Yesterday afternoon was a highlight of this trip for me as an ED nurse; a trip to a large Chinese Emergency Department in Jinan. The Emergency Center was actually an entire building of four floors, each with a wing sorting patients by their acuity or condition. We were brought to a conference room with approximately 40 young emergency nurses dressed in dark green scrubs lining the room. The department seemed particularly proud of their male nurses, who made up 51 of the 70+ nurses in their department. I was surprised to find that many were still in college going through a residency program, but more surprised that they were “placed” in the ED rather than having a reason for wanting to be there. The head ED nurse and doctor were also present to welcome us and give us an introduction to their department. How impressive! Their department features a chest pain alert vehicle which is equipped with everything needed to deal with a STEMI in the field, so that the patient is cath lab ready on arrival.

I gave a presentation on how the Emergency Department works in America. I think I may have introduced some new concepts to them, such as standing orders/protocols where nurses are permitted to begin with the patient workup. They lamented that it would be a great tool to implement in the ED, but near impossible because “we need to talk to the patient and family in a meeting before we can really do anything– right now the doctors order all of the tests.” It made me wonder, due to the intensive family involvement, if this cultural barrier to expedited care could ever be worked out. They didn’t seem to think so. My presentation was largely interactive due to the fact that my fellow travelers did not have ED experience and the presentation lead to more questions of the Chinese practices. As one of the top trauma centers in Jinan, they seemed surprised that smaller hospitals “didn’t want” complex patients, like multitraumas. We discussed resources and that often, transfer is in the patient’s best interest if they arrive at a smaller facility first– certainly not that we don’t appreciate the complexity- or the challenge.

Lastly, we touched on EMTALA in the US, and I think at this point a lot of our preconceptions of how healthcare works in China with regards to payment were put to rest. Chinese hospitals do not turn patients away if they can not pay- but they do seek payment from family members. Patients may sometimes qualify for funding from the Aid Society or costs may be absorbed by the University. But yes– it is our ethical obligation, they said, to provide care and address payment later (not the other way around!)

It seems that there are many unwritten rules of nursing and medical care here which seem in line with our laws/values in the US. This was a good time to reflect on how perception is hardly ever the reality, as there does not always need to be official direction for people to do right by their neighbors. We had fun in there, and we learned a lot. In the US, the ED nurse is a definite personality unto itself- and we found yesterday that that personality is a global attribute!

The facility was crowded, to say the least. Similar to home, stretchers lined the hallways but the patients were kept feet away from each other on narrow stretchers in large bays. Blankets, food and water was brought from home and most care was performed by an accompanying family member- maximum one per patient. Patient and family member were a generally self-sufficient pair and nurses were there “for medical care only.” Nurses had ten patients each, but family members did all washing, ambulating, toileting and feeding. When asked if they ever did these things, they said that if a patient didn’t have a family member, yes.  Most everyone comes with a family member; families are very active in caring for the patient’s needs, a sharp contrast from home where family members seldom participate.

Shandong University Emergency Department