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  1. Once upon a time, I encountered the most unexpected milestone of my life... I still find it a blessing that after 4 years, I was able to sacrifice my time and effort to leave California and adjust to life in the Philippines. I still remember my first day as a college freshman. I was sitting in the little wooden desk, waiting for my first subject, Psychology to start. It was a noisy environment. The other students in the room seemed to know each other by name. I anxiously sat as I pretended to mind my own business. I did not understand everything they were saying to each other. Next thing I knew, someone turned to me and frantically said "Tignan mo nga yun blush-on ko..parang na sampal ba ako?" (Look at my blush on, does it look like someone slapped me?) I interpreted that maybe she meant "Does my blush look okay?" I nodded with delight only to find out that my reaction was probably not the reaction she expected. It was only when each student introduced themselves to the class that everyone found out I was not raised in the Philippines. "Hi. My name is Lyzah and I'm from San Francisco." The room became so quiet that I could hear the air being blown out from the air condition. Next thing I knew, my fellow classmates put their index fingers under their nose as if pretending to wipe it. That's when I first discovered the term 'nosebleed' or otherwise the term used for those with foreign tongues. The first few years of my journey were the most difficult. I felt like I went back to my infant years of separation anxiety. It was tough to deal with being a Pacific Ocean away from my family and friends. I filled in the void by keeping myself busy with studies. Every morning when I woke up and at night before I went to sleep, I would remind myself that God gave me another day to live for a reason. Every day, God had a purpose for me. I learned to appreciate my culture. I will never forget the time when I had my first community immersion in Nueva Ejica. I learned how to clean and fry tilapia fish. I pumped my own bath water from the community well every 2 am in the morning. At night, I would sleep on the floor and make little forts with the help of my other batch mates as to prevent little bugs from falling on us. I do not really have a fear of bugs, but I have a fear of them being in contact with my body. I was not used to the tropical insects and I always remember being very cautious about things that were flying or crawling next to me or towards me. I was raised in a city with a fairly cold climate, so living without an air condition or an electric fan was quite the discipline for me. The fresh air from the provinces was like therapy for my lungs. Life was simple beyond the city. I cherished the natural beauty of the Philippines. The tropical environment that surrounded me taught me to recognize the importance of preserving God's gift to us, our very dear earth. I have always enjoyed the festivity of the Filipino people. Being around happy people made me happy as well. The positive energy really echoes to others. There was always a reason to celebrate something. For example, in America, nobody claps after the celebration of the Holy Eucharist! However here in the Philippines, everyone claps because they are praising our Lord! I love the breathtaking sensation I get whenever I watch fiesta parades of people in ravishing costumes. I never joined a dance class in my whole entire life until I found out it was part of the college curriculum. I remember participating in the Filipino Folk dance for the P.E subject. In all honesty, I was not coordinated and I easily forgot the steps. There is something quite unique about the gracefulness of Filipino dances. I have come to admire and respect our Filipino ancestors who have set our customs and traditions. With dancing, there is also singing! At every party I went to, there was always some form of karaoke. I would here "Sample, sample, sample!" Next thing I knew, someone was up at the microphone and singing their heart away. In the Philippines, one must sing, dance, or play a game during a celebration. It's impossible that one could get away with it. This is why I will miss the most-ever enjoyed nursing week. The collaboration of the nursing family and the cheerful spirit really inspires me to always relish in the company of others. The positive energy of festivities can really instill an optimistic aura in everyone. As time went on, challenges arose. The hardest and toughest year I faced was my third year. It was the first time I would sleep for an average of 2-3 hours every night. There was so much information to learn. There was also a lot of stress from classmates, friends, family, requirements, and extracurricular activities. I will always remember the time that I talked with my parents through the webcam and my tears just fell. I almost felt like I couldn't succeed anymore. I was discouraged with myself. Just when I felt like giving up, I realized something. For the whole third year, my health was never affected by the stress I was experiencing. Somehow, God was really giving me the strength to enhance my knowledge, skills, and attitude for every day that I woke up. God had been my hope and will forever be my hope. Whenever I failed at something, I perceived it as an opportunity to do better. Nobody comes into the world perfect. For me, it takes 50% faith and 50% personal effort to accomplish a goal. God listened to my prayers and he gave me the talent to surpass the challenges, but it was up to me how I would utilize these talents for the better. The best learning came from both the classroom environment and the related learning experiences. I will surely miss the long lectures and nerve-wrecking quizzes. Most of all, I will miss the related learning experiences. In the beginning, I feared that I would not be able to establish rapport with the clients because of the language barrier. However, after hearing conversations in the dormitory, in the classroom, with friends, classmates, and family, I soon found myself speaking Tagalog! Although I still cannot understand most words, I feel like it was such an accomplishment. I will never forget all the different areas of nursing that I was exposed to. I am so blessed to have had the opportunity to provide my service to the individuals who needed the most. Every rotation led to my own personal growth. I found my fortitude in the blessings and graces of God. He has truly given me the power to surpass the challenges that I came across and will come across. I cannot express how thankful I am to Him for my family, friends, college Dean, clinical instructors, mentors, advisers, and the other people that I came across with everyday. Everyday I encountered a new challenge, but it was the faith that kept me going. Within a span of four years, I was able to come up with my own personal credo that I would like to share with everyone. This is a compilation of my reflections from every year of nursing school and it helped me find more of who I was as a person and as a future nurse. I hope this serves as an inspiration to nursing students. 1st year- Fundamentals of Nursing, the basis of all: This was the foundational year of all nursing skills, knowledge, and attitude. When life becomes a challenge, look at it step by step, and begin with the central importance. 2nd year- Maternal & Child Health Nursing, appreciating life as a beautiful gift from God: Respect the ones who have raised you up meaning parents, siblings, friends, and families. These are the people who have nurtured you to be the best you could be whether or not they taught it in the hardest way or in the most loving way. Appreciate the life that God has given you. Live it to the fullest and be the caring hands of Jesus Christ for others. 3rd year- Medical & Surgical Nursing, the most rigorous yet rewarding year: Accept every challenge as a pavement for growth. Discipline is the best way to deal with the realities of the outside world. Stay positive throughout every hardship and keep faith strong with God. He will never leave your side. 4th year- Leadership & Management, taking the initiative: Be assertive and take on the lead as inspirational role models. Be the positive change for someone else's life. God does not count your success, but he counts the effort you have put to help someone else reach their own happiness and success. Taking up nursing in a different country has truly taught me to appreciate the diversity of culture. Nursing is a rewarding opportunity and a privilege because of the holistic aspect in preserving life, something so precious and unique to everyone. With all of the hard work, dedication, and passion that I have exerted within the past four years, I am proud to say that I graduated Cum Laude. This profession has been a blessing to me and I am looking forward to becoming a licensed nurse ready to care for and save lives!
  2. If you are now at the point in your life when you are one or two of these: you want a career boost, gain better experience, earn more than what you do now, live a tax free-life, encouraged by one or two of your relatives or friends, follow your family in the Middle East (or husband in my case), or simply because it is one of the countries open nowadays where nursing is in demand, you will always deem for a better life for you and your family. As I share my experiences, I will give some tips for you to save time and money as you go through the whole process of getting registered. First Step: Get Your Documents Ready You would not want to end up waiting in vain from winter to summer for your documents to come as what happened to me. To help you in getting your documents ready, here is a list from the Dubai Health Authority or DHA website from the pdf downloaded file: *please read the above carefully You should have your: High School Diploma or Certificate Nursing Diploma or Certificate Nursing Transcript with Related Learning Experience Certificates of Employment or Experience (signed by Human Resource, Nursing, or Medical Director) Nursing Licenses (Valid, from country of graduation and/or last employment) Good Standing Certificates Passport Copy (front and back) Passport Sized Photo (colored, white background) You can visit [THIS LINK] to view online from the website. Scroll down to the Nurses tab then click the link To view licensure requirements and recognized specialty qualifications. If you are from the Philippines, you might want to process this ahead of time before you come here in Dubai especially the documents from PRC. In my case they would not give me Good Standing Certificate because my license is expiring this year 2013 so I renewed my license first before I got to process the certificate which took me another 3 weeks or so waiting for my license to get here for my signature then back to the Philippines to process the certificate. Another thing to discuss is the Attestation, Authentication, Red Ribbon of documents. While it says in the image above (Documents Required image) that "Qualifications Attestation by the UAE embassy and/or Ministry of Foreign Affairs is NOT required.", some of the companies here were looking for it when I tried applying for a nursing job in some Home Nursing companies. It is also required for the application of visa to have your documents authenticated with Red Ribbon then have it attested by the UAE embassy. The documents I have "red-ribboned" were nursing diploma and transcript of records and marriage certificate. Second Step: Scan the documents. Once you completed all the documents, have it scanned in a clear copy Yesterday I submitted all the scanned documents for my application for registration through [DHA WEBSITE] ( Third Step: Create an account then follow the procedures on the video. Before anything else, you must have an individual account in their system. You have to sign up as NEW USER. This video will guide you through the whole process including the submission of all the necessary documents online. Although the applicant is a Dentist, the whole process is just the same. I actually played the video while I am submitting my documents and made sure that I follow the steps. Fourth Step: Pay with a local UAE bank account or credit card On the last page which includes authorization, you need to download the letter then sign it and upload it back with your particulars and the date. Once you reach the payment section, you need to have a local UAE credit card or bank account to be able to pay. In my case I tried to use my Singapore bank account (debit/credit card) to pay thinking it would go through but always prompted me a Failure Transaction Status on my receipt. I called the DHA hotline (800-DHA or 800-342) to confirm and they told me to pay ONLY with the local bank account. Next... Next is to wait for the assessment of all the submitted documents which will take up to 6 weeks. Hopefully, it won't take that long for me because I want to continue my nursing career as soon as possible. I hope this helps you make your own experience in registering as a Nurse here in Dubai easier as for the "First Phase". I am anxious and excited for the exam and since I am always at home, I am trying to look for some review materials to refresh my knowledge about the fundamentals of nursing. Any comments, questions, and suggestions are always welcome ~"Have Faith, Grace Always Abounds"~ a-guide-in-becoming-a-nurse-in-dubai.pdf
  3. Shenanigans

    Without Words

    Oftentimes food and drink bought in so the patient doesn't have to suffer through the horrors of hospital gruel. Some are even lucky enough to have a family member bring in their own pajamas, clothes or toiletries. But Yin, well, Yin had nothing. Even patients from lower socio-economic backgrounds had something to remind them of home. As for Yin's home? I didn't even know the name of his country. Yin had somehow found his way into New Zealand illegally, wanting freedom from whatever trauma or poverty so badly he would flout the laws of the nation he wanted to call home. On arrival in New Zealand Yin had made himself useful doing a job that most New Zealanders would shun their noses at, well, the educated New Zealanders at least. He was picking pumpkins. A rather labor intensive, thankless and probably badly paid occupation. Yin spoke no English and so when his "employer" had come running from the shed, screaming the cops had shown up with immigration officials, Yin really had no idea of what was happening. So when Yin witnessed his boss running with police officers in hot pursuit, he did what most illegals would do, he ran as well. Yin then became the target of a well-trained police dog, a large Alsatian that in all likelihood that afternoon had sat obediently in a classroom while over enthused school children patted him and asked questions about how many "baddies" he'd caught. Yin noted the closing dog, spun around awkwardly and fell over into a small ditch, in the process of escape Yin had sustained minor scrapes, bruises a sprained ankle, several broken fingers, a dislocated wrist and a painfully fractured calcaneus (heel bone). This event led Yin into my path. At the time I was a year two nursing student. I had never worked in the hospital setting, having so far only worked placements in rest homes and elder care hospitals. I was looking forward to Orthopaedics with its promise of blood, gore and horrific fractures. A chance to do dressings, injections, prime lines, essentially just get some good hands-on experiences, albeit under the watchful eyes of nursing preceptors and lecturers. It was week two of my four week placement and so far having dealt with the messy results of a motorcycle gang vs. an SUV, a workman and his adventures with an unsteady ladder, a chap who had a rugby scrum collapse on him and a multitude of little old ladies slipping downstairs, in showers and in gardens, I was getting my fill. My meeting with Yin began when my lecturer learned I was caring for a gentlemen post his total knee replacement who's resulting came back as having MRSA in his wound, school policy was students weren't allowed to care for MRSA positive patients and so I was asked to take over Mr. Yin's care. Handover from the nurse caring for Yin to me involved finding out about Yin's accident and his pre-op state, also that no one actually knew what Yin's name was, where he was from, how long he'd been in New Zealand if he had any other friends or family, nothing. Essentially, Yin was as faceless as a case in a nursing textbook. A human being with no name, no birthday, no family, no co-morbidities, no friends, nothing and no voice. I wasn't sure how I was going to deal with Yin; my nurse preceptor said it would be a good learning experience, as there would be many events in my career to come that would leave me in a situation with a non-English speaking patient. Why the interpreter service wasn't yet involved I honestly didn't know. All I knew was he was Asian. My mind conjured up scenarios of where I subconsciously offended Yin; I had a waft of knowledge about different religions and cultures and their beliefs and opinions. I gave thought to the consideration of Yin being a Muslim; there were various Asian countries where Islam was the predominant religion. If this was the case, and he was Muslim, would be cared for by a female offend him? If he was Muslim, exactly how Muslim? Was he from a small village somewhere where women were below dogs on the scale of value? Where they were covered in some form of dress and they were stoned if they ventured out against their "master's" wishes? Maybe Yin was a Buddhist? I had just had a very meaty sandwich for lunch, weren't most Buddhists vegetarians? Maybe he was Hindu, and perhaps he'd believe I'd eaten a reincarnated relative of his? Perhaps he was a Protestant Christian and the crucifix I wore about my neck would draw his scorn. Perhaps just being a woman obtaining an education would anger him. Essentially all the knowledge of other cultures and religions passed through my mind and how it was I was going to insult him. Entering the room I found Yin sitting in bed with no measure of comfort. Two heavy-set prison guards sat next to him. I smiled politely, introduced myself - and inwardly aware that it was of the only benefit to the guards as Yin just had no understanding of the words I spoke and the accent that they came with. The guards told me to go about my jobs and just pretend they weren't there, which was kind of hard to given the handcuffs that bound Yin's wrists and ankles and the rather nasty looking Trudgeon the sunglass wearing, tattooed guard was tapping against the cot side. It was a rather extreme waste of taxpayers' dollars, two muscle clad prison guards protecting New Zealand from the evil antics of an illegal immigrant with a busted foot! I explained to Yin the point of an MRSA swab, inwardly knowing it wasn't going to help, he nodded and smiled. Now was the part where I had to find a way to get Yin to swab his groin. I explained in English to a blank face. I made the motion a somewhat distance from the area of his body. I thought better to make the motion against my own body. The guards thought it was amusing and their laughter only served to make Yin a little more uncomfortable. This was going nowhere fast. I realized. If I had been a cartoon character a light bulb would have suddenly been animated above my head. I pulled a piece of paper from my pocket and drew the most G rated, non-gendered image of a smiling faced person. I indicated on the drawing where Yin was to swab himself. Yin looked somewhat horrified for a moment - an indication that he understood where he needed to rub the cotton bud on a long stick. I stepped outside the curtained cubicle; the guards remained in case Yin was able to use the swab to pick the locks of his cuffs or something. When I returned the guards confirmed Yin had swabbed. Yin spent the next three days waiting for surgery while politicians and police argued with doctors that he should be sent back to his own country - wherever that was. The politicians didn't see a point in him getting surgery; the doctors demanded that under various UN treaties and just common human decency that Yin should be cared for. All the while Yin lay in pain with no way of understanding the white men that argued about him. Yin was eventually operated on, I cared for him post-op and within 4 hours of his return to the ward, he was transferred to the nearby prison hospital. I never found out the fate of Yin, if he was deported, if he found refuge, if he was given residency, and I never even knew his name. Yin had taught me a valuable lesson in cultural sensitivity. New Zealand often peddles itself as a miss match of cultures and welcomes them into our brood, with this society we are taught to be open to all ideas and worldviews. Yin, however, caused me all manner of concerns as he couldn't speak nor understand a word of English. Most of those from other cultural backgrounds arrived on our shores with at least some understanding or friends and family who translated. Yin left an impression on my life and on my nursing career; his pain filled time in New Zealand taught me there are other ways to communicate with those of another culture that don't involve words or semantics. He also taught me that a person isn't just a religion, a worldview, a country, culture or skin color. All the inward thoughts I had about how I was going to offend him, I think at the end of the day, even if he had been some extremist, he realized I was there to help, and the kindness I and the other nurses showed him was a welcome antithesis to the ignorance of others and the authoritarian arrogance of those guards. names changed for privacy
  4. ( My English it's not 100%, thank you for your patience. ) I was young, that was my second job. I had graduated from nursing school a little more than a year before that night, I was 20 years old. Ever since I pass my initial exam to enter nursing school (I was 16 years old when I started) I've dreamed of working in that hospital. It's one of the best hospitals in our city, big, well equipped, and the nurses were well paid, at least for our culture. My supervisor only worked days, and they were short on the night shift, so a little after a month of training I was transferred to the NICU / PICU RN position. I was the only RN in the unit, and during weekends, the only RN to answer for NICU, Cardiac ICU and ICU. Yes, 3 units, 1 RN. I had several CNAs under my watch, actually, the ratio for the NICU was 1 RN for 15 patients + 6 CNAs. That night we were full. For some reason women were giving birth exactly that night, mostly preemies. I remember having 5 preemies, 3 on ventilators, 1 on cpap, 1 stable and 1 woman on the birth center with severe eclampsia, which was almost always equal to one more baby for us... On the other side of the unit there were 5 pedi patients. For some reason, I don't remember much of those patients, except for one little girl, about 2 years old, with Down syndrome, post-op for a cardiac defect, with 5-6 IV infusing pumps, ventilator and all the other stuff that cardiac patients have post-op. By the middle of the night, 2 out of my 6 CNAs were resting (Brazilian protocol stands you get 1 hour break every 12 hours shift) and I was in the unit with the other 4 CNAs when the phone rang, our next patient, another preemie, was on the way. I ran to wake up the doctor on call, got everything I could think it will be needed, call for two of my CNASs to help me admitting the baby, and left the other 2 taking care of the other 10 patients. Usually I was able to admit one baby and keep him stable in a matter of minutes, but that little guy was really struggling, and we had a lot of work just to keep him breathing. After close to 2 hours working on the little guy, he was finally stable, my other 2 cnas were back from break, and I was relieved that our 11 patients were alive. It was close to 5:30 in the morning, and I had only 1:30 hour left on that shift. I still had sooo many things to do, the unit was a mess, and I was late. I stop to think what should I do first and right on that moment I notice the little post-op girl becoming more and more restless. I got closer to her bed when I noticed the K IV site was infiltrated, her hand and arm were bigger than her thigh and she couldn't scream in pain because of the endotraqueal tube. My heart stopped at that moment. I wanted to cry, but I had to keep working. I pull the IV off, began every measure to relief pain I knew. I couldn't stop looking to her face and trying to imagine how much pain she was feeling. I asked the doctor to sedate her, it was inhuman to let her awake at that moment. I kept thinking "how did this happen? ", "for how long iwas that IV infiltrated?", "Why I didn't notice before?", "Why nobody noticed before?" In a matter of seconds my shift was over, the morning shift team had arrived but I just couldn't leave her bedside. I kept working on her until my supervisor came and sent me home, that was nothing I could do to change what had happened. She had second and third degree burns from the K solution in her arm, she was scheduled with plastic surgery to work on that arm, but the scars will be there forever. I got home that morning feeling a complete failure as a nurse. That girl was already going through so much in her life, she did not deserve a gross error like that tho happen. I thought I should quit, and never came close to a patient again. After talking to my supervisor I notice that what happen was not so uncommon under the circumstances. I was the ONLY RN signing for 3 ICUs that night, it's impossible to do it, and the worse part is, my boss knew it! It's sad to admit that in my country ratios are not followed as it should. I believe the fear of unemployment, and the excitement of a new grad didn't helped me see that. I accepted that position, I agree to work that shift, I wanted to proof I was a nurse, and I was wrong. A few months after that, my husband got a job opportunity in the US and we moved. After coming here I was able to see another world, a different way of nursing. Sure there are still many things to change here, but I'm grateful to God for this place. It has been over 6 years since that night, and I don't know what happen to that little girl, much less to all the other patients. But I do know what happen to me. I learn my limits, I know I can only do so much, and I don't have to prove anything to anybody. And if you can learn something from my experience, please learn to say no and learn to ask for help when you feel you need. Many things have changed in Brazil in 6 years and I hope Brazilian nurses learn to fight for a better work environment, and fair ratios, for the sake of our patients.
  5. jtweedie

    The Cultures of Nursing

    The job duties, the vocabulary and the hospital were a far reach from anything I had experienced as a nursing student in San Francisco. The ward of the hospital I was assigned to used to be a debtor's prison. This was culture shock. I was used to private and semi-private rooms. I felt like I was experiencing nursing history firsthand. Patients were in "Nightingale wards" with twenty to a room with each bed divided only by curtains. The walls of brick did not contain the modern conveniences I was used to. Oxygen was brought in huge green canisters and placed by the patient's bedside when ordered. The canisters were extremely heavy and only the orderlies were expected to move them. Medications had different names than in the United States, although sometimes the generic names were more familiar to me. Paracetemol was used instead of Tylenol and peppermint water was given for indigestion. And instead of sedatives for bedtime, some patients were prescribed a bit of sherry in the evening. The newest task I had to learn was to serve afternoon tea. I learned to brew the tea the proper way and then arranged the teapot and tea cups and saucers to be taken to each patient's bedside. One afternoon a patient asked me when tea would be served. I replied, "I'll go and get the cart with the tea." The whole ward of patients laughed out loud. "A cart, you're going to bring the tea on a cart? That's what a horse pulls. You mean a trolley." I learned that lollies were candy, and jumpers were pullover sweaters. I called head nurses "Sister". The hardest part was deciphering the different Scottish dialects. In the close quarters it was easy for some patients to translate for me. The word I heard spoken most often was "ken". "I no ken" and "You ken?" New to me, I finally figured out that it meant "know" or "understand". The whole experience, even the way I dressed and got dressed was different than what I had learned in nursing school. I had to go to the nurse's dormitory each morning to change into my starched white uniform and cap to walk to the hospital. One morning I returned to a ward to see how a patient was responding to a medication he had been given. There was no response at all. There was no pulse, no respirations. Another nurse and I began CPR. As a student nurse, I'd learned but never used my CPR skills. This time it was for real. The code was called, the physicians and other nurses came, and the orderly with the huge green canister of oxygen arrived. Eventually the patient was resuscitated. Most importantly I discovered that not everything I learned was different. Some things were merely part of the worldwide culture of nursing.
  6. Healthcare is the maintenance or rehabilitation of a person's physical, mental or spiritual status. It is culturally relative and therefore it means, and requires, different things in different societies. The healthcare that people in different areas of the world receive is heavily affected by financial, technological, political, and educational resources. For example, here in the United States, the world's richest country, there is a health insurance system which covers a majority of the population at a relatively high cost. Those who are insured are privileged to enjoy access to high-quality health care. There are opportunities for the uninsured to have access to free or reduced-cost healthcare, with as government-run and community-run screenings and clinics across the country. Unfortunately, however, the framework of the US' insurance system still excludes many people from adequate health care coverage. Most countries in the world have a large percentage of people living in poverty as compared to the US. According to the World Health Organization's website, 1.2 billion people in the world today are struggling to survive on less than a dollar a day. A person has to wonder how these populations are able to access any sort of quality healthcare or health education at all. being born in another part of the world shouldn't affect a person's right to quality healthcare, but it clearly does. Fortunately or unfortunately, what the US does affects many other countries. As the richest country in the world, it is important to realize that the US is not out of reach from the rest of the world. What happens outside of the US can very well affect what happens within the US. A disease present in a certain area of the world can find a resurgence in frequency in other countries due to travel, interspecies transmission, and other means. This has already happened with typhoid. With all of the technological advances made in the last 100 years, that has changed and typhoid is no longer a common disease in the US. However, in many other countries, it still is. The vast majority of the world remains without proper sanitation, potable water, and adequate food. According to the National Institutes of Health, the Centers for Disease Control and Prevention reports that about 400 Americans contract typhoid annually, most of them while abroad. This is just one example of many vaccine-preventable diseases that thrive worldwide today, which find its way into the United States despite its aggressive vaccination programs. If we work hard to fight these diseases before they become worldwide epidemics, it is possible to prevent these diseases from killing more people than necessary, and it will also curb the effects of the disease on the rest of the world. Wouldn't it make sense to begin treating and vaccinating people against typhoid and other diseases in other countries before it makes its way into the US? Isn't it worth it to prevent the suffering of thousands of people worldwide, and prevent possible catastrophe from coming to our homes in the process? Would it save money to vaccinate people in foreign countries rather than treat infected Americans? Some people follow the belief that the US should not interfere with the healthcare status of people in other countries. However, if the intervention is one that prevents suffering and the funneling of money into treatments for diseases that can be avoided through vaccination, where does the detriment lie? One thing to keep in mind is that even though an individual person might not be able to ship medical materials such as syringes, vaccines, and drugs, time and money are valuable resources as well. Donating money to a charitable organization helps by placing money where it is needed most, but many people are reluctant to donate because there is really no way to be sure exactly if and where the funds are being applied. Volunteering, then, is a good option for people who wish to contribute to the less fortunate whether they are in the US or abroad. In addition to helping others achieve their goals, it gives a sense of fulfillment to the person providing the service. one good idea, which will also enable a person to better relate to the community they serve, is to buy clothes once arriving at their destined volunteer site, and donate the clothes they arrived in when they have finished serving their volunteer term. This allows a person to make a material contribution in addition to everything else they provide. Volunteering is wonderful because it facilitates the exchange of information, and provides hands-on service to people personally. Providing education is especially important because the benefits of practices taught in the US which have been proven to save lives (hand washing, etc) may be relatively unknown, underestimated, or harder to achieve in other countries due to lack of resources. Volunteering abroad is a precious experience that has changed my life. As a prospective nurse, it made me realize that it is important to understand the cultural practices of others because the US is a multicultural country. What constitutes good health in one country does not necessarily constitute good health in another, because people from different countries might have different priorities in life. A country that seems to have nothing can yield happy and productive citizens. Just because a population does not have a certain amount of money or the same technology we do in the US, it does not mean they are unhappy or disadvantaged in every other aspect of their lives. My experience volunteering abroad consisted of spending eight weeks living with a host family in Kathmandu, Nepal. I had planned for about a year to volunteer during the summer of 2007, but I was not sure where to go. Volunteer costs helped me make a decision quickly. Every volunteer program and organization I came across during my lengthy searches required the prospective volunteers to pay a high fee to cover room and board with a host family, continuous guidance and support from the organization, and staffing. I found one program that had a lower volunteer fee than the other programs asked for. I engaged in a few email exchanges with the program director and previous volunteers and my plans for the summer were established. Once arriving in Nepal, I did not find it very difficult to adapt to the customs of my Nepali host family, since Nepali culture is pretty similar to Indian culture, and I am of Indian heritage. However, it did take work for me to put those practices in use because I was raised in the US and I have not visited India in a number of years. I was raised with some Nepali customs such as eating with my hands or washing with water after using the bathroom instead of using toilet paper. It did take me longer to get used to the things I had not been exposed to in a while such as cold water for bathing and sleeping on a wooden plank. One thing I immediately noticed, and really enjoyed about Nepal was the concentration and blending of the Chinese and Indian culture. I particularly enjoy Nepali music, which I think sounds equally Chinese and Indian. Even the faces of Nepali people have equally Chinese and Indian characteristics, which is particularly lovely. Like China and India, two huge economic entities, become more westernized in everything from clothing to music, Nepal seems relatively untouched. there was the occasional up-and-coming Nepali rap star on tv touting his beats, but people still walked the streets in traditional clothes. My first week in Nepal was spent sightseeing, shopping, and touring with a staff member. I also underwent one-on-one Nepali language training for two hours every day during that week. I was provided with a small textbook with transliterated Nepali words and their English translations. My Nepali language skills increased steadily throughout my time there because my host family and the patients I saw every day helped me retain whatever I learned. Hindi and Nepali are very closely related languages, so the fact that I don't speak Hindi was to my detriment, but even so I feel I picked up Nepali pretty quickly. I requested that my language teacher focus on teaching me healthcare-related vocabulary such as "do you have a fever?" and "where does it hurt?" After that, I was sent to work in the clinics. it took me a while to memorize the paths and get used to the numerous stray dogs that wandered the streets. I worked in two clinics: I spent from 10am-1pm at the Gothatar health post, located in Gothatar, a rural village within Kathmandu valley, and from 2pm-5pm in another health post, which was fully funded and staffed by the organization I was volunteering through. The clinics were on the same road, and it was about a 30-minute walk between the clinics and my organization's office. My focused vocabulary helped me greatly in the clinical setting because during my entire two-month stay in Nepal I had only met one patient who knew English fluently enough for us to have a significant conversation. By the time my volunteering days were over, I had built up such a strong bond with the staff and patients that it was very difficult for me to say goodbye, in part because those I worked and lived with were truly grateful that I was there, and they spoke to me with warmth and sincere interest I had never remembered receiving from anyone else before. When I went to the clinics each day, each patient I saw thanked us volunteers profusely. We were always greeted with "ji" after our names, which is a sign of respect. On the one hand I was flattered that they were so grateful to us, but on the other hand, I was saddened by the reality that they would only be receiving our care for a limited time, and that most of the health care faculty within the clinics we worked in were not trained to my extent, even though I had only just finished my first year of nursing school at that time. In the clinics, I mainly assessed patients, administered medications, educated patients, and discussed healthcare topics with the staff. It wasn't until I began working in the clinics for some time, that I became really invested in the meaning of the work I was doing, realizing especially how important education was. I heard one patient, who was severely anemic and underweight, state that she did not want to eat vegetables because she believed they would make her gain weight in an unhealthy way. I heard one more patient, whose child was suffering from recurrent intestinal worms, state that she was not boiling her tap water, only filtering it because she thought that alone was sufficient. I also began to realize how different reality is for different populations. I cared for a woman who had injured herself while cutting rice with a sickle, and after I disinfected, bandaged, and splinted her finger, I was shocked to hear her say that she would be back at work the very next day. I asked her why, and she asked me, "if I don't work, who will feed my child?" Another patient had an open sore on the sole of his foot and came into the clinic wearing thin, exposing sandals. after I and the other volunteers told him that it was not good to have his sore exposed to all of the dust from the roadsides, he revealed to us that he did not own another pair of shoes. I came back to the US and continued my research. It is difficult to volunteer in a developing country and feel like nothing you are doing is helping the people there. I realized that symptomatic treatment in a clinic is not going to help anyone long term unless waste was properly disposed of, water was purified, and people were educated on such things as how to purify their water through boiling and filtration. I again found myself searching for words, however, when one patient stated that she simply did not have any source of heat with which to boil her water. Now that I have volunteered abroad, I cannot imagine traveling anywhere in the world without at least being a responsible traveler, by not exploiting a land or culture or judging a culture's way of doing things. I feel that my time in Nepal has had tremendous positive effects, for myself and for those I worked with. the u.s. is indeed the veritable melting pot of the world, and it is critically important to know how to understand and respect the different components of what's inside that melting pot. We are all humans; how can we truly value healthcare when we don't care about health in a global perspective?
  7. spdhaka80

    First Night Duty in Labor Room

    After finishing student life in nursing, this was my first duty in labor room by myself. Because of the very limited staffs in the hospital, they used to schedule a maximum of two staffs at night, and that night I was alone because the other staff was in sick leave for three days. Although, I had informed the nurse in charge that I don't have experience in labor room she assigned me alone and said that I can get help from staffs in Med/Surg ward which was pretty close to the labor room. In addition, I was just transferred to this hospital so I was new to everybody including clients. My duty started at 8 pm, I took handover from the evening staff. There were 10 antenatal mothers with three of them in active labor. The ward had both ante and postnatal mothers in separate rooms. I was trembling with both fear and excitement. I tried to recall the necessary procedures and theory needed to take care of antenatal mother and delivery. Along with me was one lady attendant who was working there for several years. I tried my best to be calm and confident in front of her and visitors. I started attending mothers in active labor, listened fetal heart sound, took vitals, provided support to mothers and visitors. I had almost forgotten to do a pelvic examination and evaluate the result, but I did my best and stabilized the situation. I saw fear and confusion in patient's party in the ward seeing new staff alone, but I made them convinced that I could handle it. The ward was running smoothly, all of a sudden I heard noises and rush coming towards the duty station. There were four, five man with a lady carrying another lady in a stretcher who was moaning. I could not understand what they were talking, one of them asked me for the ward night staff. I said it's me, they looked each other and asked if there was any mature lady who could take care of the lady in labor. I told I am the only one staff available for tonight and will be taking care of the lady. I didn't know what they were talking, but looking at the lady in stretcher I knew that she is in severe pain and needs immediate care. I told them to let me examine her but they were confused. In the meanwhile, the ward attendant arrived, as soon as the visitors saw here they started talking with her. I thought to be old staff they knew her. The attendant was one of the local people who knew them so she made them understand the situation and we together took the lady inside the labor room. After the examination, I found she was fully dilated and ready to deliver. The attendant helped me prepare the instruments and client for delivery and I forced myself for self-preparation too. I made sure that FHS was present and the mother's condition was stable. According to the hospital policy I went to the visitors to take consent for the patient where I saw some more people outside the nursing station making noises. They started asking me about the client's condition and demanding another staff who was old enough and experienced in labor and delivery. I explained to them everything honestly and asked one of them to fetch some necessary medicines. That guy seemed a little bit understanding to me so I asked why they were not trusting me. Then, I knew that those people had a believe that delivery should be done only by old staff who had self-experience and I was a young unmarried girl who doesn't know about the labor process. Due to this superstition, they were hesitating to let me take care of the lady. For their mental peace, I called one old staff from med/surg department and told the visitors that delivery will be done under her supervision. This made them calm and we deliver the baby with no complication. As this case was solved and everything was stable, it was 11 pm, I moved to the antenatal room to check other mothers. One of them was ready, I rushed her into the labor room and prepared for delivery. This case was little complicated because it was primigravida with Breach presentation. I was trembling on my feet again in the same way as my client was with pain and urge to push. I recalled the process for Breach delivery and followed accordingly. With lots of difficulties, a cute little baby was born. But to my unfortunate, she had a big tear and she started bleeding terribly. I had not seen anybody bleeding that bad which made me nervous, and shaky. Now my situation became worse, I couldn't stop bleeding despite giving pressure against the pelvis and meanwhile, I was about to pass out because of the fear and dilemma. I told the ward attendant to call on duty doctor while trying to balance myself. When the attendant went to call the doctor, I delivered the placenta and put some dressing pads inside the pelvis with some hope to control bleeding. I saw less bleeding now, so I removed gloves and examined mother's vitals sign. I also injected the standing order medicine to stop bleeding. When the doctor arrived bleeding was much controlled, she gloved and examined the tear, it was second degree. I assisted the doctor with suture when she taught me and let me suture under her supervision. At this moment, I can't explain how I felt for the doctor who remained calm throughout the time and helped me and the mother to relaxed. When everything was finished it was 2 am. I was exhausted by now with hunger and sleeplessness, then I remembered there were two more clients out there for tonight. I had no time to rest, I rushed to them to check and found another lady ready. One after another I assisted both ladies to deliver and thank God that the previous two cases had made me much confident by now. This was one of the worst experience in my life till now. I passed that night standing for almost 11 hours with no rest at all. When the morning staff arrived at 8 am, I was buried in the paperwork of all those clients which took one more hour. I left the hospital with no energy, but I was satisfied with what I did.
  8. momofstudent

    God Bless America

    You see, as an American nurse traveling abroad, I was still unaware of how different we appear at times to foreigners. I was volunteering at the seriously understaffed zoo of a European capital helping children safely hand feed small tropical parrots in a large walk-in bird cage. To this man, my admission was something akin to admitting my working career was a failure. Fast forward eighteen months: I married that lovely man and moved to his hometown in Rio de Janeiro, Brazil. During the next 4 years, I struggled to learn that complex language knowing full well that I would never work as a nurse again if I could not speak Portuguese well. I also struggled to understand the fine nuances of that culture. With a failing public healthcare system abandoned by the wealthy, why did the Brazilian workers spend so much time singing and dancing instead of protesting? With a failing public school system also abandoned by the wealthy, why were there no protests in the street? No protests over health system officials pocketing money that was earmarked for ambulances; no protests over politicians pocketing money that was destined for textbooks? Before I could ever work in Brazil, the 2008 Dengue season hit the crowded city of 11 million like a ton of bricks. Thousands of people were overloading the already underfunded urgent care centers, hundreds were dying from lack of care. I often walked past terrified parents and frail elderly who had waited for treatment for days. Only after much bureaucratic discussion and far too much time, the Brazilian Army was finally given permission by the mayor of Rio to set up field hospital treatment centers in public parks that dotted the tropical landscape. Finally, I thought, maybe I could help. Even with my weak Portuguese, I could be helpful by triaging, starting IV`s, taking blood pressures, assuring parents. I asked friends to make calls to agencies to find out how I could volunteer. Five days passed without news from any agency or my frustrated friends. In the meantime, I read in the newspaper that a Brazilian doctor had tried in vain to volunteer. There is very little understanding of volunteerism in Rio de Janeiro. To the common person on the street, a volunteer is a rich person taking a job away from a poor person. To the more elite people, a person who volunteers without pay is some sort of fool. To the public officials, a volunteer is a nuisance who calls attention to their failing infrastructure. On the day I met my husband I told him that if Americans stopped volunteering overnight, the entire economy would collapse. The US is dependent on volunteers in every sector, from parents in education to teenagers working in animal shelters; volunteerism is an integral part of our American culture. We are raised to believe that our time and money should be given freely to those in need, to the arts, to education and of course, to healthcare. So, yes, my international healthcare experience was something not to be but it brought me to appreciate even more all that we are as Americans. They say that you cannot truly understand your own culture until you step outside of it. I believe that saying is true and I believe that even though Americans have shortcomings and failures we are so very blessed by our culture and especially our culture of volunteerism.
  9. "New age" describes a recent trend in the United States toward alternative solutions to those provided by science and modern medicine. This new sense of spiritualism embraces some old solutions like the mind-body connection, massage therapy, natural methods and medicines, homeopathy, yoga, candle therapy, acupuncture, and other things excluded from a typical visit to a physician's office. This new trend in the U.S. is not so new to immigrants from Latin America. What we call "traditional" or "folk" medicine has been practiced in their home countries for a long time. These practices have coexisted with modern medicine. Practitioners of traditional remedies do not consider the traditional and modern solutions to be distinct, but rather complementary. So we should not be surprised that some Hispanic patients may have sought natural solutions before visiting a physician's office for healing. Some patients believe strongly in curanderos or spiritual healers. Some have brought with them a system of cures passed down from generation to generation for self treatment. Supplements and special diets are popular in Latin America. Often a visit to the homeopathy shop, or even a farmer's market, provides natural medicines for certain ailments. More surprising for many U.S. healthcare providers is the belief in a direct relationship between wellness and magic. Consider the following examples of folk maladies recognizable to many Latin Americans. Digestive Distress Empacho is a type of indigestion identified with symptoms such as stomach pain, swelling, fever, vomiting, acid reflux, diarrhea, and lack of appetite. These are symptoms associated with ulcers. The condition is often described as a ball of undigested food stuck to the stomach wall. Some believe it's caused by an excess consumption of certain rich or greasy foods. Others say it results from forcing someone to eat something against their will. Psychic Distress Susto (or "fright") is an emotional illness affecting anyone at any age. Symptoms include depression, nausea, anorexia or weight loss, insomnia, hyperventilation, and nervous breakdowns. It is traced to supernatural causes. Each person has a body and a soul. If a person suffers a traumatic event, his or her soul may flee the body. The soul must be returned to the body, through magical means, or the patient's life is at risk. This condition could mask a general infestation or meningitis. Caregivers working with pediatric patients should be especially aware of this phenomenon. Mal aire ("bad air") is a psychic form of possession resulting in respiratory problems, muscle aches, and nervous or digestive problems. It is believed that people can be taken over by deities borne by the wind or by the spirits of victims of a violent death. Since the cause is spiritual, so is the cure-rituals performed by a healer-, sometimes in combination with healing herbs like the common rue plant (ruda), sage (salvia) or rosemary (romero). Infants Fallen fontanelle (mollera caída) affects new born babies. Babies are born with delicate craniums which do not firm up until 7 to 19 months of age. When a baby suffers from dehydration from excessive crying, diarrhea or fever from a bacterial infection, the upper front of the cranium may sink in. In these cases, a healer might push up on the upper palate of the baby, or hang the infant upside down. Infants are the most common victims of "evil eye" (mal de ojo) and other types of mal puesto, or hexes. This type of magic spell is performed after securing a personal object belonging to the victim such as a lock of hair or saliva. All that's required is a simple look from a powerful individual, often motivated by envy. The solution is also magical, of course. It is the caregiver's role to find a medical solution to the excessive crying, fever and other symptoms presented by infants, or time spent seeking a magical cure may allow an undiagnosed illness compromise a baby's health. A Better Cure: Culturally Competent Interviews Healthcare providers managing care for Latino immigrant patients need to be aware of the prevalence of alternative practices common in Latin America. Often these practices are not even on the radar screen of U.S. physicians and care givers. But imagine the health risks related to negative interactions between natural and pharmaceutical remedies. Natural remedies and supplements could interact with prescribed medications. And also consider the fact that patients may self treat or rely on the advice of a spiritual healer and thus delay a trip to a clinic or physician's office when haste is essential to effect a treatment or cure. The solution is not to contradict or ridicule a practitioner of alternative therapies, but to work within the cultural framework of the patient. The first task is to find out if a patient is following a form of traditional or folk medicine. Review the following culturally-sensitive questions inspired by the work of Dr. Arthur Kleinman of Harvard. (Refer also to the writings of Dr Nancy Neff of the Baylor College of Medicine, and Berlin and Fowkes' LEARN method.) Underneath each question set is an explanation for the purpose behind the questions. What do you think is the cause of your condition? What do you call this illness? How do you believe the problem started? How often does a healthcare provider ask the patient what the patient thinks is wrong with them? Surely some chatty patients will share their own theories with their doctors and nurses, but doesn't the modern provider filter out this "noise" when assessing a patient's condition? Asking these questions may identify what the patient believes is the source of the problem. With this knowledge, the provider can assess the situation and work to separate the affective or emotional side from the physical ailments. Don't discount the patient's beliefs but rather dig deeper to isolate physical symptoms. What remedies are you taking to cure the problem? Have you consulted anyone? Whom? A doctor? A spiritual healer? What did he or she advise? Did someone at home treat you? What did they give you? Are you taking any supplements? These questions are intended to reveal to the healthcare provider whether the patient is following any alternative practices or taking any natural remedies or supplements. Home remedies could be dangerous when combined with pharmaceutical drugs, or they may be benign. If the remedies have no effect on a health outcome, we advise against discouraging the patients from taking them. Respect their familiar practices and beliefs. Since spiritual healers can include Catholic priests, we advise using this term instead of curandero in order not to insult a "modern-thinking" Hispanic patient. What are you afraid will happen to you from this illness? What treatment do you believe you should follow? What results are you seeking? The answers to these questions will help the healthcare provider assess whether there will be any interference between modern and traditional cures. It also provides an opportunity to anticipate what will happen to patients as they follow recommended treatments, and to discuss realistic expectations for a cure. Including any harmless practices the patient is engaged in-like drinking an herbal tea or wearing a protective amulet-is a good idea for two reasons: it shows you respect their beliefs and it may result in a positive placebo effect. Saying there is 'nothing to fear' or that 'the best thing to do for now is nothing' is not enough. Be aware that Latin American patients who leave a physician's office without a plan of action that includes medicine or supplements may not return! The percentage of Latin American folk medicine practitioners is relatively low when compared to the huge number Hispanic patients managed by the U.S. healthcare system. But these precautions can help assimilate the recent immigrant and their families into good health and improve wellness outcomes for all patients.
  10. The preceptor that I am assigned to is helpful in some regards but she has a very condescending tone when speaking to me if I am getting overwhelmed with tasks she does not assist. I realize that she spends most if not all of the twelve hours dictating, pointing out things I should do in not a good tone of voice. I feel as if I am going to ask to be placed on the medical floor despite my 2 years of ICU experience as working with her I am slowly losing my self-confidence and in essence developing a very low self-esteem. I try my best, I read widely but it seems as if the only thing she notices are things bad, she has never given me a positive feedback on anything. For instance, I had 2 patients, one requiring a high level of nursing care and an admission. Throughout the shift I did all the nursing care plus the entire admission process, at the end of the very hectic shift she informed me that I should have taken time to read through the admissions complete history, mind you I read his admitting history and the plan of care but while I was literally drowning in tasks for both patients she was sitting down and not helping. I am asking you for advice on handling this situation because the unit is a good learning environment but if I am overwhelmed each duty I am not going to get much chance to learn anything. I am thinking of asking my unit manager if I can be placed on another floor. The other preceptors that I have had are much better than the one I presently have. Dear Overwhelmed, Your preceptor is critical and withholds any positive feedback. This does not create a good learning environment for you, and that is her job. While you can't change her, you can control your responses. Your options include speaking with her, frankly and respectfully. Tell her what you need from her and how you are feeling. Use "I" statements to avoid provoking her defenses. "I need to know what I am doing well and what I need to improve on. I really appreciate your feedback and I am feeling that you are dissatisfied with my performance. Can we talk about that?" During the shift, keep her updated on your activities and ask "Am I on the right track? Is this what you feel I should be doing, or is there another priority?" This puts more accountability on her to guide you and provide feedback. Are you receiving regular (weekly) progress evaluations and goals? Goals should be written, measurable and attainable so that it's clear to all whether or not you met them. Otherwise, it's a no-win for you. You cannot meet expectations that are never expressed. If speaking with her is not an option for you, you can ask your manager for another preceptor, citing a better fit or personality. Chances are she is this way to other orientees, and it should not come as a surprise. When you are overwhelmed, do you communicate? "I'm feeling overwhelmed right now with one patient's pressure dropping and a blood transfusion to start on another. What is your advice as far as prioritizing?" As far as her not helping, without knowing how far along you are in your orientation, it's not possible to comment. Most preceptors will allow you to feel the stress of the assignment by being hands-off, without letting you fail. I hope this resolves for you, friend. Best wishes, Nurse Beth
  11. vineyard

    Transcultural Nursing Experience

    My instructor said, Mr. Fernando...And I said who was that again ma'am? She repeated it, Mr. Fernando. The only thing I said to my instructor was "thank you so much and remember with a crocodile smile..." The moment I looked at the patient's chart, I was thinking like the patient's case was just okay and that everything will just be very fine of him, me and the significant others... Well, well, well, when I get into my patient's room, I was so shocked at the back of my mind because there were many bottles hanging on both sides of my patient. Not only one, two or three but there were four bottles hanging beside him. I said to myself while looking at the patient, oh-oh this is gonna be a very exciting yet tiresome job. I told my American classmate to really help me because I am anticipating that there will be a lot of calculations then and there will be a bunch of things to do. And so yes! Lots and lots of things to do. One day during my shift, I didn't notice that my patient deposited a bulk of smelly feces on his diaper and her daughter told me that the patient defecated a day before my shift. It was a very disgusting smell when I entered the room. And Ummm, of course, I don't have a choice but to clean it up because he was my patient. And Because my patient was so big, my clinical instructor called up four (4 ) other student nurses to help me. There was one guy on my right side near the patient's head (left side). One American female on my left side and there were two other student nurses in front of me. When we turn the patient on his right side, the smell went out and the guy on my right side was crying. I asked him why he was crying. I thought he was thinking like he can't make it but then he said because of the smell. He said it was the most disgusting smell he ever inhales in his life. And because at that time, we were not using any disposable towels or wipes. Everybody was asking on what are we going to wipe them. Suddenly our clinical instructor said, we can use a face towel. Yes, a face towel!!!! A face towel that my American classmate who was on my left side was used to clean up the patient's anal area. Would you believe that the towel used was the same towel being used the whole time until the patient's private part was clean?!? Meaning the towel has been squeezed with water just to make it clean 'til it has been finished. I can't believe it! After which, I removed the diaper but then because the patient was very heavy my hand slipped away and was able to touch the patient's feces! Eeeewwwwww! Yes, that was the only word that everybody was able to say right after I placed my hand on it. The patient's daughter was laughing while looking at me and said am so sorry about that. And after we saw the patient's daughter laughin' everybody smiled and said it's ok because I am used to touching feces.LOL...Yeah, it was okay because I had no choice, hehe! Furthermore, my clinical instructor asked us on who will put the ointment on the patient's butt, the guy who cried turned his head away and was smiling, said in a whisper "no, not me please..." Our clinical instructor noticed and call him with a big smile and said Yes you will ... hehe! He had no choice but to get the ointment to avoid sore. If only the patient was conscious, for sure he will laugh at us and with us. Seeing our different faces with the smile but with meaning would really make him smile too. The patient's daughter and wife were smiling that time during the procedure and they said a "warm thank you" to us because they said they can't do it by themselves because they are not used of cleaning up the patient. With it, I was bearing a crocodile smile when I heard the word "thank you..." Indeed, it was of great honor and privilege to help patients even in a very small way. That experience really helped me a lot and motivates me with regards to my patience, endurance and of being a good healthcare giver. I believe it did also test me of how much I care for my patient in any setting and cases. I am a nurse now in my country (Philippines) and hopefully work in the US soon with a true heart of giving care to my patients. I believe I could sincerely serve my future patients because life is important as how God treasure and value life. I hope that this article would enlighten all healthcare givers. May this article reminds us always that we are given a very good privilege to serve, care and above all love our patients no matter what race and which country he or she from. Have a nice day to all!!
  12. interleukin

    Love and Healthcare in the Third World

    It almost appears that parents in the African bush don't seem to care when flies crawl over their child's face, or when their children play in contaminated water or sleep in flea-infested dirt-floor huts or catch diseases long eradicated here in the "developed" world. But too often these images are aired to advance specific agendas. So, I wanted to check out at least some small part for myself, up close, not filtered through someone else's lens. I always thought the more I experience the landscape of human condition, the better I will be at nursing. Nearing the end of five months on a journey across Equatorial Africa, I found myself with two nurses dispensing vaccines outside the village Jinka, Ethiopia. I rode with them through a parched landscape. The riverbeds were bone dry and the sun unremitting. We visited adobe-type huts filled with families. Children played and laughed. Babies were swaddled in colorful cotton, wrapped tightly against their mothers' backs. It is said that the feet of an Ethiopian child never touches the ground for the first year. Here, in the USA, we worry about VAP rates, and we should. There, they struggle to maintain the integrity of vaccines without reliable refrigeration. Here, we worry about childhood obesity, and we should. There, they worry about malnutrition and dysentery. These nurses were like primary care physicians. But there are so few of them. The pay is desperately low and the supply chain for medicine fragmented. Much care is provided by foreign organizations. We discussed the need for education in these rural areas. But in a country of more than 77 million people, there are only seven schools that offer a Bachelors of Science in Nursing. This results in a nurse-to-person ratio of about one per 4,900. Obviously, misery exists and the challenges are daunting. But, here, in this collection of huts, I saw love in the eyes of the mothers and the of play joy in children. Outside one hut, I heard the rhythmic grinding of stones. Through the portico entrance, I saw a wrinkled neck of a woman. In her hand, she gripped an egg-shaped stone. She was crushing grain against a much larger large flat stone. "Teanaste'lle'n", I said, "hello" in Amharic. She smiled and ushered me in. In some silly western way, I wanted to show her I wasn't there to gawk and snap photos. I motioned for the stone. In short order, my muscles ached and my sweat dripped into with the grain. I felt like a first-class fool. I wished I could have told her what dignity I saw in her people. I wanted to discuss how many of us take things for granted and why it sometimes seems that the accumulation of possessions, like a parallel line, never seems to bisect the lines of contentment. I wish I could have asked her about all those television images of despair. No, I see no exotic glamour living a life devoid of running water, electricity, or one with a healthcare net consisting of a single thread. We can argue whether our lives would be richer and we more sensitive healthcare providers were we to spend part of them without material comforts. Or whether this woman's lack of access to first-world medical delivery systems somehow reduces the amount of hope she has for her children or the amount of love she offers knowing they may die before their time. I did know that I could not look at our healthcare system the same way. I knew that what we offered some of our patients in our ICU, at least provided the chance of a life that afforded the possibility of happiness--that Holy Grail of human desire. And I knew that, in large measure, love and caring was not dependant upon what we possessed, what we knew, or what we could achieve.
  13. GilaRRT

    Culture of Violence

    I walk down the spiral staircase from my third-floor room to the operations room, the nerve center of our operation. Our operations coordinator is busy talking on the phone while he feverishly types in data on his computer. One of our doctors is standing by, while one of our medics sits at our small conference table. Both are listening to the conversation with great interest. I notice the three large screens on the far end of the operations center are turned off and silent. Unusually quiet from their brightly lit activities that beam the news, clinic information, and Google earth information into the center. Among this silence, I instantly know something is up. My quiet day is about to take a turn in the other direction. We have a mission. The operations coordinator in his relaxed yet concise speech gives us the details of the mission. A person has sustained critical injuries from a gun battle. The military is asking us to assist with the operation. A military helicopter will transport the patient to the airport and our team will take over care and transport the patient to a local hospital for ongoing care. My partner, a newbie to our operation is a South African paramedic. While new, he has an aura that radiates confidence. The kind of feeling you only get from a highly seasoned provider. My deeply buried insecurities are at ease knowing he will be on this mission. The third member of the team is a local Afghan physician. He is thin and looks to be a new intern in his late twenties to early thirties. However, his external appearances are deceiving as he is most likely in his mid-forties. I remember the stories he told about fighting Russian troops in the steep mountain ranges of Afghanistan when he was a young medical student. He knows the country well and will be an asset when we have to communicate with the Afghan physicians at the receiving hospital. The typical rituals are completed without incident. We quickly check and load our medical equipment into a small Toyota van modified to perform the duties of an ambulance while blending into the local flavor for added security. Our backpacks that we call rollout bags are loaded. These bags are loaded with survival equipment in the event we end up on foot and have to survive long enough to escape the situation. It is cold comfort, as the grim reality is we would most likely not live long enough to use these supplies in the event of a major incident. I also don a soft vest of Kevlar body armor and place my plate carrier over the soft vest. The carrier contains steel plates that may stop rifle rounds from penetrating the soft Kevlar and flesh underneath. Most of my colleagues choose not to wear armor; however, I find cold comfort and a little hope that it could make a difference. Finally, we are loaded and bouncing along the pothole infested streets. Our driver tries to avoid the deep holes with limited success while our bodyguard and Afghan physician shoot the breeze in the local language of Dari in the front of the vehicle. My partner and I sit in the back of the ambulance. Silent observers of this world, we are alone in a city of millions. A concept that I never fully grasped among my fellow Americans back home. We finally reach the pickup point. I make contact with the guards to the entrance of the military base that is located next to the airport. They only speak French. I do my best to remember fragments of French that I learned as a high school student. Too many years have passed, however. I manage a feeble, " Bonjour, mon nom, je m' appelle Chris, " followed by the name of my company. Luckily, they have been briefed about our mission and allow us to wait for the patient at the gate. The patient arrives several minutes later loaded into an old Army box ambulance. The medical providers speak limited English and cannot give us an accurate report. The patient has a family member present as well. Our local doctor makes contact with the family member to gather additional information and brief the family member on the situation. Once again, I hear the unfamiliar Dari phrases. Once again, I am reminded that I am very much a stranger in a strange land. The feeling is brief as the patient is in rough shape. The injuries are critical and the sending facility was required to place a tracheostomy in order to secure the airway. The patient is receiving bag valve mask ventilation on room air. My partner assembles the scoop stretcher and vacuum mattress for packaging the patient while I assess the airway and verify proper placement of the tracheostomy. I note lung sounds in all lobes with rales throughout, thick secretions surround the tracheostomy site, I also place a colorimetric carbon dioxide detector and am pleased to note the familiar and reassuring yellow color change. The patient appears pale as I place a pulse oximeter, hook the patient to a cardiac monitor, and obtain baseline vital signs. The patient is young. Much younger than me, with strong chiseled facial characteristics common among the people of Afghanistan that would have made the patient an instant hit among the social crowd if this were the United States. I briefly wonder what this patient would have been able to accomplish in another place and another time. Would this patient have had to work a dangerous security job in the most violent areas of the world? Instantly, I know the patient is in distress. The pulse oximeter and blood pressure readings are critically low. My partner continues the packaging process with the skill of a professional while I hook the bag valve mask to high flow oxygen and ensure a reservoir is attached. I suction the purulent secretions from the tracheostomy and look for IV access. Only one IV med lock is present on a distal extremity. All of the extremities are grossly swollen and I suspect the IV is worthless. Finally, we load the patient and begin the long and bumpy journey to the hospital. While in route, we continue to suction and ventilate with high flow oxygen. The doctor takes over the bag valve mask while my partner manages the suction machine. We have a transport ventilator, but it is forgotten in the frantic activity. I am able to place an IV among the bumps and sudden stops among the chaotic traffic. My partner already has a line of saline spiked and tape torn. He congratulates me on a good job; however, I know it was luck. My partner is able to suction additional secretions and bring the patient's pulse oximetry reading into the mid-nineties. He asks about the blood pressure, it remains low. We verbally go through a list of problems that could be causing the low pressure. We rule out pneumothorax, a condition that can be caused by aggressive ventilation. Finally, we arrive at a tentative conclusion. The patient is most likely septic. This explains the lung sounds and secretions. Upon arrival at the hospital, we are met by an old run down building that is no different than the surrounding buildings. The medical unit is on the fourth floor. However, no elevator is present, and we are required to carry the patient up several flights of stairs. Luckily, the hospital staff is keen to assist. We are able to negotiate the narrow stairwells and make it to the unit. My heart sinks as I see the hospital bed. Limited supplies are present; staff members scramble to find one of the few vital signs monitors present. Even with such Spartan conditions, the staff seems determined to take care of the patient. After the mission, I ponder all that I have seen thus far. Such senseless violence. Why is it so hard for people to get along? Why do so much hate and disrespect for life exist over here? Then, I am struck with an even more sullen thought. How is this any different than what I have experienced in the United States? How is this any different than the racial violence, drug wars, gang violence, and school shootings that occur all too frequently in the United States? The only answer I can conjure is, "it's not." I have come to realize that this "culture of violence" is not isolated to the Middle East or even so-called third world countries. No, the "culture of violence" is a disease that has infected every country and every society. Violence is not simply a problem with "them." It is a human problem that will require human solutions. Is there any hope? If a South African paramedic, an American Nurse, an Afghan physician, a French soldier, and a rundown hospital in Afghanistan can put aside their differences to help a patient they do not even know, then perhaps there is hope.
  14. bat3fingers

    A Nurse Is a Nurse

    In 1997, after finishing school, I set off with my brother to visit nursing schools, in England. At first, I had no plans to leave Ireland, I was just attempting to satisfy my school that I was filling out all the right applications and that I was serious about nursing. After all, at 18 and male, with no immediate family in healthcare, perhaps I was an unlikely student for a nursing course. I think it was August 1997, the results came out. I had to get my family to go and collect them. I was at work, in a hospital operating room, as an assistant. I remember leaning on the pillar, talking to my mam on the phone. Yes, she could open the envelope and tell me if I had done well enough to get what I wanted. Forgive my memory, but in almost 12 years, I am sure that I am glossing over some of the exact details. I do remember that my brother was the one that ended up calling Liverpool, England to see if I had the required results for entry into their nursing program. Thankfully I had! I remember turning to my, then colleagues and grinning, telling them that I was going to nursing school in England. Somebody asked me, who was I going to go with, and who did I know over there already. My answer, no one! I am going to be a nurse! After all, I didn't know anyone when I started my job here, and now all of you are surrounding me, eager to know if I will be a nurse or not. My dad and I set off for Liverpool. It is amazing how much stuff you can get into one of those black cabs when you have to. I was setting up a life for myself, overseas, away from the familiarity and comfort of home. I was nervous, excited, scared, and thrilled. What would be in store for me? In those first four years of nursing school, I worried and fretted and wondered if I'd ever make it through. Thanks to my class, the tutors, the college staff and most importantly the unending support of my family I did it! I graduated as an RN in June 2001. I finally had a piece of paper that made me a nurse! At that time, the focus of my worries changed - now that I am a nurse, what sort of nurse would I be? While in nursing school, I started to do clinicals and see hospital life. I started to feel what it was like to be part of a team and care for those at times of crisis and ill health. This was not my only education. My family, especially my mam, encouraged me to be well-rounded and gather as much experience and education as I could. I think my mam was concerned that once I was done with school, I would have no time for a social life, for friends or for broadening my horizons. She may have been slightly wrong about that. Never the less, it was with this in mind that I decided to learn to scuba dive and look for a summer job. These are 2 things that played a large part in my future of transcultural nursing that I was yet to experience. Summer 1998, my first summer. What would I do? To me, there were 2 choices; go home and resume family life or look for something related to nursing that might broaden my experience. I picked up a school paper, just to see what was being offered. I remember seeing an ad for summer camp. A place in the mountains, a chance to help kids and adults with special needs have a summer vacation. A chance for their families to have a rest from complicated care. It sounded good. There was one small issue! "Mam, I found a summer job...." "O.K, what is it?" "It's a special need summer camp, it will help my nursing and broaden my skills......" "O.k, what's the catch?" My mam was and always will be very astute when it comes to me. She knew there was more to this, seemingly innocent summer job. I didn't really think it was such a big deal. I had already been away from home for, approximately 9 months. I was arranging to be home in September before, I would have to leave home again and return to nursing school. Ok, there was the issue of the camp being in the Catskill Mountains, in upstate New York. In my defense, I had the opinion that if I was away from home, I was just not there. It did not matter if I was down the street in Dublin, or across the Atlantic in another country. I knew my family would be there for me. And, they proved me right! My mam was probably shocked and amazed, but I told her, she had encouraged me, so I had to go! That summer, I went to the Catskill Mountains. I worked hard and then had some time to travel. I fell in love with the country and a certain individual. To this day, people still believe that my partner is the reason that I chose to come back to the USA. Sorry, to say this is not the case! Sure he's important, but he has not and never will stop me doing what I need to do. In fact, truth be told, he supports me, nearly as much as my mam. I could have said "more", but really over 10 years with him, can't equal the first 18 of life with mam! June 2001, I am a nurse! I have my degree in my hand. Now, what do I do? I didn't know what to do at first. So I spent one more summer in the USA, working at camp. That was my 3rd summer as a counselor and the staff wanted to see me return as a nurse one day. Maybe? I just wasn't ready for that yet. I returned home to Dublin. I needed to see my family and show them that I had made it as a nurse. My mam, unfortunately, was unable to be at my graduation, so I needed her to see the pictures and the degree and me. I felt like it had been a lifetime since we had spent any time together. She did too! My very first nursing job was per diem in Dublin. I found an agency that would accept newly graduated nurses and let them try different areas. Those few shifts in Dublin also taught me many things. Dublin is and always will be, my home. It was not the place that I was going to work. Nurses in Dublin made me feel bad! I don't think it was intentional. I was an English trained nurse that had come back to work in Dublin. A black sheep, come to fit back into the fold of Irish trained nurses and nurses that really wanted to be in Ireland. I realized I wanted more. I had seemingly outgrown the nursing jobs of Ireland and needed to reach out to find challenges and experience that I would not get living and working in my hometown. Does that sound biblical? It was how I felt. So I moved on. By December 2001, I was back in England looking to work in the health care system that I had been trained in. I had a good idea that emergency room nursing was the job for me. In my degree, I had also completed a UK specialist practitioner qualification in oncology. So armed with this and my degree and my travel to the US, I applied for an ER job close to where I had trained. At first, I got per diem there too, but then I found an ER, willing to take a new nurse, willing to learn. I was asked if ER was a suitable place for me. I responded with, I can face new challenges. I spent 4 years conquering the basics so that now I have my piece of paper that means that I can start learning in the real world. Being a student nurse is one thing, being an RN is quite different. I spent 3 years in that ER and am grateful to all the staff, patients and ems personnel that started me on my path to nursing. My love of travel had also grown. I had traveled most of Europe with my brothers for vacation, I had flown transatlantic for my summer job, I needed to see more and do more. Once again, I found an add in a magazine! Travel nursing, see the world. How could I resist? I didn't! A lecture hall in Manchester was the start of what turned into a long, long process. It would take 3 years to get my permanent resident card and end up in the States as a nurse. I was determined. There was so much experience out there, just waiting for me. I could not possibly sit around and just wait. I am impatient! I need to feel like I'm doing something. I made new friends in the process of getting my US paperwork in order. It was them that offered me one more experience that I could not turn down! "Mam, you know that I'm working on my US paperwork...." "Yes......?" "Well, people that I have met, doing the same, say that it's very easy to get an Australian visa and get into nursing over there" "Oh, I see...." October 2004, hello Sydney, Australia, Brian is here to nurse! Just outside Sydney and then an aboriginal community off the coast of Queensland were the places that I worked. Those experiences alone could take up another small book. The only problem with those jobs was REALLY being alone. By now, I was working for my US paperwork and developing a relationship with my partner. It was a difficult time to be halfway around the world, and a day apart. While my family was welcoming the New Year 2005, I was going to bed on January 1st, 2005 and my partner was getting ready for New Year's Eve celebration to begin. This was one of the loneliest times of my life. I compare this to death and dying of a close relation. I was truly alone. I survived, I learned, I grew. When I returned to England in the summer of 2005, I was getting nearer and nearer to having my paperwork in order to be a US nurse. I had always wanted to see California and I could not imagine starting my nursing anywhere else. So I did. California, October 2005. New challenges and new situations. For the 1st time, my partner and I could be closer then we had been. He traveled from New York to live with me in Anaheim. And I started work in one of the many local medical centers. A hospital that catered for tourists from Disney, prisoners from the OC jail and people from the local communities. I realized early on that I have no knowledge of Spanish, but that did not really stop me! So my triage took a little longer and I had to ask for some more help to communicate with my patients. I still was able to be a nurse and continue to learn. Once again I have a debt of gratitude to those staff and colleagues and patients that accepted me as a nurse and help me grow in the US healthcare system. I even remember defending the US health care system to an Italian patient. "No, this is not Europe and that is not what happens here" From California to New York. A long distance. Although, in case you ever wanted to know, you can drive that distance, with 2 drivers, in as little as 47 hours. This, however, I can not recommend! I came to New York to finally work as a nurse in the summer camp that I first worked at, in the summer of 1998. In fact, they paid for my license and offered me so much help, I felt like family. The only bad part about that was that it took forever and a day to finally get my New York license. After that first summer of nursing in the Catskill mountains, I need a winter job, so I came to work in Rochester. Now that is a city that you can learn a lot from. I worked at a regional trauma center and felt that I was continuing to grow and learn as a nurse. It was here that I also started to work as an EMT. I felt that I needed a new challenge, to reach out and help the people of my community. That truly was an education! There too, I made new friends and gathered colleagues that were able to help me work in a community that I previously knew so little about. May 2008, tragedy struck! My partner lost his dad. By this time, I had fit into a second family. The adoptive American family that loves me, nearly as much as I love them. I have too many experiences, as part of this family to fit into this small space. Suffice it to say, I belong to an Irish and now an American family, thanks to my partner and his family. I was at home in Dublin and my partner called me. That was one of my most difficult journeys. I had gone to Dublin, after 3 years to wish my mama happy birthday. I stood in our Dublin kitchen and heard the pain and the sadness in my partner's voice. He had lost his dad. Again, thanks to my mam's support and understanding, I left Dublin, on her birthday, to fly back to my adoptive US family. As a nurse, you strive to do everything you can for your patients. As a partner and son-in-law, you stand helpless in the face of death. Sure I understand pulmonary embolisms after surgery. I just can't explain what it feels like to lose someone that close. Even now, writing this, tears well up in my eyes and I feel their loss. I am powerless. What can be done? Challenges are not things that I move away from. Critical thinking comes with nursing. Problems need solutions. There were many options considered in those following months. In the end, the best solution was to move in with Mom and sister-in-law. So what about my nursing? I will always be a nurse. I can find a job anywhere. Any place, country, time. I am a nurse. So at the moment I per diem in 3 rather different hospitals. I can experience a variety of communities and give back to one that has been my partners home for many years. I also decided that I wanted to do more with the emergency medical services. So I am in school to be a paramedic. I finish in June and then I will be able to work pre-hospital as well as a hospital. So this is my transcultural nursing experience, so far. I have only been a nurse seven, nearly eight years. I have so much more to learn. Every experience, good or bad is an opportunity to grow. Sharing experiences helps others grow. Long may it continue!
  15. Chrissamp

    International Nursing - Whew!

    I like the smell of hospitals. I know it's more than a little odd, but, I always have. Maybe it's subconsciously one of the things that caused me to become a nurse. I smell the ammonia and something feels right about it, it puts me in the zone. The zone where I feel I am fighting the good fight for health, for knowledge, for happiness, for those rare moments when I get to be the one that offers the right word at the right time in the face of pain and death. The scrubs, the light green walls, the matching hallways with little cubbies filled with COWS, and vital sign machines, the nursing station sitting in the center of all of it like the command station with the charge nurse sitting there looking grumping as all get it, because let's face it when do charge nurses not look like that? Grumpy charge and all, it feels like coming home and I love it. Today was my first day and it was supposed to be mostly familiar plus a few new scary butterflies because maybe the walls were a little more blue than green and maybe the charting was different than I was used to and maybe I had more patients than I thought I could handle. But that wasn't the problem. There were no green or blue walls, there was no charge nurse, no beeps of Iv's needing to be changed, no, there wasn't even a hospital. Instead, there was me, and a school, and red mud, lots of red mud. It was on my shoes and smeared on the light blue uniforms of the school kids lined up neatly in the lunch line. We filed passed the kids and into our makeshift office, me and my Kenyan colleagues. Steven my fellow nursing colleague, the pharmacist Brenda, and I, and no happy butterflies. I took stock, one table, one chair inside a 12-foot by 12-foot cement building with no roof, dirt floor, no running water. We pulled out our nursing kits slathered on the hand sanitizer and put on brave faces. We worked for an NGO that provided health assessments for kids and dispensed (though the pharmacist) a limited number of drugs and provided referrals to the hospital for cases beyond our limited makeshift clinic. Our task today was to assess thirty-five of these school kids between the ages of four and eight in the next three hours. As the two nurses, my colleague Kevin and I set up the best assembly line system we could come up with including the pharmacist in any tasks she could perform to save us time like weights and heights. The next several hours were a blur of vital signs, and "please step on the scale", "please step off", "open your mouth", "stick out your tongue", "How old are you"? Some kids hid behind each other and wouldn't respond me until my Kenyan colleague told them it was ok, I realized about five kids in that they were a bit shy because I was white. I tried extra hard to smile and not make any sudden scary movement and to not seemed rushed though we were fighting the clock all day. We had about ten kids to when Steven said "it's going to rain." I gave him a funny look and took the HR for the next kid. Steven hadn't spoken a word in hours not related to our task and I didn't have the mental energy for small talk about the weather. Three minutes later. "It's going to rain." This time I said "Oh?" Using exactly the .05 percent of my brain that wasn't engrossed in the task at hand. "Yes, it's going to rain, we need to go." Surprised I said "we can't, we still have several kids left." Steven patiently pointed to the line that used to have several children in it and said no they won't be here either, their parents are coming to take them home. I was startled enough to stop my mad multitasking and saw several parents appear and whisk their children out of line and outside in a matter of seconds and our last two patients be grabbed by teachers and taken outside. I still didn't get it but it packed up my supply bag as I was told, in two minutes we were running the mile back to the gas station where we would catch a ride. We worked in a slum, no cars could get back to where we were. Then the rains hit and I got it - you don't mess with rainy session in Kenya out in the slums there is no place for the rain to go, so you find higher ground. Now. We waited at that gas station three hours before our driver could make it the two miles to get us in rain like that and it took another three hours to get the five miles back to my house that night. But in-between arriving at the school that morning and my house late that evening I found it somewhere -that this is why I do this coming home feeling. When I arrived at the school to assess the children I didn't get that feeling, just the feeling that there was a pile of work to be done and no one but us to do it. But somewhere between arriving at that school that morning and leaving in the panic of the rains I found something I had been missing. Because, somewhere between the mud, and the cement building with no sink and the line of children I realized it was never the smell, the walls, the nursing station, the familiar organization and equipment that I fell in love with when I started nursing. It was the patients. And the black smiley faces and flashes of toothy grins I received when a child realized we were there to help maybe that was when I realized that first dasy are first days and maybe they aren't so different no matter where you are. There are patients, you are nurse and you are there to help however you can with whatever you have. No ammonia, no problem. I can do first days anywhere as long as there are patients.
  16. When to start your job search Throughout my training I was constantly urged by mentors in the months prior to graduation to start applying for jobs - "It will be harder/take a lot longer than you think!". Well, take heed, finding a job in the current climate is particularly difficult - in some instances trusts are withdrawing funding for advertised positions, and besides this there are many applicants for each job - competition is tough. If you hope to stay in the area local to where you have studied, remember that everybody in your cohort will qualify around the same time, and you will all be competing for those jobs - you want to be ahead of the crowd. The bottom line is start early. Writing an effective personal statement which will appeal to an employer does take time, thought and practice - if you start thinking about it months in advance and familiarise yourself with the applications process, you will give yourself a head start. Sign up for automatic job updates relevant to your field of nursing on the NHS jobs website so that you have a good idea of what's out there, and start thinking about what kind of area/ward/environment you really want to work in. If you have an ultimate career goal, think about which opportunities will provide you with the most relevant experience and set you on the right path. Before you apply If you have an interest in an advertised position, contact the manager (details will be on the advert) and ask if you can visit the area and arrange to meet with her/him in order to discuss the details of the job. A manager I worked with on my final placement gave me this advice, and in my experience visiting is tremendously valuable to your application; it shows that you are really interested and willing to take initiative - it gets your face known. You will get a feeling for the job role and in many instances have the opportunity to take a tour and familiarise yourself with the area. Remember that in the applications process first impressions count - make the effort to dress practically though smartly and behave courteously, making sure you thank them for taking the time out of their schedule. Prior to the meeting prepare some pertinent questions and write them down to take with you. Consider topics such as what a perceptorship programme entails, what are the current initiatives running in the area, future priorities and goals etc. You will have some practical questions such as expected start dates - but remember to include some questions which portray the fact you have really looked at the job description carefully and taken an interest. Most managers are very pleased to see a visiting applicant and will really take the time to get to know you - so be prepared to talk a little bit about who you are and what you have been doing throughout your course, as well as what you hope to do in the future. Listen carefully to the information they provide and take some notes - this will invariably be pertinent to the interview questions. If you have the opportunity to visit before you apply, you will also have a better idea what to include in your personal statement - sometimes this isn't possible and time is of the essence, but it is still important to visit even if you have already applied. All in all, it can feel a bit daunting - but remember that if you are successful and get an interview, it is likely to be in the same place and with that manager - when would you rather see both for the first time? Writing an effective personal statement Assuming you are applying through the NHS online system, your personal statement will be your only real opportunity to make a personal mark. Most nursing jobs in your field will have some basic key skills and requirements in common - I found it helpful to review several job descriptions and find out what those common features were, and use this to write a basic personal statement relating my relevant placement experiences to those things. You can save this as a word document and then reinvent your basic format each time, adding more details in terms of the more specific skills relevant to the job and focusing on the personal attributes you feel you can offer which will be most valuable in that area. ALWAYS read carefully through the detailed job description, and when proof reading your personal statement tick off the requirements to ensure you have covered each one - if it is very long, it may not be possible to touch on everything, so decide beforehand which are the most important. This is valuable because whoever is short-listing applications is likely to refer to the job description and it shows that you have been conscientious and taken the time to understand their requirements. There are lots of good examples of nursing CVs and personal statements around the web, which can be a really helpful guide - but be careful not to plagiarise. In terms of presentation, make sure you spell check your statement before submitting it and you have used appropriate punctuation and paragraphing. Poor spelling and grammar will give a sloppy impression. Re-read your statement a few times to ensure you have a logical flow of ideas throughout - as a rule of thumb you should start with a brief introduction about yourself and where you are in your studies, and finish with a statement about why you think you would be a valuable contribution to their nursing team. It is a bonus if you can get others to proof read it as they may pick up on mistakes you have missed. All in all you are aiming to write a detailed but concise personal statement which also gives a flavour of your personal qualities and interest in the field. Interview Attending an interview can be a daunting experience for anybody. Thankfully, most band 5 interviews do not require you to make a presentation. Sometimes you will attend a group interview, but in most cases you will be interviewed individually. In almost all eventualities you will be interviewed by a panel rather than a single person. This sounds very daunting but most interviewers are highly skilled at making you feel comfortable within that scenario. Of course, you want to be mentally prepared for the challenge - so if details about the structure of the interview aren't provided, use your visit as an opportunity to ask so that you know what to expect. Preparation really is key to interview success. Expect to be asked to talk a little about yourself - this is often a little vague and open-ended, so remember to keep it relevant to the job and avoid talking about your hobbies unless commenting on a transferable skill. You should think about the point you're at in your studies, what they comprised of, any other relevant work experience, why you wanted to go into nursing and how you feel you have developed. You will almost always in some form or another be asked to talk about your strengths and/or weaknesses - make a short list of each. For every strength consider how you can apply that within the role/how it will add to the team, and an example of how you have displayed that attribute within your placement experiences. Turn each weakness into a strength - 'as a new student I struggled with ...., but I was able to overcome it by ....'. It goes without saying you should choose wisely - this isn't the time to reveal you have a habit of sleeping in. These seem like really simple points, but most people find it really hard to talk about themselves so be prepared. It's easy to get swept up revising different topics, only to find you draw a blank when it comes to more personal questions. Hopefully you have already met the manager by now and have picked up some hints as to what topics might be covered - use this as your guide and read, read, read! Think about and write down the types of questions you might be asked, and memorise the key points you'll hope to cover in your answer - this will help prevent your mind going blank when nerves are at work. Just as important, for each question reflect on an experience from your practice placements (or other work experience) where you have demonstrated that skill or attribute. You want to show that you not only know your stuff, but you understand how and why to apply it, too. Another thing you should look at are any current developments in nursing - key reports and significant reforms. You may be asked about these directly, but even if you aren't, paying reference to current issues shows that you maintain an interest in the direction of the profession as a whole and that you keep in touch with the drives of the NHS or of the trust. This is particularly pertinent when talking about evidence based practice. At the end of the interview, you will be asked if you have any questions for the interviewer. You should ALWAYS prepare some questions to ask - this portrays interest. Never ask about salary in the interview. You may want to cover some practicalities, but cover some topics of interest besides. Good examples of questions to ask would be things such as 'What are the main issues which will be effecting the department over the coming months?'. The RCN interview skills guide (available online) has more examples. Invest in a neat, hard-backed notebook to take along to the interview and write your questions for the panel in that. Don't underestimate the importance of asking questions. I was struck with terrible nerves on the day of my interview, but I was informed as part of my feedback that preparation along with my questions at the end had really swung it for me and got me the job. So, you have done a whole lot of preparation and the day of the interview is upon you. Make sure you allow yourself enough time to get ready without rushing and to have a last minute run through of your notes. When feeling nervous try to take some slow, steady breaths. Remember that nerves are normal in an interview situation, but you only need to hold it together for that period of time. Make sure you know where you need to be and aim to get there in plenty of time. Select an outfit which is smart and professional, but also appropriate to the area of work - for example, in a ward environment, opting for tailored trousers rather than a dress or skirt will look smart and you will also look more 'work-ready'. As with any interview, avoid showing too much skin, clothes which are ill fitting or noticeably well worn, see-through blouses or lots of jewelry. Cover any tattoos, ensure that your hair is neat and opt for natural looking make-up. Wear smart, polished but SENSIBLE shoes. You don't want to be tottering around in high heels which hurt your feet. You could be waiting around for your interview, you want to be cool and comfortable. Stand and sit up straight but be mindful to maintain a relaxed body posture as best you can. Use that 'open body language' you've been practising all these years and don't cross your arms! Bring along your ID on the day (passport/license with paper copy) and if you have it already, evidence of your NMC registration. I have never been asked for a paper copy of my CV but I think it would be wise to bring these along just in case the panel asks for more information about your education and experience. Thinking on your feet can be hard when nerves are at play - the more you can prepare before hand, the better. When entering/leaving the interview room it is appropriate manners to shake the hands of each member of the panel. This can feel quite awkward since most of us in nursing are women and it is an unfamiliar social convention, but bite the bullet and do it anyway. Be confident and make eye contact as you do it. I think the major exception to this would be if you are very familiar with the panel or assess on the day that the tone of the interview is very informal. Lastly, GOOD LUCK! If you you have an unsuccessful interview, remember that competition for jobs is tough and finding a job for anybody in any field at the moment is more about the 'long game'. Request feedback whenever possible and use it to tweak your approach - practice makes perfect. Reflect each time on what went well and what went not-so-well. Whilst you continue to search for jobs, take any opportunities to increase your skills and enhance your CV - you could attend short courses or access voluntary work placements. The nursing departments of most universities run guest lectures open to the public. Above all keep trying and don't lose heart. It won't be long before somebody sees your potential and snaps you up for a position!
  17. After 27 hours of travel I have arrived. It is very hot, there is no air conditioning and only warm bottled water to drink. On January 14th I had the amazing opportunity to travel to the jungles of southern India on a volunteer medical missions trip. I went as the nurse to help two doctors from our hospital here in Pennsylvania. We set up "medical camps" in tiny churches in the state of Kerala, India. During the 12 days we were there we saw hundreds of people. These people stood in the heat for hours waiting to be seen and never complained. After their exam it was my job to be the "pharmacist" and give out the medications that were ordered. We saw a lot of people who suffered from severe back pain from the hard manual labor they must do. By the time they got to my pharmacy they were thrilled to get a few magic pink pills (Ibuprofen). One of the ladies we saw, Mary, stands out in my mind. Mary is a middle-aged lady with severe asthma. She has had great difficulty breathing for several years. To make her condition worse, Mary works in a school kitchen. In India they cook over an open fire inside the building so she was always in a smokey room. Mary had an inhaler but was unable to properly use it because she couldn't take a deep enough breath. We were able to make her a temporary spacer out of a plastic cup. With the spacer and a few steroids, Mary was able to breath for the first time in many years. I can still see the tears streaming down her face as she kissed my hands over and over for helping her. While we were there we got to hold a clinic in the mission's home for abandoned children. These kids sat quietly on thin mats on the concrete floor for about two hours, taking turns being seen. They didn't hit the kid next to them and they didn't complain because it was past their dinner time. They didn't even carry on when the electric went off and we were in total darkness until they could get the temporary lighting on. We also did house calls for some of the people that were unable to get out to the clinics. Many of these homes were small shacks without running water and all the conveniences we have in our country. We saw frail elderly people that were very well cared for by their families even in those poor conditions. I have seen people in much worse condition come from skilled nursing facilities in the United States. In India you do not need a prescription to get medicine and it is very in-expensive compared to American standards. You can buy an inhaler for $7 but when you only make $7 a week you usually don't spend it on medicine. I think that the thing that sticks out most in my mind about my experience with nursing in a different culture is the gratefulness of the people we saw. In America there is such a sense of entitlement. We "owe" them medical care and they want it all right now! I wish that people who sit in the air conditioned ED waiting room, complaining of a terrible sore throat they have had for the last 2 weeks, while we care for an acute MI ahead of them could see these people standing for hours in 95 degree heat. Even though it was almost unbearably hot and I was totally exhausted I would not exchange the time I spent with the people of India. Since I have been home I have received messages that the people are saying things like "they came all the way from America just to see me." You never really know what you have until you visit a third world country and see how other people live.
  18. abemwe

    The Inside Culture

    It's now a decade and he is past gone, my inside is that I should care for other insides. I prefer to live with what he used to tell me, "Son the inside matters." I don't want to imagine how two races from that far could meet and produce me... I think the inside mattered very much. It is the 32nd month since I graduated. The outside confront the inside, "Work with your race / culture / community / family only." The humble inside defends with a 3-word quiz, "Which is it?" The outside your home. I only know the world. Meaning anywhere in it is my home. My major role is to attend to the insides. Mummy is old, I only see the goodness of a nurse inside her. She originated from here while dad from far Western. I must consider the inside only. I gonna leave her and attend other insides in other corners of the world. The only I have is for the insides no matter what, where, race, ethnicity. In college, during Anat. class Prof. A used to tell us "Always remember human blood is the same/red underneath the skin....." I liked that. Dad's was, "Son it is good to be born in one side of the earth and live in the other side because you will be able to touch two cultures, compare them and learn new things in life...." Yesterday at night, at 8 pm a pregnant woman entered Baraka (labor/blessing ward). She looked happy and strong. "Are you a nurse? Am in labor" "Have a sit." I welcomed her. I burst into laughter when she started dancing. In nursing, you must laugh-the music of the soul to move on. I thought it was madness, but she went on happily. "Oh! yeah, she is encouraging and sustaining the process of labor." Humbly I took the Hx without disturbing her funny movements. "Penina, I want to examine you to assess the fetus" "Not you male nurse. Only Bob can see my nakedness." I later learned Bob was the father to be. I explained to her that it was my profession which is guided by ethics and human rights. "Penina it's 9:20 pm, no female nurse around-males only on duty. She interrupted, "All of you in the wrong profession-male nurses!!!! Misplaced." Deep in my heart, I knew she was wrong. She needed information and understanding of today's healthcare, it's neither a male nor a female. What matters is how much you care for the inside. Period. The rapport was crucial here. I thought of the variability of the cultures. "Penina I understands, but let's think of what you are carrying. We need to assess the fetus status. We only care for 'the inside.' She thought of my inside, she thought of her and what she was carrying inside." Yeah, ou inside, the inside matters." She gave in. I assessed FHR continuously using EFM. "Penina why didn't you come with Bob?" "Oh! What the inside in you? In our culture, this is for female only. Male should give themselves a break." "Wrong, all should think of the inside-baby," I advised. She turned friendly. we called Bob on night duty in the cotton industry. We discussed the importance of him being around, and he joined us at 1:00 am. We discussed extensively-the psychological and emotional needs to Penina, their two races and cultures-quite different indeed. There was no time to harmonize the two cultures. We managed a great deal concerning the inside in Penina. At 3 am, things were moving very fast, a delivery tray there, Penina with strong pains, this time not dancing but moving violently. I think this is how she perceived pain. At 3:20 a baby girl was extracted. "Penina here is your baby." She made a dull smile. Bob was there looking. I thought he would be jubilant, but it turned out to be a surprise. As I did 'rub up' a contraction, I discovered there was another baby. "Undiagnosed twins," I shouted to other male nurses. Bob was alert once again. We monitored the FHR for another 20 minutes. After 25 minutes we extracted another baby-this time a baby boy. "Penina here is another baby. You see... Boy! Baby boy....." "Thanks 'inside nurse'.Ohhh! Finally a boy. You mean it was inside. Thank god. "She was warm and happy on the face. On the other side of the corridors, bob was jumping, "It's a baby boy, baby boy...it's a...Boy." Penina tuned a soft song from her mouth. It was translated to me meaning "Unexpected 'inside', unexpected blessings in Baraka/blessings ward." Around 8 am I discovered that in PN ward Penina concentrated on the baby boy than on baby girl-eye contacts and breastfeeding was more on the baby boy. It took me another mile to explain the importance of mother-baby relationships; attention should be divided equally for bonding. We advised Bob to seek permission from his place of work to give PN care to Penina. What a culture? Not going to ANC for obstetric ultrasonography-until undiagnosed twins in the labor ward. What a culture a woman don't expect a male nurse to attend to her.That no need for the husband to be around during labor and delivery.What a culture that a boy is more important than a girl in the society. What a culture? My only culture which I will stick to is my inside to care for other insides no matter what, where, race, or ethnicity. The inside culture matters.
  19. marian howe

    Human Like Me

    His wife was a superstitious woman. She believed, as did many Brazilian farmers, that the enfermera formada Americana (college-educated American nurse) would perform some bizarre procedure that would render her lame or sterile -- or both. Her bravery was made evident not only by the fact that she allowed me to originally incise her purulent boil but that she was now returning for follow-up treatment. The wound looked beefy and moist. The red streak snaking into her groin was gone. She could walk now, when but a week ago she had been carried in on her husband's back. I was satisfied the maggots had done their job and was relieved the river had dropped enough to allow a vehicle to take this patient to the nearest hospital. With her permission, I injected her with penicillin, packed her wound with gauze that had been boiled over a charcoal fire and laid a pliant tobacco leaf over the pack. It took several hours to find someone with enough courage to drive over the river but eventually, a Jeep happened by and the woman was safely on her way. The woman and I were of different educational backgrounds and different socio-economic statuses. We held contrasting religious beliefs, too, as my patient's family contained many 'espiritos,' those who donned masks and performed animal sacrifices for healing, good weather, and safe travel. Our methods of communication varied, as did our food preferences and even our clothing styles. Initially, she believed it was possible for me to draw her womb out through the hole in her hip and she refused to stay the night at the aide station, telling me honestly that she feared I would remove her leg while she slept. But ultimately -- courageously -- she trusted herself to my care. Being a nurse allowed me to enter the homes of -- and speak freely to -- those in power in our village. Not everyone trusted me and my "modern" treatment methods. But many did and word eventually spread about the enfermera Americana, bringing in patients from rural areas, patients like the woman with the hip wound. This woman's culture and mine were so different. And yet, looking back at this seemingly insignificant case, I can clearly see that I did not at the time recognize culture as a barrier. A woman in distress is a woman in distress. An infected boil is an infected boil. Does it matter that a patient believes painting an affected leg with river mud will keep away the evil so long as, along with the mud, she allows me to lance the wound and use maggots to eat away the rot? Does it make a difference that her husband placed a cut root in his pocket to prevent me from stealing his fertility when he entered my clinic with his wife on his back? And do I honestly care if the patient's family refused to watch her being transported, fearing that if they watched her leave they would never watch her return, so long as she did allow -- of her own accord -- transport to a facility that would preserve her leg and her life? I was lucky. When I was young, my parents exposed me safely to the world. Men and women of every color and ilk crossed my path. In our family, we had college professors with house servants and ranchers with outhouses. And, yes, there was bigotry and ignorance, as there is in everyone's life. But I learned early that we worry too much about getting things wrong and not enough about making things right. We stew and fret that in our ignorance we may insult someone when we should simply apologize up front for being uninformed and tell our patient what we want to do and why. If the patient consents, we should proceed with professional grace. If the patient does not consent, without guilt or condescension, we must try to find out why. It may be something easily fixed -- facing a window to sleep, not keeping dairy and meat on the same tray -- or it may be something quite complex -- not allowing a woman to touch a man. We may never be able to broach the transcultural barrier we are up against. But it can always be made better through understanding. The outcome is what counts. We are not our patients' parent, spouse, child or sibling. Our duty is to provide respect, not patronization, and treatment, not condemnation. We want what is best for our patient, but we may not agree on how to get there. I believe the solution is fairly simple: Unless a patient's behaviors infringe on the rights or safety of others, we don't need to alter his cultural beliefs to provide competent, compassionate care. Respecting others' decisions about their own choices, even if we disagree, is what matters. Culture is a skin-tight uniform we all wear, from the moment we are born to the instant we die. We are dressed by others in that culture at birth and alter that culture day by day, encounter by encounter, choice by choice. I am not naive enough to say that we are all the same. You and I are very different in many ways. You may say, in fact, that we are nothing alike and have no common bonds. But look deeper. Underneath, you are human. Just like me.
  20. The Liverpool Care Pathway (LCP) is widely used, and recognised as best practice when caring for patients who are end of life. It aim is to guide the multi-disciplinary team in areas such as discontinuation of fluids, medicines and the pathway gives guidence around comfort measures during the last days and hours of life. Organsised into sections, it has provided consistency, support and guidence for those who make use of it to promote and ensure a comfortable, dignified death. The Marie Curie Palliative Care Institute Liverpool In recent months there has been a great deal of scrutiny around the use of the pathway, orginanating from a Daily Mail article by Melanie Phillips who suggested that the pathway has been used to expidite death and without the full knowledge of relatives of dying patients. (I must warn the reader, the Daily Mail is a tabloid paper reknown for it's condemnation of the National Health Service and the UK healthcare workers) The medical profession's lethal arrogance over the Liverpool Care Pathway | Daily Mail Online The original article has caused great anxiety within the healthcare world, not because the information provided is correct but because the scaremongering tactics of this tabloid could potentially lead to end of life patients being denied best practice and subjected to painful, prolonged deaths. There have been concerns voiced on medical forums, in the British Medical Journal and via facebook fictional characters such as the "Medical Registrar", "the Palliative Care registrar" and "the Consultant Vascular Surgeon" I have used the pathway on many occasions, and in fact have on a number of occasions initiated it's use with discussions with the medical teams. I have only once had the experience of a patient who survived after being put on the pathway, it was discontinued when she showed signs of improvment (she was an elderly lady who had fallen, fractured her ribs, had a splenic bleed and had a multitude of chronic illness' ) It was felt she was unlikely to survive. She stopped bleeding and woke up a week after the pathway had been commenced, the comfort drugs were tailed off when she asked for a cup of tea. News analysis: What is the Liverpool Care Pathway? - NHS Liverpool Care Pathway: Relatives 'must be informed' - BBC News In response to the Daily Mail's article the government has responded, demanding that investigations be carried out in areas that have been named as having poor practice, there is a suggestion that healthcare organisations receive money for putting patients on the pathway, there has been an overwhelming response from medics stating that the care pathway is used after full clinical assessment and where the patient is felt to be in the last days of life. News analysis: What is the Liverpool Care Pathway? - NHS There are now genuine concerns that if healthcare professionals suggest the care pathway to families of patients who are felt to be end of life, there will be fear, misunderstanding and there is the real risk that patients will suffer as a result. Descriptions such as the "death Pathway", claims that it is used to expidite death only contribute to add to the misconceptions and further undermine the general public's trust in healthcare professionals. I have been truly saddened to see the assassination of such a helpful, clinically driven and patient focused pathway by a tabloid paper be taken by the government, and rather than getting facts and looking at the evidence behind the pathway, politicians jump on the bandwagon to condemn and give credibility to the scaremongering.
  21. ... The replies are often negative and in general try to convey how very difficult this is. There are lots of hoops to jump through and currently the economic situation in the UK is very grim, this means that jobs anywhere are scarce and our government is trying to keep UK citizens in work, therefore making obtaining a work visa more difficult. Before even being considered an international nurse will need to gain UK registration, this is done via the Nursing and Midwifery council, this organisation has the responsibility to register and regulate all registered nurses and midwives in the UK. The http://nmc-uk.org is very informative and will give you information about what you will need to do to register, as well as details of the code of conduct, and other documents that structure our practice in the UK The booklet which informs international nurses of what is needed to register can be found here The register is divided into 4 different parts Adult Mental Health Child Learning disabilities Before your application is processed you will have to pay an administration fee, and provide the required documents, this will include evidence of you passing the ILETS (the minimum score accepted is and average of 7) You should have been practising as a nurse for at least 12 months, and if you have been qualified longer than this then you must have done at least 450 hours in the last 3 years. There are also some specific requirements to register as a nurse in the UK, these can be found on the NMC website. You will also have to complete and Overseas Nursing Program (ONP) with supervised practice days before you are allowed to register. Before then being able to work in the UK you will need a work VISA as no Employer within the UK is legally allowed to consider you for work without one, as employers we are legally obliged to give work to citizens of the UK then EU first and only if the positions cannot be filled from here are we allowed to consider overseas applicants. You are only able to apply for a VISA if you have sponsorship from a UK employer, and although the Immigration and VISA has been changed to a points based system it is actually designed to make it more difficult for international applicants to get work. Nursing is no longer considered as a shortage occupation, unless you have significant experience in areas such as critical care or theatre specialities at a very senior level. (Band 7 and above) If you take a look at the Borders Agency Website you can see that overseas nurses and midwives are listed as Tier 2 and will only be considered if you already have a job offer from an employer. There have been some discussions on the international areas about studying and working in the UK, this is covered by different immigration regulations so I will address this in a different blog.
  22. Hi, I just completed my diploma in engineering field, but I just realised that Im still intetested in medic line. Biology is my fav subject as always, but since Ive got a better result in Physics, so then I proceed to study engineering. As my parents both are engineers, so I will have to be an engineer in my family, this sounds normal as everyone follow their parents footsteps. So I just went on to study without asking myself whether I like it or not. After 2 years of struggling in diploma, Ive never think about to proceed my degree in that field. My parents said that if I wanna work in medic line, is either doc or pharmacy. Nurse is definitely not a choice for us. I would like to ask, whats the problem of choosing to become a nurse? Why theres so many pupil keep saying nursing is not a good job,which not hygiene at all, gottta work shift by shift, gonna clean up form time to time. As in my opinion, I doesnt care about what they say, I just wanna serve people, makes pupil happy, works that can saves lives in every minute. This is the job that I wanted. Parents and cousins will say that Im just kidding, Im just wasting time and money to study it, not working in the field that Ive studied. But I thought that Im the one whos gonna proceed my future, live in my future myself, but not them. But if I proceed my degree in engineering, I will regret that I didn't make a choice just for myself, it will be more wasted if I continue to study. What should I do? How can I convince my parents to change their mind and thoughts about nurse? Just because I will be the first nurse in my family so they dont have any reference for me. They just simply dont allow me to study that. Im so frustrated now that I have to make a decision to choose which field to go. Im ready to get scolded by them if I discuss this topic, is just few weeks time for me to decide. But what if Im wrong? I went to school with my friends around, Im happy to be with. We discuss about engineering stuff, but Im the one whos the most quiet when it comes to this session. If someone just ask why I chose this path, my answer is always 'coz I didn't hate or like it, I just chose it.' for no reason. During festival celebrations, many of my relatives will be very busy body asking is my course tough, its obviously tough for me. When they heard the word ENGINEER, they will wowed. I was thinking, is engineering the best for you guys? Why? I saw my cousins talked about their courses, like biotecs, biomedics, architec, etc. They shared their funs ands interest one by one with excitement. My turn, I will just said, erm... Engineer is like that, about leds, lights bla bla bla... No any excitement on me, this is the first time I realised that Im not that interested in my course. Ok next is, after school, I have no other minds to think about my course stuff, Im not curious about the news, the updates. Until my sis told me one thing, she said, hey, why dont you feel curious about your stuff, your future stuff. Shes studying software, she writes codes, and once the software run, she feel curious and excited about it. But I dont really have that kind of excitement when it comes to me. Parents always tell me us to do business in futire, not just to be employed, they dont even ask about my opinion, just ask us to do what are the RIGHT things they thought of. How can I convince them about nursing?
  23. sydney1979

    Alham Dulillah

    I was just eight months in training as a staff nurse in a small hospital in our province. I really was not expecting any letter that time since I was just starting my shall I say, nursing career for that matter. I was not really expecting any letter from any agency that time because the application that I passed to the Philippine Overseas Recruitment Agency regarding my hospital experience was not enough, but anyways they accepted my papers because according to them some countries were so in need of nurses that they're not so particular with the experience. And I was lucky, Saudi Arabia was in dire need of nurses at that time and there were only a few nursing graduates since it was a recession in America when I was in college, most of my classmates also shifted to another course. Physical therapy was in demand that time so most of them shifted to the said course. Going back to the paper that I received, it was stated there that I should go to Manila for the test then if I pass the test, the interview will follow then the physical exam. I was scared that time, there was a lot of questions that enter my mind, how will I tell my seniors that I will go to Manila for an interview? And would they allow me? Where will I stay in Manila, and for how long ? Where will I get the money to pay for the physical exam? If I could pass the exam? So I prayed, Lord God please help me, I know that you're the only one who knows what's best for me so pleaseeeeeeeeeeeeee take care of me, Lord. Then, good thing my mother called me up, I told her about the letter for an interview which will be held in Manila. She told me not to worry about a thing she will send me the money for all the expenses, and she will also contact her uncle who lives in Manila where I will stay for maybe a couple of weeks or more. My mother was presently working in Saudi that time, and when she goes home for her yearly vacation which lasted only for 45 days she would tell us all about the things that happened to her in Saudi, the customs and traditions and some of their languages too, like Alham Dullilah which means thanks God, Ah salam Ahlaikum meaning Good day, Mafe malum means I don't know, mafe mok, brainless, EnsshaLlah which means in God's will. But, of all the words what l like most was Alham Dullilah! And so after talking to my mom, I made an excuse letter to my superior stating that I will be off for a week or two for an interview in Manila and then the following day I talked to them and showed them my letter which they agreed with no question asked, thank God Alham Dulillah! While in the province instead of worrying myself to death, I reviewed my notes read my textbooks for four hours every day, that's how scared I imagined that. I would also write notes and memorize and would always pray for God's guidance. Then when I arrived in Manila the uncle of my mother fetch me at the domestic airport. My brother was in Manila that time but he was very far from Makati where I took the test so the uncle of my mother which is my grandfather for short, was informed by my mother to accompany me for the processing of my papers. The day that I took the test, I was well-rested and very much prepared and I passed the exam including the interview. I was the highest among the 50 nurses who took the exam and it was posted in the bulletin board of the agency and the POEA, actually my grandfather was the one who informed me coz he was the one who's checking everything and he was so proud when he told me," nene" that's my nickname, "you're the highest among the nurses who took the test, congratulations!" Everyone looked at us, I was quite shy that time coz, I did not expect him to shout with too much excitement. Added to this there were many people that time and it is POEA, many applicants and personnel were there. Furthermore, after all the exams, including physical exams for that matter and interviews, we were set to depart from Manila, if I remembered right at around 8 or nine a.m. We're the two nurses who are assigned in the same province in Saudi Arabia, others, there were ten or more who were posted in the same place. But, before the designation of the area, I informed them that if possible they would place me in the same area of that of my mother so that somehow we would be together, but to no avail, because there was no vacancy. So I thought I was really intended to that place and indeed I was. Moreover, when my fellow nurse, I'll just name her Faz and I arrived in Saudi international airport she was so scared with the women there coz they wore this so-called "abaya", black clothing that covered their whole body except for their eyes. While me, on the other hand, was not that shocked since my mother told me already about those things. Added to this the males they wore this sort of " habit" that our priest wore here in the Philippines. Thus, it's really important that you searched through the internet or browse from a book about the customs and traditions of the country that you will be working, so to minimize "culture shock". So what I did to somehow alleviate her fear was, that I told her about my mother's hilarious experiences in Saudi and somehow she was comforted. After that, we were instructed to board another plane since our assignment was a province. Then at long last, we reached our final destination and it was already dawn. The place was the same as I imagined it to be, not so many plants and the landform that you would see was a pure desert. At long last, I was able to see the country where my mother works as a nurse, which when I was small, told her to pack me in a suitcase so that I can go with her and that we would not be separated anymore. Furthermore, the next day both of us were assigned to the emergency department. There were many Filipino nurses and a few Filipino doctors there. We were also able to work with Indian, Egyptian, Bangladeshi, Palestinian, Lebanese, Koreans and Chinese and of course Saudi nationality. And it's indeed a different experience when you're able to work with them, it's a wonderful transcultural experience since you'll be able also to know their beliefs, their customs, and traditions, etc. For our first day of duty, our task was to assist the doctors in their respective clinics. I was assigned to an Egyptian doctor. He was nice and helpful to me, alleviating my anxiety to my first day of duty. He taught me a few Arabic words like mafe which means none, eg. mafe pulos no money, while he is the opposite of "mafe. A few weeks passed and our vocabulary in Arabic increased a little. But what was the most exciting part was that there was a young and single Filipino doctor whom I did not know had a huge crush on me. That's why he was always helping me and Faz, he even gave us an Arabic translation that helped us a lot with our day to day duty, since he was three months ahead of us in that place, somehow he was quite well-versed with the spoken language there. Moreover, he would request from our head nurse that I would be the nurse assigned to him, and since they were close my superior would gladly agree to the arrangement which I would also enjoy coz I have a crush on him too. That set-up lasted for a few months only coz, he was transferred to other provinces that were 14 hours by bus. By the way courtship in Saudi, even both of you is single is not allowed and when you are husband and wife you should always bring your documents wherever you go especially outside the hospital compound signifying that you're married to each other. Because if not and you're caught by their "mutawa" both of you will be put to jail and send home. So what he did before he transferred to the other place, he gave me a marriage contract that I filled up also coz deep in my heart I really do love the person and I don't want to lose him. He gave some of his belongings to me coz he'll be the one to pay if he has excess baggage which he does not want to happen. Then when he was already there he telephoned me immediately to inform that he was safe. He would always send me letters and cards almost weekly that somehow lessen my loneliness. I, on the other hand, would write to him short letter coz I'm not that talented in writing as compared to him. He would also call me three times a week without a single missed. And this continued for eight months, then when the day of our contract almost finished, he was the one who booked for our ticket and we went home together riding the same plane. We were sitting together, hugging each other," no mutawas can stop us now", he said. Then we informed all our relatives regarding our plans to tie the knot and we were formally married in our country of origin, the Philippines after a few months of preparation. After marriage, I continued my nursing career while he pursued his passion for cosmetic surgery. Now, we're also blessed with two beautiful and gifted children, ages 5 and 2 years old respectively. And for my friend and companion Faz, she's presently working in Dubai. And I always pray for her safety anywhere she goes. We're still writing each other and sharing pictures through the internet.
  24. Meg0601

    Life in the Nursing Profession

    You have a wide variety of degrees/professions to choose from. Choose wherever you are good at. Choose whatever makes you happy. For most students, they don't really have a choice because their careers are predetermined by their parents ever since they started high school (mine was). I dreamt of becoming a veterinarian, considering my love or animals. I even considered taking up Archaeology because I loved history (Asian history more likely). But alas! My fate wasn't in my hands. My mom wanted me to take Nursing. Bachelor of Science in Nursing... It is the most common degree that graduates would consider to take or rather; their parents want them to take. Every year many students are enrolled in the Nursing career. Most know what they would expect in the Nursing profession, but do they really? Some of you may think it would only be about memorizing drugs, medical terms, diseases, etc. But joining in the Nursing profession would also mean, taking the lives of other people into your own hands; it also means that one simple mistake can cause you your license and cause other people their loved ones. I didn't expect anything or rather didn't know anything much about Nursing. I didn't even know that I have to take a license exam after I finished. I didn't even know that I have to complete a number of scrub requirements in order to graduate. I didn't even know about the hardships that I had to take when I enrolled in Nursing. It is also not an easy journey. You have to endure sleepless nights, tireless days, stocks of requirements and research works, scrubs to complete ( sometimes enduring long and boring classes in your minor subjects when you'd rather study or do you homework in your major subject), ear-splitting lectures from your clinical instructors about what you did wrong or what you missed out to do and not to mention the financial expenses that most often empties your parents bank accounts (okay, I'm exaggerating but you'll get the point). Unfortunately, the journey doesn't end on your graduation ceremony. You still have to study for your board exam. Otherwise, you cannot put your acquired skills and knowledge to use. And if you pass your board exam (Yes, IF. Sad truth in Nursing life, despite your hard work, if you cannot pass the NLE, you cannot work in the hospital as a staff nurse), you have to take trainings and seminars to start you volunteer/ hospital training (no, not as a regular paid staff nurse yet). So when you encounter one of the nurses when visiting a love one in the hospital, do greet them with respect (unless they're not treating you right. There are some who do not attain their knowledge in their Ethics class and the patient's bill of rights). Also, please do support any family member of yours that takes up nursing because they need it. We endure too much pressure already. Lastly, do some research about the professions that you want to take? It'll help you a lot.
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