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Wednesday, February 23, 2011

The Daily Grind

Well, this experience is shaping into something completely different than I ever expected.  The hospital being constructed only 5 years ago, with a new administration in the last 6 months, CHANGE is of the essence!  Despite my original impressions and observations (such as 1 ICU nurse for a 10 bed unit, no central line dressings,  or 1 nurse of a 22 bed floor), there has been drastic improvements with the implementation of protocols and new policies.  Expecting to spend more time at the bedside, I have seemed to be engrossed with working in the offices.

Yesterday I completed my second project.   Translating their research paper on the need for small bowel transplants in Brazil and the Northern Region proved to be a challenging experience.  Knowing almost nothing about small transplants I started by conducting my own literature review.  In order to be well versed on common "small bowel transplant" lingo, I read several of todays leading research.  Then the translating started.  And here in front of me I have a well (I am biased) transcribed paper proving the need for Brazil to perform small bowel transplants with my name on the top as one of the contributers.  Check that off the list of things to do, not bad for a start.

In addition to translating, I spent most of the day yesterday receiving a more in depth tour of the hospital with the Head Nursing Coordinator, Everson.  I knew I was at home when I walked into the ICU.  The medical staff busy at work with the comfort of constant beeping and alarming brought me quickly back to 5E.  I visited each floor, the holding area, the OR's, the special burn department, and even materials management!  I learned about their systems, practices, and short comings.  With a big smile, Everson asked me to give a full report on my observations and my suggestions for improvements, "I am open to what you have to say!"


ICU: One large open room with 10 beds

    • 1 nurse for 10 bed unit 
    • 1 doctor for a 10 bed unit
    • 5 nursing techs for 10 bed unit
    • Almost every patient had a tracheostomy (patients are trached after 1 week of intubation, no exceptions!)
    • No central monitor
    • Standard ICU beds 
    • All orders/ documentation hand written
    • Nursing techs administering medications
    • Almost no one wearing gloves
    • Few sinks / fewer hand hygiene stations
    • No central line dressings
    • All patients lay supine
    • No limbs elevated
    • Almost no restraints
    • Heavily sedated
    • All patients in Depends
    • No Families
 Floor: A 20-24 bed unit with two rooms for males and one room for females
    • No nurse call system
    • Almost no families
    • All in minimal clothing
    • Minimal linen and no pillows
    • No ambulation or mobility
    • No Physical or Occupational Therapy
    • One sink in each room
    • No privacy 
    • One inmate patient with no guard. Handcuffed to the bed. With other patients
    • One TV
    • No staff providing care (However only observed during the short time I was there)
    • One pharmacy for the ORs and the ICUs
    • One Pharmacy for the burn unit
    • One Pharmacy for the rest of the Hospital 

These observations are just the basic environment differences I noticed.  In addition, I discovered the hospital has no policy and procedures for patient care.  There are no guidelines documented for nursing or nursing techs to follow.  There is no follow up on patient outcomes.  

I know what you are thinking...are they looking to hire new nurses?!  A nurses dream: no families, heavily sedated patients who we don't have to turn, with no charting or protocols and assistants to do all the dirty work.  But in all seriousness it is exactly that hard work we do every day that makes the UW a competitive hospital with good patient outcomes possible. Who would of thought I ever would have valued "competencies" and "accountability" the way I do now?!  It provides a whole different perspective and is a fresh reminder why we are required to complete these hours long, pain in the butt, agonizing tasks.  It makes for better nurses, better healthcare, and healthier patients.  In short, it's a part of saving lives.

Here in Belem, they have high occurrence of central line infections, poor hand hygiene, and bed soars.  If a central line stays longer than 10 days, almost EVERY patient becomes infected.  I have been asked to create a process for changing these problems.  So onto my new adventure.  Three months, to create a complete culture change, to establish competencies, policies, procedures, and standard nursing practice not just for our new Transplant program but the whole hospital!

Wish me luck!

1 comment:

  1. What! You have to be kidding me. Only one TV?