Tuesday, February 22, 2011

Acute Practicum: St. Paul's Hospital (February 14-20th)

February 14th-20th, 2011

Another week has flown by as we continue our journey at St.Paul's Hospital Iloilo. It was a full week of Surgical Intensive Care Unit (SICU) exposure for Melanie, Cristina & Valerie and Operating Room/Delivery Room (OR/DR) exposure for Carol, Lisa, Tamara, Leia &Amy. This week also happened to be marked by some special anniversaries!


We began on Monday, February 14th with orientation where we were introduced to our instructor. We headed straight to the unit and became familiar with the environment and patient conditions. The SICU has a 6 bed capacity and upon arrival it was at full capactiy. The nursing care is provided by two staff nurses, one charge nurse, and one nurse aide. We initiated our learning by discussing each patients case as though we were in nursing rounds. From our discussions we determined nursing diagnoses as it pertained to each client. Utilizing nursing diagnoses is heavily integrated within St.Paul's nursing curriculum. We are familiar with nursing diagnoses and we felt that our discussions allowed us to fully grasp the basics of the nursing process. This helped in identifying and prioritizing nursing interventions as it relates to each client. We were 3 students to 1 instructor. This allowed for an enviornment condusive to collaboartive and reciprocative learning which stimulated questions regarding clinical manifestations.From these discussions we were inspired to research more and more!

Many patients in SICU are admitted due to trauma and need emergency operations. The main patient cases which present include severe head injuries. Utilizing Skyscape via our iPod touches provided by the College of Nursing we were able to access evidenced based research regarding brain injury patients. We learned that the etiology demonstrates that the most common admissions are related to Motor Vehicule Accidents (19%), Falls (32%), and Assaults/Child Abuse Cases. Within this week we were exposed to all of the above. We have not had the opportunity to work with critical patients previously and St.Paul's Hospital provided our first exposure. Some of the nursing interventions and treatments provided were; neurovital sign monitoring (Glascow Coma Scale), suctioning, ventilation therapy, JP drains, chest tubes, tube feeds, measuring Cardiac Venous Pressures, and IV therapy. There were ample opportunities to enhance, reinforce and increase our confidence regarding these interventions.

On the last two days, we were joined by our Filipino delegates. Increasing our student numbers to nine students to managing a recently decreased patient load of two patients. Due to the large number of students, we utilized the "Functional Nursing Approach"of care. Fucntional Nursing is when tasks (functions) are delegated to individual nurses. For example Melanie acted as bedside nurse, Valerie as medication nurse and Cristina as Charge nurse. The following day these roles were rotated. This was challenging for us as we strongly felt that continuity of care is absent in this type of appraoch. However in these circumstances, we appreciated the alternative perspective.

After spending our week in SICU we have all developed confidence and enhanced our knowledge in managing unstable patients. We learned a great deal about head injuries and it's related clinical manifestations. The skills and comptence we have gained from the SICU will undoubtfully ease our transition from nursing students to future Registered Nurses.

Valerie administering nasagastric feeds.
Cristina preparing medications.

Melanie and the suction equipment.

Filipino & Canadian Nursing Students and Clinical Instructor.

The room set up in SICU.
The first day of our OR exposure consisted of a thorough orientation. This included a cultural survey, roles and expectations, review of the principles of sterile technique in the OR, introduction to the unit routine, and a tour. We all got to scrub in on major and minor surgeries. The major surgeries included caesarean section, cholecystectomy (removal of the gallbladder), total abdominal hysterectomy (removal of the uterus), nephrourectomy (removal of the kidney and ureter), appendectomy and much more. Some of the minor surgeries consisted of pterygium excision (removal of a conjunctival growth), cataract excision, release of trigger thumb and release of carpal tunnel ligament, arterial venous fistula (joining of the artery and vein in the arm, which is used as an IV insertion site for renal dialysis). Our role as a student nurse in the OR was the same as in UERM as discussed previously.

There was only one natural delivery the whole week that we were there. Our instructor informed us that it is more expensive to deliver in the hospital rather than at home or a community clinic. Included in our DR exposure was the opportunity to provide newborn care, this entailed, cleaning, anthropometric measurements (head and chest circumference abdominal girth and length measurements), temperature, weight, cord care, foot prints and dressing. In our observations of the labouring process, nurses in the Philippines play a lesser role and are not able to practice to their full scope when compared to Canadian delivery nurses.

Overall this week, we all experienced a steep learning curve. In the five days that we were there all of us were able to memorize the names of the most commonly used surgical instruments and this enabled us to have a very hands-on experience. The staff were welcoming, supportive and fostered an environment conducive to learning.

Tamara, Leia & Amy in one of the OR theaters.

OR team (Surgeons, Residents, Nurses, Anesthesiologist & Canadian Nursing students)

OR team.

Birthday Celebration
Tuesday, February 15th marked Melanie's birthday celebration. Our Filipino nursing student delegates had been planning a surprise celebration for a few weeks and all we were told was to be ready by 5:30 pm. The night began as we made our way to Boardwalk to watch the sunset. The students then booked a restaurant room and surprised Melanie with supper, gifts, cakes, and of course some karaoke! Each student (Canadian & Filipino) was asked to give a toast to the birthday girl. Melanie was glowing with happiness as she listened to the heart warming well wishes. We will all remember Melanie's one and only birthday in Iloilo city. Despite being busy with clinical duties, midterms, and reviewing for the nursing board exams, the Filipino students still managed to plan a wonderful evening we are sure Melanie will never forget. We extend our many thanks to all those involved in planning this special event.

Canadian Students enjoying the birthday festivities.

100 Years of Healing The Body, Nurturing The Spirit

This week was also memorable for the Iloilo community as St.Paul's hospital celebrated their 100th anniversary. Music is very much a part of the Filipino culture and what a more fitting way to showcase and celebrate this milestone than with a musical. We attended the musical for the Centennial celebration titled Faith in One Dream. Through theatrical presentation of songs and dances the vision and mission of excellent and compassionate healthcare services through the years was shown. The majority of the cast were nursing staff of St.Paul's and we were informed that they prepared for 2 months for the show! Once again we were in awe by the extraordinary talent here in the Philippines.


Fun Run 2011
The celebrations continued on the weekend as 6 of us (Melanie, Cristina, Amy, Valerie, Tamara & Lisa) participated in the St.Paul's Hospital Centennial Fun Run 2011. A 5 km run where all proceeds were donated to Madre Antoine Center Foundation. For a few of the Canadian students it was a first organized community run, but for all it was an amazing feeling to have been amagonst the 800 participants celebrating this milestone of `100 Years of Healing the Body and Nurturing the Spirit`. Many staff we have worked with during our rotations in the hospital were present and we cheered eachother on throughout the race to reach the finish line! Crossing the finish line marked this day as an accomplishement that will long be remembered. It was a fantastic way to bring the community together to promote health and wellness.  

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