Dios mio!! Where to begin? I have absolutely no idea! This past week has by FAR been the busiest since I have been here, and it went by extremely fast. It began this past Monday with 6.5 hours straight of Spanish classes. This past Tuesday, was probably one of the busiest days of my life. I went to the hospital early, at 7am, to talk with my nursing supervisor, concerning my hope to start working with the children on the first floor! After waiting about an hour, she said that it would be possible starting this coming Tuesday. I also got to visit the first floor of the hospital, which is a school for mentally and physically disabled children. I am extremely excited to finally start working here in only two more days!
During my shift this past Tuesday, I was with the BEST and most proficient nurse I have encountered at the hospital here. She was absolutely amazing. Not only was she extremely kind, patient when I had to have something repeated, but she taught me more than I have yet to learn in only a few hours, and additionally took the time to explain everything she was doing to me and why she was doing it. She would then ask if I had any questions after or if I needed anything repeated. In addition to this, she was an extremely proficient nurse and I felt honored to have worked with her. She was the first I had seen to pack wounds, check IVs sites for inflammation and signs of infection, and prevent pressure ulcers. Not only did she turn each of our 24 patients, but she made foot and back pads from what was available. She told me it’s probably a lot different here than the United States because we have so many resources available, but here there is not much, and you have to improvise. Most of the nurses don’t take the time for this, as there is so much to do, but she went above and beyond in all that she did. We finished our work a lot later than the nurses I am usually with do, as we were able to do so much, and the other nurses actually told her to relax and take a break. I asked at the end of our shift together if she would be there every Tuesday, and I’m hoping she will be here this next week!!
After working with this nurse on Tuesday, I was placed with the one I seem to have the greatest deal of difficulty with this past Thursday, for the second time. There was 0 patience throughout the day, which made the entire shift very difficult. If I did not understand something the first time, it was not repeated and that was that. I was also given pop exams by her throughout the entire day, such as “Set up this tubing!” Haven’t you done this before? Faster Faster!! What if this was an emergency go faster!” I did not take any of this personally, as I was fully expecting to encounter barriers before I came to Spain. Without them, there would be nothing to accomplish or change. One part of the day I found a bit comical was when I was told to treat a pressure ulcer with cream based antibiotics via syringe. Although this seems like an easy task, but patient was face up, and his bottom was about 3 inches off the bed. When I squeezed the antibiotic out of the syringe, and it slide back down, I was responded with “Give it to me you can do the next one if you get it then.” I responded with, “I understand it now, but this defies the laws of gravity!” Needless to say, the struggle was real on Thursday.
Following my shift this past Tuesday, I went to two medical conferences at the hospital. One was concerning pressure ulcers, which I found interesting as it turned into a heated debate! There were two doctors giving the conference to a room full of nurses. The doctors were saying that it is the responsibility of the nurses to turn their patients and prevent ulcers, and it is their fault if the patient develops a pressure ulcer. This was when everything hit the fan. Many nurses started screaming at the doctors, saying that it is not their fault as they do not have enough resources to prevent these efficiently, and that they additionally each have 20-40 patients depending on the shift. This conference was in a public hospital in Spain, which had very little resourced to begin with. However, now with the negative impact of the economy, the government is cutting expenses in health care, further reducing their funding and resources. This conference was very interesting to be a part of.
After this conference, I went back to my hospital for a four hour conference on dealing with difficult patients and patients with terminal illnesses. This conference was extremely interesting and I learned a great deal about the Spanish Health Care system, as well as its differences with the US health care system. The main difference was that here in Spain, if a patient has a terminal illness and the patient’s family doesn’t want the patient to know, the doctors and nurses will not tell the patient they have this illness. For example, if a patient has cancer and is placed on an oncology floor, the doctor will tell the patient they are getting better or that they are the same, but will not state the prognoses. I found this completely ridiculous as the patient ALWAYS comes first in the US, and this has been implanted in my brain since I began nursing school. I thought it is absurd to deny a patient a right to their own body, to choose their treatment, and to know if they will live or not. The instructor of the class said he doesn’t agree with this either, and that there is currently a law being passed that will prevent this. The rational behind this was that if a patient knows they are dying, they will be stressed and could potentially lose their will to live by knowing this. I thought about this a great deal after the conference and gained a better understanding. There are a great deal of cultural factors that must go into this, such as family roles in the hospital in Spain. Here, the families stop working when their family members are sick, and stay in the hospital with them all day and night for months or years on end. They are truly amazing. They provide extraordinary care for them as well, taking on similar roles as nursing assistants in the US. This conference was very interesting as well. Although I can understand the mentality of this idea while taking Spanish culture into consideration, on a human level I still feel that it is always better to be honest with the patient or family member.
Additional differences in the Spanish health care system include the fact that Placebos are legal in Spain, and given as “pain meds” and psychological medications. I had known this before the conference as I had seen them on my own floor in a med cabinet, but still find this interesting. Also, if a patient has HIV/AIDS in Spain and does not want their wife/husband/girlfriend/boyfriend to know, the hospital will call and tell them anyways, as they are at risk and it is a public health hazard. In the US, we respect the patient’s wish and do not tell the family if they do not wish so, but I can definitely understand why this is done in Spain and am torn between the two. The nurses at the hospital stated, “But they are a person, who could die without treatment, and furthermore infect others. They need to know.” I am completely in agreement with this, but also in agreement with respecting your own patient’s wishes.
Finally, this weekend my class went to Sevilla and Cordoba! This was my final trip of the semester and it was very interesting. I had never been to either part of Spain before, and found them extremely beautiful. It was a great week overall, and I honestly can’t believe how much I learned this week!