The Walking Dead

Twice this week I'd say this was a pretty accurate description of me...

The First
My clinical place last week and this one was at an inpatient ward at the Health Center. This is a rehab ward, so we have lots of patients that are recovering from surgeries, might have infections, or something acute, not severe enough for the hospital. The doctor is there during the week, but on the weekends, if anything happens, they have to send patients to the ER. I think this is almost between a skilled nursing facility and an in-hospital rehab unit. We have patients with IVs and give injections a lot. There are others that have pretty severe wounds, some of the worst I've seen. We take of quite a few patients with amputations. We have dealt with catheters, blood draws, taking out stitches, and those normal nursing jobs. The one big difference is that nurses here don't use stethoscopes at all, even in the hospital. In our hospitals, nurses do a physical assessment at least once a shift, listening to lungs and hearts, feeling for pulses, edema, checking mental status, ect. These nurses here do a basic assessment, not a formal one, but for the most part, don't learn about listening to lungs and hearts, which is important for telling if the patient is breathing ok. My preceptor told me that she learned on her own, and will sometimes take a stethoscope if she is seriously worried, but when no one else is on hand to help. The RN's also do a lot of CNA work, liking showering and taking people to the bathroom, ect. There aren't CNAs actually (lots of LPNs though), but two nurses take care of 8-10 patients and do everything.

In case you're interested...all the rooms are shared. 

Anyway, at this ward, I have to work the shifts that my nurse preceptor works because there are few that speak English well enough to feel comfortable taking a foreign student. They do 8 hour shifts, 5 times a week. But on Sunday night she was scheduled to do a double shift, from 4pm-7am. Let's just say it was a long night. There wasn't really that much going on (besides lots of lifting and turning patients), but somewhere around 4 am, I just really felt the exhaustion creep in, like when you are at a sleepover and then things get crazy. That is what it felt like! My nurse preceptor is hilarious and ended up putting medicine cups on her eyes, saying they were the "wake up cups." We thought it was hysterical. And then we were wheeling ourselves in these wheelchairs and that lay straight back. Around 6am we went into a patient's room, where we were told, "you both look exhausted." We were.

Am I tired??

Yes of course!

At the end of the night, it was the weirdest thing to say good morning to patients that we had said goodnight to only hours before. I started falling into walls, and the long long 45 minute walk home was torturous. I'm pretty sure I was walking all zig-zag like. As I stumbled out of the health center back aching, feet sore, tired eyes, I felt like the walking dead. 15 hours is too long. The normal 8 hours they do makes you feel like you always have to be at work. However, our 12 hours is just perfect. I will never never grumble about them again!

The Second
Today I took a day off from the ward to see how home care nursing works over here. There are several offices around the town, and I had to go to the one that's about 2 miles west of the city center. Because I had to be there at 7, Leena was so nice and dropped me off in the morning, but I had to go back on my own. It was supposed to be a straight shot...more on that later.

We never did any kind of home health clinical at BYU, and I really enjoyed this. Remember, they have a public system, not private agencies that contract out home care like ours. So when the patient leaves the hospital, the doctor writes what the patient needs (such as medicines, lab draws, ect), the home nurse does them and writes in the the chart, which the hospital specialist (whose office is called the polyclinic) can then see the results. There is a doctor that works just for the home health once a week, but because everything is connected to each other, the healthcare really flows well. It also is growning quickly. They don't have enough facilities or nursing homes, so there is more need for nurses to work in this way.

The LPNs might come several times a day to make sure medicines are taken, that they eat, can shower, go to the bathroom. The RN comes maybe once a week to do a more complete assessment, do wound dressing changes, give injections, do lab tests, fill medicine boxes, ect.

I liked this because the nurse can work pretty independently. They have a schedule that the computer program makes for them, based off the patiens' orders in the computer, so she takes the list and her car for about five hours in the morning, and in the afternoon she charts. She is independent and can make decisions on her own. She always has resources if needed, but does a lot of really cool things. These patients tend to be lonely and crave company, and the nurse I was with said that bringing them that company and helping them feel another's touch is why she loves her job. I think the day shifts 7-3 is really nice and especially the driving and not being in an office.

After the day was over, I had the make the trek home. I knew it was going to take about 45 minutes, so I started out jamming to my music. 45 minutes later I start noticing that there are fewer and fewer houses, cars, and people. I'm the only one on the road. That can't be right...I should be getting close. Then I pass the sign that shows I'm leaving the city boundaries....oops. I pulled out my phone which thankfully google maps shows me my direction and location. I just kept going west instead of east!! So then there was another 45 minute walk to get back to my starting point, and then the real 45 minutes to get home. I can't believe I was so stupid! I should have looked at the map earlier, but I was content just walking and singing that I didn't even think I was going in the wrong direction!

Yep. WAY off course!

By the time I got home, my upper and lower back was hurting, my muscles were all tight, and my hands were getting swollen. It took me over 2 hours to get home, and I don't think I have ever been so happy to see the Blue House!! Again, I felt like the Walking Dead, because I walked so far I felt dead! I just collapsed onto my bed and starting writing this rant. I will be grateful again for the only 40 minute walk to the Health Center ward tomorrow! Ah, it's those little things in life!

Like a familiar lake and knowing where I am again!