Now I have had 3 days at the intensive-care unit for people who have gone through a organ-transplantat. My supervisor has given my free hands for a lot of things. E.g. does he want me to take care of our patient by myself in the morning. That means I have to take care of the documentation of the machines (if they work properly), the medication for the patient and giving them breakfast. On my second and my third day we had a post-op patient who had gone through a bypass-surgery. That means that the surgeons take a bloodvessel from the patients leg and sew it to the heart to by-pass a vessle that is constipated. So this patient had a tub in his throat when he came to us, this because this type of surgery is a pretty big one (took the whole morning).
So the patient who had gone through the by-pass surgery, had a tube. And my supervisor was about to plan the extubation. He got a syringe and gave it to me for emptiing the cuff off the tube (a cuff is small ballon for fixing the tube inside the throat. For extubating you usually have to empty the ballon that is filled with air). So I didn’t really think, just act. I took the syring and emptied the cuff. And because of my supervisor stood on the bedside and was fixing something with the patients arm I thought he saw what I was doing, but he didn’t. So the next moment he asked if I already had emptied the cuff, which I of course answered yes too. He got confused and I said that I wasn’t allowed to do that already, which of course was a missunderstanding of eachother. He than took out the tub of the patients throat immediately, and was confused towards med. Nurses in Vienna are allowed to extubate, but I acted a little to fast… I think, like I always do: you have to make misstakes to make it right, so next time a better time. But it was a little bit embaressing…
There are acctually a lot of diffrences in the care of patients here compared to what I am used to from Sweden. A tremendous diffrence are especially two things that I found out:
1. All Austrian citizens and visitors that die in Austria are automatically bound to be organ-donors. That means that Austria has no lack of organs for transplantation. Compared to Sweden the number of optional organ-donors is 15%. For Austria this means that there are a lot of people from countries around that come to Austria to get a new organs. Austria is part of an organisation called ”Eurotransplant”, where different countries work together for allocate organs. Austria has today 4 hospitals who work with organ-transplant, 3 of them are university-clinics who work with all types of organ-transplant. Sweden also has 4 hospitals who work with organ-transplant, but not all of them work with transplanting all types of organs.
2. In Sweden at the intensive-care unit in Calmare where I worked during last summer the staff was always forced to sit between patients who where waking up from a sedation. Which ment that I as a nurse had to sit between my patient, putting his hands down every time he/she tried to pull out the tube (which is common that people try to do after a sedation when they had a tub in their throat). Here in Austria there only work registrated nurses (not ”little” nurses and registrated nurses as in Calmare) at the intensive care unit. And the nurses in Vienna at the intensive-care unit for organ-transplant never sit between their patients 24/7 as we do in Calmare. So I wondered why. After 2 days of work I got the answer: here in Austria the law has given nurses a different opportunity in caring for their patients: when they come to the ward after a surgery they make the first arrangements together like changing sheets, changing maschines but they also put wrist-bands on the lower arms and tie them to the bed. This is an arrangement which is allowed in Austria and helps the nurses so they don’t have to sit besides the patient all the time as we do in Calmare. Of course the ward has monitors in the lunch-room, in the medicin-room and in the office, where all the stuff can see the values (blodpressure, puls, saturation ect.) and hear if the alarm. I think this is more convenient, though I found it hardto sit and stare at my patients the whole last summer…
I am not allowed to take any pictures from the ward, therefore I decided to draw what I see. I am not a talented drawer, but I will do what I can to give you a glimpse of what the hospital in Vienna looks like. Here you can see a picture (which I was allowed to take) and how much/little alike it is to what I see. I am trying to prior what is important, so not all details will be shown in my drawings.