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Intensivkurs i Savolinna, Nyslott

2015-10-10

Det började med att våra lärare la upp en inbjudan om att åka till Nyslott i Finland. Nyslott kallas av finnarna för Savolinna. Savolinna är en stad som är ungefär så stor som Kalmar och är lik Kalmar lite svårare tillgänglig att resa till med kollektivtrafiken. Nyslott har även ett slott som är ungefär lika gammal som Kalmar slott och byggdes också i etapper genom århundraden. Det var faktiskt en gång i tiden svensk. Så mycket likheter med Kalmar.

Det var inte så att jag var intresserad av att åka till Finland först, jag hade mycket att göra i skolan, men sedan dök det upp ytterligare ett mail på nätet då en klasskompis ville åka och sa att det fortfarande behövs 2 personer till för att åka. Då jag frågade en annan klasskompis och på kort varsel bestämde vi oss för att åka med till Finland. Eftersom ingen annan ville åka var detta perfekta sättet att se en del av Europa jag inte hade sett tidigare och komma bort lite från Kalmar och se andra sjuksköterskestudenter!

Vi packade våra väskor och åkte med tåget till Köpenhamn. En lärare från Linneuniversitetet skulle följa med vård resa. Det blev Kristiina Heikkilä som faktiskt ursprungligen är från Finland. Det visade sig vara rätt hjälpsam då Kristiina visste en hel del om Finland som hjälpte oss att få mer ut av vår resa.

Meningen med resan var att tillsammans med andra studenter från Norge, Danmark och Finland diskutera och arbeta med teknologi inom vården, kort och gott, robotar.

Från Köpenhamn flög vi till Helsingfors och tog sedan en hyrbil från flygplatsen till Nyslott.

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Finland är ett land som är del i EU och som på många sätt har kommit länge i arbetet med vården än Sverige. Vi fick reda på att det arbetas med en teknologisk dosa som heter “Mirella”. Mirella kan ställas in för olika sorteras behov i hemmet hos människor med behov av hjälp som lever ute på landet där det inte alltid är så lätt att leverera god vård. Mirella kan läsa av temperaturskillnader i en lägenhet, luftfuktighet, den kan anslutas till sändare i säng och matta bredvid sängen – allt för att på ett kontor kunna se hur personen har det i hemmet. Vi diskuterade både för- och nackdelar med teknologin, men sammanfattningsvis kom vi fram till att nya sätt kommer att behövas i framtiden då behovet av vård- och omsorg håller på att ökas och kommer fortsätta att öka med tiden då fler människor blir äldre och vårdpersonalen redan idag inte räcker till.

Det var mycket spännande att se en annan del av Skandinavien, en del som är till stor del influerad av öststaterna. Vi hann tyvärr aldrig titta på Helsinki (Helsingfors), men det får helt enkelt bli en annan gång. Jag hade turen att kunna grilla marshmallows med de finsak och danska studenterna och fick på vägen hem se denna fantastiska vy:
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Som avslutning bjöd skolan på spa på hotellet bredvid studentlägenheterna vi fick bo i under vistelsen. Där passade några finska studenter och ja på att bada iskallt i sjön efter en äkta finsk bastu.

Resan till Nyslott gjorde oss 3 hp rikare i våra betyg och blev betalt av samfundet Nordplus. De organisera var fjärde år en resa till en av de 4 universitet som arbetar tillsammans från Norge, Sverige, Danmark och Finland.

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Typisk finsk: lakritsi. Här på en glass.

Operation TLUX

It was on one of my days at my praktikum I heard there would might be a patient who would receive a lungtransplant. Already at the beginning of my praktikum here at the ICU ward “9D Transplant” at AKH I told my supervisor it would be my higest wish to be watching an organ transplant. Though the lung-transplant (besides of the combination transplant heart-lung, which is not made that often anymore) is the biggest kind of transplant you can do compared to any other transplants.

So there I was, put to the operation. It took a while, because there are a lot of doors before I could reach the right operating-room and find the right operation-nurse who would take care of me. At first Dina took care of me, but they changed later and afterwards Brigitte was the operational-nurse who explained a lot to me. She was a wonderful woman who guided me through a lot of my questions and even had so much more information I would never find in a school-book.

So there they where: 2 big boxes containing a lot of ice and one lung each – of course packed in 3 plastic bags to contain steril. There where a lot of people in the operation-room. I counted at most 13 people: 2 operating surgeons, 1 surgeon-student who was assisting, 2 operation-nurses (one assisting at the surgery at the time, the other assisting the nurse who assisted the surgeons), one person watching the ECMO-machine (a mashine I already wrote about earlier), 2 foreign doctor-students, one other student (for a job where they sterilize probs for operations), 2 anasthesia-personnal (I think on nurse and one doctor) and med. So you can understand that it wasn’t so easy to take a look at the operation. I wasnät able to see everything, but I cpould see a lot. E.g. I could see how the cheast really looks like spare-ribs from the inside. I was even allowed to touch the new (through the plastic bag) and the old lung with gloves on, but I could feel the damage on the old lung.

The person who was operated on was a girl, 18 years old. She had lung-fybrosis which is a disease who gives the person not only a hard time to breath after some years, but it also gives the person problems with hormones. That means that this girl actually looked like she only was 12 years or younger. Now, the new lung was from a boy only 14 years old. The operation-nurse sayed the lung was really beautiful and it would be good for the girl to get such a beautiful lung!

I feel really gifted and happy for this opportunity, because to be part of and watch an organ-transplant was my greatest wish at my internship at AKH. They called this surgery school-book-example transplant becaause a lung-transplant often needs 8-10 hours of operation. Even the recovery of the girl went well and she could get from our traansplant-ICU to an ordinary ward within 2 days.

This transplant was a dubble-lung-transplant. Earlier years they mostely used to transplant only one lung, but it is now more common to transplant 2 lungs at the same time. In Vienna the lung-transplant is a really common transplant-procedure and approx one lung per 10 days is transplanted in Vienna. Acctually all lungs in Austria are transplanted at AKH in Vienna. But that doesn’t mean that it isn’t a complicated procedure. There are some risk to consider by having lungs transplanted in your body. E.g. is the approx life-time of the transplanted organs 10 years, which means that this girl might has to have another lung-transplant in some years. Of course not having a trannsplant wouldn’t have been an option in her case, though of her heriditated disease, but you should consider smoking or not wearing masks in certain working-enviironments – for the health of your lungs. Other complications by transplanting lungs ccan be infections, but there is a risk that the organ that is transplanted not is in a good condition. I have still not really understood why the AKH do transplant organs that are not fully fit for transplant (e.g. a lung that is from a smoker and not so much better thann the lung the person had before – this does not regard the young girl, but other patients I have seen). But I can think of 2 reasons why:

  1. There are not enough organs to choose between. Austria is indeed one out of 3 counttries in Europe where every human beeing automatically is a organ-giver (besides you write a will not to before you get sick/die), but they are also part of an organization ccalled “Eurotransplant”. This is a organization between 8 european countries which work together to distribute organs in these countries. But, they do still have a transplantt-list and people do have to wait for organs. So if there is a person in desperate need for an organ, the person will get it, even if it is not fully fit.
  2. Prestige of doctors – doctors who like to do surgeries and want to keep up a high rate of organ-transplant on their Curriculum or for the hospital. Or because people “buy iin” themselves for an organ. I have accutally heard that this was possible once, but I have no idea if it still does.
  3. There is procedure where you can put e.g. a lung in a glas cube to ventilate it before extransplant it.

WIT – Wiener Intensivmedizinische Tage, Vienna Intensive care medical days

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As I am about to write this I am sitting on an empty train, waiting for it to depart so I can get to work on what I think is going to be a beautiful morning (I feel that today is going to be a sunny day). As I am sitting here I saw a train pass through the station i Mödling where I stay at my mothers house. I often say that my mind is like a child and my patients have thought me that you never loose that child inside of you, no matter how old or sick you are or get. So I did what I always do when seeing a industrial-train: I count the waggons. This time: 36 empty car-waggons.

A week ago my supervisor said there is going to be big congress for hospital-staff, especially for intensive-care staff. He had three tickets for the staff in his hand and said “Oh, look at her, I can see how your eyes just sparkled!” Yes, of course they did! My brain is constantly telling me to want more information and knowledge, it is like a sponge that just won’t fill up till the end! I can only explain this phenomena for myself through the fact I was told when I was little: the human will never use it’s brains full potential, the human brain can just be used partly in life. By writing about that I am thinking about how science has found out that people who use their brain more in their life, e.g. through reading, learning and brain-excercises, tend to have a lower risk of getting dementia. So I can always say that this is my way of preventing dementia in the future.

Well, Wednesday came and the first day of the big convention started. The congress planned 2 Rookie-seminars: one for doctors, one for nurses. So I thought I go to that Rookie-seminar for nurses working in intensive-care. I went to the congress that morning but they told me at the counter that this seminar was not included in the ticket I got from my unit, it was an extra seminar that would coast an extra fee and besides of that it was sold out, the lady told me. At first I was sad and thought, why? I wanted to go to that seminar so badly! So I went up to the unit, sad and disappointed. There I thought about it and how in Vienna the way of thinking is more soft than in Sweden and Germany. So I asked a co-worker if I should try to sneek in instead – he agreed. So I went back. Now with my confidence in my pocket that I would get in as a paying member. It worked! Noone asked about an extra ticket or a booking-confirmation. Besides of that the lady must have meant that the Rookie-seminar for the doctors was sold out, because when I got to the seminar of the nurses, the room was only filled with about 75% of the people who would fit in.

About the seminar: There where especially 2 presentations that cought my interest. The first was about aromatherapy – something they use here at the ICU for their patients. This can be by putting essential oils (in a really small amount) into the rooms of the patiens or by massaging or washing/bathing the patient with a small amount of oil mixed with water. These eessential oils are acutally not used for therapy in the hospital, but they are used for nursing. It is important to know that diffrent oils are used for diffrent purposes. E.g. is peppermint used for cooling, while lavender is for warming but still, calming. It also depends on how you use the oil. E.g. in massage or to smell in the room. Did you know tthat smell is the only sense that goes right up to the brain without talking “extra sidetracks”? That means that the smell is the first sense the brain realizes. And did you know that the airport in Frankfurt, Germany uses lavender in tiny amounts in the air for calming and preventing flight-axienty? At least they told me that at the seminar. The amount of lavender used in the air is so small you can’t smell it, but the brain still can. This is acctually sientifically proven, the woman told us at the seminar. For me this information is especially interessting because I am studying a course about complementary and alternative medicin, or integrative medicin during my time in Vienna at Linneaus university, over the internet. In Sweden we learned a lot about diffrent integrative methods, but I didn’t hear about aromatherapy before that. So I am really going to take that with me as a future nurse and maybe I can be one of the nurses to start using aromatherapy at the hospitals in Sweden one day. Here in Austria this woman was one of the first to use it at her hospital and now they use aromatherapy at many different hospitals in Austria, even at the ICU where I had my praktikum.

The second seminar that cout my attention was about humor within nursing, means keeeping up the spirit at your workingplace with the other co-workers and with your patients. The semminar was so good so the audience laught the 60 minutes he was holding his lecturing. The man told us about how he often found empty boxes in the medicin-cabin, wondering who would ever put an empty box in it! That meant that he got angry about his collegues and this made his day negative. He told us then that he changed HIS attitude by thinking “where is the empty box”, “where are you?”, expecting it to come out and when he found it he got happy. I am acctually thinking right know that there is something I have had hard times to handle in my life. That one thing is everytime someone askes me where I am from. Especially in that small part of Sweden where I live now people tend often to ask me about my heritage. I am actually angry everytime they ask me, because I feel that they judge me asking about this. I don’t want to be “the german” or “the austrian”. The main problem is, though I have multiculture background people always seem to get it wrong where I am from. So maybe this is the time where I have to change that feeling into something good, to think and act like noone else expects me to. Wow, this was accutally a wonderful and fun seminar! He also told us about that there is laughing-yoga you can practise for more fun and happiness in life. And did you know that there is a laughing-institute in Germanny? The work with sientific research there. I find this so funny and I am thrilled to implement more humor and fun in my life. I am acctually already trying my best to be more fun and saying things people don’t exepct me to. Of course, I am not that fast of a thinker when it comes to humor, but I hope I soon will be able to live my life in a more positive and funny way!

Taking a nap at work

Did you know that there are studies who have been made with doctors if it is good to take a nap at work when you work a long shift? These studies have shown that it is good, and that you can gain back your concentration. Here at the ward they have the modell to take a 30-minute nap at working hours sometimes. I know that not everybody is doing it every day they work, but I know that my supervisor e.g. does it sometimes. I was allowed to do that too one day and I can tell for sure that this is a modell I would like to have at my future-working-place. I felt so much better and stronger afterwards again. Just 30 min in a nice room with beautiful lights and calm music. This is actually something I want to take with me to Sweden, not just for doctors and not just for people who work long hour shifts!

 

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The end of my trip

2015-10-08

My 5 weeks of clinical rotation are soon turning to an end. Today I will do my last day at the hospital MCCG (The Medical Center of Central Georgia) in Macon. There have been a lot of good bad also bad experiences. Though this is my second time doing a clinical rotation outside of Sweden I feel that this is normal, because the health-systems work different and different countries have different issues.

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When it comes to obesity I haven’t actually seen so many obese people, more obese children. But when children are obese, they aren’t as obese as grown ups can be. Some of the students told me that it does not need much weight for a child to be obese, but it does for a grown up person. So I think the issue here is mainly children that have fast-food and a lot of sugar in different drinks. The typical drink in Georgia is sweetened-tea. It is tea that is boiled and than they put in a lot of sugar. After that it is served with a lot of cold ice. There is also a good lemonade that is typically for Georgia or you could mix both the tea and the lemonade to get a 50/50. But, there do serve unsweetened tea as well, which I am totally fine with drinking. And everybody drinks it with a plastic-straw. In a styrofoam-cup. From what I experienced here a lot of plastic-dishes are used here, instead of washing dishes. Even at the hospital everything that is used in patient care is basically one-way used. So a lot of plastic. Even the spoon, forks and knives are made in plastic and single-packed in plastic.

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Fresh Donut after a long day of clinical at the hospital 🙂

When it comes to the patient care I see that the nursing-education is very anatomy- and physiology-focused. When I look at how the nurses work though, they do work a lot more with caring-sience, which is not much educated in school, from what I understood from the students. This is the total reverse from Sweden, where the nurse is the expert in caring-sience and the physician (doctor) is the expert in the medical field. I also saw that they use restrainment-orders on arms and legs for patients that are bed-bund and are in need of intensive-care. I recognize this from Vienna in Austria where this also was used for patients awakening from anesthesia from an organ-transplantation. It may seem strange for a Sweden like me, because this is not used in Sweden and totally banned. At the ICU in Kalmar they have nurses (LPN) who sit and wait on the patients, just holding down their hands if they try to fight the tube in their throat. I have been discussing this treatment with nurses in Austria, Sweden and the U.S. and I found that there are advantages and disadvantages. It is easier to work with restrained patients, but it is also a restrainment of one others life. I think here in terms of that another person must feel trapped while awakening, but is it better to hold down the hands and legs by e person? It probably is, yes. But it also needs a lot more staff and people who watch their patients 24/7, every minute of the shift. And after my summer at the ICU working 3-shift, I can tell that it is a HARD job!

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Nursing-station in the hall-way at the pediatric-ward.

This clinical rotation was supposed to be a 5-week rotation in the community. With a community nurse. It turned out not to be exactly like that. I was the first student from Linneaus university to visit GCSU. There have been several students in Växjö at LNU’s campus, but none has gone over to the U.S. from my university. I have had issues with getting to places of my clinical rotations (everything is far away here, but thanks to ALL the WONDERFUL nursing-students I could get my way to all the rotations with them. I did organize a lot of those trips by myself and my roommate Anna which also is a nursing student. I think that 5 weeks is to short to come over to the U.S. for a clinical rotation, because there are a lot of preparations that have to be done while in the States. Their law HIPPA is for the patients safety and confidentiality and is hard regulated. I also heard that nurses have to prove their registration (legitimation in swedish) every other year at a board, so they still have the knowledge for their work. This law makes it hard to just get to a clinical rotation, especially because I am not American.

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Treatment-room for children.

It has been of huge help to live with Anna, Jennie and Beth. They helped me with a lot of questions and also allowed me to borrow their cars, which made it easy for me to shop groceries and get to barns where I spend some of my free-time riding. To live with local people is a easy way to get closer to the community and I think the whole travel mainly gave me a grate cultural experience.

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Cars for children at the ward.

Now the time has come for me to take some vacation. Since I have made all my time for my clinicals and I got signed all my papers, I will leave for Miami on Sunday. I booked a flight yesterday and I hope that I might even make it for a Cruise to the Caribbean. I still don’t know, but there are also other option, e.g. the network called “Air bnb”, which is a homepage where people rent their apartments for a good price. It also gives you the opportunity to meet local people. I plan on grabbing my bags and leaving them at the airport in Atlanta. I will than only travel with my backpack to Florida and later next week return to Atlanta for my final flight home.

I hope you had a great time reading my blog, I will return with some vacation pictures though.

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Georgia is a State well known for casting movies. “Forrest Gump” and “Fried Green Tomatoes” are two movies recorded in Georgia. Anna and I went to “The Whistle Stop Café” which was build for the movie “Fried Green Tomatoes” and we had food with fried green tomatoes which was delicious. Even though the place is simple, it has outstanding food and is situated in a neat surrounding. And of course it looks just like in the movie! A special thank you to Anna Agyao, without here all this has not been possible!

See ya later!