Normal 0 false false false MicrosoftInternetExplorer4 st1\:*{behavior:url(#ieooui) } Dr. James McCord and his wife, Margaret, opened the faith-based Missionary hospital just outside the boundaries of Durban on May 1^st, 1909. The school of nursing was developed in 1920. With a supportive nursing and medical staff, The facility provided health care services to the Zulu people of the area, and also offered treatment and training programs to all who walked through the doors. As the city changed over the years, the white urbanites were unhappy having a hospital for mainly black patients so nearby. Through the apartheid era, McCord hospital has faced political and social opposition, yet retains a reputation for providing excellent and compassionate care to those in need.

“The hospital’s visionary leadership, deep Christian faith and resolute perseverance in its stand for righteousness and justice in serving primarily the black population has enabled it to survive these turbulent years of opposition, threats of closure, political persecution, and financial pressures” –Dr. Helga Holst, CEO

As a semi-private hospital, the 166 bed facility has provided cost-effective health care services and training to the under-served in the greater eThekwini region. Through state and donor funding, the hospital requires patients to pay only 70% of the costs for consultations and treatments.

McCord is internationally recognized in the field of HIV/Aids care and treatment. The HIV/Aids clinic was named Sinikithemba, which in Zulu means “We give Hope”. Researchers from Harvard University have partnered with this hospital to continue researching the disease. Partnerships have also been formed with Massachusetts General Hospital in order to develop research and training programs.

The Nursing Hierarchy at McCord Hospital:

Nursing assistants: 1 year of training to make beds and perform patient observations.

Enrolled nurses: 2 years of training, primarily take blood and give injections

Professional nurses: 4 years of education which includes general nursing, midwifery, psychiatric and community nursing.

Nursing Service Managers: The highest nursing position. "Senior Nursing Service Manager"

 Nursing seniority and level of experience is indicated on the uniform; various badges are pinned onto epaulettes. Basically, the more qualified and educated a nurse, the more badges and bars on the epaulettes of the uniform.

During my six week rotation in the hospital, I spent two weeks on a post-operative surgical floor for female patients, and then the remaining four weeks in the casualty department. Through working at the Johns Hopkins Hospital part-time during school, I was accustomed to working really hard at a very fast past. The transition into a surgical ward at McCord’s was a change in clinical practice as well as clinical pace. I completed my assigned tasks and additional allocated jobs and then spent the remainder of my time talking with nurses, doctors, and interns about their experiences in the South African system of health care.

While in the casualty department, I reviewed and learned clinical pathophysiology from working closely with the doctors and interns and assisted nursing students in completing daily allocated tasks. A typical day included sitting in on clinical consultations with doctors, reading x-rays, providing basic interventions for patients with hyperglycemia or hypertension, assisting with IV set-ups, monitoring patients, completing ECG’s, applying and removing plaster casts for orthopedic patients,  and documenting interventions. On most days during the week, I would go on rounds with the interns to follow-up on patients who came into the casualty department and were subsequently admitted to the hospital. The nurses were full of priceless stories about their history during the apartheid era and history of South Africa and Africa as a whole. The best compliment I received during the stay at McCord was when one of the older Black African night nurses said to another nurse regarding my company on the unit: “She’s not a white woman… she’s one of us!” I felt so honored to be accepted into the McCord Family and to be viewed as an interested and caring person.

What a way to finish with nursing school. I am delighted and honored to have taken part in this international transitions experience and look forward to a return trip in the future.

As earnest and genuine as all intentions are for every patient, mistakes happen.

My dear 57 year old woman was visited by her two teenage sons today on my unit at the hospital. Due to her transmittable infections, this woman was placed in her own room on specific isolation procedures. The requirement for entering these types of rooms involves gowning up, wearing gloves, and sometimes a mask to avoid spreading infectious agents to other patients. Visitors are encouraged to wrap up their bulky belongings into clear bags before entering the room to avoid introducing other transmittable germs from the outside. The patient’s boys wore heavy coats into the hospital, and a staff member assisted them in removing their outer layer and placing it into a bag before entering their mom’s room.

The woman went off for a procedure, and as her boys followed, the empty room received some cleaning and straightening up. At the end of the routine cleaning, two full linen bags made their journey down 9 floors through the linen chute, garbage was taken out, and the room was neat, tidy, and ready for the patient to return.

Thirty minutes later, the staff warmly welcomed the patient back from her procedure, but her sons immediately noticed that their bag of clothing left in the room was missing. The boys’ jackets were mistakenly placed into a blue linen bag instead of a clear one for isolation precautions and were subsequently deposited down the line chute during routine cleaning.

I quickly reassured the teens that their jackets would be retrieved; it was simply a matter of sorting through all the linen bags in order to find their belongings. Unfortunately, a staff member from the floor was required to do the dirty work. Due to my oversensitive conscious and true devotion to my patient’s care, I found myself running down 8 flights of stairs and then into the basement to dig through linen bags piled three feet high in a 5x5 room. Determined to return the jackets safely to their owner, I ripped open bags, dug deep into piles of damp linens, and heaved the rejected bags into a corner. Meanwhile, the over-head chute continued to drop bags above my head.

The stench of soaked bed sheets, gowns, and blankets infiltrated my nostrils. Overcome with the moist smell and my own bodily perspiration from tearing open and sorting through all the linen bags from 8 different floors, my heart dropped when my hands opened the last bag and only found a dirty baby blanket. Two young linen assistants standing nearby explained that the most recent pick-up for linen cleaning was thirty minutes earlier. The jackets were already on their way to the hospital’s major cleaning facility. My hands were sweating profusely due to thirty minute of manual labor while encased in medical surgical gloves. My own scrubs stunk of soiled bed sheets. After an honest search, I admitted defeat and glumly returned to the floor empty-handed. The charge nurse and desk clerk played telephone tag with the managers in charge of the hospital linen to report the missing belongings. The family was made aware of the situation and our efforts to ameliorate the mistake.

After a bit of time has passed, I entered the woman’s room with hesitation. Her sons left the hospital all worked up, and now it was just the two of us. I felt uneasy, assuming that she too, was still upset. We sat for a while together discussing the day’s events. To my surprise, she didn’t dwell on the fact that two expensive jackets were lost. She instead disclosed that her life had continually been full of hardships, one of which included losing her son in a shooting. “Patience, kindness, and forgiveness” she said, “is what I teach my sons.” She was calm, collected, and emphasized the point that life happens, mistakes occur, but it is truly how we respond to mistakes which makes the difference. Her words soothed my angst about the material loss and comforted my worried conscious. I regained a fresh perspective on what I value in life and reminded myself of the difference between crisis and inconvenience.  As a nursing student, I am learning how to take care of my patients, but today, this woman helped to take care of me.

I began my journey in the outpatient Ear Nose and Throat Clinic (Otolaryngology) with the first (of many) patients for the day. This patient waited patiently in the exam room ready to have his nasal cavity invaded by an intrusive scope meant to creep down the back of the throat until reaching the vocal cords. If the sensation of a snake slithering up through a narrow nasal cavity and down to the vocal cords isn’t strange enough, all of the internal action would be recorded on a videoscope camera. The scope projects the internal airway anatomy onto a computer screen as the clinician probes. After “scoping” the patient, the movement of the vocal cords could be re-played on the computer screen in order to be viewed by the patient and other clinicians for an assessment of the case.

During my two days shadowing in the ENT clinic, two doctors/surgeons allowed me to assist with their patients’ care, health histories, and subsequent evaluation of the presenting cases. I viewed every single set of vocal cords that walked into the clinic, and in one case, viewed the bronchi of a patient with a tracheostomy. The videoscope went directly through the tracheostomy hole.  It’s not every day that a student nurse views the inside of a patient’s trachea and bifurcation of the bronchii through a videoscope.

Other interesting sites that the videoscope showed me:
Abnormal unilateral mass on of the vocal cords
Vocal cord paralysis
Fused vocal cords
The effects of fractured arytenoids on the larynx

Reasons patients attend the ENT clinic when I was visiting:
Wheelbarrow accident: A patient fell against the edge of a wheelbarrow and fractured his arytenoid cartilage which surrounds his larynx.
Hoarseness: A nuclear physicist visited the clinic after experiencing a loss of voice and pain radiating through his ear during his lectures at the University.
Sinus issues: A patient’s sinuses were chronically plugged up, so the doctors recommended surgical intervention to clear them.
Abnormal lesions on the tongue (possibly related to a base of tongue cancer)
Cancer or abnormalities in any part of the ear, nose, throat anatomy
Pain when speaking
Tracheostomy scoping
Sleep apnea

These doctors see patients in the outpatient clinic a few days a week. On days that they don’t present to the clinic, they may be found in the operating room wearing the hat of the surgeon and operating on their patients, or taking on the role of the researcher and working in the lab. Many of the doctors in the ENT clinic also teach in the medical school.

The hospital is the most amazing place to learn about unique medical cases and subsequent patient care. The doctors and nurses in the ENT clinic welcomed me into their treatment area, incorporated my skills into their patients’ care, and oriented me to their passion of treatment and diagnosis of head and neck abnormalities. They are recruiting nurses, and I would love to go back.

Here are the overdue-notices from the life of the working half-time and studying full-time nursing student. The end of October finds me up to my nostrils in school assignments, clinical, and readings. I’m facing this intense “busyness” with meticulous time management and a jar of peanut butter in one hand along with a spoon in the other.

Medical Surgical Nursing Clinical began last week. I’m working on a unit for post-surgical oncology patients. Drains and holes are quiet prevalent. With any drain, there is leakage, and with any hole, (especially from the tracheal area) suctioning is required. Fluid must come out of the body! Welcome to Nursing in the Head and Neck Oncology Unit! Students in my clinical group are becoming more familiar with the art of tracheostomy care, suctioning airways, caring for patients with complete laryngectomies (the larynx-voice box is completely removed due to cancer), administering feedings through tubes and emptying tubes from surgically-created holes in random parts of the body. From day one on the floor, we recognized very quickly the detrimental effects of smoking and drinking which (in many cases) lead patients to develop cancer and land themselves on our unit.

Clinical work and the half-time commitment to the other medical surgical unit are very rewarding experiences right now. It’s a joy to work with patients and help them through their time of distress, and General Medicine and Surgery absolutely fascinates me. Anatomy and Physiology captured my interest early on and by working in the hospital with the drains, holes, and internal medical issues, I am constantly learning more about the human body.

1. Work  

2. Visit Fort McHenry

3. Attend Baltimore’s very unique annual “Artscape”

 

4. Road trip up to Philadelphia for the Mütter Museum of Anatomical Awesomeness

5. Take the Marc Train to DC

6. Spend a day at Delaware’s Eastern Shoreline










7.  Explore Harpers Ferry, hike the AT, and catch a view of three states- MD, VA, WV

8. Go Hiking on the Maryland Heights and the Appalachian Trail

9.  Visit Baltimore's Museums- Art, History, Culture galore

10. Wear sunscreen and have fun outdoors

 She dug through the pretzel bag searching for just the right one as her husband fondly looked on. “It’s the little things,” he whispered, as I watched their interaction from the edge of the bed. My patient’s husband predictably drove to the hospital every morning to arrive promptly at 10:00 with the coveted bag of pretzels from Trader Joes. His wife eagerly awaited his visit and told the nurses not to flirt too much with him, after all, he had been “taken” for 47 years.  Since being diagnosed with a mysterious tumor in the posterior lobe of her brain, this woman began to rely more heavily on the devout support of her husband and enjoy the little things in life a bit more, as the extent of her future was unknown.

Sitting next to her on the bed, I assessed her vitals beginning by gently squeezing my blood pressure cuff around her thin and frail arm. Counting her respirations, I heard wheezes and saw muscular strain upon breathing. She was losing weight and her condition was deteriorating. When asked how her condition originally manifested itself, she stated that her friends and family commented on the development of odd behaviors. “It was a team effort,” she said. “Without my husband, friends, and family, I wouldn’t have known. What scares me most, however, is what will happen in the future. The doctors just don’t know what’s going on.” I sat near her on the bed, patting a homemade quilt that a friend knitted for her. Her hand met mine, and I gave it a warm squeeze, and let her interpret the kind and supportive meaning behind the gesture.  
 

Her wedding band caught in the folds of the quilt. She gently unhooked the fabric and looked onward at her husband. “Remember when you gave this to me?” She turned toward me and mentioned that she looked a lot better when her proposed to her than now, as she wrapped up her small body in a loose hospital gown and thin bathrobe. Her husband pulled from his wallet the pictures from when they were “going steady” and bragged about how lucky he felt dating the most beautiful woman in town.
 

A knock on the door interrupted the flashback down memory lane. The doctor on rounds entered the room and explained the next brain imaging test to be performed. He briefly addressed what he hoped that the results would show and touched lightly on the next step in treatment. As he exited the room, a sigh slipped from my patient’s lips. “These doctors are good- they are knowledgeable, professional, and they know their tests … I just wish that they would find something so that I could go home.”
 

As I gathered some of my equipment from the bedside, I looked at my patient and said, “So, your doctors are checking up on you, your husband never leaves your side, but what can I do as a nurse to help you through this process?” She met my eyes with a soft and compassionate look and said, “A good nurse, honey, looks at pictures from my youth, listens to me tell about important parts of my life, and takes the time to remind me that I am really a person, and not just a patient in the hospital. Just keep on doing what you are doing.” A little bit of time, patience, kindness, and compassion made a unique difference in the health and healing of this woman in the hospital bed.

Physical assessments and patient education are critical in nursing, but this profession also allows for very personalized attention at the bedside which may just be the healing touch in the recovery process- be it physical, mental, or spiritual.

Thursday:
8:00 AM:  A 19 year-old Hispanic Woman comes into the unit for a scheduled C-Section.  She speaks no English. With a few years of undergraduate Spanish and a recent medical terminology course under my belt, she's designated to be my patient for the day.
 8:30: As a translator, I help the nurse complete her assessment information and prepare her for the operating room.
9:00: I orient her husband to the recovery room, assist him in gowning up for the operating room, and explain what will happen during the procedure.
9:30: My patient and I are in the OR with the scrub nurse, resident and attending anesthesiologist, and resident and attending surgeon. As my patient receives her epidural, the attending anesthesiologist explains to me step-by-step what the resident will do to administer the pain medication. I help to translate this process to my patient.
9:45: I gown myself in sterile scrubs and gloves to assist in the operation with the surgeon and resident. Elbow to elbow with the surgeon, she explains to me the process of the cesarean. Layer by layer my patient is sliced open. Upon reaching the uterus, one last precise incision is made and the bag of water is ruptured. My gown is soaked in amniotic fluid, my hands and wrists are covered in blood.
10:04: The attending pulls out a 38 week-old baby boy. My hands catch part of the baby and cradle him as the umbilical cord is cut. The attending surgeon pulls the uterus out of the woman’s abdomen while cleansing  the patient’s inner cavity. She points out to me the ovaries and the fallopian tubes. I help the attending and resident by retracting the initial incision’s edges while my patient’s uterus is sewn back together and returned to the abdomen. 
10:45: My patient is stitched up, her baby is in a bassinet nearby undergoing initial assessments, and the surgeons are leaving the OR. I speak with my patient about her delivery, ask her how she is feeling, and reenact the sensation of catching her baby from the uterus, and how beautiful his little face was. 
11:15: In the recovery room, I assess the vital signs of my new mom, put a warm blanket on her, and explain to her how to use her patient-controlled anesthesia pump.
11:30: I wrap up her new baby in a warm blanket, bring it to her chest, and we both admire his soft features and tiny body. He sucks on my finger.
11:45: A lesson in breast feeding- My new mom never breast fed .  I teach her how to cradle his head against her chest,  which sounds to listen for to assure that he is suckling, and I explain the importance of her own milk during the first few hours of the child’s life.
12:00: I recognize the phenomenal opportunity that I have as a nurse to support my patient.  I was at her side from the moment she walked in the door to the unit until that priceless moment when her baby suckled from her breast for the first time.  For a 19 year-old woman, these moments are scary, anxiety provoking, and extremely personal.  As a nursing student and her advocate, I educated and comforted my patient while simultaneously acting as her voice and translator.

Why I chose nursing? For priceless experiences  like these: using the Spanish language to coach a fearful young patient through the process of receiving an epidural and catheter; the opportunity teach her the process of breast feeding;  and the ability to sooth this new mom’s worries by assuring her that I’ll be at her side through the entire process.

The way I felt today is how I want to feel the rest of my career in nursing.

Spring has sprung and spring break is knocking on our front doors... really breaking the door down. We are all ready for our upcoming ten days of freedom.

This term is half-way through. It's notorious (and now I understand why) for the intense work load with pathophysiology, pharmacology, OB and Psychiatric Nursing rotations. I just finished my Psych rotation and will begin OB after the break. The experience in the psychiatric unit was tremendous. My clinical instructor's contribution to our learning was priceless, and the interaction with patients was humbling. Each day I left the unit with a broader sense of what happiness, joy, and suffering means to different people.

Here are some of my favorite snippets of information from pharmacology and pathophysiology flashcard* land:

1. The length of the human kidney is comparable to the length of a business card.

2. Tuberculosis may be in any part of the human body, not just the lungs.

3. Periwinkle isn't just the pretty little flower- It is also used therapeutically in medicine as a pain reliever.

* Flashcards make the difference when studying for tests...A very effective technique for memorizing different medications.

What I've learned from fellow students:

1. After fleeing countries of origin during civil wars, taking tests in the university setting really isn't a big deal. What a valuable perspective to keep in mind when it seems that the world is ending after a bad test!

2. Balancing family and school is a challenge. When I think about how busy I am with school, I remember my peers who take  care of their children, husbands, or wives as well. My perspective on "busy" changes. One of the nurses on my psych unit mentioned how she raised her two teenagers while getting through nursing school. She would sit in her car to study.  

3. I can travel around the world just by listening to classmate's stories from their international experiences. The greatest lessons that I've learned during this program actually come from my fellow students. From years of travel, teaching, and learning in different parts of the world, they bring to this program unique perspectives on how to live life in a manner that respects their happiness and health.