Zamboanga City Medical Center Exposure

"This was done on March 19, 2007 and was addressed to Mrs. Evelyn T. Monsanto, RN, M. Ed., MN, the Chief Nurse VI, of Zamboanga City Medical Center"

"Made by chokoloko, RN, a Volunteer Nurse at the Surgical Ward (Ward 4) of Zamboanga City Medical Center"

May I respectfully submit my narrative evaluation regarding my three months volunteer training at Zamboanga City Medical Center Ward 4 (Surgical Ward) from December 1, 2006 to February 28, 2007.

The first day of training was orientation. Mrs. Mismen Felices oriented us on the hospital policies, requirements for completion of training, conducts while on duty and physical tour. Then, Mrs. Evelyn Monsanto, oriented us on the hospital organizational structure, nursing personnel and standard operating procedures. On my assigned ward, I was oriented by the supervisor as to the ward policies, different routines, and the physical set-up. I was also introduced to the staff nurses, nursing attendants and orderlies. Then off I went to my first task, that is, to take the vital signs of the patients admitted.

My first day proper duty in the ward was not that surprising. I previously had my exposure here and I am already expecting such reality. Reality that the ward is experiencing ever since. At first, I was asked to do the basic procedures like taking of vital signs, changing of bed linens and requisition. But as the days goes by, I was delegated more tasks. Of course, I was taught and guided in details by the staff nurse initially, and little by little, I am expected to do it alone. In the beginning, I was still having the tremble but as I do the procedure again, that tremble fades away.

This area gave me the chance to handle patient pre and post-op. Upon receiving the admissions notes I checked the doctor’s order and nurse’s notes and carry out orders that are not yet done. Depending on the type of surgery indicated tells my next move. If elective, I usually secure the inform consent, patient’s weight, vital signs and then, prepare his bed. If emergency case, I checked the vital signs, IVF Level and IV site, secure inform consent, checked the OR materials, changed his clothing to OR gown, administer pre-op meds ( IM, SC, and ID), remove his dentures and unnecessary clothing, and then transport to OR with side rails up and locked. Mrs. Amelia Suan, gave me the chance to endorse the patient to the OR nurse. There were also many instances that I got the chance receive patients from PACU.

Many times, I was assigned at Surgical Intensive Care Unit and got the chance to handle Level IV patients who have undergone open heart surgery, thyrotoxicosis with brain death, generalized sepsis, and were among the top list. On that exposure, I had the chance to carry out doctor’s orders every after thirty minutes like doing the laboratory requests, and then once results are in, referred to the physician with new orders again. I’ve also observed how ABG is done by a Respiratory Therapist. I also learned how to use the different drain devices like hemovac for MRM, JP drain for cholecystectomy, and penrose drain for common wound drainage. There were some alternative drain devices used in the ward like the asepto syringe and the empty IVF bottle. I’ve also got the chance to reposition and changed bed linens of Level 4 patients with Mrs. Evelyn Monsanto’s supervision. At first, I was too nervous even to touch the patient, what more, to move him with all those tubings attached. I’m afraid that I might remove the ET tube connected to a ventilator. But after that event, I gained confidence and learned that such devices can be reattached if accidentally remove. I have also learned how to nebulize patient hooked to a ventilator for as long as that special tube is available. I have got the chance to suction patient’s endotracheal, oral, and tracheostomy while using the sterile technique. I was taught by the supervisor, Mrs. Lucita Tardo, that there should be separate suction tips with individual irrigating solution. She also taught me how to place the three electrodes on the chest to be hooked to Cardiac Holter Machine. In addition to that, she taught me on the correct technique of Blood Transfusion administration. To prevent errors, accordingly, double check the doctor’s order, cross match result, blood type, and the vital signs of the patient. She taught me to grip the tube of the BT bag where the spike of the BT set is punctured so as to prevent thru-and-thru puncture. Furthermore, with her supervision, I have got the chance to do cleansing enema and hot sitz bath on a patient with hemorrhoids and preparing diet list and census. When I handled a burn patient, I was taught by Mr. Allan Lavina, how to use the infusion pump. According to him, such patients need an accurate I&O and such device infuses IVF accurately. But such device is too sensitive like presence of bubbles on its tubings. When my patient had an order for ECG, I have got the chance to know the placement of the wirings. Mrs. Julieta Atilano taught me that you should reassure your patient that they will not feel anything and to keep still and relax so as not to alter the readings. I have also got the chance to use the glucometer (optium) with Mrs. Zenaida Aldeon. She also taught me how to do bedside endorsement. This way, I got the chance to receive the ward, read the endorsement book, the patient’s IVF and site, different tubings and devices attached, position, and most important, status of the patient. During the Tzu Chi Foundation day, Mrs. Leonisa Dapiosen finds time to teach us on how to handle such huge census. From her, I have learned to manage my time, set priorities, learned to focus and use available resources. During our free time, she discussed topics like IVTT calculations, administration, reconstitution, and incorporation and even at bedside. She taught us on the possible complications arising from negligence on part of the nurse like wrong medication, patient and dosage. Such events, accordingly, can be prevented if you are going to check carefully the order and medication card. There were also instances when we had an expired patient. I got the chance to perform post-mortem care with Mrs. Sharon Calunod. She taught me how to remove the ET tube, terminate CVP line and position. She added that even if patient is dead, I should treat her/him with dignity same as that of alive patient.

I also obtained the self confidence in dealing with my supervisor, co-workers, other hospital personnel and patient. Therefore, I developed more of my communication skills and in establishing good rapport.

My main objective as to why I volunteered to have my training at this hospital is to test myself whether or not I could endure the challenges that people are saying once you are employed here. Many say that I will just volunteer for a week or two and that I can not finish the program. There are several hospitals and even schools who offer me an employment but I choose Zamboanga City Medical Center as the opening salvo of practicing nursing. And I did not fail. I did end the training program with fulfillment and satisfaction in my heart. Satisfaction in the sense that, I did not only gain the self-confidence, exposure and realization of my purpose, but I was able to feel the exact feeling of a real nurse. This training gave me the first exposure, as a Registered Nurse, to the real world of my chosen profession. I really learned a lot even just for three months.

Overall, it was worthwhile to have the training at Zamboanga City Medical Center. Now I can be able to say that I am now a Registered Nurse, capable of doing things expected of me. Now that I am armed with the learning and the self-confidence acquired, I am ready to take a leap towards my next employer.

I would like to express my whole-hearted genuine gratitude to the supervisor, staff nurses, physicians, nursing attendants and even, orderlies of Ward 4 for their warm acceptance, patience on our sometimes childish-behavior, and enduring for answering our never-ending queries.

Recommendations. A lot of times, cats loiter around the Nurse station and that; it could be a possible vehicle of transmission of infection. I suggest calling animal control of City Health Office to answer this problem. There are also times that nurses failed to complete their tasks, but I do not blame them because they are overloaded. I suggest employing additional staff nurses to cope up with the demands, alleviate workload and comply with ideal nurse-patient ratio. Giving Oral medications are given to watchers but sometimes, they do not even know the schedule. I suggest to give a written, understandable instructions to them. There are also times, that I got a false reading especially blood pressure. Equipments like BP apparatus, even the Cardiac Holter Machine, are not functioning well. Please replace it with functioning ones because these are vital informations. Now, I would not be surprise if incidents like giving an antihypertensive drug to a patient who is actually having an internal bleeding occur. Due to financial constraints, they will sort to using In empty IVF bottle for NGT drainage. The problem there is that these bottles are not change. I suggest replacing them every shift since it
could be a possible route for ascending infection.