Last Day in the Hospital!

I can’t believe I’m even saying this, but today was my last day in the hospital! I remember the first day I walked onto the floor at Hospital San Juan de Dios. I remember being so nervous but excited to see how things happened in Spain. I wanted to know all about the similarities and differences. My goal was to able to learn more Spanish, so I could bring that back to the states and eventually speak with my patients at work in my future career. The first few days at the hospital were mentally and physically exhausting. It was so hard at first to think entirely in another language. No one was there to translate for me, and no one spoke my language. I had stepped into an entirely new territory. And this was different, because people’s lives were in my hands. The responsibility of this made the first couple days that much harder. I wanted nothing more than to understand what was going on. I was constantly taking notes of unfamiliar words or medicines, in hopes I could learn them for the next time and be better prepared.

I think one of the biggest lessons I’ve learned from this entire experience is how hard it can really be to navigate a hospital without knowing or understanding the hospital. It really put me into the patient’s perspectives. So often, patients come into the hospital in Boston and don’t speak English or maybe have a lower education level. In the beginning parts of my clinical, I feel as though I was in their shoes. I didn’t understand much of what was going on the first few times, no to mention it was all entirely in a foreign language. How hard is this situation for those patients in America? To not have someone there with you, translating at all times, and simply having to trust in what is going on around you? After this experience, I feel like I took a few steps in those patient’s shoes, and saw truly how hard it can be to be in a hospital where others might not understand you.

As I was finishing up for the day at the hospital, I went into one patient’s room. She had been there the entire time, since I’ve started working on the floor, but never understood what I was saying. Every week I would go in to take her blood pressure or check her blood sugar, but she would never hear me correctly. Today, I figured it would be more of the same, but I always let my patients know what exactly I’m about to do. So I say in Spanish, “I’m going to take your blood sugar now!” And surprisingly, this woman actually understood me! She said, “Ok go ahead!” *in Spanish of course haha*. I have never been more proud than in that moment. It was like everything I had been working for, to communicate with my Spanish patients just clicked in that moment. I cannot wait to bring home my new Spanish knowledge and be able to speak to my patients at home.

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Adventures in Krakow!

These past few days, I have been having the time of my life in Krakow, Poland! We had an extremely long holiday weekend here in Spain, so my friend Ronald and I figured why not go? Little background, my family came from a part outside of Krakow named Ropica, and I’ve always considered myself extremely Polish and relate the most with this culture. The food, the music- I just feel so connected to this group of people!

To start our journey, we had to go through a series of flights. Granada to Madrid, Madrid to Berlin, then finally Berlin to Krakow. As we were waiting in the Berlin airport, we decided to grab a German beer. I actually remember saying, “I’ve never been to Germany before now! I wish I had more time here!” I guess sometimes dreams do come true (haha) because our flight from Berlin was cancelled due to “technical difficulties”. Luckily, as we were waiting in line to talk to customer service, we met some really nice people from Krakow on our flight that helped us find a hotel for the night and transportation to and from the airport. They became our tour guides for the night in Berlin, and gave us directions around the city a bit before we headed out for a late dinner! Ronald and I found a great place with live music and I tried schnitzel for the first time!

The next morning we finally headed into Krakow! This city is what I picture when I think of an older Europe. Full of cobblestone streets, beautiful architecture, cathedrals on every corner, etc. Our hostel was right in the center of the Old Town. A little square currently filled with outdoor shops selling cute Christmas items, traditional Polish art, and food!! In this square we tried keilbasa and potatoes one night, and the other I had peroigis! The first day in Krakow we mostly wandered around, soaking in the beautiful surroundings and taking pictures, visiting a few cathedrals here and there. We also found a “Milk Bar”, which was made during the war. It was designed as a cheaper restaurant so that people who needed to eat, but didn’t have a lot of money due to the war, could go out! It was a really neat place to see! Later that night we headed out to the bars and hung out with the locals, which was really fun! Everyone was really excited to meet the Americans. :)

I was also fortunate enough to visit Auschwitz, a Nazi concentration camp right outside of Krakow. This place is considered to be one of the biggest mass murdering sights in the world, where thousands of people were murdered due to their heritage or beliefs by the Nazis. Visiting Auschwitz was a surreal but profound moment for me. At first glance it seems like an abandoned place, but by going through the tour and listening to the horrific stories of this place, you begin to truly soak it all in. There was one moment where I was brought to tears on our tour. We entered a room that stored the pairs of shoes of many of the victims. This place was practically filled to the brim of old shoes, one on top of the other. To try and even fathom all the people that had worn these shoes was overwhelming. Each pair of shoes had a story, belonging to a unique individual. And to think that all those people were murdered simply because of who they were was truly upsetting to me. However, there is a saying from Auschwitz that says, “The one who does not remember history is bound to live through it again.” I think that as sad as this experience was for me, it truly taught me some lessons and I will always remember what has happened to those people. I think it’s important that we as humans work hard to make sure things like that never occur again, and to work for the rights of all kinds of people in general.

After Auschwitz, we headed off to the Salt Mine. This place was gigantic! It is the oldest Salt mine in all of the world, starting in the Middle Ages. It goes down 135 meters deep, and has a ballroom for weddings, a few cathedrals, and beautiful statues. Our tour guide says you can lick the walls because it tastes like salt and the salt keeps it clean/sterile. I didn’t actually do it though haha.

Our last full day in Krakow, we headed off in search of the Jewish Ghettos. Unfortunately Schindler’s Factory was sold out for the day by the time we found it, but we found the old pharmacy in the ghetto. There, they used to help the Jewish people during the time of the Nazi’s with medicines and shelter. It was a really interesting place to visit with a lot of history!

Overall, Poland was absolutely amazing, easily one of the best places I’ve visited so far in my life. I feel as though I got to see some of what my ancestors may have seen, maybe eaten what they liked to eat on a daily basis, and just experience life for a bit through their eyes. I think this trip gave me a little more perspective of where I come from and my heritage, and I really cannot even put into words how much all of this meant to me. I am definitely one extremely lucky girl!

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Being Thankful

Considering yesterday was Thanksgiving and all, I figured this post could be themed on thankfulness and such! Here it goes! :) Full disclosure this is going to be a little cheesy, but oh well!

First, I’m going to begin with how truly thankful I am for my health. Unfortunately, here in Spain, yesterday was not a national holiday and I still had to go in for a shift at the hospital. It was another typical day on the floor here. However, one patient was particularly ill. Her daughter was recounting the patient’s night, how difficult each breath had been, how uncomfortable she seems, etc. It was a really sad scene altogether. As I was helping the nurse change this woman’s IV fluids, I was thinking about how much it means to truly be healthy. I am a 21 year old, with barely any complaints health wise. Yeah, I had a cold this past week, but nothing in comparison to what my patient was facing yesterday. I had a moment then and there, where I placed myself in the patient’s shoes, and really thought about the significance of health. I am so very thankful for the ease of each breath I take, the constant beating of my heart, and every other part of my health that I so often take for granted.

Second, I am thankful for this opportunity to have celebrated such an American holiday in Spain. Waking up yesterday, I have to admit I was pretty grumpy and upset. I was bummed I had to still go to the hospital to work, and that I didn’t have a day off like the rest of my friends back home. Then I was upset I wasn’t home enjoying the normal things with my family. However, after a long day at the hospital, a friend of mine found a place online that streams the Macy’s Day Parade and the dog show! Elizabeth and I actually got to share a little bit of the parade with our host mom and explain what Thanksgiving is about. Then, later on, we headed off to a dinner hosted by our University. To be honest, I didn’t think that this would be anything like home. Sometimes I really don’t like the food here in Spain, and I didn’t want to get my hopes up. However, when we arrived, the entire room was filled with the amazing scent of turkey. We were served cranberry sauce, mashed potatoes, green beans, and everything else I would think of for a “normal” Thanksgiving. Our directors had worked so hard to deliver a traditional American feast, and I really think they went above and beyond. It was more than I could have asked for, and I am so grateful to have celebrated Thanksgiving in Spain!

Third, I am most definitely thankful for the people in my life here while studying abroad. I feel like my time here in Spain could have been so much harder if I didn’t meet the awesome friends I did here. I am so thankful to become friends with the people I have, and to continue being friends with my awesome roommate as well! :) We’ve been through a lot here in Granada, and I definitely wouldn’t want to experience it with anyone else!

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Above is our beautiful table for Thanksgiving Dinner! :)

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The Longest Week Yet!

This past week here in Spain has definitely been one of the longest and hardest yet for me! But there’s less than a month left here, so I’m pushing through to the end! :) This past week, we began going to the hospital two times instead of once. I really want to learn as much as I can during my time here, so I’m definitely not complaining :)

On Tuesday night, Elizabeth and I attended a class after our shift at the hospital about communication with patients and families. Little did I know how eye opening and interesting this class would be! We discussed normal things like how to deal with hard situations, death, etc. But then we began discussing things that are quite different than the USA. For example, the use of placebos. Placebos, for anyone who might not know, are drugs generally used in experiments that don’t cause an effect in a person. So basically a sugar pill, or something to that affect. However, in the United States placebos are only given as controls in experiments. In Spain, it is legal to give placebos to patients instead of pain medicine, which is extremely interesting and confusing to me. My instructor told us that if a patient keeps asking for pain medicine, it’s completely alright as the medical provider or nurse to give them a placebo instead of their actual medicine. (Disclaimer, not in palliative care) So different, and still not sure exactly how I feel about it honestly!

Another point brought up in our class that was really controversial between the Spanish and Americans is about the diagnosis of a patient. The United States has a patient centered care plan. Everything begins and ends with the patient at the front of everything. When a patient is diagnosed with something like cancer, the doctor tells them and explains all their options etc. In Spain, it can work slightly differently. If a patient or their family does not want to them to know their diagnosis, such as in the case of cancer, the doctor does not have to tell them. For example, if the wife believes they will deteriorate quickly because of a diagnosis such as cancer, the doctor does not have to tell them what they have. From my original view point, this seemed really backwards. How could a medical provider not tell a person what they have, and wouldn’t that hurt them worse in the long run? But then I began to think from a more culturally open view. Here in Spain, the family is definitely considered more important with the care in the hospital. The families are here and involved so much more than in the United States. These families are so tightly knit that I could see why the opinions of the family members or the spouses would mean so much and influence the care. From this point of view I can begin to understand and accept what this healthcare system uses as their point of view.

Although these two ideas are really, really different than the United States, I can’t say they are wrong. In many of these cases, there’s so many sides to every story. No patient has just one diagnosis or one story/background. Patients are influenced by so much, emotionally, physically, spiritually, etc. I think that just because one health care system does something differently than another, I can’t simply jump to this is right and the other is wrong. There is so much that is not just black and white in health care. I really enjoyed learning about these interesting and complex ethics differences between these two healthcare systems! :)

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Differences Between Spanish and American Hospitals *As Observed by a Nursing Student*

I just want to start off this post with a disclaimer. I’ve been thinking about writing this blog for some time. However, after this week in clinical, I finally feel prepared to sit down and analyze some of the major differences between these very different health care centers in two entirely different countries. BUT- I would like to point out, neither hospital or health care system is necessarily better, they are both just set up in different ways with resources they have. I think it’s really easy to jump to, “well this is my way, and I like it better, therefore it must be the best possible.” That’s something I’ve definitely learned is not true during my time here in Spain.

So anyways, here’s some of the things I’ve observed these past few weeks as a nursing student in a Spanish hospital for the first time as some of the major differences :)

1) Patient Case Load- In the hospitals I’ve studied and worked in so far in America, a typical nurse tends to have an average of 5-8 patients a shift, depending on what type of floor you work on or how ill your patients are. Here in Granada, the nurses tend to have a patient case load of upwards of 15-20 patients every day. The evening and night shifts are even more! The nurses here are really working their butts off and know how to effectively manage their time every single day. It’s really fascinating and educating to simply watch the nurses here in action, able to balance all of their work load with so many patients to take care of.

2)Medication Distribution and Administration- In Boston, almost every single hospital has some sort of electronic machine or sorting system, where we go, punch in a patients name, and the machine says exactly what medicines are ordered and doses. It’s super great to have technology and money for all that, but in the hospital in Spain there doesn’t seem to funds for such a device. Hence, we distribute medications all at once, with the entire floors medications presorted and then passed out by one nurse at once. To someone not used to this method, at first it can seem very overwhelming and scary, but with practice passing out meds this way is not too hard!

3)Family Presence at the Hospital- Generally, in the United States, family members come and visit their loved ones in the hospital for about a 1/2 hour to an hour, depending on each patient of course. Sometimes in the US, we can find cots or pull out beds to and the significant other can stay the night. Here in Granada, it seems as though every single patient has a family member with them all the time. And the family members here in Spain really do a lot. They help feed their loved ones, help them to the bathroom, and take them on walks. It’s really touching to see the connections between the families here in Spain.

4)Health Care Team- In the US, there are nursing assistants, which generally work under strict guidelines and the watchful eye of the Registered Nurse. Nursing assistants have certain responsibilities and usually aren’t able to work outside of their legal practice. Here in Spain, it seems as though nursing assistants are generally given more responsibility.  Nursing assistants here change and set up tube/enteral feeds, change dressings for severe pressure ulcers, and fix tracheotomies sometimes (among many other things as well) Another difference within the health care team is the way the nurses and doctors interact. Nurses in Spain seem to follow a more traditional system, where the doctor tends  to have more power. Doctors here in Spain check lung sounds, heart sounds, and anything else, because nurses don’t tend to carry around stethoscopes. I actually had to stop bringing mine to clinical because people thought I was a medical student. It seems as though the doctor-nurse relationship is more collaborative in the US, simply because the nurse can do more assessment prior to bringing an issue or suggestion to the doctor.

Quick Fun/Interesting Differences-

1) The use of Silver Tracheostomies vs Plastic- I’m not sure if places in the United States still use silver tracheostomies, but in Granada it seems to be very common!

2)White Uniforms- All of the nurses and nurses aide’s wear white scrubs. I definitely miss the fun colored scrubs from the US!

3)Animals in the Hospital- We have fish and parakeets inside the hospital at Granada. And on top of that we have two hawks outside in the patio area! We are definitely full of animals here! In the United States, I have yet to stumble upon a large hospital with animals living there full time like here in Granada!

 

Although there may be certain differences between the United States and Spanish health care systems that I’ve observed in my clinical experience, there is certainly one thing in common between both. No matter what country or city a nurse or health care provider ends up working in, the main focus is to provide the best possible care to the patient. I am sure that both places I’ve worked and studied in have demonstrated the compassionate care for their patients,  and this will always been the main similarity between all health care.

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Half Way There!

“Life is a series of natural and spontaneous changes. Don’t resist them; that only creates sorrow. Let reality be reality. Let things flow naturally forward in whatever way they like.” Lao Tzu

It’s honestly really crazy to think about, but I’m over half way done with my time in Granada! What a bittersweet thing to think about. On one hand, I’m definitely sad that this once in a life time experience is in part, completed already. I’ve been learning so much in every single moment, things about Spanish and myself. Growing as an individual. On the other hand though, I definitely have been missing some American things…(my family, my boyfriend, my DOG!, the food!!, Dunkin Donuts…I could go on forever) It’s hard to not miss some of your favorite stuff that seem so “normal” and regular to have.

But today was another shift at the hospital, something I look forward too every single week. Today was a little more hectic than usual because a few people called out sick today from our floor, and we were really understaffed. The nurse I was following seemed sort of stressed, but she was really nice!

This week was all about changes though. The more I feel like I’m finally settling into my daily routines at the hospital, something new always seems to challenge me and throw me off a bit. Today, I walked onto the floor expecting everything to be as I left it last week. However, one of my favorite patients has recently become more ill. She was not very responsive today, especially compared to other weeks, and that really threw me off for a bit. I felt sad for this woman I have become connected to. However, especially in the world of palliative care nursing, this is bound to come up. Unfortunately my patients don’t come to this end of the floor to get better and be sent home. They’re usually sent home in a more profound sense. After reflecting on how seeing this woman decline more and more was making me feel, I’ve realized that I can be sad about seeing such an amazing person get sicker, this is only natural. However, as a nursing professional,  it motivates me to do the best I can do for her. I want to make sure she is as comfortable and happy as possible in such a time, and that is my purpose. Although there are changes occurring outside of my control, on this floor and in my life, I can choose how to view them. With a good outlook and hard work, I can do the best I can to provide this woman what she deserves most. This is one of many reasons why I wish to be a palliative care/hospice nurse.

Another, certainly happier, change that occurred today was related to one of my other favorite patients on the floor. (Remember the one who sits in the hallway calling me “extranjera/foreigner.”?) I was so confused to see this old man in regular clothing instead of the hospital Johnny this morning. I had almost forgotten, that on the other side of the floor which is dedicated to rehabilitation patients, people can go home and get better! What an amazing thing haha. This patient was beyond excited, after  2 1/2 months at the hospital, to finally get to leave with his family. Although seeing him go was also sort of sad, I was really excited for my patient to get to go home as well.

So I guess the moral of this blog is that change is bond to happen. I’ve been here over half way and I like to think I’m making major changes in my own life. I’m becoming more fluent in another language, learning new nursing skills, becoming more independent as a young woman, etc etc. It really just depends your outlook on the changes. Embrace the changes that come, seems like life gets a lot easier that way.

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Taking Time to Listen

 

It is not how much you do but how much love you put in the doing”.- Mother Teresa

 

Today was my fourth week at clinical here in Granada! I can hardly believe it! I’ve been enjoying and learning from every single moment here. Sometimes it feels like the time is going by too fast, and I wish I had more. Today was another amazing day, helping the palliative care nurse. I feel as though I really know my patients on my floor now. I’m remembering names and their stories. Some of the family members smile when they see me now because they remember me as the “Inglesa” (English Girl) or the “Extranjera” (Foreigner). But honestly for me, it’s sort of fun being known as the “different” girl. I have become pretty close with some of the patients on my floor, and I love being able to talk to them and get to know everyone better.

The nurse I was shadowing today, however, usually works on the rehabilitation side of our floor. She found out that one of her regular patients was upset, and we went over to see what was going on. Although I could only understand some of what she was saying, she was very frustrated today with everything going on in her life. She had a lot of pain and wasn’t progressing as she wanted in physical therapy. At points throughout the conversation, she would get teary eyed. I could see that this woman was really hurting.

Fortunately, I was put into the right situation at the right time to be able to talk to her. The nurse asked me to make up the beds and get the two ladies in the room ready for the day. As I was fixing up her bed, I started asking her questions in my broken Spanish. She was excited that I was interested in her life and was asking me questions as well. One thing led to another and I’d figure I’d ask about her family, “Do you have children?” She started laughing, and said that she’s a nun and couldn’t have a family. I was scared that I had offended her, but it actually opened a door to a whole new conversation. She was so excited to talk about her life in the convent, and how before she became ill she wasn’t even allowed to leave or go outside. Of course this intrigued me, because we don’t have many nuns in the States, so I was more than happy to listen to her stories.

By simply asking a few questions and listening to this woman, her tears turned into smiles. I’m hoping that helping her reflect on her life, the positive things, and her religion made her day even slightly better. I think sometimes nurses get so busy, we forget that listening to the patient for a few moments can completely change their outlook on their day. Sometimes all someone needs is a compassionate listener.

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