January 9, 2009!!! Greetings!!

I finished my initial week of induction for the NHS Trust, for employment at the National, short for the National Hospital of Neurology and Neuroscience, part of the UCL, University College of London! I think I am starting to figure out everything. It gets confusing. I am finding myself very challenged to understand people, and embarrass myself frequently by asking them to repeat something.
I found induction very interesting, as many people made presentations about different aspects of working for the trust. A note, the purpose of my blog is to somewhat contrast and compare my observations of nursing in a neuro unit at Providence Medical Center in Portland, Oregon, USA, with that of nursing at the National in London. I have no intentions of being ethnocentric, and I would surmise that a nurse coming to Portland, Oregon, would be expressing herself with how we do things with the same interest. That is the intrigue that I have with my opportunity, to immerse in a nursing culture and saturate myself in the experience.
So there I am, being induced!! One of the first presenters was from risk management, and shared a story that was interesting to me, and it all centered around the use of bedrails. Bedrails are not a standard item on a bed, and they are not always available. I might use a parallel example of seizure pads on my unit. Maybe they are available, maybe not, and a thorough assessment needs to be made regarding the need. EXAMPLE; an elderly fell at home and injured her shoulder. Admitted to the hospital. Was assessed to not need side rails. Stayed over a length of time and was declining. Fell out of bed and hit her head. CT was negative for a bleed, but apparently had a small one that was not detected. Died a week later. This went to court, and the hospital was found to be negligent for not putting up the bedrails in the first place. I spoke to the presenter afterwards with my comment that I have never seen a bed without bedrails. Apparently, this is typical. He pointed out that this country does not sue with the frequency as the U.S. does, and therefore, bedrails are not standard. I will follow up on this when I am on the ward.
Nurses wear uniforms. I have an order sheet that I need to turn in for mine. I need to measure from the nape of my neck to an inch below my knee, hmm... Tunics are worn with short sleeves; nothing is to be worn below the elbows for cleanliness. Hand washing is a "dip tip" technique, putting cleanser in the palm of your hand, dipping tips of fingers, transferring cleanser to other palm and dipping other hand finger tips, then scrubbing up to your elbows! Quite clever! No rings with stones are allowed, or watches.
They use a tube delivery system like ours, but no blood products are put into it as it is questioned that the speed may damage the blood, ie., potassium is driven out of the cells and/or it may cause hemolysis.
Diversity presenter. Not all buildings have to be accessible to the disabled, but all services have to be available. If a person is not able to access a building of its services, the services will make house calls!
A nurse practitioner specializing in pain presented on pca use. Nurses do not set pcas, but do verify them shift to shift. Nurses make the syringes for them. They mostly use morphine, rarely fentanyl, the concentration is 1mg/1ml and set 1mg/5 min. Rarely is the setting different. IV acetaminophen is frequently given to augment the pca morphine! I found it interesting that the resources for her presentation were American McCaferty and Beebe, 1972, and American Pain Society 2004.
They use a peripheral iv that has two lumens!
CPR class. The likelihood of surviving a heart attack on the sidewalks of London are 8%, elsewhere in the UK, 6%. Best chance of surviving a heart attack in the world? Seattle!!! Next best, a beach with life guards. Third best, Las Vegas!!! Reasoning, the training and availability of AEDs in Seattle, even grade schoolers receive it, life guards with cpr training and aeds, Las Vegas, the cameras and aeds!!
Blood administration presentation. Example of an error: nurse asked porter to get a bag out of the refrigerator for John Smith. There were 2 John Smiths, wrong bag was taken. Message: get the bag out of the frige yourself. Only one nurse verifies the bag, as it is felt if there are two nurses, both of them may not be completely focus sing on the task.
Now, keep in mind, these observations were noted from my induction. I can be accent challenged!
I went and met with my manager yesterday to talk about my "rota", and I start Sunday, an LD, short for long day, 745am to 815pm. At that point, my observations will be from a first hand experience, rather than from a presenter with a non-American accent. I am so excited to get started!!!!! Stay tuned!!!
One more note. The only thing that I could not find in my bag was my camera. Not sure why. But I should have one soon, and then I will get some pictures up of my dorm room and everything else!! Cheers!!