Blog 3
6/12/12
Wow, time has flown by! I can’t
believe that we are into our last week in Panama. As much as I miss home, I
really don’t want to leave Panama!
The San Felix community has been so
inviting! I have felt so welcome and safe here. I have even ran alone down the
main road- something that I am not even always comfortable doing in Tampa.
Everyone always waves and/or greets me when I pass them on the streets. I also
sometimes receive odd looks running. I have not seen many people run here for
the fun of it- life is their exercise. I like that.
Last Thursday, June 7th,
we spent the first half of the day in San Felix and the second half of the day
in David at the main hospital with the UNACHI students. Just as we have started
to adapt some of our American ways to get by here (cold showers, no ac, etc),
the compound has also started to make some changes. The last few meals have
been made with more butter, more salt, and less rice. They have also started
serving breakfast buffet style rather than pre-plating the food because we were
wasting a lot. It is interesting how people accommodate, both ways. I was not
expecting this. Nevertheless, I miss my BIG GREEN salads and special k.
In the hospital in David, I started
out on the gynecology floor and moved to the ob/gyn high-risk side after
dinner. The gynecology floor was
very slow. There were five students on the floor, one charge nurse, and the
UNACHI instructor. The UNACHI student that I paired with was assigned one
patient. Her and I both introduced ourselves to the patient (me using my broken
Spanish- my name is CHA-nel here… lol) and performed a ten minute assessment. That morning she had had a hysterectomy. The patient had a history of breast
cancer and a mastectomy on her left breast. At the bedside she had an IV in her
jugular vein. It was very interesting because the student performed all of her
vitals and ten-minute assessment before checking the patient’s charts or
history. In fact, she did not refer to the records until she went to document
the vitals. This is different from nursing in the US. I have seen most
nurses at least receive a verbal report (and if not, check the charts) before
vitals so they have a picture of the patient. The only other thing we did for
the patient before dinner was empty her Foley-catheter bag. She had 100cc of
fluid, which was appropriate from the time it was last emptied 3 hours before.
My time on the ob/gyn high-risk
side of the floor was a lot more interesting. There were three registered
nurses on the floor and six nursing students. Their instructor was in and out.
I walked around with the UNACHI student that I was paired with to perform
routine beginning of shift tasks. Again, the same was true as before about
never checking the charts or receiving a report. We went around taking manual
blood pressures, temperatures, pulses, respirations, and fetal assessments
(palpating positions and fetal heart rate).
It was a lot of fun working through
the language barrier with the UNACHI student. In previous situations it has
been somewhat frustrating but the UNACHI student was very patient with me. She
was also open to learning a few English words. I taught her how to say “blood
pressure” and “respirations.”
There was one thing that really
frustrated me during this visit, however. The UNACHI student was very sweet
about sharing her tasks with me but I don’t feel that she always trusted me. On
the first patient, I got a manual blood pressure reading of 108/58. The student
looked at me funny and then re-checked the blood pressure. She got 120/78 and
then underlined the 120 when showing me her data and said “normal.” I am really
comfortable with taking manual blood pressures and I did not appreciate this. I
also was wondering how our numbers were so far off and, if I was doing it
wrong, what I did wrong. So, I asked Chiara to take a third reading on the
patient. She got 110/ 58. The nursing student still documented the number that
she got even after we mentioned to her that we both got a lower reading. This
happened several other times as well. After talking
to a few of my USF colleagues, we discovered they all did this. It seemed
as if they were afraid to chart anything outside of the “normal” range. Here it
is important to note that we are the patients’ advocates! What is “normal” for
one patient may be abnormal for the next one. It is important and CRUCIAL to
document accurately so that a baseline is recorded and trends can be monitored
over time.
I also got to use a Doppler to monitor
fetal heart rates. This is something that I had only done once before in the
Chami clinic. It was great getting to practice this more! The student also
showed me how to manually assess the position of the baby. There are three
points on the stomach that you are supposed to palpate to feel for the baby’s
head or butt. I loved being introduced to these techniques. I think that nurses
in the US have lost a lot of valuable (and inexpensive) assessment skills due
to their dependence on technology (electronic blood pressures, sonograms, etc).
Being creative with their skills and resources (something that culturally
competent nurses excel in) is something I highly respect Panamanian nurses for.
There were also a few other
differences I noticed besides the ones already mentioned…
1)
No electronic charting. Everything was recorded
manually. Red pens were used for night shifts and blue/ black pens for day
shifts.
2)
There are three shifts in a day rather than the
two that I am used to seeing.
3)
The nursing student has more autonomy, not
working one on one with a preceptor. However, from what I saw on these two
floors, it seemed that the student nurse did less actual nursing skills than I
am used to doing. The role seemed more along the lines of a tech.
4)
The nursing students have to deliver eight
babies before they graduate- without the assistance of a doctor! This is not
within the scope of practice of a nurse in the US.
5)
The IVs are all set by gravity, using drip
rates.
All in all, I really enjoyed my
time at the hospital and working with the UNACHI students. They were all very
welcoming and patient with us. I feel that being exposed to a few pediatric and
women’s nursing skills now will help me in the near future as I take these
courses.
I also think that this visit to
the hospital increased my cultural competency nursing skills. I was exposed to
the relationships between Panamanian nurses and their patients- their deep level
of interaction both physically and verbally. This is a great example of the
intimacy principle that culturally competent nurses must possess. Additionally,
I have challenged myself to learn Spanish once I return home.
This trip to Panama has been a
life changing experience for me. Envisioning my future… This trip has built a
strong foundation to a successful nursing career. Additionally, prior to this
trip, I was extremely nervous about graduating and becoming an independent
nurse. I was hesitant about practicing at such a young age and how I would be received by patients because of this. I saw graduate school in my
very near future, as I wanted to rush for higher accreditation. Sometime during
these three weeks, I have become so excited about all that awaits me and want to slow down my course. I no
longer want to jump into graduate school but embrace my time as a young nurse to
discover what specialty truly fits me and learn more about the vast variety of people
that I can impact.
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