers and continue up through nurses aids, nurses, charge nurses, on and on. More on that as I learn more.
By the end of the shifts, I drag my tired self back to the dorm, climb the stairs to my room, pick up my laptop, drudge back down to the lobby, and do a quick catch up on my email, as that is where I can access the internet. Sometimes I am able to skype, as Jean Harris and my family know. I have become such a fixture in the lobby, I am starting to draw attention from others who are coming and going, and are learning about my find, and joining me. Anyway, enough for now.
I again apologize for any repetition or boring content. Also, for any typos or grammatical errors. I am finding that I sometimes rely too much on spell and grammar check, and go back and read my content to find embarrassing errors!!