Playing around

Well, I just finished my clinical hours at the health center. I was suppposed to go in this evening (uhh...my last Friday evening in Savonlinna). I had a meeting with my clinical instructor though to go to beforehand, and the first thing she said to me right when I walked in was,

Her: "I've been looking at your schedule."
Me: "Yeah I wanted to talk to you about that."
Her: "You don't have to go today."
Me: "...uh."
Her: "Really."
Me: "Thanks!!!!" Big Smile on my face

I didn't want to spend my last weekend at the Health Center ward, and it was a beautiful day!

No, my days at the Health Center ward were actually pretty good. It was a rehab unit, and it gave me a good picture of what nurses do here in Finland.

There are lots of similarities but also lots of big differences. Like I've already mentioned, there aren't any CNAs so the nurses not only give medications, do wound care, ect, they also do all vital signs, bathing, turning, lifting, ect. So these nurses have 8-10 patients during the day, but can have about 20 at night. The nurses also don't do physical assessments. In the United States, nurses carry and use stethoscopes very, very often. It is a critical and expected part of our work skills to assess a patient's condition very quickly. I was surprised that Finnish nurses don't do this.

The Day Room

The nurse preceptor I had these two weeks was absolutely fabulous! I loved being around her and we had a great time. Even though I wasn't able to communicate in Finnish, she did a great job translating rounds, nursing report, and conversations in general to me.

We also never could pose for a serious picture....

 Unfortunately, this was the first time I really got that in my entire time here. So I feel like I learned a lot more from that. She also let me do things right away, which I appreciated. Like, "do you want to give this shot?" Or on my first day, "Ok, you change this (very big, very bad) wound." No problem. She also was just so much fun to be around. I think that nightshift bonding really helped, but we laughed and had so many great times comparing nursing and cultural differences between Finland, US, and Germany (where she was born.)

Just having a fun time!

The "serious" picture! We cracked up right after this was taken

The work at this ward was very difficult, and I think that it would be hard for me to want to do it long term. It's physically demanding on your body, lots of lifting and moving patients who may not have or be able to use limbs. It also takes a lot of mental strength to take care of that many patients on your own.

Part of the day room

Rehab room

We saw patients with everything from dementia, to strokes, joint replacements, heart failure, amputations, and infections. Some patients had IVs, but not all. Some also had catheters.

There was a doctor on hand during the days. Apparently, there used to be one always there, but they've had to make money cuts somewhere, and that was one way to do it. Also, there is a shortage of doctors around here, too. Because of those two things, they are closing wards at health centers and hospitals. For example, the labor and delivery unit at the hospital here is closing, and people will have to travel to Kuopio (100km away) in order to have their baby! I think that is so far away.

The health center ward is part of the same hospital/healthcare system. After they are discharged from the hospital, if they need more rehab they come here. Afterwards, they might go to a nursing home or assisted living. People might stay anywhere from 2 weeks to a few months, but no longer. It's not intended to be a long term care facility.

And for all my nursing friends out there, I know you're interested in their different medicines and IV equipment :) haha, maybe not.

Med Room

SO much easier to use...

Ok, so it wasn't the location that I really wanted to be at for clinical. Let's be honest, I wanted to be at the hospital. But it turned out ok. I had a great time with the nurses there, the patients were very kind and patient with my lack of Finnish. One sweet old man knew no English except for "Good Morning, Darling." THAT was funny :) and sweet. Another lady laid her head on my shoulder when I was sitting next to her on the bed, and another lady whose legs had to be amputated was always so so happy to see us enter the room, and gave such big smiles, it made ME happy. I found that these elderly patients were very sweet and accepting of me!

And clearly I have no self-preservation....

Racing down the hall

Oh look!

In spite of the awful white uniforms, I learned a lot and enjoyed overall my time at the Health Center Ward 1!

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!

Welcome back winter!

You thought winter was over?? Psych. It came back with a vengeance today with over a foot of snow. Last Friday we were enjoying this:

And then today we found this (At the same time of day!): 

It's really ok. I like snow. But the nurses all told me that the reason it snowed was because it's market day. It only happens twice a year, and only for two days. And every year, it snows. I was thinking, of course Finland is the only place where a market is so dedicated that it would stay open in spite of inches of snow!!

There were breads, sweets, sausages, food, toys, handmade wooden carvings, wool knit socks and scarves, clothes, ect. People from all around the area travel here for these two days. I didn't buy anything, but I was so happy to find out when I got home that Leena had already bought some of the sweet breads :) Yum. I'm going back tomorrow...maybe I'll buy something!

On another note, last week was the last week of our Finnish lessons. This week we decided to get together and celebrate not having class anymore. I was grateful for this class because it has helped me meet many other exchange students here studying different things. Also, I have never been part of a more international group, and it was both fun and exciting. German, Austrian, Chinese, Hungarian, French, English... My favorite moment of the night was when we were talking about how animal sounds are said in different languages. Everybody cracked up when I said that a rooster goes "cock-a-doodle-doo."Meeting so many friends from around the world has been a great experience, learning about other countries, cultures, mannerisms. I was amazed tonight that there were 12 of us, from around the world brought together by this experience in Finland, speaking English to each other, but at times breaking into these other languages. 

No matter the political conflicts or differences of opinion, people are people and by human nature we bond and create friendships regardless of backgrounds, culture, language, or country!

Emergencies!

On Sunday, our Branch President (leader of the congregation) approached me and asked if I would like to visit the firestation where he works and learn about how the Finns do emergency care. Of course, I can't say no when someone offers to show me something...So I got my very own private tour of the Savonlinna Firestation. Be impressed.

This adventure started off with the 30 minute hike in negative degree weather to the firestation...that I had only ever seen in passing. I just jammed to the Frozen soundtrack on my phone (I can really relate you know? Especially that line "the cold never bothered me anyways." It's like repeating that line will actually make me believe it haha :) ) Actually, when I'm bundled up in my ski pants, hat, mittens, and fat scarf, it isn't too bad!

So here is the gist of what I learned. The firefighters and paramedics operate under one jurisdiction. The government supports both with about 1% of taxes. The government organizes the country into regions, and these regions are responsible for the cities and firestations in their area. So Savonlinna is part of a district that covers Mikkeli, Savonranta, and a few others, and the firefighters can float among those areas. Because the federal government regulates the firestations, everything is structured so similarly. The branch president told me that if he had to go to Helsinki to work for example, he would be ok because the order of things, the layout of the trucks, and the system is so precise. There are no volunteer firefighters, it is their career. He said that that is how it should be, because the people are paying for their service, so they expect quality.

I had to admit that I didn't really know much about how our system works. All those elementary trips to the firestation haven't seemed to pay off much. After researching it, I relearned that ours are regulated by the city or local government, and we have about 70% (according to the website I found) volunteer firefighters.

I was very impressed with the Savonlinna station. The firestation has a dive team, a water boat (because of all the lakes), several fire trucks, their own mechanic shop. And every member of the team is cross-trained for every job. They have hydraulics for opening cars, so many electric tools, generators that can maintain electricity for entire buildings, saws for dealing with storms and fallen trees. They deal with water rescue, animal rescue wildfire, car accidents, fires, medical emergencies, you name it. Within one minute of receiving the call, they are ready to leave for the run. Basically, I've decided that a firefighter would make a good boyfriend because he would be handy to have around.

I mentioned that the paramedics fall under this jurisdiction as well. In the old days, firefighters were crosstrained as paramedics and they did both. Now it has become so specialized that this isn't practical. All the paramedics now are specially trained nurses. They went to nursing school and then furthered their education with a 4 year specialty training. They can give about 55 different medications on route, and have full authority to treat the patient in the ambulance.  Our branch president actually trained as a nurse too and then moved to the firefighter side.

As a nurse, I really like this idea of nurse run paramedic teams. I don't claim to be an expert though, so please don't quote me on any of this. In our system, paramedics are only able to give a small handful of medicines: nitroglycerin, saline, morphine, epinephrine, some basic medications. They can do resusitation, and some can intubate. Because the paramedics are trained nurses, they can treat on the spot much better than in our system. We have to take the time to deliver the patient into the care of doctors and nurses, but here, the nurses and sometimes doctors too come directly to the patient. By the time they have arrived at the ER, many patients are stabilized. This provides for continuity of care. Also, since this is part of the federal government, it is structured very exactly. Everything is the same anywhere you go. In the US, training and certification of EMTs and paramedics also is very variable and differs in different cities, or states. I think that sometimes our system is very fragmented by shifting patients from different hands. This continuity of care is one plus for their healthcare system.

Overall I was impressed with the emergency care provided by the government here in Finland. I was thinking about this through, and realized how difficult that would be to implement in our country. Think about it. We have to train more specialized nurses...but what would that do for the livlihood of all our paramedics? And we are already short on nurses. The ambulances would need to be affiliated with an organization....is it problematic that our private ones have limits to which hospital they go to? With as many people in our country, could we pass a law requiring 1% of taxes to go to this service? The sheer number of private hospitals and lack of nurses would make this a very difficult project. I can't help but see, though, this system provides continuity of care in a way that improves outcomes for patients. In an emergency setting, the structure of this system is what patients need to be stabilized.

The whole time I was there I kept wanting to take pictures of everything. But I decided to be polite and wait til the end so I could get a picture with the branch president. Too bad they got a call and he to leave. Literally, we were talking and one minute later he drove the firetruck away. Talk about an exciting end to it all. So all I have is this selfie after I was left alone :)

Comments or questions? Anything I left out? I'd love to answer any or find out the answers if there are any :)

Getting down to business

So I guess amid all the exciting posts these last two weeks, I may have you all confused into thinking that I'm on a vacation here in Finland. I'm actually not... Starting next week things really pick up big time. So let me give you low down on what I'll actually be doing here. (Let's be honest, I just found out today haha)

Basically, this is my capstone semester, my last semester, before I graduate with a bachelor's degree in Nursing. If I had stayed in Utah, I would be doing about 216 hours on one hospital unit during the semester. I would work with one nurse and sort of get a feel for nursing and learn to be my own nurse. We also have classes about leadership, NCLEX (board exams) prep and basically preparing to graduate. However, I'm not really doing any of that while I'm here.

When I decided to come to Finland, the BYU College of Nursing agreed to accept any work I do over here as my capstone. This university in Finland signed me up for their Community Health and International Nursing class and Finnish Language and Culture class. They are taught in English and have a mixture of students from other countries. This community class is only three weeks of lecture, three weeks of clinical practice. So I have already spent one week in that class, and next week I'll start everyday all day in community centers for clinical for three weeks. I'm very excited! I'm doing the first week at an elementary school, the next at a pregnancy clinic, and the last at a pediatric clinic. Now, this class wraps up at the end of February, but I have to fill my time somehow right?

The last month or so I'm here will be so crazy. After the community class is over and I celebrate my one week ski holiday (yay! finally a spring break!) I'll be working 2 weeks in the Pre-op/OR/Post-op at the hospital, 2 weeks at a rehab/progressive care at the hospital, and one week in a nursing home. That combined with the three weeks before in the community will give me around 280 clinical hours. No more sleeping in and having fun days :(

Actually, I'm very excited to see all the different areas of healthcare here. Finland has socialized medical care, so as I learn about each of these places, I'll be updating my blog and sharing my thoughts on their system and how it compares to ours. Stay tuned!

And see, this page doesn't even have a single picture! Proof that this is a serious, studious trip :)

Church and Chocolate Chip Cookies

We have had a very busy weekend here in Savonlinna.

As I mentioned in my last post, as a way to welcome me here, Saarika invited me to her house for dinner on Friday night. Well, something that I learned very quickly was that she loves chocolate. Brownies are her absolute favorite, but when she asked me, I told her chocolate chip cookies. And I'm not even going to be humble, my recipe is the best. It just is. So we decided to give those a try because she loves cookies but had never made homemade ones before, and I love to bake. It was an adventure.

When we were getting the ingredients at the store, we had a hard time finding vanilla. That's just an easy thing to find back home, but the store didn't have the liquid kind. It had the plant. Which we had to open and scrape out to get our vanilla. That's the first difference.

Secondly, I was worried because my recipe uses cups. Thank goodness previous BYU groups that have visited brought cups for Saarika to use with brownie mixes from the U.S. They use deciliters here for measuring-that would be tricky to convert.

Third. No hand mixer. Usually you beat the sugar and butter together until they're mixed. I used my hands. It was left as sort of a grainy texture...

Fourth. No teaspoons. It was a guestimate. I only hoped we didn't add too much salt.

Finally, the oven was in Celsius. So we had to eyeball the cooking time. Overall I was very impressed. They turned out exactly like my favorite ones we make at home. And the kids loved them, too. They were gone by the next day. :)

_______________________________________________________________________________

Some of my extended family lives in a small town in South Dakota. We are all members of the Church of Jesus Christ of Latter-day Saints also known as "Mormons," but since there are few people in that small town, there are few members as well. We call our large congregations "wards", but when they are small they are called a "branch." The branch in South Dakota has about 20 people. I knew Savonlinna had a branch, and I was prepared that it would be smaller than my 150 member student ward at BYU. I was very interested to see how differently church might function. 

In our church we have three hours of meetings. First we have our worship service, our "Sacrament Meeting." Then we have Sunday School and finally Relief Society for women and Priesthood for men. This branch only meets for two hours and rotates Sunday School and Relief Society/Priesthood every other week because they are small. There were probably 15-18 people there for Sacrament Meeting and 8 for Sunday School. One of the missionaries blessed the Sacrament and the other passed it. Leena was playing the piano for the meeting so she told me to sit by the elders (missionaries) so they could translate for me. I was very impressed. One had only been in Finland for 8 months but was able to translate most of the talk for me, except for quotes. For scriptures he just told me the reference and we looked them up in my English scriptures. 

Leena taught Sunday School and she asked me questions in English and interpreted my answers for the class. Even though I was separated by the language barrier, I felt the Spirit very strongly in their branch. These members know the Gospel well. They love and serve each other and try very hard to live good lives. Between the missionaries and the Spirit, I learned a lot today. 

In between the two meetings, I took a few moments to read my favorite chapter in the Book of Mormon. It's Alma 26. At the very end, I stumbled upon a treasure in verses 36-37.

"Blessed is the name of my God, who has been mindful of this people, who are a branch of the tree of Israel...Now my brethren, we see that God is mindful of every people, whatsoever land they may be in; yea, he numbereth his people, and his bowels of mercy are over all the earth."

When I read this, I knew and felt very strongly that this was true. This small and faithful branch of members in Savonlinna are loved and watched over by a loving God. He knows them, and they are never forgotten. They are a small group in our eyes, but God knows every one of them. I began to feel a different sort of love: for a moment, I believe I felt a little of God's love for this branch. 

The Church might function differently in different areas of the world, but it is the same Church and the same Gospel of Jesus Christ. I am grateful for my membership and the strength that I feel from it. I am blessed that I can travel thousands of miles away and still feel the love and hand of the Lord guiding my life. 

Minun nimeni on Melanie

Whew. This has been quite a whirlwind of a few days, that's the only way I know how to describe it!

First, let me explain the process of how I got to Savonlinna. It was long, and it was crazy. I'm amazed that it went down without a problem.

After arriving in Helsinki, I knew that the my journey was just starting. I was a little nervous going through the border control because as U.S. citizens, we can only be in the E.U. for 90 days at a time. My trip is 89 days. However, the guy started questioning me, asking me why I was coming, where I was going, who I was staying with, and how I was going to Savonlinna. After this hoard of questions, he started looking through my passport for a visa. My heart was pounding! When he understood that I was staying for 90 days, but he gave a look, like "you are cutting it close" and then let me in! It was scary!

After the airport, I had to catch a bus to the city center, then catch a train to Parikkala, and then switch trains there in order to get to Savonlinna. That first train ride was 3.5 hours! And it was so empty. I was the only person in the whole train car, and I sat in a very cute, Harry Potter-esque compartment. Like so....

I have to admit, the thought crossed my mind several times that if someone tried to attack me there, they would get away with it because no one was around! But really, I felt very safe.

All in all, I had it very easy and it was very smooth. Leena met me at the station and we drove to her house, even though it was a short walk. As we were driving, she put her hand on my knee and said "I think we will get along well." I was really happy because I was worried that she wouldn't like me! It was a huge relief. It turns out there is a lot to talk about with her. She speaks Spanish very well, and when she found I do too, she was very excited, and now sometimes we talk only in Spanish. I think it may be easier sometimes for her to use Spanish instead of English.

The very next day I had to show up at the school for registration and orientation. There are 8 other nursing students here. 4 from Portugal and 4 from Kansas, but the Kansas girls are only staying for one month. There are several other students studying different things as well, and I think I will become good friends with some of them. They will be staying here as long as me.

The really weird thing is that I haven't at all been hungry. That is so odd for me because as my family knows, I really love to eat! I still don't think I have gotten over my jet lag either because today I slept until 11! I was so embarrassed. It doesn't help that the sky is darker so the sun doesn't really wake me up.

I have to admit, after the first day I was feeling very overwhelmed. Leena took me to Finnish lessons Thursday night after my long day and then we visited her daughter's family, and we were gone all day!

Finnish is the hardest thing so far for me. I forgot what it was like to be in a country where you don't speak the main language. I can't even pick out some words! I literally knew no Finnish when I got here.  Leena has a "plan" though. She is determined that I will learn Finnish. She is going to ask me to say ten words a day. For example, before we go to the pool tonight (in an hour) I have to recite 1-10 in Finnish. She is very good at teaching. She teaches me something and then tells me to say it to people. For example, this morning, she quickly taught me "minun nimeni on Melanie" and then insisted I use it all day. (That means my name is Melanie.) She also signed me up for a Finnish class that meets on Tuesdays and Thursdays.

I haven't really had time to settle down because there is so much to fill my days. I feels like I have been here longer than two days! There is so much more I would want to add. I will be grateful when school starts on Monday because then I will have a routine! I hope to take more pictures this weekend when maybe I'll have more time? It finally snowed today so it is prettier :)

Change is in the air...

I was really not excited to come back to Provo for my last year of nursing school.

After working at a real job this summer at a hospital back home, I felt like I was so ready to just be done with school and couldn't wait to start working as a registered nurse. Also, it was really hard for me to come back, especially with so many of my friends moving on, graduating, and getting married.

I was going to be on my own. I had to start over.

Needless to say, these past few weeks have been very difficult for me. (That's hard for me to admit.)

Then in one of my classes, our professor told us about a amazing and unique opportunity. The College could send one student to Finland for the capstone semester. They could work at a hospital there, learn about another culture, and another healthcare system.

I really can't describe how I felt that day. I was sitting there with about 50 other friends, but she was talking just to me. I felt something, and I knew that this was for me.

After talking with the professor that day, I decided to do some soul-searching. I prayed. I cried. I planned. I analyzed. I broke this decision down bit by bit. I agonized. Everybody told me, "just do what you want." But I didn't know what I wanted.

Finally, I decided to fast and to pray about this decision. I took the frustration and excitement to the Lord and poured out my heart. I have never felt so much overpowering love as I did that night on my knees in the basement of my apartment. I was surrounded by God's love and guidance. He was telling me to go to Finland. He told me that it would be alright. He told me that this was a blessing for me. This is a gift and an opportunity. One that I have to take advantage of. I don't have to feel left behind, I can make my own path. I can take my life into my own hands.

It's once in a lifetime. 

So here I am. The bottom line is this. In less than two months,

I'll be in Finland
I'll learn nursing from another perspective.
I'll learn about another culture.
I'll learn about another system of healthcare.
I'll learn about people.
I'll make new friends.
And I'll fall in love...with another country.

With Savonlinna, Finland.