As we wrap up our final two days here in China I want to thank Dr. Zhang and Dr. King and UMASS Lowell for a truly amazing experience.   This trip was all I hoped it would be and more. The staff at the Shandong University and at the hospitals we visited were kind, generous and extremely hospitable. It is apparent that they are proud of their advances in Healthcare and yet were also interested and willing to learn from us about our system.  It showed to me that no matter how different we think we are nursing care is the same. Today on our final clinical day we visited the Provincial Hospital and their mission is Excellence, Honesty,  Harmony and Kindness with an aim to” Listen to their patients needs and conquer their challenges together”. That really says it all. So as we all look forward to getting back to our loved ones may we all take a moment to realize this amazing opportunity we have been given!

Pinning Ceremony

About Lucky

Hello friends, family, and curious strangers! Forgive me for having posted yet, there were some technical difficulties that took a bit to sort out – but I hope you will enjoy my upcoming collection of thoughts from here on out. A little about myself before I begin: My name is Srayluckyna Thach, but most people call me Lucky. I have just graduated with my BS degree from the School of Nursing at UMass Lowell! I am currently studying and planning to take my NCLEX-RN exam this summer and (hopefully) pass with flying colors, so cross your fingers for Nicole and I (she also graduated with me as you may already know!) I am Cambodian-American and I am the first (soon to be) nurse in my family. I currently do not work, but I am hoping to become an RN in community health. I enjoy the setting and working with families and individuals of all ages. I also enjoy health promotion and outpatient clinic settings. Although this is my interest right now, I honestly believe that I am up for whatever kind of nursing. Because nursing is so versatile, I believe that I will have more than one interest, and therefore perhaps, more than on “home” in nursing. I do not know where I will end up, but I hope to gain a lot of experience and of course, continue my education once I find my niche. I hope to continue my education within 5 years and obtain my master’s degree!

There’s been so much to say and I’ve been taking everything in and observing. For me, there are many things I see in China that his also common in Cambodia and within the Cambodian community in the U.S.. I took interest in comparing and contrasting the three different cultures (American, Cambodian, and Chinese), and it is indeed fascinating to see the reality of how close we may actually be in technology and healthcare development, but in other concepts such as mannerisms and educational structure, we are very (VERY) different!

On another note, I wanted to elaborate on my thoughts on our visit to the community health center. This particularly interested me because this was when I really began to think about home care and the role of the visiting nurse in the U.S. It was Dr. King who brought up an interesting aspect of visiting nursing that I had never thought about before. I always had wanted to be involved in more health promotion, therefore I have always had a strong interest in community health nursing. Dr. King had elaborated on her experience of being a home health nurse, and how she was really able to assess the patient conditions and lifestyle, and therefore are also able to formulate a better perception of the patient’s lifestyle, and then be able to help them outside the hospital. She was speaking about how people are not themselves when they are in the hospital, so when a nurse visits the home however, they can really help integrate better care in a managebale setting. I also enjoy the contunity of care aspect of visitng nursing as well.

Postpartum Visit

Today Nicole and I did a post partum visit with a doctor. We visited a baby girl who was 10 days old, and this was after a vaginal delivery. We visited with a doctor who was very kind, and we went with our student translator (Star). The doctor’s assessments included assesing the fontanels, testing for infant reflexes, and checking jaundice levels. She also assessed the perineum of the mother, measured her blood pressure, taught breastfeeding techniques, and performed traditioanl Chinese medicine techniques of massage on the baby for calming the baby down. There were several interesting things I learned on this visit about maternal care in China! We learned that the services were free for the mother, however the jaundice test was 15 yuan (equivalent to about $2-$3). Also if the jaundice level is above 6, the doctor will post pone vaccinations. I also noticed that the father was not involved in the visit, nor was encouraged to. He was somewhat just in the other room, and instruction seemed to be only addressed to the mother of the baby. In the beginning of the visit, an older woman opened the door with baby in hand, and Nicole and I had thought this was the grandmother of the newborn baby, however it turns out that this is the Nurse Maid (who is specialized and licensed) in helping to take care of the baby; after all, we learned earlier on this trip that the mother of the baby was not allowed to leave the room or the house (depending on how much one adheres to strict traditions) or shower, for approximately 1 month. This was according to traditional Chinese medicine, and this information was given to us by Dr. Zhang and also verified by several nurses here in China. Interesting, right? I could not be able to do that so I give credit to these wonderful ladies for their faith in tradition, as I know very well myself that tradition is important. Altough, sometimes as nurse, we may not agree with a patient’s beliefs about something, we at least need to respect the patient’s decision in their care. Sometimes as a nurse we may forget that, which is why it is important to learn about various cultures and gain that cultural competency a nurse should have – so then we are able to understand various traditions in order to better comfort our patients 🙂 Anyway, getting back on track, this tradition has to do with the concept of yin and yang concepts, so the Nurse maid helps cook, clean, and bottle feed the baby. Often times family would be involved in the newborn care such as grandparents of the newborn, however when we visited it was just the nursemaid, mother, husband, and baby at home. Another interesting fact we learned is that the mother will have her postpartum visit at the clinic 42 days post vaginal delivery, and this will be the first time the mother goes in and out of the house, to the clinic for follow ups.

Amongst several things we learned on this visit, I felt that the most valuable part of the visit was watching the doctor and the patient communicate. It was very welcoming, and I felt that much patient education was being done and that the patient was willing to learn as well. The things that the doctor did however, I thought were also very nurse-like in the us, and things basically a nurse is licensed to do. It Is interesting to see how also it would be vice versa where a mother would come in the clinic in the us, seeing a doctor, and here in china, it is a doctor visiting the mother. Above that, the doctor was going things that a nurse would be considered able to do in her scope of practice. Either way, the relationship that the participants seem to have was very earnest and welcoming. I find this as a trajectory into what I will be taking home from this experience here in China, and I really want to begin about doing home nursing after my 1 year of med surge. There’s actually SO much more I want to share because I felt that this visit had really gave me a better perspective or area of nursing that I want to begin in. I had always loved working in the community setting, and i know this through my numerous accounts of volunteering throughout high school- that this would be something I want to continue doing. I always saw myself out and about in the community, whether it’d be outpatient or at family health clinics. I am actually really ecstatic that I found or really have begun to see an open door for my niche to settle in. This visit was short simple, and enlightening for me. I loved seeing learning in the home environment, and the calm and happy expressions of the patient and doctor. I am excited for what awaits for me. Thank you everyone. I promise my future post will not be as extensive, but I have to make up for all these days of not posting!

                                                                       At the Shandong University Nursing Lab

As I stop and reflect on our time here in China I think of all the sites we have seen and things we have learned.  This week each morning our day begins with a walk to either the University or TCM ( traditional Chinese medicine hospital).  I notice as I walk around our surroundings are starting to look vaguely familiar.  We encounter many bicycle riders, people on mopeds, cars and a few motorcycles.  Many people have on masks that are decorated with pretty flowers and multiple different colors.  I have decided my favorite color mask is pink and Krisitn has a beautiful one that is pale in color.  It is quite noisey with everyone either honking their horns or honking on there bicycles. We have become accustomed to no longer be startled by the beeps but rather move over without the anxiety we once felt. I now realize these beeps are not one of anger or frustration but merely to say “I’m behind you, move over”.  I also have decided the best way to cross the street is to wait for the green walk person on the traffic light and wedge yourself inbetween the mortorcycles because this seems to be the safest place to position yourself when crossing the street. Unlike the U.S. I think the cars have the right of way, not the pedestrian, even in the walkway.  The traffic is congested here and if  I were to  live here I  am convinced  the best way to travel is to walk or buy a moped because they seem to make better time than sitting in traffic.

On the sidewalks you will encounter many different vendors selling a variety of things. There are people with fruit stands, juices, newspapers, children’s toys,  and what I believe to be people with long strands of what appeared to have come from and old potato sack and they looks as if they are making brooms. My favorite of all is this elderly man we pass each time who has three bowls with water in them . One is filled with four baby gold fish ( yes, I count them every day) and my favorite of all is the other two buckets. One has baby turtles while the other has large ones.  This gentleman is here every morning and I am not sure how much money he makes but he he appears happy with this business of his. I can’t help to think  in the U.S. Selling turtles, little gold fish and other items such as drinks and toys would probably not be rewarding to most.

So in closing I would like to remind us all to stop, slow down and smell the roses.  Enjoy the beauty and surroundings. Don’t discount the small things in life and take time to enjoy what you truly love, appreciate what you have.

Thank you for reading my post and I hope you enjoyed reading it as much I did writing this.

Barbara

As we begin our final week in China I’d like to share some personal reflections on our experience this past week in the Traditional Chinese medicine hospital. The motivating factor for me taking this trip was my interest in holistic medicine so this was a highlight for me. As we entered the front door of the hospital you could not help but notice the massive Ying Yang symbol on the floor. Balance is the foundation of Traditional Chinese medicine. Moving onto the units I noticed how calm the staff was. The nurses and doctors walked the halls unrushed. It struck me as very different than the halls of my hospital with the overhead paging system squawking and the nurses and doctors walking swiftly as to avoid eye contact with visitors who may delay them by asking for directions.  From the hospital rooms you can see an enormous gold Buddha sitting on a mountainside.

So now for some first hand data. Being outside of my normal environment and eating different foods had caused me some GI upset. I tried over the counter remedies without success so when the nurses offered  “acupressure ” treatment I was happy to volunteer.  I’m pleased to report the treatment was successful and I have not had symptoms since. Another interesting discovery was after trying massage, cupping and scraping yesterday, today was the the first time in a very long time I went an entire day without a hot flash. So while it is easy to be skeptical and find other reasons for these personal experiences there is something to be said for treatments that have been around for 3000 years!  I definitely will take this knowledge with me back to the US and hope someday we will use more of this therapy as an adjunct to our current practices.

Hello all! I apologize about my delay in adding to the blog, was having some technological difficulties. Let me first introduce myself- my name is Kalie Marion and I am going into my second year studying in UMass Lowell’s Family Nurse Practitioner program. I have been working as a pediatric primary care nurse since 2013 and love it but I am very excited to advance my career with my masters degree and take on more of a leadership role.

Today we had the pleasure of listening to a variety of presentations from individuals representing UMass Lowell as well as Shandong University. Dr. King gave a great presentation on what it is like to be a preceptor in the United States which truly gave some perspective on how challenging it can be. A perspective we do not get to see as the student. All of the UMass Lowell students presented excellent topics discussing topics relevant to our nursing practice in the United States.

One presentation I found particularly interesting was a PhD student from Shandong University who discussed suicide in the Chinese population. She reported that 1/3 of those who committed suicide did not had a diagnosed mental health disorder. She brought up that unlike the U.S. where suicide has a high correlation with mental health disorders that maybe there is a different root cause for the Chinese population. I thought a lot about how this statement could relate to the Chinese culture. She discussed how during the research study she conducted that the Chinese people interviewed were hesitant to discuss mental health disorders openly which led me to believe that just because something is not diagnosed does not mean it is not an issue with the patient or in the society. It led me to think a lot about the negative associations regarding mental health disorders and how in the United States and abroad we should still be working towards improving the stigma that is associated  with mental health disorders in order to improve treatment outcomes for patients suffering from this condition.

I am including some excellent photos from today’s presentations!

Hello everyone! It truly has been such an amazing trip so far. As you can probably tell from other blog posts we have been very busy everyday. I’m going to go back a few days to Tuesday when we visited the Cardiac unit. Now first image what a cardiac unit looks like in an American Hospital. Then throw that image out because it is nothing like this Cardiac unit at the Qilu Shandong University Hospital.

On this unit there was a 1 to 8 nurse patient ratio. 1 to 8 CRAZY right?? And to top off the fact that each nurse has 8 patients, the is no AIDES to help the nurses. The nurses do EVERYTHING!  They also believe in patient centered care, as we do in the states, and they spend about 50% of their time with the patients, which sad to say, from talking to others in my group who have been nurses for years probably spend maybe 30% of the time with patients in the US due to all of the documentation. Another large difference I found is that this cardiac unit does not have any cardiac monitors that show at the nurses station. So NO telemetry monitors at the nurses station. If someone needs to be on a monitor you can only see the monitor if you are in the patients room. I guess it makes since why they see the patients so much because there is no alarm system that goes off if someone goes into a life threatening rhythm.

There is between 3-6 patients in every room, but on this unit there are no curtains. All procedures are done within view of other patients and no one tries to keep up with patient privacy. But no one seems to care, even the patients do not care about the privacy issue. It’s a norm in China. Nurses can ask patients if they can take pictures and will take pictures of themselves with patients and pictures of patients. I asked one of the nurses and she said that there is no equivalent to HIPPA in China, but it’s just known that you do not share information with other people and you must ask a patient before you take a picture. They aren’t worried of getting sued for taking pictures or talking about patients with other people around.

Here is something interesting for you all to think about. I watched a doctor go between three patients without washing his hands. I figured because of this there is a high rate of hospital acquired infections, but they told me that they have almost NO hospital acquired infections. I wonder if this is because they do not use a lot of antibiotics, so they do not have as many drug resistant organisms. This is something to look into on whether the fact that in the US we worry so much about infection control, that we overuse infection control products to the point where people don’t have an immunity to these organisms anymore.

I also noticed that many of the patients are mostly stable. They did not seem to need any acute help, but more as if they were at a rehab being monitored until they were strong enough to go home. When we saw the ED it seemed as if their ED is more of their acute hospital and then if someone needs long term monitoring then they go to this unit.

One last thing that I noticed Is that they did not have many alarms. The call bell was very quiet and it was a soothing chime. Very different than units in the US, where it is so loud and noisy and there are alarms going off left and right. I bet there is probably a lesser rate of alarm fatigue than in the US. The nurses also just seemed so calm and collected. None of them seemed stressed about the fact that they had eight patients and had to medicate all eight of them and had no help from any AIDES. I could not even imagine what they would think of our nurses in the US who are running around like lunatics trying to get all of their work done!

Sorry for the long one! I just have so much to say and this experience has been so interesting and eye opening! Let me know if you have any questions!

-Nicole xD

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

The past few days has been a whirlwind and I am sure I am not alone saying that I am exhausted!  Between the palace visits, climbing the Great Wall, visiting factories and experiencing a lot of local culture, we have been surprised and proud of how much we have seen and accomplished in such a small amount of time– our fitbits are happy, too. Yesterday we said Goodbye to Tiger and Mr. Liu, our amazing tour guide and driver for the previous three days and boarded a high speed train from Beijing to Jinan. Today we explored Jinan in preparation for the week ahead. We visited some of the parks in Jinan and saw not only beautiful views and some interesting wildlife, but also families enjoying each other’s company, kids playing with squirt guns with their parents near the blue green waters filled with hungry koi, beautiful trees and buildings decorated with bright red lanterns, flowers and wreaths. The stone walkways wrapped around the park through porous rock gardens and small bamboo, pomegranate and apricot groves. We sat with a man playing a traditional Chinese Instrument, the Erhu, and listened to several of his songs. Of course, our group piqued the curiosity of other park goers as we are a rather diverse group ourselves. Many people wanted to be a part of our group photo and many more stopped each of us wanting to take “selfies.” After, we took a boat tour across several of the city’s adjoining springs, which Dr. Zhang tells us was a protective moat for the city in earlier times. Less congested than Beijing, Jinan still has massive skyscrapers, plenty of pedestrians, taxis, buses and mopeds zipping by in every direction. Toward the end of the day, we experienced a Chinese “supermarket,” which reminded me more of a mall without walls separating the stores. They have a couple of whatever you are looking for, in case you were wondering. To us, the experience was overwhelming, but to the Chinese patrons, another day at the store. A mother fixing her daughter’s hair, a young couple and their child grocery shopping. Life as usual. We all got a few snacks to keep in our rooms and came back for the night. Tomorrow, we go to college 🙂

ps: camera trouble, will revisit picture situation at later time. Sorry!

It’s Kristen here, and I am sorry for the delay on my part. I have been under the weather for the past several days and have much to catch up on. First, let me tell you a little bit about who I am, besides being one of ten travelers to this great country. I am a 2014 Graduate of the BSN program at the University of New England and a current FNP student at UMASS- Lowell. Currently, I am entering my second year as an Emergency Department RN. Prior to that, I was a medic in the USAF. In 2009 I was deployed to Bagram Air Field, Afghanistan where I worked in an ICU step down unit for seven months. It was a unique experience there as there were so many different kinds of people being treated– most of them heavy trauma patients but many humanitarian cases including correction of cleft palates and other facial deformities in children. Shortly thereafter, I went to Joint Base Balad, Iraq for 6 months where I performed Contingency Aeromedical Staging Facility Command and Control- but just call me C2– I helped the injured guys (and one lady) get home, by far one of the most rewarding things I have ever done. After that, I have gone on several small trips abroad including one, teaching urban search and rescue and patient trauma assessment to “baby” El Salvadoran Special Forces troops. Currently, I live with my family in NH and we raise chickens, ducks, pigs, turkeys and have five “rescued” cats and a retired racing Greyhound. That’s me in a nutshell. My next post will have lots of pictures!