Northern Ireland 2011

2011 Northern Ireland!, a set on Flickr.

It's 11:30am at home and 4:30pm in Ireland.  I'm sitting above the Atlantic Ocean, near Nova Scotia, at the moment.  We have 2hr 21min until we are in Newark, NJ, and from that, just a couple hours until we are home! I'm starting to really reflect on my trip.  It's not quite "over" in my mind, so I'm interested to see what the next few days will be like as I settle back into my normal life.  These 2 weeks will all be a dream from here on out. I've missed so much from home that, while bittersweet, I'm excited to see or have again.  I can't wait for the weather - it will be a welcome change from grey skies and rainy, windy weather.  I've heard we're in the 80s right now - that beats the low-mid 50s anyway!  I missed my family so much, as well as my friends.  I am so excited to give people their souvenirs.  My heart is eager to get home and be with my friends and family so we all can grieve the death of my precious Uncle Ronnie together.  I'm eager for my Poppop to be in Ohio as he's a "snowbird" from Florida.  I'd like to talk to him about the stroke he had and make sure he has been educated about  the risks and things he can do for prevention.  I'm excited to go shopping and drive a car on the "normal" side of the road!  I'm eager to get some certain things over with and get a massage and osteomanipulative treatment for my back problems.  I'm beyond excited to see my furbaby, Miss Haylie Brooke.  I know she's been waiting for me each and every night but I haven't come home, and that breaks my heart.  I want to catch up with my friends and enjoy wi-fi in my house.  I'm desperately stressed about my room and how messy it is, and I'm also worried to unpack my luggage because I literally just threw random things in both suitcases until I got them around the 50lb limit.  Let's hope my mom doesn't see them - she may cringe at the wrinkled clothing.  I'm excited for my swimming pool and to hang out with my sister although she starts her new job this week!  I did okay in Ireland with my picky eating, but I do best at home, or at least in America, with my picky food "rules."  I'm so excited to get all of my Ireland photos printed and to make an online Shutterfly scrapbook (if all goes as planned, fingers crossed!)  I want to tell everyone my stories and add that little pin in my World Map to show that I've finally been here, to beautiful Ireland.  I am especially excited to show Grandma my pictures - she's been to Ireland, too and was so excited for this experience. Most of all, I am excited for what has just happened.  I'm so happy about the experiences, the new people I met, the things we learned in school and out of school, the things we saw, everything.  I have to say I'm pleasantly surprised that my body was able to do this for 2 weeks.  Sure, it's back to the healthcare grind Tuesday, but for these 2 weeks, I was able to push myself to do everything I needed to for the course while doing extra things with my group.  There were no health accidents, just back pain and a lot of fatigue.  But I pushed through it, and I'm just amazed I'm on the other side now, looking back at something I was able to accomplish despite my health issues and restrictions.  This is for-sure the most intensive thing I've done since the transplant, and I hope it sets a new precedent.  I will be posting photos as soon as I get time at home to make them look nice and upload them.  Hang tight.  :) Thanks for following my journey! Love, Amanda

Here is my big project if you're interested.

This is the PowerPoint, and below is the video that is supposed to be on the slide that is a black box.  It's called "Without A Transplant" ...

Today was our last day of clinicals and we really enjoyed them, as usual. My first stop was Lodge Health in Coleraine.  It's a doctors office, and I spent the morning in their Treatment Room.  The US doesn't necessarily have a "Treatment Room" equivalent.  The TR here is where patients leaving the doctors (general practitioner) can get their labs/urine tests/vaccinations taken care of.  Also, nurses can see patients independently in the TR on an emergency or appointment basis.  Here too, as you would expect, we broke for 10:30 tea.  I saw Mr. Nimmons in the tea room.  Apparently he helps out there during the morning. Over the course of the day, the nurses in the TR drew labs, trimmed fingernails for a fungal test, gave vaccinations, and took cervical mucous samples. I found the TR to be a little too redundant, although it was definitely fast-paced. After lunch back at the hospital, we all went to Balleymoney with Helen McKay to visit two nursing homes.  (Ours was called "the Model Care Home") She first explained about nursing homes and the standards of care they must maintain.  Similar to the US, they are monitored well, especially when the Trust is paying for a patient's  care.  They receive regular inspections (announced or unannounced) and the results are published online for the public.  They do thorough assessments to ensure a careful fit of residents, and a specific care plan is then devised.  A care review takes place a few times to make sure the patient is doing well and meeting goals. At the nursing homes, they have a 35/65 nurse to care assistant ratio, which I think would be much higher than in the US.  I'd be interested in seeing our rates for this.  In the Model, the residents are highly dependent in ADLs.  There are 33 beds, and many of the patients are very local.  The residents want to be close to their family, friends, neighbors and very close-knit communities, and here, they can do so.  Most of the patients have a medical diagnosis as well as dementia.  Many of the patients' carers are 60-70 themselves, often too old to care for a completely dependent loved one. My favorite part of the nursing home was meeting the patients.  I've done clinicals at a nursing home before, and I love interacting with the patients.  Their eyes light up so much when I talk to them or shake their hand.  Sometimes they'll mumble something, just look at me, or start a discussion.  I know how much it means for someone to notice you when you feel like you're just another patient. Visiting the nursing home, we noticed a handwritten Scottish poem framed on the wall.  I've read it before, and I think it's very important for carers of elderly patients, especially, to read.

Old Lady's Poem What do you see, nurses, what do you see? What are you thinking when you're looking at me? A crabby old woman, not very wise, Uncertain of habit, with faraway eyes? Who dribbles her food and makes no reply When you say in a loud voice, "I do wish you'd try!" Who seems not to notice the things that you do, and Forever is losing a stocking or shoe..... Who, resisting or not, lets you do as you will, With bathing and feeding, the long day to fill.... Is that what you're thinking? Is that what you see? Then open your eyes, nurse; you're not looking at me. I'll tell you who I am as I sit here so still, As I do at your bidding, as I eat at your will. I'm a small child of ten ....with a father and mother, Brothers and sisters, who love one another. A young girl of sixteen, with wings on her feet, Dreaming that soon now a lover she'll meet. A bride soon at twenty -- my heart gives a leap, Remembering the vows that I promised to keep. At twenty-five now, I have young of my own, Who need me to guide and a secure happy home. A woman of thirty, my young now grown fast, Bound to each other with ties that should last. At forty, my young sons have grown and are gone, But my man's beside me to see I don't mourn. At fifty once more, babies play round my knee, Again we know children, my loved one and me. Dark days are upon me, my husband is dead; I look at the future, I shudder with dread. For my young are all rearing young of their own, And I think of the years and the love that I've known. I'm now an old woman...and nature is cruel; 'Tis jest to make old age look like a fool. The body, it crumbles, grace and vigor depart, There is now a stone where I once had a heart. But inside this old carcass a young girl still dwells, And now and again, my battered heart swells. I remember the joys, I remember the pain, And I'm loving and living life over again. I think of the years....all too few, gone too fast, And accept the stark fact that nothing can last. So open your eyes, people, open and see, Not a crabby old woman; look closer ... see ME!!

Today was the most amazing clinical day ever!  I got to shadow in both A&E (Accident & Emergency, aka our "ER") and pediatrics, or "paediatrics," as they spell it here.  Two of my favorites :)

First off was A&E.  The first hour or two was very slow.  A few patients were already staying there, such as a fireman who fell off of a ladder, but mainly, nothing was going on.  My nurse let me "play" with the student nurses who were practicing their casting in the room next door.  We had a lot of fun.  I observed them doing various casting techniques, and I volunteered to be their practice mannequin and even got a short arm cast myself!  I wished for it to be pink, but that only comes in another kind of cast.

As I learned from my nurse, each patient comes in, and using a computer system, a nurse triages them in.  The Manchester triage system is used here, and I enjoyed learning about it from my nurse.  It's based upon flow charts used to organize data to find the level of the patient's condition.  It's based on colors - for example, someone resulting in yellow will get a bed earlier than someone labeled as green.  It was cool to practice putting people's symptoms together to form a diagnostic suggestion, as well.

Another interesting factor is that they are on a 12 hour system here which means that an imaginary clock starts ticking the second a patient is triaged.  There is a 4 hour limit for them to be  in a bed, diagnosed, and their treatment begun.  If they have not progressed that far by 4 hours, the hospital gets fined by the government.  By hour 12, each patient is to be discharged or transferred, no exceptions, or again, the hospital gets fined.

Over the course of the day, we had a jolly older man complaining of DVTs, a baby with a respiratory infection, a restless toddler needing an arm cast, a sweet little boy whose foot was run over, a man with a steel rod embedded in his leg (stitches and a tetanus shot!), a constipated boy, and even a prisoner in for a "tramadol overdose," also with labs proving he had much beyond the safe blood alcohol level.  Suspicious.  My favorite patient was one who came in via ambulance with a terrible fall and broken, dislodged ribs sticking out of his back, completely swollen and bruised.  He was in excruciating pain but was too hypotensive to tolerate something like morphine.  Since we're limited in practice here, all I could do was help his positioning and hold his hand, so that is what I did.  He seemed so comforted every time I talked to him, and while it's not necessarily practical, I think all trauma patients should have a nurse present just for comfort and support!

I've always loved working in the ER (or A&E :) because of the fast pace and variety of patients.  Here was no difference.  I called patients' names in the ER and put them in rooms.  My nurse also showed me their computer software which is pretty neat.

Lunch came too soon, and afterwards, I had the opportunity to go to the pediatric unit.  My first surprise was all the staff of the floor was in a separate room having a party to celebrate one of the staff members.  Who was watching the patients?  Not sure.  Then I saw all of the nurses picking up the dishes and cleaning them in their full-size kitchen.  Then I saw them giving patients their food.  One of the nurses told me they're responsible for making the children on the floor their food.  I know I'm definitely not going to nursing school to learn to cook meals for the floor! 

The floor had 6 patients, but room for 3 or 4 contact precautions and 12 children in the 6-bed group rooms.  It was a smaller sized unit, and with 6 patients, it seemed to be overstaffed.  However, the nurse I was with, Lynn, said there's too big of a risk of the floor's census changing in one second to keep fewer staff on hand.

Our patients included children with a diabetes crisis, 2 with gastroenteritis, a premie at 2 weeks with feeding problems, a 6 week old with apnea, and a little one with chronic constipation.  The ward also keeps a bed open at all times for two brothers they see often, both diagnosed with an inherited disease called Sanfilippo Syndrome.  I didn't know what this syndrome was - nor did Lynn - so I looked it up.  Apparently, it occurs when the body is missing or has defective enzymes that break down long chains of sugar.  It's something both parents must pass genes down to their child, and first symptoms appear after year 1.  Delayed development, seizures, blindness, and nerve damage are all serious complications of this disorder which usually takes its patients' lives by their teenage years. 

Charting on this floor was a mess.  The floor only has a few computers, period, and they're mostly for the unit secretary and the doctors' research.  Patient information is jammed into stacks of folders all over the main desk to the extent where no one can find any chart they're looking for.

One of my favorite patients on the peds unit is a 2 week old premie recovering from tube feedings and trying to develop a normal eating pattern.  Sadly, her parents were younger teenagers.  Lynn made sure to tell me that sex in Ireland is illegal before age 18.  I said that law would not mean a thing in America!  When it was time for the baby to eat and get updated vitals, I got to rock and cuddle her.  She had beautiful dark eyes, dark hair, and a lovely pink blanket.  I wish I could have taken her home with me!

One more thing I must mention - the second that 3.30 hit, the nurses ran around and got each other, and the secretary, doctors, and nurses gathered in the "tea room" to drink coffee, tea, and eat a lot of snacks.  Other options included talking and reading People magazine.  The Irish are so interesting with their tea time.  They take it religiously and feel strongly about it.  I love it!

After the hospital, we spent our evening doing homework, working on our projects, and watching TV with Mrs. Nimmons.  Then it thunder-stormed, and the trees blew and blew!

Tuesday was spent at the University.  We had a full agenda with several speakers and even a luncheon with Professor Hugh McKenna, Dean of Faculty of Life and Health Services.  

Marina Lupari, Assistant Director of Nursing, began our morning with her lecture, "Introduction to the Northern Health and Social Care Trust," or NHSCT.  The trust holds 5000 nurses.  She explained all of the positions appointed in the trust and levels for salaries available.  It was surprising how different the publicly funded UK's health system is from the US'.  They also have so many budgets and plans and rules.

One of the issues I had with doing clinicals at the Causeway Hospital was seeing their 6-bed rooms.  As I said yesterday, I think they destroy patient privacy and decrease rest by increasing noise and distraction levels.  Well, that situation will likely not change in Northern Ireland as an increased staff ratio is needed for single-bed rooms, and the Trust does not have the finances for increased staff.

I also found it interesting that patients need to be transferred to Antrim from the Causeway to get an MRI or have certain treatments or surgeries.  Living in the Akron/Cleveland area, we are not used to that since we live in a healthcare hub.

For infection control, all of the nursing staff is getting new scrubs.  Additionally, the hospitals are very strict on hair (pulled back!), nails (no polish!), earrings (only 1 small pair), and arms (forearms and wrists free from clothing or jewelry).  As opposed to home, these rules are strictly enforced.

One of the best parts of the Trust?  It/the government pays student nurses' tuitions and fees, except for textbooks.  Nursing is a public service position that they run, so that's just how things work around here. That would save us Kent students around $9000/yr, even more if we live out of state.  But their education is a lot different and - not to start a debate - I think American BSN-RNs are better educated than nurses in the UK at the graduation level.  Marina even said we are much more advanced in critical understanding and pathophysiology while nurses in Ireland are task-oriented.

Marina said right now in Ireland, nurse leaders are working on implementing the following: - Redefine to whole system approach - Center on case management - Predictive risk - who needs service the most? - Nurse-led discharge - Call rapid response nurse vs. calling 999

Additionally, nurses need to understand politics and the relationships existing between things so they can deal with measuring health expenses.  Marina said if one understands that, they are way ahead of the game.

After Marina's lecture, we had a lunch with Professor Hugh McKenna.  He treated us to a catered lunch, and we discussed our future career goals and recommendations he had for us.  I found him friendly and wise, like in a sage sort of way.  He seemed to be  very good at his job with a strong ability to see the "big picture."  It was an honor to meet him.

After lunch, Ann Marie Tunney spoke to us about a concept called Practice Development, based upon standards, communication, critical thinking, and continuing education.  It is defined by a continuous process of improvement … through the enabling of nurses and healthcare teams to transform the culture and context of care. - McCormack

She described Practice Development as deriving a culture, a way of life, or "the way we do things around here."  The context is the setting of care and the idea works with qualities and skills as well as perceived roles.  The E's of Practice Development are: Enlightenment, Empowerment, Emancipation, and Evaluation.  Ann Marie then gave us example studies such as Developing person-centred palliative care in NHSCT as well as From venus to LUMAS - Improving service delivery for patients with leg ulcers in NHSCT - the journey so far.  The key is: A systematic change in practice leads to new research and the cycle repeats itself.

Next, Patricia Holley, my stroke nurse from yesterday, came and spoke to us about her project, a support group for stroke patients' carers geared to meet their specific expressed needs.  The group was developed because as a stroke nurse, Patricia noticed that her patients' spouses were often left to tirelessly care for their spouses without any type of respite.  She initiated the group as an outlet for them to come talk, express themselves, or just listen.  Her group has baked, had reflexology, participated in mind mapping, visited gardens, and enjoyed special visitors and speakers.  The group has been so much help to the members but is continually evolving to find just the right medium to continue its success.  Such research is called active research as it's continually changing, dependent on members' desires and needs.

Monday was a really great day.  It was our first day shadowing in the Causeway Hospital, and we learned so much.

Throughout the day, we learned a few difference in UK hospitals vs. hospitals in America.  There were similarities, of course, but also noticeable differences.  There was increased documentation and decreased care.  There were 6-bed rooms and a few private rooms for patients with infections or young patients.  In America, there have been many movements to decrease noise and infections and increase comfort and privacy, and 6-bed rooms promote the opposite.  We later learned, however, that the funding to increase staff and redo wards is too expensive to fix the "norm." I would never want to be a patient in a 6-bed room. Would you?

I spent my morning with a nurse named Patricia, a stroke nurse specialist.  Her job was to check on all new stroke patients, oversee their care, and manage a support group for her patients' caregivers.  Her floor was mainly the Medical 2 Rehab floor, but if there were new stroke patients on different wards, she was called there for consults.  I loved shadowing her and seeing how she assessed her stroke patients.  We discussed strokes which reviewed my previous knowledge, and it was rewarding to see how she interacted with her patients.  After seeing her patients, she would call for consults or work with other healthcare team members to streamline their care, and I was impressed how well she handled her jobs.  One of my favorite parts was seeing her fill-in-the-blanks assessment form and learning how she applied it to her patients.  She was so organized and her sheets were so thorough.  I realized having an assessment sheet doesn't mean you're "cheating" but rather it guarantees you're thorough and helps reduce errors.

Probably the most impacting part of watching Patricia's care was seeing how she interacted with her patients' families.  While many nurses would focus on the patient, Patricia focused on both the patient and the family.  One stroke victim's wife was a nurse, and she was obsessed with her husband's care.  She had to know everything that was going on and worried about every detail.  After assessing this woman's husband, Patricia made sure to call his wife and tell her how well he was doing and how he was doing so much better than his previous admission.  The patient's wife was so relieved and put at ease just by Patricia's simple, short phone call.  I thought this was so important to patient care.

After time with Patricia, she gave me several informative brochures and even a copy of her assessment sheet.  I really appreciated the time she let me spend with her, and I learned a lot about patient care and strokes in general.

After lunch, we had the great opportunity to meet with nursing students at the University of Ulster.  We had a discussion time to learn about each country's nursing curriculum and compare the two. A few things I found most interesting was the number of students both of our relative schools receive applications from, vs. accept.  At Ulster, they receive 1300 applications and accept 250.  At KSU, around 4-500 applications are received, and they accept around 120.  Compare those ratios!  Yes, Ulster students do care plans, too, and there are 3 specialties you can choose for their regular 3-year university degree, as opposed to Americans graduating as generalists, being skilled to work in all fields with the option of masters degrees for higher positions within specialties. 

It was funny because as different as the two countries' educational programs can be, they both share common goals and objectives, and the students share similar feelings, stressors, and opinions.  While our educational systems differ, we are all the same - nursing students - at the core.