January 12th - Day Seven

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Today we started out our day on our units at the hospital. It was kind of crazy how different the unit was since Professor Debbie was with me this time. They seemed afraid to work in front of her and therefore pretty much had her precept me instead of another Thai nurse, as I had done previously in the week. Instead of doing more tasks, we spent a lot more time talking. The nurses and physicians explained different patient cases and care plans to Debbie, so I listened alongside here. Fortunately, I was able to squeeze in blood work (no butterfly needle!), NG tube insertion which came out her mouth the first time ahhh, wound dressing care, and catheter observation since the sterile field is a little different than what I am used to. Debbie was also able to get me onto the burn unit. It was really tough to watch because the patients had not received much pain medicine. She was intense pain during the debridement, which for some reason made me physically nauseous, a similar experience I had in Rwanda with C-section wound cleanings. I don’t think I can watch other people be in intense physical pain, which is an interesting characteristic for a nurse. I’m going to have to learn how to deal with that if I practice abroad. At least in America, I can offer pain medication for pain, so it is a little bit more bearable to deal with.



After lunch, we had post conference with all of our instructors. We shared case studies, what we learned, and differences between American and Thai practices in the hospital. It was funny to me how when sharing evaluations of the hospital and program, we had to share in a positive light even if it was a criticism. It takes a lot more thought and careful wording to speak in this manner. I kind of enjoyed this because I do not handle criticism very well, often taking it too personally. This reminded me of that weakness and what I can do to communicate with other people better, but also how I can respond to criticism in America which usually is not protected by positive word choices. Overall, it was wonderful to see how each group interacted with one another. We all definitely entered this experience with an open mind, both Thai and American nurses, so it was a positive learning experience for us all.



My case study is as followed (for all you medical minded folks who would like to see it:

Case Study Summary:

•25 yo male presented to emergency department at midnight after independent motorcycle
accident from drunk driving.

•EMS took patient to community hospital but transferred to Nakornping Hospital for CT scan of
brain and facial bone. Patient arrived unconscious but with stable vital signs.

•Pt. only injured self, so no alcohol blood test, and police notified of arrival to ER.

•Impressions: acute epidermal hematoma at the right frontal convexity, right frontal bone
fracture extended to roof of right orbit, lateral wall of right orbit, and arterial and lateral wall of maxillary sinus and wall of right sphenoid sinus, and fracture to left temporal bone via left mated air cells.

Orders:

•Oxygen, CT scan of brain, chest x-ray, CBC, observe neuro signs and report if drop >2
(Glascow coma scale currently 15/15), NPO, V/S

•0.9%!N(MISSING)aCl 1000 mL IV 80 mL/hr, Tramol 50 mg (pain) IV Q6hr, Cefazolin IV Q6h (high WBC).

•Consult plastic surgery, neurology, and general surgery team.

Difference:

•America: We believe that unresolved pain can lead to issues such as impaired recovery from acute illness and surgery, immunosuppression, and potentially sleep disorders; therefore we offer our patients pain medications very often and many patients request for them at least every other hour.

•Thailand: I have noticed that the Thai people are very strong and resilient to pain.

•Ex: When discussing concerns with the patient mentioned above, he stated that his pain
was a 5/10. His headache was constant since the accident. Pt. did not take pain medication
during hospitalization, like many other patients on the ward.

•Not taking these medications as often may lower the risk of adverse effects from medication
overuse such as bleeding stomach ulcers.



Learning: IV drip rates. Sterile technique with reusable materials. Removing stitches.





PS. We ended the night with a night safari which was pretty much like driving a tram through a zoo. It was super fun, but I wish I had a little more energy to enjoy it. I also begin to question why we have zoos. I don’t think animals were made to be boxed up for human entertainment. It just didn't feel right.

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