Friday, February 25, 2011

Week 7 - Last week of our acute care practicum!

It’s hard to believe that this was the last week of our acute care practicum; the time has just flown by!! All 8 of us got to the opportunity to be placed in an Intensive care unit (ICU) this week; it was a great way to end things off.

Medical Intensive Care Unit (MICU)

We (Melanie, Tamara, Valerie and Cristina) had our rotation in the Medical Intensive Care Unit at St. Paul Hospital this past week.  The unit has a twelve bed capacity which is staffed with one head nurse, six registered nurses, and one nursing aid. The main types of cases seen in the MICU are cerebral vascular accidents, and acute respiratory illnesses (i.e. pneumonia, asthma exacerbation). Our first impression of the unit was that the physical appearance and set up were modern and very comparable to what we are used to seeing in Canada. For example, the unit had a central nursing station, spacious private rooms equipped with cardiac monitors and wall suction. As the week went on we came to realize that although the unit appeared to be similar to those back home, essential medical supplies were lacking. Although technology is available on MICU, the quality of care depends on the financial status of the patients.  As an example, in the hospital at home gloves are available in abundance here, however, patients supply the gloves and if unavailable you improvise.  Also this week we learned about the financial burdens many families face when their loved one is hospitalized, a typical cost per day would be 15,000- 20,000 php which exchanges to approximately 400- $600.00 dollars Canadian. 
One of the experiences we observed while on the unit was a patient receiving emergency medical interventions.  This patient was suffering from acute respiratory distress which was related to thick, dry secretions compromising his airway. For all of us this was our first experience observing a medical emergency where a patient was in need of intubation. This experience gave us a clear picture of what it is like working with an unstable patient given that their health status can deteriorate within minutes. Thankfully the patient was successfully intubated and stabilized due to the timely response of the MICU team.
We spent the week working with mechanical ventilators, suctioning, monitoring central venous pressure( monitors hydration status), nasogastric and PEG tube feeds, the Glasgow coma scale (assesses neuro status through best verbal response, eye opening, and motor response), decubitus ulcer (bed sore) dressing changes, and monitoring vital signs. Our final week in hospital allowed for us to refine our skills as these patients required close monitoring and in-depth assessment.  

Neonatal Intensive Care Unit (NICU)

This week Carol and Lisa were in the Neonatal Intensive Care Unit (NICU).   During this time we both had the opportunity to care for infants in all the different areas of the NICU, which meant caring for newborns with various levels of acuity.  The most common cases we observed on the unit were jaundice and premature newborns.  A more rare and severe case was a baby that had an esophageal atresia, which occurs when the esophagus ends in a pouch rather than connecting normally to the stomach, as well as a tracheal-esophageal fistula, which is an abnormal connection between the trachea and the esophagus.  This same baby also had an imperforated anus, a congenital (present from birth) defect in which the opening to the anus is missing or blocked.  Another infant had a large hemangioma, which is a benign self-involuting tumour (swelling or growth) of endothelial cells, the cells that line blood vessels.
Our roles and responsibilities on the unit included monitoring vital signs, providing regular feedings both orally and via oral-gastric tubes, testing blood glucose levels, preparing and administering IV medications, monitoring output, reconstituting medications, providing mouth care, inserting oral-gastric tubes, providing colostomy care, and administering erythromycin gel into the eyes and Vitamin K injections to newborns. 
This week we both had the opportunity to observe a circumcision, which was the first time for both of us. The procedure was difficult to watch as the baby appeared to be in excruciating pain. We were both surprised to learn that no anesthetic was provided.  It was a challenge for us to observe the remainder of the procedure knowing that the infant had received nothing for pain.
Another challenge we identified this week was when we were assigned service/charity patients that could not afford to pay for the medical care prescribed for them.  If families were unable to pay for treatments, then the patients would not get them.  An example that occurred quite frequently was medications not being available and the patient would end up missing that scheduled dose.   Another example we observed this week was one service patient with a colostomy who could not afford the proper colostomy pouch, thus the stoma was covered only with gauze and tape.  The use of gauze demonstrated to us how here in the Philippines they really utilize and manage their resources according to the situation.  However, we knew that over time the gauze would not be ideal because there is large potential for skin breakdown.  Witnessing the service patients miss out on medical treatments due to their own lack of funds made us feel fortunate to have socialized medicine back in Canada where each person has access to all treatments while in the hospital.
Overall, we had an amazing learning experience on the unit. The staff were all very welcoming to our presence and enriched our experience by answering any of the questions we had.  Although there were moments when it was difficult to witness newborns with ill health, it was rewarding to know that we could be the person that comforted them when they cried.  Our time on the unit started and ended just as quickly, however we both leave feeling more confident in our abilities to care for newborns.

Surgical Intensive Care Unit (SICU)
Amy and Leia were the students placed in the SICU this week. We started off our week with an orientation to the unit and the nursing functions that we were allowed to do and not allowed to do. This unit is a six bed capacity with acute critical patients, ranging from pediatric to geriatric patients. This week the unit census included; head injury (motor vehicle accident and craniotomy), spinal cord compression and appendectomy. Both of us got to do nasogastric tube feeds and administration of medications, suctioning of oral secretions of an endotrachial tube and tracheostomy. One thing that we both got to practice on an hourly basis for the four days was the neurological vital signs. This allowed us to assess the patients level of consciousness and ultimately if they were progressing negatively or positively with their current medical condition.
On our last day the both of us got to observe a code blue (which is a cardiac arrest) on our unit. The professionals involved were very calm and collected throughout the whole process. We imagined this process to be a lot more urgent and faster. We were thinking that this could be because it is an intensive care unit and that the experience they possess with codes has influenced how they react and practice in a high stress situation.
Overall, it was great week in SICU because of our clinical instructor, staff and the learning opportunities that were offered to us. From this exposure we both have experienced a steep learning curve. We were able to have discussions throughout the week where we both realized there is a universality of nursing care that we shared with our counterparts.


We had the opportunity to watch a velada (play) put on by some of the students at St. Paul’s University and produced by Sr. Carolina Agravante. The Velada this year marked an historic event in the life and mission of the Sisters of St. Paul of Chartres in the Philippines. It is the Sister’s 100th year of presence here in Iloilo City. The production captured the Sister’s charisma and influence in the building up of St Paul’s University through song and dance set to the music of the new generation of pop and rock.

Valerie was asked to give a lecture to a class of 4th year nursing students on her experience with type I Diabetes and the use of an insulin pump to manage her glucose levels. Valerie gave the students the opportunity to see and learn about something that they have never had first-hand experience with before. She was able to provide a view of health care from the patient’s perspective and help us all to understand the central role of the patient in the provision of health care services. Her presentation was very informative and stimulated the audience to get involved and ask questions. Great job Val!!

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