Jan. 18, 2009
Greetings to all!!! It is hard to believe I have been here over 2 weeks! The time has gone by so fast. I am finding that the days are not long enough for everything I want to get done, be it do laundry, or exchange my television antennae for the fourth time.
I had coffee the other day with a woman who I met in induction. She is a neonatal nurse originally from Scotland, and just changed jobs. She had lots of good tips regarding housing, neighborhoods, the work atmosphere, and other topics. I enjoyed her company, and we plan on going out on the town later.
Dow, my husband, arrived yesterday. He came while I was at work, so managed to take the tube from Heathrow and come up to my ward. I took him over to the dorm and showed him how to use the three systems to access the room, two different key cards and a key. His directions are to act like he knows what he is doing to blend in, as technically, he is not to come in unescorted, let alone, stay the night! I had seen in the hall an extra bed, mattress and frame, so we have decided to borrow it for a while.
Today I showed him some of the ropes of my routines, starting off with coffee and a free croissant (before 12pm!) and shopping at Tesco for 1 pound dinners. We went to Argos and bought a coffee pot, then treated ourselves to the movie “Slumdog Millionaire”. For those who have not seen it, it comes highly recommended by me. Very intense!
Back to the work environment. Except for the fact that the shifts are brutally long, I am thoroughly enjoying them. I learn so much every day, and I am so intrigued by how things are done at this particular hospital.
The morning starts out with “hand over”. It is 745am, and all of the lights are turned on. The nurses are divided into two groups, each group is assigned to two bays of patients (each bay consists of 6 patients), and those nurses work as a team. The team then goes from bed to bed of those twelve patients, and the night nurse for that patient gives report. As us nurses know, everything is discussed during report, and this is also true here. We stand at the foot of the bed and discuss all issues about this person as the whole room can listen in. Some patients impress me, as they seem to be able to sleep through this process, but they are definitely the exception.
There is a route for morphine that I have not seen before. They call it “sub-cut morphine”, or rather, subcutaneous morphine. It is a subcutaneous needle access that is put usually in the upper arm, and then used for morphine injections, and in the case that I observed, the volume was 2 mls. I am told that this is a common form of pain administration. The access looks just like an iv site.
For post op pain management, the preference for the first administration is iv paracetemol, which comes in 100 ml bottles. The order read, paracetemol (acetaminophen), iv, pr, or po. I made comment that I would have probably gone the po route (oral), but apparently, that is not commonly done. I still want more information on this.
Nurses mix all of the antibiotic bags. Phlebotomy comes in once a day in the morning, except not at all on weekends, for draws, if more are needed the doctors do them.
Visiting hours are from 11am to 8pm, but visitors have to leave from 1-2pm, when the lights are turned off for quiet time. Actually, that seems to be a good time for all patients, as they then have a time of day when the ward is not full of people and the noise level comes down.
I had a most charming patient yesterday. He was a 95-year-old gentleman who had fallen and hit his head, and was sent over from another hospital. He had had some confusion earlier, but that had cleared. He took care of his wife and would drive 100 miles to visit his son. He was hungry and it was past time that the kitchen was open, so I warmed him up a fish pie from the refrigerator. As I brought it to him I said something to the effect that he would need to sing for his supper. At that he said, “I used to sing in the choir”, to which I said, “Well then, what would you like to sing?” The answer was Ave Maria! He started singing in a beautiful, old 95-year-old voice, and sang well into the evening, changing over to love songs. I believe all of us, patients and all, had our hearts well warmed.
Until later.
Monday, January 19, 2009
Wednesday, January 14, 2009
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!!
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!!
Saturday, January 10, 2009
January 10, 2009
January 10th, 2009
This is a good day. I got up late and was making myself some tea in the communal room. I met a woman, Mariana, who is a surgeon from Italy, who speaks 7 languages, who was last positioned in Denmark, and is presently based here in London. She was very informational, and I learned some good tips from her.
My next goal was to go to a London street market. Dow gave me a book on markets that I have been reading. I have been to the world famous Portobello market, but I did not realize that London is full of other markets. With the help of the book to guide me, I plan on visiting as many markets as I can. Today the temperature was probably in the high 20’s, so I treated myself to a tube ride from Goodge station to Camden Town, and went to the markets there, which seem to be a group of them together. They were wonderful, all kinds of stands, food, clothes, music, antiques, vintage shops, leather, it went on and on. They seemed align up along a canal that had locks and boats in it. I broke down and bought two DVDs that I thought I needed, but follow events reduced that need. One movie that I bought, however, was an almost required purchase because the storekeeper was so enthusiastic about the movie, which is “Tampopo”, a Japanese movie about finding the perfect noodle!
I finally got to the point where I was so cold my joints were fusing, so I took the tube back to Goodge, and treated myself to a pub dinner of bangers and mash. The serving was more than plentiful, but I ate the whole thing! I figure a few extra calories are warranted to keep a body warm!
On the way back to the room, I stopped into an electrical store and bought a TV antennae, which actually improved my TV to the point where I can watch it with shadows as long as I move the antennae around 20 times before finding the most optimal position! HUGE IMPROVEMENT FOR THE QUALITY OF LIVING!!!! A TELEVISION!!! Now my cell/phone radio can take a break!
I start on the ward tomorrow. I stopped at a stationary store and picked up a folder and notepad to get organized. I just hope it does not snow so that I can walk to work!!
January 9th Amendment
My evening became amusing to me. I was heading up to my room when I ran into an advertisement that had been taped to the wall advertising a television for 30 pounds. I promptly called the number, which answered to a screeching answering machine for about a minute. Finally a friendly voice answered the phone, and he gave me directions that I had to fumble with several times in order to get to his and his wife’s flat. They had bought a new flat-screened TV that they were very proud of, and were getting rid of their old 20-inch box TV that weighs approximately 40 pounds. Well, of course I wanted that TV, so asked if 30 pounds was their best price. Come to find out, they had advertised it in the paper for 25 pounds!! Sold!! Now, how to get it back to my room, about ½ mile away. It was also about 28 degrees. The man, approx. 5’2”, 95 pounds, carried it back all the way, much to my insisting that we could take turns!! I wished I had paid the 30 pounds!! Then, here at my room, the 60-year-old “lift” was broken, so I had to bring it up to the fourth floor! I felt like the character in “In America”, remember, the illegal alien Irish family who had the apartment in New York, and the scene where the father drags the air conditioner up to their shabby apartment? Well, I excitedly plugged it in, then looked for the antennae outlet to realize there was none, and found myself looking at a television screen that got a snowstorm on one station. Oh well, slow progress!
This is a good day. I got up late and was making myself some tea in the communal room. I met a woman, Mariana, who is a surgeon from Italy, who speaks 7 languages, who was last positioned in Denmark, and is presently based here in London. She was very informational, and I learned some good tips from her.
My next goal was to go to a London street market. Dow gave me a book on markets that I have been reading. I have been to the world famous Portobello market, but I did not realize that London is full of other markets. With the help of the book to guide me, I plan on visiting as many markets as I can. Today the temperature was probably in the high 20’s, so I treated myself to a tube ride from Goodge station to Camden Town, and went to the markets there, which seem to be a group of them together. They were wonderful, all kinds of stands, food, clothes, music, antiques, vintage shops, leather, it went on and on. They seemed align up along a canal that had locks and boats in it. I broke down and bought two DVDs that I thought I needed, but follow events reduced that need. One movie that I bought, however, was an almost required purchase because the storekeeper was so enthusiastic about the movie, which is “Tampopo”, a Japanese movie about finding the perfect noodle!
I finally got to the point where I was so cold my joints were fusing, so I took the tube back to Goodge, and treated myself to a pub dinner of bangers and mash. The serving was more than plentiful, but I ate the whole thing! I figure a few extra calories are warranted to keep a body warm!
On the way back to the room, I stopped into an electrical store and bought a TV antennae, which actually improved my TV to the point where I can watch it with shadows as long as I move the antennae around 20 times before finding the most optimal position! HUGE IMPROVEMENT FOR THE QUALITY OF LIVING!!!! A TELEVISION!!! Now my cell/phone radio can take a break!
I start on the ward tomorrow. I stopped at a stationary store and picked up a folder and notepad to get organized. I just hope it does not snow so that I can walk to work!!
January 9th Amendment
My evening became amusing to me. I was heading up to my room when I ran into an advertisement that had been taped to the wall advertising a television for 30 pounds. I promptly called the number, which answered to a screeching answering machine for about a minute. Finally a friendly voice answered the phone, and he gave me directions that I had to fumble with several times in order to get to his and his wife’s flat. They had bought a new flat-screened TV that they were very proud of, and were getting rid of their old 20-inch box TV that weighs approximately 40 pounds. Well, of course I wanted that TV, so asked if 30 pounds was their best price. Come to find out, they had advertised it in the paper for 25 pounds!! Sold!! Now, how to get it back to my room, about ½ mile away. It was also about 28 degrees. The man, approx. 5’2”, 95 pounds, carried it back all the way, much to my insisting that we could take turns!! I wished I had paid the 30 pounds!! Then, here at my room, the 60-year-old “lift” was broken, so I had to bring it up to the fourth floor! I felt like the character in “In America”, remember, the illegal alien Irish family who had the apartment in New York, and the scene where the father drags the air conditioner up to their shabby apartment? Well, I excitedly plugged it in, then looked for the antennae outlet to realize there was none, and found myself looking at a television screen that got a snowstorm on one station. Oh well, slow progress!
Friday, January 9, 2009
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!!
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!!
Tuesday, January 6, 2009
I have not posted in a couple of days, as I have been having a challenge with internet access, which I cannot get in my room!! In the basement is a club "52 Club", which is a sports club, night club, spa, pool......on and on, and you can pay 5pounds for 6 hours of internet. I thought I could access it in my room, but, oh no, not the case. I am able, however, to access it in the lobby, a floor above the club, but even that is hit and miss. So therefore, I now sit in the lobby as passersby come in and out!!
My room is very austere. No radio, tv, internet. I was using my itunes on my computer, but somehow erased them when I tried to upgrade my software. With my new cell phone, however, I am able to get the radio!!! yeah!!! and although grainy, better than nothing.
I just had two days of new employee induction, and it has been very interesting. I am going to elaborate on them in my next blog, as my battery is running low, and I left my notes up in the room. But I am completely fascinated sitting listening to the presenters. One thing that totally made me laugh today, and I will laugh in my head for the rest of my life, was the woman who did a diversity presentation. She had been talking about being sensitive to others, when she started stereotyping people. Australians, how friendly they are. French, how it is hard to know the sincerity of their smiles. And Americans, how loud they are and how they want to tell you about their divorces!! At that I sat up to pay close attention! Did I really hear what I thought I heard? At the break, I asked the man sitting next to me if Americans had that stereotype. The next presenter was the safety manager who talked about procedures for a fire alarm. He was very animated and enthused about his topic, and wove personal stories into his presentation, and kept making references to his divorces!!! Made me laugh!!
My room is very austere. No radio, tv, internet. I was using my itunes on my computer, but somehow erased them when I tried to upgrade my software. With my new cell phone, however, I am able to get the radio!!! yeah!!! and although grainy, better than nothing.
I just had two days of new employee induction, and it has been very interesting. I am going to elaborate on them in my next blog, as my battery is running low, and I left my notes up in the room. But I am completely fascinated sitting listening to the presenters. One thing that totally made me laugh today, and I will laugh in my head for the rest of my life, was the woman who did a diversity presentation. She had been talking about being sensitive to others, when she started stereotyping people. Australians, how friendly they are. French, how it is hard to know the sincerity of their smiles. And Americans, how loud they are and how they want to tell you about their divorces!! At that I sat up to pay close attention! Did I really hear what I thought I heard? At the break, I asked the man sitting next to me if Americans had that stereotype. The next presenter was the safety manager who talked about procedures for a fire alarm. He was very animated and enthused about his topic, and wove personal stories into his presentation, and kept making references to his divorces!!! Made me laugh!!
Sunday, January 4, 2009
Jan. 4, 2009 Greetings to All! I arrived in London on Friday afternoon, as I needed to check into my dorm room before 5pm. I looked another flat first at Earl's Court. It had a lot going for it, a television, phone, wifi internet, great location, but it was lacking in orderliness, and I was afraid it would have driven me crazy. The only window looked out on two moldy patio umbrellas, and I know I could not have tolerated it. I have spent the last two days trying to be hyper thrifty and walk the streets of London over using the tube. As the temperatures have been in the 20-30's, I have frozen, and have needed to use one of the lovely bathtubs available (yes, they really are lovely, the showers have a button that only keeps the water on for seconds, so you are constantly pushing the button, and on top of that, the light is on a timer, so if you are not quick enough, the light goes off!!!) to thaw my cold feet.
I decided to get a phone, as I am realizing that it will be a necessary tool for the future. That was an experience in itself, however, I believe it is all in place.
I think I shall be well qualified to eventually write a travel book, How To Do London on 9 pounds a Day!
One of my greatest joys was skyping to my daughter Kate this morning at 4am. I am not yet acclimated to the time zone, and am awake in the middle of the night. I think tonight I am going to resort to an ambien that I brought along for that reason.
I bought an alarm clock in China Town today, and I am not sure if I have it set up correctly. I am nervous about taking a sleeping pill and missing my first day at my new job!!! Between the alarm clock and my cell phone, hopefully one of them will go off accurately!!
Anyway, stay tuned. Tomorrow will be the beginning of my nursing adventure!!! Cheers, Donna
I decided to get a phone, as I am realizing that it will be a necessary tool for the future. That was an experience in itself, however, I believe it is all in place.
I think I shall be well qualified to eventually write a travel book, How To Do London on 9 pounds a Day!
One of my greatest joys was skyping to my daughter Kate this morning at 4am. I am not yet acclimated to the time zone, and am awake in the middle of the night. I think tonight I am going to resort to an ambien that I brought along for that reason.
I bought an alarm clock in China Town today, and I am not sure if I have it set up correctly. I am nervous about taking a sleeping pill and missing my first day at my new job!!! Between the alarm clock and my cell phone, hopefully one of them will go off accurately!!
Anyway, stay tuned. Tomorrow will be the beginning of my nursing adventure!!! Cheers, Donna
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