Monday, February 14, 2011

Acute Practicum - St.Paul's Hospital Iloilo

The eight of us arrived late Sunday night in Iliolo to a warm greeting where we had a shell Lei placed on our necks from the students of St. Paul’s university. After the initial introductions we crashed in the spacious accommodations on campus that we will call home for the next 3 weeks.
Monday brought on an orientation of St. Paul’s nursing curriculum, as well as a tour of St. Paul’s hospital. We toured the many units that we will be dispersed in over the next few weeks which include; Operating room/Delivery room, Medical Intensive Care Unit, Surgical Intensive Care Unit, Neonatal intensive Care Unit, Pediatrics, Kidney/Renal Unit, and Postpartum.
Kidney Center:
Melanie, Cristina, Lisa, and Valerie were placed on the Kidney Center this week. On Tuesday morning the four of us attended the Kidney center’s 16th anniversary, which was marked by a kidney seminar. Guest speakers included Surgeons and Registered Nurses who spoke about the three treatment options for acute and chronic renal failure. That afternoon we were orientated to the Kidney Unit, learning the basics of the assessment forms, the functioning of the dialysis machines, and routines of the center.
The rest of the week we were responsible for patient care, including preparing the hemodialysis machine, monitoring vital signs of patients, and reprocessing the dialyzer. We learned that weighing the patients pre and post dialysis is crucial to evaluate the effectiveness of treatment, as it determines ultra-filtration goals of the patient (how much toxins and fluids are removed each treatment).
We thoroughly enjoyed the learning experiences on the unit, specifically the long term relationships built between the nurses and patients. This unit is unique in this area, as the patients return on weekly basis and spend long hours with the staff. This type of treatment allows for the staff to assess patients frequently, therefore evaluating the progression of their health status.
Although we spent only a short period of time on this unit, we learned a great deal from the very informative and helpful staff, students, patients and our clinical instructor. We left this unit with a positive outlook on kidney care which will be of benefit in our future nursing careers. 
Dialysis Machine (Kidney Center Iloilo)
Tamara, Amy and Leia are the three students on Pedia (pediatrics) this week. The cases on the unit that we most commonly saw were bronchopneumonia and Gastrointestinal illnesses. We were surprised that the unit was only operating at half capacity and in general their medical conditions were fairly stable. Our facilitator shared the reasoning behind this was due to the inability of families to access healthcare services which was most commonly related to limited funds.
The ward was separated into pay and service (charity) consisting of nine pay beds and five service beds. An interesting practice that we noticed was the fact that students are required to provide supplies (syringes, normal saline, gloves, etc.) that the patient’s family could not afford or did not have available at the time.
Our duties on the unit included: vital signs, medication administration, assessments, and treatments. We were paired with third year students for the first couple days and on our last day we were with fourth year students. There was a significant difference when comparing the years. We felt the third year students in the Philippines worked at much the same capacity as we did in our third year. As fourth year students we felt more equally matched in terms of clinical skills, ability to critically think through challenging clinical situations and practice independently when paired with the fourth year students.
This experience provided a good refresher of pediatric nursing, and the needs and challenges of working with this population. For example, application of medication calculations based on weight, setting IV drip rates, and working with gravity IV’s instead of IV machines. This experience gave new meaning the phrase “if there is a will there is a way.” Even with limited funds the staff and students always found a way to be innovative in meeting the needs of their patient. For example, the use of a Styrofoam cup as a way to administer aerosolized medications instead of an Aerochamber (a holding chamber to maximize the delivery of aerosolized medications, used most commonly in the pediatric population). Overall this was a great learning experience.
Neonatal Intensive Care Unit:
This week Carol was exposed to the Neonatal Intensive Care Unit (NICU). Some differences when comparing the NICU to home is that not all the patients are classified as having intensive care needs. There is a row of beds for newborns waiting for a physician’s approval to join their mothers on the obstetrics ward. This row is more like a Nursery unit. There is also a row of beds for babies that are sick, but not critical, which would be similar to our pediatric unit at home. Finally, there is also a room for critically ill babies with actual intensive care needs, such as ventilators. The entire unit is connected directly to the Delivery Room in order to immediately receive babies after birth.
I was impressed with the level of infection control in the NICU. In fact, there are even several awards hanging outside recognizing the unit for their efforts. Everyone changes their uniform and shoes upon arrival to the unit and wears a cap and mask while inside. In addition, each baby has their own supplies and instruments in order to avoid cross-contamination.
I also learned that the NICU here participates in the Mother-Baby Friendly Hospital Initiative. This initiative promotes early breastfeeding soon after birth as well as 24 hour rooming-in of the newborn with the mother. Dummies or pacifiers are not allowed in the NICU as they can interfere with attempts to establish breastfeeding and they require a different sucking pattern from the baby. There is also a policy that no bottles or formula are allowed unless a doctor deems there is a medical indication for it. Such a policy does not exist in Saskatoon. Of course I think it would be extremely difficult to implement such a policy at home due to the fact that Canadian society is strongly based on giving women the freedom of choice, which includes the choice to breastfeed or use formula. However, it was still interesting to see St. Paul’s proactive and assertive approach to promoting breastfeeding in order to create a mother-baby friendly environment.

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