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!

Wrapping up Public Health

In my last week of Public Health Rotations here, I spent my time at the Pediatric Clinic at the Savonlinna Health Center. I have explained that all preventative services are provided at these clinics. It's one big building that has many separate offices.

The Pediatric Clinic takes care of babies from the time they are born until they are 6 years old, getting ready to start pre-school. (Here their kindergarten is what we call pre-school and vice versa). Here is the break down of visists, if you are interested

2-3 weeks old
6 weeks (doctor)
2 months
4 months (doctor)
6 months
8 months (doctor)
10 months
12 months
1.5 years (doctor)
2 years
3 years
4 years (see the doctor and public health nurse)
5 years
6 years

This week I helped the nurse during these appointments. Mostly it was checking development, like rolling over, hearing, losing baby reflexes, ect. It is difficult when the parents feel uncomfortable speaking English, so then I end up spending the hour not understanding...sometimes it took all my concentration to stay awake!! But the nurse again was so wonderful and very passionate about her work. She told me at the end that before I came she was very nervous to have an international student, because she wasn't sure what I'd be like and she thought she would struggle with English. It's very humbling to be told something like that, and then hear that she really enjoyed her week, couldn't have asked for a better student (yay!), and to come back and visit her!

Another thing I was interested in is the differences in vaccination recommendations. In the US the routine is to give Hep B at birth before leaving the hospital, unless parents decide not to have it. They only give it here if there is a high risk factor for the baby getting the disease. They also don't immunize against Chicken Pox at all. The government pays for all the childhood vaccinations and decided that the HPV vaccine was more of a priority than the Chicken Pox. Of course if the parents want it they can pay to have it. They also have to pay to get Hep A/B. So that's one big downside of this kind of healthcare. The government has to prioritize the importance of immunizations. But I have noticed that there is excellent continuity in healthcare. They have good interdisciplinary teams and the pediatric nurse works closely with the school nurse so as the child transitions in life, there is an easy transition to those changes in healthcare. They don't have to fill out so many forms every time they go somewhere. It is all in the system :)

The pediatric clinic was probably my favorite place to be. There is no language barrier with babies and children. :) I loved making faces and playing with them in my broken Finnish. I did notice that in cultural and language boundaries one of the most important things is nonverbal communication: how you sit, how you pay attention to how they are speaking, your facial expressions, ect. I made a point to introduce myself and greet in Finnish. I could understand the nurse introducing me, so I was able to talk to them at that point a little in Finnish and English. I noticed that playing with their kids and seeming at the same time like I was listening is what warmed the parents up to me and to speaking English to me. They were able to see that I was interested in them and their child's healthcare, and because I had to make the extra effort to go out of my way to talk to them and interact with them, they were very willing to let me be an active part of the appointment. I really appreciated that! I know that sometimes I can be an introvert and it would have been easy just to sit there the whole time. But nursing school has put me in very uncomfortable situations before where I have had to be an active voice and make myself a participant. That has served me well and prepared me for being here. I had to make an extra effort here to learn and participate, and in a way that makes me feel like it is that much harder and probably that much more rewarding for me, too.

So all in all my three weeks of public health nursing have been very eye-opening. I've learned that people like their healthcare here (they hate the huge taxes and cost of it), but enjoy the benefits and services that they see as the government taking care of them. I've met really fantastic nurses who have a passion for teaching and sharing their knowledge. I've improved my Finnish :) This week is a wrapup final group presentation and exam at the university. Then I'm off to my Winter Ski Holiday!

We were good buddies :)

School Health Nursing

Disclaimer: long post ahead!

As I've mentioned, I spent my first clinical week following a public health nurse at two different elementary schools, Normaalikoulu and Kellarpellon koulu.

See this unassuming field?
They teach the kids how to ski and ice skate starting in 1st grade!

Public health nurses have additional education beyond a nurse and work somewhat independently in this healthcare system. They make their own appointments and manage the health of school age children, looking out for diseases such as diabetes type 1, eyesight problems, hearing, or vaccination needs.

In this public system, nobody falls through cracks. From the time the child is born, they are part of the child clinic that follows up until school age, then the school health care, then student university healthcare, then occupational care, and if needed, maternity care. As the people move up in age, their "primary care" is offered at these clinics. For the school age children, this clinic is at school.  Some of those primary healthcare services that are provided include yearly health checks by nurses, and physical exams by physicians every few years. Public health nurses manage these clinics and perform a lot of services for families. When the family goes to the doctor for a physical, they see their nurse, who remains the same, but they cannot pick their physician. The nurse may spend 40-60minutes doing a health check and interview, the doctor usually only gets 20 if it's a healthy child. In these elementary schools, the doctor visits once a week, and that's when the school nurse can discuss any concerns about specific children needing appointments or referrals to a specialist.

In this system, public health nurses are very well respected and needed. Parents call them first for child illnesses, and in school health, she is the most visible healthcare provider. If they feel ill at home (and it's non emergent) they call the school health nurse. She then assesses and advises them on what to do, and if needed, makes an appointment with the school physician. Those appointments take place usually at school. Basically, the healthcare for the school age child is provided at the elementary school level.

The office...

This week at school, I helped the nurse perform health checks. In grades 1,5, and 9, they have a physical with the doctor as well. Our health checks included interviewing them about their stage in life, their hobbies, interests, family life, and stressors. We took height, weight, hearing, vision, BP, and hemoglobin levels. We talked about alcohol and tobacco use and eating healthy. For these kids, I was able to talk to them on a basic level in english. The nurse translated for me for other times. We also gave vaccinations as needed (many of those are free to students through their healthcare) and washed out many ears :) A useful skill. Of course, there were kids that got hurt at gym or felt ill. We assessed them as needed. We also checked blood sugars and were watching out for symptoms of diabetes. We had meetings to attend with the interdisciplinary team: principal, teachers, social worker, special education teacher, and school psychologist if needed. The school health nurse provides teaching as needed for these members about different illnesses and is the person responsible for catching changes in health and promoting it.


I think that having health care in the schools makes the public health nurse visible to students. I noticed that the kids all knew her by name and came to her with their concerns. Because anytime they are sick or for their yearly health checks they come to her, they know her and trust her. When I think back to the school nurses I had, I don't remember them. Because they weren't really visible. Yes, they performed eye or ear checks. They check for scoliosis.  But these school nurses are part of the primary health care system, and do the work we would think of in our doctor's offices.

Sirkku, the nurse I worked with was so kind and compassionate to these kids. She has a gentle voice and a calm demeanor that puts the kids to ease at once. I was nervous, too, haha but she made me feel so welcome! She answered my millions of questions so patiently. She is a gem :)

I'm also a giant when you compare height!