Showing posts with label Surgical Block. Show all posts
Showing posts with label Surgical Block. Show all posts

Monday, June 5, 2017

Singapore General Hospital Attachment (Week 3 & 4), 22 May to 02 June 2017 - Reflection

By Bernard Goh - My week 4 attachment at SGH in the Nursing course


Time past very fast.
PHOTO: Time past very fast. We are now into our 3rd and 4th week at the surgical block. Theoretical knowledge and practical skills are both indispensable. In fact they complement each other when comes to error detection, error prevention, and making the decisive course of action.
Experience and information are required to perform the tasks efficiently with minimum discomfort to the patients. This is where proper documentation plays an important part in the healthcare process. Records of patients need to be created and kept properly for the benefits of everybody in the team. Patients' admission, medication, drugs allergy, treatment, history and after discharge planning are vital information that every healthcare professional must know how to record, maintain and use.
Picture posted by SporeLa.com
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh034S7rWVWgeXMxX0huj92lE8cSnK7juT0e2rncNMFfq-uoZ3lnC5iu3ovenvNAJLhSZGzo2WxLG4wqk1phVyUPy7ersD1KBahj5FzhTLhJqSz9nGcPWNr2EFAiyec7EcbTDfZvZ2ry_8f/s1600/singapore_general_hospital_pic2a-400px.jpg
http://www.sporela.com/images/media2014/frontpage2015/2015/singapore_general_hospital_pic2a-400px.jpg
http://www.sporela.com/index.php/latest-singapore-news/2062-22-acute-hepatitis-c-infections-found-in-singapore-general-hospital-sgh-incident-being-reviewed


Without noticing, we are already approaching the last week of surgical posting at SGH. It has definitely been a very tiring but fulfilling journey for our first posting at an acute hospital. Theory and practical may not always be exactly similar but theoretical knowledge is definitely indispensable from preventing avoidable errors from happening.

Some of the main highlights that I manage to experience these 2 weeks would be patient admission and discharge planning, along with brushing up skills on serving medication and IV therapy. IV is an abbreviation for intravenous, a procedure where a needle is inserted directly into a vein to deliver liquids to the blood stream.


During week 3 and 4, we managed to have hands-on experience on patients' documentation in the ward.
PHOTO: During week 3 and 4, we managed to have hands-on experience on patients' documentation in the ward. This include paper work for patient admission and after discharge planning, as well as updating, maintaining and populating the patients' vital signs records daily. The administrators and doctors need these data to implement the best solution for the patients. Our accuracy is a must for their fast recovery and later stage planning.
Picture posted by Eastern Daylight Time on 23 July 2015 at 07:33 AM
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB09o0BRLBwO_Ic2U9ECK_X9plVkHzzfGhz4TV5OhGqn7JEh7sTqgJhok34J05Ht_6-T3LoKr4uAhwMvcjCxitxdOPg4hHjruzyuopbX2iuxLBOf_oXtwsE70NKTMNeO-F3yEF4tm9WiJ2/s1600/JJ8A0698.jpg
http://mms.businesswire.com/media/20150723005636/en/478204/5/JJ8A0698.jpg
http://www.businesswire.com/news/home/20150723005636/en/Panasonic-Autonomous-Delivery-Robots-%E2%80%93-HOSPI-%E2%80%93


What does IV stand for in the hospital?
PHOTO: What does IV stand for in the hospital?
According to MedlinePlus, "IV" stands for "intravenous," which means "within a vein." The term "IV" typically refers to an intravenous needle or tube used to deliver additional blood, medication or other fluids directly into the body's bloodstream. [1]
Picture posted by Wikipedia, the free encyclopedia - Infusion therapy: A person receiving medication via intravenous therapy
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVWn3Zp1o7ZQ8OvwCy88NPRwePH098Jedb3iLiMSu9NUQEBG7jl2GXRZzogzOGFwo47iTlfjJskWr-YJB1BapagRUGiZ09VuIcCypr0kmkAYurM3cp1HTNv1gKDpF3CHXM20YA5YYKOGZb/s1600/ICU_IV_1.jpg
https://upload.wikimedia.org/wikipedia/commons/0/0d/ICU_IV_1.jpg
https://en.wikipedia.org/wiki/Intravenous_therapy


Firstly, I am thankful to have met helpful colleagues who were willing to take some time off during the work to guide us. It means a lot to me that we were being seen as part of the team working together. Through this 2 weeks I have managed to explored the COW (Computer On Wheels) more and familiarize myself with it. Using the COW, we were also tasked to complete a single case study which was to be presented to our CI (Clinical Instructor).

Preparing a case study made me realize how difficult and important it is just to plan a care for one patient. And it is just one patient, not to mention that the nurses or doing adjustment to care plans daily for multiple patients. Knowing the medications on our fingertips is something that I am still far from satisfactory but I’m making progress. Knowing the medication would give us firsthand information on what could possibly be the condition of the patient.


Computer On Wheels (COW)
PHOTO: Computer On Wheels (COW)
Our hospitals in Singapore are going high-tech and Computer On Wheel are being used in many tasks like nurse medication dispensing, presentation, and patient care planning. All these tasks can now be carry out with the help of these COWs almost anywhere, and information are available almost instantly within the hospital.
Knowing the medication for a patient is already an indication of what could possibly be the condition of the patient. We can then recommend, for example, the correct meals selection to the patients. A patient with irregular heart beats will not be offered coffee, tea or milo. Strictly no caffeine because it can irritate the central nervous system further. Any food or fruits with high potassium content may increases the body's potassium level above the unacceptable 5.1 value, and is therefore not appropriate to be taken.
Picture posted by Rubbermaid Healthcare
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https://www.rubbermaidhealthcare.com/SiteAssets/img/products/in-use-images/computer-carts-overview.png
https://www.rubbermaidhealthcare.com/products/pages/computer-carts-solution.aspx


Knowing the admission and discharge procedures is another important aspect of patient care. Initially, I was sort of fixated on just the patient’s condition. However, it is also important to find out more about the patient’s living condition and special requirements. A more holistic understanding would allow us to better plan our care for them as we cannot be there for them after they leave the hospital. Furthermore, there are those who are lacking in knowledge, access to help or just simply alone. These reasons are also why we are there to minimize the problems that they have hopefully to evoke a positive change in their life.


It is not just the patient's medical condition that determines the survival well-being.
PHOTO: It is not just the patient's medical condition that determines the survival well-being. Equally important are the patient's living condition, financial ability, and special requirements. A more holistic understanding would allow us to better plan the after care for them after they leave the hospital. A peaceful community hospital without the full emergency facilities 7/24 may be more suitable for recuperation and peace of mind. The patient might be sent for financial counseling.
Picture posted by Singapore General Hospital on 03 March 2016
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBqpj612EgF6CUZSb660HFQg0_glYjo0-hNDq8j4yaxTHClylX-WNQeAt1cYq8Yj-hRLruaPwyxBDJyos7faQNhxZkHbwxYzcTSBzgvv6JRTPwY5nHnqKZx8xJnqSo-YYg1ieq_racA-oq/s1600/Cost+and+Payment-1.png
https://www.facebook.com/SingaporeGeneralHospital/videos/vb.47292171680/10153319139906681/?type=2&theater


Along the way I definitely managed to gain quite a bit of positive experience but also little sorrowful ones. Sadly, during my surgical posting there was a patient who had unfortunately passed on. Although it wasn’t during my shift, it has undoubtedly struck me emotionally. It made me wonder if there was any care that I have done that might have contributed to it, or have I actually made the situation better than it would have been. Various thoughts flowed through my mind, thinking how fragile life is. Of course entering such an environment, one should expect to see such cases. Witnessing the loss of one’s patient under your care would nonetheless nail a soft spot somewhere within me, but I guess that’s what makes us human.


Sometime it strikes us very hard, especially when our patient whom we have developed affection suddenly passed on.
PHOTO: Sometime it strikes us very hard, especially when our patient whom we have developed affection suddenly passed on. Life is very fragile despite all the calling for us to become the invincible. We are all human and human have emotional feelings. Witnessing the loss of one’s patient under our care would nonetheless nail a soft spot somewhere. The call to be with God once more may be a happy occasion but we can't help feeling sad when our loved one is no longer with us.
Picture posted by Singapore Health Issue on 01 March 2016 - A last good deed (Singapore Health Issue, March-April 2016, Pg 10)
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKcN3hjKFX9ecaek8TfEtrC9g6fL-qzaZET03yMVAmBjuh5xPshb0utZ2nGfaW0FQBqY0oYe5jP-PsIOY2L70gli0kEg0fdp2s8YLhsSBbx7QlxPftBBUfPkxbIYg6BMtxnpeKp8OhwDSH/s1600/10-NEWS_organ-donation_V3_ML-1.gif
https://www.sgh.com.sg/about-us/newsroom/News-Articles-Reports/PublishingImages/2016/Singapore%20Health/Mar-Apr%202016/10-NEWS_organ-donation_V3_ML-1.gif
https://www.sgh.com.sg/about-us/newsroom/News-Articles-Reports/Pages/Alastgooddeed.aspx


As our surgical posting draws to an end, a new chapter is about to unfold. Bringing our experiences and knowledge from the past 4 weeks, I tell myself to be more capable and useful and most importantly make a positive change in others’ lives whoever I may come across.


Everything comes to an end sooner or later.
PHOTO: Everything comes to an end sooner or later. The same for our surgical posting but we will be venturing into the medical block. Hopefully our experiences and friendship gained can make us more capable and useful to the healthcare industry, now and in the future. Whoever and wherever we are, we have yet to touch more life and continue to make the positive changes in others and ourselves for the better. May God's blessing descend upon us.
Picture posted by Todays, Mediacorp Press Ltd - Mr Lee Kuan Yew remembered across Singapore. A woman is comforted by hospital staff as she cries at Singapore General Hospital where former prime minister Lee Kuan Yew passed away in Singapore on 23 March 2015 (03:18 am) at the age of 91. [2]
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitLLjG9ujxObgcnsjPwZw2hQu2w_O7iHvKoZUG27lefAOHYMmM6Fo6Fz73MrcQO-HGR_klMcuWS2oGZqpwO4FI1lhOUvw7_HuELl4rb4CpREngln6v60P1-x_a3YnrIVlLxbR9Lvaf6eiu/s1600/aptopix_singapore_lee_kuan_yew_reaction.jpeg-0fed3_read-only.jpg
http://m.todayonline.com/sites/default/files/styles/photo_gallery_image_lightbox/public/photos/43_images/aptopix_singapore_lee_kuan_yew_reaction.jpeg-0fed3_read-only.jpg?itok=40LM_f-F
http://m.todayonline.com/rememberinglky/singaporeans-remember-lee-kuan-yew

By Bernard Goh - My week 4 attachment at SGH in the Nursing course



Reference
[1] Wikipedia, the free encyclopedia, Intravenous therapy, https://en.wikipedia.org/wiki/Intravenous_therapy

[2] Wikipedia, the free encyclopedia, Lee Kuan Yew, https://en.wikipedia.org/wiki/Lee_Kuan_Yew

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Sunday, June 4, 2017

Singapore General Hospital Attachment (Week 2), 08 to 19 May 2017 - Reflection

By Bernard Goh - My week 2 attachment at SGH in the Nursing course


What is an acute care hospital?
PHOTO: What is an acute care hospital?
Acute care is a branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. In medical terms, care for acute health conditions is the opposite from chronic care, or longer term care. [1]
 
My course-mates and I are assigned to Singapore General Hospital for our 6 weeks attachment after the second semester in Nursing Studies. As with the first attachment at Ang Mo Kio - Thye Hwa Kwang Hospital, we are expected to adapt to our new working environment and quickly build rapport with the staffs.

What that follows is again another exciting and interesting learning journey in the Healthcare industry. We get to meet many people from all walks of life. They are the patients whom we have to help to rebuilt their health to their former healthy days, and the staffs whose one sole aim is to contribute professionally to the Healthcare industry in the midst of all the obstacles, challenges and difficulties.
Picture posted by The Straits Times, SPH Digital News on 16 October 2015 at 8:13 pm SGT
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http://www.straitstimes.com/sites/default/files/styles/x_large/public/articles/2015/10/16/mhpixsgh161015.jpg?itok=MH6uWkF4
http://www.straitstimes.com/singapore/health/441-sgh-patients-tested-negative-for-hepatitis-c


The first thought of being posted to an acute hospital is that everything is going to faster pace as compared to community hospitals. As expected, it really is. The expectations of us despite being a year 1 student was to pick up information quickly, learn to adapt to our new working environment and quickly build rapport with the staffs. Personally, I felt that building rapport was my top priority at the start as it determines whether or not we would be able to proceed smoothly for the first 2 weeks. And I’m glad things turned out well.


Building a good rapport with the staffs in the ward is very important because then we can carry on to work together smoothly and efficiently without sacrificing the quality of our services.
PHOTO: Building a good rapport with the staffs in the ward is very important because then we can carry on to work together smoothly and efficiently without sacrificing the quality of our services. We are taught to be attentive to details and have a humble attitude when being instructed by others who have been experienced in this line of duty. Things turned out well for us as we managed to gain the trust of the staffs, and also because of their ability and willingness to impart the skills and knowledge to us.
Picture posted by The Business Times, SPH Digital News on Tuesday, 08 December 2015 at 15:35
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4Mlph3COGnZnD_Ziic-Zt9TziqSqEDSYzU79PB2yyavKyT7mbKalf_Ka4nUgkiAHEE5eN4bqgI0KvUioDQsYloaRLw1mdROtt38v5uNO9lAw4auJiBbBGXxVAqC06DOeG0mPb1yjHMUm6/s1600/SGHWard081215_0.jpg
http://www.businesstimes.com.sg/sites/default/files/styles/lifestyle_cover/public/image/2015/12/08/SGHWard081215_0.jpg?itok=bEN8ZxyV
http://www.businesstimes.com.sg/government-economy/sgh-hep-c-outbreak-due-to-multiple-factors-panel


Jumping into the ward after 1 day of orientation definitely wasn’t enough for me to familiarize. It took me approximately till the end of week 1 for me to get the hang of what I was doing. On a positive note, I didn’t have much problem opening up to my patients and they were very understanding of my situation as student. It wasn’t long before I gained their trust to let me attend to them.


Gaining the trust of the staffs is an important task of anybody new to the Hospital.
PHOTO: Gaining the trust of the staffs is an important task of anybody new to the Hospital. But gaining the trust of the patients to allow us to attend to them is also another challenging tasks. Fortunately the patients are very understanding and after the first week they accepted us, although as student nurses.
Photo by Tukiman Warji
Picture posted by The Straits Times on 21 July 2015 at 5:10 am SGT - Ms Nur Faridah Mohd Mokhtar, senior staff nurse at Singapore General Hospital (SGH) attending to the needs of a patient.
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9ur5vVsBERO-EKHGRcd6bcsIc-RzbCCsBrtc_f1I4d4nsisc78SXpp8-xtvn0ItIUvrsI0Yx4WR1G_iexCf-uziDJrsJLfBRTXZwFlsNDI4JRhAW-7m2V5lx2m1153sziVtbSqIs77ek3/s1600/nur2107153-1.jpg
http://www.straitstimes.com/sites/default/files/styles/article_pictrure_780x520_/public/articles/2015/07/21/nur2107153.jpg?itok=j5-zLF6g
http://www.straitstimes.com/forum/letters-in-print/retaining-talent-takes-confidence


Initially, anything that we do had to be supervised by the SN/EN (Staff Nurse/Enrol Nurse) in the ward. I see it as a trust building phase where they roughly get a gauge of how capable are we at handling situations and to what extent. Slowly but surely, we begin to build rapport with our fellow colleagues in the ward. Soon they too started trusting us. I felt that this milestone was very important in reassuring us whether or not we are going the right track. Of course, not everything was allowed to be done without their supervision, but for routines like vital signs or oral feeding, it is possible.


Being new to the ward, we are supervised by the SN/EN (Staff Nurse/Enroll Nurse).
PHOTO: Being new to the ward, we are supervised by the SN/EN (Staff Nurse/Enrol Nurse). After the initial phase we are only allowed to perform routine tasks like taking vital signs, oral feeding and attend to the patients' toilet needs. For example, washing and taking care of patients' body.
Nurse Educators, mentor and coach students attached to SGH and also serve as an educational resource for nurses.
Picture posted by Singapore General Hospital
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https://www.sgh.com.sg/Clinical-Departments-Centers/Nursing/nursingprofession/PublishingImages/nurseEdu.jpg
https://www.sgh.com.sg/clinical-departments-centers/nursing/nursingprofession/pages/nurse-educator.aspx


Through this 2 weeks I get to experience a variety of different interactions not with the patients but their family members. I’ll just list 1 or 2 examples. There was a family member that was extremely concerned as to why the patient has to be on NGT (Nasogastric Tube). To me, I saw it as a privilege for me to be able to explain to them the need and also educate them slightly on what to look out for NGT. In response, they were very appreciative and it has definitely raised the mood for my day. Following, there are also family members that are extremely concerned with the condition of the patient such that they question the nurses frequently. As this is our profession, we are not supposed to reject or turn down no matter how busy we are and to patiently handle the situation and hopefully minimize their anxiety.


Nasogastric Tube (NGT)
PHOTO: Nasogastric Tube (NGT)
Ø  Gavage (feeding) / Lavage (suctioning)
Ø  Select the nostril that has greater airflow.
Ø  Assist the client to a high fowler’s position
Ø  NEX technique (nose-ear-xiphoid)

Ø  Checking the patency:
ü  Aspirate stomach contents and check the pH, which should be acidic
ü  Introduce 10-30 ml of air into the NGT and auscultate at the epigastric area, gurgling sound is heard
ü  The most accurate method of assessing the placement of NGT is X-ray study

Ø  Before feeding assess residual feeding contents. To assess absorption of the last feeding, if 50 ml or more, verify if the feeding will be given.
Ø  Height of feeding is 12 inches above the point of insertion.
Ø  Ask the client to remain in position for at least 30 min

Ø  Common Problems of Tube Feedings
Vomiting
Aspiration
Diarrhea
Hyperglycemia
Picture posted by Mister Blogger, All For Nursing at 9:55 AM - Fundamentals of Nursing
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEOxxxTVanLBhQW6ZjfAeOAGzGCjnlLdOdLDH5ra8kKR9tSnJD3s9EcNkQxOzM5nQ98qYrzpA2ZAkqZQUtcilnYqMwTOY5ha_q0c_jF2D5zhidSDyS44L1XZr1l0hdMvVGjvoVl-uPPz9_/s1600/NGT.jpg
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFXINelPIM5WfrmhUhuT2B2KCGg619_zOcz0qIMZ-IBXvHIkeYt00RRjXMWK744jpooOo0fQ7-KszLQzwt0_RDe1rDMALQY8qkXkNfBhgvLjQ4rtEh16heQGmWUTlDz_yHlv4_YxkqnG88/s1600/NGT.jpg
http://allfornursing.blogspot.sg/2013/06/nursing-review-nasogastric-tube-ngt.html


Moving on to the skills segment, which was the more challenging task as well. Once again not forgetting that this is the place where we integrate knowledge into real life application. Over the course of 2 weeks, the most challenging task for me was wound dressing. With the strict supervision of our CI (Clinical Instructor), we had to carry out the skill well despite nervousness setting in. I was definitely not confident and lacking in many areas but it is a phase that I have to overcome. There were many learning points and tips/tricks to procedures like this that will never be taught in textbooks or lectures. And this, is where we start building our experience.


Wound dressing

PHOTO: Wound dressing
We start building our experience in wound dressing under the strict supervision of our CI (Clinical Instructor).
There are many skills, tips/tricks to procedures like this that can only be acquired in reality and a best place is at SGH's surgical ward. This is the place where we integrate knowledge into real life application.
Clean wounds ​with sterile water or isotonic saline. and not Antiseptic solutions, Alcohol or acetone. Alcohol or acetone should be avoided completely as they can burn the newly healing wound tissues, making full healing hard to achieve. [2]
Picture posted by Ms Karen Lim Yu Shi, Pharmacist (SGH Pharmacy Department)
https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgIUsNOWYFRiEAO7GVcGh9p958I5SjSEDLmphAXisc6qknAzsmPV5gFIjemTxGi32XrzxfGVjmpF2V9b-8nsdgQGs5DnElR1SP3_jpf-dZsn2307v1tTxr7A8cj_KgbmVgMez8PzW9qJDTU/s1600/how-to-clean-and-treat-a-skin-wound.jpg
https://www.healthxchange.sg/sites/hexassets/Assets/medicine-first-aid/how-to-clean-and-treat-a-skin-wound.jpg
https://www.healthxchange.sg/medicine-first-aid/first-aid/how-clean-treat-skin-wound


Throughout this entire 2 weeks, our CI made us felt very comfortable and welcomed. I liked how she sets a clear line between being like a friend to us and also a strict and demanding instructor. Occasionally testing us on our knowledge has definitely triggered me to keep thinking of the how’s and why’s as well. That is something that I’ll continuously keep telling myself to become a better nurse.


Anatomy of a Nurse

PHOTO: Anatomy of a Nurse
Our CI made us felt very comfortable and welcomed although she occasionally tests us on our knowledge and triggers us to keep thinking of the how’s and why’s. That is something that I’ll continuously keep telling myself in order to become a better nurse in the healthcare industry.
Picture saved by Contyra Carter to Just because (Pinterest)
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https://s-media-cache-ak0.pinimg.com/564x/f3/31/49/f33149db2457c49547ae96aa8810fba4.jpg
https://www.pinterest.com/pin/AfU2OB9e2_pnDK8QcUb7LbXbOWl4rp6QhOePVCeQU2mpSBWyHIj-RmM/

By Bernard Goh - My week 2 attachment at SGH in the Nursing course



Reference
[1] Wikipedia, the free encyclopedia, Acute care, https://en.wikipedia.org/wiki/Acute_care

[2] Ms Karen Lim Yu Shi, Pharmacist​ from the ​Department of Pharmacy at Singapore General Hospital (SGH), How to Clean and Treat a Skin Wound, https://www.healthxchange.sg/medicine-first-aid/first-aid/how-clean-treat-skin-wound

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